PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (533)
 

Clipboard (0)
None

Select a Filter Below

Journals
Year of Publication
more »
1.  Opioid Dependence during Pregnancy: Relationships of Anxiety and Depression Symptoms to Treatment Outcomes 
Addiction (Abingdon, England)  2012;107(0 1):74-82.
Aims
To examine the relationship of anxiety and depression symptoms with treatment outcomes (treatment discontinuation, rates of ongoing use of illicit drugs, and likelihood of preterm delivery) in opioid-dependent pregnant women and describe their use of psychotropic medications.
Design and setting
Secondary data analysis from a randomized controlled trial of treatment for opioid dependence during pregnancy.
Participants
175 opioid-dependent pregnant women, of whom 131 completed treatment.
Measurements
Symptoms of anxiety and depression were captured with the 15-item Mini International Neuropsychiatric Interview (MINI) screen. Use of illicit drugs was measured by urine drug screening. Preterm delivery was defined as delivery prior to 37 weeks gestation. Self-reported use of concomitant psychotropic medication at any point during the study was recorded.
Findings
Women reporting only anxiety symptoms at study entry were more likely to discontinue treatment (adjusted OR = 4.56, 95% CI = 1.91–13.26, P = 0.012) while those reporting only depression symptoms were less likely to discontinue treatment (adjusted OR = 0.14, 95% CI = 0.20 – 0.88, P = 0.036) compared to women who reported neither depression nor anxiety symptoms. No statistically significant between group differences were observed for ongoing illicit drug use or preterm delivery. A majority (61.4%) of women reported use of concomitant psychotropic medication at some point during study participation.
Conclusions
Opioid-agonist-treated pregnant patients with co-occurring symptoms of anxiety require additional clinical resources to prevent premature discontinuation.
doi:10.1111/j.1360-0443.2012.04041.x
PMCID: PMC4315620  PMID: 23106929
tbc
2.  [No title available] 
PMCID: PMC3937856  PMID: 24571025
3.  [No title available] 
PMCID: PMC3947108  PMID: 24033715
4.  [No title available] 
PMCID: PMC3947129  PMID: 24261614
5.  [No title available] 
PMCID: PMC3947163  PMID: 23889901
6.  [No title available] 
PMCID: PMC3956073  PMID: 24261668
7.  [No title available] 
PMCID: PMC4020783  PMID: 24329972
8.  Nonmedical Use of Prescription Opioids during the Transition to Adulthood: A Multi-Cohort National Longitudinal Study 
Addiction (Abingdon, England)  2013;109(1):102-110.
Aims
To examine nonmedical use of prescription opioids (NMUPO) patterns during the transition from adolescence to adulthood, and assess individual characteristics and other substance use behaviors associated with longitudinal patterns of NMUPO.
Design
Nationally representative samples of high school seniors in the United States (wave 1: modal age 18 years) were followed longitudinally across three biennial follow-up waves (waves 2, 3, and 4: modal ages 19/20, 21/22, and 23/24).
Setting
Data were collected via self-administered questionnaires to high school seniors and young adults.
Participants
The longitudinal sample consisted of 27,268 individuals in 30 cohorts (high school senior years 1976–2005) who participated in all four waves.
Measurements
Self-reports of NMUPO and other substance use behaviors.
Findings
Approximately 11.6% (95% CI = 11.2%, 12.0%) of the sample reported past-year NMUPO in at least one of the four waves. Among those who reported past-year NMUPO in at least one wave, 69.0% (67.6%, 70.4%), 20.5% (19.3%, 21.7%), 7.8% (7.1%, 8.6%), and 2.7% (2.3%, 3.1%) reported NMUPO at one, two, three, and four waves, respectively. Several wave 1 variables were associated with greater odds of multiple waves of NMUPO and individuals who reported more waves of NMUPO had greater odds of other substance use behaviors.
