Substance Abuse Treatment, Prevention, and Policy - Latest Articles

Prevalence of and Factors Associated with Daily Smoking among Inner Mongolia Medical Students in China: A Cross-sectional Questionnaire Survey

Jiang Bian — 2012-05-16T00:00:00Z

Background: To date no study on smoking behavior of medical students in Inner Mongolia has been carried out. The aim of the present study was to determine the prevalence of and factors associated with daily smoking among medical students in Inner Mongolia of China, to assist interventions designed to reduce the smoking behavior of medical college students in this region. Methods: During December 2010 and January 2011 a cross-sectional survey was conducted among medical students at the Inner Mongolia Medical College using a self-administered questionnaire. The questionnaire consisted of three sections: students' basic information, attitude on smoking behavior, and smoking status of the student daily smokers. Students who smoked every day in the last 30 days were regarded as daily smokers. Factors associated with smoking were identified using binary logistic regression analysis. Results: A total of 6044 valid surveys were returned. The overall prevalence of daily smoking was 9.8% while the prevalence of daily smoking among males and females were 29.4% and 1.7%, respectively. Males in the Faculty of Medicine Information Management had the highest daily smoking rate (48.9%). Logistic regression models found that the main factors associated with daily smoking among male medical students were highest year of study (OR=3.62; CI: 1.18-11.05); attitude towards smoking behavior Do not care about people smoking around you (OR=2.75; CI: 2.08-3.64); and Smoking is harmful to their health (OR=4.40; CI: 2.21-8.75). The main factor associated with daily smoking among female medical students was attitude towards smoking behavior Eliminate smoking on campus (OR=0.11; CI: 0.06-0.23). Both for male and female medical students, there was no association between ethnicity and cigarette daily smoking. In regard to smoking status, more than 60% of daily smokers began smoking in high school, 61.3% smoked less than 5 cigarettes per day, 62.9% of the daily smokers' families opposed their smoking behavior, and after an hour of not smoking 74.6% daily smokers did not feel uncomfortable. Conclusions: Antismoking education should be further promoted in Inner Mongolia medical students, with consideration given to the factors associated with daily smoking behavior found in the present study.

Reports of past alcohol and drug use following participation in a motivation enhancing intervention: Implications for clinical assessment and program evaluation

David Rosengren — 2012-05-14T00:00:00Z

Background: There is significant interest in the value of motivational approaches that enhance participant readiness to change, but less is known about clients' self-reports of problematic behavior when participating in such interventions. Methods: We examined whether participants in a motivationally-based intervention for DUI offenders changed their reports of substance use at postintervention (when reporting on the same 30 days that they reported on at preintervention). Specifically, Study 1 (N = 8,387) tested whether participants in PRIME For Life (PFL) changed their reports about baseline substance levels when asked at postintervention versus at preintervention. Study 2 (N = 192) compared changes in self-reported baseline drinking between PFL and intervention as usual (IAU) participants. Results: Many participants in Study 1 did not change their reports about how much they used substances during the 30-day period before baseline. Among those who did, the most common change was an increase in reported amounts of baseline drug use, and typical and peak alcohol use. This sample also showed changes in reports of their baseline pattern of high-risk-use (consistent versus occasional). At postintervention, participants who were younger, single, or endorsing more indicators of alcohol dependence were more likely to later report greater frequency of baseline drug use, and greater peak and typical number of baseline drinks. Gender, education, and race were also associated with reporting inconsistency on some behaviors. In Study 2, PFL participants showed greater increases in reports of peak alcohol use compared to IAU, but both conditions showed similar increases for drugs and typical alcohol use. Conclusions: In both research and clinical settings, a segment of participants may initially report less substance use than they do when asked later about the same baseline period. These preliminary findings suggest clinicians and researchers may find postintervention evaluations yield reports of greater baseline alcohol or drug use for some people. For some behaviors, this may occur more often in interventions that target client motivation. Future research should attempt to identify which reports - preintervention vs. postintervention - better reflect actual baseline substance use.

