Drug and Alcohol Dependence

Editorial Board

2010-04-01

The serotonin transporter gene and risk for alcohol dependence: A meta-analytic review

2010-04-01

Abstract: Previous studies have implicated a relationship between particular allelic variations of the serotonin transporter gene (5HTTLPR) and alcohol dependence. To provide a current estimate of the strength of this association, particularly in light of inconsistent results for 5HTTLPR, we conducted a meta-analytic review of the association between 5HTTLPR and a clinical diagnosis of alcohol dependence. Of 145 studies initially identified, 22 (including 8050 participants) met inclusion criteria. Results indicated that there was a significant albeit modest association between alcohol dependence diagnosis and the presence of at least 1 short allele (OR=1.15, 95% CI=1.01, 1.30, p<.05). Slightly more robust results were observed for participants who were homogeneous for the short allele (OR=1.21, 95% CI=1.02, 1.44, p<.05). These results were unrelated to sex and race/ethnicity of participants; however, the effect size was moderated by study sample size and publication year. Additionally, the fail-safe N analysis indicated potential publication bias. Therefore, although our review indicates that there is a significant association between 5HTTLPR and alcohol dependence diagnosis, this result should be interpreted with caution.

Nicotine withdrawal in U.S. smokers with current mood, anxiety, alcohol use, and substance use disorders

Andrea H. Weinberger, Rani A. Desai, Sherry A. McKee — 2010-04-01

Abstract: Background: The current study examined tobacco withdrawal symptoms and withdrawal-related discomfort and relapse in smokers with and without current mood disorders, anxiety disorders, alcohol use disorders (AUD), and substance use disorders (SUD).Methods: The subsample of current daily smokers (n=8213) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, Wave 1, 2001–2002, full sample n=43,093) were included in these analyses. Cross-sectional data compared smokers with and without current psychiatric disorders on withdrawal symptoms using logistic regression models. The effects of having a co-morbid psychiatric disorder and AUD/SUD compared to a psychiatric disorder alone on nicotine withdrawal were also examined.Results: Participants with a current mood disorder, anxiety disorder, AUD, or SUD were more likely to report withdrawal symptoms and reported more withdrawal symptoms than those without current disorders. Having a current mood disorder, anxiety disorder, or SUD was also associated with increased likelihood of withdrawal-related discomfort and relapse. There were no significant interactions between psychiatric disorders and AUDs/SUDs on withdrawal symptoms or behavior.Conclusions: Participants with a current Axis I disorder were more likely to experience tobacco withdrawal symptoms and withdrawal-related discomfort and relapse. Having a co-morbid psychiatric disorder and AUD/SUD did not synergistically increase the experience of withdrawal-related symptoms or relapse. It is important to identify Axis I disorders in smokers and provide these smokers with more intensive and/or longer treatments to help them cope with withdrawal symptoms and prevent relapse.

Late-life and life history predictors of older adults’ high-risk alcohol consumption and drinking problems

Rudolf H. Moos, Kathleen K. Schutte, Penny L. Brennan, Bernice S. Moos — 2010-04-01

Abstract: Aims: This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55–65 to 75–85.Design, setting, participants: A sample of older community residents (N=719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.Measurements: At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.Results: Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.Conclusion: Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Dimensionality of DSM-IV nicotine dependence in a national sample: An item response theory application

2010-04-01

Abstract: Background: Research focusing on the development of a dimensional representation of DSM-IV nicotine dependence is scarce and prior research has not assessed the role of nicotine use criteria in that a dimensional representation, nor the invariance of the DSM-IV nicotine dependence criteria across important population subgroups.Methods: Using a large, representative sample of the U.S. population, this study utilized item response theory (IRT) analyses to explore the dimensionality of DSM-IV nicotine dependence criteria and several candidate criteria for cigarette use among past-year cigarette smokers (n=10,163).Results: Factor analyses demonstrated the unidimensionality of nicotine dependence criteria and IRT analyses demonstrated good fit of the observed responses and the underlying, unobserved latent trait of dependence severity. The model containing all seven DSM-IV dependence criteria, along with the consumption criterion of smoking at least a quarter of a pack of cigarettes in a day in the past year, was identified as the best-fitting model. No differential criterion functioning was shown across sex, race-ethnicity, and age subgroups.Discussion: Major implications of this study are discussed in terms of the addition of a dimensional representation of nicotine dependence to pre-existing categorical representations of the disorder in the DSM-V, and the need for a nicotine consumption criterion to improve representations of nicotine dependence severity.

