To assess the incidence of long-term smoking cessation as a function of age, gender, social grade and their interactions.

Cross-sectional surveys of population representative samples of smokers in England.

24,094 ever smokers (≥21 and ≤60 years of age) participating in household surveys between November 2006 and February 2011.

The ratio of long-term (>1 year) ex-smokers to ever-smokers was calculated for each age. Regression analyses were used to model the association between age and quit ratio, with the change in quit ratio by year of age n years versus all years up to n-1 years yielding an estimate of the quitting incidence at that age. Analyses were conducted for the entire sample and then for the sample stratified by gender and social grade, and interactions assessed between these variables.

A cubic trend was needed to fit the data. The estimated long-term annual quitting incidence between ages 18 and 30 was 1.5% (95% CI=0.8%-2.2%), between 31 and 50 it was 0.3% (95% CI=0.0%-0.7%) and between 51 and 60 it was 1.2% (95% CI=0.0%-2.4%). Age interacted with gender and social grade: women and smokers from higher social grades had a higher incidence of quitting than men and those from lower social grades specifically in young adulthood.

The incidence of smoking cessation in England appears to be greater in young and old adults compared with those in middle age. Women and higher social grade smokers show a greater incidence of quitting than men and those from lower social grades specifically in young adulthood.

To examine prospectively the contribution of the recreational social environment to Ecstasy initiation.

Population-based retrospective/prospective cohort study.

Data from screening an Australian young adult population to obtain samples of users and non-users of Ecstasy.

A sample of 204 Ecstasy-naïve participants aged 19 to 23 years was obtained, and a 6 month follow-up identified those who initiated Ecstasy use.

We assessed a range of predictors of Ecstasy initiation, including elements of participants’ social environment, such as Ecstasy-using social contacts and involvement in recreational settings.

More than 40% of Ecstasy-naïve young adults reported ever receiving Ecstasy offers. Ecstasy initiation after 6 months was independently predicted by having, at recruitment, many Ecstasy-using social contacts (OR 6.30, 95% CI: 1.60, 24.76), attending electronic/dance music events (OR 5.06, 95% CI: 1.48, 17.27), receiving an Ecstasy offer (OR 4.55, 95% CI: 1.12, 18.45), early cannabis use (OR 8.35, 95% CI: 1.65, 42.23) and psychological distress (OR 7.16, 95% CI: 1.75, 29.18). Adjusted population attributable fractions were highest for Ecstasy-using social contacts (21.4%) and event attendance (18.3%).

In Australia, Ecstasy initiation in early adulthood is predominantly associated with social environmental factors, including Ecstasy-using social contacts and attendance at dance music events, and is less commonly associated with psychological distress and early cannabis use, respectively. A combination of universal and targeted education programs may be appropriate for reducing rates of Ecstasy initiation and associated harms.

Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator.

Secondary mediation and moderation analyses of COMBINE study data.

11 United States academic sites.

863 patients randomized to one of four treatment groups: naltrexone (100mg/d; n=209), the Combined Behavioral Intervention (CBI, n=236), naltrexone and CBI combined (n=213), and placebo naltrexone (n=205).

Percent Days Abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, were measured at baseline, week 4 and week 12 using the Obsessive-Compulsive Drinking Scale.

Compared with placebo, naltrexone, CBI, and the combination all increased PDA by an additional 6-10 percentage points for those with high cravings (p<0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were at least partially mediated by cravings; craving reduction explained 48-53% of treatment effects (p<0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks.

The Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) naltrexone + Combined Behavioral Intervention combination may not be more beneficial than either monotherapy because craving reduction is a common mechanism of both.

To prospectively investigate the relation between cannabis use expectancies and cannabis use prior to and during a self-initiated cannabis cessation attempt.

Cohort design that followed participants for four weeks following a self-initiated cessation attempt.

United States Department of Veterans Affairs medical center.

100 cannabis dependent military veterans.

The Marijuana Effects Expectancy Questionnaire [1] at baseline. The timeline follow-back procedure [2] at baseline and during the cessation attempt.

Cannabis use at baseline was associated with positive (p = .01), but not negative expectancies (p = .25). Cannabis lapse was associated with positive (p = .03) and negative expectancies (p = .01), and relapse was associated with positive (p = .04), but not negative expectancies (p = .21). The trajectory of average cannabis use during the cessation period was associated with positive (p = .03), but not negative expectancies (p = .96). Results were similar in effect and statistical significance when adjusting for demographic factors, motivation to quit cannabis, mental disorder diagnoses, and alcohol and tobacco use, and when analyzing complete data sets obtained through multiple imputation.

In the United States, cannabis use expectancies, especially those regarding the positive effects of cannabis use, appear to be strongly and consistently linked to cannabis use and quit failure.

To conduct a systematic review and meta-analysis on all-cause mortality in people with alcohol use disorders.

Using the MOOSE guidelines, studies were identified through MEDLINE, EMBASE, and Web of Science up to August, 2012. Prospective and historical cohort studies including a comparison of alcohol use disorder with a control group investigating all-cause mortality risk were included.

This meta-analysis included 81 observational studies with 221 683 observed deaths among 853 722 people with alcohol use disorder. In men, the relative risk (RR) among clinical samples was 3.38 (95% confidence interval [CI]: 2.98-3.84); in women it was 4.57 (95% CI: 3.86-5.42). Alcohol use disorders identified in general population surveys showed a 2-fold higher risk compared with no alcohol use disorder in men; no data were available for women. RRs were markedly higher for those ≤40 years old (8-fold in men, 13-fold in women) while still being at least 2-fold among those 60 years or older.

Mortality in people with alcohol use disorders is markedly higher than previously thought. Women have generally higher mortality risks than men. Among all people with alcohol use disorders, people in younger age groups and people in treatment show substantially higher mortality risk than others in that group.

To assess reliability and validity of self-reported cannabis dose and potency measures.

Cross-sectional study comparing self-reports with objective measures of amount of cannabis and THC concentration.

Ecological study with assessments at participants′ home or in a coffee shop.

Young adult frequent cannabis users (n=106) from the CanDep study.

The objectively measured amount of cannabis per joint (dose in grams) was compared with self-reported estimates using a prompt card and average number of joints made from one gram of cannabis. In addition, objectively assessed THC concentration in participant's cannabis was compared with self-reported level of intoxication, subjective estimate of cannabis potency, and price per gram of cannabis.

Objective estimates of doses per joint (0.07-0.88 grams/joint) and cannabis potency (1.1-24.7%) varied widely. Self-reported measures of dose were imprecise, but at group level average dose per joint was accurately estimated with the number of joints made from one gram (limit of agreement (loa) = -0.02 gram, 95% confidence interval (CI) = -0.29; 0.26), whereas the prompt card resulted in serious underestimation (loa = 0.14 gram, 95% CI = -0.10; 0.37). THC concentration in cannabis was associated with subjective potency (‘average’ 3.77% (P=0.002) and ‘(very) strong’ 5.13% more THC (P<0.001) than ‘(very) mild’ cannabis) and with cannabis price (about 1% increase in THC concentration per euro spent on one gram of cannabis, P<0.001), but not with level of intoxication.

Self-report measures relating to cannabis use appear at best to be weakly associated with objective measures. Of the self-report measures, number of joints per gram, cannabis price and subjective potency have at least some validity.

To provide novel, population-based estimates of the influence of minimum legal drinking age (MLDA) legislation on target in-patient hospital events in Canada.

Regression–discontinuity analyses on rates of Canadian in-patient admissions.

All in-patient hospitalizations in Canada (except Québec) between 1 April 1997 and 31 March 2007.

Individuals aged 15–22 years admitted to hospital.

International Classification of Diseases-9/10 codes for alcohol-use disorders/poisoning, injury, suicide, assault and motor vehicle accidents were considered as target morbidity conditions.

Compared with the baseline hospitalization rate just prior to the MLDA, admissions at the MLDA rose significantly (P ≤ 0.001) for alcohol-use disorders/poisoning for males (17.3%) and females (21.1%), as well as for suicide events for the combined sample (9.6%, P = 0.029). Among males, there was a significant 4.4% increase (P = 0.001) in a broad class of injuries, including a 9.2% jump (P = 0.020) in admissions for motor vehicle accidents compared with the baseline hospitalization rate just prior to the MLDA.

Removal of minimum legal drinking age restrictions is associated with significant population-level increases in hospital admissions among young adults in Canada for alcohol-use disorders/poisoning, as well as for other serious injuries, especially among males. Current international minimum legal drinking age policy discussions should account for the impact of the minimum legal drinking age on severe morbidity outcomes.

To determine the longitudinal associations between perceived pubertal timing and recent substance use between the ages of 11 and 17 years.

A school-based cohort sequential study of adolescents in rural North Carolina, USA (n = 6892, 50% female) in the 6–8th grades at baseline and interviewed across five consecutive semesters.

Self-administered questionnaires in a group setting measured perceived pubertal development using the Pubertal Development Scale and adolescents reported past 3-month use of cigarettes, alcohol and marijuana. Latent class growth analysis determined the longitudinal relationships between perceived pubertal timing (early, on-time and late) and use of the three substances.

A negative quadratic model was the best-fitting model for all three substances. Higher proportions of early developers had used cigarettes and marijuana within the past 3 months at age 11 compared with on-time (P < 0.001 and P = 0.013) and late developers (P = 0.010 and P = 0.014) and a higher proportion of early developers had recently used alcohol at age 11 compared with on-time adolescents (P < 0.001). However, the proportion of recent cigarette and marijuana users increased more across adolescence for on-time adolescents compared with early developers (P = 0.020 and P = 0.037). Desistance in the proportion of substance users was similar for all adolescents (all P > 0.050).

Adolescents who believe they are more advanced in puberty than their peers are more likely to have used cigarettes, alcohol and marijuana recently compared with adolescents who believe they are on-time or late developing; these findings are mainly due to differences in use at age 11.

Cross-study comparisons of effect sizes suggest that varenicline is more effective than nicotine replacement therapy (NRT) in aiding smoking cessation, but evidence from direct comparisons is limited. This study compared biochemically verified 52-week sustained abstinence rates in smokers attending the same clinical service according to whether they used varenicline or NRT in their quit attempt.

