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CORK Bibliography: Substance Abuse Associated Morbidity

81 citations. December 2006 to present

Prepared: June 2007

Alcohol Epidemiologic Data System; Chen CM; Yi H-Y; Falk DE; Stinson FS; Dawson DA; Grant BF. Alcohol Use and Alcohol Use Disorders in the United States: Main Findings from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2006. (18 refs.)

In 2001-2002, the National Institute on Alcohol Abuse and Alcoholism conducted the first wave of a longitudinal study to provide information on alcohol use and associated problems. Information gathered includes patterns of alcohol consumption, demographic information, family history of alcoholism, history of treatment for alcohol problems, medical problems, as well as questions to allow diagnoses of alcohol use disorders and other psychiatric conditions. Data is presented in 48 detailed tables. Appendices include copies of the survey instrument.

Al-Kandari FH; Yacoub K; Omu FE. Effect of drug addiction on the biopsychosocial aspects of persons with addiction in Kuwait: Nursing implications. Journal of Addictions Nursing 18(1): 31-40, 2007. (37 refs.)

Addiction is often seen as a "family illness" that has biological, psychological, and socio-cultural aspects that should be taken into consideration in order to achieve successful treatment and prevent relapse. The aims of this study are to describe the effect of drug abuse on the biophysical and mental health, family relationships, and job performance of individuals with addiction. The study also investigated drug-associated habits of persons with addiction in an Arabic society. This study was conducted in the Psychological Medicine Hospital, Kuwait. Data were obtained from 237 persons with addiction who were receiving treatment in the addiction center. A self-administered questionnaire designed in Arabic was used for data collection. Pearson and Mantel Hazel tests showed that addiction affects the biophysical, mental, behavioral, and occupational status of individuals with addiction. Also a relationship was found between drug addiction and disrupted family environment. Strategies for nursing intervention focused on family therapy as an important consideration in the management of drug addiction.

Anderson P. Global use of alcohol, drugs and tobacco. (review). Drug and Alcohol Review 25(6): 489-502, 2006. (138 refs.)

Humans have always used drugs, probably as part of their evolutionary and nutritional heritage. However, this previous biological adaptation is unlikely to be so in the modern world, in which 2 billion adults (48% of the adult population) are current users of alcohol, 1.1 billion adults (29% of the adult population) are current smokers of cigarettes and 185 million adults (4.5% of the adult population) are current users of illicit drugs. The use of drugs is determined largely by market forces, with increases in affordability and availability increasing use. People with socio-economic deprivation, however measured, are at increased risk of harmful drug use, as are those with a disadvantaged family environment, and those who live in a community with higher levels of substance use. Substance use is on the increase in low-income countries which, in the coming decades, will bear a disproportionate burden of substance-related disability and premature death.

Antai-Otong D. Medical complications of cocaine addiction: Clinical implications for nursing practice. Journal of Addictions Nursing 17(4): 215-225, 2006. (51 refs.)

Cocaine abuse is an important public health problem, with almost two million users in the United States alone. Cocaine abuse kills thousands annually. According to medical examiners, cocaine is the most frequent cause of drug-related deaths. As the use of cocaine remains pervasive so have cocaine-related medical problems. The most serious medical consequences of cocaine abuse are associated with the drug's potent vasoconstrictor properties that can cause life-threatening cocaine-related medical problems such as myocardial ischemia, cardiomyopathies, strokes, renal failure, respiratory arrest, neuronal destruction, and sudden death. Addiction nurses are challenged to not only understand the complexity of cocaine addiction and its potential and actual deleterious effects on major body systems but also implement interventions that reduce health risks and facilitate recovery. This article focuses on cocaine-related medical complications, medical stabilization, and drug rehabilitation. The role of the nurse is discussed along with strategies and evidence-based approaches to treating patients presenting with cocaine related medical and psychiatric consequences.

Anthony JC; Degenhardt L. Projecting the impact of changes in cannabis use upon schizophrenia in England and Wales: The role of assumptions and balance in framing an evidence-based cannabis policy. (editorial). Addiction 102(4): 515-516, 2007. (1 refs.)

Arve S; Savikko N; Lavonius S; Lehtonen A; Isoaho H. Physical functioning, health and survival: A ten-year follow-up study. Aging. Clinical and Experimental Research 18(5): 367-373, 2006. (33 refs.)

Background and aims: Cutbacks in human resources are putting home care personnel under increasing pressure in their work. Home health care personnel need to know how they can prevent undesirable conditions and support older people towards successful aging. The aim of this ten-year follow-up study was to identify factors associated with increased mortality among 70-year-old subjects living in the community. Methods: Data were collected in 1991 by a postal questionnaire sent to all residents of Turku, Finland, born in 1920. A physical examination was also conducted. Ten years later, in 2001, the mortality rate of this population was determined. The data were examined statistically. Results: Many health-related factors, such as smoking, poor subjective health, and mobility, were related to an increased level of mortality. In addition, several diseases (e.g., diabetes, angina pectoris, cancer) at age 70 were associated with increased mortality over ten years. Difficulties in daily activities at age 70 also increased the risk of mortality. Conclusions: The findings offer useful clues for planning health care services and preventive interventions provided by home health care personnel. Home health care personnel should give special attention to older people who feel ill or very ill.

Bard MR; Goettler CE; Toschlog EA; Sagraves SG; Schenarts PJ; Newell MA et al. Alcohol withdrawal syndrome: Turning minor injuries into a major problem. Journal of Trauma, Injury, Infection and Critical Care 61(6): 1441-1445, 2006. (28 refs.)

Background: Abrupt cessation of chronic drinking patterns places hospitalized patients at risk for alcohol withdrawal syndrome (AWS). The purpose of this study was to investigate the effect of AWS on length of stay, morbidity, mortality, and cost in low injury acuity trauma patients. Methods: A retrospective review of the National Trauma Registry of the American College of Surgeons database from July 1999 to February 2004 was performed. All patients 15 years or older admitted to our Level I trauma center with an Injury Severity Score (ISS) < 16 were included. AWS patients were compared with those without AWS. Demographics, mechanism of injury (MOI), ISS, revised trauma score, Glasgow Coma score, hospital course, morbidity, requirement of additional procedures, mortality, and cost were compared. Analysis was done with chi(2) test and Student's t test. A p value of <= 0.05 determined significance. Results: Of 6,431 patients, 55 (0.9%) developed AWS. AWS patients were likely men (p < 0.001); had a higher ISS (p = 0.001) and lower Glasgow Coma score (p = 0.01); had more ventilator days (p = 0.008), intensive care unit days (p < 0.0001), and hospital days (p < 0.0001); suffered more complications, including respiratory failure (p < 0.0001), pneumonia (p < 0.0001), urinary tract infection (p = 0.0005), sepsis (p < 0.0001), tracheostomy (p < 0.0001), and percutaneous endoscopic gastrostomy (p < 0.0001); and had higher cost (p < 0.0001). Mortality was similar (p = 0.38) among groups. Conclusions: Low injury acuity patients with AWS have increased morbidity, leading to increased hospital stay and cost. To allow minor injuries to remain minor problems, the best modality to identify patients at risk and to achieve AWS prophylaxis require further investigation.

Barnoya J; Glantz SA. Cardiovascular effects of secondhand smoke nearly as large as those of smoking - and how about renal effects? Journal of the American Society of Nephrology 17(1): 7-11, 2006. (49 refs.)

Benishek LA; Dugosh KL; Faranda-Diedrich TM; Kirby KC. Development of the Significant Other Survey: An interview for family members of substance users. American Journal of Family Therapy 34(1): 33-46, 2006. (31 refs.)

The Significant Other Survey (SOS) is a semi-structured interview designed to measure the multidimensional problems experienced by family members with a substance abusing loved one. This article describes the development of the SOS & its psychometric properties based on data obtained from significant others of 110 substance abusing adults. Interrater & test-retest reliability estimates were within acceptable ranges, adequate internal consistency was demonstrated for six of seven problem domains, & the problem domains were low to moderately correlated with each other. Issues related to future instrument development & the utility of the SOS for both family practitioners & researchers are described.

Biederman J; Spencer TJ; Wilens TE; Prince JB; Faraone SV. Treatment of ADHD with stimulant medications: Response to Nissen perspective in The New England Journal of Medicine. (editorial). Journal of the American Academy of Child and Adolescent Psychiatry 45(10): 1147-1150, 2006

This editorial is a response to an article in the New England Journal of Medicine (SE Nissen, ADHD drugs and cardiovascular risk, 354(14): 1445-1448, 2006) written by a consultant to the Food and Drug and Administration (FDA) Committee that recommended a "black-box" warning describing the cardiovascular risks associated with stimulant drugs used to treat attention deficit-hyperactivity disorder (ADHD).

Bongaerts BWC; de Goeij AFPM; de Vogel S; van den Brandt PA; Goldbohm RA; Weijenberg MP. Alcohol consumption and distinct molecular pathways to colorectal cancer. British Journal of Nutrition 97(3): 430-434, 2007. (26 refs.)

High alcohol consumption is related to colorectal cancer (CRC). Our objective was to study associations between alcohol consumption and risk of CRC according to characteristics of aetiological pathways: the chromosomal instability (CIN) and the microsatellite instability (MIN) pathway. We classified CIN+ tumours (tumours with either a truncating APC mutation, an activating K-ras mutation or overexpression of p53), MIN+ tumours (tumours lacking hMLH1 expression) and CIN-/MIN- tumours (tumours without these defects). In the Netherlands Cohort Study on diet and cancer, 120852 men and women, aged 55-69 years, completed a questionnaire on risk factors for cancer at baseline (1986). Case-cohort analyses were conducted using 573 CRC cases with complete data after 7.3 years of follow-up, excluding the first 23 years. Adjusted incidence rate ratios (RR) and 95% confidence intervals (CI) were estimated. Compared with abstaining, alcohol consumption of >= 30 g/d was positively associated with the risk of CRC irrespective of genetic or molecular aberrations present, although statistical significance was not reached (RR 1.35 (95 % CI 0.9-2-0) for the CIN+ tumours, RR 1.59 (95 % CI 0.4-5-8) for the MIN+ tumours and RR 1.15 (95 % CI 0-5-2-7) for the CIN-/MIN- tumours). Beer, wine and liquor consumption were, independent of their alcoholic content, not consistently associated with the risk of CRC within the defined subgroups. In conclusion, our results indicate that a daily alcohol consumption of >= 30 g is associated with an increase in risk of CRC, independent of the presence or absence of the studied characteristics of different aetiological pathways.

Bouchard P; Boutouyrie P; Mattout C; Bourgeois D. Risk assessment for severe clinical attachment loss in an adult population. Journal of Periodontology 77(3): 479-489, 2006. (77 refs.)

Background: This study was carried out to identify variables related to severe clinical attachment loss (CAL) in an adult French population. Methods: This cross-sectional survey employed 2,132 subjects of the First National Periodontal and Systemic Examination Survey (NPASES 1) aged 35 to 64 years, each with at least six teeth. A nationally representative sample was obtained from September 2002 to June 2003 by a quota method stratified on age, gender, socioeconomic status, and geographic areas. The subjects had a complete full-mouth periodontal examination of four sites per tooth, assessment of missing teeth, and a number of laboratory tests and questionnaires. The periodontal status of each subject was assessed by criteria based on the severity and extent of CAL. The data were analyzed by univariable and multivariable models using logistic regression analyses. Results: Nineteen and seven-tenths percent (19.7%) of the subjects had CAL > 5 mm. When dental variables were not included in the analysis (model 1), age (odds ratio [OR] = 1.8), male gender (OR = 1.7), body mass index (OR = 1.2), and white blood cell count (OR = 2.2) showed significant association with severe CAL. A significantly higher risk was also present in non-drinkers and regular drinkers compared to occasional drinkers (OR= 1.6). Model 2, including dental variables in addition to model 1 variables, showed that a significantly higher risk for severe CAL was also present with age (OR = 1.6) and in males (OR = 1.7). The number of teeth (OR = 1.1), and the mean gingival bleeding index (OR= 1.7) were the dental variables significantly associated with severe CAL. Conclusions: The results indicated that age and gender are powerful independent predictors of clinical attachment loss, as is the mean gingival bleeding index. To a lesser extent, the number of missing teeth was a good predictive variable. The patient profile for severe clinical attachment loss also included body mass index and white blood cell count. Occasional drinking may be associated with decreased severity of CAL.

Buc E; Kwiatkowski F; Alves A; Panis Y; Mantion G; Slim K. Tobacco smoking: A factor of early onset of colorectal cancer. Diseases of the Colon & Rectum 49(12): 1893-1896, 2006. (18 refs.)

