Aims

To describe the derivation of Recent Status Scores (RSSs) for Version 6 of the Addiction Severity Index (ASI-6).

Design

118 ASI-6 recent status items were subjected to nonparametric item response theory (NIRT) analyses followed by confirmatory factor analysis (CFA). Generalizability and concurrent validity of the derived scores were determined.

Setting and Participants

607 recent admissions to variety of substance abuse treatment programs constituted the derivation sample; a subset (N = 254) comprised the validity sample.

Measurements

The ASI-6 interview and a validity battery of primarily self-report questionnaires that included at least one measure corresponding to each of the seven ASI domains were administered.

Findings

Nine summary scales describing recent status that achieved or approached both high scalability and reliability were derived; one scale for each of six areas (medical, employment/finances, alcohol, drug, legal, psychiatric), and three scales for the family/social area. Intercorrelations among the RSSs also supported the multidimensionality of the ASI-6. Concurrent validity analyses yielded strong evidence supporting the validity of the six of the RSSs (Medical, Alcohol, Drug, Employment, Family/Social Problems, Psychiatric). Evidence was weaker for the Legal, Family/Social Support and Child Problems RSSs. Generalizability analyses of the scales to males versus females and whites versus blacks supported the comparability of the findings with slight exceptions.

Conclusions

The psychometric analyses to derive Addiction Severity Index-6 Recent Status Scores (RSSs) support the multidimensionality of the ASI-6 (i.e., the relative independence of different life functioning areas), consistent with research on earlier editions of the instrument. In general, the ASI-6 scales demonstrate acceptable scalability, reliability and concurrent validity. While questions remain about the generalizability of some scales to population subgroups, the overall findings coupled with updated and more extensive content in the ASI-6 support its use in clinical practice and research.

Aims

Research on drug dependence often involves the administration of drugs of abuse to experienced drug users under controlled laboratory conditions. The primary objective of this study was to assess whether participation in such research alters the frequency of heroin use by non-treatment seeking opioid-dependent volunteers after study completion.

Design

Data were examined from four inpatient studies involving controlled opioid administration.

Setting

Substance Use Research Center at Columbia University, New York State Psychiatric Institute.

Participants

Sixty-nine heroin dependent volunteers.

Measurements

Participants’ self-reported heroin use prior to and one month after study participation was compared using a Wilcoxon test. Because a number of participants reported that they had stopped using heroin, a logistic regression was used to identify correlates of heroin cessation one month after study completion.

Findings

One hundred one participants entered laboratory studies and 69 completed them. Self-reported heroin use significantly decreased one month after study participation [1.7 (+/− 2) bags per day] compared to baseline [6.8 (+/− 4.2) bags per day], p < 0.001 among the 69 completers. In addition, 42% of the completers were heroin abstinent one month after study completion. Being African American, having a history of opioid dependence treatment, reporting heavier heroin use at baseline, and a longer history of heroin use were correlated with cessation of heroin use.

Conclusions

These findings demonstrate that participation in opioid administration studies does not increase subsequent heroin use and for some individuals leads to accessing opioid dependence treatment and cessation of heroin use in the short term.

Context

DSM-IV drug use disorders, a major public health problem, are highly comorbid with other psychiatric disorders, but little is known about the role of this comorbidity when studied prospectively in the general population.

Aims

Determine the role of comorbid psychopathology in the three-year persistence of drug use disorders.

Design

Secondary data analysis using Waves 1 (2001-2) and 2 (2004-5) of the National Epidemiologic Survey on Alcohol and Related Conditions.

Participants

Respondents with current DSM-IV drug use disorder at Wave 1 who participated in Wave 2 (N=613).

Measurements

AUDADIS-IV obtained DSM-IV Axis I and II diagnoses. Persistent drug use disorder was defined as meeting full criteria for any drug use disorder between Waves 1 and 2.

