Literature Update for CERGA November 2010

Contents

LIST OF JOURNALS CHECKEDLIST OF REFERENCES

AlcoholAlcohol TreatmentAlcohol UseBlood Borne VirusesCo-DependencyCo-MorbidityDrug PolicyEconomicsEconomics Of Service DeliveryEpidemiology And DemographyMiscellaneousOpiate TreatmentPharmacyPolicyServices And Professionals

LIST OF ABSTRACTSAlcoholAlcohol TreatmentAlcohol UseBlood Borne VirusesCo-DependencyCo-MorbidityDrug PolicyEconomicsEconomics Of Service DeliveryEpidemiology And DemographyMiscellaneousOpiate TreatmentPharmacyPolicyServices And Professionals

CERGA Journal Title and Abstracts November 2010

Journal Title Volumes and Issues CheckedNumber of

issues per year

Addiction Volume 105issue 8 (August) [5] issue 9 (September) [5] issue 10 October [4]

6

Addictive Behaviours Volume 35issue 9 [2], issue 10 [1], issue 11 [1] 12

Addictive Disorders & Their Treatment

Volume 9issue 3 (September) [1] 4

Alcohol and Alcoholism Volume 45issue 5 September – October [1] 6

Alcoholism Clinical & Experimental Research

Volume 34issue 8 (August) [1], issue 10 (October) [2], issue 11 (November) [5]

12

Drug and Alcohol Dependence Volume111issues (1-2) [8]

21

Drug and Alcohol Review Volume 29 issue 5 (September) [3], issue 6 (November) [4]

6

Drugs: Education, Prevention, and Policy

Volume 17issue 4 [5], issue 5 [3], issue 6 [5]

6

International Journal of Drug Policy

Volume 21issue 5 (September) [7] 6

Journal of Public Health Volume 32issue 3 (September) [1]

6

Journal of Substance Abuse Treatment

Volume 39issue 2 [3], issue 3 [1] 8

British Journal of General Practice

Volume 60 issue 576 12

British Medical Journal Specialist Subject Alerts from August- October

The American Journal of Drug and Alcohol Abuse

Volume 36 issue 6 (September)6

Journal of Addictive Diseases Volume 29 - temporarily unavailable online

4

CERGA References and Abstracts November 2010

ALCOHOL

Drug and Alcohol Review 2010 Vol 29 Issue 6Special Issue on Alcohol brief Interventions: breaking New Ground. Guest editors: Nick Heather and Eileen Kaner

1. The importance of family management, closeness with father and family structure in early adolescent alcohol useCherine Habib, Joseph Santoro, Peter Kremer, John Toumbourou, Eva Leslie & Joanne WilliamsAddiction 2010;105(10):1750-1758

2. A Sigh of Relief About Treating Influenza in Individuals With Alcohol-Use Disorders?David M. GuidotAlcoholism: Clinical and Experimental Research 2010;34(8):1432

3. Alcohol and Hepatitis C Virus–Interactions in Immune Dysfunctions and Liver DamageGyongyi Szabo, Jack R. Wands, Ahmet Eken, Natalia A. Osna, Steven A. Weinman,Keigo Machida, and H. Joe WangAlcoholism: Clinical and Experimental Research 2010;34(10):1675-1686

4. Acute and Chronic Alcohol Exposure Impair the Phagocytosis of Apoptotic Cells and Enhance the Pulmonary Inflammatory ResponseDarren M. Boe´, Tiffany R. Richens, Sarah A. Horstmann, Ellen L. Burnham,William J. Janssen, Peter M. Henson, Marc Moss, and R. William VandivierAlcoholism: Clinical and Experimental Research 2010;34(10):1723-1732

5. Disability Associated With Alcohol Abuse and DependenceAndriy V. Samokhvalov, Svetlana Popova, Robin Room, Milita Ramonas,and Ju¨rgen RehmAlcoholism: Clinical and Experimental Research 2010;34(11):1871-1878

6. Reduced Expression of Circadian Clock Genes in Male Alcoholic PatientsMing-Chyi Huang, Chia-Wei Ho, Chun-Hsin Chen, Shing-Cheng Liu, Chiao-Chicy Chen, and Sy-Jye Leu

Alcoholism: Clinical and Experimental Research 2010;34(11):1899-1904

7. Late-Life Alcohol Consumption and 20-Year MortalityCharles J. Holahan, Kathleen K. Schutte, Penny L. Brennan, Carole K. Holahan, Bernice S. Moos, and Rudolf H. MoosAlcoholism: Clinical and Experimental Research 2010;34(11):1961-1971

8. Increased Risk of Esophageal Varices, Liver Cancer, and Death in Patients With Alcoholic Liver DiseaseKnut Stokkeland, Fereshte Ebrahim, and Anders EkbomAlcoholism: Clinical and Experimental Research 2010;34(11):1993-1999

9. New figures show major increase in alcohol related hospital admissions in EnglandSusan MayorBMJ 2010;341:522

ALCOHOL TREATMENT

10. Breaking new ground in the study and practice of alcohol brief interventionsdar_204 Nick HeatherDrug Alcohol Rev 2010;29;584–588

11. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policyar_245 603Lesley J. C. Graham & Donna MackinnonDrug Alcohol Rev 2010;29;603–607

12. What process research tells us about brief intervention efficacydar_235 612 Jean-Bernard Daeppen, Nicolas Bertholet & Jacques Gaume

Drug Alcohol Rev 2010;29;612–616

13. The role of alcohol misuse in PTSD outcomes for women in community treatment: A secondary analysis of NIDA's Women and Trauma Study Denise A. Hien, Aimee N.C. Campbell, Lesia M. Ruglass, Mei-Chen Hu and Therese KilleenDrug and Alcohol dependence 2010;111(1-2):114-119

14. The research translation problem: Alcohol screening and brief intervention in primary care – Real world evidence supports theory

Ross Mccormick, Barbara Docherty, Lidia Segura, Joan Colom, Antoni Gual, Paul Cassidy, Eileen Kaner, & Nick HeatherInforma Healthcare 2010;17(6):732-748

ALCOHOL USE

15. Alcohol use and mortality in older men and womenadd_2972 Kieran A. McCaul1, Osvaldo P. Almeida1, Graeme J. Hankey, Konrad Jamrozik, Julie E. Byles & Leon FlickerAddiction 2010;105(8):1391-1400

16. Supporting parents to reduce the misuse of alcohol by young peopleBernadette Ward & Pamela SnowInforma Healthcare 2010;17(6):718-731

BLOOD BORNE VIRUSES

17. Socio-behavioral and geographic correlates of prevalent hepatitis C virus infection among young injection drug users in metropolitan Baltimore and Chicago Basmattee Boodram, Elizabeth T. Golub and Lawrence J. OuelletDrug and Alcohol dependence 2010;111(1-2):136-145

18. Injecting practices and knowledge of the associated risk among 16–19-year-old injecting drug users in Plymouth, UKHelen Trudgeon & David EvansInforma Healthcare 2010;17(6):808-820

19. Hepatitis C knowledge among new injection drug usersJohn J. Jost, Lloyd A. Goldsamt, Alex Harocopos, Paul Kobrak, & Michael C. ClattsInforma Healthcare 2010;17(6):821-834

20. Using mindfulness to develop health education strategies for blood borne virus prevention in injecting drug useCarla Treloar, Becky Laybutt, & Susan CarruthersInforma Healthcare 2010;17(6):431-422

21. Study finds hepatitis C infections more prevalent than previously thoughtCaroline WhiteBMJ 2010;341:C4598

COCAINE

22. Demand for crack and cocaine addiction treatment dropsJacqui WiseBMJ 2010;341:C5616

CO-DEPENDENCY

23. Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future researchdLeanne Hides, Sharon Samet & Dan I. LubmanDrug Alcohol Rev 2010;29:508–517

24. Determinants of alcohol consumption in HIV-uninfected injection drug users Petra M. Sander, Stephen R. Cole, David G. Ostrow, Shruti H. Mehta and Gregory D. KirkDrug and Alcohol dependence 2010;111(1-2):173-176

25. Comparison of opiate-primary treatment seekers with and without alcohol use disorder Bryan Hartzler Ph.D., Dennis M. Donovan Ph.D. and Zhen Huang M.S. Journal of Substance Abuse Treatment 2010;39(2):114-123

26. Misuse of Alcohol During Opiate Substitution TreatmentRengade, Charles-Edouard MDAddictive Disorders & Their Treatment 2010;9(3):99-105

CO-MORBIDITY

27. Individualized smoking cessation treatment in an outpatient setting: Predictors of outcome in a sample with psychiatric and addictions co-morbidity Peter Selby, Sabrina C. Voci, Laurie A. Zawertailo, Tony P. George and Bruna Brands

Addictive Behaviors 2010;35(9):811-817

28. Substance use and common child mental health problems: examining longitudinal associations in a British sampleAnna GoodmanAddiction 2010;105(8):1484-1496

29. The 10-year course of remission, abstinence, and recovery in dual diagnosis Haiyi Xie Ph.D., Robert E. Drake M.D., Ph.D., Gregory J. McHugo Ph.D., Lynn Xie and Anita Mohandas B.A. Journal of Substance Abuse treatment 2010;39(2):132-140

DRUG POLICY

30. Is UK drug policy evidence based? Trevor Bennett and Katy HollowayInternational Journal of Drug Policy 2010;21(5):411-417

31. Contingency management treatments: controversies and challengesNancy M. PetryAddiction 2010;105(9):1507-1509

32. Why Is Natural Recovery So Common For Addictive Disorders?Wendy S. SlutskeAddiction 2010;105(9):1520-1521

33. Drug decriminalisation in PortugalPaula Vale de Andrade and Ludmila CarapinhaBMJ 2010;341:C4554

34. Policy resistance to harm reduction for drug users and potential effect of change

Tim Rhodes, Anya Sarang, Peter Vickerman and Matthew HickmanBMJ 2010;341:C3439

ECONOMICS

35. Beyond neoclassical economics: Social process, agency and the maintenance of order in an Australian illicit drug marketplace Robyn Dwyer and David MooreInternational Journal of Drug Policy 2010;21(5):390-398

36. Is Vancouver Canada’s supervised injection facility cost-saving? 1436Steven D. PinkertonAddiction 2010;105(8):1429-1436

ECONOMICS OF SERVICE DELIVERY

37. Effects of Alcohol Taxes on Alcohol-Related Mortality in Florida: Time-Series Analyses From 1969 to 2004Mildred M. Maldonado-Molina and Alexander C. WagenaarAlcoholism: Clinical and Experimental Research 2010;34(11):1915-1921

EPIDEMIOLOGY AND DEMOGRAPHY

38. Combined effects of law enforcement and substitution treatment on heroin MortalityCarlos Nordt & Rudolf StohlerDrug Alcohol Rev 2010;29;540–545

39. Older and sicker: Changing mortality of drug users in treatment in the North West of England Caryl Beynon, Jim McVeigh, Ayesha Hurst and Adam MarrInternational Journal of Drug Policy 2010;21(5):429-431

40. Adolescent alcohol use trajectories: Predictors and subsequent problems Anna-Karin Danielsson, Peter Wennberg, Anders Tengström and Anders RomelsjöAddictive Behaviors 2010;35(9):848-852

41. The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility Paulo Jannuzzi Cunha, Sergio Nicastri, Arthur Guerra de Andrade and Karen I. BollaAddictive Behaviors 2010;35(10):875-881

42. Gender and prescription opioids: Findings from the National Survey on Drug se and Health Sudie E. Back, Rebecca L. Payne, Annie N. Simpson and Kathleen T. BradyAddictive Behaviors 2010;35(11):1001-1007

43. Estimating the numbers of children of problematic drug users and their residential circumstances to inform United Kingdom research, policy and practicePaul Duffy, Claire Shaw, Kerry Woolfall, & Caryl M. BeynonInforma Healthcare 2010;17(5):470-484

44. Polydrug use among 15- to 16-year olds: Similarities and differences in EuropeDeborah Olszewski, Joa˜O Matias, Karin Monshouwer, & Anna KokkeviInforma Healthcare 2010;17(4):287-302

45. No one written off ? Welfare, work and problem drug useChris Grover & Ian PaylorInforma Healthcare 2010;17(4):315-332

46. Survey of injecting users’ health shows mixed pictureZosia KmietowiczBMJ 2010;341:C4276

MISCELLANEOUS

47. The Global Diversion of Pharmaceutical Drugs Opiate treatment and the diversion of pharmaceutical opiates: a clinician’s perspectiveadd_3014 James BellAddiction 2010;105(9):1531-1537

NEEDLE EXCHANGE

48. Characteristics of injecting drug users accessing different types of needle and syringe programme or using secondary distributionN. Craine, M. Hickman, J.V. Parry, J. Smith, T. McDonald, M. LyonsJournal of Public Health 2010;32(3):328-335

49. Optimal provision of needle and syringe programmes for injecting drug users: A systematic review Lisa Jones, Lucy Pickering, Harry Sumnall, James McVeigh and Mark A. BellisInternational Journal of Drug Policy 2010;21(5);335-342

50. Racial differences in acquisition of syringes from pharmacies under conditions of legal but restricted sales Elizabeth C. Costenbader, William A. Zule and Curtis C. CoomesInternational Journal of Drug Policy 2010;21(5);425-428

51. Misdirected opposition: Evidence opposing “not in my back yard” arguments against syringe exchange programmes Chyvette T. Williams and Lawrence J. Ouellet