This was a prospective cohort study of 855 smokers attending a large smoking cessation clinic who used their choice of NRT product or varenicline in their quit attempt. All received the same behavioural support programme and chose their medication option (n = 519 varenicline; n = 336 NRT). The primary outcome measure was self-report of 52 weeks' abstinence following the target quit date confirmed by expired air carbon monoxide concentration. Baseline measures included socio-demographic variables, mental health diagnoses, measures of smoking, cigarette dependence and past use of NRT or varenicline.

The 52-week abstinence rates were 42.8% versus 31.0% in those using varenicline versus NRT, respectively (P < 0.001). After adjusting for all baseline variables, the odds of remaining abstinent for 52 weeks were 2.03 (95% CI 1.46–2.82), P < 0.001 times higher in those using varenicline than those using NRT.

Smokers in the same behavioural support programme who use varenicline appear to have a greater probability of achieving long-term abstinence than those using their choice of nicotine replacement therapy options, even after adjusting for potentially confounding smoker characteristics.

Skog's theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit ‘collective displacement’ of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol.

Data on alcohol consumption from the World Health Organization's general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution.

The distribution of consumption was strongly positively skewed, with 10–15% of the drinkers consuming more than twice the mean consumption. There was also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers.

The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog's theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption.

To examine the association of alcohol-related mortality and other causes of death with neighbourhood density of alcohol-selling outlets for on-site consumption.

Longitudinal study of the adult Swiss population (n = 4 376 873) based on census records linked to mortality data from 2001 to 2008.

Sex-specific hazard ratios (HR) for death and 95% confidence intervals (95%CI) were calculated using Cox models adjusting for age, educational level, occupational attainment, marital status and other potential confounders. The density of alcohol-selling outlets within 1000 m of the residence was calculated using geocodes of outlets and residences.

Compared with >17 outlets within 1000 m the HR for alcohol-related mortality in men was 0.95 (95%CI: 0.89–1.02) for 8–17 outlets, 0.84 (95%CI: 0.77–0.90) for 3–7 outlets, 0.76 (95%CI: 0.68–0.83) for 1–2 outlets and 0.60 (95%CI: 0.51–0.72) for 0 outlets. The gradient in women was somewhat steeper, with a HR comparing 0 with >17 outlets of 0.39 (95%CI: 0.26–0.60). Mortality from mental and behavioural causes and lung cancer were also associated with density of alcohol-selling outlets: HRs comparing 0 outlets with >17 outlets were 0.64 (95%CI: 0.52–0.79) and 0.79 (95%CI: 0.72–0.88), respectively, in men and 0.46 (95%CI: 0.27–0.78) and 0.63 (95%CI: 0.52–0.77), respectively, in women. There were weak associations in the same direction with all-cause mortality in men but not in women.

In Switzerland, alcohol-related mortality is associated with the density of outlets around the place of residence. Community-level interventions to reduce alcohol outlet density may usefully complement existing interventions.

To test the feasibility and effectiveness of brief counseling intervention (BCI) and naltrexone integrated into tuberculosis (TB) care in Tomsk, Russia.

Using a factorial randomized controlled trial design, patients were randomized into: naltrexone (NTX), brief behavioral compliance enhancement therapy (BBCET), treatment as usual (TAU) and BCI.

In the Tomsk Oblast, hospitalized TB patients diagnosed with alcohol use disorders (AUDs) by the DSM-IV were referred at the start of TB treatment. Of the 196 participants, the mean age was 41 years and 82% were male. Severe TB (84.7% had cavitary disease) and smoking (92.9%) were common. The majority had a diagnosis of an AUD (63.0%); 27.6% reported nearly daily drinking and consumed a median of 16 standard drinks per day.

Primary outcomes were ‘favorable’ TB outcome (cured, completed treatment) and change in mean number of abstinent days in the last month of study compared with baseline. Change in mean number of heavy drinking days, defined as four drinks per day and five drinks per day for women and men, respectively, and TB adherence, measured as percentage of doses taken as prescribed under direct observation, were secondary outcomes. Analysis based on ‘intention-to-treat’ was performed for multivariable analysis.

Primary TB and alcohol end-points between naltrexone and no-naltrexone or BCI and no-BCI groups did not differ significantly. TB treatment adherence and change in number of heavy drinking days also did not differ significantly among treatment arms. Among individuals with a prior quitting attempt (n = 111), naltrexone use was associated with an increased likelihood of favorable TB outcomes (92.3% versus 75.9%, P = 0.02).

In Tomsk Oblast, Russia, tuberculosis patients with severe alcohol use disorders who were not seeking alcohol treatment did not respond to naltrexone or behavioral counselling integrated into tuberculosis care; however, those patients with past attempts to quit drinking had improved tuberculosis outcomes.

To characterize sudden or unnatural deaths with very high-range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1 January 1997 and 31 December 2011.

Case series.

Sydney, Australia.

A total of 263 cases of sudden or unnatural death with a BAC of ≥0.300 g/100 ml.

Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology.

The mean age of decedents was 46.7 years and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (35.0%), combined alcohol/other drug toxicity (14.8%), accidents (18.6%), natural disease (13.3%), suicide (11.0%), homicide (6.8%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371 g/100 ml (range 0.300–0.820 g/100 ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410 g/100 ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%) and cerebellar atrophy (9.0%).

Unnatural deaths with very high-range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle-aged males, with long histories of alcohol problems.

Excessive internet use is becoming a concern, and some have proposed that it may involve addiction. We evaluated the dimensions assessed by, and psychometric properties of, a range of questionnaires purporting to assess internet addiction.

Fourteen questionnaires were identified purporting to assess internet addiction among adolescents and adults published between January 1993 and October 2011. Their reported dimensional structure, construct, discriminant and convergent validity and reliability were assessed, as well as the methods used to derive these.

Methods used to evaluate internet addiction questionnaires varied considerably. Three dimensions of addiction predominated: compulsive use (79%), negative outcomes (86%) and salience (71%). Less common were escapism (21%), withdrawal symptoms (36%) and other dimensions. Measures of validity and reliability were found to be within normally acceptable limits.

There is a broad convergence of questionnaires purporting to assess internet addiction suggesting that compulsive use, negative outcome and salience should be covered and the questionnaires show adequate psychometric properties. However, the methods used to evaluate the questionnaires vary widely and possible factors contributing to excessive use such as social motivation do not appear to be covered.

Animal models show that a single dose of 3,4-methylenedioxymethamhetamine (MDMA; ‘ecstasy’) can result in long-term disruption of sleep. We evaluated the relationship between ecstasy consumption and the use of sleep medications in humans after controlling for key factors.

The Personality and Total Health Through Life project uses a longitudinal cohort with follow-up every 4 years. This study reports data from waves 2 and 3.

Participants were recruited from the electoral roll in the Australian Capital Territory and Queanbeyan, New South Wales, Australia.

Participants were aged 20–24 years at wave 1 (1999–2000).

The study collected self-reported data on ecstasy, meth/amphetamine, cannabis, alcohol, tobacco and use of sleeping medications (pharmaceutical or other substances). Depression was categorized using the Brief Patient Health Questionnaire (BPHQ). Other psychosocial measures included life-time traumas. We used generalized estimating equations to model outcomes.

Ecstasy data were available from 2128 people at wave 2 and 1977 at wave 3: sleeping medication use was reported by 227 (10.7%) respondents at wave 2 and 239 (12.1%) at wave 3. Increased odds ratios (OR) for sleeping medication use was found for those with depression [OR = 1.88, 95% confidence interval (CI): 1.39, 2.53], women (OR = 1.44, 95% CI: 1.13, 1.84), and increased by 19% for each life-time trauma. Ecstasy use was not a significant predictor, but ≥monthly versus never meth/amphetamine use increased the odds (OR = 3.03, 95% CI 1.30, 7.03).

The use of ecstasy appears to be associated with the use of sleeping medications but this association can be accounted for by other factors.

To examine whether DSM-IV symptoms of substance dependence are psychometrically equivalent between existing community-sampled and clinically overselected studies.

A total of 2476 adult twins born in Minnesota and 4121 unrelated adult participants from a case–control study of alcohol dependence.

Life-time DSM-IV alcohol, marijuana and cocaine dependence symptoms and ever use of each substance.

We fitted a hierarchical model to the data, in which ever use and dependence symptoms for each substance were indicators of alcohol, marijuana or cocaine dependence which were, in turn, indicators of a multi-substance dependence factor. We then tested the model for measurement invariance across participant groups, defined by study source and participant sex.

The hierarchical model fitted well among males and females within each sample [comparative fit index (CFI) > 0.96, Tucker–Lewis index (TLI) > 0.95 and root mean square error of approximation (RMSEA) < 0.04 for all], and a multi-group model demonstrated that model parameters were equivalent across sample- and sex-defined groups (ΔCFI = 0.002 between constrained and unconstrained models). Differences between groups in symptom endorsement rates could be expressed solely as mean differences in the multi-substance dependence factor.

Life-time substance dependence symptoms fitted a dimensional model well. Although clinically overselected participants endorsed more dependence symptoms, on average, than community-sampled participants, the pattern of symptom endorsement was similar across groups. From a measurement perspective, DSM-IV criteria are equally appropriate for describing substance dependence across different sampling methods.

This paper provides a historical review of gambling in Canada and examines the benefits and shortcomings of present-day Canadian gambling policies and practices. This includes a discussion of provincial and federal government roles in gambling regulation and an overview of problem gambling prevention and treatment initiatives.

The gambling studies literature was probed for pertinent information on factors such as historical development, legislative changes, economic conditions and cultural influences that have affected gambling participation and social responsibility strategies in Canada.

Two major Criminal Code of Canada amendments (in 1969 and 1985) were pivotal in Canadian gambling expansion. The first decriminalized lotteries and casinos, while the second allowed electronic gambling devices and authorized provinces to operate and regulate gambling. These changes resulted in a radical gambling expansion which, in addition to raising provincial revenues, created public policy concerns. Varying provincial government interpretations of the ambiguous Criminal Code gambling statutes led to a lack of uniformity in how provinces regulate and operate gambling; when gambling expanded, there were no legislative safeguards in place to deal with the personal and societal effects of problem gambling. Subsequent programs designed to prevent and treat problem gambling have not been overly effective.