PURPOSE: Tobacco smoking is associated with a higher risk of developing colorectal cancer. This study was designed to assess the role of smoking in early onset of colorectal pathology. METHODS: This was a prospective cross-sectional study of 997 patients with colorectal cancer. Age of colorectal cancer diagnosis was studied in two groups of patients, i.e., smokers (> 10 pack-years) and nonsmokers. Confounding factors, such as alcohol drinking, obesity, and gender, also were studied using a correlation analysis and multivariate logistic regression analysis. RESULTS: Of the 997 patients, 852 had sufficient data for analysis and were included. Baseline analysis showed that excluded patients had similar demographic characteristics. Smokers (n = 108) reported symptoms related to colorectal cancer at an earlier mean age (64.1 (standard deviation, 11.7) years) than nonsmokers (69.6 (standard deviation, 12.6) years; mean difference, 5.5 (standard deviation, 1.2 years); P < 0.001). Impact of smoking according to the bowel segment involved was significant for slow-transit segments (transverse and sigmoid colon and rectum). Multivariate analysis revealed that tobacco smoking was the only independent risk factor of early onset of colorectal cancers. CONCLUSIONS: Tobacco smoking could be a factor of early onset of colorectal cancers especially for slow-transit bowel segments. If these findings are confirmed in larger studies, screening for colorectal cancer should not involve a simple sigmoidoscopy but also an exploration of transverse colon in smokers.

Burnham EL; Moss M; Ritzenthaler JD; Roman J. Increased fibronectin expression in lung in the setting of chronic alcohol abuse. Alcoholism: Clinical and Experimental Research 31(4): 675-683, 2007. (37 refs.)

Background: The incidence and severity of the acute respiratory distress syndrome (ARDS) is increased in individuals who abuse alcohol. One possible mechanism by which alcohol increases susceptibility to acute lung injury is through alterations in alveolar macrophage function and induction of tissue remodeling activity. Our objective was to determine whether alcohol abuse, independent of other comorbidities, alters fibronectin and metalloproteinase gene expression in alveolar macrophages and in epithelial lining fluid (ELF) of the lung. Methods: Otherwise healthy subjects with alcohol abuse (n=21) and smoking-matched controls (n=17) underwent bronchoalveolar lavage. Alveolar macrophage fibronectin and matrix metalloproteinase (MMP) mRNA expression were measured via reverse transcription-polymerase chain reaction. The supernatant from cultured alveolar macrophages and lung ELF were tested for their ability to induce fibronectin and MMP-9 gene transcription in cell-based assays. Results: Alveolar macrophages from subjects with alcohol abuse demonstrated increased fibronectin mRNA expression (p < 0.001), and their ELF also elicited more fibronectin gene transcription in lung fibroblasts compared with controls (p < 0.001). In contrast, alveolar macrophages from subjects with alcohol abuse had decreased MMP-9 and MMP-2 mRNA expression (p < 0.03 and p < 0.005, respectively). Similarly, the supernatant (p < 0.001) and ELF (p < 0.01) from these subjects induced less MMP-9 gene transcription in THP-1 cells. Conclusions: Alcohol abuse is associated with increased fibronectin mRNA expression in alveolar macrophages and increased fibronectin-inducing activity in the ELF. This appears to be a specific effect as other tissue remodeling genes, such as MMPs, were not equally affected. These findings suggest activation of tissue remodeling that may contribute to the increased susceptibility for the ARDS observed in alcoholism.

Carls KA; Ruehter VL. An evaluation of phencyclidine (PCP) psychosis: A retrospective analysis at a state facility. American Journal of Drug and Alcohol Abuse 32(4): 673-678, 2006. (13 refs.)

It has been reported in the literature that phencyclidine (PCP) psychosis recovery may take up to 4-6 weeks. This retrospective review sought to determine whether patients with a new onset of PCP psychosis have a longer hospitalization than those patients with new onset functional psychosis. The PCP arm (N = 20) was found to have a significantly shorter hospitalization than those with a new onset functional psychosis (N = 20)-mean 4.8 days (range 1-9) versus 13.6 days (range 3-41), p < .05. In addition, patients with psychosis related to PCP use were treated more aggressively with conventional antipsychotics than patients with a new onset functional psychosis at this facility.

Cebasek-Travnik Z. Slovenia: Alcohol today - could a country be addicted to alcohol? (commentary). Addiction 102(1): 11-14, 2007. (31 refs.)

Chen H; Yi H-Y. Trends in Alcohol-Related Morbidity among Short-Stay Community Hospital Discharges, United States, 1979-2004. Surveillance Report #77. Bethesda MD: National Institute on Alcohol Abuse and Alcoholism, 2006. (10 refs.)

This surveillance report, prepared annually by the Alcohol Epidemiologic Data System (AEDS), National Institute on Alcohol Abuse and Alcoholism (NIAAA), presents data on alcohol-related morbidity in the United States from 1979 to 2004. AEDS compiles these statistics on alcohol-related inpatient stays based on a national sample of hospital discharge episodes from the National Hospital Discharge Survey (NHDS), conducted annually by the National Center for Health Statistics (NCHS). Civilian population data estimated by the U.S. Census Bureau are used as the denominators to calculate rates. The following are highlights of general trends and notable findings: Alcohol-Related Hospital Discharges in 2004: Approximately 434,000 hospital discharge episodes for persons ages 15 and older had a principal (first-listed) alcohol-related diagnosis, and approximately 1.7 million discharge episodes had an any (all-listed) alcohol-related diagnosis. These figures represent 18.7 principal (first-listed) and 71.2 any (all-listed) alcohol-related discharges per 10,000 population, a slight increase in both the principal (first-listed) alcohol-related discharge rate and the any (all-listed) alcohol-related discharge rate compared with the 2003 rates (18.5 and 68.8, respectively). Alcohol dependence syndrome composed the largest group (33 percent) of principal (first-listed) diagnoses, followed by alcoholic psychoses (31 percent), cirrhosis of the liver (27 percent), and nondependent abuse of alcohol (9 percent). A substantial difference exists between rates based on principal (first-listed) and any (all-listed) diagnoses. As much as three-quarters (73.7 percent) of alcohol-related morbidity episodes did not appear as a principal (first-listed) diagnosis. Alcohol-related diagnoses in decreasing order of severity as measured by average length of hospital stay were cirrhosis (6.1 days, with 6.3 days for alcoholic cirrhosis), alcoholic psychoses (5.3 days), alcohol dependence syndrome (4.6 days), and nondependent abuse of alcohol (2.7 days). General Trends: Hospital discharge rates showed a clear upward trend for both principal (first-listed) and any (all-listed) alcoholic psychoses as well as all chronic liver disease and cirrhosis, and for any (all-listed) nondependent abuse of alcohol during 1988 to 2004. In contrast, there was an downward trend for both principal (first-listed) and any (alllisted) alcohol dependence syndrome between 1995 and 2004. For all alcohol-related diagnoses, except cirrhosis without mention of alcohol, hospital discharge rates continue to be higher for males than for females. Persons ages 45 to 64 generally have the highest any (all-listed) alcohol-related morbidity rates, although persons ages 65 and older have higher rates of cirrhosis without mention of alcohol. Persons ages 15 to 24 have the lowest alcohol-related morbidity rates. In terms of percentages , the relative ranks of principal (first-listed) alcohol-related diagnoses are fairly constant over the 26-year study period. However, the percentage of alcohol dependence diagnoses has declined substantially in the past few years, while the percentages of diagnoses for alcoholic psychoses and any cirrhosis have increased. On average, principal (first-listed) alcohol-related diagnoses accounted for less than one-half (38 percent) of alcohol-related diagnoses in the NHDS samples over the 26-year study period. While there has been relatively little change in the percentage of hospital discharges with principal (first-listed) mention of an alcohol-related diagnosis, the proportion of hospital discharges with any (all-listed) mention of an alcohol-related diagnosis has increased. For alcohol dependence syndrome and cirrhosis, declines in average length of stay were observed between 1988 and 2004. Data is presented in 11 tables and figures.

Public Domain

Chen L; Wang MY; Villalta PW; Luo XH; Feuer R; Jensen J et al. Quantitation of an acetaldehyde adduct in human leukocyte DNA and the effect of smoking cessation. Chemical Research in Toxicology 20(1): 108-113, 2007. (17 refs.)

Acetaldehyde is one of the most prevalent carcinogens in cigarette smoke. It is also a major metabolite of ethanol and is found widely in the human diet and environment. Acetaldehyde DNA adducts are critical for its carcinogenic properties. The role of acetaldehyde DNA adducts in human cancer related to tobacco and alcohol exposure could be investigated with a suitable biomarker. Therefore, in this study, we have developed a method for analysis of the major DNA adduct of acetaldehyde, N-2-ethylidene-dGuo (1), in human leukocyte DNA. Leukocyte DNA was subjected to enzyme hydrolysis in the presence of NaBH3CN, which converts adduct 1 to N-2-ethyl-dGuo (2). [N-15(5)]N-2-ethyl-dGuo was used as the internal standard. After solid-phase extraction, N-2-ethyl-dGuo was quantified by LC-ESI-MS/MS-SRM. The method was sensitive, accurate, and precise, and applicable to low microgram amounts of DNA. It was applied to investigate the effect of smoking cessation on levels of adduct 1, measured as adduct 2. Twenty-five smokers who were only light drinkers were eligible for the study. Levels of adduct 2 were quantified at two baseline time points separated by one week and again after four weeks of abstinence from smoking and alcohol consumption. The mean (+/- S.D.) levels of adduct 2 measured in the leukocytes of the smokers were 1310 +/- 1720 (range 124-7700) and 1120 +/- 1140 (range 138-5760) fmol/mu mol dGuo at the two baseline points and 705 +/- 438 (range 111-1530) fmol/mu mol dGuo after 4 weeks of cessation. The median level of adduct 2 decreased significantly by 28% upon quitting smoking (P = 0.02). These results demonstrate that the major acetaldehyde DNA adduct can be reliably quantified by MS/MS methods in human leukocyte DNA and that cigarette smoking has a modest but significant effect on its levels.

Clemens KJ; McGregor IS; Hunt GE; Cornish JL. MDMA, methamphetamine and their combination: Possible lessons for party drug users from recent preclinical research. Drug and Alcohol Review 26(1): 9-15, 2007. (70 refs.)

The substituted amphetamines 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy) and methamphetamine (METH, 'ice'. 'speed) are increasingly popular drugs amongst party-drug users. Studies with humans have investigated the acute and possible long-term adverse effects of these drugs, yet outcomes of such studies are often ambiguous due to a variety of confounding factors. Studies employing animal models have value in determining the acute and long-term effects of MDMA and METH on brain and behaviour. Self-administration studies show that intravenous METH is a particularly potent reinforcer in rats and other species. In contrast, MDMA appears to have powerful effects in enhancing social behaviour in laboratory animals. Brief exposure to MDMA or METH may produce long-term reductions in dopamine, serotonin and noradrenaline in the brain and alterations in the density of various receptor and transporter proteins. However it is still unclear, particularly in the case of MDMA, whether this reflects a 'neurotoxic' effect of the drug. Lasting alterations in social behaviour, anxiety, depressive symptoms and memory have been demonstrated in laboratory rats given MDMA or METH and this matches long-term changes reported in some human studies. Recent laboratory studies suggest that MDMA/METH combinations may produce greater adverse neurochemical and behavioural effects than either drug alone. This is of some concern given recent evidence that party drug users may be frequently exposed to this combination of drugs.

Community Epidemiology Work Group, ed. Epidemiologic Trends in Drug Abuse. Volume I: Proceedings of the Community Epidemiology Work Group. Highlights and Executive Summary, June 2005. Bethesda MD: National Institute on Drug Abuse, 2006. (35 refs.)

Overview of Key Findings: Cocaine abuse indicators, particularly those for crack, continue to dominate in many CEWG areas and to have serious consequences for users, service providers, and law enforcement personnel. High levels of gang activity and violence are associated with cocaine trafficking. Indicator data, primarily for 2004, show that cocaine items reported by NFLIS exceeded those for other drugs in 12 CEWG areas, and crack accounted for 50 to more than 90 percent of primary cocaine treatment admissions in 15 of 16 reporting areas. eroin abuse indicators continued to be high in Baltimore and Newark and relatively high in Boston, Chicago, New York, Philadelphia, San Francisco, Seattle, and Washington, DC. arcotic Analgesic/Other Opiates abuse continued to cause concern in most CEWG areas. Treatment data indicate increases in admissions for primary opiate (other than heroin) abuse in 7 of the 14 CEWG areas in which treatment data for 2002 to 2004 were reported. Four CEWG participants reported that prescription-type narcotic drugs were being used with or in place of heroin. ethamphetamine abuse indicators continued at high levels in western and southwestern areas of the county. In 2004, indicators increased dramatically in Phoenix, and increasing levels were reported in Atlanta, Minneapolis/St. Paul, and St. Louis. Increasing numbers of Hispanics entered treatment for primary methamphetamine abuse in some CEWG areas. In Los Angeles, Hispanics represented 47 percent of all primary methamphetamine admissions in the second half of 2004. arijuana continues to be readily available and the most widely used drug in CEWG areas. In 2004, relatively high percentages of the items reported by forensic laboratories (NFLIS) contained marijuana in New Orleans, San Diego, Chicago, Boston, Detroit, St. Louis, Washington, DC, and Philadelphia. In 12 CEWG areas, 20-40 percent of 2004 illicit drug abuse admissions were for primary marijuana abuse. In four CEWG areas, primary marijuana treatment admissions (excluding alcohol) exceeded those for other illicit drugs: Seattle, Minneapolis/St. Paul, New Orleans, and Denver.