International Journal of Drug Policy 2010;21(5);437-439

52. Prevalence and predictors of transitions to and away from syringe exchange use over time in 3 US cities with varied syringe dispensing policies Traci C. Green, Ricky N. Bluthenthal, Merrill Singer, Leo Beletsky, Lauretta E. Grau, Patricia Marshall and Robert HeimerDrug and Alcohol Dependence 2010;111(1-2):74-81

OPIATE TREATMENT

53. Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatmentadd_3016 1729Hendrik G. Roozen, Ranne de Waart & Petra van der KroftAddiction 2010;105(10):

54. Commentary on Boscarino et al. (2010): Understanding the spectrum of opioid abuse, misuse and harms among chronic opioid therapy patients Michael von KorffAddiction 2010;105(10):1783-1784

55. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care systemJoseph A. Boscarino, Margaret Rukstalis, Stuart N. Hoffman, John J. Han,Porat M. Erlich, Glenn S. Gerhard & Walter F. StewartAddiction 2010;105(10):1776-1782

56. Infant mortality among women on a methadone program during pregnancydar_176 Lucy Burns, Elizabeth Conroy & Richard P. MattickDrug Alcohol Rev 2010;29;551–556

57. Quality of life among opiate-dependent individuals: A review of the literature Jessica De Maeyer, Wouter Vanderplasschen and Eric BroekaertInternational Journal of Drug Policy 2010;21(5);364-380

58. Cost-effectiveness of extended buprenorphine–naloxone treatment for opioid-dependent youth: data from a randomized trialadd_3001 1616Daniel Polsky, Henry A. Glick, Jianing Yang, Geetha A. Subramaniam, Sabrina A. Poole & George E. WoodyAddiction 2010;105(9):1616-1624

59. Were the changes to Sweden’s maintenance treatment policy 2000–06 related to changes in opiate-related mortality and morbidity?add_2999 Anders Romelsjö, Barbro Engdahl, Marlene Stenbacka, Anna Fugelstad, Ingrid Davstad, Anders Leifman & Ingemar ThiblinAddiction 2010;105(9):1625-1632

60. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women Eugenia Oviedo-Joekes, Daphne Guh, Suzanne Brissette, Kirsten Marchand, David Marsh Jill Chettiar, Bohdan Nosyk, Michael Krausz, Aslam Anis and Martin T. SchechterDrug and Alcohol Dependence 2010;111(1-2):50-57

61. Effects of experimental Unemployment, Employment and Punishment analogs on opioid seeking and consumption in heroin-dependent volunteers Mark K. GreenwaldDrug and Alcohol Dependence 2010;111(1-2):64-73

62. The effect of motivational status on treatment outcome in the North American Opiate Medication Initiative (NAOMI) study Bohdan Nosyk, Josie Geller, Daphne P. Guh, Eugenia Oviedo-Joekes, Suzanne Brissette, David C. Marsh, Martin T. Schechter and Aslam H. AnisDrug and Alcohol dependence 2010;111(1-2):161-165

63. Retention in naltrexone implant treatment for opioid dependence Nikolaj Kunøe, Philipp Lobmaier, John Kåre Vederhus, Bjørg Hjerkinn, Solfrid Hegstad, Michael Gossop, Øistein Kristensen and Helge WaalDrug and Alcohol dependence 2010;111(1-2):161-165

64. The cost of concordance with opiate substitution treatment guidelines Paul G. Barnett Ph.D., Jodie A. Trafton Ph.D. and Keith Humphreys Ph.D.Journal of Substance Abuse Treatment 2010;39(2):141-149

65. Analysis of the impact of treatment setting on outcomes from methadone treatment Catherine M. Comiskey Ph.D. and Gemma Cox Ph.D. Journal of Substance Abuse Treatment 2010;39(3):195-201

66. Treatment pathways and longitudinal outcomes for opiate users: Implications for treatment policy and planning

Catherine Comiskey & Robert StapletonInforma Healthcare 2010;17(6):707-717

67. Responsible management and use of a personal take-home naloxone supply: A pilot projectAndrew Mcauley, George Lindsay, Maureen Woods, & Derek LouttitInforma Healthcare 2010;17(4):388-399

68. Survival and cessation ininjecting drug users: prospective observational study of outcomes and effect of opiate substitution treatmentKimber J, Copeland L, Hickman M, MacLeod J, McKenzie J, De Angelis D and Robertson JR.BMJ 2010;341:135-

PHARMACY

69. Community pharmacy service users’ views and perceptions of alcohol screening and brief interventiondar_234 596Ranjita Dhital, Cate M. Whittlesea, Ian J. Norman & Peter MilliganDrug Alcohol Rev 2010;29;596–602

POLICY

70. The Implicit Rules Of Evidence-Based Policy Analysis, UpdatedRobert J. MaccounAddiction 2010;105(8);1335-1336

71. Is There A Causal Linkage Between Cannabis Use And Increased Risks Of Psychotic Symptoms?David M. FergussonAddiction 2010;105(8);1336-1337

72. Substitution and Complementarity in the Face of Alcohol-Specific Policy InterventionsSimon C. MooreAlcohol and Alcoholism 2010;45(5):403-408

SERVICES AND PROFESSIONALS

73. Medical student views of substance abuse treatment, policy and trainingShantanu Agrawal, Worth W. Everett, & Sonali SharmaInforma Healthcare 2010;17(5):587-602

74. Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literatureLeon W. J. WylieInforma Healthcare 2010;17(5):618-631

75. Fitting a quart into a black box: Keyworking in quasi-coercive drug treatment in EnglandDavid Best, Kelly Wood, Ruth Sweeting, Bill Morgan, & Ed DayInforma Healthcare 2010;17(4):370-387

ALCOHOL

Drug and Alcohol Review 2010 Vol29 Issue 6Special Issue on Alcohol brief Interventions: breaking New Ground. Guest editors: Nick Heather and Eileen Kaner

1. The importance of family management, closeness with father and family structure in early adolescent alcohol useCherine Habib, Joseph Santoro, Peter Kremer, John Toumbourou, Eva Leslie &Joanne WilliamsAddiction 2010;105(10):1750-1758

ABSTRACTAims To examine the importance of family management, family structure and father–adolescent relationships on early adolescent alcohol use. Design Cross-sectional data was collected across 30 randomly selected Australian communities stratified to represent a range of socio-economic and regional variation. Setting Data were collected during school time from adolescents attending a broad range of schools. Participants The sample consisted of a combined 8256 students (aged 10–14 years). Measurements Students completed a web-based survey as part of the Healthy Neighbourhoods project. Findings Family management—which included practices such as parental monitoring and family rules about alcohol use—had the strongest and most consistent relationship with alcohol use in early adolescence. Adolescents reporting higher family management were less likely to have drunk alcohol in their life-time, less likely to drink alcohol in the preceding 30 days and less likely to have had an alcohol binge. Adolescents reporting emotionally close relationships with their fathers were less likely to have drunk alcohol in their life-time and less likely to have had an alcohol binge in the preceding fortnight. Conclusions Findings indicate that family management practices may contribute to alcohol abstinence in adolescents. Furthermore, emotionally close father–adolescent relationships may also foster abstinence; however, fathers’ drinking behaviours need to be considered.

Keywords Alcohol, early adolescent, family, father closeness

2. A Sigh of Relief About Treating Influenza in Individuals With Alcohol-Use Disorders?David M. GuidotAlcoholism: Clinical and Experimental Research 2010;34(8):1432

No Abstract for this article

3. Alcohol and Hepatitis C Virus–Interactions in Immune Dysfunctions and Liver DamageGyongyi Szabo, Jack R. Wands, Ahmet Eken, Natalia A. Osna, Steven A. Weinman,Keigo Machida, and H. Joe WangAlcoholism: Clinical and Experimental Research 2010;34(10):1675-1686

ABSTRACTHepatitis C virus infection affects 170 million people worldwide, and the majority of individuals exposed to HCV develop chronic hepatitis leading to progressive liver damage, cirrhosis, and hepatocellular cancer. The natural history of HCV infection is influenced by genetic and environmental factors of which chronic alcohol use is an independent risk factor for cirrhosis in HCVinfected individuals. Both the hepatitis C virus and alcohol damage the liver and result in immune alterations contributing to both decreased viral clearance and liver injury. This review will capture the major components of the interactions between alcohol and HCV infection to provide better understanding for the molecular basis of the dangerous combination of alcohol use and HCV infection. Common targets of HCV and alcohol involve innate immune recognition and dendritic cells, the critical cell type in antigen presentation and antiviral immunity. In addition, both alcohol and HCV affect intracellular processes critical for hepatocyte and immune cell functions including mitochondrial and proteasomal activation. Finally, both chronic alcohol use and hepatitis C virus infection increase the risk of hepatocellular cancer. The common molecular mechanisms underlying the pathological interactions between alcohol and HCV include the modulation of cytokine production, lipopolysaccharide (LPS)-TLR4 signaling, and reactive oxygen species (ROS) production. LPS-induced chronic inflammation is not only a major cause of progressive liver injury and fibrosis, but it can also contribute to modification of the tissue environment and stem cells to promote hepatocellular cancer development. Alteration of these processes by alcohol and HCV produces an environment of impaired antiviral immune response, greater hepatocellular injury, and activation of cell proliferation and dedifferentiation.

Key Words: Antigen-Presenting Cells, CD4+ T Cells, CD8+ T Cells, Cytotoxic T Lymphocytes (CTL), Cytokines, CYP2E1, Dendritic Cells (DCs), HCV, HCV Core Protein, NS5a Protein, Hepatocytes, Hepatocellular Carcinoma (HCC), Innate and Adaptive Immunity, Lieber-DeCarli diet, Lipopolysaccharide (LPS), Mitochondrial Ca2+, Mitochondrial Dysfunction, Mn-Superoxide Dismutase (SOD2), Proteasome, Reactive Oxygen Species (ROS), Toll-Like Receptor 4 (TLR4), Transgenic Mice.

4. Acute and Chronic Alcohol Exposure Impair the Phagocytosis of Apoptotic Cells and Enhance the Pulmonary Inflammatory ResponseDarren M. Boe´, Tiffany R. Richens, Sarah A. Horstmann, Ellen L. Burnham,William J. Janssen, Peter M. Henson, Marc Moss, and R. William VandivierAlcoholism: Clinical and Experimental Research 2010;34(10):1723-1732

ABSTRACTBackground: Alcohol abuse increases the risk for acute respiratory distress syndrome (ARDS). Efferocytosis, the clearance of apoptotic cells, is important in the resolution of inflammation and is regulated by RhoA and rho kinase (ROCK) activation. The effects of alcohol on pulmonary Rho pathway activation and

efferocytosis have not been determined. We hypothesize that acute and chronic alcohol exposure impair pulmonary efferocytosis, leading to heightened inflammation during ARDS. Methods: For in vivo experiments, C57BL ⁄ 6 mice received either a single intraperitoneal injection of alcohol or chronic ethanol-in-water for 8 weeks prior to intratracheal instillation of apoptotic cells or lipopolysaccharide (LPS). Bronchoalveolar lavage (BAL) was performed for cells counts, calculation of the phagocytic index (PI), and Rho activity measurements. For in vitrostudies, primary alveolar macrophages were cultured in alcohol (25–100 mM) and then cocultured with apoptotic cells. RhoA activity was determined following alcohol exposure, and the PI was determined before and after treatment with the ROCK inhibitor, Y27632.Results: Acute alcohol exposure was associated with impaired efferocytosis. Following LPS exposure, acute alcohol exposure was also associated with increased BAL neutrophils. Chronic alcohol exposure alone did not alter efferocytosis. However, following exposure to LPS, chronic alcohol exposure was associated with both impaired efferocytosis and increased BAL neutrophils. In vitro alcohol exposure caused a dose-dependent decrease in efferocytosis. Despite the fact that RhoA activity was decreased by alcohol exposure and RhoA inhibition did not alter the effects of alcohol on efferocytosis, treatment with the Rho kinase inhibitor, Y27632, reversed the effects of alcohol on efferocytosis. Conclusions: Acute alcohol exposure impairs pulmonary efferocytosis, whereas exposure to chronic alcohol is only associated with impaired efferocytosis following LPS-induced lung injury.Both forms of alcohol exposure are associated with increased alveolar neutrophil numbers in response to LPS. The acute effects of alcohol on efferocytosis appear to be mediated, at least in part, by RhoA-independent activation of ROCK. Further studies are needed to dissect the differences between the effects of acute and chronic alcohol exposure on efferocytosis and to determine the effects of alcohol on alternative activators of ROCK.

Key Words: Alcohol, Acute Respiratory Distress Syndrome, Efferocytosis, RhoA, Rho Kinase.

5. Disability Associated With Alcohol Abuse and DependenceAndriy V. Samokhvalov, Svetlana Popova, Robin Room, Milita Ramonas,and Ju¨rgen RehmAlcoholism: Clinical and Experimental Research 2010;34(11):1871-1878

ABSTRACTBackground: Alcohol use disorders (AUD), i.e., alcohol dependence and abuse, are major contributors to burden of disease. A large part of this burden is because of disability. However, there is still controversy about the best disability weighting for AUD. The objective of this study was to provide an overview of alcohol-related disabilities.Methods: Systematic literature review and expert interviews. Results: There is heterogeneity in experts’ descriptions of disabilities related to AUD. The major core attributes of disability related to AUD are changes of emotional state, social relationships, memory and thinking. The most important supplementary attributes are anxiety, impairments of speech and hearing.