Findings

Drug use disorders persisted in 30.9% of respondents. No Axis I disorders predicted persistence. Antisocial (OR=2.75; 95% CI=1.27–5.99), borderline (OR=1.91; 95% CI=1.06–3.45) and schizotypal (OR=2.77; 95% CI=1.42–5.39) personality disorders were significant predictors of persistent drug use disorders, controlling for demographics, psychiatric comorbidity, family history, treatment and number of drug use disorders. Deceitfulness and lack of remorse were the strongest antisocial criteria predictors of drug use disorder persistence, identity disturbance and self-damaging impulsivity were the strongest borderline criteria predictors, and ideas of reference and social anxiety were the strongest schizotypal criteria predictors.

Conclusions

Antisocial, borderline and schizotypal personality disorders are specific predictors of drug use disorder persistence over a three-year period.

Aim

The study's objectives were to characterize initiation of injection drug use, examine the independent association of specific substance use with injection drug use, and determine factors associated with rates of transition from first illicit drug use to first injection among a sample of rural Appalachian drug users.

Design

Interview-administered questionnaires were administered to a sample of drug users recruited via respondent-driven sampling.

Setting

Appalachian Kentucky

Participants

Injection drug users (IDUs) (n=394) and non-IDUs (n=109)

Measurements

Data were collected on substance use and years from age at initiation of illicit substance use to ‘event’ (initiation of injection or date of baseline interview for non-IDUs). Logistic regression and Cox regression were used to identify factors associated with lifetime injection drug use and transition time to injection, respectively.

Findings

OxyContin® was involved in nearly as many initiations to injection (48%) as were stimulants, other prescription opioids, and heroin combined; for participants who initiated with OxyContin®, the median time from which they began OxyContin® use to their first injection of OxyContin® was 3 years. Adjusting for demographics, five prescription drugs (benzodiazepines, illicit methadone, oxycodone, OxyContin® and other opiates) were associated with an increased hazard for transitioning from first illicit drug use to first injection drug use (each at p<.01).

Conclusions

In Appalachia, in the US, the prescription opioid, OxyContin®, is widely used nonmedically and appears to show a particularly high risk of rapid transition to injection compared with the use of other illicit drugs.

Aims

The average US adolescent is exposed to 34 references to alcohol in popular music daily. Although brand recognition is an independent, potent risk factor for alcohol outcomes among adolescents, alcohol brand appearances in popular music have not been systematically assessed. We aimed to determine the prevalence of and contextual elements associated with alcohol brand appearances in U.S. popular music.

Design

Qualitative content analysis.

Setting

We used Billboard Magazine to identify songs to which US adolescents were most exposed in 2005-2007. For each of the 793 songs, two trained coders independently analyzed the lyrics of each song for references to alcohol and alcohol brand appearances. Subsequent in-depth assessments utilised Atlas.ti to determine contextual factors associated with each of the alcohol brand appearances.

Measurements

Our final code book contained 27 relevant codes representing 6 categories: alcohol types, consequences, emotional states, activities, status, and objects.

Findings

Average inter-rater reliability was high (κ=0.80), and all differences were easily adjudicated. Of the 793 songs in our sample, 169 (21.3%) explicitly referred to alcohol, and of those, 41 (24.3%) contained an alcohol brand appearance. Consequences associated with alcohol were more often positive than negative (41.5% vs. 17.1%, P<.001). Alcohol brand appearances were commonly associated with wealth (63.4%), sex (58.5%), luxury objects (51.2%), partying (48.8%), other drugs (43.9%), and vehicles (39.0%).

Conclusions

One-in-five songs sampled from U.S. popular music had explicit references to alcohol, and one quarter of these mentioned a specific alcohol brand. These alcohol brand appearances are commonly associated with a luxury lifestyle characterised by wealth, sex, partying, and other drugs.

Aims

Examine the reciprocal effects between the onset and course of alcohol use disorder (AUD) and normative changes in personality traits of behavioral disinhibition and negative emotionality during the transition between adolescence and young adulthood.

