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CERGA Journal Title and Abstracts March 2014Contents PAGE

LIST OF JOURNALS CHECKED 2

LIST OF REFERENCES

Alcohol – Brief Intervention 3

Alcohol - Miscellaneous 3

Alcohol Treatment 3

Alcohol – Young People 4

Blood Borne Viruses 5

Co-Morbidity 5

Drug Related Deaths 6

Epidemiology and Demography 6

Hepatitis C 6

Injecting Behaviour 7

Methadone Maintenance Treatment 7

New Psychoactive Substances 8

Opiate Treatment 8

Prescription and OTC Dependence 9

Prevention and Diversionary Activities 9

Recovery 9

Smoking Cessation 9

Stigma 10

LIST OF ABSTRACTS 11-48

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Journal Title Volumes and Issues CheckedNumber of issues

per year

Addiction Volume 109 Issue 1[3], Issue 2[1] Issue 3[3] 12Addictive Behaviours Volume 39 Issue 1[1], Issue 3[3] 12Alcohol and Alcoholism Volume 49 Issue 1[2] 6Alcoholism Clinical & Experimental Research

Volume 38 Issue 1[2], Issue 2[2]12

Drug and Alcohol Dependence Volume 134[2], 135[3], 136[1] 12Drugs Education Prevention and Policy

Volume 21 Issue 1[3], Early Issue 2[3] 6

Drug and Alcohol Review Volume 33 Issue 1[1] Issue 2 [1] 6European Addiction Research Volume 20 Issue 3[1] 4-5International Journal of Drug Policy

Volume 24 Issue 6[6]Volume 25 Issue 1[1] 6

Journal of Substance Abuse Treatment

Volume 46 Issue 3[3], Issue 4[5]8

The American Journal of Drug and Alcohol Abuse

Volume 40 Issue 2 [1]6

Substance Use and Misuse Volume 49 Issue 1-2[1], Issue 3[2] Issue 4[3] 12

Alcohol and Alcoholism: Special Issue on Alcohol related brain damage in Adolescence January 2014

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LIST OF REFERENCES

ALCOHOL – BRIEF INTERVENTION

1. Regression to the mean and alcohol consumption: A cohort study exploring implications for the interpretation of change in control groups in brief intervention trials Jim McCambridge, Kypros Kypri, Patrick McElduffDrug and Alcohol Dependence 2014:135(1st Feb 2014);156-159

ALCOHOL - MISCELLANEOUS

2. Half Full or Empty: Cues That Lead Wine Drinkers to Unintentionally OverpourDoug Walker, Laura Smarandescu, Brian WansinkSubstance Use & Misuse 2014:49(3);295-302

3. Assessing and responding to hazardous and risky alcohol and other drug use:

The practice, knowledge and attitudes of staff working in mental health servicesAmanda Wheeler, Michelle Crozier, Gail Robinson, Natale Pawlow, Gabor MihalaDrugs: Education, Prevention, and Policy 2014:Early Online Issue 2;1-10 Posted online on 2 Dec 2013

4. The Association of Mild, Moderate, and Binge Prenatal Alcohol Exposure and Child Neuropsychological Outcomes: A Meta-AnalysisAudrey L. Flak, Su Su, Jacquelyn Bertrand, Clark H. Denny, Ulrik S. Kesmodel, Mary E. CogswellAlcoholism: Clinical and Experimental Research 2014:38(1);214-226

5. Does the Severity of Hangovers Decline with Age? Survey of the Incidence of Hangover in Different Age GroupsJanne S. Tolstrup, Richard Stephens, Morten GrønbækAlcoholism: Clinical and Experimental Research 2014:38(2);466-470

ALCOHOL TREATMENT

6. Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysisHeleen Riper, Gerhard Andersson, Sarah B. Hunter, Jessica de Wit, Matthias Berking, Pim CuijpersAddiction 2014:109(3);394-406

7. Outcome predictors for problem drinkers treated with combined cognitive

behavioral therapy and naltrexoneSalla Vuoristo-Myllys, Jari Lipsanen, Jari Lahti, Hely Kalska, Hannu AlhoThe American Journal of Drug and Alcohol Abuse 2014:40(2);103–110

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8. Continuing care for patients with alcohol use disorders: A systematic review Evelien Lenaerts, Catharina Matheï, Frieda Matthys, Dieter Zeeuws, Leo Pas, Peter Anderson, Bert AertgeertsDrug and Alcohol Dependence 2014:135(1st Feb 2014);9-21

9. Antioxidant Vitamins and Brain Dysfunction in AlcoholicsEmilio González-Reimers, Camino M. Fernández-Rodríguez, M. Candelaria Martín-González, Iván Hernández-Betancor, Pedro Abreu-González, María José de la Vega-Prieto, Oswaldo Elvira-Cabrera, Francisco Santolaria-FernándezAlcohol and Alcoholism 2014:49(1);45-50

10. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of ReviewsAmy O'Donnell, Peter Anderson, Dorothy Newbury-Birch, Bernd Schulte, Christiane Schmidt, Jens Reimer, Eileen Kaner Alcohol and Alcoholism 2014:49(1);66-78

ALCOHOL – YOUNG PEOPLE

11. Factors Associated With Parental Rules for Adolescent Alcohol UseConor Gilligan, John W. Toumbourou, Kypros Kypri, Patrick McElduffSubstance Use & Misuse 2014:49(1-2);145-153

12. “Everyone can loosen up and get a bit of a buzz on”: Young adults, alcohol and

friendship practicesPatricia Niland, Antonia C. Lyons, Ian Goodwin, Fiona HuttonInternational Journal of Drug Policy 2013:24(6);530-537

13. Which alcohol control strategies do young people think are effective?Richard O. de Visser, Angie Hart, Charles Abraham, Anjum Memon, Rebecca Graber, Tom ScanlonDrug and Alcohol Review 2104:33(2);144-151

14. Parenting styles and alcohol use among children and adolescents: A systematic reviewLenka Čablová, Kristýna Pazderková, Michal MiovskýDrugs: Education, Prevention and Policy 2014:21(1);1-13

15. The role of parental alcohol use, parental discipline and antisocial behaviour on adolescent drinking trajectoriesR. Alati, P. Baker, K.S. Betts, J.P. Connor, K. Little, A. Sanson, C.A. OlssonDrug and Alcohol Dependence 2014:134(1st Jan 2014);178-184

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BLOOD BORNE VIRUSES

16. Desired Social Distance From People Who Have Hepatitis C Virus: An Exploration Among Staff in Health Care, Dentistry, Drug Treatment, and Tattoo/Body PiercingAlicia Elena Suarez, Deidre RedmondSubstance Use & Misuse 2014:49(4);466–474

17. Education and counseling in the methadone treatment setting improves knowledge of viral hepatitisSandra E. Larios, Carmen L. Masson, Michael S. Shopshire, Jennifer Hettema, Ashly E. Jordan, Courtney McKnight, Christopher Young, Mandana Khalili, Randy M. Seewald, Albert Min, Nicholas Hengl, James L. Sorensen, Don C. Des Jarlais, David C. PerlmanJournal of Substance Abuse Treatment 2014:46(4);528-531

18. Transitions from injecting to non-injecting drug use: Potential protection against

HCV infectionDon C. Des Jarlais, Courtney McKnight, Kamyar Arasteh, Jonathan Feelemyer, David C. Perlman, Holly Hagan, Hannah L.F. CooperJournal of Substance Abuse Treatment 2014:46(3);325-331

CO-MORBIDITY

19. 12-step facilitation for the dually diagnosed: A randomized clinical trialMichael P. Bogenschutz, Samara L. Rice, J. Scott Tonigan, Howard S. Vogel, Joseph Nowinski, Donald Hume, Pamela B. ArenellaJournal of Substance Abuse Treatment 2014:46(4);403-411

20. Young adults with co-occurring disorders: substance use disorder treatment response and outcomesBrandon G. Bergman, M. Claire Greene, Valerie Slaymaker, Bettina B. Hoeppner, John F. Kelly,Journal of Substance Abuse Treatment 2014:46(4);420-428

21. Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A ReviewDe Witte N.A.J, Crunelle C.L, Sabbe B, Moggi F, Dom G European Addiction Research 2014:20(3);105-114

22. Needs assessment of dual diagnosis: A cross-sectional survey using routine clinical dataKhodayar Shahriyarmolki, Tim MeynenDrugs: Education, Prevention, and Policy 2014:21(1);43-49

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DRUG RELATED DEATH

23. Causes of death in a cohort treated for opioid dependence between 1985 and 2005Louisa Degenhardt, Sarah Larney, Deborah Randall, Lucy Burns, Wayne HallAddiction 2104:109(1);90-99

24. Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudesAnna V. Williams, John Marsden, John StrangAddiction 2014:109(2);250-259

EPIDEMIOLOGY AND DEMOGRAPHY

25. Drug Misuse Among University Students in the UK: Implications for PreventionTrevor Hugh Bennett, Katy Rose HollowaySubstance Use & Misuse 2014:49(4);448-455

26. Intergenerational Continuity of Substance UseKelly E. Knight, Scott Menard, Sara B. SimmonsSubstance Use & Misuse 2014: 49(3);221–233

27. The Patterns of Drug and Alcohol Use and Associated Problems Over 30 Years in 397 MenMarc A. Schuckit, Tom L. Smith, Jelger A. KalmijnAlcoholism: Clinical and Experimental Research 2014:38(1);227-234