Canadian provinces have a monopoly on gambling within their borders and treat the activity as a profit-driven business enterprise. Problems associated with widespread gambling such as addiction, increased crime, bankruptcy and suicide are seen as minor concerns and not addressed in an aggressive fashion. Given the Canadian federal government's detachment from gambling policy and Canadian provinces' heavy reliance on gambling revenues, little change in the Canadian gambling landscape is anticipated in the near future.

The historical and economic involvement of Brazil with tobacco, as a major producer and exporter, was considered an insurmountable obstacle to controlling the consumption of this product. Nevertheless, the country was able to achieve significant progress in implementing public policies and to take an international leadership position, meeting its constitutional commitment to protect public health. In this paper we provide a brief historical overview of tobacco control (TC) in Brazil, and analyse the factors that contributed to the major decline in tobacco consumption in the country over the last 20 years, as well as identify the challenges that had to be overcome and those still at play.

The Brazilian case demonstrates how cross-sectorial collaborations among health-related groups that capitalize on their respective strengths and capacities can help to influence public policy and overcome industry and population resistance to change. Although Brazil still lags behind some leading TC nations, the country has an extensive collaborative TC network that was built over time and continues to focus upon this issue.

The tobacco experience can serve as an example for other fields, such as alcoholic beverages, of how networks can be formed to influence the legislative process and the development of public policies. Brazilian statistics show that problems related to non-communicable diseases are a pressing public health issue, and advocacy groups, policy-makers and government departments can benefit from tobacco control history to fashion their own strategies.

To compare the prevalence of mental disorders between frequent cannabis users with and without dependence and the general population.

Cross-sectional comparison of interview data.

Enriched community sample of frequent cannabis users and a representative sample of non-users and non-frequent users from the general population.

A total of 521 young adult (aged 18–30 years) frequent cannabis users, 252 of whom were with DSM-IV cannabis dependence (D+) and 269 without DSM-IV cannabis dependence (D−), and 1072 young adults from the general population.

Multinomial logistic regression was used to compare groups regarding the presence of DSM-IV mental disorders. Detailed measures of cannabis use, childhood adversity and other substance use were considered confounders.

Compared with the general population, externalizing disorders were more prevalent in D− [odds ratio (OR) = 8.91, P < 0.001] and most prevalent in D+ (OR = 17.75, P < 0.001), but internalizing disorders were associated only with D+ (mood OR = 4.15, P < 0.001; anxiety OR = 2.20, P = 0.002). Associations were attenuated (and often became non-significant) after correction for childhood adversity and substance use other than cannabis. However, the prevalence of mental disorders remained higher in D+ compared with D− (OR = 2.40, P < 0.001), although cannabis use patterns were remarkably similar.

Cannabis use patterns, childhood adversity and the use of other substances are similar in dependent and non-dependent frequent cannabis users. With the exception of more externalizing disorders, the mental health condition of non-dependent frequent cannabis users is similar to that of the general population, whereas it is worse in dependent frequent cannabis users.

The efficacy of batterer intervention programs to reduce intimate partner violence (IPV) is questionable, with individuals with alcohol problems particularly unlikely to benefit. We examined whether adding adjunctive alcohol intervention to batterer intervention reduced the likelihood of substance use and violence relative to batterer intervention alone.

Randomized clinical trial.

Batterer intervention programs in Rhode Island, USA.

 A total of 252 hazardous drinking men in batterer intervention programs. Participants were randomized to receive 40 hours of standard batterer program (SBP) or the SBP plus a 90-minute alcohol intervention (SBP + BAI). None withdrew due to adverse effects. Data were collected at baseline, 3-, 6- and 12-month follow-up, with follow-up rates of 95, 89 and 82%, respectively.

Substance use was measured with a well-validated calendar-assisted interview. Violence was measured with a validated questionnaire. Arrest records were obtained for all participants. The primary substance use outcome was drinks per drinking day (DPDD) and the primary violence outcome was frequency of any physical IPV.

Relative to SBP alone, men receiving SBP + BAI reported consuming fewer DPDD at 3-month follow-up [B = −1.36, 95% confidence interval (CI): −2.65, −0.04, P = 0.04] but not 6- or 12-month follow-up. In secondary analyses, men receiving SBP + BAI reported significantly greater abstinence at 3- (B = 0.09, 95% CI: 0.03, 0.14, P = 0.002) and 6-month (B = 0.06, 95% CI: 0.01, 0.11, P = 0.01) follow-up but not 12-month follow-up. There were no significant differences in physical IPV between men receiving SBP and men receiving SBP + BAI. In secondary analyses, men receiving SBP + BAI reported less severe physical aggression at 3-month (IRR = 0.18, 95% CI: 0.05, 0.65, P = 0.009) but not 6- or 12-month follow-up. Men receiving SBP + BAI reported less severe psychological aggression (B = −1.24, 95% CI: −2.47, −0.02, P = 0.04) and fewer injuries to partners at 3- and 6-month follow-up (IRR = 0.33, 95% CI: 0.12, 0.92, P = 0.03), with differences fading by 12 months.

Men with a history of intimate partner violence and hazardous drinking who received a batterer intervention plus an alcohol intervention showed improved alcohol and violence outcomes initially, but improvements faded by 12 months.

To examine the relationship between a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD)/conduct disorder (CD) and the development of later alcohol/drug use disorder [psychoactive substance use disorder (PSUD)] and nicotine dependence in a large European sample of ADHD probands, their siblings and healthy control subjects.

Subjects (n = 1017) were participants in the Belgian, Dutch and German part of the International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified through ADHD probands aged 5–17 years attending out-patient clinics, and control subjects from the same geographic areas. After a follow-up period (mean: 4.4 years) this subsample was re-assessed at a mean age of 16.4 years.

PSUD and nicotine dependence were assessed using the Diagnostic Interview Schedule for Children, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test and Fagerström test for Nicotine Dependence.

The ADHD sample was at higher risk of developing PSUD [hazard ratio (HR) = 1.77, 95% confidence interval (CI) = 1.05–3.00] and nicotine dependence (HR = 8.61, 95% CI = 2.44–30.34) than healthy controls. The rates of these disorders were highest for ADHD youth who also had CD, but could not be accounted for by this comorbidity. We did not find an increased risk of developing PSUD (HR = 1.18, 95% CI = 0.62–2.27) or nicotine dependence (HR = 1.89, 95% CI = 0.46–7.77) among unaffected siblings of ADHD youth.

A childhood diagnosis of attention deficit hyperactivity disorder is a risk factor for psychoactive substance use disorder and nicotine dependence in adolescence and comorbid conduct disorder, but not oppositional defiant disorder, further increases the risk of developing psychoactive substance use disorder and nicotine dependence.

To use tobacco industry documents on cigarette pack shape, size and openings to identify industry findings on associations with brand imagery, product attributes, consumer perceptions and behaviour.

Internal tobacco industry research and marketing documents obtained through court disclosure contained in the Legacy Tobacco Documents Library were searched using keywords related to pack shapes, sizes and opening methods. The search identified 66 documents related to consumer research and marketing plans on pack shape, size and openings, drawn from 1973 to 2002.

Industry research consistently found that packs that deviated from the traditional flip-top box projected impressions of ‘modern’, ‘elegant’ and ‘unique’ brand imagery. Alternative pack shape and openings were identified as an effective means to communicate product attributes, particularly with regard to premium quality and smooth taste. Consumer studies consistently found that pack shape, size and opening style influenced perceptions of reduced product harm, and were often used to communicate a ‘lighter’ product. Slim, rounded, oval and booklet packs were found to be particularly appealing among young adults, and several studies demonstrated increased purchase interest for tobacco products presented in novel packaging shape or opening. Evidence from consumer tracking reports and company presentations indicate that pack innovations in shape or opening method increased market share of brands.

Consumer research by the tobacco industry between 1973 and 2002 found that variations in packaging shape, size and opening method could influence brand appeal and risk perceptions and increase cigarette sales.

To characterize drug prevalence among fatally injured drivers, identify significant associations (i.e. day of week, time of day, age, gender), and compare findings with those for alcohol.

Descriptive and logistic mixed-model regression analyses of Fatality Analysis Reporting System data.

US states with drug test results for >80% of fatally injured drivers, 1998–2010.

Drivers killed in single-vehicle crashes on public roads who died at the scene of the crash (n = 16 942).

Drug test results, blood alcohol concentration (BAC), gender, age and day and time of crash.

Overall, 45.1% of fatally injured drivers tested positive for alcohol (39.9% BAC ≥ 0.08) and 25.9% for drugs. The most common drugs present were stimulants (7.2%) and cannabinols (7.1%), followed by ‘other’ drugs (4.1%), multiple drugs (4.1%), narcotics (2.1%) and depressants (1.5%). Drug-involved crashes occurred with relative uniformity throughout the day while alcohol-involved crashes were more common at night (P < 0.01). The odds of testing positive for drugs varied depending upon drug class, driver characteristics, time of day and the presence of alcohol.

Fatal single-vehicle crashes involving drugs are less common than those involving alcohol and the characteristics of drug-involved crashes differ, depending upon drug class and whether alcohol is present. Concerns about drug-impaired driving should not detract from the current law enforcement focus on alcohol-impaired driving.

To identify characteristics of social network members with whom homeless youth engage in drinking and drug use.

A multi-stage probability sample of homeless youth completed a social network survey.

Forty-one shelters, drop-in centers and known street hangouts in Los Angeles County.

A total of 419 homeless youth, aged 13–24 years (mean age = 20.09, standard deviation = 2.80).

Respondents described 20 individuals in their networks, including their substance use and demographics, and the characteristics of the relationships they shared, including with whom they drank and used drugs. Dyadic, multi-level regressions identified predictors of shared substance use.