Public Domain

Cooper C; Mills E. Therapeutic challenges in hepatitis C-infected injection drug using patients. Harm Reduction Journal 3(article 31), 2006. (86 refs.)

Hepatitis C Viral (HCV) infection in the injection drug user (IDU) population is a major medical concern. Concurrent substance abuse, co-morbid mental health conditions, poor socioeconomic status and a complex treatment protocol that is often incompatible with the life styles of IDUs combine to account for poor uptake and completion of HCV treatment. This article discusses HCV antiviral treatment issues relevant to IDUs chronically infected with this virus. The effect of non-injected substances of abuse on treatment outcome is considered. Priority issues requiring research are discussed.

Cruz-Almanza MD; Gaona-Marquez L; Sanchez-Sosa JJ. Empowering women abused by their problem drinker spouses: Effects of a cognitive-behavioral intervention. Salud Mental 29(5): 25-31, 2006. (41 refs.)

According to the National Survey of Addictions, in Mexico nearly one in ten males (9.6%) inhabiting urban areas complies with the alcohol dependence criterion established in the DSM-IV. Problem drinking men frequently drive their spouses to develop severe personality disorders and tolerate extremely degrading situations. Diverse interventions have been used to treat these problems. These include group counseling, and improving self-esteem. Family therapy has also been used to assess the extent to which these women actually influence their problem-drinking partner. Family education may promote self-sufficiency and assertiveness. Other results suggest that group training reduces the abused spouse's psychiatric symptoms. Rational-Emotive Behavioral Therapy (REBT) operates on cognitive biases related to personal interaction and assertiveness. This includes effectively expressing desires, beliefs, needs, and opinions. Thus, the purpose of the present study was to examine the effects of an intervention designed to promote self-esteem, coping strategies and assertiveness in abused spouses of problem drinkers. Method A non-probabilistic random sampling procedure was used to select 35 women from two community centers. One produced 18 participants, and the other 17. All were spouses of problem drinkers, between 25 and 50 years of age and their schooling fluctuated from complete elementary school to college education and their socioeconomic level fluctuated from low to middle. A scheme similar to a multiple baseline design across two groups as well as an accidental control group, was used to evaluate the pertinent comparisons. Instruments used to collect data included the Assertion Inventory validated for Mexico by Guerra, the Coopersmith's Self-esteem Inventory, validated by Lara-Cantu, Verduzco, Acevedo and Cortes, The Coping Inventory an the Mini International Neuropsychiatric Interview (MINI). The Wilcoxon statistical test was run on the data in order to establish the probability associated to the differences between pre-test and post-test, follow-up 1, follow-up 2 and follow-up 3. Results revealed significant improving differences on assertiveness, coping-responses and self-esteem.

Degenhardt L; Roxburgh A; McKetin R. Hospital separations for cannabis- and methamphetamine-related psychotic episodes in Australia. Medical Journal of Australia 186(7): 342-345, 2007. (25 refs.)

Objective: To examine trends in hospital separations related to "drug-induced" psychosis for cannabis and methamphetamine, in the context of patterns of cannabis and methamphetamine use in the Australian population. Design and setting: Analysis of prospectively collected data from the National Hospital Morbidity Database on hospital separations primarily attributed to drug-induced psychosis (July 1993 - June 2004), and specifically for cannabis and amphetamines (1999-2004). Calculation of Australian population-adjusted rates of drug-induced psychosis hospital separations using estimated resident population data from the Australian Bureau of Statistics (at 30 June each year) and data on cannabis and methamphetamine use from the 2004 National Drug Strategy Household Survey. Main outcome measures: Number of hospital separations due to drug-induced psychosis, and standardised (age-specific) rates per million population and per million users. Results: There have been notable increases in hospital separations due to drug-induced psychosis, which appear to have been driven by amphetamine-related rather than cannabis-related episodes. The rate of hospital separations was higher for amphetamine users than for cannabis users in all age groups, and the rate increased among older amphetamine users. Conclusions: The risk of hospitalisation for a drug-induced psychotic episode associated with amphetamine use appears to be greater than that for cannabls use in all age groups.

Dom G; De Wilde B; Hulstijn W; Van Den Drink W; Sabbe B. Behavioral aspects of impulsivity in alcoholics with and without a cluster-B personality disorder. Alcohol and Alcoholism 41(4): 412-420, 2006. (92 refs.)

Aims: Studies have shown that alcoholics with a cluster-B personality disorder (cluster-B PD) are characterized by high levels of impulsivity. However, impulsivity has mainly been studied as a broad concept without its different aspects being considered. The present study compared abstinent alcoholic inpatients without any personality disorder (PD) and abstinent alcoholics with cluster-B PD on different aspects of impulsivity, i.e. self-reported impulsivity and neuropsychological indicators such as behavioural control and delay of gratification. Methods: Forty alcohol-dependent inpatients without PD and 22 alcohol-dependent inpatients with a cluster-B PD were compared on two self-report impulsivity questionnaires (Barratt impulsiveness scale; sensation-seeking scales) and three behavioural impulsivity tasks [Go/No-Go task; delay discounting task (DDT); Stroop colour word test]. Tests were administered after stable abstinence of at least 3 weeks. Results: Self-report measures of impulsivity were higher in cluster-B alcoholics than in alcoholics without PD. Behavioural tasks revealed a more differentiated pattern of impairments. On the Go/No-Go task, cluster-B alcoholics were impaired in inhibitory control but not in reaction time compared with alcoholics without PD. In contrast, no significant differences on the DDT and the Stroop were observed. Conclusion: Alcohol-dependent patients with and without a cluster-B PD differ in terms of behavioural inhibition but not in terms of activation or the ability to delay gratification. This finding may partly account for their impulsive and (self-) destructive behaviours. Treatment planning should pay specific attention to these impairments in behavioural control.

Ehlers CL; Phillips E; Finnerman G; Gilder D; Lau P; Criado J. P3 components and adolescent binge drinking in Southwest California. (review) Indians. Neurotoxicology and Teratology 29(1): 153-163, 2007. (138 refs.)

In adolescence, consuming a large number of drinks over a short interval of time (e.g. hinging) is not an uncommon occurrence. Since adolescence is an important neurodevelopmental period, the effect of binge drinking on brain and behavior has become a significant health concern. The present study evaluated event-related potentials (ERPs) in young adult Southwest California Indians who had a history of binge drinking during their adolescence. One hundred twenty five participants who were currently 18-25 yrs of age who were free of Axis I psychiatric diagnoses were categorized as: 1) reporting no binge drinking during adolescence (> 5 drinks per occasion before age 18) or drug dependence diagnoses 2) reporting binge drinking during adolescence with no drug dependence diagnoses 3) reporting binge drinking during adolescence and drug dependence diagnoses. ERPs were collected using a facial discrimination task. Adolescent alcohol and drug exposure was found to be associated with decreases in the latency of an early P3 component (P350). Decreases in a later component amplitude (P450) were also found in young adults exposed to alcohol, and those exposed to alcohol and drugs. However, that finding appears to be a combined result of predisposing factors such as family history of alcoholism and presence of other extemalizing diagnoses. Taken together these preliminary studies suggests that adolescent binge drinking may result in a decreases in P3 component latencies and amplitudes perhaps reflecting a loss or delay in the development of inhibitory brain systems.

Engberg J; Morral AR. Reducing substance use improves adolescents' school attendance. Addiction 101(12): 1741-1751, 2006. (49 refs.)

Aims: Substance use initiation and frequency are associated with reduced educational attainments among adolescents. We examined if decreases in substance use substantially improve youths' school attendance. Design: A total of 1084 US adolescents followed quarterly for 1 year after entering substance abuse treatment. Methods Random and fixed effects regression models were used to differentiate the lagged effects of drug use from other time-varying and time-invariant covariates. Self-reports of alcohol, marijuana, stimulants, sedatives, hallucinogens and other drug use were used to predict subsequent school attendance, after controlling for demographic and drug use history characteristics, problem indices and other covariates. Findings: Reductions in the frequency of alcohol, stimulants and other drug use and the elimination of marijuana use were each associated independently with increased likelihoods of school attendance. Conclusions: Because years of completed schooling is highly correlated with long-term social and economic outcomes, the possibility that reductions in substance use may improve school attendance has significant implications for the cost-effectiveness of substance abuse treatment and other interventions designed to reduce adolescents' substance use.

Femia R; Natali A; L'Abbate A; Ferrannini E. Coronary atherosclerosis and alcohol consumption: Angiographic and mortality data. Arteriosclerosis, Thrombosis, and Vascular Biology 26(7): 1607-1612, 2006. (34 refs.)

Objective - Moderate alcohol consumption is associated with reduced cardiovascular disease (CVD) risk. Whether this protection is based on a lesser degree of coronary atherosclerosis has not been established. Methods and Results - We studied 1676 men and 465 women consecutively undergoing coronary angiography. A score (ATS) was calculated by summing the percent lumen narrowing of all main vessels; alcohol consumption was quantitated by questionnaire. In univariate analysis, ATS was significantly (P <= 0.001) associated with male sex, age, familial CVD, smoking, diabetes, hypertension, and serum cholesterol levels; alcohol consumption was associated with less frequent diabetes (P < 0.001) and lower ATS (P=0.02). By multivariate analysis, alcohol intake was associated with lower ATS (P < 0.01) independently of the other risk factors; the estimated effect size was comparable to that associated with a 1-mmol decrement in serum cholesterol. Over a median follow-up of 93 months, 37 women and 194 men died from a cardiac cause. By Cox analysis, positive predictors for cardiac mortality were male sex (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.1 to 2.6]), age (HR, 2.1; 95% CI, 1.8 to 2.5 per decade) and diabetes (HR, 1.7; 95% CI, 1.2 to 2.4), whereas alcohol consumption was the only negative predictor (HR, 0.84; 95% CI, 0.71 to 1.00). Conclusions - In a selected high-risk population, moderate alcohol consumption was independently associated with less coronary atherosclerosis and lower risk for cardiac mortality.

Fingerhood MI. Co-morbid medical disorders. IN: Strain EC; Stitzer ML, eds. The Treatment of Opioid Dependence. Baltimore: Johns Hopkins University Press, 2006. pp. 398-420. (65 refs.)

This chapter focuses on the provision of medical care to individuals receiving opioid agonist medications. It considers the issues related to health maintenance, and the multiple medical complications. Among those with a history of intravenous use, there are special concerns related to the route of administration -- including viruses from needle sharing as well as the soft tissue infections from injecting technique. These problems are not restricted to those involved with opiates, but also common in cocaine users. The chapter begins with an overview of basic primary care, with attention to medical history and physical exam. It then turns of matters related to prescribing, pain management, and drug interactions with methadone, that may have an impact on blood levels or alter methadone's effects. Also specifically addressed are skin and soft tissue infections, HIV/AIDS, sexually transmitted disease, hepatitis, as well as cardiac, pulmonary, renal, neurological, and immunologic complications, and for women concerns related to domestic violence.

Fischer B; Rehm J; Patra J; Kalousek K; Haydon E; Tyndall M et al. Crack across Canada: Comparing crack users and crack non-users in a Canadian multi-city cohort of illicit opioid users. Addiction 101(12): 1760-1770, 2006. (89 refs.)

Aims: To examine possible differences between crack users and crack non-users across Canada. Design: Cohort study of illicit opioid and other drug users in five cities across Canada. Setting: Vancouver, Edmonton, Toronto, Montreal and Quebec City, Canada. Participants Regular illicit opioid and other street drug users not in treatment at time of assessment. Measurements Participants (n = 677) were assessed at baseline (2002) by way of an interviewer-administered questionnaire, a psychiatric diagnostic instrument (Composite International Diagnostic Interview), and salivary antibody tests for infectious disease. Findings Approximately half the sample had used crack in the past 30 days, although prevalence rates differed strongly between study sites. When examined by discriminant analysis, crack users in the study population were more likely to have: no permanent housing, have illegal and sex work income, indicate physical health problems and hepatitis C virus (HCV) antibodies, use walk-in clinics, use heroin and to have been arrested and in detention (in past year). They were less likely to report depressive symptoms, and use Dilaudid (hydromorphone) and alcohol. Conclusion: These results illustrate crack users' pronounced social marginalization (as expressed by homelessness and high involvement in illegal activities) as well as extensive health problems compared to non-crack users in the Canadian context. The development of targeted interventions -- addressing the dynamics of social marginalization -- of this population is urgently needed.