28. Alcohol Consumption, Heavy Drinking, and Mortality: Rethinking the J-Shaped CurveAndrew D. Plunk, Husham Syed-Mohammed, Patricia Cavazos-Rehg, Laura J. Bierut, Richard A. GruczaAlcoholism: Clinical and Experimental Research 2014:38(2);471-478

HEPATITIS C

29. Chronic hepatitis C virus infection is associated with all-cause and liver-related mortality in a cohort of HIV-infected patients with alcohol problemsDaniel Fuster, Debbie M. Cheng, Emily K. Quinn, David Nunes, Richard Saitz, Jeffrey H. Samet, Judith I. TsuiAddiction 2014:109(1);62-70

30. ‘Not just Methadone Tracy’: transformations in service-user identity following

the introduction of hepatitis C treatment into Australian opiate substitution settingsJake Rance, Carla Treloar, on behalf of the ETHOS Study GroupAddiction 2014:109(3);452-459

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31. “It gives me a sense of belonging”: Providing integrated health care and treatment to people with HCV engaged in a psycho-educational support groupSusan Woolhouse, Emily Cooper, Angela PickardInternational Journal of Drug Policy 2013:24(6);550-557

32. Hepatitis C prevention education needs to be grounded in social relationshipsSuzanne Fraser, Carla Treloar, Joanne Bryant, Tim RhodesDrugs: Education, Prevention, and Policy 2014:21(1);88-92

INJECTING BEHAVIOUR

33. Dependent heroin use and associated risky behaviour: The role of rash impulsiveness and reward sensitivityLakal O. Dissabandara, Natalie J. Loxton, Shavindra R. Dias, Peter R. Dodd, Mark Daglish, Alfreda StadlinAddictive Behaviors 2014:39(1);71-76

METHADONE MAINTENANCE TREATMENT

34. Interim versus standard methadone treatment: A benefit–cost analysisRobert P. Schwartz, Pierre K. Alexandre, Sharon M. Kelly, Kevin E. O'Grady, Jan Gryczynski, Jerome H. JaffeJournal of Substance Abuse Treatment 2014:46(3);306-314

35. Methadone diversion as a protective strategy: The harm reduction potential of ‘generous constraints’Magdalena Harris, Tim RhodesInternational Journal of Drug Policy 2013:24(6);e43-e50

36. What is low threshold methadone maintenance treatment?Carol Strike, Margaret Millson, Shaun Hopkins, Christopher SmithInternational Journal of Drug Policy 2013:24(6);e51-e56

37. Work and the journey to recovery: Exploring the implications of welfare reform for methadone maintenance clientsMark Monaghan, Emma WincupInternational Journal of Drug Policy 2013:24(6);e81-e86

38. Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial)Caroline Lions, M. Patrizia Carrieri, Laurent Michel, Marion Mora, Fabienne Marcellin, Alain Morel, Bruno Spire, Perrine Roux, the Methaville study group Drug and Alcohol Dependence 2014:135(1st Feb 2014);1-8

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NEW PSYCHOACTIVE SUBSTANCE

39. Are “Legal Highs” Users Satisfied? Evidence from Online Customer CommentsChristophe-Alain Bruneel, Christian Ben Lakhdar, Nicolas G. VaillantSubstance Use & Misuse 2014:49(4);364-373

OPIATE TREATMENT

40. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trialYih-Ing Hser, Andrew J. Saxon, David Huang, Al Hasson, Christie Thomas, Maureen Hillhouse, Petra Jacobs, Cheryl Teruya, Paul McLaughlin, Katharina Wiest, Allan Cohen, Walter LingAddiction 2014:109(1);79-87

41. Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment programBryan Hartzler, T. Ron Jackson, Brinn E. Jones, Blair Beadnell, Donald A. CalsynJournal of Substance Abuse Treatment 2014:46(4);429-438

42. Does age at first treatment episode make a difference in outcomes over 11 years?Felicia W. Chi, Constance Weisner, Christine E. Grella, Yih-Ing Hser, Charles Moore, Jennifer MertensJournal of Substance Abuse Treatment 2014:46(4);482-490

43. A qualitative study of the adoption of buprenorphine for opioid addiction treatmentCarla A. Green, Dennis McCarty, Jennifer Mertens, Frances L. Lynch, Anadam Hilde, Alison Firemark, Constance M. Weisne, David Pating, Bradley M. AndersonJournal of Substance Abuse Treatment 2014:46(3);390-401

44. Substance abuse treatment and the stages of change, by Gerard J. Connors, Carlo C. DiClemente, Mary Marden Velasquez, & Dennis M. DonovanRobin DavidsonDrugs: Education, Prevention, and Policy 2014:Early Online of Issue 2,1-1: Posted online 25th October 2013