Estimating risk of alcohol dependence using alcohol screening scores

2010-04-01

Abstract: Brief alcohol counseling interventions can reduce alcohol consumption and related morbidity among non-dependent risky drinkers, but more intensive alcohol treatment is recommended for persons with alcohol dependence. This study evaluated whether scores on common alcohol screening tests could identify patients likely to have current alcohol dependence so that more appropriate follow-up assessment and/or intervention could be offered. This cross-sectional study used secondary data from 392 male and 927 female adult family medicine outpatients (1993–1994). Likelihood ratios were used to empirically identify and evaluate ranges of scores of the AUDIT, the AUDIT-C, two single-item questions about frequency of binge drinking, and the CAGE questionnaire for detecting DSM-IV past-year alcohol dependence. Based on the prevalence of past-year alcohol dependence in this sample (men: 12.2%; women: 5.8%), zones of the AUDIT and AUDIT-C identified wide variability in the post-screening risk of alcohol dependence in men and women, even among those who screened positive for alcohol misuse. Among men, AUDIT zones 5–10, 11–14 and 15–40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 18 to 87%, and AUDIT-C zones 5–6, 7–9 and 10–12 were associated with probabilities ranging from 22 to 75%. Among women, AUDIT zones 3–4, 5–8, 9–12 and 13–40 were associated with post-screening probabilities of past-year alcohol dependence ranging from 6 to 94%, and AUDIT-C zones 3, 4–6, 7–9 and 10–12 were associated with probabilities ranging from 9 to 88%. AUDIT or AUDIT-C scores could be used to estimate the probability of past-year alcohol dependence among patients who screen positive for alcohol misuse and inform clinical decision-making.

Alcohol misuse and functional impairment in the UK Armed Forces: A population-based study

2010-04-01

Abstract: Aim: To assess whether alcohol misuse was associated with functional impairment in the military, and whether an association between any of the measures of alcohol misuse and impairment would be explained by psychiatric comorbidity.Design: Large cross-sectional study.Participants: 8585 responders of a random sample of the regular United Kingdom Armed Forces who completed a questionnaire in 2005 were included in the analyses.Measurements: Five items of the Short Form Questionnaire-36 (SF-36) specifically dealing with functional impairment, and the main independent variable was alcohol misuse based on the Alcohol Use Disorders Identification Test (AUDIT).Findings: An AUDIT score of ≥20 was consistently associated with impairment with odds ratios between 1.8 (95% confidence interval 1.4–2.3) and 3.7 (2.8–4.8). AUDIT scores <20 did not increase impairment. Those with a hazardous pattern of drinking (AUDIT score 8–15) perceived their functioning to be better than those with an AUDIT score <8. A score indicating alcohol dependence was associated with impairment, as, to a lesser extent, was alcohol related-harm. Binge drinking was not associated with impairment. Half of those with an AUDIT score of ≥20 had psychological comorbidities.Conclusion: Perception of impairment was mainly related to those with an AUDIT score of ≥20 or more, those who had an indication of alcohol dependence or alcohol related-harm. Intervention on an individual basis should be focused on these groups, while effective public health interventions could be enhanced for everyone.

A new definition of early age at onset in alcohol dependence

Yann Le Strat, Bridget F. Grant, Nicolas Ramoz, Philip Gorwood — 2010-04-01

Abstract: Objective: The accurate cut-off of an early onset of alcohol dependence is unknown. The objectives of this analysis are (1) to confirm that ages at onset variability in alcohol dependence is best described as a two subgroups entity, (2) to define the most appropriate cut-off, and (3) to test the relevancy of such distinction.Method: Data were drawn the Epidemiologic Survey on Alcohol and Related Conditions (NESARC). This study focused on the 4782 adults with lifetime alcohol dependence.Results: The best-fit model distinguished two subgroups of age at onset of alcohol dependence, with a cut-off point at 22 years. Subjects with an earlier onset of alcohol dependence (≤22 years old) reported higher lifetime rates of specific phobia, antisocial behaviors and nearly all addictive disorders.Conclusions: The early onset of alcohol dependence is best defined as beginning before the age of 22 years.