Gentilello LM. Alcohol and the intensive care unit: It's not just an antiseptic. (editorial). Critical Care Medicine 35(2): 627-628, 2006. (10 refs.)

All patients admitted to the intensive care unit (ICU) undergo a complete medical history that includes drugs taken, dosages, and dosing frequency. For a large segment of the ICU population, the most commonly used drug is alcohol. However, there are more publications in the recent intensive care literature on alcohol as a hand-washing disinfectant than as a drug that may influence complications and overall outcome. This editorial emphasizes the importance of being informed about complications associated with chronic use. it comments upon an article in this issue by O'Brien that documents a strong association between alcohol dependence and sepsis, septic shock, and mortality. It is also emphasized that while dependent patients have the highest risk of medical complications, most alcohol-related problems occur in patients who are not dependent, since such patients make up the largest portion of the problem drinking population. A large number of people at moderate risk give rise to more health problems than a small number of patients who are at high risk. For example, more coronary artery disease is caused by cholesterol levels between 200 and 250 mg/dL than by levels higher than 300 mg/dL because levels between 200 and 250 mg/dL are more common. Similarly, alcohol-related medical conditions in ICU patients are more likely to be associated with drinkers who do not meet criteria for dependence. By restricting the analysis of alcohol-related complications to dependent patients, this study probably underestimated the magnitude of the effect of alcohol on complication rates.

Ghosheh FR; Kathuria SS. Intraorbital heroin injection resulting in orbital cellulitis and superior ophthalmic vein thrombosis. Ophthalmic Plastic and Reconstructive Surgery 22(6): 473-475, 2006. (6 refs.)

A 47-year-old man with decreased vision, ophthalmoplegia, proptosis, and chemosis of his right eye admitted to injecting heroin directly into his orbit. He was placed on intravenous antibiotics for orbital cellulitis, and computed tomography and magnetic resonance imaging were performed. Superior ophthalmic vein thrombosis (SOVT) was noted on magnetic resonance imaging. The patient responded well to intravenous antibiotics, and his symptoms resolved with minimal deficits. Steroids and anticoagulants were not administered. We review the pathogenesis of septic SOVT and briefly discuss the role of anticoagulants and steroids in this setting.

Glauser J; Queen JR. An overview of non-cardiac cocaine toxicity. Journal of Emergency Medicine 32(2): 181-186, 2007. (66 refs.)

Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article. Cocaine use is also responsible for a variety of non-cardiac, systemic complications, which it is our purpose to review. Multiple systemic effects of cocaine are seen with both acute and chronic use. These systems include: psychological and psychiatric, neurological, renal, pulmonary, gastrointestinal, obstetrical, and otolaryngological.

Godette DC; Headen S; Ford CL. Windows of opportunity: Fundamental concepts for understanding alcohol-related disparities experienced by young Blacks in the United States. Prevention Science 7(4): 377-387, 2006. (85 refs.)

This paper presents a theoretical framework for conceptualizing alcohol-related disparities experienced by young Blacks in the United States. The framework highlights areas of risk and opportunity as they relate to the development of alcohol use and alcohol-related problems. In this paper, life course development theory serves as a guide for identifying a critical period in the development of alcohol-related disparities and it serves to guide the identification of opportunities to prevent or attenuate this health outcome. We also highlight concepts from ecosocial theory, resilience theory, and prevention science that advance our understanding of risk and protective factors for the social problems that young Blacks experience related to alcohol use. We conclude with suggestions for designing studies that range from etiology to preventive interventions. We also recommend methodologies that allow for more nuanced understandings of the etiology and prevention of alcohol use and alcohol-related problems experienced by young Blacks than have been available to date.

Haning W; Goebert D. Electrocardiographic abnormalities in methamphetamine abusers. Addiction 102(Supplement 1): 70-75, 2007. (46 refs.)

Aims: Although many adverse cardiovascular outcomes are mentioned in conjunction with methamphetamine use, a causal relationship between methamphetamine use and arrhythmia or cardiomyopathy has not been demonstrated in man. Clinical experience with methamphetamine users suggested a higher incidence of electrocardiographic abnormalities. This study seeks to quantify that incidence, among subjects enrolled in a study of adults with methamphetamine dependence. Methods: Electrocardiograms obtained during screening in a previous clinical trial were examined. The study population (n = 158) of adults with methamphetamine dependence [Diagnostic and Statistical Manual version IV (DSM IV-TR)] was drawn from five sites across the United States, recruited in the interval 2002-03. Results A significant variance from the normal population was noted in the electrocardiograms of the study cohort. Among the abnormalities was a prolongation of the QTc beyond 440 ms in 27.2% of the group. QTc prolongation to this extent poses a particular risk for ventricular arrhythmias, most notably torsades de pointes. Conclusions: We believe that this is the first demonstration of clinically significant QTc prolongation in a methamphetamine-using population, and that this has implications for the types of arrhythmias for which this population is at risk. It may further provide a marker for risk of cardiomyopathy. The fact of electrocardiographic changes with potential cardiac risks may be useful in a motivational interviewing approach, in challenging the methamphetamine user's basis for continuing use.

Hickman M; Vickerman P; Macleod J; Kirkbride J; Jones PB. Cannabis and schizophrenia: Model projections of the impact of the rise in cannabis use on historical and future trends in schizophrenia in England and Wales. Addiction 102(4): 597-606, 2007. (25 refs.)

Aims: To estimate long-term trends in cannabis use and projections of schizophrenia assuming a causal relation between cannabis use and schizophrenia. Methods: Trends in cannabis use were estimated from a national survey, 2003; and incidence of schizophrenia was derived from surveys in three English cities, 1997-99. A difference equation cohort model was fitted against estimates of schizophrenia incidence, trends in cannabis exposure and assumptions on association between cannabis and schizophrenia. The model projects trends in schizophrenia incidence, prevalence and attributable fraction of cannabis induced schizophrenia. Results Between 1970 and 2002 cannabis exposure increased: incidence by fourfold; period prevalence by 10-fold; and use among under 18-year-olds by 18-fold. In 1997-99 incidence and prevalence of schizophrenia were 17 per 100 000 and 0.63% among men and 7.3 per 100 000 and 0.23% among women, respectively. If cannabis use causes schizophrenia, earlier increases in cannabis use would lead to increases in overall schizophrenia incidence and prevalence of 29% and 12% among men between 1990 and 2010. By 2010 model projections which assume an association between schizophrenia and light and heavy users suggest that approximately one-quarter of new schizophrenia cases could be due to cannabis, whereas if the association is twofold and confined to heavy cannabis users, then approximately 10% of schizophrenia cases may be due to cannabis. Conclusions: If cannabis use causes schizophrenia, and assuming other causes are unchanged, then relatively substantial increases in both prevalence and incidence of schizophrenia should be apparent by 2010. More accurate data on cannabis consumption and future monitoring of schizophrenia are critical.

Hudetz JA; Iqbal Z; Gandhi SD; Patterson KM; Hyde TF; Reddy DM et al. Postoperative cognitive dysfunction in older patients with a history of alcohol abuse. Anesthesiology 106(3): 423-430, 2007. (64 refs.)

Background: Postoperative cognitive dysfunction (POCD) affects a significant number of patients and may have serious consequences for quality of life. Although POCD is most frequent after cardiac surgery, the prevalence of POCD after noncardiac surgery in older patients is also significant. The risk factors for POCD after noncardiac surgery include advanced age and preexisting cognitive impairment. Self-reported alcohol abuse is a risk factor for postoperative delirium, but its significance for long-term POCD has not been investigated. The goal of this study was to determine whether neurocognitive function is impaired after noncardiac surgery during general anesthesia in older patients with a history of alcohol abuse. Methods: Subjects aged 55 yr and older with self-reported alcohol abuse (n = 28) and age-, sex-, education-matched non-alcoholic controls (n = 28) were tested using a neurocognitive battery before and 2 weeks after elective surgery (n = 28) or a corresponding time interval without surgery (n = 28). Verbal memory, visuospatial memory, and executive functions were assessed. A neurologic examination was performed to exclude subjects with potential cerebrovascular damage. Results: Significant three-way interactions (analysis of variance) for Visual immediate Recall, Visual Delayed Recall, Semantic Fluency, Phonemic Fluency, and the Color-Word Stroop Test implied that cognitive performance in the alcoholic group decreased after surgery more than it did in the other three groups. Conclusions: The results suggest that a history of alcohol abuse in older patients presents a risk for postoperative cognitive impairment in the domains of visuospatial abilities and executive functions that may have important implications for quality of life and health risks.

Hylkema MN; Sterk PJ; de Boer WI; Postma DS. Tobacco use in relation to COPD and asthma. European Respiratory Journal 29(3): 438-445, 2007. (71 refs.)

Smoking is the leading cause of preventable death worldwide. Hundreds of millions of individuals still smoke, affecting their health as well as that of their peers, family and offspring. Smoking is a well-established prime risk factor for chronic obstructive pulmonary disease and hampers the response to treatment in asthma and chronic obstructive pulmonary disease. In the present paper, new concepts are discussed with respect to pathology, treatment, smoking cessation and tobacco control. Recommendations for future directions are given.

Jakobovits SL; Mcdonough M; Chen RY. Buprenorphine-associated gastroparesis during in-patient heroin detoxification. Addiction 102(3): 490-491, 2007. (6 refs.)

Background: Buprenorphine is a partial mu receptor agonist used in opiate detoxification. It has been shown to cause delayed gastric emptying in healthy volunteers. Case description: We describe a case of clinically severe gastroparesis (delayed gastric emptying due to impaired contraction of the stomach) whose onset coincided with the commencement of buprenorphine-assisted detoxification. Conclusion: We review the literature on gastric effects of buprenorphine in healthy volunteers, providing proof of the concept that this was the most probable cause of this patient's gastroparesis.

Kraus L; Augustin R; Kunz-Ebrecht S; Orth B. Drug use patterns and drug-related disorders of cocaine users in a sample of the general population in Germany. European Addiction Research 13(2): 116-125, 2007. (55 refs.)

Aims: The prevalence of cocaine use is still very low in Germany, but rates have been increasing over the past few decades. Patterns of drug consumption and related adverse consequences in individuals who have used cocaine were investigated in order to distinguish different types of cocaine users. Methods: Data come from two national representative surveys on substance abuse in the German general population conducted in 1997 and 2000 using self-administered questionnaires. Overall response rates were 65 and 51%, respectively. The two samples were pooled (n = 16,159) and latent cluster analysis was conducted using a sub-sample of 272 lifetime cocaine users. Results: Three clusters were derived: the majority belonged to the group of mainly unproblematic users (UPG, 80%), the second group comprised non-amphetamine poly-problem drug users (NAPPG, 12%), and a small group was composed of poly-problem drug users (PPG, 8%). Comparisons of sociodemographic characteristics, consumption patterns and age of onset for licit and illicit drug use revealed significant differences between the groups. Conclusions: The majority of cocaine users in the general population are experimental or occasional users of licit and illicit drugs. Rather than being a major drug, cocaine is one of many other licit and illicit drugs. Cocaine use as part of predominantly poly-drug use behaviour is strongly associated with substance-related disorders.

Lacy BW; Ditzler TF. Inhalant abuse in the military: An unrecognized threat. Military Medicine 172(4): 388-392, 2007. (42 refs.)

Although inhalant abuse represents the third most commonly abused class of drugs in the military, it is a frequently overlooked form of substance abuse in the active duty population. Inhalants' lack of visibility is also evident in the civilian community. In both the civilian and military communities, the factors leading to underrecognition of inhalant abuse include high availability, low cost, lack of drug screening and drug treatment programs, and frequent misdiagnosis by clinicians. This review seeks to inform care providers about the prevalence, health risks, diagnosis, and treatment of inhalant abuse in the active duty population, and encourages clinicians to be more aggressive in the identification of this serious but underrecognized problem.

Luo H-R; Konishi T; Tsuang J; Wan Y-JY. Comparison of alcohol drinking behaviors and associated problems between benders and nonbenders in Mexican Americans who drink excessively. Addictive Disorders and their Treatment 5(3): 121-127, 2006. (19 refs.)