45. The diversion and injection of a buprenorphine-naloxone soluble film

formulation Briony Larance, Nicholas Lintzeris, Robert Ali, Paul Dietze, Richard Mattick, Rebecca Jenkinson, Nancy White, Louisa DegenhardtDrug and Alcohol Dependence 2014:136(1st Mar 2014);21-27

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PRESCRIPTION AND OTC DEPENDENCE

46. Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sampleJessica Belcher, Suzanne Nielsen, Gabrielle Campbell, Raimondo Bruno, Bianca Hoban, Briony Larance, Nicholas Lintzeris, Louisa DegenhardtDrug and Alcohol Review 2014:33(1);27-32

47. Pill popping problems: The non-medical use of stimulant medications in an undergraduate sampleAndrew R.  Gallucci, Stuart L. Usdan, Ryan J. Martin, Kathleen A. BollandDrugs: Education, Prevention, and Policy 2014:Early Online of Issue 2,1-8: Posted online 28th October 2013

PREVENTION AND DIVERSIONARY ACTIVITIES

48. Sport participation and alcohol and illicit drug use in adolescents and young adults: A systematic review of longitudinal studiesMatthew Kwan, Sarah Bobko, Guy Faulkner, Peter Donnelly, John CairneyAddictive Behaviors 2014:39(3);497-506

PROFESSIONALS AND SERVICES

49. Healthcare professionals’ regard towards working with patients with substance use disorders: Comparison of primary care, general psychiatry and specialist addiction servicesLeonieke C. van Boekel, Evelien P.M. Brouwers, Jaap van Weeghel, Henk F.L. GarretsenDrug and Alcohol Dependence 2014:134(1st Jan 2014);92-98

RECOVERY

50. Clear rhetoric and blurred reality – The development of a recovery focus in UK drug treatment policy and practiceNeil McKeganeyInternational Journal of Drug Policy, In Press, Corrected Proof, Available online 31 January 2014

SMOKING CESSATION

51. Real-world’ effectiveness of smoking cessation treatments: a population studyDaniel Kotz, Jamie Brown, Robert WestAddiction 2014:109(3);491-499

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52. Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies Nadra E. Lisha, Timothy P. Carmody, Gary L. Humfleet, Kevin L. DelucchiAddictive Behaviors 2014:39(3);637-643

53. Small financial incentives increase smoking cessation in homeless smokers: A pilot studyMichael S. Businelle, Darla E. Kendzor, Anshula Kesh, Erica L. Cuate, Insiya B. Poonawalla, Lorraine R. Reitzel, Kolawole S. Okuyemi, David W. WetterAddictive Behaviors 2014:39(3);717-720

STIGMA

54. Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periodsAmy Chandler, Anne Whittaker, Sarah Cunningham-Burley, Nigel Williams, Kelly McGorm, Gillian MathewsInternational Journal of Drug Policy 2013:24(6);e35-e42

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LIST OF ABSTRACTS

ALCOHOL – BRIEF INTERVENTION

1. Regression to the mean and alcohol consumption: A cohort study exploring implications for the interpretation of change in control groups in brief intervention trials Jim McCambridge, Kypros Kypri, Patrick McElduffDrug and Alcohol Dependence 2014:135(1st Feb 2014);156-159 AbstractBackground Reductions in drinking among individuals randomised to control groups in brief alcohol intervention trials are common and suggest that asking study participants about their drinking may itself cause them to reduce their consumption. We sought to test the hypothesis that the statistical artefact regression to the mean (RTM) explains part of the reduction in such studies. Methods 967 participants in a cohort study of alcohol consumption in New Zealand provided data at baseline and again six months later. We use graphical methods and apply thresholds of 8, 12, 16 and 20 in AUDIT scores to explore RTM. Results There was a negative association between baseline AUDIT scores and change in AUDIT scores from baseline to six months, which in the absence of bias and confounding, is RTM. Students with lower baseline scores tended to have higher follow-up scores and conversely, those with higher baseline scores tended to have lower follow-up scores. When a threshold score of 8 was used to select a subgroup, the observed mean change was approximately half of that observed without a threshold. The application of higher thresholds produced greater apparent reductions in alcohol consumption. Conclusions Part of the reduction seen in the control groups of brief alcohol intervention trials is likely to be due to RTM and the amount of change is likely to be greater as the threshold for entry to the trial increases. Quantification of RTM warrants further study and should assist understanding assessment and other research participation effects.Keywords: Regression to the mean; Brief intervention; Alcohol; Student; Research participation