Mechanisms underlying the lifetime co-occurrence of tobacco and cannabis use in adolescent and young adult twins

2010-04-01

Abstract: Using twins assessed during adolescence (Virginia Twin Study of Adolescent Behavioral Development: 8–17 years) and followed up in early adulthood (Young Adult Follow-Up, 18–27 years), we tested 13 genetically informative models of co-occurrence, adapted for the inclusion of covariates. Models were fit, in Mx, to data at both assessments allowing for a comparison of the mechanisms that underlie the lifetime co-occurrence of cannabis and tobacco use in adolescence and early adulthood. Both cannabis and tobacco use were influenced by additive genetic (38–81%) and non-shared environmental factors with the possible role of non-shared environment in the adolescent assessment only. Causation models, where liability to use cannabis exerted a causal influence on the liability to use tobacco fit the adolescent data best, while the reverse causation model (tobacco causes cannabis) fit the early adult data best. Both causation models (cannabis to tobacco and tobacco to cannabis) and the correlated liabilities model fit data from the adolescent and young adult assessments well. Genetic correlations (0.59–0.74) were moderate. Therefore, the relationship between cannabis and tobacco use is fairly similar during adolescence and early adulthood with reciprocal influences across the two psychoactive substances. However, our study could not exclude the possibility that ‘gateways’ and ‘reverse gateways’, particularly within a genetic context, exist, such that predisposition to using one substance (cannabis or tobacco) modifies predisposition to using the other. Given the high addictive potential of nicotine and the ubiquitous nature of cannabis use, this is a public health concern worthy of considerable attention.

The effectiveness of a school-based substance abuse prevention program: 18-Month follow-up of the EU-Dap cluster randomized controlled trial

2010-04-01

Abstract: Aim: To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial).Materials and methods: Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12–14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models.Results: Persisting beneficial program effects were found for episodes of drunkenness (any, POR=0.80; 0.67–0.97; frequent, POR=0.62; 0.47–0.81) and for frequent cannabis use in the past 30 days (POR=0.74; 0.53–1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers.Conclusion: The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.

Mortality among drug users after discharge from inpatient treatment: An 8-year prospective study

Edle Ravndal, Ellen J. Amundsen — 2010-04-01

Abstract: Background: Drug users who are leaving/completing inpatient medication-free treatment may, like drug users released from prison, have an elevated risk of dying from fatal overdoses. This is mainly explained by their low drug tolerance.Methods: Two hundred and seventy-six drug users who had been admitted to 11 inpatient facilities in Norway, were followed prospectively after discharge from treatment during an 8-year period (1998–2006). The following instruments were used: EuropASI, SCL-25 and MCMI II. Information on deaths and causes of death were obtained from the National Death Register.Results: A total of 36 deaths were registered after discharge from treatment during the observation period, of which 24 were classified as overdose deaths. During the first 4 weeks after discharge six persons died, yielding an unadjusted excess mortality of 15.7 (rate ratio) in this period (CI 5.3–38.3). All were dropouts and all deaths were classified as opiate overdoses. There was no significant association between time in index treatment and mortality after discharge, nor did any background characteristics correlate significantly with elevated mortality shortly after discharge.Conclusions: The elevated risk of dying from overdose within the first 4 weeks of leaving medication-free inpatient treatment is so dramatic that preventive measures should be taken. More studies from similar inpatient programmes are needed in order to obtain systematic knowledge about determinants of overdose deaths shortly after leaving treatment, and possible preventive measures.

Association of polymorphisms of the serotonergic system with smoking initiation in Caucasians