Conclusions
Although most nonmedical use of prescription opioids (NMUPO) among 18-year-olds in the United States appears to be non-continuing, about one-third of the sample reporting NMUPO appear to continue use beyond age 18 and have elevated odds of other substance use behaviors at ages 23/24.
doi:10.1111/add.12347
PMCID: PMC3930150  PMID: 24025114
Longitudinal; Prescription Opioids; Nonmedical Use; Epidemiology; Adolescents; Substance Use
9.  Pharmacotherapy Effects on Smoking Cessation Vary with Nicotine Metabolism Gene (CYP2A6) 
Addiction (Abingdon, England)  2013;109(1):128-137.
Background and aims
Evidence suggests that both the nicotinic receptor α5 subunit (CHRNA5) and Cytochrome P450 2A6 (CYP2A6) genotypes influence smoking cessation success and response to pharmacotherapy. We examine the effect of CYP2A6 genotype on smoking cessation success and response to cessation pharmacotherapy, and combine these effects with those of CHRNA5 genotypes.
Design
Placebo-controlled randomized smoking cessation trial
Setting
Ambulatory care facility in Wisconsin, USA.
Participants
Smokers (N=709) of European ancestry were randomized to placebo, bupropion, nicotine replacement therapy, or combined bupropion and nicotine replacement therapy.
Measurements
Survival analysis was used to model time to relapse using nicotine metabolism derived from CYP2A6 genotype-based estimates. Slow metabolism is defined as the lowest quartile of estimated metabolic function.
Findings
CYP2A6-defined nicotine metabolic function moderated the effect of smoking cessation pharmacotherapy on smoking relapse over 90 days (Hazard Ratio (HR) = 2.81, 95%CI=1.32-5.99, p=0.0075), with pharmacotherapy significantly slowing relapse in fast (HR=0.39, 95%CI=0.28-0.55, p=1.97×10-8), but not slow, metabolizers (HR=1.09, 95%CI=0.55-2.17, p=0.80). Further, only the effect of nicotine replacement, and not bupropion, varies with CYP2A6-defined metabolic function. The effect of nicotine replacement on continuous abstinence is moderated by the combined genetic risks from CYP2A6 and CHRNA5 (interaction effect size=0.74, 95%CI=0.59-0.94, p=0.013).
Conclusions
Nicotine replacement therapy is effective amongst individuals with fast, but not slow, CYP2A6-defined nicotine metabolism. The effect of bupropion on relapse likelihood is unlikely affected by nicotine metabolism as estimated from CYP2A6 genotype. The variation in treatment responses amongst smokers with genes may guide future personalized smoking cessation interventions.
doi:10.1111/add.12353
PMCID: PMC3946972  PMID: 24033696
Smoking Cessation; Nicotine; Metabolism; Pharmacogenetics
10.  A Closer Look at the Evidence for Sex Differences in the Genetic and Environmental Influences on Gambling in the National Longitudinal Study of Adolescent Health: From Dis-ordered to Ordered Gambling 
Addiction (Abingdon, England)  2013;109(1):120-127.
Aims
To reconcile an inconsistency in the disordered gambling literature by revisiting a previous study that claimed to find evidence for large gender differences in the magnitude of genetic and environmental influences.
Design
Univariate structural equation twin models were fit to decompose the variation in gambling behavior into additive genetic, shared environmental, and unique environmental influences.
Setting
United States.
Participants
Participants were 1,196 same-sex and unlike-sex twins (18–28 years of age, 49% male, 51% female) from the National Longitudinal Study of Adolescent Health (Add Health).
Measurements
Eight questions about normative and problematic gambling involvement were assessed by in-person interview. Although disordered gambling symptoms were assessed, the number of individuals that were administered these questions precluded twin analysis, including analysis of potential gender differences. Of the eight questions, only three were deemed usable for twin analysis – these were all questions about normative gambling involvement.