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ALCOHOL - MISCELLANEOUS

2. Half Full or Empty: Cues That Lead Wine Drinkers to Unintentionally OverpourDoug Walker, Laura Smarandescu, Brian WansinkSubstance Use & Misuse 2014:49(3);295-302 Abstract What might unknowingly bias the amount of wine a person serves themselves? Wine is often self-poured in various settings (e.g., at home, restaurants, receptions, parties). Building on research involving visual illusions and haptic cues, an exploratory field study finds that environmental factors (e.g., glass shape, pouring position, wine color) affect how much wine is poured in different scenarios. When individuals overpoured, they were generally accurate in post hoc perceptions of the relative extent to which the environmental cues affected their pouring. Increasing awareness of pouring biases is a step toward limiting alcohol intake for improved health outcomes and preventing alcohol-related problems.Keywords: overpouring; overconsuming; environmental cues; wine

3. Assessing and responding to hazardous and risky alcohol and other drug use: The practice, knowledge and attitudes of staff working in mental health servicesAmanda Wheeler, Michelle Crozier, Gail Robinson, Natale Pawlow, Gabor MihalaDrugs: Education, Prevention, and Policy 2014:Early Online Issue 2;1-10 Posted online on 2 Dec 2013.

Abstract Introduction Comorbidity of mental illness and alcohol and other drugs (AOD) raises workforce challenges in terms of appropriate knowledge, skills and attitudes required for delivering best care. Aim  (1) To assess the knowledge, skills and attitudes of mental health staff in relation to AOD use and (2) to inform development of training to provide effective screening and interventions for people with both mental health and AOD problems (co-morbidity). Method  Quantitative survey of knowledge, skills and attitudes regarding AOD issues completed by multidisciplinary mental health staff (n = 104/218) working across acute and community settings. Results A 47.7% response rate was achieved. Generally staff held positive attitudes and motivation towards working with people with comorbidity, but there was an absence of formal training, experience or knowledge. Most staff believed they could deal with AOD issues; however, confidence was higher with assessment over AOD-related interventions (brief interventions, motivational approaches and goal setting) and only 24% of staff correctly identified standard drinks. Most staff recognized that AOD assessment and intervention is part of their role and access to training would facilitate their ability to improve service to mental health consumers. Conclusion Integrated care for people with comorbidity requires mental health service providers to address identified gaps in clinician's knowledge, skills and attitudes with training in relation to AOD. To ensure effective training uptake and implementation, workforce leaders need to target identified barriers with initiatives such as support, mentoring and appropriate tools in relation to AOD.

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4. The Association of Mild, Moderate, and Binge Prenatal Alcohol Exposure and Child Neuropsychological Outcomes: A Meta-AnalysisAudrey L. Flak, Su Su, Jacquelyn Bertrand, Clark H. Denny, Ulrik S. Kesmodel, Mary E. CogswellAlcoholism: Clinical and Experimental Research 2014:38(1);214-226

Abstract Background The objective of this review is to evaluate the literature on the association between mild, moderate, and binge prenatal alcohol exposure and child neurodevelopment.Methods Meta-analysis with systematic searches of MEDLINE (1970 through August 2012), EMBASE (1988 through August 2012), and PsycINFO® (1970 through August 2012) and examination of selected references. Results From 1,593 articles, we identified 34 presenting data from cohort studies that met our inclusion criteria. Information on study population, outcomes, measurement instruments, timing and quantification of alcohol exposure, covariates, and results was abstracted. Outcomes included academic performance, attention, behavior, cognition, language skills, memory, and visual and motor development. The quality of each article was assessed by 2 researchers using the Newcastle–Ottawa Scale. Based on 8 studies of 10,000 children aged 6 months through 14 years, we observed a significant detrimental association between any binge prenatal alcohol exposure and child cognition (Cohen's d [a standardized mean difference score] −0.13; 95% confidence interval [CI], −0.21, −0.05). Based on 3 high-quality studies of 11,900 children aged 9 months to 5 years, we observed a statistically significant detrimental association between moderate prenatal alcohol exposure and child behavior (Cohen's d −0.15; 95% CI, −0.28, −0.03). We observed a significant, albeit small, positive association between mild-to-moderate prenatal alcohol exposure and child cognition (Cohen's d 0.04; 95% CI, 0.00, 0.08), but the association was not significant after post hoc exclusion of 1 large study that assessed mild consumption nor was it significant when including only studies that assessed moderate alcohol consumption. None of the other completed meta-analyses resulted in statistically significant associations between mild, moderate, or binge prenatal alcohol exposure and child neuropsychological outcomes. Conclusions Our findings support previous findings suggesting the detrimental effects of prenatal binge drinking on child cognition. Prenatal alcohol exposure at levels less than daily drinking might be detrimentally associated with child behavior. The results of this review highlight the importance of abstaining from binge drinking during pregnancy and provide evidence that there is no known safe amount of alcohol to consume while pregnant.Keywords: Prenatal Alcohol Exposure; Child Neurodevelopment; Systematic Review; Meta-Analysis