2010-04-01

Abstract: Background: The serotonergic system may be implicated in susceptibility to nicotine dependence as nicotine increases 5-hydroxytryptamine (5-HT) release in brain and symptoms of nicotine withdrawal may be modulated by diminished serotonergic neurotransmission. We examined the association of polymorphisms of genes involved in release and receptor function of 5-HT with cigarette smoking initiation in subjects of Caucasian origin.Methods: 5-HTTLPR polymorphism of the 5-HT transporter gene and −759C/T (rs3813929) and −697G/C (rs518147) polymorphisms of the 5-HT2C receptor gene were analyzed in 172 smoking initiators and 254 non-initiators, using PCR–RFLP method. Smoking behavior was assessed with a questionnaire about tobacco use.Results: We found no differences in the frequency of the 5-HTTLPR genotypes between smoking initiators and non-initiators. However, the frequency of 5-HT2C −759T allele was significantly higher in non-initiators than smoking initiators (29.5% vs 16.3%, p=0.002) and the same was true for 5-HT2C −697C allele carriers (48.8% vs 34.9%, p=0.004). Sex-dependent analysis revealed that these increased frequencies of −759T and −697C allele carriers were present only in males. No association was observed between any quantitative measures of smoking and these three polymorphisms.Conclusions: 5-HTTLPR polymorphism was not associated with smoking initiation in either male or female subjects. However, significant association was found between 5-HT2C receptor gene polymorphisms and smoking initiation in male Caucasian subjects.

Obstructive sleep apnea is more common than central sleep apnea in methadone maintenance patients with subjective sleep complaints

2010-04-01

Abstract: Objectives: Opioid-dependent patients treated with methadone have subjective sleep complaints and disrupted sleep on polysomnography (PSG). Previous studies of sleep-disordered breathing (SDB) in this population have focused on central sleep apnea (CSA). Our objectives were to: (1) characterize obstructive sleep apnea (OSA) and CSA in patients in methadone maintenance treatment (MMT) for opioid dependence; (2) examine factors associated with SDB in this population; and (3) investigate whether SDB was related to severity of subjective sleep complaints in MMT patients with subjective sleep disturbances.Methods: We analyzed OSA and CSA from one night of home PSG in 71 patients who were in MMT for at least 3 months and had a Pittsburgh Sleep Quality Inventory (PSQI) score >5.Results: OSA (defined as obstructive apnea–hypopnea index (OAHI)≥5) was observed in 35.2% of our sample. OSA was associated with higher body mass index, longer duration in MMT, and non-Caucasian race. CSA (defined as central apnea index (CAI)≥5) was observed in 14.1% of the sample. CSA was not associated with methadone dose or concomitant drug use. Subjective sleep disturbance measured with the PSQI was not related to OSA or CSA.Conclusions: SDB was common in this sample of MMT patients and OSA was more common than CSA. Given the lack of association between presence of SDB and severity of subjective sleep difficulties, factors other than sleep apnea must account for complaints of disturbed sleep in this population.

Evaluating the drug use “gateway” theory using cross-national data: Consistency and associations of the order of initiation of drug use among participants in the WHO World Mental Health Surveys

2010-04-01

Abstract: Background: It is unclear whether the normative sequence of drug use initiation, beginning with tobacco and alcohol, progressing to cannabis and then other illicit drugs, is due to causal effects of specific earlier drug use promoting progression, or to influences of other variables such as drug availability and attitudes. One way to investigate this is to see whether risk of later drug use in the sequence, conditional on use of drugs earlier in the sequence, changes according to time-space variation in use prevalence. We compared patterns and order of initiation of alcohol, tobacco, cannabis, and other illicit drug use across 17 countries with a wide range of drug use prevalence.Method: Analyses used data from World Health Organization (WHO) World Mental Health (WMH) Surveys, a series of parallel community epidemiological surveys using the same instruments and field procedures carried out in 17 countries throughout the world.Results: Initiation of “gateway” substances (i.e. alcohol, tobacco and cannabis) was differentially associated with subsequent onset of other illicit drug use based on background prevalence of gateway substance use. Cross-country differences in substance use prevalence also corresponded to differences in the likelihood of individuals reporting a non-normative sequence of substance initiation.Conclusion: These results suggest the “gateway” pattern at least partially reflects unmeasured common causes rather than causal effects of specific drugs on subsequent use of others. This implies that successful efforts to prevent use of specific “gateway” drugs may not in themselves lead to major reductions in the use of later drugs.