Findings
Individual differences in (non-disordered) gambling involvement were completely explained by family (C = 38% [30–46%]) and unique environmental factors (E = 62% [54–70%]). There was no evidence for genetic factors (A = 0), nor was there evidence for sex differences (Δχ2 = 1.23, df = 2, p = .54).
Conclusions
There appears to be no evidence for gender differences in the genetic contributions to disordered gambling. Family environment appears to play a significant role in explaining individual differences in (non-disordered) gambling involvement among emerging adults.
doi:10.1111/add.12345
PMCID: PMC3946982  PMID: 24033632
11.  Chronic Hepatitis C Virus Infection is Associated with All-Cause and Liver-Related Mortality in a Cohort of HIV-Infected Patients with Alcohol Problems 
Addiction (Abingdon, England)  2013;109(1):62-70.
Aims
To assess the association between hepatitis C virus (HCV) infection and overall and liver-related death in human immunodeficiency virus (HIV)-infected patients with alcohol problems.
Design
We analyzed data from a cohort of HIV-infected adults with current or past alcohol problems enrolled between 2001 and 2003, searching for causes of death until 2010 using the National Death Index.
Setting and participants
Participants were HIV-infected adults with current or past alcohol problems, recruited in Boston, MA from HIV clinics at two hospitals, homeless shelters, drug treatment programs, subject referrals, flyers, and another cohort study with comparable recruitment sites.
Measurements
The primary and secondary outcomes were all-cause and liver-related mortality, respectively. The main independent variable was HCV RNA status (positive vs. negative). Mortality rates and Kaplan-Meier survival curves were calculated by HCV status for both overall and liver-related mortality. Cox proportional hazards models were used to assess the association between HCV infection and overall and liver-related death, adjusting for alcohol and drug use over time.
Findings
397 adults (50% HCV-infected) were included. As of December 31, 2009, 83 cohort participants had died (60 HCV-infected, 23 HCV-uninfected; log rank test p<0.001), and 26 of those deaths were liver-related (21 HCV-infected, 5 HCV-uninfected; log rank test p<0.001). All-cause and liver-related mortality rates were 4.68 and 1.64 deaths per 100 person-years for HCV-infected patients and 1.65 and 0.36 per 100 person-years for those without HCV, respectively. In the fully adjusted Cox model, HCV infection was associated with both overall [HR 2.55 (95%CI:1.50–4.33), p<0.01], and liver-related mortality [HR 3.24 (95%CI:1.18–8.94), p=0.02].
Conclusion
Hepatitis C virus infection is independently associated with all-cause and liver-related mortality in human immunodeficiency virus-infected patients with alcohol problems, even when accounting for alcohol and other drug use.
doi:10.1111/add.12367
PMCID: PMC3947001  PMID: 24112091
12.  Legalization of Sunday alcohol sales and alcohol consumption in the United States 
Addiction (Abingdon, England)  2013;109(1):55-61.
Aims
To investigate the relationship between legalization of Sunday alcohol sales and alcohol consumption in the United States.
Design
State-level per capita consumption of beer, wine, and spirits was analyzed using difference-in-differences econometric methods.
Setting
United States.
Participants
5 treatment states that repealed their laws restricting Sunday alcohol sales during 1990–2007 and 12 control states that retained their Sunday alcohol laws during the same period.
Measurements
Outcome measures are state-level per capita consumption of overall alcohol, beer, wine, and spirits.
Findings
Among the states that legalized Sunday sales of alcoholic beverages, Delaware, Pennsylvania, and New Mexico experienced significant increases in overall alcohol consumption (P<0.05). However, the effect of the legalization of Sunday alcohol sales in Massachusetts and Rhode Island on per capita alcohol consumption was insignificant (P=0.964 and P=0.367).
Conclusions
Three out of five states in the USA that repealed their laws restricting Sunday sale of alcoholic beverages during 1990–2007, experienced significant increases in per capita alcohol consumption. This finding implies that increased alcohol availability leads to an increase in alcohol consumption.
doi:10.1111/add.12358
PMCID: PMC3947002  PMID: 24103041
13.  Treatment Retention among Patients Randomized to Buprenorphine/Naloxone Compared to Methadone in A Multi-site Trial 
Addiction (Abingdon, England)  2013;109(1):79-87.