Design

Longitudinal-epidemiological study assessing AUD and personality at age 17 and 24.

Setting

Participants were recruited from the community and took part in a day-long, in-person assessment.

Participants

Male (nmen = 1161) and female (nwomen = 1022) twins participating in the Minnesota Twin Family Study.

Measurements

The effects of onset (adolescent versus young adult) and course (persistent versus desistent) of AUD on change in personality traits of behavioral disinhibition and negative emotionality from age 17 to 24.

Findings

Onset and course of AUD moderated personality change from age 17 to 24. Adolescent onset AUD was associated with greater decreases in behavioral disinhibition. Those with an adolescent onset and persistent course failed to exhibit normative declines in negative emotionality. Desistence was associated with a “recovery” toward psychological maturity in young adulthood, while persistence was associated with continued personality dysfunction. Personality traits at age 11 predicted onset and course of AUD, indicating personality differences were not due to active substance abuse.

Conclusions

Personality differences present prior to initiation of use increase risk for AUD, but the course of AUD affects the rate of personality change during emerging adulthood. Examining the reciprocal effects of personality and AUD within a developmental context is necessary to improve understanding of theory and intervention.

Aims

To characterize factors associated with injection cessation, relapse and initiation.

Design

MIDACS is a prospective cohort of injection drug users (IDUs) recruited in 2005–06 with semi-annual follow-up through 2009. Discrete-time survival models were used to characterize predictors of time to first injection cessation and relapse.

Setting

Chennai, India

Participants

855 IDUs who reported injecting in the six months prior to baseline and had > 1 follow-up visit.

Measurements

Cessation was defined as the first visit where no injection drug use was reported (prior six months) and relapse as the first visit where drug injection (prior six months) was reported after first cessation.

Findings

All participants were male; median age was 35. Over three years, 92.7% reported cessation (incidence rate [IR]: 117 per 100 person-years). Factors positively associated with cessation included daily injection and incarceration and factors negatively associated with cessation included marriage, alcohol and homelessness. Of those who reported cessation, 24% relapsed (IR: 19.7 per 100 person-years). Factors positively associated with relapse included any education, injection in the month prior to baseline, sex with a casual partner, non-injection drug use, incarceration and homelessness. Alcohol was negatively associated with relapse. The primary reasons for cessation were medical conditions (36%) and family pressure (22%). The majority initiated with non-injection drugs, transitioning to injection after a median 4 years.

Conclusions

Injection drug users in Southern India demonstrate a high rate of injection cessation over three years, but relapse is not uncommon. Compensatory increases in alcohol use indicate that cessation of injection does not mean cessation of all substance use. Family pressure, concerns about general health, fear of HIV infection, and a history of non-injection drug use are important correlates of cessation.

Aims

Evidence indicates AA participation reduces relapse risk but less is known about the mechanisms through which AA confers this benefit. Initial studies indicate self-efficacy, negative affect, adaptive social networks, and spiritual practices are mediators of this effect, but because these have been tested in isolation, their relative importance remains elusive. This study tested multiple mediators simultaneously to help determine the most influential pathways.

Design

Prospective, statistically controlled, naturalistic investigation examined the extent to which purported mechanisms mediated the effect of AA attendance on alcohol outcomes controlling for baseline outcome values, mediators, treatment, and other confounders.

Setting

Nine clinical sites within the United States.

Participants

Adults (N=1,726) suffering from alcohol use disorder (AUD) with varying levels of severity initially enrolled in a randomized study with two arms: Aftercare (n=774); and Outpatient (n-952) comparing three outpatient treatments (Project MATCH)

Measurements

AA attendance during treatment; mediators at 9 months; and, outcomes (Percent Days Abstinent [PDA] and Drinks per Drinking Day [DDD]) at 15 months.