The cost of crime to society: New crime-specific estimates for policy and program evaluation

Kathryn E. McCollister, Michael T. French, Hai Fang — 2010-04-01

Abstract: Estimating the cost to society of individual crimes is essential to the economic evaluation of many social programs, such as substance abuse treatment and community policing. A review of the crime-costing literature reveals multiple sources, including published articles and government reports, which collectively represent the alternative approaches for estimating the economic losses associated with criminal activity. Many of these sources are based upon data that are more than 10 years old, indicating a need for updated figures. This study presents a comprehensive methodology for calculating the cost to society of various criminal acts. Tangible and intangible losses are estimated using the most current data available. The selected approach, which incorporates both the cost-of-illness and the jury compensation methods, yields cost estimates for more than a dozen major crime categories, including several categories not found in previous studies. Updated crime cost estimates can help government agencies and other organizations execute more prudent policy evaluations, particularly benefit–cost analyses of substance abuse treatment or other interventions that reduce crime.

A comparison of methadone, buprenorphine and alpha2 adrenergic agonists for opioid detoxification: A mixed treatment comparison meta-analysis

Nicholas Meader — 2010-04-01

Abstract: Objectives: The aim of this systematic review was to compare the efficacy of methadone, buprenorphine, clonidine and lofexidine for opioid detoxification. Mixed treatment comparison meta-analyses were used to synthesise the data as it is designed for data-sets where limitations in standard pairwise meta-analyses make comparisons difficult to interpret.Data sources: A systematic search was conducted using the following databases: CENTRAL, CINAHL, Embase, HMIC, Medline and PsycINFO.Review methods: RCTs that included opioid dependent participants over a mean age of 16 receiving opioid detoxification using buprenorphine, methadone, clonidine or lofexidine were included in the systematic review. Included studies were quality assessed and the completion of treatment data was extracted by the author and a research assistant independently. Mixed treatment comparison methods were used to synthesise the data.Results: There were 23 RCTs included in the systematic review (and 20 included in the meta-analysis) comprising a total of 2112 participants. Buprenorphine and methadone were ranked as the most effective methods of opioid detoxification followed by lofexidine and clonidine respectively.Conclusion: Buprenorpine and methadone appear to be the most effective detoxification treatments. While the analysis suggests buprenorphine is the most effective method of detoxification there is some uncertainty on whether it is more effective than methadone and requires further research to confirm this result.

Relationship of combat experiences to alcohol misuse among U.S. soldiers returning from the Iraq war

2010-04-01

Abstract: Objective: Studies have shown a relationship between combat experiences and alcohol misuse in military personnel; it is not known if there are specific combat experiences that confer a greater risk. The current study examined the association of specific types of combat experiences with a positive screen for alcohol misuse.Methods: 1120 U.S. soldiers who were members of brigade combat infantry teams were surveyed anonymously 3–4 months after returning from deployment to Iraq regarding their experiences in combat and their physical and mental health. Combat items were independently rated and placed into the following categories: (1) Fighting; (2) Killing; (3) Threat to oneself; (4) Death/injury of others; (5) Atrocities; and, (6) Positive experiences. Alcohol misuse was measured using a 2-item alcohol screen combined with alcohol-related behavioral items.Results: Of the soldiers sampled, 25% (N=275) screened positive for alcohol misuse 3–4 months post-deployment; 12% (N=125) screened positive and exhibited alcohol-related behavioral problems. Most combat exposure factors were significantly related to alcohol misuse individually. When factors were analyzed simultaneously, soldiers who had higher rates of exposure to the threat of death/injury were significantly more likely to screen positive for alcohol misuse; exposure to atrocities predicted misuse of alcohol with alcohol-related behavioral problems.Conclusions: High exposure to threatening situations and atrocities was associated with a positive screen for alcohol misuse. Clinicians treating combat veterans should be aware of the potential association of alcohol misuse with specific types of experiences and closely follow those soldiers upon their return home.

Low-to-moderate alcohol consumption and smoking cessation rates: Retrospective analysis of 4576 elderly ever-smokers