Shared drinking was more likely to occur with recent sex partners [odds ratio (OR) = 2.64, confidence interval (CI): 1.67, 4.18], drug users (OR = 4.57, CI: 3.21, 6.49), sexual risk takers (OR = 1.71, CI: 1.25, 2.33), opinion leaders (OR = 1.69, CI: 1.42, 2.00), support providers (OR = 1.41, CI: 1.03, 1.93) and popular people (those with high degree scores in the network) (OR = 1.07, CI: 1.01, 1.14). Shared drug use was more likely to occur with recent sex partners (OR = 2.44, CI: 1.57, 3.80), drinkers (OR = 4.53, CI: 3.05, 6.74), sexual risk takers (OR = 1.51, CI: 1.06, 2.17), opinion leaders (OR = 1.24, CI: 1.03, 1.50), support providers (OR = 1.83, CI: 1.29, 2.60) and popular people (OR = 1.16, CI: 1.08, 1.24).

Homeless youth in the United States are more likely to drink or use drugs with those who engage in multiple risk behaviors and who occupy influential social roles (popular, opinion leaders, support providers, sex partners). Understanding these social networks may be helpful in designing interventions to combat substance misuse.

To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing national tobacco treatment guidelines in accordance with FCTC Article 14 guideline recommendations.

Cross-sectional study.

Electronic survey from December 2011 to August 2012; participants were asked to complete either an online or attached Microsoft Word questionnaire.

One hundred and sixty-three of the 173 Parties to the FCTC at the time of our survey.

The 51-item questionnaire contained 30 items specifically on guidelines. Questions covered the areas of guidelines writing process, content, key recommendations and other characteristics.

One hundred and twenty-one countries (73%) responded. Fifty-three countries (44%) had guidelines, ranging from 75% among high-income countries to 11% among low-income countries. Nearly all guidelines recommended brief advice (93%), intensive specialist support (93%) and medications (96%), while 66% recommended quitlines. Fifty-seven percent had a dissemination strategy, 76% stated funding source and 68% had professional endorsement.

Fewer than half of the Parties to the WHO FCTC have developed national tobacco treatment guidelines, but, where guidelines exist, they broadly follow FCTC Article 14 guideline recommendations.

In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients.

Parallel random assignment to control (n = 88), MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients.

Large urban HIV primary care clinic.

Patients consuming ≥4 drinks at least once in prior 30 days.

Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days.

End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model χ², d.f. = 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control; P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant.

For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.

Tobacco tax increases are the most effective means of reducing tobacco use and inequalities in smoking, but effectiveness depends on transnational tobacco company (TTC) pricing strategies, specifically whether TTCs overshift tax increases (increase prices on top of the tax increase) or undershift the taxes (absorb the tax increases so they are not passed onto consumers), about which little is known.

Review of literature on brand segmentation. Analysis of 1999–2009 data to explore the extent to which tax increases are shifted to consumers, if this differs by brand segment and whether cigarette price indices accurately reflect cigarette prices.

UK.

UK smokers.

Real cigarette prices, volumes and net-of-tax- revenue by price segment.

TTCs categorise brands into four price segments: premium, economy, mid and ‘ultra-low price’ (ULP). TTCs have sold ULP brands since 2006; since then, their real price has remained virtually static and market share doubled. The price gap between premium and ULP brands is increasing because the industry differentially shifts tax increases between brand segments; while, on average, taxes are overshifted, taxes on ULP brands are not always fully passed onto consumers (being absorbed at the point each year when tobacco taxes increase). Price indices reflect the price of premium brands only and fail to detect these problems.

Industry-initiated cigarette price changes in the UK appear timed to accentuate the price gap between premium and ULP brands. Increasing the prices of more expensive cigarettes on top of tobacco tax increases should benefit public health, but the growing price gap enables smokers to downtrade to cheaper tobacco products and may explain smoking-related inequalities. Governments must monitor cigarette prices by price segment and consider industry pricing strategies in setting tobacco tax policies.

The main intention of this retrospective study was to investigate whether chronic illicit drug abuse, especially the intravenous use of opioids (heroin), could potentially trigger the development of myocardial fibrosis in drug addicts.

A retrospective case–control study was performed using myocardial tissue samples from both drug-related deaths (DRD) with verifiable opioid abuse and non-drug-related deaths in the same age group.

Department of Forensic Medicine, Medical University of Vienna, Austria (1993–94).

Myocardial specimens were retrieved from 76 deceased intravenous opioid users and compared to those of 23 deceased non-drug users.

Drug quantification was carried out using the enzyme-multiplied immunoassay technique (EMIT), followed by [gas chromatography–mass spectrometry (GC–MS), MAT 112^®], and analysed using the Integrator 3390A by Hewlett Packard^® and LABCOM.1 computer (MSS-G.G.). The amount of fibrous connective tissue (FCT) in the myocardium was determined by using the morphometric software LUCIA Net version 1.16.2^©, Laboratory Imaging, with NIS Elements 3.0^®.

Drug analysis revealed that 67.11% were polydrug users and the same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM)—32.89% were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63% consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum and 275.52 ng/g in the medulla oblongata, respectively. Morphometric analysis exhibited a strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT content in the drug group was 7.6 ± 2.9% (females: 6.30 ± 2.19%; males: 7.91 ± 3.01%) in contrast to 5.2 ± 1.7% (females: 4.45 ± 1.23%; males: 5.50 ± 1.78%) in the control group, indicating a significant difference (P = 0.0012), and a significant difference in the amount of FCT between females and males (P = 0.0383). There was no significant interaction of age and FCT (P = 0.8472).

There is a long-term risk of cardiac dysfunction following chronic illicit drug abuse with opioids as a principal component. Regular cardiological examination of patients receiving substitution treatment with morphine is strongly recommended.

To report progress among Parties to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in developing tobacco dependence treatment systems in accordance with FCTC Article 14 and the Article 14 guidelines recommendations.

Cross-sectional study.

Electronic survey from December 2011 to August 2012.

One hundred and sixty-three of the 174 Parties to the FCTC at the time of our survey.

The 51-item questionnaire contained 21 items specifically on treatment systems. Questions covered the availability of basic treatment infrastructure and national cessation support systems.

We received responses from 121 (73%) of the 166 countries surveyed. Fewer than half of the countries had national treatment guidelines (n = 53, 44%), a government official responsible for tobacco dependence treatment (n = 49, 41%), an official national treatment strategy (n = 53, 44%) or provided tobacco cessation support for health workers (n = 55, 46%). More than half encouraged brief advice in existing health care services (n = 68, 56%), while only 44 (36%) had quitlines and only 20 (17%) had a network of treatment support covering the whole country. Low- and middle-income countries had less tobacco dependence treatment provision than high-income countries.

Most countries, especially low- and middle-income countries, have not yet implemented the recommendations of FCTC Article 14 or the FCTC Article 14 guidelines.

This study estimates life-time incidence trends of cannabis and cocaine use over 38 years from general population surveys of drug use (GPSDU) in Spain, taking into account changes of population age structure.

Periodic cross-sectional studies.

Eight biennial GPSDU from 1995 to 2009 in Spain.

Interviewees aged 15–64 years who reported age of first ever cannabis and/or cocaine use between 10 and 64 years between 1971 and 2008.

Estimates of raw and standardized incidences were calculated as a weighted mean of the incidences from all surveys. Standardization was conducted to take into account changes of population age structure. Incidence trends were extracted applying weighted cubic smoothing splines to incidence estimates.

For both substances, estimated raw incidence trends increased up until 2000 (rates of 11.5 ± 0.7 and 3.6 ± 0.5 per 1000, respectively, for cannabis and cocaine), and then decreased significantly (in 2008, 9.6 ± 1.2 and 2.7 ± 0.6, respectively). In contrast, standardized rates exhibit a steadily increasing trend up to 2000 (9.0 ± 0.6 and 2.8 ± 0.4), followed by a statistically non-significant increasing trend afterwards (in 2008, 9.5 ± 1.2 and 2.8 ± 0.6). The largest increases of incidence were observed in both male and female subjects aged 15–19 years.

Using data from Spanish general population surveys of drug use, an apparently decreasing trend of raw incidence rates in both cannabis and cocaine use from 2000 became non-decreasing trends when these rates were standardized. First experiences of cannabis and cocaine use in Spain occur mainly in younger ages (15–19 years).

To investigate whether socio-economic status (SES) in childhood and school failure at 15 years of age predict illicit drug abuse in youth and young adulthood.

Register study in a Swedish national cohort born 1973–88 (n = 1 405 763), followed from age 16 to 20–35 years. Cox regression analyses were used to calculate hazard ratios (HR) for any indication of drug abuse.

Our outcomes were hospital admissions, death and criminality associated with illicit drug abuse. Data on socio-demographics, school grades and parental psychosocial problems were collected from censuses (1985 and 1990) and national registers. School failure was defined as having mean school grades from the final year in primary school lower than −1 standard deviation and/or no grades in core subjects.

School failure was a strong predictor of illicit drug abuse with an HR of 5.87 (95% CI: 5.76–5.99) after adjustment for age and sex. Childhood SES was associated with illicit drug abuse later in life in a stepwise manner. The lowest stratum had a HR of 2.28 (95% CI: 2.20–2.37) compared with the highest stratum as the reference, when adjusted for other socio-demographic variables. In the fully adjusted model, the effect of SES was greatly attenuated to an HR of 1.23 (95% CI: 1.19–1.28) in the lowest SES category, while the effect of school failure remained high with an HR of 4.22 (95% CI: 4.13–4.31).

School failure and childhood socio-economic status predict illicit drug abuse independently in youth and young adults in Sweden.

To investigate whether varenicline use was associated with increased risk of psychiatric adverse events, compared with bupropion, another drug used for smoking cessation.

We conducted a registry-based cohort study in Denmark, 2007–10, comparing new users of varenicline and bupropion in unmatched and 1 : 1 propensity score-matched analyses.

Using Cox regression, we estimated the hazard ratio (HR) of any psychiatric adverse event (emergency department visit or in-patient admission with a psychiatric diagnosis) within 30 days following treatment initiation. The unmatched and matched analyses correspond to conventional crude and fully adjusted analyses, respectively.