Findings

Among outpatients the effect of AA attendance on alcohol outcomes was explained primarily by adaptive social network changes and increases in social abstinence self-efficacy. Among more impaired aftercare patients, in addition to mediation through adaptive network changes and increases in social self-efficacy, AA lead to better outcomes through increasing spirituality/religiosity and by reducing negative affect. The degree to which mediators explained the relationship between AA and outcomes ranged from 43%–67%.

Conclusion

AA facilitates recovery by mobilizing several processes simultaneously, however it is changes in social factors which appear to be of primary importance.

Aims

This paper aims to identify appropriate criteria for tobacco dependence assessment, evaluate relevant research, and suggest revisions that may be incorporated into DSM-5.

Methods

Desirable conceptual and psychometric features of tobacco dependence assessments were identified, including the types of outcomes against which such assessment should be validated. DSM-IV criteria were matched against these criteria and compared with other dependence measures.

Results

DSM-IV criteria were found to be ambiguous, little used in tobacco research, and have relatively low predictive validity. Other dependence measures were found to have greater validity in the prediction of important dependence features such as relapse likelihood. Strength of urges to smoke on typical smoking days and during abstinence, markers of nicotine intake or frequency of smoking, and latency to smoke soon after waking were found to be useful dependence measures.

Conclusion

The use and utility of DSM-5 will be enhanced by eliminating most DSM-IV criteria and adding new ones based on smoking pattern, smoking heaviness, and the severity of craving during periods of smoking and withdrawal.

Aims

To evaluate delay discounting and self-reported impulsive behavior in a sample of adolescents experimenting with cigarette smoking compared with adolescents who had never smoked or were daily smokers.

Setting

Columbus, Ohio, a city of approximately 780,000

Participants

A sample of 141 male and female adolescents with a mean age of 15.37 (SD = 1.09) years.

Measurements

Primary measures included a computerized assessment of delay discounting, a self-report assessment of impulsivity (BIS-11-A), and verifications of cigarette smoking status (breath CO and urinary cotinine level).

Findings

Smokers discounted more by delay and had higher impulsivity scores than non-smokers. Experimenters had scores intermediate to those of smokers and non-smokers on both measures. In some analyses the difference between experimenters and non-smokers was significant, with experimenters showing greater delay discounting, but in no case did experimenters differ significantly from the smokers.

Conclusions

Young people who experiment with cigarettes appear to be similar to those who smoke regularly in terms of tendency to discount future gains and report impulsive tendencies, and generally higher in these traits than non-smokers.

Aims

To construct AA attendance, sponsorship, and abstinence latent class trajectories to test the added benefit of having a sponsor above the benefits of attendance in predicting abstinence over time.

Design

Prospective with 1-, 3-, 5-, and 7-year follow-ups.

Setting and participants

Alcoholic-dependent individuals from two probability samples, one from representative public and private treatment programs and another from the general population (n=495).

Findings

Individuals in the low attendance class (4 classes identified) were less likely than those in the high, descending, and medium attendance classes to be in high (vs. low) abstinence class (3 classes identified). No differences were found between the other attendance classes as related to abstinence class membership. Overall, being in the high sponsor class (3 classes identified) predicted better abstinence outcomes than being in either of two other classes (descending and low), independent of attendance class effects. Though declining sponsor involvement was associated with greater likelihood of high abstinence than low sponsor involvement, being in the descending sponsor class also increased the odds of being in the descending abstinence class.

Conclusions

Any pattern of AA attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance.

Aims

This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries.

Design

A prospective multi-country cohort design was employed.

Setting

Australia, Canada, the UK and the US.

Participants

21,613 adult smokers who completed at least one of the seven waves (2002-2008) of the International Tobacco Control Four Country Survey were included in the analysis.

Measurements

Reported exposure to POS anti-smoking warnings and smokers’ interest in quitting at the same wave and quit attempts over the following year.

Findings

Compared to smokers in Canada, the UK and the US, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting (adjusted odds ratio = 1.139, 95% CI 1.039~1.249, p<0.01) and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114~1.327, p<0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information, and awareness of anti-smoking material from channels other than POS.