2010-04-01

Abstract: Background: Smoking and alcohol consumption are two major risk factors for manifold morbidity and mortality outcomes and are highly correlated with each other. No conclusion has been reached concerning whether cigarette smokers drinking alcohol have more difficulties with smoking cessation. We aimed to elucidate the association of concurrent alcohol consumption with the probability of smoking cessation in non-clinical populations.Methods: Retrospective analysis in 4576 ever-smoking participants of the baseline survey of ESTHER, a population-based study in Germany, aged 50–74 at enrollment in general practitioner offices. Life-course histories of alcohol consumption were obtained from questionnaire items covering exposure intensities at ages 20, 30, 40, 50 and at the time of enrollment. Extended Cox regression modelling allowing for the time-varying nature of alcohol consumption was employed to model the time from smoking initiation to smoking cessation.Results: Using alcohol abstainers as the reference group and controlling for potential confounders, relative cessation rates (95% CI) increased to 1.17 (1.02, 1.34), 1.36 (1.20, 1.55), 1.45 (1.27, 1.66) and 1.32 (1.13, 1.53) with concurrent consumption of 1–39, 40–99, 100–199 and 200+g alcohol/week. This pattern persisted in extensive sensitivity analyses.Conclusions: The results of these analyses of time-varying concurrent alcohol consumption and smoking suggest that drinking low-to-moderate amounts of alcohol as common in the general population might actually facilitate cessation in non-clinical settings.

Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: A pilot study

Maija Konstenius, Nitya Jayaram-Lindström, Olof Beck, Johan Franck — 2010-04-01

Abstract: The efficacy of stimulant treatment in patients with substance use disorders and comorbid attention deficit hyperactivity disorder (ADHD) has been tested for cocaine and alcohol dependence but so far no studies have been conducted in amphetamine dependent individuals.The present trial was a pilot study aiming to test the feasibility of treating amphetamine dependent patients with comorbid ADHD with central stimulant medication. The study was a double-blind, placebo controlled trial with parallel groups design comparing the efficacy of a fixed dose (72mg) of OROS methylphenidate (MPH) with placebo (PL) in reducing ADHD symptoms in currently abstinent adults with amphetamine dependence and ADHD. Twenty-four treatment seeking patients who met the DSM IV criteria for amphetamine dependence and ADHD were randomized to MPH/PL. The trial was conducted at an outpatient facility with twice weekly visits, measuring ADHD symptoms and drug use. Patients rated their ADHD symptoms on a weekly basis and provided supervised urine specimens for drug toxicology twice weekly. All patients participated in weekly sessions of a skills training programme. Both the groups significantly reduced their self-rated ADHD symptoms during the 12-week treatment but there was no difference between the two treatment arms. Drug use, both measured by urine toxicology and self-report did not differ between the groups. No difference was found between the two groups with regards to craving for amphetamine or in retention in treatment. Larger studies with higher doses combined with individual dosage and longer follow-up periods are warranted.

Hepatitis B virus among injecting drug users in Sydney, Australia: Prevalence, vaccination and knowledge of status

2010-04-01

Abstract: Background: Despite the availability of an inexpensive and safe vaccine, injecting drug users (IDUs) remain at risk of hepatitis B virus (HBV) infection. This paper aimed to measure HBV prevalence and vaccination coverage and to assess knowledge and concordance of status among IDUs.Methods: Participants were recruited through a primary health care and a drug treatment service and via street press in Sydney, Australia. Face-to-face interviews were conducted and serology collected. All received $30 for participation.Results: 229 participants were recruited, serology was available for 209. Almost all those interviewed had been tested for HBV (95%) a median of four (IQR 2–10) times and 61% had been tested in the preceding year. Fifty-four percent had evidence of previous infection (anti-HBc) and 5% were HBsAg positive. Only 27% had serological evidence of vaccination immunity; however, 43% of the sample recalled having being told by a health professional that they were vaccinated against HBV. Although only three participants reported they did not understand the results of their last HBV test, confusion was evident based on self-reported status.Conclusions: Levels of understanding and vaccination coverage were low while evidence of prior infection was high among this IDU sample. This is cause for concern given the majority of participants were recruited through primary care and treatment services. Strategies to bolster vaccination among this group will be discussed.

Salvia divinorum: Effects and use among YouTube users

James E. Lange, Jason Daniel, Kestrel Homer, Mark B. Reed, John D. Clapp — 2010-04-01

Abstract: Salvia divinorum (salvia) is an intense, short-acting hallucinogenic plant gaining popularity among adolescents in the United States. There has been little scientific documentation of salvia's effects. The popular video-sharing website YouTube has received literally thousands of video-posts of people using salvia. The objective of this study was to assess the effects of salvia use through systematic observations of YouTube videos. A sample of salvia videos was obtained using the search term “salvia.” The videos were further screened and only videos that captured the entire drug “trip” without video edits were included in the analyses described here (n=34). Three trained research assistants independently watched the videos and rated their observations on 42 effects in 30-s intervals. Onset of symptoms was quick (often less than 30s) and tended to dissipate within 8min. Further, there was a relationship between salvia dose and effect duration. Since salvia's effects on humans are largely undocumented, this study provides the look at users in a non-laboratory environment (e.g. self-taped videos) exhibiting impairments and behaviors consistent with this powerful hallucinogen. Also, this study demonstrates the feasibility and shortcomings of using YouTube videos to assess emerging drugs and drug effects.