Conclusions: This review identified the main patterns of disability associated with AUD. However, there was considerable variability, and data on less prominent patterns were fragmented. Further and systematic research is required for increasing the knowledge on disability related to AUD and for application of interventions for reducing the associated burden.

Key Words: Alcohol Abuse, Alcohol Dependence, Alcohol Use Disorders, Disability, Global Burden of Disease.

6. Reduced Expression of Circadian Clock Genes in Male Alcoholic PatientsMing-Chyi Huang, Chia-Wei Ho, Chun-Hsin Chen, Shing-Cheng Liu, Chiao-Chicy Chen, and Sy-Jye LeuAlcoholism: Clinical and Experimental Research 2010;34(11):1899-1904

ABSTRACTBackground: There are clear interactions between chronic alcohol consumption and circadian rhythmicity that is regulated by several circadian clock genes. The altered expressions of these genes have been mainly described in animals. The mammalian master clock in the suprachiasmatic nuclei orchestrates the biological rhythms in peripheral tissues. As peripheral blood mononuclear cells (PBMCs) are the most accessible tissue clinically, we assessed the mRNA levels of these genes in patients with alcohol dependence (AD) undergoing alcohol-withdrawal (AW) treatment. Methods: Twenty-two male patients fulfilled the DSM-IV diagnostic criteria of AD, and 12 comparison healthy control subjects were recruited. The patients with AD were further divided by the presence of delirium tremens (DTs), the most severe form of AW syndrome, into DT group and non-DT group. All the participants received blood withdrawal at 9 am, while the patients with AD had blood collection twice: on the next morning of admission (baseline) and on the seventh day. PBMCs were isolated from whole blood, and the mRNA expression profiles of hClock1, hBmal1, hPer1, hPer2, hCry1, and hCry2 were determined by quantitative real-time PCR. Results: The baseline mRNA levels of the target circadian clock genes were markedly lower in patients with AD than in control subjects. After 1 week of alcohol detoxification, there were very limited restorations of discrete circadian gene expressions. DT group did not differ in the expression patterns of circadian clock genes from non-DT group. Conclusions: This is the first study demonstrating the overall lowering of circadian clock genes among patients with AD. The expression pattern is comparable between patients with and without DTs. Although preliminary with data at only one single time point, the observation of strikingly reduced mRNA levels supports the association between circadian clock gene dysregulationand chronic alcohol intake.

Key Words: Circadian Rhythm, Circadian Clock Gene, Alcohol Dependence, Alcohol Withdrawal.

7. Late-Life Alcohol Consumption and 20-Year MortalityCharles J. Holahan, Kathleen K. Schutte, Penny L. Brennan, Carole K. Holahan,Bernice S. Moos, and Rudolf H. Moos

Alcoholism: Clinical and Experimental Research 2010;34(11):1961-1971

ABSTRACTBackground: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. Methods: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate. Results: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. Conclusions: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.

Key Words: Alcohol Consumption, Problem Drinking, Mortality, Aging.

8. Increased Risk of Esophageal Varices, Liver Cancer, and Death in Patients With Alcoholic Liver DiseaseKnut Stokkeland, Fereshte Ebrahim, and Anders EkbomAlcoholism: Clinical and Experimental Research 2010;34(11):1993-1999

ABSTRACTBackground and Aims: During the last decades, a multitude of different treatments for chronic liver disease have been introduced. New surveillance programs have been established to detect esophageal varices and liver cancer. The aims of our study were to assess whether the prognosis for patients hospitalized with liver diseases between 1969 and 2006 had improved and to study the differences in mortality and complications between patients with alcoholic liver disease and nonalcoholic liver diseases. Methods: We used the Swedish Hospital Discharge Register and Cause of Death Register at the National Board of Health and Welfare in

Sweden between 1969 and 2006 to identify and follow-up a cohort of patients with liver disease according to the International Classification of Diseases-8, -9, and -10.Results: There were 36,462 patients hospitalized with alcoholic and 95,842 with non-alcoholic liver diseases. The main finding was that patients hospitalized with alcoholic liver disease had an increased mortality risk, compared to patient with nonalcoholic liver disease, 1.89 (1.85 to 1.92). In addition, the patients with alcoholic liver disease had an increased risk for esophageal varices and liver cancer. There was a reduced risk for hospitalization with esophageal varices for patients with nonalcoholic liver disease up to 1998. Conclusions: We found that the prognosis for patients hospitalized with chronic liver diseases had not improved. Patients with alcoholic liver disease have an increased risk of complications, which suggest that the disease is more aggressive and are in need of closer follow-up than other chronic liver diseases.

Key Words: Mortality, Morbidity, Epidemiology.

9. New figures show major increase in alcohol related hospital admissions in EnglandSusan MayorBMJ 2010;341:522

No Abstract for this paper.

ALCOHOL TREATMENT

10. Breaking new ground in the study and practice of alcohol brief interventionsdar_204 Nick HeatherDrug Alcohol Rev 2010;29;584–588

ABSTRACTThis article amplifies the decision to subtitle the INEBRIA2009 Conference ‘Breaking New Ground’. The effectiveness of screening and brief intervention (SBI) for hazardous and harmful drinking is now well-established for primary health care and is promising for other medical settings. In addition, significant advances in the implementation of SBI are being made in various parts of the world. But, because of the need to establish efficacy and effectiveness, and perhaps too because of a preoccupation with meta-analysis of existing research findings, progress in other aspects of the theory and practice of SBI has been slower than ideal. There may also be a risk of complacency in the SBI field of study. For these reasons and others, the Conference Organizing Committee decided to focus the conference and invite presentations on a number of specific topics in the field of alcohol SBI andthese are listed here followed by a discussion of other areas in which new ground needs to be broken.

Key words: alcohol-related problem, brief intervention, theory, research, practice.

11. Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policyar_245 603Lesley J. C. Graham & Donna MackinnonDrug Alcohol Rev 2010;29;603–607

ABSTRACTIssue. Scotland has experienced a substantial rise in alcohol-related harm, which is now one of the biggest public health challenges it faces. Approach. Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein. Key Findings. In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most ofWestern Europe are falling. Scotland’s alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy.A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse. Implications. Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland’s policy is addressing these determinants with both population-based and population-targeted interventions. Conclusion. Scotland has a serious problem with alcohol. A

comprehensive, evidencebased, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition

Key words: public policy, alcohol consumption, alcoholism, liver cirrhosis, epidemiology.

12. What process research tells us about brief intervention efficacydar_235 Jean-Bernard Daeppen, Nicolas Bertholet & Jacques GaumeDrug Alcohol Rev 2010;29;612–616

ABSTRACTIssue. This article explores mechanisms of the efficacy of brief intervention (BI). Approach. We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups. The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome. Key Findings. Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention. Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later. Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change. Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention. Implication. These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients.

Key words: brief intervention, alcohol, process, Motivational Interviewing Skill Code.

13. The role of alcohol misuse in PTSD outcomes for women in community treatment: A secondary analysis of NIDA's Women and Trauma Study Denise A. Hien, Aimee N.C. Campbell, Lesia M. Ruglass, Mei-Chen Hu and Therese KilleenDrug and Alcohol dependence 2010;111(1-2):114-119

ABSTRACTBackgroundIndividuals with comorbid substance use and posttraumatic stress disorder may differentially benefit from integrated trauma-focused interventions based on specific

presenting characteristics such as substance use type and PTSD severity. The current study is a secondary analysis of a NIDA Clinical Trials Network study exploring the effectiveness of two interventions for women with comorbid PTSD and substance use disorders.MethodGeneralized estimating equations were used to examine the association of baseline alcohol misuse with PTSD outcome measures over time for all randomized participants.ResultsWomen entering treatment with baseline alcohol misuse had higher Post Traumatic Stress Disorder Symptom Scale (PSS-SR) total scores (t = 2.43, p < .05), cluster C (avoidance/numbing) scores (t = 2.63, p < .01), and cluster D (hyper-arousal) scores (t = 2.31, p < .05). For women with alcohol misuse, after treatment week 1, PSS-SR scores were significantly lower in the Seeking Safety intervention during treatment (χ2(1) = 4.00, p < .05) and follow-up (χ2(1) = 4.87, p < .05) compared to those in the health education intervention. Alcohol misusers in the Seeking Safety group who had higher baseline hyper-arousal severity improved more quickly than those with lower baseline hyper-arousal severity during treatment (χ2(1) = 4.06, p < .05).ConclusionsThese findings suggest that the type of substance abuse at treatment entry may inform treatment selection, predict treatment response among those with co-occurring PTSD and substance use disorders, and indicate a more severe clinical picture.

Keywords: Posttraumatic stress; Substance abuse; Alcohol misuse; Comorbidity; Cognitive-behavioral therapy

14. The research translation problem: Alcohol screening and brief intervention in primary care – Real world evidence supports theoryRoss Mccormick, Barbara Docherty, Lidia Segura, Joan Colom, Antoni Gual, Paul Cassidy, Eileen Kaner, & Nick HeatherInforma Healthcare 2010;17(6):732-748

ABSTRACTTranslational research projects based in England, New Zealand and Catalonia aredescribed. In combination they provide real world evidence in support of the evolvingdiscourse on translating the evidence on screening and brief intervention for problem use of alcohol so that it is acceptable and fit for routine practice. Acceptance and uptake was enhanced by encouraging primary health clinicians to use evidence-based screening and brief intervention processes which fit with the context in which they work and which build on the skills they already have and use in practice. Emerging general principles included: tailoring procedures to fit with local circumstances; breaking the process down into clinically acceptable steps and negotiating where there is flexibility. Key issues explored in each case study included how ‘screening’ is best conducted, what is a brief intervention best suited to which provider and which providers should run the process

ALCOHOL USE

15. Alcohol use and mortality in older men and womenadd_2972 Kieran A. McCaul1, Osvaldo P. Almeida1, Graeme J. Hankey, Konrad Jamrozik, Julie E. Byles & Leon FlickerAddiction 2010;105(8):1391-1400

ABSTRACTAims To compare the effect of alcohol intake on 10-year mortality for men and women over the age of 65 years. Design, setting and participants Two prospective cohorts of community-dwelling men aged 65–79 years at baseline in 1996 (n = 11 727) and women aged 70–75 years in 1996 (n = 12 432). Measurements Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all-cause and cause-specific mortality. Findings Compared with older adults who did not consume alcohol every week, the risk of all-cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol-free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease. Conclusions In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol-free days per week.

Keywords Aged, alcohol consumption, cause of death, cohort studies, drinking patterns, gender differences, mortality.

16. Supporting parents to reduce the misuse of alcohol by young peopleBernadette Ward & Pamela SnowInforma Healthcare 2010;17(6):718-731

ABSTRACTThe majority of parents report that they believe they have an important role in shaping adolescents’ values and behaviours in relation to drinking, but they also report that they need more support in this area. Education, welfare, health, youth and other professionals have an important role in providing services to young people and/or their families and have significant opportunities to provide information and support to families in relation to alcohol use. This article provides a framework for practitioners to use when assisting families to develop strategies to reduce young peoples’ exposure to risky situations and subsequent alcohol-related harm.

BLOOD BORNE VIRUSES

17. Socio-behavioral and geographic correlates of prevalent hepatitis C virus infection among young injection drug users in metropolitan Baltimore and Chicago Basmattee Boodram, Elizabeth T. Golub and Lawrence J. OuelletDrug and Alcohol dependence 2010;111(1-2):136-145

ABSTRACTBackgroundHepatitis C virus (HCV) infection prevalence among young injection drug users (IDUs) differs substantially between cities in the United States (U.S.).MethodsBetween 2002 and 2004, IDUs aged 15–30 were recruited for the Third Collaborative Injection Drug User Study in five U.S. cities using respondent-driven methods. Our cross-sectional study examined correlates and geographic distribution of prevalent HCV infection (HCV+) from the Baltimore (n = 736) and Chicago (n = 586) study sites. We evaluated baseline socio-demographic and behavioral data collected from computer-assisted self-interviews and serological antibody testing for human immunodeficiency virus (HIV) and hepatitis A, B, and C.ResultsHCV prevalence was 53.0% in Baltimore and 13.7% in Chicago (p < 0.0001). Baltimore compared to Chicago participants were significantly (p < 0.05) more likely to be older, co-infected with HIV and other hepatitis viruses, reside in an urban area, inject primarily cocaine, inject in public settings, inject with used syringes and paraphernalia, and have been injecting longer; they were less likely to utilize syringe exchange programs. However, after accounting for socio-demographic and behavioral risk factors in multivariable logistic regression, city was the strongest predictor of HCV prevalence (Baltimore versus Chicago adjusted odds ratio = 3.5 [95% confidence interval, 2.2–5.6]). Geospatial analyses showed that almost half of all HCV+ participants in Baltimore resided within a 5-mile urban area, while Chicago participants were dispersed across the metropolitan area.ConclusionsThe disparate HCV prevalence between the two cities is only partially explained by individual-level factors. Future studies should examine the network configurations and injection partners’ characteristics of young IDUs.