Effects of expertise on football betting

Yasser Khazaal — 2012-05-11T00:00:00Z

Background: Football (soccer) is one of the most popular sports in the world, including Europe. It is associated with important betting activities. A common belief, widely spread among those who participate in gambling activities, is that knowledge and expertise on football lead to better prediction skills for match outcomes. If unfounded, however, this belief should be considered as a form of "illusion of control." The aim of this study was to examine whether football experts are better than nonexperts at predicting football match scores. Methods: Two hundred and fifty-eight persons took part in the study: 21.3% as football experts, 54.3% as laypersons (non-initiated to football), and 24.4% as football amateurs. They predicted the scores of the first 10 matches of the 2008 UEFA European Football Championship. Logistic regressions were carried out to assess the link between the accuracy of the forecasted scores and the expertise of the participants (expert, amateur, layperson), controlling for age and gender. Results: The variables assessed did not predict the accuracy of scoring prognosis (R2 ranged from 1% to 6%). Conclusions: Expertise, age, and gender did not appear to have an impact on the accuracy of the football match prognoses. Therefore, the belief that football expertise improves betting skills is no more than a cognitive distortion called the "illusion of control." Gamblers may benefit from psychological interventions that target the illusion of control related to their believed links between betting skills and football expertise. Public health policies may need to consider the phenomenon in order to prevent problem gambling related to football betting.

The predictive validity of the Drinking-Related Cognitions Scale in alcohol-dependent patients under abstinence-oriented treatment

Toru Sawayama — 2012-05-04T00:00:00Z

Background: Cognitive factors associated with drinking behavior such as positive alcohol expectancies, self-efficacy, perception of impaired control over drinking and perception of drinking problems are considered to have a significant influence on treatment effects and outcome in alcohol-dependent patients. However, the development of a rating scale on lack of perception or denial of drinking problems and impaired control over drinking has not been substantial, even though these are important factors in patients under abstinence-oriented treatment as well as participants in self-help groups such as Alcoholics Anonymous (AA). The Drinking-Related Cognitions Scale (DRCS) is a new self-reported rating scale developed to briefly measure cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment, including positive alcohol expectancies, abstinence self-efficacy, perception of impaired control over drinking, and perception of drinking problems. Here, we conducted a prospective cohort study to explore the predictive validity of DRCS. Methods: Participants in this study were 175 middle-aged and elderly Japanese male patients who satisfied the DSM-IV Diagnostic Criteria for Alcohol Dependence. DRCS scores were recorded before and after the inpatient abstinence-oriented treatment program, and treatment outcome was evaluated one year after discharge. Results: Of the 175 participants, 30 were not available for follow-up; thus the number of subjects for analysis in this study was 145. When the total DRCS score and subscale scores were compared before and after inpatient treatment, a significant increase was seen for both scores. Both the total DRCS score and each subscale score were significantly related to total abstinence, percentage of abstinent days, and the first drinking occasion during the one-year post-treatment period. Therefore, good treatment outcome was significantly predicted by low positive alcohol expectancies, high abstinence self-efficacy, high perception level of impaired control over drinking, and high perception level of drinking problems measured by DRCS. Conclusions: The DRCS was considered to have satisfactory predictive validity, which further supports our previous findings. It was suggested that DRCS is a promising rating scale for evaluating multidimensional cognitive factors associated with drinking behavior in alcohol-dependent patients under abstinence-oriented treatment.

The readiness of addiction treatment agencies for health care reform

Todd Molfenter — 2012-05-02T00:00:00Z

The Patient Protection and Affordable Care Act (PPACA) aims to provide affordable health insurance and expanded health care coverage for some 32 million Americans. The PPACA makes provisions for modernizing the delivery of health care services using technology, evidence-based treatments, and integrated and patient-centered care to ensure effectiveness, efficiency and cost-savings within the health care system.To gauge the addiction treatment field's readiness for health reform, the authors developed a Health Reform Readiness Index (HRRI) survey for substance use disorder (SUD) treatment agencies. Addiction treatment administrators and providers from around the United States were invited to complete the survey. Respondents self-assessed their agency based on thirteen conditions pertinent to health reform readiness, and received a confidential score and instant feedback.Overall, agencies (n=276) indicated, on a scale of "Needs to Begin," "Early Stages," "On the Way," and "Advanced", that they were in the Early Stages of health reform preparation for eleven of thirteen conditions. Of greater concern was organizations that had budgets of < $5 million (n = 193) were less likely than those with > $5 million budgets to have information technology, evidence based practices, quality management systems, a continuum of care, good financial health, or a board of directors informed about PPACA.Based on the findings of the HRRI, it is clear that the SUD field, and in particular smaller organizations, have much to do to prepare for a future environment that has greater health information technology, credentialed workforce, quality of care, and continuum of care expectations.