Conclusions

Point-of-sale health warnings about tobacco are more prominent in Australia than US, UK or Canada and appear to act as a prompt to quitting.

Aims

This article examines the effects of experiencing violent victimization in young adulthood on pathways of substance use from adolescence to mid-adulthood.

Design

Data come from four assessments of an African American community cohort followed longitudinally from age 6 to 42.

Setting

The cohort lived in the urban, disadvantaged Woodlawn neighborhood of Chicago in 1966.

Participants

All first graders from the public and parochial schools were asked to participate (N=1,242).

Measurement

Dependent variables - alcohol, marijuana, and cocaine use - came from self reports at age 42. Young adult violent victimization was reported at age 32, as were acts of violence, substance use, social integration, and socioeconomic resources. First grade risk factors came from mothers’ and teachers’ reports; adolescent substance use was self reported.

Findings

Structural equation models indicate a pathway from adolescent substance use to young adult violent victimization for females and those who did not grow up in extreme poverty (betas ranging from .15 to .20, p<.05). In turn, experiencing violent victimization in young adulthood increased alcohol, marijuana, and cocaine use yet results varied by gender and early poverty status (betas ranging from .12 to .15, p<.05).

Conclusions

Violent victimization appears to play an important role in perpetuating substance use among the African American population. However, within-group variations are evident, identifying those who are not raised in extreme poverty as the most negatively affected by violence.

Aims

To describe alcohol use and alcohol brand appearances in popular movies and estimate adolescents’ exposure to this alcohol-related content.

Design and setting

Nationally representative, random-digit dialed survey in the United States and content analysis of alcohol depictions in the top 100 U.S. box office hits each year from 1998 to 2002 and 34 top movies from early 2003.

Participants

6522 U.S. adolescents aged 10-14.

Measurements

Frequency of alcohol use and brand appearances in movies by Motion Picture Association of America (MPAA) rating. Estimated exposure to minutes of movie alcohol use and brand appearances among U.S. adolescents in this age group.

Findings

Most movies (83%, including 57% of G/PG-rated movies) depicted alcohol use and 52% (including 19% of G/PG movies) contained at least one alcohol brand appearance, which consisted of branded use by an actor 30% of the time. These movies exposed the average U.S. adolescent 10-14 years of age to 5.6 (95% CI 5.4,5.7) hours of movie alcohol use and 244 (95% CI 238,250) alcohol brand appearances (5 billion in total), mostly from youth-rated movies. Exposure to movie alcohol content was significantly higher among African American youth than youth of other races.

Conclusions

Alcohol use and brand appearances are frequently portrayed in popular U.S. movies (which are distributed worldwide). Children and adolescents in the U.S. are exposed to hours of alcohol use depictions and numerous brand appearances in movies and most of this exposure is from movies rated for this segment of the population.

Aims

Clinical trials test the safety and efficacy of behavioral and pharmacological interventions in drug-dependent individuals. However, there is no consensus about the most appropriate outcome(s) to consider in determining treatment efficacy or on the most appropriate methods for assessing selected outcome(s). We summarize the discussion and recommendations of treatment and research experts, convened by the US National Institute on Drug Abuse, to select appropriate primary outcomes for drug dependence treatment clinical trials, and in particular the feasibility of selecting a common outcome to be included in all or most trials.

Methods

A brief history of outcomes employed in prior drug dependence treatment research, incorporating perspectives from tobacco and alcohol research, is included. The relative merits and limitations of focusing on drug-taking behavior, as measured by self-report and qualitative or quantitative biological markers, are evaluated.

Results

Drug-taking behavior, measured ideally by a combination of self-report and biological indicators, is seen as the most appropriate proximal primary outcome in drug dependence treatment clinical trials.