OBJECTIVE: Bender drinking (defined as 2 or more days of sustained drinking) is common among Hispanic/Mexican Americans. However, no data are available on whether there are significant differences in alcohol-related behavioral and medical problems between benders and nonbenders, when both groups are heavy drinkers. To bridge this research gap, we investigated drinking behavior and alcohol-associated problems in Mexican American alcoholics using the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA-II). METHODS: Participants included 201 heavy drinking (?6 drinks/d) Mexican American men with 75.6% of them meeting criteria for bender drinking. Drinking behaviors, demographics, and alcohol-related problems were characterized in the 201 alcoholics, and then these variables were compared between benders and nonbenders. RESULTS: Demographically, benders were more likely to be single than nonbenders (P=0.001) but there were no other differences between the 2 groups. Regarding drinking patterns, benders exhibited distinct [P<0.001, odds ratios (ORs)=3.65 to 10.20] drinking behaviors to that of nonbenders, including thinking of drinking where it was prohibited, drinking regularly before age 20, and drinking nonbeverage alcohol such as mouthwash. Moreover, benders exhibited significantly (P<0.001, ORs=3.63 to 6.42) more drinking-related negative behaviors compared to nonbenders, such as forfeiting important things, putting oneself in dangerous situations, becoming less responsible, exhibiting problems at work or school, losing friendships, accidentally injuring oneself, hitting other people, as well as more alcohol-related medical and emotional problems (ORs=3.02 to 6.94), such as feeling depressed for longer than 24 hours, having trouble thinking for longer than 24 hours, hallucinations, and stomach disease. CONCLUSIONS: Among a group of excessive drinking Mexican American men, benders had more serious negative drinking-related behavioral and health problems than nonbenders. Thus, from a public health perspective, reducing the number of benders among heavy drinking Mexican Americans should be considered as an initial step to reduce alcohol-related problems. These data might be useful in developing strategies to reduce alcohol-related problems in Mexican Americans.

Mahid SS; Minor KS; Stromberg AJ; Galandiuk S. Active and passive smoking in childhood is related to the development of inflammatory bowel disease. Inflamatory Bowel Diseases 13(4): 431-438, 2007. (57 refs.)

Background: The highest prevalence of smoking in the United States is in Kentucky, where smoking typically begins in childhood. The state has many patients who suffer from inflammatory bowel diseases (IBD). The primary aim of this study was to assess whether exposure to active and/or passive tobacco smoke in childhood is related to the likelihood of developing IBD. Methods: Recruited into this prospective study were a total of 672 participants (253 patients with Crohn's disease [CD], 177 patients with ulcerative colitis [UC], and 242 controls), all of whom were asked to complete the Behavioral Risk Factor Surveillance Survey modified by the addition of 4 questions on childhood passive smoke exposure. Results: Survey response rate was 84%. CD and UC patients were more likely than controls to begin smoking regularly by ages 10 and 15, respectively, suggesting that becoming a regular smoker at a younger age may be associated with a subsequent diagnosis of IBD. Smoking by age 10 was associated with an earlier age at diagnosis with UC, but not with CD. CD patients were more likely than controls to have prenatal smoke exposure (odds ratio [OR], 1.72; 95% confidence interval [Cl], 1.1-2.71) and were more likely to have passive smoke exposure during childhood, with I or both parents or other household members being smokers (OR, 2.04; 95% Cl, 1.28-3.31). Conclusions: Passive and active smoke exposure in childhood influences the development of I BD. A high incidence of this disease in a state with a high rate of cigarette smoking underscores the profound role of environmental factors in the etiology of these illnesses.

Mancinelli R; Binetti R; Ceccanti M. Woman, alcohol and environment: Emerging risks for health. (review). Neuroscience and Biobehavioral Reviews 31(2): 246-253, 2007. (78 refs.)

Alcohol drinking is one of the most relevant problems in Western Countries but the negative effects of alcohol misuse are often neglected or underestimated with serious consequences for public health. Over the last few years a rapid growth in the number of drinking females and the decrease of their age of first use, have increased the health risk for women and their offspring. Moreover, modern environments facilitate pollutants exposure, further escalating the health risks due to lifestyle habits. This review takes into account the peculiarities of alcohol effects on female health and the risks of teratogenic effects. The possible interaction between alcohol and pollutants exposure is also discussed. The role of biomarkers against alcohol-related damage is presented as an invaluable clinical tool, including early intervention, treatment monitoring and, above all, prevention of prenatal non-reversible damage. Recent alcohol studies show the greater severity of alcohol damage in female subjects and the need of gender-targeted intervention.

McCrystal P; Percy A; Higgins K. Frequent cannabis use among 14/15 years old in Northern Ireland. Drug and Alcohol Dependence 88(1): 19-27, 2007. (65 refs.)

The relatively high levels of cannabis use among young people is a cause of concern because of the positive relationship between its early onset use, antisocial behaviours and associated lifestyle. Amongst a survey of 3919 young people at school year I I in Northern Ireland (aged 14/15 years) 142 reported daily cannabis use. These young people also reported particularly high levels of legal and illegal drug use and accounted for a high proportion of use of hard drugs such as cocaine and heroin for the full school cohort. Daily cannabis users also reported high levels of antisocial behaviour and disaffection with school. The findings perhaps raise questions about the existence of a potentially 'hidden' high risk school based group of young people during adolescence who require specific targeted prevention strategies.

Moon M; Do KS; Park J; Kim D. Memory impairment in methamphetamine dependent patients. International Journal of Neuroscience 117(1): 1-9, 2007. (16 refs.)

The authors examined the verbal memory and visual memory of 19 patients with methamphetamine dependence and 18 normal controls to assess the memory impairment due to the use of methamphetamine. There was no significant difference in the verbal memory, but a significant difference was detected in the visual memory. The results that the meth amphetamine selectively impairs visual memory seem to be because visual memory tasks are more sensitive to the damage of the executive function.

Moran A; Harbour DV; Teeter LD; Musser JM; Graviss EA. Is alcohol use associated with cavitary disease in tuberculosis? Alcoholism: Clinical and Experimental Research 31(1): 33-38, 2007. (30 refs.)

Background: Alcohol mediates detrimental alterations in the immune response to Mycobacterium tuberculosis. The association between quantity and frequency of alcohol use and the prevalence of cavitary disease in tuberculosis (TB) has not been analyzed. To investigate the relationship of alcohol use and the prevalence of cavitary disease in a 6-year population-based data set of individuals with TB. Methods: We assessed quantity and frequency of alcohol use (daily alcohol use, years of alcohol use, and lifetime alcohol use) with a standardized questionnaire. The study group consisted of 1,250 patients analyzed for cavitary disease (HIV sero-negative subjects that were 18 years or older). Significant covariates for cavitary disease were entered into multiple logistic regression models. Results: Although daily alcohol use, years of alcohol use, and alcohol use 30 days or 6 months before symptom onset were significant predictors of cavitary disease in univariate analysis, no independent associations were found between alcohol use and cavitary disease in the multivariate analysis. Only diabetes mellitus was independently associated with cavitary disease at any level or frequency of alcohol use. Conclusion: Alcohol use is not independently associated with increased prevalence of cavitary disease in adult patients with TB.

Murray RP; Connett JE; Skeans MA; Tashkin DP. Menthol cigarettes and health risks in Lung Health Study data. Nicotine & Tobacco Research 9(1): 101-107, 2007. (28 refs.)

Whether menthol cigarettes confer a higher risk of death than plain cigarettes is not known. The Lung Health Study (LHS) enrolled 5,887 adult smokers in a clinical trial of smoking cessation and ipratropium in the prevention of chronic obstructive pulmonary disease. LHS participants have been subjected to surveillance for mortality from all causes for 14 years. We examined these data for differences between self-reported smokers of menthol cigarettes versus plain cigarettes. Using proportional hazards regression methods, we found no differences in hazard ratios for coronary heart disease, cardiovascular disease, lung cancer, or death from any cause. Contrary to expectations about nicotine dependence, we found that users of menthol cigarettes had smoked fewer pack-years at baseline. We found no difference in success at smoking cessation with or without menthol. We conclude that our data contain no evidence that mentholation of cigarettes increases the hazards of smoking.

Nilsson KW; Sjoberg RL; Wargelius HL; Leppert J; Lindstrom L; Oreland L. The monoamine oxidase A (MAO-A) gene, family function and maltreatment as predictors of destructive behaviour during male adolescent alcohol consumption. Addiction 102(3): 389-398, 2007. (41 refs.)

Aim To investigate possible interactions between a polymorphism in the monoamine oxidase A (MAO-A) gene promoter, family relations and maltreatment/sexual abuse on adolescent alcohol-related problem behaviour among male adolescents. Design, setting and participants A cross-sectional study of a randomized sample of 66 male individuals from a total population of 16- and 19-year adolescents from a Swedish county. Boys, who volunteered to participate answering an alcohol-related problem/ behaviour questionnaire, were investigated with regard to interactions between such problems, family function, maltreatment and MAO-A genotype. Measurements MAO-A genotype, family relations history, history of being maltreated or abused and alcohol-related problem behaviour. Findings: Boys with the short (three-repeat) variant of the MAO-A gene, who had been maltreated/abused or came from families with poor relations, showed significantly higher scores of alcohol-related problems. We also found that maltreatment/ abuse independently showed the strongest relation to alcohol-related problems among boys in our model. Conclusions: The results suggest that both maltreatment and MAO-A genotype may be useful for the understanding of male adolescent alcohol-related problem behaviour.

Norberg M; Stenlund H; Lindahl B; Boman K; Weinehall L. Contribution of Swedish moist snuff to the metabolic syndrome: A wolf in sheep's clothing? Scandinavian Journal of Public Health 34(6): 576-583, 2006. (34 refs.)

Aim: Combined effects of genetic and environmental factors underlie the clustering of cardiovascular risk factors in the metabolic syndrome (MetSy). The aim was to investigate associations between several lifestyle factors and MetSy, with a focus on the possible role of smokeless tobacco in the form of Swedish moist snuff (snus). Methods: A population-based longitudinal cohort study within the Vasterbotten Intervention Programme in Northern Sweden. All inhabitants at the ages of 30, 40, 50, and 60 are invited to participate in a health survey that includes a questionnaire on psychosocial conditions and lifestyle and measurement of biological variables. Individuals examined in 1990-94 (n=24,230) and who also returned for follow-up after 10 years were included ( total of 16,492 individuals: 46.6% men and 53.4% women). Regression analyses were performed. MetSy was the outcome and analyses were adjusted for age, sex, alcohol abuse, and family history of CVD and diabetes. Results: Ten-year development of MetSy was associated with high-dose consumption of snus at baseline ( OR 1.6 [95% CI 1.26-2.15]), low education (2.2 [1.92-2.63]), physical inactivity (1.5 [1.22-1.73]) and former smoking (1.2 [1.06-1.38]). Snus was associated with separate components of MetSy, including triglycerides ( 1.6, 1.30-1.95), obesity (1.7 [1.36-2.18]) but not hypertension, dysglycemia and low HDL cholesterol. Conclusions: MetSy is independently associated with high consumption of snus, even when controlling for smoking status. The finding is of public health interest in societies with widespread use of snus. More research is needed to better understand the mechanisms underlying this effect.

Obot IS. Nigeria: alcohol and society today. (editorial). Addiction 102(4): 519-522, 2007. (16 refs.)

O'Brien JM Jr; Lu B; Ali NA; Martin GS; Aberegg SK; Marsh CB et al. Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among adult intensive care unit patients. Critical Care Medicine 35(2): 345-350, 2006. (32 refs.)

Objective: To determine the association between alcohol dependence (alcoholism not in remission and/or alcohol withdrawal) and sepsis, septic shock, and hospital mortality among intensive care unit (ICU) patients. Design: Retrospective cohort study. Setting: Two ICUs in an urban hospital. Patients: Patients included 11,651 adult admissions to Denver Health Medical Center from January 1, 1999, to December 31, 2004, with >=1 ICU day. nterventions: None. Measurements and Main Results: Of first admissions appearing in the data set (n = 9,981), 1,222 (12.2%) had a diagnosis consistent with alcohol dependence. These patients had higher rates of sepsis (12.9% vs. 7.6%, p < .001), organ failure (67.3% vs. 45.8%, p < .001), septic shock (3.6% vs. 2.1%, p = .001), and hospital mortality (9.4% vs. 7.5%, p = .022) on unadjusted analyses. Patients with alcohol dependence also had fewer hospital-free days. After adjustment for factors with known association with sepsis, alcohol dependence was associated with sepsis. This association was modified if the patient received (adjusted odds ratio, 0.92; 95% confidence interval, 0.65-1.31) or did not receive (adjusted odds ratio, 1.91; 95% confidence interval, 1.49-2.44) red cell transfusions. A general predisposition to infections mediated some, but not all, of this association. Results were similar when repeat admissions were included in the analysis. Alcohol dependence was also associated with septic shock and hospital mortality in multivariable analyses. Among those with liver disease and sepsis, alcohol dependence was associated with more than two-fold increased risk-adjusted odds of hospital mortality (adjusted odds ration, 2.31; 95% confidence interval, 1.26-4.24). Similarly, sepsis and liver disease carried higher odds of death for alcohol-dependent patients than for those without alcohol dependence. Conclusions: Alcohol dependence is independently associated with sepsis, septic shock, and hospital mortality among ICU patients. The underlying mechanisms of this association require exploration, as an increased rate of infections mediated some, but not all, of this association.