5. Does the Severity of Hangovers Decline with Age? Survey of the Incidence of Hangover in Different Age GroupsJanne S. Tolstrup, Richard Stephens, Morten GrønbækAlcoholism: Clinical and Experimental Research 2014:38(2);466-470

Abstract Background Alcohol hangover is a growing research area, but differences across the life span have not been assessed. Here, we test the hypothesis that the severity of hangovers

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depends on age. Methods A cross-sectional study of 51,645 men and women aged 18 to 94 years old, who participated in the population-based Danish Health Examination Study (DANHES) in Denmark between 2007 and 2008, formed the database for our study. Results The incidence of severe hangover was lower among older than younger participants. Odds ratios for experiencing severe hangover following an episode of binge drinking were 6.8, 4.8, 3.0, and 2.0 among the 18 to 29, 30 to 39, 40 to 49, and 50 to 59-year-old men, compared with those aged 60+ years. For women, similar results were obtained. This finding could not be explained by the usual amount of alcohol consumption, frequency of binge drinking, or the proportion of alcohol consumed with meals. Conclusions We found that hangover following engagement in binge drinking is much more common in the young than in the older age groupKeywords: Age; Hangover; Alcohol

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ALCOHOL TREATMENT

6. Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysisHeleen Riper, Gerhard Andersson, Sarah B. Hunter, Jessica de Wit, Matthias Berking, Pim CuijpersAddiction 2014:109(3);394-406 AbstractBackground and Aims To review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care. Methods We conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes. Results CBT/MI proved effective for treating subclinical and clinical AUD and MDD compared with controls, with small overall effect sizes at post-treatment [g = 0.17, confidence interval (CI) = 0.07–0.28, P < 0.001 for decrease of alcohol consumption and g = 0.27, CI: 0.13–0.41, P < 0.001 for decrease of symptoms of depression, respectively]. Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face-to-face interventions (g = 0.73 and g = 0.23, respectively, P = 0.030).Conclusions Combined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual.Keywords: Alcohol use disorders; cognitive-behavioural therapy; comorbidity; major depression; meta-analysis; motivational interviewing; randomized controlled trials; treatment effect

7. Outcome predictors for problem drinkers treated with combined cognitive behavioral therapy and naltrexoneSalla Vuoristo-Myllys, Jari Lipsanen, Jari Lahti, Hely Kalska, Hannu AlhoThe American Journal of Drug and Alcohol Abuse 2014:40(2);103–110

AbstractBackground  The opioid antagonist naltrexone, combined with cognitive behavioural therapy (CBT), has proven efficacious for patients with alcohol dependence, but studies examining how this treatment works in a naturalistic treatment setting are lacking. Objectives This study examined predictors of the outcome of targeted naltrexone and CBT in a real-life outpatient setting. Participants were 315 patients who attended a treatment program providing CBT combined with the targeted use of naltrexone. Methods  Mixture models for estimating developmental trajectories were used to examine change in patients’ alcohol consumption and symptoms of alcohol craving from treatment entry until the end of the treatment (20 weeks) or dropout. Predictors of treatment outcome were examined with analyses of multinomial logistic regression. Minimal exclusion criteria were applied to enhance the generalizability of the findings. Results  Regular drinking pattern, having no history of previous treatments, and high-risk alcohol consumption level

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before the treatment were associated with less change in alcohol use during the treatment. The patients with low-risk alcohol consumption level before the treatment had the most rapid reduction in alcohol craving. Patients who drank more alcohol during the treatment had lower adherence with naltrexone. Conclusion Medication non-adherence is a major barrier to naltrexone’s effectiveness in a real-life treatment setting. Patients with more severe alcohol problems may need more intensive treatment for achieving better treatment outcome in real-word treatment settings.Keywords: Alcohol dependence; cognitive behavioural therapy; naltrexone; problem drinking; predictors

8. Continuing care for patients with alcohol use disorders: A systematic review Evelien Lenaerts, Catharina Matheï, Frieda Matthys, Dieter Zeeuws, Leo Pas, Peter Anderson, Bert AertgeertsDrug and Alcohol Dependence 2014:135(1st Feb 2014);9-21