Keywords: Hepatitis C; Prevalence; Injection drug user; CIDUS III; Geographic; City

18. Injecting practices and knowledge of the associated risk among 16–19-year-old injecting drug users in Plymouth, UKHelen Trudgeon & David EvansInforma Healthcare 2010;17(6):808-820

ABSTRACTThere has been significant research into the harms associated with injecting drugs and about the use of needle exchange programmes (NEPs) by adult injecting drug users (IDUs) in the United Kingdom. However, very limited research has been

conducted investigating the knowledge, experiences and beliefs of IDUs under 18 years old, who due to their age are denied access to anonymous NEPs. This article reports on a small, exploratory study which examines the injecting practices of 16–19-year-old IDUs from Plymouth, UK. It investigates a range of injecting experiences, such as initiation into drug use, knowledge of harms and harm reduction strategies and the interviewees’ perception of such practices. Results are presented from five in-depth semi-structured interviews. Analysis of the data indicated that peers play a significant part in injecting, particularly in terms of initiation and acquired knowledge. Also, it appears that knowledge does not necessarily lead to behaviour change, with some young people choosing to adopt high-risk practices despite knowing the potential consequences. This supports previous study findings in relation to young people’s knowledge and associated behaviour, but also highlights the value placed on peers and their influence, particularly during the initial stages of an injecting ‘career

19. Hepatitis C knowledge among new injection drug usersJohn J. Jost, Lloyd A. Goldsamt, Alex Harocopos, Paul Kobrak, & Michael C. ClattsInforma Healthcare 2010;17(6):821-834

ABSTRACTAims: New injection drug users (IDUs) are vulnerable to hepatitis C infection from risky injection practices. This article considers the range of hepatits C virus (HCV) knowledge among participants in a 2-year study examining the behaviours of new IDUs. Methods: Respondents (n¼36) were members of a cohort of new IDUs recruited in the New York City metropolitan area whose first injection occurred within the previous 18 months. Respondents were offered human immuno virus (HIV), hepatits B virus (HBV) and HCV testing. Two tested HIV positive and 12 tested HCV positive. During pre-test counselling they completed a qualitative interview focusing on aspects of HCV including: transmission, symptoms, long-term effects, prevention, treatment, concern regarding contracting HCV and how this concern impacted drug use and injection practices. Findings: Substantial gaps were seen in HCV knowledge. While respondents were aware that HCV is a blood-borne virus, the majority had only approximate knowledge regarding transmission, symptoms and effects. Respondents reported little discussion of HCV with peers and minimal concern about contracting HCV, especially compared with HIV. Conclusion: Accurate HCV information is failing to reach new IDUs, and new IDUs may not value the little information they do receive. More effective and innovative effortsare required to disseminate effective HCV prevention information to new IDUs.

20. Using mindfulness to develop health education strategies for blood borne virus prevention in injecting drug useCarla Treloar, Becky Laybutt, & Susan CarruthersInforma Healthcare 2010;17(6):431-422

ABSTRACTAims: Prevention education has had limited success in reducing transmission of blood borne virus among people who inject drugs. Innovative approaches to

prevention education are required. Method: This study used video recordings of injecting episodes and interviews with participants reviewing their video recordings to explore the concept of mindlessness as a new tool for prevention education.Findings: The data demonstrate elements of mindlessness in participants’ injectingpractice. Participants were unable to provide detailed description of their practice,could not recall the origin of their practices, described limited sensitivity to theenvironment around them and described learned behaviours ‘dropping out of mind’.Conclusions: Although potentially useful as a prevention tool, prevention messagesusing mindlessness concepts should be developed in collaboration with injecting drug users to avoid judgmental or alienating messages. Finally, the use of these video recordings themselves can be a powerful education tool given the very hidden and stigmatized nature of injecting drug use.

21. Study finds hepatitis C infections more prevalent than previously thoughtCaroline WhiteBMJ 2010:341:C4598

No Abstract for this paper

COCAINE

22. Demand for crack and cocaine addiction treatment dropsJacqui WiseBMJ 2010;341:C5616

No Abstract for this paper.

CO-DEPENDENCY

23. Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use: Current evidence and directions for future researchdLeanne Hides, Sharon Samet & Dan I. LubmanDrug Alcohol Rev 2010;29;508–517

ABSTRACTIssues and Approach.The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT).This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and sychINFO (CSA),were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. Key Findings. There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. Conclusions. Rather than declaring the ‘dodo bird verdict’ that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.

Key words: comorbidity, depression, drug abuse, cognitive behaviour therapy, pharmacotherapy

24. Determinants of alcohol consumption in HIV-uninfected injection drug users Petra M. Sander, Stephen R. Cole, David G. Ostrow, Shruti H. Mehta and Gregory D. KirkDrug and Alcohol dependence 2010;111(1-2):173-176

ABSTRACTWe assess the association between time fixed and time varying participant characteristics and subsequent alcohol consumption in 1968 injection drug users (median age 37 years, 28% female, 90% African-American) followed semi-annually from 1988 to 2008. Median alcohol consumption was seven drinks per week at study entry (first and third quartile: 1, 26) with 36% reporting binge drinking. Alcohol consumption and binge drinking decreased over follow-up. Older individuals and women reported consuming fewer drinks per week. Higher typical alcohol consumption was reported by those participants who reported in the prior 6 months:

non-injection cocaine use, injection drug use, having one or more sex partners, or among men, a same sex partner. Associations were generally similar for drinks per week and binge drinking. This study demonstrates that in a large urban cohort of persons with a history of injection drug use, risky drug use and sexual risk behavior are associated with subsequent alcohol consumption.

Keywords: Alcohol; Bias; Cohort study; HIV/AIDS

25. Comparison of opiate-primary treatment seekers with and without alcohol use disorder Bryan Hartzler Ph.D., Dennis M. Donovan Ph.D. and Zhen Huang M.S. Journal of Substance Abuse Treatment 2010;39(2):114-123

ABSTRACTMany persons seeking opiate treatment present with complex clinical challenges, which may be exacerbated by alcohol misuse. This report details secondary data analyses aggregating treatment-seeking samples across 10 National Institute on Drug Abuse (NIDA) Clinical Trials Network treatment trials to examine alcohol-related characteristics of opiate-primary (OP) clients and compare broad pretreatment characteristics of those with and without an alcohol use disorder (AUD). Analysis of this aggregate OP client sample (n = 1,396) indicated that 38% had comorbid AUD and that a history of alcohol treatment episodes and recent alcohol problems were common. Further, comparisons of OP clients with and without AUD revealed the former were more likely to have had a history of pervasive difficulties in psychosocial functioning. Findings suggest the need for detection of and intervention for alcohol misuse at the outset of opiate treatment and support for the practice of availing medical, psychological, case management, and other support services.

Keywords: Opiate treatment; Alcohol misuse; Psychosocial functioning

26. Misuse of Alcohol During Opiate Substitution TreatmentRengade, Charles-Edouard MDAddictive Disorders & Their Treatment 2010;9(3):99-105

Context: Although alcohol misuse is a common phenomenon during opiate substitution treatment, the etiologic explanations advanced for it are generally no more than speculative.Objectives: To identify differences in alexithymia, self-esteem, and temperament among patients undergoing methadone or buprenorphine substitution treatment having excessive alcohol consumption from those who have not.Design: This was an open prospective study conducted from September 2007 to January 2008.Setting: The cohort was recruited from 9 drug addiction treatment centers in 2 regions of France, Alsace and Moselle.Participants: The study was based on 203 patients on opiate substitution programs whose dosage had been stable for at least 1 month and who had given their consent to take part.

Main Measurement Tools: The participants completed a series of self-administered questionnaires in the treatment centers: Alcohol Use Disorders Identification Test (AUDIT), Toronto Alexithymia Scale (TAS-20), Coopersmith's Self-Esteem Inventory (SEI), Temperament and Character Inventory (TCI-R).Results: We observed high alexithymia scores, low self-esteem scores, and low self-directedness scores among patients with excessive alcohol consumption.Conclusions: We make some recommendations for new therapeutic approaches.

Keywordsbuprenorphine, methadone, alcohol, alexithymia, self-esteem, temperament

CO-MORBIDITY

27. Individualized smoking cessation treatment in an outpatient setting: Predictors of outcome in a sample with psychiatric and addictions co-morbidity Peter Selby, Sabrina C. Voci, Laurie A. Zawertailo, Tony P. George and Bruna Brands

Addictive Behaviors 2010;35(9):811-817

ABSTRACTObjectivePatients with psychiatric disorders have higher rates of smoking and greater difficulty quitting smoking. However, few studies have compared patients with schizophrenia or schizoaffective disorders to patients with other psychiatric diagnoses without psychosis, addressing ability to quit and differences in treatment characteristics.MethodA retrospective chart review was conducted on a sample of 165 cigarette smokers admitted to an outpatient smoking cessation clinic located in a large inner-city psychiatric hospital. Patients with schizophrenia and schizoaffective disorder (n = 55) were matched for age and sex at a ratio of 1:2 with a comparison group without psychosis (n = 110) from the same clinic. Primary outcomes of interest were quit status (7-day point prevalence) and significant reduction in cigarettes per day (≥ 50% but not quit) at final treatment session.ResultsThere were no significant differences between groups for end-of-treatment quit rate or significant reduction (≥ 50%) in cigarettes per day. Patients with schizophrenia made significantly more visits to the clinic and were in treatment for a longer period of time. A greater number of individual treatment sessions and being male were the most significant predictors of cessation.ConclusionPatients with schizophrenia were as likely to quit smoking as a comparison group of patients with a high rate of other psychiatric comorbidities without psychosis. Findings suggest treatment success in this population requires an extended number of clinic visits, group therapy, and possibly higher doses of nicotine replacement.

Keywords: Schizophrenia; Psychiatric comorbidity; Nicotine; Tobacco; Addiction; Treatment

28. Substance use and common child mental health problems: examining longitudinal associations in a British sampleAnna GoodmanAddiction 2010;105(8):1484-1496

ABSTRACTAims To examine the longitudinal associations in both directions between mental health and substance use in adolescence. Design Three-year longitudinal cohort. Setting Britain (nationally representative sample). Participants 3607 youths aged 11–16 years at baseline. Measurements Externalizing and internalizing mental health problems were measured using brief questionnaires (parent-reported Strengths and Difficulties Questionnaire) and diagnostic interviews, including clinician-rated diagnoses of mental disorder. Substance use was measured by youth self-report, and included regular smoking, frequent alcohol consumption, regular cannabis use and ever taking other illicit drugs. Findings Externalizing (specifically behavioural) problems at baseline independently predicted all forms of substance use, with a particularly strong effect on smoking. In all cases this association showed a dose–response relationship. In contrast, although internalizing problems had a strong univariable association with smoking, this disappeared after adjusting for comorbid externalizing problems. There was little or no evidence that baseline substance use predicted mental health at follow-up. Conclusions Externalizing problems predict adolescent substance use, and adjusting for comorbid externalizing problems is vital when investigating the effects of internalizing problems.Adose–response effect of externalizing problems is seen across the full range. Programmes seeking to prevent adolescent substance use by reducing externalizing problems may therefore wish to consider population-wide interventionsrather than targeting individuals only at the negative extreme.

Keywords Adolescence, externalizing problems, internalizing problems, substance use.

29. The 10-year course of remission, abstinence, and recovery in dual diagnosis Haiyi Xie Ph.D., Robert E. Drake M.D., Ph.D., Gregory J. McHugo Ph.D., Lynn Xie and Anita Mohandas B.A. Journal of Substance Abuse treatment 2010;39(2):132-140

ABSTRACTThis study examined the frequency, stability, predictors, and long-term outcomes of 6-month remissions of alcohol use disorders among 116 adults with co-occurring severe mental illnesses followed up prospectively for 10 years. Remission was defined as 6 months without meeting syndromal criteria for alcohol abuse or dependence. Most participants (86%) experienced at least one 6-month remission, and these remissions were relatively durable. One third did not relapse during follow-up, and two thirds relapsed on average 3 years after remission. Six-month

remissions were preceded by increased participation in substance abuse treatments, reductions in alcohol and drug use, decreases in psychiatric symptoms, increases in competitive employment, and increases in life satisfaction. Following remissions, participants improved in multiple domains of adjustment: reductions of psychiatric symptoms, decreases in alcohol and drug use, increases in work and social contacts with nonabusers, decreases in hospitalizations and incarcerations, increases in independent living, and increases in life satisfaction. Participants with alcohol dependence rather than alcohol abuse were less likely to attain 6-month remissions and more likely to relapse after attaining remissions.

Keywords: Remission; Abstinence; Recovery; Relapse; Dual diagnosis

DRUG POLICY

30. Is UK drug policy evidence based? Trevor Bennett and Katy HollowayInternational Journal of Drug Policy 2010;21(5):411-417

ABSTRACTBackgroundAll public services in the UK are expected to produce evidence-based policies. This principle was argued particularly strongly in relation to policies for tackling drug misuse. However, concerns have been expressed that commitment to this principle is not matched by the reality of policy making. In this paper, we examine the extent to which the UK drug strategy can be regarded as evidence-based.MethodsFocusing on case studies of policies implemented as part of the four main strands of the strategy, evidence reported by the government as forming the basis of the policy is examined as are findings of the published sources of evidence cited.ResultsIn most cases, the evidence was of a good quality in that it reflected the general standard of research in the area. The main problem lies in the interpretation and reporting of research results. Two of four case studies were reported as biased in terms of research study selection and in two there was some evidence that the reporting was not wholly representative of the conclusions drawn.ConclusionThere are many factors that influence the generation of policy and it is unrealistic, and perhaps disingenuous, to suggest in relation to drugs policy, that evidence is its primary focus.