Office of Applied Studies. The NSDUH Report. Academic Performance and Substance Use among Students Aged 12-17: 2002, 2003, 2004. Issue 18. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (5 refs.)

This short report examines the relationship between substance use patterns and academic performance among students age 12-17, based on data from the National Survey on Drug Use and Health. About 70% of students reported an A or B average in the most recent grading period. About 30% had a C average or less. The data shows that academic performance is related to substance use. Three groups were identified, those who didn't use alcohol in the previous month, those who did drink but hadn't engaged in binge drinking, and those who reporting binge drinkinging. The corresponging proportion of students in each group having an A or B average was 73% (non-drinkers), 67% drinkers, and 58% recent history of binge drinking. Similarly, academic performace and different frequencies of marijuana use were examined. Those who had used marijuana on 1-4 days in the prior month had a lower proportion of A or B grades, and the proportion was still lower within the group that used marijuana or 5 or more days.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration. The DAWN Report. Emergency Department Visits Involving ADHD Stimulant Medication. Issue 29. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (10 refs.)

Recent studies have indicated that as many as 7 percent of children and 4 percent of adults meet the criteria for a diagnosis of attention-deficit/hyperactivity disorder (ADHD). As a result, more prescriptions are being written for the stimulants used to treat ADHD. Accordingly, this likely leads to increases in medical side effects with the use of these drugs, as well as greater use of these drugs for nonmedical purposes. Research also indicates that peers are a common source of ADHD medications; although nonmedical use of stimulant medications is still relatively low: 0.3 percent of the population aged 12 or older reported using such stimulants non-medically during the past year. However, those aged 18 to 25 had a higher rate of nonmedical use than those who were younger or older. College students who may use these drugs as study aids because of their stimulant properties fall primarily in this 18-25 age group. ED visits involving adverse reactions associated with medical use typically involved only a single drug (77%).

Pagonis TA; Angelopoulos NV; Koukoulis GN; Hadjichristodoulou CS. Psychiatric side effects induced by supraphysiological doses of combinations of anabolic steroids correlate to the severity of abuse. European Psychiatry 21(8): 551-562, 2006. (71 refs.)

Objective. - The objective of our study was to evaluate the psychological consequences of real-world AAS use in athletes abusing such agents, in comparison with a placebo and control group of comparable athletes, while correlating the severity of abuse with the side effects observed. The hypothesis tested by the study was that the use of AAS induces a wide range of psychological side effects whose impact and emergence is dependent upon the severity of the abuse. Design. - The study includes a substantial group of AAS abusing athletes and two more groups demographically similar to the first, one composed of athletes not using any substance and a placebo group. All athletes were stratified according to the severity of AAS abuse. Psychometric instruments were applied to all athletes in specific time intervals, dependent to the AAS abusers' regimens, providing us with a final psychological profile that was to be compared to the pre-study profile. All results were comparable (within and between groups) for statistically significant differences and correlated to the severity of the abuse. Homogeneity of all groups was safeguarded by random doping controls, monitoring of drug levels and analysis of all self obtained drugs by method of liquid chromatography/mass spectrometry. All athletes were provided with a common exercise and dietary regime, so common training and nutritional conditions were achieved. Methods. - We studied a cohort of 320 body-building, amateur and recreational athletes, of whom 160 were active users of AAS (group C), 80 users administering placebo drugs (group B) and 80 not abusing any substance (Group A). Group C athletes were stratified according to AAS abuse parameters, thus providing us with three subgroups of "light, medium and heavy abuse". Athletes of groups A and B were included in a "no abuse" subgroup. The psychometric instruments used were the Symptoms Check List-90 (SCL-90) and the Hostility and Direction of Hostility Questionnaire (HDHQ). The psychometric evaluations took place within a time interval of 13 months. Statistical analysis was performed by using the Mann-Whitney/Wilcoxon two-sample non-parametric test (Kruskal-Wallis test for two groups) for data that were not normally distributed and Linear regression analysis was used to ascertain the correlation between severity of use and escalation of side effects. Results. - The study showed a statistically significant increase in all psychometric subscales recorded in group C, and no statistically significant difference in group C and A. There was a significant increase in the scorings of group C for all subscales of SCL-90 and HDHQ. Correlation of abuse severity and side effects showed that there was a statistical significant increase in Delta values of all SCL-90 and HDHQ subscales that escalated from light abuse to medium and heavy abuse/consumption patterns. Conclusions. - The results of the study suggest that the wide range of psychiatric side effects induced by the use of AAS is correlated to the severity of abuse and the force of these side effects intensifies as the abuse escalates.

Peyrot I; Garsaud AM; Saint-Cyr I; Quitman O; Sanchez B; Quist D. Cannabis arteritis: A new case report and a review of literature. (review). Journal of the European Academy of Dermatology and Venerology 21(3): 388-391, 2007. (10 refs.)

Cannabis arteritis manifests in cannabis users, independently of tobacco consumption. Around 50 cases were reported in the literature since the first description of this entity in 1960. We report the case of a 36-year-old man, cannabis user, without vascular risk factor who developed digital necrosis on the right foot. The pedal pulses were not palpable. He had no abnormal laboratory findings. Arteriography revealed distal segmental lesions and occlusion of popliteal artery. This arteritis was linked to cannabis use, but the patient did not stop cannabis consumption. His symptoms became even worse and he eventually developed sub-acute ischaemia in his left leg despite vascular treatments. Amputation of the right second toe and of the left leg finally became necessary. Cannabis arteritis is relatively similar to thromboangiitis obliterans in its clinical and arteriographical presentation. A parallelism can be made between the role of tobacco in thromboangiitis obliterans pathogenesis and the role of cannabis in cannabis arteritis. Cannabis use must be searched in young patients presenting with arteriopathy. Cannabis arteritis may indeed represent a frequent cause of juvenile peripheral obstructive arterial disease, but is probably under-diagnosed.

Pietrzak RH; Morasco BJ; Blanco C; Grant BF; Petry NM. Gambling level and psychiatric and medical disorders in older adults: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. American Journal of Geriatric Psychiatry 15(4): 301-313, 2007. (58 refs.)

Objective: This study examined the association between gambling level and psychiatric and medical disorders in a nationally representative sample of older adults. Method: Data on 10,563 U. S. older adults (age 60 or older) were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. Results: A total 28.74% of older adults were lifetime recreational gamblers and 0.85% were lifetime disordered gamblers. Compared with older adults without a history of regular gambling, recreational gamblers had significantly elevated rates of alcohol (30.1% versus 12.8%), nicotine (16.9% versus 8.0%), mood (12.6% versus 11.0%), anxiety (15.0% versus 11.6%), and personality disorders (11.3% versus 7.3%) and obesity (25.6% versus 20.8%), but were less likely to have past-year diagnoses of arteriosclerosis (4.7% versus 6.0%) or cirrhosis (0.2% versus 0.4%). Disordered gamblers were significantly more likely than older adults without a history of regular gambling to have alcohol (53.2% versus 12.8%), nicotine (43.2% versus 8.0%), drug (4.6% versus 0.7%), mood (39.5% versus 11.0%), anxiety (34.5% versus 11.6%), and personality (43.0% versus 7.3%) disorders, and to have past-year diagnoses of arthritis (60.2% versus 44.3%) or angina (22.7% versus 8.8%). These results remained significant even after controlling for demographic, psychiatric, and behavioral risk factors. Conclusions: Lifetime recreational gamblers were more likely than nonregular gamblers to have psychiatric disorders but were less likely to have some medical conditions. Lifetime disordered gamblers had a range of lifetime psychiatric disorders and were more likely than nonregular gamblers to have past-year diagnoses of angina and arthritis.

Plant M; Plant M. Binge Britain: Alcohol and the national response. Oxford: Oxford University Press, 2006. (605 refs.)

This book discusses alcohol use in Britain. The use of "binge" in the title is a bit confusing, as the authors in their preface have some criticisms of the widespead and often contradictory ways in which the term is used, i.e. if a "binge" is synonymous with an occassion that may encompass a whole day versus severall hours, the likely related dangers and feeling states are quite different. The book is organized into seven chapters with an appended bibliography. The first chapter describes the use of alcohol over historical periods dating back to the Roman conquest, but focusing largely upon the periods from the Tudors and Stuarts. Chapter 2 considers the current drinking patterns and trends, with comparisons to other nations. Chapter 3 deals with problems related on alcohol use, considering both health consequences and social problems. Chapter 4 discusses alcohol policy. Chapter 5 examines some of the recent controversies around alcohol policy, including the changes in licensing allowing extended hours in bars, the media response, the response of police, and public opinion. Chapter 6 addresses "Lessons from the past." It looks to earlier periods in which licensing standards were eaased, as well as the experiences of other countries. Chapter 7 considers alternative and future policy initiatives, from restricting access of young people to alcohol, to tax policy, to drinking and driving, community action inititives, and ways of working with the beverage industry.

Polednak AP. Secular trend in US black-white disparities in selected alcohol-related cancer incidence rates. Alcohol and Alcoholism 42(2): 125-130, 2007. (44 refs.)

Aims: To examine secular trends in incidence rates for the cancer types most strongly associated with alcohol in African Americans (blacks) and whites. Methods: Average annual age-standardized incidence rates (ASIRs) for years of diagnosis 1973-1975 through 2000-2002 were analysed for squamous cell carcinomas of the oral cavity pharynx, oesophagus and larynx in U.S. blacks and whites by sex, using data from a group of high-quality population-based cancer registries. Also examined were National Health Interview Survey (NHIS) results on prevalence of current drinking and cigarette smoking among the U.S. population, and U.S. age-standardized mortality rates for alcoholic liver disease-damage from 1979 to 2003. Results: In 1973-1975, ASIRs were greater in blacks than whites for cancers of the oesophagus and larynx but not oral cavity pharynx, and peaks in the disparity reached in the 1980's were followed by declines except for laryngeal cancer (the cancer most strongly associated with tobacco). By 2000-2002, black-white disparities in ASIRs were highest for oesophagus (black/white ratio 4.3 for males and 2.9 for females) but lower for laryngeal cancer and small or non-existent for oral cavity pharynx. NHIS data showed that by the 1970s the U.S. black/white ratios of prevalence were slightly > 1.0 for current smoking but 0.9 (and 0.7 by 1997 and 2003) for current drinking. Disparities in alcoholic liver disease had disappeared by 2003. Conclusions: Further declines in black-white disparities in cancer rates may occur (allowing for lag times), but the larger disparities for oesophageal cancer support the need to explore etiologic factors interacting with alcohol that continue to differ in prevalence between blacks and whites.

Prakash KM; Fook-Choong S; Yuen Y; Tan EK. Exploring the relationship between caffeine intake and essential tremor. Journal of Neurological Sciences 251(1-2): 98-101, 2006. (22 refs.)

Background: It has been suggested that environmental factors may be associated with essential tremor (ET). This study was carried out to evaluate the association of caffeine intake with ET. Method: In a case control study, patients diagnosed with ET and healthy controls underwent a standardized questionnaire interview to evaluate the exposure to coffee and tea intake. A multivariate logistic regression analysis was carried out to evaluate the association of caffeine intake and other environmental factors with risk of ET. Results: 179 subjects including 79 ET patients and 100 controls matched for age, gender and ethnicity were included in the analysis. Univariate analysis revealed that caffeine consumption in ET patients was higher than control group (median and 90th percentile range: 2300 (0, 9000) mg-years versus 1500 (0, 6090) mg-years, p=0.01). However, the multivariate logistic regression analysis demonstrated that caffeine was no longer a significant factor associated with ET (p=0.119). There was no significant correlation between amount of caffeine intake and disease duration (Spearman's r=0.194; p=0.202) or total tremor score (Spearman's r=0.045; p=0.771) in ET patients. Conclusion: Caffeine consumption was not associated with risk of ET in our study population. Further studies are needed to investigate the significance of gene-environmental interaction in ET.

Rehm J; Taylor B. Alcohol consumption, stroke and public health: An overlooked relation? (editorial). Addiction 101(12): 1679-1681, 2006. (25 refs.)

Rehm J; Taylor B; Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug and Alcohol Review 25(6): 503-513, 2006. (45 refs.)