Conclusions

We conclude that the most appropriate outcome will vary as a function of salient variables inherent in the clinical trial, such as the type of intervention, its target, treatment goals (e.g. abstinence or reduction of use) and the perspective being taken (e.g. researcher, clinical program, patient, society). It is recommended that a decision process, based on such trial variables, be developed to guide the selection of primary and secondary outcomes as well as the methods to assess them.

Aims

To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality.

Design, setting, participants

This is a prospective study of a cohort of 4,447 substance-using mothers (pregnant or parenting) who were enrolled during 2000 to 2002 in 40 drug abuse treatment programs across California.

Methods

All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard (Cox) regression was used to identify risk factors predicting death.

Results

By the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% CI=7.2–9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine, or marijuana (relative to methamphetamine) as the primary drug problem, drug injection, and greater severity of employment, medical/health, and psychiatric problems.

Conclusions

Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/health, and psychiatric problems contributed to the elevated mortality.

Aims

Alcohol-exposed pregnancies (AEP) are the direct cause of Fetal Alcohol Spectrum Disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world.

Design

Cross-sectional survey.

Setting

7 public women’s clinics in two locations: St. Petersburg (SPB) and the Nizhny Novgorod region (NNR).

Participants

648 pregnant and non-pregnant childbearing age women.

Measurements

A face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition.

Findings

89% of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past three months. 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at-risk for AEP. There was a significant decline in drinking after pregnancy identification. 20% of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive.

Conclusions

Russian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The preconception period presents a risk window and, therefore, a prevention opportunity.

Aims

Whether the selective serotonin reuptake inhibitor sertraline at 200 mg/day delays relapse in recently abstinent cocaine dependent individuals

Design

12-week, double blind, placebo-controlled clinical trial with 2-week residential stay followed by 10-wk outpatient participation

Setting

Veterans Affairs residential unit and outpatient treatment research program

Participants

Cocaine-dependent volunteers (N=86) with depressive symptoms (Hamilton score > 15), but otherwise no major psychiatric or medical disorder or contraindication to sertraline.

Measurements

Participants were housed on a drug-free residential unit (wks 1–2) and randomized to receive sertraline or placebo. Participants then participated on an outpatient basis during weeks 3–12 while continuing to receive study medication. Patients participated in a day substance abuse day treatment program during weeks 1–3 and underwent weekly cognitive behavioral therapy during weeks 4–12. The primary outcome measure was thrice-weekly urine results and secondary measure was Hamilton Depression scores.

Findings

Pre hoc analyses were performed on those who participated beyond week 2. Generally no group differences in retention or baseline characteristics occurred. Sertraline patients showed a trend toward longer time before their first cocaine-positive urine (“lapse,” χ2=3.67, p=0.056), went significantly longer before having two consecutive urine samples positive for cocaine (“relapse,” χ2=4.03, p=0.04) and showed significantly more days to lapse (26.1±3.2±10.5; z = 2.89, p=0.004) and relapse (21.3±10.8 vs 32.3±14.9; z=2.25, p=0.02). Depression scores decreased over time (F=43.43, p<0.0001), but did not differ between groups (F =0.09, p = 0.77).

Conclusions

Sertraline delays time to relapse relative to placebo in cocaine dependent patients who initially achieve at least two weeks of abstinence.

Aims

Adolescents with substance use disorders (SUD) have difficulties with cognitive, behavioral and affective regulation. White matter (WM) disorganization has been observed in adolescents with SUD and may be related to psychological dysregulation. This study compared adolescents with SUD and control adolescents to investigate relationships among psychological dysregulation, WM disorganization, and SUD symptoms.

Design

Cross-sectional observation.

Setting

Adolescents with SUD were recruited from SUD treatment programs. Controls were recruited from the community.

Participants

The 55 participants were ages 14–19; 35 with SUD, 20 controls without SUD.

Measurements

Psychological dysregulation was characterized by the Behavior Rating Inventory of Executive Function. WM disorganization was measured by diffusion tensor imaging, and fractional anisotropy, radial diffusivity and axial diffusivity were examined within cortical regions of interest.