Keywords: Evidence-based; Evidence informed; Policy; Drug strategy

31. Contingency management treatments: controversies and challengesNancy M. PetryAddiction 2010;105(9):1507-1509

No Abstract fort his article

Keywords: Contingency management, treatment, substance abuse

32. Why Is Natural Recovery So Common For Addictive Disorders?Wendy S. SlutskeAddiction 2010;105(9):1520-1521

No Abstract for this article

Keywords: natural recovery, self-change. sex differences, treatment seeking

33. Drug decriminalisation in PortugalPaula Vale de Andrade and Ludmila Carapinha

BMJ 2010;341:C4554

No Abstract for this paper.

34. Policy resistance to harm reduction for drug users and potential effect of changeTim Rhodes, Anya Sarang, Peter Vickerman and Matthew HickmanBMJ 2010;341:C3439

No Abstract for this paper.

ECONOMICS

35. Beyond neoclassical economics: Social process, agency and the maintenance of order in an Australian illicit drug marketplace Robyn Dwyer and David MooreInternational Journal of Drug Policy 2010;21(5):390-398

ABSTRACTBackgroundThe dominant Australian approaches to understanding illicit drug marketplaces are surveillance and criminological research. These approaches rely on the elementary neoclassical economic model of the market which focuses primarily on supply and demand. In this paper, we draw on anthropological and sociological research to develop an alternative framework for understanding Australian illicit drug marketplaces that emphasises their constituent processes.MethodsThe paper draws on two years of ethnographic research among heroin user/sellers of Vietnamese ethnicity in an Australian heroin marketplace.ResultsTrade and barter were key modes of exchange in this marketplace. We identified active negotiation and bargaining over price on the basis of social relationships, with dealers and customers actively working to develop and maintain such ties. Dealers set price collectively and this was shaped by moral and cultural elements such as notions of a ‘fair’ price. Social processes and relations as well as shared cultural expectations helped to generate trust and maintain order in the marketplace.ConclusionOur ethnographic research suggests that the dominant Australian approaches to the study of illicit drug markets, with their reliance on the elementary neoclassical economic market model, ignore the social processes and social relations through which such sites are made and remade. Nor do they adequately capture the complex character of the subjects who act within these sites. If we are to expand our understanding of illicit drug markets and marketplaces in Australia, we must look beyond the conceptions offered by surveillance and criminological approaches.

Keywords: Illicit drug marketplaces; Dealers; Social relations; Modes of exchange; Agency

36. Is Vancouver Canada’s supervised injection facility cost-saving? 1436Steven D. PinkertonAddiction 2010;105(8):1429-1436

ABSTRACTObjective To determine whether Vancouver’s Insite supervised injection facility and syringe exchange programs are cost-saving—that is, are the savings due to averted HIV-related medical care costs sufficient to offset Insite’s operating costs? Methods The analyses examined the impact of Insite’s programs for a single year. Mathematical models were used to calculate the number of additional HIV infections that would be expected if Insite were closed. The life-time HIV-related medical costs associated with these additional infections were compared to the annual operating costs of the Insite facility. Results If Insite were closed, the annual number of incident HIV infections among Vancouver IDU would be expected to increase from 179.3 to 262.8. These 83.5 preventable infections are associated with $17.6 million (Canadian) in life-time HIV-related medical care costs, greatly exceeding Insite’s operating costs, which are approximately $3 million per year. Conclusions Insite’s safe injection facility and syringe exchange program substantially reduce the incidence of HIV infection within Vancouver’s IDU community. The associated savings in averted HIV-related medical care costs are more than sufficient to offset Insite’s operating costs.

Keywords Cost-effectiveness, HIV transmission, injection drug use, mathematical model, supervised injection facility, syringe exchange.

ECONOMICS OF SERVICE DELIVERY

37. Effects of Alcohol Taxes on Alcohol-Related Mortality in Florida: Time-Series Analyses From 1969 to 2004Mildred M. Maldonado-Molina and Alexander C. WagenaarAlcoholism: Clinical and Experimental Research 2010;34(11):1915-1921

ABSTRACTBackground: Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol-related mortality. We evaluated effects of multiple changes in alcohol tax rates in the state of Florida from 1969 to 2004 on disease (not injury) mortality. Methods: A time-series quasi-experimental research design was used, including nonalcohol deaths within Florida and other states’ rates of alcohol-related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36-year period. Analyses included ARIMA, fixed-effects, and random-effects models, including a noise model, tax independent variables, and structural covariates. Results: We found significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida. The frequency ofdeaths (t = )2.73, p = 0.007) and the rate per population (t = )2.06, p = 0.04) declined significantly. The elasticity effect estimate is )0.22 (t = )1.88, p = 0.06), indicating a 10% increase in tax is associated with a 2.2% decline in deaths. Conclusions: Increased alcohol taxes are associated with significant and sizable reductions in alcohol-attributable mortality in Florida. Results indicate that 600 to 800 lives per year could be saved if real tax rates were returned to 1983 levels (when the last tax increase occurred). Findings highlight the role of tax policy as an effective means for reducing deaths associated with chronicheavy alcohol use.

Key Words: Alcohol Taxes, Florida, Time-Series, Alcohol Policy, Mortality.

EPIDEMIOLOGY AND DEMOGRAPHY

38. Combined effects of law enforcement and substitution treatment on heroin MortalityCarlos Nordt & Rudolf StohlerDrug Alcohol Rev 2010;29;540–545

ABSTRACTIntroduction and Aims.To explore the combined effects of street-level law enforcement and substitution treatment programs on drug-related mortality, taking into account prevalence of heroin use and changes in injecting behaviour. Design and Methods. Time trend analysis using annual police reports and case register data of opioid substitution treatments in Switzerland, 1975–2007. Results. Drug-related mortality increased during times of more intense street-level law enforcement [odds ratio (OR) 1.32, 95% confidence interval (95% CI) 1.15–1.51], and the number of drug-related deaths predicted the number of heroin possession offences 2 years later (r = 0.97, P < 0.001). Substitution treatment had a protective effect on drug-related mortality (OR 0.23, 95% CI 0.18–0.30). Surprisingly, the number of drug-related deaths was substantially biased by an oscillation period of 14 years (OR 1.24, 95% CI 1.17–1.32). Discussion and Conclusions. Our analysis revealed that the amount of police resources allocated to law enforcement was determined rationally, however, on biased grounds and with untoward consequences. Substitution treatment of heroin users reduced drug-related mortality in the long run, but different factors masked its impact for several years. Therefore, the introduction—or the expansion—of opioId substitution treatment programs should not be promoted with the argument of an immediate reduction of drug-related deaths in a country.

Key words: heroin, drug-related deaths, opioid substitution treatment, law enforcement.

39. Older and sicker: Changing mortality of drug users in treatment in the North West of England Caryl Beynon, Jim McVeigh, Ayesha Hurst and Adam MarrInternational Journal of Drug Policy 2010;21(5):429-431

ABSTRACTBackgroundThe study examines the age at which drug users die and ascertains whether there is a significant difference in the causes of death (‘drug related’ versus ‘non-drug related’) according to age.MethodsDetails of people reported to the North West of England's National Drug Treatment Monitoring System as dying (years 2003/2004–2007/2008) were matched by the Office for National Statistics to death notifications to identify the cause and date of death. Spearman's rank correlation was performed on median age at death by year. Mantel–Haenszel statistics tested the association between age and type of death, adjusted for year.Results

Causes of death were ascertained for 504 people. Median age at death increased significantly from 36.46 in 2003/2004 to 41.38 in 2007/2008. The odds of a person aged 40 and over dying from a non-drug related death were 3.27 the odds of a person aged less than 40 dying from a non-drug related death.ConclusionCurrent focus on drug related deaths detracts attention from other causes; in particular, the types of death which disproportionately affect older drug users. Ongoing debates about reintegration into society and employment presuppose that drug users are of working age and are healthy enough to work.

Keywords: Drug use; Ageing; Mortality; Morbidity; Drug related death; Policy

40. Adolescent alcohol use trajectories: Predictors and subsequent problems Anna-Karin Danielsson, Peter Wennberg, Anders Tengström and Anders RomelsjöAddictive Behaviors 2010;35(9):848-852

ABSTRACTThis study aimed at identifying different alcohol drinking trajectories in early to late adolescence. We also examined whether certain factors predicted membership of a specific trajectory and to what extent trajectory membership was linked to later negative consequences. Data were drawn from a longitudinal cohort study starting with 1923 adolescents including all seventh grade students in six school districts in Stockholm, Sweden 2001 (age 14), with follow-up in 2002, 2003, and 2006 (age 19). Cluster- and multinomial logistic regression analyses revealed four developmental pathways: low, gradually increasing, high, and suddenly increasing consumption. “High consumers” and “sudden increasers” reported higher levels of alcohol consumption, heavy episodic drinking, and alcohol-related problems both at age 14–16 and at age 19. The “gradual increasers” were more likely to smoke cigarettes, have easy access to alcohol, visit youth recreation centres, have friends who drink, and report a poorer health, compared to the “low consumer/abstainer group”. “High consumers” were more likely to have drinking peers than both “low consumers/abstainers” and “gradual increasers”.

Keywords: Adolescence; Alcohol; Trajectories; Predictors; Problems

41. The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility Paulo Jannuzzi Cunha, Sergio Nicastri, Arthur Guerra de Andrade and Karen I. BollaAddictive Behaviors 2010;35(10):875-881

ABSTRACTSubstance-dependence is highly associated with executive cognitive function (ECF) impairments. However, considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery — FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2 weeks of abstinence, and 32

healthy individuals (control group) were evaluated with FAB and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in DF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FAB's results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI.

Keywords: Neuropsychology; Prefrontal cortex; Substance use; Alcohol; Cannabis; Cocaine

42. Gender and prescription opioids: Findings from the National Survey on Drug Use and Health Sudie E. Back, Rebecca L. Payne, Annie N. Simpson and Kathleen T. BradyAddictive Behaviors 2010;35(11):1001-1007

ABSTRACTBackgroundSignificant gender differences in drug and alcohol use have been reported; however, little is known about gender differences in prescription opioid misuse and dependence. This study compared correlates, sources and predictors of prescription opioid non-medical use, as well as abuse or dependence among men and women in a nationally-representative sample.MethodsParticipants were 55,279 (26,746 men, 28,533 women) non-institutionalized civilians aged 12 years and older who participated in the National Survey on Drug Use and Health.ResultsRates of lifetime and past-year non-medical use of prescription opiates were 13.6% and 5.1%, respectively. Significantly more men than women endorsed lifetime (15.9% vs. 11.2%) and past-year use (5.9% vs. 4.2%; ps < 0.0001). Among past-year users, 13.2% met criteria for current prescription opiate abuse or dependence, and this did not differ significantly by gender. Polysubstance use and treatment underutilization were common among both men and women, however significantly fewer women than men had received alcohol or drug abuse treatment (p = 0.001). Men were more likely than women to obtain prescription opioids for free from family or friends, and were more likely to purchase them from a dealer (ps < .01). Gender-specific predictors of use as compared to abuse/dependence were also observed.ConclusionsThe findings highlight important differences between men and women using prescription opiates. The observed differences may help enhance the design of gender-sensitive surveillance, identification, prevention and treatment interventions.

Keywords: Gender; Prescription opioids; Pain relievers; Opiates; Prescription drugs; Non-medical use

43. Estimating the numbers of children of problematic drug users and their residential circumstances to inform United Kingdom research, policy and practicePaul Duffy, Claire Shaw, Kerry Woolfall, & Caryl M. BeynonInforma Healthcare 2010;17(5):470-484

ABSTRACTAims: To estimate the number of children of problematic drug users (PDU) inCheshire and Merseyside (England) in 2007/08 and their residential circumstancesusing two national monitoring systems, and to assess the suitability of these systems for this purpose.Methods: The proportions of PDU reporting numbers of children were calculated(e.g. zero – 40%, 1 child – 20%) for three datasets (National Drug Treatment Monitoring System (NDTMS), Drug Interventions Programme (DIP) and DIP/NDTMS amalgamated). Indirect standardization was used to estimate the number of children of PDU in Cheshire and Merseyside. The proportion of the overall population of under 16 years old who are children of PDU was calculated. Residential circumstances of children of PDU were examined using DIP data.Results: The estimated total number of children of PDU residing in Cheshire andMerseyside were 14,517 (NDTMS), 24,552 (DIP) and 19,029 (amalgamated dataset); 3.3% (NDTMS), 5.3% (DIP) and 4.3% (amalgamated dataset) of the total population were of under 16-year olds. Children of male and female PDU had different residential profiles.Conclusions: Findings illustrate the substantial potential burden of care on services and family members. Inconsistencies in data collection mean the use of these monitoring systems to produce estimates need further consideration.

44. Polydrug use among 15- to 16-year olds: Similarities and differences in EuropeDeborah Olszewski, Joa˜O Matias, Karin Monshouwer, & Anna KokkeviInforma Healthcare 2010;17(4):287-302

ABSTRACTAims: We describe types of polydrug use among school students across Europe andexplore differences between high, medium and low drug prevalence countries.Method: Analysis is based on survey data from over 70,000 15- to 16-year-old school students in 22 European countries. Polydrug use (defined as the use of two or more listed substances during the last 30 days) is compared across three country clusters based on drug prevalences by hierarchical cluster analysis. Affinity between substances is measured by pairwise associations and regression analysis was used to assess the differences in rate ratio across the country clusters.Results: A third of all school students had consumed two or more substances. The most common combinations were: alcohol and cigarettes, followed by alcohol or cigarettes combined with cannabis, followed by alcohol or cigarettes, cannabis and at least one other illegal drug. Pairwise associations show that cannabis and cocaine

users are more likely to use illegal drugs than the general student populations but least likely to do so in countries with high prevalence levels ( p50.0005).Conclusion: Consideration of country differences and objective measures for the concept of normalization could help to inform more holistic prevention initiatives that respond to country-specific contexts.