In unmatched analyses, there were 106 (0.18%) psychiatric adverse events among 59 790 varenicline users (rate 22 events per 1000 person-years), compared with 46 (0.26%) events among 17 936 bupropion users (rate 31 per 1000); the HR was 0.69 [95% confidence interval (CI): 0.49–0.98]. In propensity score-matched analyses, 39 (0.22%) events occurred among 17 935 varenicline users (rate 27 per 1000), compared with 46 (0.26%) events among 17 935 bupropion users (rate 31 per 1000); varenicline was not associated with increased risk of psychiatric adverse events (HR 0.85, 95% CI: 0.55–1.30). The overall rate of psychiatric adverse events was substantially higher among participants with a history of psychiatric disorder than in patients without such history; the risk associated with varenicline did not differ significantly by history of psychiatric disorder.

In Denmark, the risk of psychiatric adverse events diagnosed during an emergency department visit or in-patient admission was not significantly higher with varenicline use compared with bupropion.

This study aimed to test the efficacy of integrated cognitive behaviour therapy (CBT) for coexisting post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD).

Clinics across Sydney, Australia.

Randomized controlled trial of 12 once-weekly individual sessions of either integrated CBT for PTSD and AUD (integrated therapy, IT; n = 33) or CBT for AUD plus supportive counselling (alcohol-support, AS; n = 29). Blind assessments were conducted at baseline and post-treatment and at 5 [standard deviation (SD) = 2.25] and 9.16 (SD = 3.45) months post-treatment.

Sixty-two adults with concurrent PTSD and AUD.

Outcomes included changes in alcohol consumption (time-line follow-back), PTSD severity [clinician-administered PTSD scale (CAPS)], alcohol dependence and problems, and depression and anxiety.

Reductions in PTSD severity were evident in both groups. IT participants who had received one or more sessions of exposure therapy exhibited a twofold greater rate of clinically significant change in CAPS severity at follow-up than AS participants [IT 60%, AS 39%, odds ratio (OR): 2.31, 95% confidence interval (CI): 1.06, 5.01]. AS participants exhibited larger reductions than IT participants in alcohol consumption, dependence and problems within the context of greater treatment from other services during follow-up. Results lend support to a mutually maintaining effect between AUD and PTSD.

Individuals with severe and complex presentations of coexisting post-traumatic stress disorder (PTSD) and alcohol use disorders (AUD) can derive substantial benefit from cognitive behaviour therapy targeting AUD, with greater benefits associated with exposure for PTSD. Among individuals with dual disorders, these therapies can generate significant, well-maintained treatment effects on PTSD, AUD and psychopathology.

To test whether psychological factors predict male smokeless tobacco (SLT) initiation and cessation longitudinally.

Sixteen-year longitudinal design with 95% retention at year 6 and 82% at year 16.

Forty Washington State school districts.

SLT use data were gathered on a cohort of adolescents (91% Caucasian). For SLT initiation, the sample size was 2468. For SLT cessation, sample sizes were 219 (age 20 outcome) and 192 (age 28 outcome).

Self-reported psychological measures of parental disobedience (‘parent non-compliance’), peer influence (‘friend compliance’), rebelliousness and thrill-seeking were taken at ages 12 and 18. SLT use was measured at ages 12, 18, 20 and 28 years.

For SLT initiation, scoring highly on the following psychological factors at age 12 at least doubled the odds of daily SLT use at age 18 (P < 0.001): friend compliance [odds ratio (OR): 2.56, 95% confidence interval (CI): 1.78–3.68), rebelliousness (OR: 2.16, 95% CI: 1.46–3.19) and thrill-seeking (OR: 2.33, 95% CI: 1.45–3.75). For SLT cessation, none of the psychological factors at age 18 predicted SLT cessation at age 20 or 28 (P value range: 0.06–0.84).

Peer influence, rebelliousness, and thrill-seeking appear to predict smokeless tobacco initiation strongly among male youth in the United States.

To investigate the mediating role of attentional bias for alcohol cues on alcohol-seeking following devaluation of alcohol.

Between subject.

Eye-tracking laboratory at the University of Liverpool.

Student social drinkers (n = 64).

An operant choice task in which participants chose between simultaneously presented alcohol and non-alcohol drink rewards, while attentional bias for alcohol and non-alcohol drink cues was inferred from eye movements. Participants then consumed 30 mL of an alcoholic beverage, which was either presented alone (no devaluation: n = 32) or had been adulterated to taste unpleasant (devaluation: n = 32). Choice and attentional bias for the alcohol and non-alcohol drink pictures were then measured again.

Alcohol devaluation reduced behavioural choice for alcohol (F = 32.64, P < 0.001) and attentional bias for the alcohol pictures indexed by dwell time (F = 22.68, P < 0.001), initial fixation (F = 7.08, P = 0.01) and final fixation (F = 22.44, P < 0.001). Mediation analysis revealed that attentional bias partially mediated the effect of devaluation on alcohol choice; however, the proportion of the variance accounted for by attentional bias is low to moderate (∼30%).

Among student social drinkers, attentional bias is only a partial mediator of alcohol choice following devaluation of alcohol. Value-based decision-making may be a more important determinant of drinking behaviour among student social drinkers than attentional bias.

To examine the association between military deployment of a parent and use of alcohol and drugs among children of deployed military personnel.

Observational and cross-sectional study.

Data from the USA 2010 Iowa Youth Survey, a statewide survey of 6th, 8th and 11th graders, were analyzed during 2011.

Of all 6th-, 8th- and 11th-grade students enrolled in Iowa in 2010, 69% (n = 78 240) completed the survey.

Ever drink more than a few sips of alcohol and past 30-day: binge drinking, marijuana consumption, other illegal drug use and prescription drug misuse.

The rates of alcohol use [risk difference (RD) = 7.85, 99.91% confidence interval (CI) = 4.44–11.26], binge drinking (RD = 8.02, 99.91% CI = 4.91–11.13), marijuana use (RD = 5.30, 99.91% CI = 2.83–7.77), other illegal drug use (RD = 7.10, 99.91% CI = 4.63–9.56) and prescription drug misuse (RD = 8.58, 99.91% CI = 5.64–11.51) are greater for children of currently or recently deployed parents than for children of parents who are not in the military. The magnitude of the effects is consistent across 6th, 8th and 11th grades. Disrupted living arrangements further accentuate increased substance use, with the largest effect seen in children with a deployed parent who was not living with a parent or relative.

Children of deployed military personnel should be considered at higher risk for substance use than children of non-military citizens.

To characterize longitudinal patterns of substance use across a large sample of psychiatric patients discharged from inpatient admission, followed for 1-year post-hospitalization.

Prospective cohort study.

Kansas City, MO, USA; Pittsburgh, PA, USA; Worcester, MA, USA.

Eight hundred and one schizophrenia-spectrum (n = 204), bipolar (n = 137) and depressive disorder (n = 460) patients from the MacArthur Violence Risk Assessment Study.

Symptoms, functioning, drug/alcohol use assessed by the Brief Psychiatric Rating Scale, the Global Assessment of Functioning, and substance use interviews.

Patients used alcohol (67.0%; n = 540) and cannabis (30.0%; n = 237) more frequently than other substances up to 30 days before admission, and those with depressive and schizophrenia-spectrum used heroin more than individuals with bipolar (P = 0.023). Post-hospitalization, patients using alcohol (B = −0.15, P < 0.001) and cannabis (B = −0.27, P < 0.001) decreased, but patterns varied across diagnosis and genders. Patients using cannabis decreased at greater rates in depressive and schizophrenia-spectrum compared with bipolar (all P < 0.05), and more men used alcohol (B = 0.76, P < 0.001) and cannabis (B = 1.56, P < 0.001) than women. Cannabis (B = 1.65, P < 0.001) and alcohol (B = 1.04, P = 0.002) were associated with higher symptomatology; cannabis (B = −2.33, P < 0.001) and alcohol (B = −1.45, P = 0.012) were associated with lower functioning.

Substance use is frequent and associated with poor recovery in patients with serious mental illness recently discharged from psychiatric hospitalization. Addiction treatments personalized by diagnosis and gender may be effective for improving outcomes in people with serious mental illness.

To assess heroin injectors' perceptions of and responses to a warning issued by public health officials regarding high-potency heroin and increases in fatal overdoses.

Semi-structured qualitative interviews.

Vancouver, Canada.

Eighteen active heroin injectors.

Semi-structured interview guide focussing on heroin injectors' perceptions of and responses to the overdose warning, including reasons for failing to adhere to risk reduction recommendations.

Although nearly all participants were aware of the warning, their recollections of the message and the timing of its release were obscured by on-going social interactions within the drug scene focussed on heroin quality. Many injection drug users reported seeking the high potency heroin and nearly all reported no change in overdose risk behaviours. Responses to the warning were shaped by various social, economic and structural forces that interacted with individual behaviour and undermined efforts to promote behavioural change, including sales tactics employed by dealers, poverty, the high cost and shifting quality of available heroin, and risks associated with income-generating activities. Individual-level factors, including emotional suffering, withdrawal, entrenched injecting routines, perceived invincibility and the desire for intense intoxication also undermined risk reduction messages.

Among heroin injectors in British Columbia, a 2011 overdose warning campaign appeared to be of limited effectiveness and also produced unintended negative consequences that exacerbated overdose risk.

To quantify the extent to which smokers with indicators of poor mental health receive smoking cessation support in primary care consultations compared with those without.

Cross-sectional study within a database of electronic primary care medical records.

A total of 495 general practices in the United Kingdom contributing data to The Health Improvement Network (THIN) database.

A total of 2 493 085 patients aged 16+ registered with a THIN practice for the year from 1 July 2009 to 30 June 2010.

The proportion of patients with a diagnostic Read code or British National Formulary (BNF) drug code indicating a mental health diagnosis or psychoactive medication prescription, respectively, who smoke and who have cessation advice or a smoking cessation medication prescription recorded during consultations within the 1-year study period.

Of 32 154 smokers, 50.6% [95% confidence interval (CI): 50.0–51.2] with a mental health diagnosis and 49.3% (95% CI: 49.0–49.7) of 96 285 smokers prescribed a psychoactive medication had a record of cessation advice, higher than the prevalence of advice recording in smokers without these indicators (33.4%, 95% CI: 33.3–33.6). Similarly, smoking cessation medication prescribing was higher: 11.2% (95% CI: 10.8–11.6) of smokers with a mental health diagnosis and 11.0% (95% CI: 10.8–11.2) of smokers prescribed psychoactive medication received a prescription, compared with 6.73% of smokers without these indicators (95% CI: 6.65–6.81). Smoking cessation support was offered in a lower proportion of consultations for smokers with indicators of poor mental health than for those without. Advice was recorded in 7.9% of consultations with smokers with a mental health diagnosis, 8.2% of consultations with smokers prescribed psychoactive medication and 12.3% of consultations with smokers without these indicators; comparable figures for prescribing of cessation medication were 2.9%, 3.2% and 4.4%, respectively.