Findings

Compared to controls, SUD adolescents showed significantly greater psychological dysregulation and prefrontal and parietal WM disorganization. WM disorganization was positively correlated with psychological dysregulation and cannabis-related symptoms. In multivariate mediation models, the results were consistent with both the Neurodevelopmental Immaturity model, in which WM disorganization leads to psychological dysregulation and cannabis-related symptoms, and with the Substance Effects Model, in which cannabis-related symptoms lead to WM disorganization and psychological dysregulation.

Conclusions

In adolescents, substance use disorder and psychological dysregulation appear to be associated with reduced frontoparietal network white matter maturation.

Aims

To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.

Design

Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).

Settings

Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, Netherlands, New Zealand, South Korea, Thailand, UK, Uruguay and USA.

Measures

Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.

Findings

Prevalence of quit attempts in the last year varied from under 20% to over 50% across countries. Similarly, smokers varied greatly in reporting of visiting health professionals in the last year (< 20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.

Conclusions

There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Aims

Evaluate the effects of lowering the blood alcohol concentration (BAC) limit on road traffic fatalities and injuries in the State and capital of Sao Paulo, Brazil.

Design

Time series analysis using ARIMA modelling.

Setting

The augmented risk of road traffic accidents when under the influence of alcohol is well documented. However, many developing countries do not have a drink-driving law or have BAC limits that are above 0.05 g/dl. In Brazil, a new law introduced in 2008 has lowered the BAC limit for drivers from 0.06 to 0.02, but the effectiveness in reducing traffic accidents remains uncertain.

Measurements and participants

Data on injuries and deaths caused by road traffic accidents in both regions were collected from January 2001 to June 2010, comprising a total of 1,417,087 injuries and 51,561 fatalities.

Findings

The new traffic law was responsible for significant reductions in traffic injuries and fatalities rates in both localities (P<0.05). A stronger effect was observed for traffic fatalities (−7.2 and −16.0% in the average monthly rate in the State and capital, respectively) compared to traffic injuries rates (−1.8 and −2.3% in the State and capital, respectively).

Conclusions

Lowering BAC limits had a greater impact on traffic fatalities than injuries, with a higher effect in the capital where presumably the police enforcement was enhanced, and points to the relevance of these measures on the effectiveness of such law. Rigorous investigations on the effects of strategies derived from high-income countries to control alcohol-impaired driving should be promoted in developing countries.

Aims

Examine whether decreases in impulsivity account for links between AA attendance and better drinking and psychosocial outcomes, and whether these mediational “effects” are conditional on age.

Design

A naturalistic study in which individuals were assessed at baseline, and 1, 8, and 16 years later.

Setting

Participants initiated help-seeking through the alcohol intervention system (detoxification programs, information and referral centers).

Participants

Individuals with alcohol use disorders and no prior history of substance abuse treatment at baseline [N=628; 47% women; mean age = 34.7 years (SD=9.4)].

Measurements

Self-reports of impulsivity and drinking pattern at baseline and Year 1, duration of AA (number of weeks) in Year 1, and drinking (alcohol use problems, self-efficacy to resist drinking) and psychosocial outcomes (emotional discharge coping, social support) at baseline and follow-ups.

Findings

Controlling for changes in drinking pattern, decreases in impulsivity were associated with fewer alcohol use problems, better coping, and greater social support and self-efficacy at Year 1, and better coping and greater social support at Year 8. Decreases in impulsivity statistically mediated associations between longer AA duration and improvements on all Year 1 outcomes, and indirect effects were moderated by participant age (significant only for individuals 25 years of age or younger).

Conclusions

Decreased impulsivity appears to mediate reductions in alcohol-related problems over 8 years in people attending Alcoholics Anonymous.

Aims

Dual epidemics of HIV and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted 6-session gender-stratified group cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya.