AbstractBackground A chronic care perspective should be adopted in the treatment of patients with alcohol use disorders (AUDs). Initial treatment in a more intense psychiatric care setting should be followed by continuing care. This systematic review aims to identify effective continuing care interventions for patients with AUDs. Methods Electronic databases were searched up to February 2013 (MEDLINE, EMBASE, CENTRAL, CINAHL and PsycINFO) to identify RCTs studying continuing care interventions for patients with AUDs. Study selection and quality appraisal was done independently by two reviewers. Drinking and treatment engagement outcomes were considered. Relative risks and mean differences were calculated with 95% confidence intervals. A statistical pooling of results was planned. Results 20 trials out of 15,235 identified studies met the inclusion criteria. Only six were evaluated as methodologically strong enough and included for further analysis. Interventions ranged from telephone calls and nurse follow-up to various forms of individual or couples counseling. Four trials suggested that supplementing usual continuing care with an active intervention empowering the patient, could be beneficial to drinking outcomes. Effect sizes were limited and not consistent across all outcomes. Because of heterogeneity in the interventions and outcome measures, a meta-analysis could not be performed. Conclusion For the treatment of a disease with such devastating consequences, it is remarkable how few high quality studies are available. Adding an active intervention to usual continuing care seems to improve treatment outcomes. We propose an integrated care program with different elements from the selected studies and discuss implications for further research.Keywords: Alcohol use disorders treatment; Substance use disorders treatment; Continuing care; Aftercare; Integrated care

9. Antioxidant Vitamins and Brain Dysfunction in AlcoholicsEmilio González-Reimers, Camino M. Fernández-Rodríguez, M. Candelaria Martín-González, Iván Hernández-Betancor, Pedro Abreu-González, María José de la Vega-Prieto, Oswaldo Elvira-Cabrera, Francisco Santolaria-FernándezAlcohol and Alcoholism 2014:49(1);45-50

Abstract Aims Alcohol induces cytokine secretion by Kupffer cells, which may exert also deleterious effects on distant organs, mediated in part by cytokine-derived increased production of reactive oxygen species (ROS). It is therefore important to assess antioxidant levels. The objective of this study is to analyse the relation of antioxidant vitamins with brain atrophy

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and cognitive dysfunction. Methods In 77 alcoholic patients admitted for withdrawal syndrome, subjected to brain computed tomography (CT), and 19 controls, we determined antioxidant vitamin levels and analysed their relationships with data of brain atrophy and dysfunction. Searching for causes of altered vitamin levels, we also assessed liver function, nutritional status, eating habits, alcohol intake, proinflammatory cytokine (TNF-α, IL-6, IL-8) levels and malondialdehyde (MDA) levels. Results Both retinol (vitamin A) and tocopherol (vitamin E) levels were decreased in alcoholics, the former in relation with liver failure, and the latter in relation with triglyceride levels and fat mass. Both were related to data of brain atrophy and cerebellar shrinkage (to which also IL-6 was significantly related). Conclusion Among alcoholics, liver function impairment leads to altered serum vitamin A levels, which are related to brain alterations. Vitamin E levels are also decreased, but although in relation with liver function impairment, its decrease seems to be more dependent on nutritional status and irregular eating habits. Both vitamins are lower in patients with cerebellar atrophy and other features related to brain atrophy.

10. The Impact of Brief Alcohol Interventions in Primary Healthcare: A Systematic Review of ReviewsAmy O'Donnell, Peter Anderson, Dorothy Newbury-Birch, Bernd Schulte, Christiane Schmidt, Jens Reimer, Eileen Kaner Alcohol and Alcoholism 2014:49(1);66-78

Abstract Aims The aim of the study was to assess the cumulative evidence on the effectiveness of brief alcohol interventions in primary healthcare in order to highlight key knowledge gaps for further research. Methods An overview of systematic reviews and meta-analyses of the effectiveness of brief alcohol intervention in primary healthcare published between 2002 and 2012. Findings Twenty-four systematic reviews met the eligibility criteria (covering a total of 56 randomized controlled trials reported across 80 papers). Across the included studies, it was consistently reported that brief intervention was effective for addressing hazardous and harmful drinking in primary healthcare, particularly in middle-aged, male drinkers. Evidence gaps included: brief intervention effectiveness in key groups (women, older and younger drinkers, minority ethnic groups, dependent/co-morbid drinkers and those living in transitional and developing countries); and the optimum brief intervention length and frequency to maintain longer-term effectiveness. Conclusion This overview highlights the large volume of primarily positive evidence supporting brief alcohol intervention effects as well as some unanswered questions with regards to the effectiveness of brief alcohol intervention across different cultural settings and in specific population groups, and in respect of the optimum content of brief interventions that might benefit from further research.