Approximately half of smokers with indicators of poor mental health receive advice to quit during primary care consultations in the United Kingdom, and one in 10 receive a cessation medication. Interventions are lower per consultation for smokers with mental health indicators compared with smokers without mental health indicators.

Studying alcohol abuse impact, as measured by physicians' perceptions and patients' self-reports, on HIV virological rebound among patients chronically co-infected with HIV and hepatitis C virus (HCV).

Cohort study.

Seventeen French hospitals.

Five hundred and twelve patients receiving antiretroviral therapy (ART) with an undetectable initial HIV viral load and at least two viral load measures during follow-up.

Medical records and self-administered questionnaires. HIV virological rebound defined as HIV viral load above the limit of detection of the given hospital's laboratory test. Alcohol abuse defined as reporting to have drunk regularly at least 4 (for men) or 3 (for women) alcohol units per day during the previous 6 months. Correlates of time to HIV virological rebound identified using Cox proportional hazards models.

At enrolment, 9% of patients reported alcohol abuse. Physicians considered 14.8% of all participants as alcohol abusers. Self-reported alcohol abuse was associated independently with HIV virological rebound [hazard ratio (95% confidence interval): 2.04 (1.13–3.67); P = 0.02], after adjustment for CD4 count, time since ART initiation and hospital HIV caseload. No significant relationship was observed between physician-reported alcohol abuse and virological rebound (P = 0.87).

In France, the assessment of alcohol abuse in patients co-infected with HIV and hepatitis C virus should be based on patients' self-reports, rather than physicians' perceptions. Baseline screening of self-reported alcohol abuse may help identify co-infected patients at risk of subsequent HIV virological rebound.

To investigate the associations between economic stress in childhood and adulthood and tobacco smoking, with reference to the accumulation, critical period and social mobility hypotheses from life-course epidemiology.

The 2008 public health survey in Skåne, Sweden is a cross-sectional postal questionnaire study based on a random sample which yielded 28 198 participants aged 18–80 years (55% participation). Logistic regression models were used to investigate associations between economic stress in childhood and adulthood and tobacco smoking.

A 17.4% prevalence of men and 19.1% of women reported tobacco smoking. Tobacco smoking was more prevalent among middle-aged men and young women, among those born outside Sweden, with low occupational status, low social support, low trust, economic stress in childhood and adulthood. The accumulation hypothesis was confirmed because combined childhood and adulthood exposures to economic stress were associated (P < 0.001) with tobacco smoking in a graded manner. The critical period hypothesis was not supported because the associations between economic stress in childhood as well as adulthood, respectively, and tobacco smoking were significant (P = 0.004 and P < 0.001) throughout the analyses. The social mobility hypothesis was confirmed because upward social mobility was associated significantly (P < 0.001) with lower odds of smoking, while downward social mobility was associated significantly (P < 0.001) with higher odds of smoking.

Downward social mobility and economic stress in both childhood and adulthood should be considered as risk factors for tobacco smoking over the life-course.

To investigate the competing effects of increased anti-drink driving legislation and the recent elimination of excise taxes on wine and beer.

Serial cross-sectional telephone surveys were conducted in 2006 (n = 9860) and 2011 (n = 4800).

Hong Kong, China.

Chinese adults (≥18 years of age).

Respondents were asked about their drinking patterns, past-year experience of driving within 2 hours of drinking, drinking-related attitudes and reported deterrents to drink driving.

Following the legislative changes, the age-standardized past-year prevalence of drink driving decreased significantly from 5.2 to 2.8% (P < 0.001) among all males, from 9.0 to 4.4% (P < 0.001) among male past-year drinkers and from 13.7 to 8.5% (P < 0.01) among male weekly drinkers. The past-year prevalence of drink driving in 2011 among all females (0.08%), female past-year drinkers (1.6%), male binge drinkers (12.5%), female weekly drinkers (4.7%) and female binge drinkers (7.9%) were not significantly different from 2006. Drink driving was associated independently with business sector employment [odds ratio (OR) = 2.47], past-month binge drinking (OR = 6.08) and beliefs in the benefits to one's wellbeing of drinking (OR = 2.62) among males and past-month binge drinking (OR = 5.57), belief in the social benefits of drinking (OR = 5.66) and being unmarried (OR = 3.00) in females (P < 0.05). The most commonly reported drink driving deterrents were concerns about random breath tests (93.8%) and the potential legal consequences of conviction (93.6–96.5%).

Despite greater alcohol consumption in Hong Kong, the current anti-drink driving strategy appears to reduce drink driving in males and prevent increased levels among females. Binge drinkers, however, remain a high-risk group that should be monitored continually.

To assess the efficacy of methylphenidate as a substitution therapy for amphetamine/methamphetamine dependence in Finland and New Zealand.

Parallel-group, double-blind, randomized placebo-controlled trial.

Out-patient care.

Amphetamine-/methamphetamine-dependent, aged 16–65 years.

The primary outcome measure was presence/absence of amphetamine/methamphetamine in urine samples collected twice weekly. Secondary measures included treatment adherence, alterations in craving scores and self-reported use. Primary analysis was by intention-to-treat (ITT). The study drug, methylphenidate (as Concerta^®), was up-titrated over 2 weeks to a maximum dose of 54 mg daily and continued for a further 20 weeks. Doses were given under daily supervision at the clinics.

Seventy-nine participants were randomized (40 methylphenidate; 39 placebo); 76 received allocated treatment and 27 completed the trial. ITT analysis (n = 78) showed no statistically significant difference in the percentage of positive urines between the methylphenidate and placebo arms (odds ratio: 0.95, 95% confidence interval: 0.83–1.08). However, there was a significant difference (P < 0.05) between the active and placebo arms in retention, the placebo arm displaying a significantly lower retention from 6 weeks that persisted until the end of the trial.

The trial failed to replicate earlier findings suggesting that methylphenidate was superior to placebo. The low retention rate confounded the ability to draw firm conclusions about efficacy. The higher retention rate was observed in the methylphenidate arm. Any replication of this work would need to consider alternatives to the rigid clinic attendance criteria, and consider an increased dose.

In observational studies, moderate drinking is associated with a reduced risk of more than twenty different diseases and health problems. However, it would be premature to conclude that there is a causal relationship.

This paper critically reviews the evidence for such associations.

It was found that reasons for questioning the causal association of moderate drinking and a reduced health risk are: the lack of dose-response relationships; the characteristics and lifestyles of today's abstainers and moderate drinkers; the lack of plausible biological mechanisms; the problems in the classification of drinking groups, and; the general limitations of observational studies.

The evidence for the harmful effects of alcohol is undoubtedly stronger than the evidence for beneficial effects.

To provide an overview, with respect to Sweden, of the cultural history of gambling, the commercialization of gambling, problem gambling research, the prevalence of problem gambling and its prevention and treatment.

A review of the literature and official documents relating to gambling in Sweden; involvement in gambling research and regulation.

Gambling has long been part of Swedish culture. Since about 1980 the gambling market, although still largely monopolistic, has been commercialized. At the same time, problem gambling has emerged as a concept in the public health paradigm. Debate regarding whether or not Sweden's national restrictions on the gambling market are compliant with European Community legislation has helped to put problem gambling on the political agenda. Despite expanded gambling services, the extent of problem gambling on the population level has not changed significantly over the past decade.

The stability of problem gambling in Sweden at the population level suggests a homeostatic system involving the gambling market, regulation, prevention and treatment and adaption to risk and harm by gamblers. We have relatively good knowledge of the extent and characteristics of problem gambling in Sweden and of how to treat it, but little is known of how to prevent it effectively. Knowledge is needed of the effectiveness of regulatory actions and approaches, and of responsible gambling measures implemented by gambling companies.

To estimate hepatitis C virus (HCV) incidence and HCV risk among Scottish prisoners.

National sero-behavioural survey; dried blood spots were collected in order to identify recent HCV infections (i.e. HCV antibody-negative and HCV polymerase chain reaction (PCR)-positive).

All 14 closed prisons in Scotland.

A total of 5187 prisoners responded to the survey (79% of available prisoners on survey days) comprising 5076 individuals (after removing incomplete returns and participants surveyed in more than one prison); 95% men, 32% (1625) reported an injecting history (PWID) and median sentence of 9.5 months. HCV antibody samples were available for 4904 participants; there was sufficient sera for HCV PCR for 2446 prisoners who had been in prison for at least 75 days.

The estimate of in-prison recent infections is based on prisoners incarcerated for a sufficient period, i.e. at least 75 days, so that recent infections could be attributed to prison.

Overall HCV prevalence was 19%; 53% among people who reported an injecting history and 3% among other prisoners. Three recent infections probably acquired in prison were detected. None of the cases reported injecting during their current sentence or any other potential exposure. Estimated incidence was 0.6–0.9% overall and 3.0–4.3% among PWID (assuming all infections acquired through injecting). Fifty-seven per cent (929) of PWID were receiving opiate substitution treatment (OST) at the time of the survey. Of all prisoners, 2.5% and 8% of PWID reported injecting during their current period of incarceration.

The low incidence of HCV infections in Scottish prisons is due most probably to the low occurrence of in-prison injecting and high coverage of OST. Low HCV risk can be achieved in prisons without necessarily introducing needle exchange programmes, but close monitoring of risk behaviours is essential. If risk increases, provision of needle exchange should be considered.

Despite recognition of the harms related to alcohol misuse and its potential to interfere substantially with sustained recovery from drug dependency, research evaluating drug treatment outcomes has not addressed the issue comprehensively. It has been overlooked possibly because treatment research has been framed according to the primary drug of choice, rather than investigating the interactions between different combinations of drugs and/or alcohol use. This paper reports on a systematic review investigating whether concurrent alcohol use could impede recovery from illicit drug use in two potential ways: first, alcohol could become a substitute addiction and/or secondly, alcohol misuse post-treatment may place an individual at risk for relapse to their primary drug problem.