Aims
To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence.
Design/Settings/Participants
This secondary analysis included 1,267 opioid-dependent individuals participating in 9 opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks.
Measurements
The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes, and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24 week trial.
Findings
The treatment completion rate was 74% for MET vs. 46% for BUP (p<.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30–32mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower (OR=0.63, 95%CI=0.52–0.76, p<.01) among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (1) BUP (vs. MET, HR=1.61, CI:1.20–2.15), (2) lower medication dose (<16mg for BUP, <60mg for MET; HR=3.09, CI:2.19–4.37), (3) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (4) being younger, Hispanic, and using heroin or other substances during treatment.
Conclusions
Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids.
doi:10.1111/add.12333
PMCID: PMC3947022  PMID: 23961726
14.  Fetal Assessment before and after Dosing with Buprenorphine or Methadone 
Addiction (Abingdon, England)  2012;107(0 1):36-44.
Aim
To determine pre- and post-dosing effects of prenatal methadone compared to buprenorphine on fetal well-being.
Design
A secondary analysis of data derived from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a double-blind, double-dummy, randomized clinical trial.
Setting
Six United States sites and one European site that provided comprehensive opioid-dependence treatment to pregnant women.
Participants
81 of the 131 opioid-dependent pregnant women completing the MOTHER clinical trial, assessed between 31 and 33 weeks of gestation.
Measurements
Two fetal assessments were conducted, once before and once after study medication dosing. Measures included mean fetal heart rate (FHR), number of FHR accelerations, FHR reactivity in the fetal non-stress test (NST), and biophysical profile (BPP) score.
Findings
Significant group differences were found for number of FHR accelerations, non-reactive NST, and BPP scores (all Ps < 0.05). There were no significant group differences before time of dosing. Significant decreases (all Ps < 0.05) occurred from pre- to post-dose assessment for mean FHR, FHR accelerations, reactive NST, and fetal movement. The decrease in accelerations and reactive NST were only significant for fetuses in the methadone group and this resulted in a significantly lower likelihood of a reactive NST compared to fetuses in the buprenorphine group.
Conclusion
Buprenorphine compared with methadone appears to result in less suppression of mean fetal heart rate, fetal heart rate reactivity, and the biophysical profile score after medication dosing and provide support for the relative safety of buprenorphine when fetal indices are considered as part of the complete risk-benefit ratio.
doi:10.1111/j.1360-0443.2012.04037.x
PMCID: PMC4277183  PMID: 23106925
fetal; opiates; biophysical profile; heart rate; tbc
15.  The Post-Repeal Eclipse in Knowledge About The Harmful Effects of Alcohol 
Addiction (Abingdon, England)  1993;88(6):729-744.
National Prohibition in the USA (1919 to 1933) was followed by an era in which medical scientists played an important role in minimizing the harmful effects of alcohol. Cirrhosis, cardiomyopathy, adverse fetal effects, and esophageal cancer are examples of alcohol-related health problems that were well known at the beginning of the 20th century but were dismissed during the late 1930’s and early 1940’s, only to be rediscovered during the 1960’s and afterwards. This eclipse in knowledge occurred because of skepticism about earlier claims that had been made in the name of scientific temperance and, most importantly, because of changing standards for medical evidence. The paradigm for disease causation that gave birth to modern medicine was based on microbiology and reinforced by hormone and nutrition discoveries. Most alcohol-related health problems are poorly explained by this paradigm. The more recent epidemiologic paradigm for noninfectious disease is more applicable to the health risks associated with heavy drinking. A transformation of knowledge about alcohol’s relationship to disease has occurred.
PMCID: PMC4273899  PMID: 8329965
16.  Effect of HCV status on liver enzymes in opioid-dependent pregnant women maintained on opioid-agonist medication 
Addiction (Abingdon, England)  2012;107(0 1):91-97.