45. No one written off ? Welfare, work and problem drug useChris Grover & Ian PaylorInforma Healthcare 2010;17(4):315-332

ABSTRACTThe welfare ‘reform’ Green Paper, No one written off, outlined a range of proposals related to getting problem drug users into treatment as a first step to getting such people into paid work. This article outlines and critically engages with the contents of No one written off, particularly those aspects associated with the proposed introduction of a new social security benefit – a treatment allowance – for problem drug users. The article locates the proposed changes to income maintenance policy for problem drug users in Labour’s concern with the behaviour of those people it defines as deviant and/or irresponsible. The article argues that because of the level of coercion proposed in the changes, they have the potential to impoverish further problem users. This, along with the pathologizing of problem drug users, means the proposals are likely to have little effect in getting problem users into either drug treatment programmes or paid work.

46. Survey of injecting users’ health shows mixed pictureZosia KmietowiczBMJ 2010;341:C4276

No Abstract for this paper.

MISCELLANEOUS

47. The Global Diversion of Pharmaceutical Drugs Opiate treatment and the diversion of pharmaceutical opiates: a clinician’s perspectiveadd_3014 James BellAddiction 2010;105(9):1531-1537

ABSTRACTAim To provide a clinician’s perspective on the problem of diversion of prescribed pharmaceuticals. Methods The paper provides a personal account of working in a treatment context where diversion from opioid substitution treatment (OST) became a political issue potentially compromising the continued delivery of OST. It summarizes evidence on the impact of diversion, and measures to contain it, from the United Kingdom 1986–2006, Australia 1996–2008 and the United States and France from the mid-1990s. Results Opioid diversion to the black market occurs in proportion to the amount of opioids prescribed to be taken without supervision, and in inverse proportion to the availability of heroin. Diversion for OST programmes using supervision of dosing is less than diversion of opioids prescribed for pain, which is now a growing public health problem. Adverse consequences of diversion include opioid overdose fatalities, an increased incidence of addiction (particularly in jurisdictions where heroin is scarce) and compromising the public acceptance of long-term opioid prescribing. All long-term opioid prescribing requires monitoring of risk and appropriate dispensing arrangements—including dilution of methadone take-aways, supervision of administration for high-risk patients and random urine testing. Clinical guidelines influence practice, although prescribing often deviates from guidelines. Conclusion Clinical guidelines and clinical audit to enhance compliance with guidelines are helpful in maintaining the quality and integrity of the treatment system, and can contribute to keeping diversion within acceptable levels.

Keywords Buprenorphine, clinical audit, diversion, guidelines, methadone, opioids, prescription drugs.

NEEDLE EXCHANGE

48. Characteristics of injecting drug users accessing different types of needle and syringe programme or using secondary distributionN. Craine, M. Hickman, J.V. Parry, J. Smith, T. McDonald, M. LyonsJournal of Public Health 2010;32(3):328-335

ABSTRACTBackground In the UK, needle and syringe programmes (NSP) are delivered via community pharmacies or substance misuse services (SMSNSP).Understanding the profile of drug injectors primarily using different sources of injecting equipment can help service design.Methods Blood spot samples and behavioural data were collected from drug injectors and tested for antibodies to hepatitis C and hepatitis B. Data were analysed in relation to NSP use by multivariate logistic regression.Results Of 700 eligible individuals interviewed, 657 provided information on their main source of equipment; 26% reported pharmacy NSP, 56% SMSNSP and 18% secondary distribution. In the adjusted analysis, individuals whose main source was SMSNSP were more likely to report markers of increased risk (homelessness, groin injection, having injected .16 days/month) and had a higher hepatitis B antibody prevalence than individuals primarily using pharmacy NSP. Individuals whose main source was secondary distribution had a different profile (e.g. they were younger, more likely to be recent onset injectors than main source SMSNSP users and less likely to report being in drug treatment).Conclusion Differences exist in the populations primarily accessing different NSP and commissioning of services must reflect these differences.Injecting drug users relying on secondary exchange should be targeted to improve health service contact.

Keywords individual behaviour, population-based and preventative services, public health

49. Optimal provision of needle and syringe programmes for injecting drug users: A systematic review Lisa Jones, Lucy Pickering, Harry Sumnall, James McVeigh and Mark A. BellisInternational Journal of Drug Policy 2010;21(5);335-342

ABSTRACTThe introduction of needle and syringe programmes (NSPs) during the 1980s is credited with averting an HIV epidemic in the United Kingdom and Australia, but hepatitis C (HCV) incidence continues to rise among injecting drug users (IDUs). NSPs incorporating additional harm reduction strategies have been highlighted as an approach that may impact on HCV incidence. This systematic review sought to determine which approaches to the organisation and delivery of NSPs are effective. Fifteen databases were searched for studies published since 1990. Two reviewers screened all titles and abstracts, and data extraction and quality assessment of individual studies were undertaken independently by one reviewer and checked for accuracy by a second. Sixteen studies met the criteria for inclusion. Based on 11 studies there was no evidence of an impact of different NSP settings or syringe

dispensation policies on drug injecting behaviours, but mobile van sites and vending machines appeared to attract younger IDUs and IDUs with higher risk profiles. Two studies of interventions aimed at encouraging IDUs to enter drug treatment reported limited effects, but one study found that the combination of methadone treatment and full participation in NSPs was associated with a lower incidence of HIV and HCV. In addition, one study indicated that hospital-based programmes may improve access to health care services among IDUs. Currently, it is difficult to draw conclusions on ‘what works best’ within the range of harm reduction services available to IDUs. Further studies are required which have a stated aim of evaluating how different approaches to the organisation and delivery NSPs impact on effectiveness.

Keywords: Systematic review; Injecting drug users; Needle and syringe programmes

50. Racial differences in acquisition of syringes from pharmacies under conditions of legal but restricted sales Elizabeth C. Costenbader, William A. Zule and Curtis C. CoomesInternational Journal of Drug Policy 2010;21(5);425-428

ABSTRACTBackgroundInjecting drug users (IDUs) are at increased risk of acquiring and transmitting HIV and other bloodborne pathogens through the multi-person use of syringes. Although research has shown that increased access to syringes through syringe exchange programs (SEPs) is an effective strategy to reduce risky injection practices many areas of the United States still do not have SEPs. In the absence of SEPs, legislation allowing pharmacies over-the-counter sales of syringes has also been shown to reduce syringe sharing. The success of pharmacy sales however is limited by other legal stipulations, such as drug paraphernalia laws, which in turn may contribute to fear among IDUs about being caught purchasing and carrying syringes.MethodsBetween 2003 and 2006, 851 out-of-treatment IDUs were recruited using street outreach in the Raleigh-Durham (North Carolina) area. Data were collected using audio-computer assisted interview (ACASI) technology. Multiple logistic regression analyses were performed to assess factors associated with purchasing syringes from pharmacies.ResultsIn our study sample, African-American IDUs were one-fifth as likely as white IDUs to report pharmacies as their primary source of syringes.ConclusionsGiven the absence of syringe exchange programs and the relatively high prevalence of HCV and HIV among IDUs in the Raleigh-Durham area, the limited use of pharmacies as a source of syringes among African-American IDUs in this study sample is problematic. The study findings support the need for effective multilevel interventions to increase access to clean needles in this population, as well as for policy interventions, such as legalization of SEPs and elimination of penalties for carrying syringes, to reduce harm and eliminate the health threats posed by receptive syringe sharing.

Keywords: Injecting drug users; African-Americans; Purchasing syringes; Carrying syringes

51. Misdirected opposition: Evidence opposing “not in my back yard” arguments against syringe exchange programmes Chyvette T. Williams and Lawrence J. OuelletInternational Journal of Drug Policy 2010;21(5);437-439

ABSTRACTBackgroundDespite overwhelming evidence of their effectiveness, the establishment and maintenance of syringe exchange programmes (SEPs) in the US continue to draw opposition from community members, religious and political leaders, and law enforcement officials. One argument against SEPs is that they draw drug activity into the communities where they operate.MethodsWe use 8 years of survey data from participants attending an SEP in Chicago to explore this argument by reviewing responses (N = 4827) to a question asking participants the main reason they spend time in the area.ResultsFindings show far more participants come to the area to buy drugs (60%) than to exchange needles (3.8%), and differences exist by ethnicity. More whites than blacks or Latinos reported being in the area primarily to buy drugs and use the SEP.ConclusionRe-directing opposition from SEPs to constructive ways of addressing fundamental causes of drug markets is recommended.

Keywords: Syringe exchange programmes; Illicit drug markets; Ethnicity; Harm reduction policy

52. Prevalence and predictors of transitions to and away from syringe exchange use over time in 3 US cities with varied syringe dispensing policies Traci C. Green, Ricky N. Bluthenthal, Merrill Singer, Leo Beletsky, Lauretta E. Grau, Patricia Marshall and Robert HeimerDrug and Alcohol Dependence 2010;111(1-2):74-81

ABSTRACTSyringe exchange programs (SEPs) can reduce HIV risk among injecting drug users (IDUs) but their use may depend heavily on contextual factors such as local syringe policies. The frequency and predictors of transitioning over time to and from direct, indirect, and non-use of SEPs are unknown. We sought, over one year, to: (1) quantify and characterize transition probabilities of SEP attendance typologies; (2) identify factors associated with (a) change in typology, and (b) becoming and maintaining Direct SEP use; and (3) quantify and characterize transition probabilities of SEP attendance before and after changes in policy designed to increase access. Using data collected from 583 IDUs participating in a three-city cohort study of SEPs, we conducted a latent transition analysis and multinomial regressions. Three

typologies were detected: Direct SEP users, Indirect SEP users and Isolated IDUs. Transitions to Direct SEP use were most prevalent. Factors associated with becoming or maintaining Direct SEP use were female sex, Latino ethnicity, fewer injections per syringe, homelessness, recruitment city, injecting speedballs (cocaine and heroin), and police contact involving drug paraphernalia possession. Similar factors influenced transitions in the syringe policy change analysis. Policy change cities experienced an increase in Indirect SEP users (43–51%) with little increased direct use (29–31%). We found that, over time, IDUs tended to become Direct SEP users. Policies improving syringe availability influenced SEP use by increasing secondary syringe exchange. Interactions with police around drug paraphernalia may encourage SEP use for some IDUs and may provide opportunities for other health interventions.

Keywords: Syringe exchange; Injecting drug use; HIV/AIDS; Longitudinal study; Latent transition analysis

OPIATE TREATMENT

53. Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatmentadd_3016 1729Hendrik G. Roozen, Ranne de Waart & Petra van der KroftAddiction 2010;105(10):

ABSTRACTAims Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs. Methods The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model.Results CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon [relative risk (RR) 3.25, 95% confidence interval (CI) 2.11–5.02, P < 0.0001; numbers needed to treat (NNT) = 2] and twice the engagement of the Johnson Institute intervention (RR 2.15, 95% CI 1.28–3.62, P = 0.004; NNT = 3). Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window. Conclusion CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.

Keywords Addiction, alcohol, community reinforcement and family training, CRAFT, drugs, family, metaanalysis, substance use, systematic review, treatment-resistant

54. Commentary on Boscarino et al. (2010): Understanding the spectrum of opioid abuse, misuse and harms among chronic opioid therapy patients Michael von KorffAddiction 2010;105(10):1783-1784

No Abstract for this article

55. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care systemJoseph A. Boscarino, Margaret Rukstalis, Stuart N. Hoffman, John J. Han,

Porat M. Erlich, Glenn S. Gerhard & Walter F. StewartAddiction 2010;105(10):1776-1782

ABSTRACTAims Our study sought to assess the prevalence of and risk factors for opioid drug dependence among out-patients on long-term opioid therapy in a large health-care system. Methods Using electronic health records, we identified out-patients receiving 4+ physician orders for opioid therapy in the past 12 months for non-cancer pain within a large US health-care system.We completed diagnostic interviews with 705 of these patients to identify opioid use disorders and assess risk factors. Results Preliminary analyses suggested that current opioid dependence might be as high as 26% [95% confidence interval (CI) = 22.0–29.9] among the patients studied. Logistic regressions indicated that current dependence was associated with variables often in the medical record, including age <65 [odds ratio(OR) = 2.33, P = 0.001], opioid abuse history (OR = 3.81, P < 0.001), high dependence severity (OR = 1.85, P = 0.001), major depression (OR = 1.29, P = 0.022) and psychotropic medication use (OR = 1.73, P = 0.006). Four variables combined (age, depression, psychotropic medications and pain impairment) predicted increased risk for current dependence, compared to those without these factors (OR = 8.01, P < 0.001). Knowing that the patient also had a history of severe dependence and opioid abuse increased this risk substantially (OR = 56.36, P < 0.001).Conclusion Opioid misuse and dependence among prescription opioid patients in the United States may be higher than expected. A small number of factors, many documented in the medical record, predicted opioid dependence among the out-patients studied. These preliminary findings should be useful in future research efforts.

Keywords Drug abuse, drug dependence, opioids, out-patients, pain management, prescription drugs.