A systematic search of four relevant databases was undertaken to identify peer-reviewed, quantitative drug treatment outcome studies that reported alcohol use pre-, post-treatment and follow-up.

The search revealed 567 papers, of which 13 were assessed as fulfilling the key inclusion criteria.The review indicated inconsistent and therefore inconclusive support for the substitution hypothesis. However, the data revealed consistent support for the hypothesis that alcohol use increases relapse to drug use.

(i) The potential negative impact of alcohol misuse on drug treatment outcomes remains under-researched and overlooked; (ii) alcohol consumption post-drug treatment may increase the likelihood that an individual will relapse to their primary drug; (ii) existing evidence regarding the substitution hypothesis is inconclusive, although there was an indication that a subgroup of participants will be vulnerable to alcohol becoming the primary addiction instead of drugs. We argue that future drug treatment outcome studies need to include detailed analysis of the influence of alcohol use pre- and post-drug treatment.

Many observational studies suggest that increased drinking frequency is associated with reduced mortality among those with low-dose alcohol consumption. The purpose of this paper was to examine whether frequent drinkers consume lower-risk amounts during drinking days or have favorable risk factor profiles compared with those who drink less frequently, and discuss implications for the larger debate about the limitations of non-randomized studies about ‘moderate’ drinking and the development of low-risk drinking guidelines.

Data from the 2008 Behavioral Risk Factor Surveillance System survey were used to characterize alcohol consumption characteristics and their relationship with risk factors among adult drinking men who consumed an average of fewer than two drinks per day and adult drinking adult women who consumed an average of less than one drink per day.

Those who drank relatively infrequently (14 or fewer days per month) consumed more during drinking days, were more likely to exceed the US Dietary Guidelines drinking limits (41.0% versus 9.7%) and had a larger proportion of drinking days that included binge drinking (13.4% versus 4.3%). Infrequent drinkers also had a higher prevalence of 13 of 15 risk factors assessed. Findings from analyses of those aged ≥40 years were similar.

Among those with low average alcohol consumption, infrequent drinkers drink more during drinking days and have unfavorable risk factors profiles compared with more frequent drinkers, suggesting that confounding may contribute to favorable associations with ‘moderate’ average alcohol consumption and increased drinking frequency observed in non-randomized studies.

This paper seeks to provide a historical overview of gambling and contemporary anti-gambling legislation in India.

Based on a review of available literature, including historical sources, publications in the lay press and internet sources, this paper draws together evidence to present a synopsis of gambling and anti-gambling measures from antiquity to present times.

Gambling is a popular pastime and has been a ubiquitous part of daily life from antiquity until the present. Archaic laws, framed in the 19th century, still regulate gambling in India, with a formal ban on most forms of gambling. This has created a huge illegal gambling market, with its attendant problems. Recent developments, including an explosion of sports betting operations (especially in cricket) and internet betting sites, are challenging the status quo and leading to calls for legalizing gambling. Concern for the consequences of pathological/ problem gambling is conspicuous by its absence in popular discourse and academic research.

Despite the importance and longevity of the practice of gambling in the daily life of India, and the opposition to it, due to the potential for individual and societal harm there is a surprising lack of contemporary curiosity and scholarly literature on pathological gambling from the region. The prohibitions against gambling are being increasingly challenged to change to a system of legalized gambling. To inform and guide public policy and future legislation, there is a serious need to initiate rational, scientific enquiries into the nature and impact of gambling in India.

The objective of this paper is to present an overview of gambling in Germany, including historical development, legislative and economic changes as well as treatment options and their effectiveness.

The available scientific literature and research reports on gambling in Germany were reviewed to obtain relevant information on history, commercialization, legislation, treatment and research agenda.

Gambling in Germany is characterized by compromises between protective and economic efforts. At present, gambling is illegal in Germany, and provision is subject to the state monopoly. Mere gaming machines (specific slot machines) are not classified as gambling activity, permitting commercial providers. In recent years, implementing regulations for state gambling and gaming machines have been changed. Concerning the treatment of pathological gambling, various options exist; treatment costs have been covered by health and pension insurance since 2001. Information on the effectiveness of treatment in Germany is limited. Similarly, the number of peer-reviewed publications on gambling is small.

German gambling legislation was subject to major changes in the past years. Based on the available body of research (longitudinal), studies on risk and protective factors and the aetiology of pathological gambling are needed. The effectiveness of pathological gambling treatment in Germany and the impact of gambling regulations on gambling behaviour also need to be investigated.

To estimate age-period-cohort models predicting alcohol volume, heavy drinking and beverage-specific alcohol volume in order to evaluate whether the 1976–1985 birth cohorts drink relatively heavily.

Data from seven cross-sectional surveys of the USA conducted between 1979 and 2010 were utilized in negative binomial generalized linear models of age, period and cohort effects predicting alcohol measures.

General population surveys of the USA.

Thirty-six thousand four hundred and thirty-two US adults (aged 18 years or older).

Monthly number of alcohol drinks, beer, wine and spirits drinks, and days drinking five or more drinks in the past year derived from beverage-specific graduated frequency questions.

Relative to the reference 1956–60 birth cohort, men in the 1976–1980 cohort for were found to consume more alcohol [incidence rate ratio (IRR) = 1.222: confidence interval (CI) 1.07–1.39) and to have more 5+ days (the number of days having five or more drinks) (IRR = 1.365: CI 1.09–1.71) as were men in the 1980–85 cohort for volume (IRR = 1.284: CI 1.10–1.50) and 5+ days (IRR = 1.437: CI 1.09–1.89). For women, those in the 1980–85 cohort were found to have higher alcohol volume (IRR = 1.299: CI 1.07–1.58) and more 5+ days (IRR = 1.547: CI 1.01–2.36). Beverage-specific models found different age patterns of volume by beverage with a flat age pattern for both genders' spirits and women's wine, an increasing age pattern for men's wine and a declining age pattern from those in their early 20s for beer.

In the USA, men born between 1976 and 1985, and women born between 1981 and 1985 have higher alcohol consumption than in earlier or later years.

Research suggests an association between population drinking and a large number of outcomes. However, driving while under the influence of alcohol (DWI) is conspicuously absent from this list of outcomes. The aim of this study was to estimate the relation between DWI and total consumption of alcohol on annual time–series data for Norway and Sweden.

For Norway, we used data on convictions for DWI per 100 000 inhabitants (aged 15–69 years). The DWI proxy for Sweden comprised the proportion (%) of all police-reported traffic accidents with personal injuries where the driver was under the influence of alcohol. Data on total alcohol sales in litres of pure alcohol per inhabitant (aged 15 years and older) were used as proxy for total alcohol consumption. We focused on the period 1957–89, during which the legislation concerning DWI remained unchanged in Norway as well as in Sweden. The statistical analyses were based on co-integrated models.

The estimates of the association between DWI and per capita alcohol consumption were strongly significant in Norway as well as in Sweden. For Norway, the estimated elasticity equalled 2 (P < 0.001) and for Sweden 1.5 (P < 0.001).

In Norway and Sweden, as total population level of alcohol consumption increases or decreases so does the incidence of driving while intoxicated.

To investigate relationships between periodic increases in minimum alcohol prices, changing densities of liquor stores and alcohol-attributable (AA) deaths in British Columbia, Canada.

Cross-section (16 geographic areas) versus time–series (32 annual quarters) panel analyses were conducted with AA deaths as dependent variables and price, outlet densities and socio-demographic characteristics as independent variables.

Populations of 16 Health Service Delivery Areas in British Columbia, Canada.

Age–sex-standardized rates of acute, chronic and wholly AA mortality; population densities of restaurants, bars, government and private liquor stores; minimum prices of alcohol in dollars per standard drink.

A 10% increase in average minimum price for all alcoholic beverages was associated with a 31.72% [95% confidence interval (CI): ± 25.73%, P < 0.05] reduction in wholly AA deaths. Significantly negative lagged associations were also detected up to 12 months after minimum price increases for wholly but not for acute or chronic AA deaths. Significant reductions in chronic and total AA deaths were detected between 2 and 3 years after minimum price increases. Significant but inconsistent lagged associations were detected for acute AA deaths. A 10% increase in private liquor stores was associated with a 2.45% (95% CI: ± 2.39%, P < 0.05), 2.36% (95% CI: ± 1.57%, P < 0.05) and 1.99% (95% CI: ± 1.76%, P < 0.05) increase in acute, chronic and total AA mortality rates.

Increases in the minimum price of alcohol in British Columbia, Canada, between 2002 and 2009 were associated with immediate and delayed decreases in alcohol-attributable mortality. By contrast, increases in the density of private liquor stores were associated with increases in alcohol-attributable mortality.

In Amsterdam, HIV prevalence has nearly halved among injecting drug users (IDU) since 1990. Hepatitis C virus (HCV) prevalence also declined; HIV and HCV incidence dropped to nearly zero. We examined possible explanations for these time trends, among which the implementation of harm reduction measures aimed at reducing the risk behaviour of IDU.

We used individual-based modelling of the spread of HIV and HCV. Information about demographic parameters was obtained from the Amsterdam Cohort Study (ACS) among drug users. The model included changes in inflow of new IDU and death rates over time, the latter dependent on age and time since HIV seroconversion. We considered different scenarios of risk behaviour.

IDU in Amsterdam.

Simulated HIV and HCV incidence and prevalence were compared with ACS data.

Assuming that harm reduction measures had led to a strong decrease in risk behaviour over time improved the model fit (squared residuals decreased by 30%). However, substantial incidence and HIV prevalence decline were already reproduced by incorporating demographic changes into the model. In particular, lowered disease spread might be a result of depletion of high-risk IDU among those at risk for disease, and a decrease in the number of high-risk individuals in the population due to HIV-related mortality.

Marked decreases in HIV and HCV in Amsterdam since 1990 could be due partly to harm reduction measures; however, they may also be attributable largely to changes in the IDU population. Future research aimed at quantifying the benefits of interventions should not neglect the impact of natural epidemic progression and demographic changes.