Aim
To examine hepatic enzyme test results throughout the course of pregnancy in women maintained on methadone or buprenorphine.
Design
Participants were randomized to either methadone or buprenorphine maintenance. Blood chemistry tests, including liver transaminases and HCV status, were determined every four weeks and once postpartum. As part of a planned secondary analysis, generalized mixed linear models were conducted with aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) as the dependent variables.
Setting
Six United States sites and one European site that provided comprehensive treatment to pregnant opioid-dependent women.
Participants
n = 175 opioid-dependent pregnant women enrolled in the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study.
Findings
ALT, AST, and GGT levels decreased for all subjects across pregnancy trimesters, rising slightly postpartum. Hepatitis C (HCV)-positive subjects exhibited higher transaminases at all time points compared to HCV-negative subjects, regardless of medication condition. Both HCV-positive and negative buprenorphine-maintained participants exhibited lower GGT levels than those who were methadone-maintained.
Conclusions
Neither methadone nor buprenorphine appear to have adverse hepatic effects in the treatment of pregnant opioid-dependent women.
doi:10.1111/j.1360-0443.2012.04043.x
PMCID: PMC4268861  PMID: 23106931
tbc
17.  Predicting Treatment for Neonatal Abstinence Syndrome in Infants Born to Women Maintained on Opioid Agonist Medication 
Addiction (Abingdon, England)  2012;107(0 1):45-52.
Aim
To identify factors that predict the expression of neonatal abstinence syndrome (NAS) in infants exposed to methadone or buprenorphine in utero.
Design and Setting
Multi-site randomized clinical trial in which infants were observed for a minimum of 10 days following birth, and assessed for NAS symptoms by trained raters.
Participants
n = 131 infants born to opioid dependent mothers, 129 of which were available for NAS assessment.
Measurements
Generalized linear modeling was performed using maternal and infant characteristics to predict: peak NAS score prior to treatment, whether an infant required NAS treatment, length of NAS treatment, and total dose of morphine required for treatment of NAS symptoms.
Findings
53% of the sample (68 infants) required treatment for NAS. Lower maternal weight at delivery, later estimated gestational age (EGA), maternal use of selective serotonin reuptake inhibitors (SSRIs), vaginal delivery, and higher infant birth weight predicted higher peak NAS scores. Higher infant birth weight and greater maternal nicotine use at delivery predicted receipt of NAS treatment for infants. Maternal use of SSRIs, higher nicotine use, and fewer days of study medication received also predicted total dose of medication required to treat NAS symptoms. No variables predicted length of treatment for NAS.
Conclusions
Maternal weight at delivery, estimated gestational age, infant birth weight, delivery type, maternal nicotine use, and days of maternal study medication received, and the use of psychotropic medications in pregnancy may play a role in the expression of neonatal abstinence syndrome severity in infants exposed to either methadone or buprenorphine.
doi:10.1111/j.1360-0443.2012.04038.x
PMCID: PMC4268864  PMID: 23106926
tbc
18.  An early evaluation of implementation of brief intervention for unhealthy alcohol use in the US Veterans Health Administration 
Addiction (Abingdon, England)  2014;109(9):1472-1481.
Aims
The US Veterans Health Administration [Veterans Affairs (VA)] used performance measures and electronic clinical reminders to implement brief intervention for unhealthy alcohol use. We evaluated whether documented brief intervention was associated with subsequent changes in drinking during early implementation.
Design
Observational, retrospective cohort study using secondary clinical and administrative data.
Setting
Thirty VA facilities.
Participants
Outpatients who screened positive for unhealthy alcohol use [Alcohol Use Disorders Identification Test Consumption (AUDIT-C ≥ 5)] in the 6 months after the brief intervention performance measure (n = 22 214) and had follow-up screening 9–15 months later (n = 6210; 28%).