12-month follow-up of an exploratory 'brief intervention' for high-frequency cannabis users among Canadian university students

Benedikt Fischer — 2012-04-26T00:00:00Z

Background: One in three young people use cannabis in Canada. Cannabis use can be associated with avariety of health problems which occur primarily among intensive/frequent users.Availability and effectiveness of conventional treatment for cannabis use is limited. WhileBrief Interventions (BIs) have been shown to result in short-term reductions of cannabis userisks or problems, few studies have assessed their longer-term effects. The present studyexamined 12-month follow-up outcomes for BIs in a cohort of young Canadian highfrequencycannabis users where select short-term effects (3 months) had previously beenassessed and demonstrated.FindingsN = 134 frequent cannabis users were recruited from among university students in Toronto,randomized to either an oral or a written cannabis BI, or corresponding health controls, andassessed in-person at baseline, 3-months, and 12-months. N = 72 (54 %) of the originalsample were retained for follow-up analyses at 12-months where reductions in 'deepinhalation/breathholding' (Q = 13.1; p < .05) and 'driving after cannabis use' (Q = 9.3; p <.05) were observed in the experimental groups. Reductions for these indicators had beenshown at 3-months in the experimental groups; these reductions were maintained over theyear. Other indicators assessed remained overall stable in both experimental and controlgroups. Conclusions: The results confirm findings from select other studies indicating the potential for longer-termand sustained risk reduction effects of BIs for cannabis use. While further research is neededon the long-term effects of BIs, these may be a valuable - and efficient - intervention tool ina public health approach to high-risk cannabis use.

Validation of the French version of the alcohol, smoking and substance involvement screening test (ASSIST) in the elderly

Riaz khan — 2012-04-26T00:00:00Z

Background: Substance use disorders seem to be an under considered health problem amongst the elderly.The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), was developedby the World Health Organization to detect substance use disorders.The present study evaluates the psychometric properties of the French version of ASSIST in asample of elderly people attending geriatric outpatient facilities (primary care or psychiatricfacilities). Methods: One hundred persons older than 65 years were recruited from clients attending a geriatricpoliclinic day care centre and from geriatric psychiatric facilities. Measures includedASSIST, Addiction Severity Index (ASI), Mini-International Neuropsychiatric Interview(MINI-Plus), Alcohol Use Disorders Identification Test (AUDIT), Revised FagerstromTolerance Questionnaire-Smoking (RTQ) and MiniMental State(MMS). Results: Concurrent validity was established with significant correlations between ASSIST scores,scores from ASI, AUDIT, RTQ, and significantly higher ASSIST scores for patients with aMINI-Plus diagnosis of abuse or dependence. The ASSIST questionnaire was found to havehigh internal consistency for the total substance involvement along with specific substanceinvolvement as assessed by Cronbach's alpha, ranging from 0.66, to 0.89 . Conclusions: The findings demonstrate that ASSIST is a valid screening test for identifying substance usedisorders in elderly.Funding source: funds made available from the division of quality university hospitalsGeneva

Screening of cannabis-related problems among youth: the CPQ-A-S and CAST questionnaires

Sergio Fernandez-Artamendi — 2012-04-02T00:00:00Z

Background: Cannabis use among young people is a significant problem, making particularly necessary validated screening instruments that permit secondary prevention. The purpose of this study was to analyze and compare the psychometric properties of the CAST and CPQ-A-S questionnaires, two screening instruments specifically addressing the youth population. Methods: Information was obtained on sociodemographics, frequency of substance use, psychopathological symptoms and cannabis-use problems, and the CPQ-A-S and CAST were applied, as well as an infrequency scale for discarding responses made randomly. The sample was made up of 144 young people aged 16 to 20 that had used cannabis in the last month, of which 71.5% were boys. Mean age of the sample was 17.38 years (SD = 1.16). Results: The results show that from the psychometric point of view both the CAST and the CPQ-A-S are good screening instruments. Conclusions: The CAST is shorter and presents slightly better internal consistency than the CPQ-A-S. Both instruments show high sensitivity and specificity in the detection of young people dependent on cannabis according to the DSM IV-TR criteria. The CPQ-A-S appears to show greater capacity for detecting psychopathological distress associated with use. Both questionnaires yield significant odds ratios as predictors of frequent cannabis use and of the DSM IV-TR abuse and dependence criteria. In general, the CPQ-A-S emerges as a better predictor than the CAST.