The relationship of DSM-IV personality disorders to nicotine dependence-results from a national survey

2010-04-01

Abstract: This study examined the prevalence of nicotine dependence (ND) and its associations with DSM-IV personality disorders (PDs) among current smokers (n=7078), controlling for sociodemographic characteristics and comorbid Axis I and II disorders. Data were derived from a nationally representative sample of the U.S. population. Although all PDs were significantly associated with ND when sociodemographic factors were controlled, only schizotypal, borderline, narcissistic and obsessive–compulsive PDs were associated with ND after adding controls for Axis I and other Axis II disorders. These associations remained significant after controlling for degree of smoking exposure. The results suggest that both shared and PD-specific pathogenetic factors underlie these PD-ND associations. Implications are also discussed in terms of the relationship between personality features of schizotypal, borderline, narcissistic and obsessive–compulsive PDs and the self-medication hypothesis and the role of neurotransmission.

SPECT imaging of nicotinic acetylcholine receptors in nonsmoking heavy alcohol drinking individuals

2010-04-01

Abstract: Background: The high rate of comorbidity of tobacco smoking with alcohol drinking suggests common neural substrates mediate the two addictive disorders. The beta2*-containing nicotinic acetylcholine receptor (β2*-nAChR) has recently emerged as a prime candidate because some alpha and beta subunit genes have been linked to alcohol consumption and alcohol use behaviors. We hypothesized that β2*-nAChR availability would be altered by alcohol in heavy drinking nonsmokers.Methods: Eleven heavy drinking (mean age 39.6±12.1 years) and 11 age and sex-matched control (mean age 40.8±14.1 years) nonsmokers were imaged using [123I]5-IA-85380 ([123I]5-IA) single photon emission computed tomography (SPECT). Heavy alcohol drinkers drank varied amounts of alcohol (70–428/month) to facilitate exploratory linear analyses of the possible effects of alcohol.Results: Heavy drinkers consumed on average 9.1±7.3 drinks/occasion; whereas controls drank 1.2±0.9 drinks/occasion. Heavy drinkers were imaged 2.0±1.6 days after last alcoholic beverage. Overall, there were no significant differences in β2*-nAChR availability between the heavy drinking and control nonsmokers. Exploratory analyses of other factors that may be uniquely regulated by alcohol suggested no effects of age, number of alcohol drinks, years drinking, severity of drinking, craving or withdrawal.Conclusions: These preliminary analyses do not suggest a decrease in receptor availability in heavy drinking nonsmokers as compared to control nonsmokers. However, a larger study is warranted to explore effects of heavy alcohol drinking on other variables, such as sex, smoking, and genetic make up.

Corrigendum to “Change over time in alcohol consumption in control groups in brief intervention studies: Systematic review and meta-regression study” [Drug Alcohol Depend. 100 (2009) 107–114]

Richard J. Jenkins, John McAlaney, Jim McCambridge — 2010-04-01

In this paper we made a basic error with important implications for the interpretation of data. Colleagues Judith Bernstein, Ed Bernstein and Tim Heeren in Boston discovered this problem when attempting to partially replicate this study and we are very grateful to them for having done so. We were working with within-group continuous data in the form of percentage change in alcohol consumption over time. In calculating the standard errors for this variable we inappropriately used the formula appropriate for the proportion of participants with a specific characteristic (p(1−p)/n). This formula is incorrect because it takes no account of the fact that the before and after observations are not independent of each other. This report followed on from an earlier study of this literature in this journal by us () for which this formula was appropriately used in meta-analyses of between-group percentage of participants with smoking cessation outcome and in numbers of cigarettes smoked. We thus treated within-group data as between-group data in the study. This means that the confidence intervals we presented and the analyses based upon them are invalid.