To evaluate whether venlafaxine-extended release (VEN-XR) is an effective treatment for cannabis dependence with concurrent depressive disorders.

This was a randomized, 12-week, double-blind, placebo-controlled trial of out-patients (n = 103) with DSM-IV cannabis dependence and major depressive disorder or dysthymia. Participants received up to 375 mg VEN-XR on a fixed-flexible schedule or placebo. All patients received weekly individual cognitive–behavioral psychotherapy that primarily targeted marijuana use.

The trial was conducted at two university research centers in the United States.

One hundred and three cannabis-dependent adults participated in the trial.

The primary outcome measures were (i) abstinence from marijuana defined as at least two consecutive urine-confirmed abstinent weeks and (ii) improvement in depressive symptoms based on the Hamilton Depression Rating Scale.

The proportion of patients achieving a clinically significant mood improvement (50% decrease in Hamilton Depression score from baseline) was high and did not differ between groups receiving VEN-XR (63%) and placebo (69%) (χ₁² = 0.48, P = 0.49). The proportion of patients achieving abstinence was low overall, but was significantly worse on VEN-XR (11.8%) compared to placebo (36.5%) (χ₁² = 7.46, P < 0.01; odds ratio = 4.51, 95% confidence interval: 1.53, 13.3). Mood improvement was associated with reduction in marijuana use in the placebo group (F_1,179 = 30.49, P < 0.01), but not the VEN-XR group (F_1,186 = 0.02, P = 0.89).

For depressed, cannabis-dependent patients, venlafaxine-extended release does not appear to be effective at reducing depression and may lead to an increase in cannabis use.

To examine whether tamper-resistant formulations (TRFs) of tapentadol hydrochloride extended-release (ER) 50 mg (TAP50) and tapentadol hydrochloride 250 mg (TAP250) could be converted into forms amenable to intranasal (study 1) or intravenous abuse (study 2).

Randomized, repeated-measures study designs were employed. A non-TRF of OxyContin® 40 mg (OXY40) served as a positive control. No drug was taken in either study.

The studies took place in an out-patient setting in New York, NY.

Twenty-five experienced, healthy ER oxycodone abusers participated in each study.

The primary outcome for study 1 was the percentage of participants who indicated that they would snort the tampered tablets, while the primary outcome for study 2 was the percentage yield of active drug in solution. Other descriptive variables, such as time spent manipulating the tablets, were also examined to characterize tampering behaviors more clearly.

Tampered TRF tablets were less desirable than the tampered OXY40 tablets. Few individuals were willing to snort the TRF particles (TAP50: 24%, TAP250: 16%; OXY40: 100% P < 0.001). There was less drug extracted from the TAP50 tablet than from the OXY40 tablet (3.52 versus 37.02%, P = 0.008), and no samples from the TAP250 tablets contained analyzable solutions of the drug. It took participants longer to tamper with the TAPs (study 1: TAP50 versus OXY40, P < 0.01; TAP250 versus OXY40, P < 0.01; study 2: TAP250 versus OXY40, P < 0.05).

Tamper-resistant formulations of taptentadol (pain relief) tablets do not appear to be well-liked by individuals who tamper regularly with extended-release oxycodone tablets. Employing tamper-resistant technology may be a promising approach towards reducing the abuse potential of tapentadol extended-release.

In a previous study, neurological and cognitive deficits reflecting central nervous system (CNS) disruption from chronic inhalant abuse showed substantial recovery after 2 years' abstinence. Functional recovery was progressive, with recovery rates dependent on the degree of impairment prior to abstinence, and severity and duration of initial abuse. Persistent deficits occurred in those with previous ‘lead encephalopathy’ from leaded petrol abuse. The current study examined recovery in the same cohort 15 years after baseline.

Prospective cohort design.

Two remote Aboriginal communities in Arnhem Land, Australia.

Using baseline group classifications, 27 healthy controls, 60 ex-chronic inhalant abusers and an additional 17 with previous lead encephalopathy were assessed.

Standard neurological, ocular-motor and cognitive functions and blood lead levels.

Chronic (non-encephalopathic) inhalant abusers showed elevated blood lead levels and abnormal scores on most tasks at baseline. At 2 years' abstinence, blood lead was reduced but remained elevated and most scores had normalized. By 15 years, blood lead and all performance scores were equivalent to healthy controls for this group (P > 0.05). The encephalopathic group was more severely impaired on all scores at baseline and showed little improvement, if any, across all tests after both 2 and 15 years' abstinence. Blood lead for this group declined, and was not significantly different to controls after 15 years.

Some inhalant abusers experience severe and persistent neurological deficits, suggesting irrecoverable damage attributable to lead encephalopathy. In the absence of this encephalopathy long-term abstinence from inhalants may allow recovery of normal brain function.

To characterize e-cigarette use, users and effects in a sample of Electronic Cigarette Company (TECC) and Totally Wicked E-Liquid (TWEL) users.

Online survey hosted at the University of East London with links from TECC/TWEL websites from September 2011 to May 2012.

Online questionnaire.

One thousand three hundred and forty-seven respondents from 33 countries (72% European), mean age 43 years, 70% male, 96% Causacian, 44% educated to degree level or above.

Seventy-four percent of participants reported not smoking for at least a few weeks since using the e-cigarette and 70% reported reduced urge to smoke. Seventy-two percent of participants used a ‘tank’ system, most commonly, the eGo-C (23%). Mean duration of use was 10 months. Only 1% reported exclusive use of non-nicotine (0 mg) containing liquid. E-cigarettes were generally considered to be satisfying to use; elicit few side effects; be healthier than smoking; improve cough/breathing; and be associated with low levels of craving. Among ex-smokers, ‘time to first vape’ was significantly longer than ‘time to first cigarette’ (t₁₁₀₄ = 11.16, P < 0.001) suggesting a lower level of dependence to e-cigarettes. Ex-smokers reported significantly greater reduction in craving than current smokers (χ²₁ = 133.66, P < 0.0007) although few other differences emerged between these groups. Compared with males, females opted more for chocolate/sweet flavours (χ²₁ = 16.16, P < 0.001) and liked the e-cigarette because it resembles a cigarette (χ²₃ = 42.65, P < 0.001).

E-cigarettes are used primarily for smoking cessation, but for a longer duration than nicotine replacement therapy, and users believe them to be safer than smoking.

To explore tobacco dependence (TD) diagnosis and treatment utilization, and identify predictors of nicotine replacement therapy (NRT) among veterans with substance use disorders (SUDs) enrolled in Veterans Health Administration (VHA) SUD residential treatment programs (SRTPs).

Retrospective cohort study.

VHA SRTPs, which treat veterans with SUD and multiple severe psychosocial deficits, from 1 October 2009 to 31 September 2010.

Identified tobacco users among veterans with SUD treated in SRTPs during fiscal year 2010 (FY10).

Rates of documented TD diagnosis and pharmacotherapy were assessed nationally, regionally and by facility. Patient-level predictors of NRT were examined using a mixed-effects logistic regression model with facility as a random effect.

A total of 12 097 of the 15 320 veterans in SRTPs in FY10 (79%) were identified as probable tobacco users. Among these, 33% had a documented TD diagnosis, 34% were treated with pharmacotherapy and only 11% were both diagnosed and treated for TD while in SRTP. NRT was more common among patients with a current documented TD diagnosis, recent history of TD treatment, comorbid mental health disorder, age 55 years or younger and identified as white.

Most veterans in Veterans Health Administration substance use disorders residential treatment programs appear to use tobacco, yet only one in 10 receives a documented ICD-9 TD diagnosis and pharmacotherapy while in a substance use disorders residential treatment program.

To assess the effects of adding motivational interviewing (MI) counseling to nicotine patch for smoking cessation among homeless smokers.

Two-group randomized controlled trial with 26-week follow-up.

A total of 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/St Paul, Minnesota, USA.

All participants received 8-week treatment of 21-mg nicotine patch. In addition, participants in the intervention group received six individual sessions of MI counseling which aimed to increase adherence to nicotine patches and to motivate cessation. Participants in the standard care control group received one session of brief advice to quit smoking. Primary outcome was 7-day abstinence from cigarette smoking at 26 weeks, as validated by exhaled carbon monoxide and salivary cotinine.

Using intention-to-treat analysis, verified 7-day abstinence rate at week 26 for the intervention group was non-significantly higher than for the control group (9.3% versus 5.6%, P = 0.15). Among participants who did not quit smoking, reduction in number of cigarettes from baseline to week 26 was equally high in both study groups (−13.7 ± 11.9 for MI versus −13.5 ± 16.2 for standard care).

Adding motivational interviewing counseling to nicotine patch did not increase smoking rate significantly at 26-week follow-up for homeless smokers.

Improvement collaboratives consisting of various components are used throughout health care to improve quality, but no study has identified which components work best. This study tested the effectiveness of different components in addiction treatment services, hypothesizing that a combination of all components would be most effective.

An unblinded cluster-randomized trial assigned clinics to one of four groups: interest circle calls (group teleconferences), clinic-level coaching, learning sessions (large face-to-face meetings) and a combination of all three. Interest circle calls functioned as a minimal intervention comparison group.

Out-patient addiction treatment clinics in the United States.

Two hundred and one clinics in five states.

Clinic data managers submitted data on three primary outcomes: waiting-time (mean days between first contact and first treatment), retention (percentage of patients retained from first to fourth treatment session) and annual number of new patients. State and group costs were collected for a cost-effectiveness analysis.

Waiting-time declined significantly for three groups: coaching (an average of 4.6 days/clinic, P = 0.001), learning sessions (3.5 days/clinic, P = 0.012) and the combination (4.7 days/clinic, P = 0.001). The coaching and combination groups increased significantly the number of new patients (19.5%, P = 0.028; 8.9%, P = 0.029; respectively). Interest circle calls showed no significant effect on outcomes. None of the groups improved retention significantly. The estimated cost per clinic was $2878 for coaching versus $7930 for the combination. Coaching and the combination of collaborative components were about equally effective in achieving study aims, but coaching was substantially more cost-effective.

When trying to improve the effectiveness of addiction treatment services, clinic-level coaching appears to help improve waiting-time and number of new patients while other components of improvement collaboratives (interest circles calls and learning sessions) do not seem to add further value.