Single dose testosterone increases total cholesterol levels and induces the expression of HMG CoA Reductase

Nina Garevik — 2012-03-20T00:00:00Z

Background: Cholesterol is mainly synthesised in liver and the rate-limiting step is the reduction of 3-hydroxy-3methylglutaryl coenzyme A (HMG-CoA) to mevalonate, a reaction catalysed by HMG-CoA reductase (HMGCR). There is a comprehensive body of evidence documenting that anabolic-androgenic steroids are associated with deleterious alterations of lipid profile. In this study we investigated whether a single dose of testosterone enanthate affects the cholesterol biosynthesis and the expression of HMGCR. Methods: 39 healthy male volunteers were given 500 mg testosterone enanthate as single intramuscular dose of Testoviron®--Depot. The total cholesterol levels prior to and two days after testosterone administration were analysed. Protein expression of HMGCR in whole blood was investigated by Western blotting. In order to study whether testosterone regulates the mRNA expression of HMGCR, in vitro studies were performed in a human liver cell-line (HepG2). Results: The total cholesterol level was significantly increased 15% two days after the testosterone injection (p = 0.007). This is the first time a perturbation in the lipoprotein profile is observed after only a single dose of testosterone. Moreover, the HMGCR mRNA and protein expression was induced by testosterone in vitro and in vivo, respectively. Conclusion: Here we provide a molecular explanation how anabolic androgenic steroids may impact on the cholesterol homeostasis, i.e. via an increase of the HMGCR expression. Increasing knowledge and understanding of AAS induced side-effects is important in order to find measures for treatment and care of these abusers.

Survey of methadone-drug interactions among patients of methadone maintenance treatment program in Taiwan

Hsin-Ya Lee — 2012-03-20T00:00:00Z

Background: Although methadone has been used for the maintenance treatment of opioid dependence for decades, it was not introduced in China or Taiwan until 2000s. Methadone-drug interactions (MDIs) have been shown to cause many adverse effects. However, such effects have not been scrutinized in the ethnic Chinese community. Methods: The study was performed in two major hospitals in southern Taiwan. A total of 178 non-HIV patients aged [greater than or equal to] 20 years who had participated in the Methadone Maintenance Treatment Program (MMTP) [greater than or equal to] 1 month were recruited. An MDI is defined as concurrent use of drug(s) with methadone that may result in an increase or decrease of effectiveness and/or adverse effect of methadone. To determine the prevalence and clinical characteristics of MDIs, credible data sources, including the National Health Insurance (NHI) database, face-to-face interviews, medical records, and methadone computer databases, were linked for analysis. Socio-demographic and clinical factors associated with MDIs and co-medications were also examined. Results: 128 (72%) MMTP patients took at least one medication. Clinically significant MDIs included withdrawal symptoms, which were found among MMTP patients co-administered with buprenorphine or tramadol; severe QTc prolongation effect, which might be associated with use of haloperidol or droperidol; and additive CNS and respiratory depression, which could result from use of methadone in combination with chlorpromazine or thioridazine. Past amphetamine use, co-infection with hepatitis C, and a longer retention in the MMTP were associated with increased odds of co-medication. Among patients with co-medication use, significant correlates of MDIs included the male gender and length of co-medication in the MMTP. Conclusions: The results demonstrate clinical evidence of significant MDIs among MMTP patients. Clinicians should check the past medical history of MMTP clients carefully before prescribing medicines. Because combinations of methadone with other psychotropic or opioid medications can affect treatment outcomes or precipitate withdrawal symptoms, clinicians should be cautious when prescribing these medications to MMTP patients and monitor the therapeutic effects and adverse drug reactions. Although it is difficult to interconnect medical data from different sources for the sake of privacy protection, the incumbent agency should develop pharmacovigilant measures to prevent the MDIs from occurring. Physicians are also advised to check more carefully on the medication history of their MMTP patients.