56. Infant mortality among women on a methadone program during pregnancydar_176 Lucy Burns, Elizabeth Conroy & Richard P. MattickDrug Alcohol Rev 2010;29;551–556

ABSTRACTIntroduction and Aims. The rate and correlates of infant death in those born to opioid-dependent women are unclear. This study aims to determine the infant mortality rate of infants born to women on a methadone program during pregnancy and to identify any modifiable risk factors. Design and Methods. A retrospective study of live births to all women in New South Wales, Australia during the period 1995–2002. Using record linkage four groups were compared: (i) live births to women on a methadone program during pregnancy who subsequently died during infancy; (ii) live births to women not on a methadone program who subsequently died during infancy; (iii) live births to women on a methadone program during pregnancy who did not die during infancy; and (iv) live births to women not on a methadone program who did not die during infancy.

Results, Discussion and Conclusion. The infant mortality rate was higher among infants whose mothers were on methadone during pregnancy (24.3 per 1000 live born infants in group 1 and 4.0 per 1000 live born infants in group 2) compared with infants of all other mothers.The single main cause of death for all infants was Sudden Infant Death Syndrome.There was a higher rate of smoking among women on methadone.The findings suggest that methadone and non-methadone infant–mother pairs have different symptom profiles, diagnostic procedures and/or different patterns of access to care.

Key words: infant mortality, methadone, pregnancy.

57. Quality of life among opiate-dependent individuals: A review of the literature Jessica De Maeyer, Wouter Vanderplasschen and Eric BroekaertInternational Journal of Drug Policy 2010;21(5);364-380

ABSTRACTQuality of life (QoL) has become an important outcome indicator in health care evaluation. A clear distinction has to be made between QoL – focussing on individuals’ subjective satisfaction with life as a whole and different life domains – and health-related QoL (HRQoL), which refers to the absence of pathology. As opiate dependence is the primary drug of most persons entering treatment and as the attention for QoL in addiction research is growing, this review of the literature intends to summarise and differentiate the available information on QoL in opiate-dependent individuals. A comprehensive literature review was conducted, including database searches in Web of Science, Pubmed and Cochrane Database of Systematic Reviews. Articles were eligible for review if they assessed QoL or HRQoL of opiate-dependent individuals, used a QoL or HRQoL instrument and reported at least one specific outcome on QoL or HRQoL. In total, 38 articles have been selected. The review showed that various instruments (n = 15) were used to measure QoL, mostly HRQoL instruments. Opiate-dependent individuals report low (HR)QoL compared with the general population and people with various medical illnesses. Generally, participation in substitution treatment had a positive effect on individuals’ (HR)QoL, but long-term effects remain unclear. Psychological problems, older age and excessive alcohol use seem to be related with lower (HR)QoL scores. The assessment of QoL in research on opiate dependence is still in its infancy. Still, the chronic nature of drug use problems creates the necessity to look at outcomes beyond the direct consequences of drug dependence and based on clients’ needs. HRQoL, with its unilateral focus on the functional status of clients, does not give information on clients’ own experiences about the goodness of life, and is as a consequence unsuitable for measuring QoL. Future research starting from a subjective, multidimensional approach of the concept of QoL is required.

Keywords: Review; Quality of life; Health-related quality of life; Opiate dependence; Heroin; Substitution treatment

58. Cost-effectiveness of extended buprenorphine–naloxone treatment for opioid-dependent youth: data from a randomized trialadd_3001 1616

Daniel Polsky, Henry A. Glick, Jianing Yang, Geetha A. Subramaniam, Sabrina A. Poole & George E. WoodyAddiction 2010;105(9):1616-1624

ABSTRACTAims The objective is to estimate cost, net social cost and cost-effectiveness in a clinical trial of extended buprenorphine–naloxone (BUP) treatment versus brief detoxification treatment in opioid-dependent youth. Design Economic evaluation of a clinical trial conducted at six community out-patient treatment programs from July 2003 to December 2006, who were randomized to 12 weeks of BUP or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg per day for 9 weeks and then tapered to zero at the end of week 12. DETOX patients were prescribed up to 14 mg per day and then tapered to zero on day 14. All were offered twice-weekly drug counseling. Participants 152 patients aged 15–21 years. Measurements Data were collected prospectively during the 12-week treatment and at follow-up interviews atmonths 6, 9 and 12. Findings The 12-week out-patient study treatment cost was $1514 (P < 0.001) higher for BUP relative to DETOX. One-year total direct medical cost was only $83 higher for BUP (P = 0.97). The cost-effectiveness ratio of BUP relative to DETOX was $1376 in terms of 1-year direct medical cost per quality-adjusted life year (QALY) and $25 049 in terms of out-patient treatment program cost per QALY. The acceptability curve suggests that the cost-effectiveness ratio of BUP relative to DETOX has an 86% chance of being accepted as cost-effective for a threshold of $100 000 per QALY. Conclusions Extended BUP treatment relative to brief detoxification is cost effective in the US health-care system for the outpatient treatment of opioid-dependent youth.

Keywords Buprenorphine, cost-effectiveness, detoxification, drug treatment, economic evaluation, opioiddependent youth, out-patient, randomized.

59. Were the changes to Sweden’s maintenance treatment policy 2000–06 related to changes in opiate-related mortality and morbidity?999 1625..1632Anders Romelsjö, Barbro Engdahl, Marlene Stenbacka, Anna Fugelstad, Ingrid Davstad, Anders Leifman & Ingemar ThiblinAddiction 2010;105(9):1625-1632

ABSTRACTAims To analyse whether changes in maintenance treatment of opiate-dependent subjects in Sweden were related to changes in opiate-related mortality and inpatient care from 1998 to 2006. Design We collected data from surveys of methadone maintenance treatment units, of buprenorphine and methadone sales, and of mortality and inpatient care in Sweden. Setting Sweden. Participants Patients in maintenance treatment. Measurements Survey data of treatment policy to all units in 2003 and 2005. Trend tests and correlation analyses of data on sales, mortality, inpatient care and forensic investigations.

Findings The surveys showed a marked change to a less restrictive policy, with increased use of ‘take-away doses’ and a reduction of discharges due to side misuse. The one-year retention rate stayed high. Sales of buprenorphine and methadone and the number of patients in treatment increased more thanthreefold from 2000 to 2006, with the greatest increase for buprenoprphine, introduced in year 2000. There was a significant 20–30% reduction in opiate-related mortality and inpatient care between 2000–2002 and 2004–2006 but not of other drug-related mortality and inpatient care. This decline was larger in Stockholm County, which had a less restricted treatment policy. However, a significant increase in buprenorphine- and methadone-related mortality occurred. For the study period 1998–2006, statistically significant declines occurred only in Stockholm County. Conclusions The liberalization of Sweden’s drug policy correlated with an increase in maintenance treatment, a decrease in opiate-related mortality and inpatient care and an increase in deaths with methadone and buprenorphine in the tissues.

Keywords Buprenorphine, methadone, morbidity, mortality, opiate dependence, treatment policy.

60. Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women Eugenia Oviedo-Joekes, Daphne Guh, Suzanne Brissette, Kirsten Marchand, David Marsh Jill Chettiar, Bohdan Nosyk, Michael Krausz, Aslam Anis and Martin T. SchechterDrug and Alcohol Dependence 2010;111(1-2):50-57

ABSTRACTBackgroundThere is consistent evidence showing women access treatment with more severe substance-related profiles relative to men; however, treatment outcome evaluation shows inconclusive results regarding gender differences. Furthermore, few studies evaluate response by gender.MethodsThe present analyses were performed using data from the NAOMI study, an open-label, phase III randomized controlled trial, carried out between 2005 and 2008 in Vancouver and Montreal, Canada. A total of 226 long-term treatment-refractory opioid dependent individuals were randomized to receive injectable diacetylmorphine or oral methadone for 12 months. Patients in both treatment groups were offered psychosocial and primary care services. Main outcomes were retention in addiction treatment at 12 months. Drug use, health, psychosocial adjustment and health-related quality of life were examined at baseline and during treatment, using the European Addiction Severity Index, Maudsley Addiction Profile, SF-6D and EuroQol EQ-5D.ResultsA total of 88 (38.9%) females and 138 (61.1%) males were included in the present analysis. Retention rates among female participants in the diacetylmorphine group were significantly higher than oral methadone (83.3% vs. 47.8%). Males receiving diacetylmorphine improved significantly more than females in physical health, health-related quality of life, and family relations but female participants in the

diacetylmorphine group had significantly greater improvements in illicit drug use scores and psychological health compared to females allocated to oral methadone.ConclusionsAmong long-term opioid dependent women who have not benefited sufficiently from available treatments, medically prescribed diacetylmorphine is more effective than oral methadone. Men receiving diacetylmorphine showed more improvements than women.

Keywords: Gender; Opioid dependence; Substitution treatment; Diacetylmorphine; Injectable; Methadone; Oral; Treatment outcome

61. Effects of experimental Unemployment, Employment and Punishment analogs on opioid seeking and consumption in heroin-dependent volunteers Mark K. GreenwaldDrug and Alcohol Dependence 2010;111(1-2):64-73

ABSTRACTThis study investigated the extent to which hydromorphone (HYD) choice and behavioral economic demand differed during experimental analogs of Unemployment (Drug Only: HYD and no money alternative), Employment (Drug or Money: HYD and $4 alternative), and Punishment (Drug Only + Money Loss: HYD only and $4 subtracted for each HYD choice), in the context of anticipated high vs. low post-session drug availability (HYD 24 mg vs. placebo). Eleven heroin-dependent, buprenorphine-stabilized (8 mg/day) volunteers first sampled two HYD doses (0 and 24 mg IM in randomized, counterbalanced order, labeled Drug A [session 1] and Drug B [session 2]). In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio (PR) task and could work to receive HYD unit doses (2 mg each); cumulative dose units earned were administered in a bolus injection after the work session. Before the PR task, volunteers were told which HYD dose (Drug A or B) would be available 3 h after the PR-contingent injection. Relative to Unemployment (Drug Only), Employment (Drug or Money) and Punishment (Drug Only + Money Loss) each significantly suppressed HYD seeking (e.g., breakpoints). Employment and Punishment also reduced HYD behavioral economic demand, but via different mechanisms: Employment increased HYD price-elasticity, whereas Punishment decreased HYD demand intensity. Adjusting for the initial level difference (i.e., normalized demand), Employment significantly decreased Pmax (i.e., lower “essential value” of HYD) and Omax (maximum HYD responding) compared to Punishment or Unemployment. These effects were not significantly altered by post-session drug availability.

Keywords: Behavioral economic analysis; Heroin dependence; Employment; Unemployment; Punishment; Contingencies; Drug seeking

62. The effect of motivational status on treatment outcome in the North American Opiate Medication Initiative (NAOMI) study Bohdan Nosyk, Josie Geller, Daphne P. Guh, Eugenia Oviedo-Joekes, Suzanne Brissette, David C. Marsh, Martin T. Schechter and Aslam H. AnisDrug and Alcohol dependence 2010;111(1-2):161-165

ABSTRACTDropout and recidivism from addiction treatment has been found to be associated with individuals’ readiness for change. Motivation for treatment among participants entering the North American Opiate Medication Initiative (NAOMI) randomized controlled trial, which compared heroin assisted treatment (HAT) to optimized methadone maintenance treatment (MMT), was assessed. Through multivariate regression, we aimed to determine whether baseline motivational status was predictive of four treatment outcomes: early dropout, 12-month retention, 12-month response to treatment, and time to discontinuation of treatment. Among the 251 out-of-treatment chronic opioid dependent patients recruited in Montreal, Quebec and Vancouver, British Columbia, 52% reported having a high level of motivation for treatment. HAT was statistically significantly more effective than MMT on each of the outcomes assessed. Baseline motivational status did not predict retention or time to discontinuation in either HAT or MMT. However, while patients were retained in HAT regardless of motivational status, motivated patients showed a more favourable response to treatment in terms of decreases in crime and illicit drug use. These results suggest that HAT successfully retains opioid dependent patients who otherwise may not have been attracted into existing treatment options, and may enhance the odds of successful rehabilitation among patients motivated for treatment.

Keywords: Heroin assisted treatment; Methadone maintenance treatment; Motivational status; Opioid dependence

63. Retention in naltrexone implant treatment for opioid dependence Nikolaj Kunøe, Philipp Lobmaier, John Kåre Vederhus, Bjørg Hjerkinn, Solfrid Hegstad, Michael Gossop, Øistein Kristensen and Helge WaalDrug and Alcohol dependence 2010;111(1-2):161-165

ABSTRACTBackgroundNaltrexone's usefulness in the treatment of opioid dependence stems from its ability to block the action of heroin and other opioids. However, many patients are ambivalent towards naltrexone and often drop out of treatment with orally administered naltrexone. Sustained release naltrexone seems promising in reducing opioid use, but the extent to which patients remain in treatment beyond the first dosage of naltrexone is not clear.MethodsPatients (n = 61) receving treatment with sustained release naltrexone implants were offered a second naltrexone implant after 6 months. Patients who remained in treatment were compared to those who did not, on drug use, mental health, and social problems before and during naltrexone implant treatment. Information was obtained on other treatments sought by patients who discontinued naltrexone. Blood samples were used to verify naltrexone release, and hair samples to confirm opioid intake.ResultsOf the patients who received the first naltrexone implant, 51% (n = 31) remained in naltrexone implant treatment. Among those who discontinued treatment, 21%

expressed a wish to reimplant but failed to attend for reimplantation and 28% declined reimplantation: 6 non-retained patients initiated maintenance or residential treatment. Remaining in naltrexone treatment was related to pre-study length of employment, illicit drug use, and concern for family problems. Higher levels of substance misuse and criminal activity during naltrexone treatment were negatively related to subsequent retention.ConclusionRates of retention among opioid-dependent patients receiving naltrexone implant treatment are encouraging and support this as a feasible long-term treatment option.