Design

Randomized clinical trial comparing CBT against a usual care assessment only control

Setting

A large HIV outpatient clinic in Eldoret, Kenya, part of the Academic Model for Providing Access to Healthcare collaboration

Participants

75 HIV-infected outpatients who were antiretroviral (ARV)-initiated or ARV-eligible and who reported hazardous or binge drinking

Measurements

Percent drinking days (PDD) and mean drinks per drinking days (DDD) measured continuously using the Timeline Followback

Findings

There were 299 ineligible and 102 eligible outpatients with 12 refusals. Effect sizes of the change in alcohol use since baseline between the two conditions at the 30-day follow-up were large (d=.95, p=.0002, mean difference=24.93 (95% CI: 12.43, 37.43) PDD; d=.76, p=.002, mean difference=2.88 (95% CI: 1.05, 4.70) DDD). Randomized participants attended 93% of the 6 CBT sessions offered. Reported alcohol abstinence at the 90-day follow-up was 69.4% (CBT) and 37.5% (usual care). Paraprofessional counselors achieved independent ratings of adherence and competence equivalent to college-educated therapists in the U.S. Treatment effect sizes were comparable to alcohol intervention studies conducted in the U.S.

Conclusions

Cognitive-behavioral therapy can be successfully adapted to group paraprofessional delivery in Kenya and may be effective in reducing alcohol use among HIV-infected Kenyan outpatients.

Aims

To examine the 1) prevalence, 2) predictors, and 3) cessation outcomes of smokers who engage in undisclosed quit attempts.

Design

Online survey (N=524), with balanced recruitment of current smokers (55%) and past-year quitters (45%). Participants were daily smokers (current or previous) who had at least one quit attempt in the past year.

Measurements

Respondents were grouped on whether they did vs. did not make advanced disclosure to others of their most recent quit attempt.

Findings

Almost half (n=234; 45%) reported that their most recent quit attempt was undisclosed to anyone in advance. Those who planned their quit attempt in advance (OR = 0.10; 95% CI: 0.05 – 0.23) and those who used behavioral treatment (OR = 0.14; 95% CI: 0.05 – 0.43) were less likely to make ‘closet quit attempts’, while those who rated their attempt as being serious (OR = 2.52; 95% CI: 1.16 – 5.46) and those who deemed social support to be unhelpful (OR = 1.91; 95% CI: 1.24 – 2.95) were more likely to make such attempts. Closet quit attempters were more likely to achieve 30 days of abstinence than were those who made advanced disclosure (67% vs. 58%; adjusted OR 1.8; 95% CI: 1.1–2.8), but there were no differences for achieving six months of abstinence (52% vs. 49%; adjusted OR 1.2; 95% CI: 0.7–2.0).

Conclusions

Attempting to quit smoking without telling anyone in advance is common and does not appear to impede success. These findings do not support blanket advice to smokers to tell others about pending quit attempts.

Aim

This paper examines how smokers’ beliefs about “light/ mild” cigarettes in Australia, Canada and the UK were affected by the removal of misleading “light/mild” terms from packs.

Design, setting and participants

The data come from the first 7 waves (2002–2009) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, United States, United Kingdom, and Australia (21,613 individual cases). “Light” and “mild” descriptors were removed in 2003 in the UK, in 2006 in Australia, and in 2007 in Canada. We compare beliefs about “light” cigarettes both before and after the bans, with those of smokers in the US serving as the control condition.

Findings

The proportions of respondents reporting misperceptions about light cigarettes declined between 2002 and 2009 in all four countries. There were marked temporary reductions in reported misperceptions in the UK and Australia but not in Canada following the removal of “light/mild” descriptors.

Conclusions

Removal of “light/mild” descriptors and tar, nicotine and carbon monoxide yield information from cigarette packs is insufficient to effectively eliminate false beliefs. The combination of alternative descriptors and design features that produce differences in taste strength and harshness, independent of actual intakes, are sufficient to produce or sustain the same misbeliefs.