Measurements
Multi-level logistic regression estimated the adjusted prevalence of resolution of unhealthy alcohol use (follow-up AUDIT-C <5 with ≥2 point reduction) for patients with and without documented brief intervention (documented advice to reduce or abstain from drinking).
Findings
Among 6210 patients with follow-up alcohol screening, 1751 (28%) had brief intervention and 2922 (47%) resolved unhealthy alcohol use at follow-up. Patients with documented brief intervention were older and more likely to have other substance use disorders, mental health conditions, poor health and more severe unhealthy alcohol use than those without (P-values < 0.05). Adjusted prevalences of resolution were 47% [95% confidence interval (CI) = 42–52%] and 48% (95% CI = 42–54%) for patients with and without documented brief intervention, respectively (P = 0.50).
Conclusions
During early implementation of brief intervention in the US Veterans Health Administration, documented brief intervention was not associated with subsequent changes in drinking among outpatients with unhealthy alcohol use and repeat alcohol screening.
doi:10.1111/add.12600
PMCID: PMC4257468  PMID: 24773590
Alcohol; brief intervention; implementation; unhealthy alcohol use; veterans
19.  Influence of Affective Manipulations on Cigarette Craving: A Meta-Analysis 
Addiction (Abingdon, England)  2013;108(12):10.1111/add.12284.
Background and Aims
Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators.
Methods
We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single vs. multi-item craving assessment, and affect induction method were tested as moderators of affective cue-induced craving.
Results
NA manipulations produced a medium effect (g = .47; CI = .31 – .63) on craving, but no main effects were found for PA manipulations (g = .05; CI = −.09 – .20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (p’s < .02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA.
Conclusions
Laboratory studies indicate that negative affect, but not positive affect, is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke.
doi:10.1111/add.12284
PMCID: PMC3830730  PMID: 23795674
tobacco; smoking; craving; conditioned stimuli; affect; cue-reactivity
20.  Cumulative and Recent Psychiatric Symptoms as Predictors of Substance Use Onset: Does Timing Matter? 
Addiction (Abingdon, England)  2013;108(12):10.1111/add.12323.
Aims
We examined two questions about the relationship between conduct disorder (CD), depression, and anxiety symptoms and substance use onset: (1) what is the relative influence of recent and more chronic psychiatric symptoms on alcohol and marijuana use initiation and (2) are there sensitive developmental periods when psychiatric symptoms have a stronger influence on substance use initiation?
Design
Secondary analysis of longitudinal data from the Pittsburgh Youth Study, a cohort study of boys followed annually from 7–19 years of age.
Setting
Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA.
Participants
Five hundred and three boys.
Measurements
The primary outcomes were age of alcohol and marijuana use onset. Discrete-time hazard models were used to determine whether (a) recent (prior year); and (b) cumulative (from age 7 until 2 years prior to substance use onset) psychiatric symptoms were associated with substance use onset.
Findings
Recent anxiety symptoms (HR= 1.10, 95% CI=1.03–1.17), recent (HR=1.59, 95% CI=1.35–1.87), cumulative (HR=1.45, 95% CI=1.03–2.03) CD symptoms, and cumulative depression symptoms (HR= 1.04, 95% CI=1.01–1.08) were associated with earlier alcohol use onset. Recent (HR=1.39, 95% CI=1.22–1.58) and cumulative CD symptoms (HR=1.38, 95% CI=1.02–1.85) were associated with marijuana use onset. Recent anxiety symptoms were only associated with alcohol use onset among black participants.
Conclusions
Timing matters in the relationship between psychiatric symptoms and substance use onset in childhood and adolescence, and the psychiatric predictors of onset are substance-specific. There is no single sensitive developmental period for the influence of psychiatric symptoms on alcohol and marijuana use initiation.
doi:10.1111/add.12323
PMCID: PMC3833999  PMID: 23941263
comorbidity; substance use onset; depression; anxiety; conduct disorder
21.  Cost-Effectiveness analysis of Recovery Management Checkups (RMC) for adults with chronic substance use disorders: evidence from a four-year randomized trial 
Addiction (Abingdon, England)  2013;108(12):10.1111/add.12335.