Keywords: Opioids; Heroin; Naltrexone; Retention; Sustained release; Naltrexone implant

64. The cost of concordance with opiate substitution treatment guidelines Paul G. Barnett Ph.D., Jodie A. Trafton Ph.D. and Keith Humphreys Ph.D.Journal of Substance Abuse Treatment 2010;39(2):141-149 ABSTRACTThe Multisite Opiate Substitution Treatment study compared four opioid substitution programs that were highly concordant with clinical practice guidelines to four programs that were less concordant. Program staff were surveyed, and consenting new patients from highly concordant (n = 164) and less-concordant programs (n = 91) were assessed. After 12 months, treatment of new clients of highly staffed, guideline concordant sites cost $10,252, which is significantly more than the $6,476 cost at less-concordant programs (p < .01). Clients at highly concordant sites received significantly more group visits (M = 37.0 vs. 13.1, p < .01) but fewer dosing visits. There were no significant differences in medical care costs. Opioid substitution therapy was effective at reducing heroin use, especially at sites that were highly concordant with treatment guidelines. Annual mortality was 3.0% and did not differ by type of care. Preference-based quality of life significantly improved only at highly concordant sites.

Keywords: MOST study; Opioid substitution program; Concordance; Cost

65. Analysis of the impact of treatment setting on outcomes from methadone treatment Catherine M. Comiskey Ph.D. and Gemma Cox Ph.D. Journal of Substance Abuse Treatment 2010;39(3):195-201

ABSTRACTHow methadone setting, duration of drug career, and dose impact on treatment are assessed. Two hundred fifteen participants were recruited. Analysis revealed significant reductions in drug use at 1 year within all settings, but the pattern varied. Proportions using heroin reduced in all settings, unprescribed benzodiazepines reduced in community, and general practitioner settings and cocaine use reduced in community and Government health board settings. A logistic model controlling for intake methadone dose, setting, previous treatments, and intake heroin use revealed that setting was a significant factor in predicting heroin use at 1 year but was not significant in predicting changes in health. Findings illustrate that drug outcomes improved across all settings, and health did not improve in any setting. For optimum outcomes to be achieved, opiate users must be directed to settings that best match their needs and that the “one-stop-shop for methadone” is not the most effective solution.

Keywords: Opiates; Treatment; Setting; Methadone; Outcomes

66. Treatment pathways and longitudinal outcomes for opiate users: Implications for treatment policy and planningCatherine Comiskey & Robert StapletonInforma Healthcare 2010;17(6):707-717

ABSTRACTThe aim is to model treatment pathways and outcomes of opiate users at intake and at 1- and 3-year follow-up and to assess the implications of these for treatment policy. Opiate users entering a new treatment episode were recruited. Tree diagrams were used to map treatment relapse and re-entry. A within subjects repeated measures analyses of variance was conducted on each of the outcomes. The effect of being in treatment at 1-year on the 3-year outcomes was measured controlling for the value of the outcome variable at intake. A total of 404 opiate users were recruited. Follow-up interview rates were 88.4% at 3-years. Three years after intake 15% were drug free, 70% were in treatment and 15% were not in treatment and were using illegal drugs. Analysis revealed that there were no differences between the three outcome groups at intake. Those who were not in treatment and using at 3-years had displayed little improvement at 1-year and those whowere not in treatment and not using at 3-years had displayed improvements in physical and mental health outcomes at 1-year. Regardless of treatment modality, treatment policy needs to reflect, support and encourage individuals during the treatment relapse cycle.

67. Responsible management and use of a personal take-home naloxone supply: A pilot projectAndrew Mcauley, George Lindsay, Maureen Woods, & Derek Louttit

Informa Healthcare 2010;17(4):388-399

ABSTRACTAims: To assess if Scottish drug users, their family and friends could be trained in critical incident management and the safe and effective administration of naloxone. The project also sought to monitor whether drug users can manage their own personal take-home naloxone (THN) supply and use it appropriately in an emergency opiate overdose situation. Methods: Twenty-three clients were trained alongside 18 ‘buddies’ and 19 clients were issued with naloxone packs following successful completion of training. Findings: Three overdoses were witnessed by three participant clients during the pilot with two reported ‘saves’; pilot training procedure was followed on both occasions. Each reported overdose was validated by police and ambulance service records. Eighty-nine percent (n¼17) were followed up at 2 months; 94% (n¼16) of these claimed to still have their THN; 89% (n¼17) followed up at 6 months; 100% (n¼17) of these claimed to still have their THN.Results: This data suggests that Scottish drug users can be trained to identify andrespond to an opiate overdose utilizing basic life support and naloxone administration skills similar to their counterparts from other parts of the world. Moreover these results suggest that a majority of opiate users can responsibly manage their own personal THN supply when trained appropriately.

68. Survival and cessation ininjecting drug users: prospective observational study of outcomes and effect of opiate substitution treatmentKimber J, Copeland L, Hickman M, MacLeod J, McKenzie J, De Angelis D and Robertson JR.BMJ 2010;341:135-

ABSTRACTObjectives To examine survival and long term cessation of injecting in a cohort of drug users and to assess the influence of opiate substitution treatment on these outcomes. Design Prospective open cohort study. Setting A single primary care facility in Edinburgh. Participants 794 patients with a history of injecting drug use presenting between 1980 and 2007; 655 (82%) were followed up by interview or linkage to primary care records and mortality register, or both, and contributed 10 390 person years at risk; 557 (85%) had received opiate substitution treatment. Main outcome measures Duration of injecting: years from first injection to long term cessation, defined as last injection before period of five years of non-injecting; mortality before cessation; overall survival. Results In the entire cohort 277 participants achieved long term cessation of injecting, and 228 died. Half of the survivors had poor health related quality of life. Median duration from first injection to death was 24 years for participants with HIV and 41 years for those without HIV. For each additional year of opiate substitution treatment the hazard of death before long term cessation fell 13% (95% confidence interval 17% to 9%) after adjustment for HIV, sex, calendar period, age at first injection, and history of prison and overdose. Conversely exposure to opiate substitution treatment was inversely related to the chances of achieving long term cessation.

Conclusions Opiate substitution treatment in injecting drug users in primary care reduces this risk of mortality, with survival benefits increasing with cumulative exposure to treatment. Treatment does not reduce the overall duration of injecting.

PHARMACY

69. Community pharmacy service users’ views and perceptions of alcohol screening and brief interventiondar_234 596Ranjita Dhital, Cate M. Whittlesea, Ian J. Norman & Peter MilliganDrug Alcohol Rev 2010;29;596–602

ABSTRACTIntroduction and Aims. Community pharmacists have the potential to deliver alcohol screening and brief interventions (SBI) to pharmacy users. However, little is known if SBI would be utilised and views of people who might use the service. Therefore, the aim was to investigate potential barriers and enablers of pharmacy SBI. Design and Methods. Purposive sampling was used to select four pharmacies within the London borough of Westminster, UK. Semistructured interview schedule recorded participants’ views of pharmacy SBI. The Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) was incorporated to record views of high and low-risk drinkers. Categorical data were analysed and content analysis undertaken. Results. Of the 237 participants (149 female) approached 102 (43%) agreed to be interviewed (63 female). Of these 98 completed AUDIT-C, with 51 (52%) identified as risky drinkers. Risky drinkers were significantly identified among theyounger age group (c2 = 11.03, P = 0.004), professional occupations (c2 = 10.41, P = 0.015), with higher qualifications (c2 = 10.46, P = 0.033), were least frequent visitors to a pharmacy (c2 = 11.58, P = 0.021) and more frequently identified in multiple pharmacy establishments than independents (c2 = 8.52, P = 0.004). Most were willing to discuss drinking (97, 96%) and accept written information (99, 98%). Accessibility and anonymity were reported as positive aspects and concerns were expressed about lack of privacy and time (pharmacist and user). Discussion and Conclusions. This study reports the first results of pharmacy users’ views on SBI. Regardless of drinking status, most were willing to utilise the service and positive about pharmacists’ involvement

Key words: alcohol, brief intervention, community pharmacy, pharmacy service user, service uptake

POLICY

70. The Implicit Rules Of Evidence-Based Policy Analysis, UpdatedRobert J. MaccounAddiction 2010;105(8);1335-1336

No Abstract for this article

Keywords Cannabis policy, cannabis prevalence, drug policy, drug prohibition, evidence-based policy making, standards of proof.

71. Is There A Causal Linkage Between Cannabis Use And Increased Risks Of Psychotic Symptoms?David M. FergussonAddiction 2010;105(8);1336-1337

No Abstract for this article

Keywords Cannabis, causation, psychotic symptoms.

72. Substitution and Complementarity in the Face of Alcohol-Specific Policy InterventionsSimon C. MooreAlcohol and Alcoholism 2010;45(5):403-408

ABSTRACT — Aim: Policy responses to the growing burden of alcohol-related disease fail to consider the interrelated nature of substance misuse and the potential for complex interactions in response to alcohol-specific interventions. This paper considers possible aggregate level responses to the alcohol policy and whether alcohol policy can be expected to reduce overall harm. Methods: A review and discussion of the relevant literature was conducted. Results: Evidence indicates that those at greatest risk consume stronger alcoholic beverages more frequently, that they are likely to complement their consumption with a range of intoxicants and that they are more likely to substitute alcohol with other substances. Conclusions: Policies aimed at reducing alcohol consumption can be successful. However, evidence suggests a significant minority of consumers are likely to substitute or complement consumption with a range of intoxicants suggesting that policy is unlikely to reduce all-cause mortality and morbidity. Further research into thenature of substitution and complementarity is required.

SERVICES AND PROFESSIONALS

73. Medical student views of substance abuse treatment, policy and trainingShantanu Agrawal, Worth W. Everett, & Sonali SharmaInforma Healthcare 2010;17(5):587-602

ABSTRACTPurpose: This study examined the impact of medical education on students’ views ofsubstance abuse treatment, public policy options and training. Method: A longitudinal survey was conducted on a single-class cohort of 101 studentsin a major American, urban medical school. The survey was administered in the Spring semesters of the first to third years of the curriculum. The survey evaluated attitudes in three areas: (1) Treatment: efficacy of treatment and ideal level of physician involvement in substance abuse issues, (2) Public policy: degrees of support for competing public policy strategies and (3) Training: the amount of substance abuse education offered in medical school. Results: Response rates were 92% in the first year, 90% in the second and 75% in the third. About 54% of respondents were female, 55% were white (non-Hispanic) and 71% were 20–24 years old. Treatment: students held consistent views towards treating substance abuse patients, but there was a significant decline in the percentage who felt that drug addiction can be successfully treated (from 47 to 22%, p< 0.001). Public policy: support for public health approaches ranged from 86 to 92%, but most criminal justice approaches were favoured by fewer than 40% of respondents. Training: respondents reported a significant increase in any degree of substance abuse training ( p¼0.0001); classroom and clinical experiences were the predominant sources of training. Conclusions: Surveyed medical students retained many of their a priori beliefs about substance abuse, though there were some significant changes during the survey period. Further studies are required to evaluate how these views were established and how medical education impacts potentially malleable attitudes.

74. Assessing user perceptions of staff training requirements in the substance use workforce: A review of the literatureLeon W. J. WylieInforma Healthcare 2010;17(5):618-631

ABSTRACTAlthough the potential range of the workforce that may positively interact with substance users is large, and takes in all who may have to deal with substance use issues in some way, the literature mainly focuses on user views of specialist substance use or health and social care staff. With client-centred care a key policy of modern service delivery, this review assesses the available literature on service user perceptions of staff abilities and comments on possible training needs. Many service users rated a positive attitude towards the user as the key staff attribute that enhanced quality of care. There was also evidence that generally users desired more knowledgeable staff, both professional and ex-user, and that staff working within sub-specialties require advanced training. However, a positive attitude towards the user in interpersonal therapeutic situations was potentially able to

overcome a staff member’s knowledge deficiency. Potential methods of instilling positive attitudes within the substance use workforce are discussed, including organizational culture and potential educational requirements.

75. Fitting a quart into a black box: Keyworking in quasi-coercive drug treatment in EnglandDavid Best, Kelly Wood, Ruth Sweeting, Bill Morgan, & Ed DayInforma Healthcare 2010;17(4):370-387

ABSTRACTAims: The aim of this article is to assess what goes on in treatment sessions in courtmandated drug treatment in the UK. Methods: The study used a case note audit involving interviews with drug workers about each of their active cases, assessing client characteristics and their reports on what activities had taken place in treatment sessions. Findings: The average session lasts just under 30 minutes and typically at least three different types of worker-led activity are engaged in per session, often including time spent on compliance with treatment, with prescriptions and with the testing requirements of the court mandate. The amount of time dedicated to evidenced psychosocial interventions is typically less than 10 minutes.Conclusions: The tensions reported elsewhere for drug workers engaged in criminaljustice services are evidenced in the study given the range of tasks (potentially conflicting) that drug workers are required to engage in and the limited opportunity for them to engage in effective psychosocial drug treatment.