The use of alcohol, tobacco and illicit drugs entails considerable burden of disease: in 2000, about 4% of the global burden as measured in disability adjusted life years was attributable to each alcohol and tobacco, and 0.8% to illicit drugs. The burden of alcohol in the above statistic was calculated as net burden, i.e. incorporating the protective health effects. Tobacco use was found to be the most important of 25 risk factors for developed countries in the comparative risk assessment underlying the data. It had the highest mortality risk of all the substance use categories, especially for the elderly. Alcohol use was also important in developed countries, but constituted the most important of all risk factors in emerging economies. Alcohol use affected younger people than tobacco, both in terms of disability and mortality. The burden of disease attributable to the use of legal substances clearly outweighed the use of illegal drugs. A large part of the substance-attributable burden would be avoidable if known effective interventions were implemented.

Ross J; Teesson M; Darke S; Lynskey M; Ali R; Ritter A et al. Short-term outcomes for the treatment of heroin dependence: Findings from the Australian Treatment Outcome Study (ATOS). Addictive Disorders and their Treatment 5(3): 133-143, 2006. (26 refs.)

AIMS: To examine drug use, crime, physical and mental health at 3 months postentry to treatment for heroin dependence. DESIGN: Longitudinal cohort study. SETTING: Sydney, Melbourne, and Adelaide, Australia. PARTICIPANTS: Seven hundred forty-five individuals recruited on entry to treatment for heroin dependence in the 3 main treatment modalities (methadone/buprenorphine maintenance therapy; detoxification; residential rehabilitation), and 80 heroin users who were not seeking treatment at baseline. MEASUREMENTS: Structured questionnaires were used to measure drug use, crime, psychopathology, and physical health. At 3 months 10% of the cohort were randomly selected and provided a hair sample as a biologic measure of heroin use for the month preceding interview. FINDINGS: A 3-month follow-up rate of 88% (n=728) was achieved. There were substantial reductions in heroin use, polydrug use, injection-related risk-taking, heroin overdose, and criminal activity, as well as improvements in physical and mental health. Improvements were less marked among the nontreatment group. There was strong concordance between the cohort's self-reported heroin use and hair analysis results. Positive outcomes tended to be associated with a greater cumulative number of treatment days, and fewer treatment episodes. CONCLUSIONS: Treatment works in the short term. Greater treatment exposure was related to improvements across a range of outcomes.

Selin KH. Alcohol Use Disorder Identification Test (AUDIT): What does it screen? Performance of the AUDIT against four different criteria in a Swedish population sample. Substance Use & Misuse 41(14): 1881-1899, 2006. (27 refs.)

The purpose of this article was to examine the kinds of alcohol use disorder the AUDIT most accurately screens for since the literature is inconsistent in the use of the AUDIT. Sometimes it is viewed as a measure of hazardous or harmful drinking and sometimes as a measure of dependence. The performance of its subsets (consumption items, AUDIT-C; and problem items, AUDIT-P) and of the full AUDIT (AUDIT-10) was tested against four criteria: high-volume drinking, alcohol-related social problems, alcohol-related health problems, and alcohol dependence. A general population sample of 600 Swedish subjects was interviewed during the winter 2000-01. The results document that, at the recommended cutoff score of 8+, the AUDIT-10 performed well against all four criteria, even if less well against the alcohol-related health problems. The AUDIT-C also performed well against all the problem criteria, showing high areas under the ROC curve, even though significantly lower than the full scale. When measuring high-volume drinking, the AUDIT-C outperformed the full instrument. Scoring at least 1 on the AUDIT-P improved sensitivity of the instrument when screening for social problems and dependence and made it a satisfactory measure of health problems. It is suggested that, when using the full AUDIT to screen for problems more severe than high-volume drinking, the criterion of scoring at least 1 on the AUDIT-P should be applied in combination with a cutoff score on the AUDIT-C.

Shahpesandy H; Pristasova J; Janikova Z; Mojzisova R; Kasanicka V; Supalova O. Alcoholism in the elderly: A study of elderly alcoholics compared with healthy elderly and young alcoholics. Neuroendocrinology Letters 27(5): 651-657, 2006. (58 refs.)

OBJECTIVES: To test the hypothesis that early-onset alcoholism can be differentiated from alcoholism in the elderly by more severe substance related problems, more frequent family history, higher mortality rate, and antisocial behaviour. METHODS: 73 elderly alcoholics (mean age 70.2 yrs) were compared with 90 young alcoholics (mean age 43.9 yrs) and 70 elderly non alcoholics (mean age 76 yrs). We focused on, family history, co-morbidity, mortality, biological markers (AST, GGT, MCV), and demographics. Geriatric Scale of Depression, Standardized Mini-Mental State Examination and Munich Alkoholisin Test were also used. All results analysed by the SPSS. RESULTS: FH was significantly (p < 0.001) more often positive in Y (52%) than in the elderly (15%) and controls (10%). Significantly (p < 0.001) more elderly (57.5%) are married than young alcoholics (37.8%) and controls (21.4%), significantly (p < 0.001) more elderly (72.6%) has elementary education compared with young (44.4%). Elderly alcoholics abstain significantly (p < 0.001) more (> 27 months) than the young ones (similar to 11 months). Significantly (p < 0.001) more young (43%) had forensic history than the elderly (8.2%). Significantly (p < 0.01) more death rate was found in the elderly (19.2%) than in the young (5.6%) and controls (1.4%). Significantly (p < 0.01) more elderly (61%) prefer spirits than the young (21%), but significantly more of the young (> 63%) combine spirits with beer and wine than did the elderly (> 32%). Significintly (p < 0.001) more alcoholics (both elderly and young) had elated levels of MCV (> 70%), AST and GGT (> 60%) than control. We have found significantly (p < 0.001) higher rate of comorbidity of CNS diseases, GIT, injuries, haematological and infectious diseases in the groups of elderly and young alcoholics than in control subjects. On the other hand, prevalence of cardiovascular, ORL, ophtahmological, endocrine and orthopedic diseases were significantly (p < 0.01) higher in C. To compare elderly patients with young ones, we found significantly (p < 0.01) higher rate of respiratory, endocrine, cardiovascular and CNS diseases, and dementia in elderly alcoholics (p < 0.001). Depression and abuse of prescribed medication was significantly (p < 0.01) more often in the C, but suicide attempts, neurotic spectrum disorders and personality disorders were significantly (p < 0.01) often in group of Y. CONCLUSION: Young alcoholics have significantly more often positive family history of alcoholism, drink significantly bigger amounts of alcohol, have more forensic history, and personality disorders in comparison to elderly ones. On the other hand elderly alcoholics tend to have more somatic complication due to alcohol abuse, but drink less alcohol, tend to abstain longer, and have less psychopathic traits. In contrast to literature, the majority of elderly alcoholics are married, have low education and do not belong to high social classes.

Shane P; Diamond GS; Mensinger JL; Shera D; Wintersteen MB. Impact of victimization on substance abuse treatment outcomes for adolescents in outpatient and residential substance abuse treatment. American Journal on Addictions 15(Supplement 1): 34-42, 2006. (32 refs.)

This paper considers whether victimization moderates adolescents' outcomes in substance abuse treatment. Adolescents (N = 975) in outpatient and residential settings were assessed at intake, three, six, nine, and 12 months. Differential outcomes by gender and degree of victimization were analyzed. Dependent variables were marijuana use and substance-related problems. The residential sample reported higher baseline marijuana use and victimization. Both samples significantly reduced marijuana use and associated-problems during treatment. Victimization was significantly related to more substance-related problems at intake and follow-up. More severe trauma histories in residential females were associated with significantly greater persistence in substance-related problems post-discharge.

Shiri R; Hassani KF; Ansari M. Association between opium abuse and comorbidity in diabetic men. American Journal on Addictions 15(6): 468-472, 2006. (30 refs.)

The aims of this study were to determine the prevalence of opium abuse in diabetic men and to investigate its association with comorbidity. The study population was comprised of 312 consecutive diabetic men aged 20 years or older residing in the study area in 2005. The prevalence of self-reported opium abuse was 11.2%. Opium use was associated with low socioeconomic status, smoking, tea consumption, and a higher prevalence of erectile dysfunction (ED) and severe depression. The prevalence of severe depression was 22.8% among 35 men who used opium and 13.4% among 277 who did not use it. The prevalence of moderate or severe ED was 85.7% among opium users and 66.1% among non-users. The risk of ED was two times (95% CI 1.0-7.4) higher in opium users compared with nonusers.

Singh S. Adolescent salvia substance abuse. Addiction 102(5): 823-824, 2007. (8 refs.)

Background: Salvia divinorum is a non-water-soluble hallucinogen that is becoming increasingly popular among adolescents. Salvia is a highly selective full agonist of primate and cloned human cerebral kappa-opioid receptors, although its psychotomimetic effects are similar to serotonergic agonists and NMDA glutamate antagonists. Salvia has been associated with depersonalization, laughter, feelings of levitation and self-consciousness. These effects resolve within 30 minutes following use. Salvia has been banned in many countries, although it remains legal and easily assessable over the internet in the United States. Case description A 15-year-old man with a history of salvia and marijuana use presented to psychiatric emergency services with acute onset of mental status changes characterized by paranoia, deja vu, blunted affect, thought blocking and slow speech of 3 days' duration. Conclusion: There is limited literature discussing the clinical effects of salvia use. Based on this case presentation, salvia use may be associated with many undocumented long-term effects such as deja vu. The ease of use and increasing popularity of salvia requires further investigation into the clinical effects of salvia use.

Spinks R; Caspers K; Langbehn D; Yucuis R; McKirgan LW; Arndt S; Pfalzgraf CJ; Cadoret R. Co-morbid health conditions at mid-life in the Iowa adoptees. Addictive Behaviors 32(5): 991-1002, 2007. (38 refs.)

Adverse health effects due to alcohol and illicit drug abuse and dependence have been well documented. This study examines the effect of substance misuse on five major groups of health conditions using a sample of well characterized adoptees. The sample consisted of 742 adoptees interviewed in the last wave of the Iowa Adoption Studies. Death rate analyses included an additional 34 participants who had died prior to the last follow-up. Substance use patterns and medical history were assessed using the SSAGA-II (Bucholz, K. K., Cadoret, R. J., Cloninger, C. R., Dinwiddic, S. H., Hesselbrock, V M., Numberger, J. L., Jr.,//// (1994). A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. Journal of Studies on Alcohol, 55 (2), 149-158). Subjects were divided into three groups according to DSM-IV diagnostic criteria, controls, alcohol abuse or dependence only (alcohol only), and the Alcohol-Drug group (abuse or dependence diagnosis on at least one illicit substance with or without alcohol diagnosis). Incidence rates of various diseases were measured using logistic regression. Survival analyses were used to examine whether substance abusers developed cardiovascular or metabolic disease at an earlier age than control subjects. Diagnostic grouping made no difference in the incidence rates or age of onset of health conditions. The amount of alcohol consumed by males significantly predicted higher number of overall health complaints as well as higher incidence rates of cardiovascular disease. The amount of illicit drug exposure did not predict an earlier age of diagnosis for cardiovascular or metabolic disease. Individuals in the Alcohol-Drug group had an increased incidence of deaths than either the alcohol-only or the control groups.

Strain EC. Methadone dose during maintenance treatment. IN: Strain EC; Stitzer ML, eds. The Treatment of Opioid Dependence. Baltimore: Johns Hopkins University Press, 2006. pp. 89-118. (114 refs.)

Despite over 35 years of clinical use of methadone for opioid dependence, appropriate dosing remains controversial. Average dose can vary widely. There are those who advocate 'low' doses and others 'high' doses. The chapter has three sections. The first section provides an historical overview of methadone dosing, to provide the context. The second section examines the efficacy of methadone treatment based on survey data. The third section addresses a series of topics related to dosage, including side effects, methadone blood levels, and current recommendations for dosage.

Sykes T. What did I do last night?. Emmaus PA: Rodale, 2006. (0 refs.)

This is a well-written memoir of the author's emerging alcohol problem, the events that led him to recognize the need to cease drinking, and what he did to accomplish this, and his experience of this. The book covers a 15 year period. The chapters are titled in a count-down fashion, i.e the number of days prior to or after the day on which he had his last drink, Day 0. It begins on "-5214 days", when as a student at Eton in England he was allowed to drink at the the College's school bar, the Tap, which circumvented licensing laws by presenting itself as a private social club. It proceeds through a number of landmark occasions, if unrecognized at the time, such as on "-350 Days" finding the perfect job. In New York as a journalist, he became the bar columnist for the New York Post. It concludes on "+396 Days", when, still living in New York, he is headed to the airport to journey to Ireland where he and his wife will await the birth of their first son.

Taylor J. Life events and peer substance use and their relation to substance use problems in college students. Journal of Drug Education 36(2): 179-191, 2006. (29 refs.)