Aims
This study performs the first cost-effectiveness analysis (CEA) of Recovery Management Checkups (RMC) for adults with chronic substance use disorders.
Design
Cost-effectiveness analysis of a randomized clinical trial of RMC. Participants were randomly assigned to a control condition of outcome monitoring (OM-only) or the experimental condition OM-plus-RMC, with quarterly follow-up for four years.
Setting
Participants were recruited from the largest central intake unit for substance abuse treatment in Chicago, Illinois, USA.
Participants
446 participants who were 38 years old on average, 54 percent male, and predominantly African American (85%).
Measurements
Data on the quarterly cost per participant come from a previous study of OM and RMC intervention costs. Effectiveness is measured as the number of days of abstinence and number of substance-use-related problems.
Findings
Over the four-year trial, OM-plus-RMC cost on average $2,184 more than OM-only (p<0.01). Participants in OM-plus-RMC averaged 1,026 days abstinent and had 89 substance-use-related problems. OM-only averaged 932 days abstinent and reported 126 substance-use-related problems. Mean differences for both effectiveness measures were statistically significant (p<0.01). The incremental cost-effectiveness ratio for OM-plus-RMC was $23.38 per day abstinent and $59.51 per reduced substance-related problem. When additional costs to society were factored into the analysis, OM-plus-RMC was less costly and more effective than OM-only.
Conclusions
Recovery Management Checkups are a cost-effective and potentially cost-saving strategy for promoting abstinence and reducing substance-use-related problems among chronic substance users.
doi:10.1111/add.12335
PMCID: PMC3834076  PMID: 23961833
Cost-effectiveness analysis; economic evaluation; recovery management checkups; chronic substance use disorder
22.  Influence of a Dopamine Pathway Additive Genetic Efficacy Score on Smoking Cessation: Results from Two Randomized Clinical Trials of Bupropion 
Addiction (Abingdon, England)  2013;108(12):10.1111/add.12325.
Aims
To evaluate associations of treatment and an ‘additive genetic efficacy score’ (AGES) based on dopamine functional polymorphisms with time to first smoking lapse and point prevalence abstinence at end of treatment among participants enrolled in two randomized clinical trials of smoking cessation therapies.
Design
Double-blind pharmacogenetic efficacy trials randomizing participants to active or placebo bupropion. Study 1 also randomized participants to cognitive-behavioral smoking cessation treatment (CBT) or this treatment with CBT for depression. Study 2 provided standardized behavioural support.
Setting
Two Hospital-affiliated clinics (Study 1), and two University-affiliated clinics (Study 2).
Participants
N=792 self-identified white treatment-seeking smokers aged ≥18 years smoking ≥10 cigarettes per day over the last year.
Measurements
Age, gender, Fagerström Test for Nicotine Dependence, dopamine pathway genotypes (rs1800497 [ANKK1 E713K], rs4680 [COMT V158M], DRD4 exon 3 Variable Number of Tandem Repeats polymorphism [DRD4 VNTR], SLC6A3 3' VNTR) analyzed both separately and as part of an AGES, time to first lapse, and point prevalence abstinence at end of treatment.
Findings
Significant associations of the AGES (hazard ratio = 1.10, 95% Confidence Interval [CI] = 1.06–1.14], p=0.0099) and of the DRD4 VNTR (HR = 1.29, 95%CI 1.17–1.41, p=0.0073) were observed with time to first lapse. A significant AGES by pharmacotherapy interaction was observed (β [SE]=−0.18 [0.07], p=0.016), such that AGES predicted risk for time to first lapse only for individuals randomized to placebo.
Conclusions
A score based on functional polymorphisms relating to dopamine pathways appears to predict lapse to smoking following a quit attempt, and the association is mitigated in smokers using bupropion.
doi:10.1111/add.12325
PMCID: PMC3834197  PMID: 23941313
Bupropion; genetic; pharmacogenetic analysis; randomized clinical trial; first lapse
23.  Drinking context-specific associations between intimate partner violence and frequency and volume of alcohol consumption 
Addiction (Abingdon, England)  2013;108(12):10.1111/add.12322.
Aims
To quantify two specific aspects of drinking in various venues (past-year frequency of drinking in each venue and volume consumed per venue) and assess their relationships with intimate partner violence.
Design, Setting, and Participants
A geographic sample of married or cohabiting couples residing in 50 medium-to-large cities in California, USA (n=1,585 couples) was obtained. Cross-sectional survey data were collected via confidential telephone interviews.
Measurements
Each partner in the couple provided information about past-year male-to-female and female-to-male intimate partner violence (IPV), drinking contexts, and psychosocial and demographic factors. Frequency of drinking in six contexts and volume consumed in those contexts were used in censored Tobit models to evaluate associations between IPV and male and female drinking contexts.
Findings
Risks for IPV differed among drinking contexts and were sometimes related to heavier volumes consumed. In fully adjusted models, male partners’ frequency of drinking at parties at another’s home (b(s.e.) 0.130(0.060); p=0.030) was associated with risk for male-to-female IPV and frequency of drinking during quiet evenings at home was associated with risk for female-to-male IPV (b(s.e.) 0.017(0.008); p=0.033). Female partners’ frequency of drinking with friends at home (b(s.e.) −0.080(0.037); p=0.030) was associated with decreased male-to-female IPV, but volume consumed was associated with increased risk (b(s.e.) 0.049(0.024); p=0.044).
Conclusions
Social context in which drinking occurs appears to play a role in violence against partners, with male violence being linked to drinking away from home and female violence being linked to drinking at home.
doi:10.1111/add.12322
PMCID: PMC3834225  PMID: 24112796
25.  Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death 
Addiction (Abingdon, England)  2014;109(12):2018-2026.
Aims
Alcohol can induce diverse serious pathologies, yet this complexity may be obscured when alcohol-related deaths are classified according to a single underlying cause. We sought to quantify this issue and its implications for analysing mortality data.
Design, Setting and Participants
Cross-sectional study included 554 men aged 25–54 in Estonia undergoing forensic autopsy in 2008–09.
Measurements
Potentially alcohol-related pathologies were identified following macroscopic and histological examination. Alcohol biomarkers levels were determined. For a subset (26%), drinking behaviour was provided by next-of-kin. The Estonian Statistics Office provided underlying cause of death.
Findings
Most deaths (75%) showed evidence of potentially alcohol-related pathologies, and 32% had pathologies in two or more organs. The liver was most commonly affected [60.5%, 95% confidence interval (CI) = 56.3–64.6] followed by the lungs (18.6%, 95% CI = 15.4–22.1), stomach (17.5%, 95% CI = 14.4–20.9), pancreas (14.1%, 95% CI = 11.3–17.3), heart (4.9%, 95% CI = 3.2–7.0) and oesophagus (1.4%, 95% CI = 0.6–2.8). Only a minority with liver pathology had a second pathology. The number of pathologies correlated with alcohol biomarkers (phosphatidylethanol, gamma-glytamyl transpeptidase in blood, ethylglucuronide, ethylsulphate in urine). Despite the high prevalence of liver pathology, few deaths had alcoholic liver disease specified as the underlying cause.
Conclusion
The majority of 554 men aged 25–54 undergoing forensic autopsy in Estonia in 2008–09 showed evidence of alcohol-related pathology. However, the recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found.
doi:10.1111/add.12695
PMCID: PMC4241049  PMID: 25066373
Alcohol drinking; alcohol-related pathologies; epidemiology; Estonia/forensic autopsy; ICD codes; post-mortem alcohol biomarkers.

Results 1-25 (533)