Substance use disorders among college students are not well understood, and the present study examined the relationship of two environmental factors to alcohol and drug use problems in 616 (316 women) college students. Participants completed measures assessing substance use problems, life events, and substance use among peers. Alcohol use problems were significantly associated with higher drug use problems and regular use of illicit drugs among friends. Drug use problems were significantly associated with male gender, higher alcohol use problems, regular use of alcohol and drugs among friends, illicit drug use among romantic partners, and higher numbers of negative life events. Results extend previous research and suggest that college students who experience multiple negative life events and/or affiliate with substance using friends and romantic partners may be at risk for developing a substance use problem.

Taylor B; Rehm J; Patra J; Popova S; Baliunas D. Alcohol-attributable morbidity and resulting health care costs in Canada in 2002: Recommendations for policy and prevention. Journal of Studies on Alcohol 68(1): 36-47, 2007. (46 refs.)

Objective: Alcohol is one of the most important risk factors for burden of disease, particularly in high-income countries such as Canada. The purpose of this article was to estimate the number of hospitalizations, hospital days, and the resulting costs attributable to alcohol for Canada in 2002. Method: Exposure distribution was taken from the Canadian Addiction Survey and corrected for per capita consumption from production and sales. For chronic disease, risk relations were taken from the published literature and combined with exposure to calculate age- and gender-specific alcohol-attributable fractions. For injury, alcohol-attributable fractions were taken directly from available statistics. Data on the most responsible diagnosis, length of stay for hospitalizations, and costs were obtained from the national Canadian databases. Results: For Canada in 2002, there were 195,970 alcohol-related diagnoses among acute care hospitalizations, 2,058 alcohol-attributable psychiatric hospitalizations, and 183,589 alcohol-attributable admissions to specialized treatment centers. These accounted for 1,246,945 hospital days in acute care facilities, 54,114 hospital days in psychiatric hospitals, and 3,018,688 hospital days in specialized treatment centers (inpatient and outpatient). The main causes of alcohol-attributable morbidity were neuropsychiatric conditions, cardiovascular disease, and unintentional injuries. In total, Can. $2.29 billion were spent on alcohol-related health care. Conclusions: Alcohol poses a heavy burden of disease as well as a financial strain on Canadian society. However, there are evidence-based effective and cost-effective policy and legislative interventions as well as measures to better enforce these laws.

Templer R; Boyer R; Lambert J; Mosier K; Duncan CR. Psychological distress among female spouses of male at-risk drinkers. Alcohol 40(1): 41-49, 2007. (63 refs.)

The consequences of alcoholism on the mental health of spouses of lifetime at-risk drinkers are only known from studies on alcoholics already in treatment. A retrospective analysis was conducted using data from a Quebec community health survey. The purpose of this study was twofold. First, our goal was to ascertain the mental health of female spouses living with a male lifetime at-risk drinker. Secondly, we wanted to examine the relationship between male lifetime at-risk drinkers (aged 30-54 years) and the psychological distress of their nondrinking female spouses. Lifetime at-risk drinking, for the purposes of this study, was defined as having at least two positive answers to the CAGE questionnaire. Couples wherein both spouses were deemed not at-risk for problem drinking by the CAGE instrument (0 or I positive answer) formed the control group. Psychological distress was measured using the Indice de Detresse Psychologique de l'Enque'te Sante Quebec (Preville, M., Boyer, R., Potvin, L., Perrreault, C., & Legare, G. (1992). La detresse psychologique: determination de la fiabilite' et de la validite' de la mesure utilisee dans l'enquelte SanteQuebec. Cahier de recherches #7, Montreal, Sante Quebec.). It measures symptoms of anxiety, depression, aggressivity, and cognitive impairments. Scores of >= 22 (out of 100) were indicative of a high level of psychological distress. This study confirmed higher levels of psychological distress in female spouses of male lifetime at-risk drinkers in the general population. An exploratory study examined the association between the psychological distress of female spouses and each of the following nine independent variables: male partner lifetime at-risk drinker, stressful life events, job situation, socioeconomic status, perceived health status, presence of children less than 15 years, length of the marital relationship, presence of a confidant, and availability of social support. Lifetime at-risk drinking is a risk factor for the spouse's psychological distress. An examination of the demographic characteristics related to alcohol intake in male lifetime at-risk drinkers is also described in this study.

Trim RS; Meehan BT; King KM; Chassin L. The relation between adolescent substance use and young adult internalizing symptoms: Findings from a high-risk longitudinal sample. Psychology of Addictive Behaviors 21(1): 97-107, 2007. (45 refs.)

The present study examined the role of adolescent substance use and its antecedent behavioral and familial risk factors in the prediction of young adult internalizing symptoms 10 years later, using a community sample of children of alcoholics (n = 194) and demographically matched controls (n = 209). Using growth curve modeling, the authors found that initial levels of adolescent alcohol and drug use (Rag, = 13) and growth in drug use during adolescence predicted higher levels of internalizing symptoms in young adulthood, even after including in the models shared risk factors for both internalizing symptoms and adolescent substance use. These effects remained significant after including concurrent substance use in adulthood, suggesting that adolescent substance use exerts a long-term impact on young adult internalizing symptoms over and above the effects of persistent substance use over time. The present investigation further revealed that initial levels of alcohol and drug use in adolescence mediate the relation between parental alcoholism and young adult internalizing symptoms. Findings provide evidence for the long-term effects of adolescent substance use on young adult functioning and can help inform both etiological and prevention research.

Turrisi R; Mallett KA; Mastroleo NR; Larimer ME. Heavy drinking in college students: Who is at risk and what is being done about it? (review). Journal of General Psychology 133(4): 401-420, 2006. (101 refs.)

Problem drinking and related consequences are a major social issue plaguing college campuses across the United States. Each year, alcohol is responsible for fatalities, assaults, serious injuries, and arrests that occur among college students. The authors review and discuss the risk factors, drinking patterns, and consequences that are relevant to the general student population. In addition, the authors highlight individuals at an increased risk of experiencing alcohol-related problems, such as Greek-letter social organization members and student athletes. The authors also discuss the interventions that attempt to reduce risky drinking and related problems in these subgroups as well as the future directions for research.

Venn A; Britton J. Exposure to secondhand smoke and biomarkers of cardiovascular disease risk in never-smoking adults. Circulation 115(8): 990-995, 2007. (17 refs.)

Background - Exposure to secondhand smoke has been associated with a disproportionately high risk of coronary heart disease, thought to be mediated through inflammation, platelet aggregation, and/or endothelial dysfunction. The epidemiological association between objectively measured exposure to secondhand smoke and biomarkers of heart disease risk has not been investigated, however. Methods and Results - We have investigated the cross-sectional relation between secondhand smoke exposure, measured objectively as cotinine, and recognized biomarkers of heart disease risk, namely C-reactive protein, homocysteine, fibrinogen, and white blood cell count, in 7599 never-smoking adults from the Third National Health and Nutrition Examination Survey. Compared with subjects with no detectable cotinine, those with detectable but low-level cotinine (range, 0.05 to 0.215 ng/mL) had significantly higher levels of both fibrinogen ( adjusted mean difference, 8.9 mg/dL; 95% CI, 0.9 to 17.0; P = 0.03) and homocysteine (0.8 mu mol/L; 95% CI, 0.4 to 1.1; P < 0.001) but not C-reactive protein or white blood cell count. Effect estimates of similar magnitude and significance were seen in subjects in the high category of cotinine exposure (> 0.215 ng/mL). The increased levels of fibrinogen and homocysteine seen in relation to secondhand smoke exposure were equivalent to approximate to 30% to 45% of those seen for active smoking. Conclusions - Passive smokers appear to have disproportionately increased levels of 2 biomarkers of cardiovascular disease risk, fibrinogen and homocysteine. This finding provides further evidence to suggest that low-level exposure to secondhand smoke has a clinically important effect on susceptibility to cardiovascular disease.

Virmani A; Binienda Z; Ali S; Gaetani F. Links between nutrition, drug abuse, and the metabolic syndrome. Annals of the New York Academy of Sciences. Cellular and molecular mechanisms of drugs of abuse and neurotoxicity 1074: 303-314, 2006. (56 refs.)

Nutritional deficiency in combination with drug abuse may increase risk of developing the metabolic syndrome by augmenting cell damage, excitotoxicity, reducing energy production, and lowering the antioxidant potential of the cells. We have reviewed here the following points: effects of drugs of abuse on nutrition and brain metabolism; effects of nutrition on actions of the drugs of abuse; drug abuse and probability of developing metabolic syndrome; role of genetic vulnerability in nutrition/drug abuse and brain damage; and the role of neuroprotective supplements in drug abuse. Nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. The strategies available, in particular the nutritional approach to protect the drug abusers from the metabolic syndrome and other diseases are discussed.

Wang JY; Hsueh PR; Jan IS; Lee LN; Liaw YS; Yang PC et al. The effect of smoking on tuberculosis: different patterns and poorer outcomes. International Journal of Tuberculosis and Lung Disease 11(2): 143-149, 2007. (34 refs.)

SETTING: It has been well documented that smoking increases the risk of tuberculosis (TB). However, few studies have evaluated the impact of smoking on TB. We conducted this retrospective study to evaluate the influences of smoking on the manifestation and outcome of TB. DESIGN: All culture-confirmed TB patients from July 2002 to December 2003 were identified and their medical records reviewed. RESULTS: A total of 523 TB patients, including 207 (39.6%) who had ever smoked, were studied. The ever-smokers were significantly older, more likely to have underlying diseases and a duration of symptoms >60 days, and less likely to have extra-pulmonary involvement and have completed treatment (64.7% vs. 78.5%). Radiographically, more ever-smokers with pulmonary tuberculosis (PTB) presented with miliary lesions, multiple nodules or masses, upper lung predominance and cavitation than never-smokers. Although smoking was associated with poor prognosis on univariate survival analysis, multivariate analysis revealed that independent poor prognostic factors included age, underlying disease, symptom duration <= 60 days, extra-pulmonary involvement, serum albumin level < 3.5 g/dl and delayed treatment. CONCLUSIONS: Our results demonstrate that smoking is significantly associated with radiographic manifestations of PTB, but not with death among PTB patients.

White B; Day C; Maher L. Self reported risk behaviour among injecting drug users: Self versus assisted questionnaire completion. AIDS Care 19(3): 441-447, 2007. (21 refs.)

The current study aimed to compare self-reported injecting and sexual risk behaviour among Needle and Syringe Program (NSP) attendees who self-completed a questionnaire to that of those who received assistance in completing the questionnaire. Information on demographic, injecting and sexual risk behaviour was collected via a self- completed questionnaire for an annual cross-sectional survey of injecting drug users (IDUs) recruited from sentinel NSPs around Australia. Assistance was provided when necessary and recorded. Of 2,035 participants, 1,452 (71%) reported completing the questionnaire without assistance. Being male and nominating a language other than English spoken at home was independently associated with receiving assistance with questionnaire completion. Participants who reported heroin as the drug last injected were also more likely to receive assistance. Multivariate analyses revealed those who received assistance with questionnaire completion were less likely to report re-using a syringe after someone else and less likely to report sex work in the past month. The current findings suggest self- completion of risk behaviour questionnaires should be considered as an alternative to interviewer administered questionnaires to maximise accuracy of self- reports.

Wright T; Myrick H; Henderson S; Peters H; Malcolm R. Risk factors for delirium tremens: A retrospective chart review. (review). American Journal on Addictions 15(3): 213-219, 2006. (36 refs.)

A retrospective chart review was performed within an inpatient VA hospital setting in an attempt to identify risk factors for delirium tremens (DTs). Cases of delirium tremens were compared to cases where patients' alcohol withdrawal during hospitalization did not progress to DTs. Significant differences were found in regard to prior histories of DTs and laboratory values at admission. The amount and duration of benzodiazepine use during hospitalization, antipsychotic use during hospitalization, and length of hospitalization were also statistically different between the groups. While not reaching statistical significance, there were differences in reason for admission and relapse rate upon follow-up between the groups.

Yang SM; Lynch JW; Raghunathan TE; Kauhanen J; Salonen JT; Kaplan GA. Socioeconomic and psychosocial exposures across the life course and binge drinking in adulthood: Population-based study. American Journal of Epidemiology 165(2): 184-193, 2007. (51 refs.)

Despite recognition of the health risks of binge drinking, its life-course precursors have not been widely examined. Data from the Kuopio Ischemic Heart Disease Risk Factor Study (1984-1989) were used to investigate the association between socioeconomic and psychosocial exposures across the life course and binge drinking in a population-based sample of 2,316 middle-aged men. Binge drinking was defined as drinking at least four bottles of beer, one bottle of wine, one bottle of strong wine, or six servings of spirits on a single occasion. A composite indicator of childhood socioeconomic position was based on parental education, occupation, and number of rooms and divided into tertiles. Low childhood socioeco