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ALCOHOL – YOUNG PEOPLE

11. Factors Associated With Parental Rules for Adolescent Alcohol UseConor Gilligan, John W. Toumbourou, Kypros Kypri, Patrick McElduffSubstance Use & Misuse 2014:49(1-2);145-153 Abstract This study used the Resilient Families baseline survey to examine associations between the connectedness of parents within the school and parents' rules regarding their children's use of alcohol, prior participation in parenting education, and parents' demographic characteristics. The study involved parents of Year 7 students (mean age 12 years) at secondary schools in Melbourne, Australia (N = 1,238; 2004). Most parents (54%) had no connections with parents of other children in their child's school year. Allowing children to have sips of alcohol or drinks on special occasions was reported by 23% and 6% of parents, respectively, but neither was significantly associated with parental connectedness.Keywords: alcohol; adolescents; parents; social connectedness

12. “Everyone can loosen up and get a bit of a buzz on”: Young adults, alcohol and friendship practicesPatricia Niland, Antonia C. Lyons, Ian Goodwin, Fiona HuttonInternational Journal of Drug Policy 2013:24(6);530-537

AbstractIn countries with liberalised alcohol policies, alcohol harm reduction strategies predominantly focus on young adults’ excessive drinking harms and risks. However, research shows such risks are largely irrelevant for young adults, who emphasise the sociability, release, pleasure and fun of drinking. Friendship is a central part of their lives and an integral part of their drinking experiences. This study aimed to explore everyday friendship practices, drinking, and pleasure in young people's routine and shared social lives. Twelve friendship discussion groups were conducted in urban and non-urban New Zealand, with 26 women and 25 men aged 18–25 years. Our Foucauldian discursive analysis enabled us to identify how the young adults drew on drinking as ‘friendship fun’ and ‘friends with a buzz’ discourses to construct drinking as a pleasurable and socially embodied friendship practice. Yet the young adults also drew on ‘good always outweighs bad experiences’ and friendship ‘caring and protection’ discourses to smooth over disruptive negative drinking experiences. Together these discourses function to justify young adults’ drinking as friendship pleasure, minimising alcohol harms, and setting up powerful resistances to individualised risk-based alcohol-harm reduction campaigns. These findings are discussed in terms of new insights and implications for alcohol harm reduction strategies that target young adults.Keywords: Young adult; Emerging adult; Friendship; Drinking; Alcohol-harm reduction

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13. Which alcohol control strategies do young people think are effective?Richard O. de Visser, Angie Hart, Charles Abraham, Anjum Memon, Rebecca Graber, Tom ScanlonDrug and Alcohol Review 2104:33(2);144-151

AbstractIntroduction and Aims The aims of this study were to examine young people's belief in the effectiveness of various alcohol control strategies and to identify demographic, attitudinal and behavioural correlates of perceived effectiveness. Design and Methods An online questionnaire hosted on a secure server was completed by 1418 men and women aged 16–21 years living in South-East England. It assessed the perceived effectiveness of various alcohol control strategies. Key correlates included sensation seeking, impulsivity, conscientiousness, alcohol outcome expectancies, drink refusal self-efficacy, perceived peer alcohol use and Alcohol Use Disorders Identification Test scores. Results The most effective strategies were perceived to be enforcing responsible service legislation, strictly monitoring late-night licensed premises and teaching alcohol refusal skills. Greater belief in the effectiveness of alcohol control strategies was expressed by older participants, those who consumed less alcohol and those who expected more negative outcomes from alcohol consumption. Discussion and Conclusions The data suggest that in order to increase the perceived effectiveness of alcohol control strategies, we may need to address young people's beliefs about the negative outcomes of alcohol use. Strategies that young people believe are effective may be easier to implement, but this does not imply that unpopular but effective strategies should not be tried.Keywords: alcohol; policy; attitude; youth

14. Parenting styles and alcohol use among children and adolescents: A systematic reviewLenka Čablová, Kristýna Pazderková, Michal MiovskýDrugs: Education, Prevention and Policy 2014:21(1);1-13

Abstract Introduction Research studies have been focusing on the prevalence of alcohol use among children and adolescents since the 1990s. There are many individual, family, and social factors that can influence this kind of risk behaviour. The present review is focused on the influence of parenting styles. Aims The main aim is to provide a systematic review of studies published from 1995 until 2012 which investigate the relationship between alcohol use among adolescents and parenting styles. Methods A systematic search of literature employing the PRISMA method identified and evaluated 16 original studies published in the EBSCO, MEDLINE/PubMed, JSTOR, and ScienceDirect databases. The studies were classified according to their research design, the age group of the respondents, the participation of parents, the effects of parenting styles, and the sociocultural setting of the study. Findings The studies were subjected to quantitative evaluation according to their

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methodological criteria and forms of parenting styles. Qualitative evaluation showed a broader context and complexity of study results. While there is some evidence of the protective effect of an authoritative parenting style, there are many other individual, social, and environmental factors. Conclusions There is evidence of a connection between parenting styles and the forms of alcohol use among children and adolescents. Such conclusions should be reflected in national primary prevention strategies and family-based prevention programmes.

15. The role of parental alcohol use, parental discipline and antisocial behaviour on adolescent drinking trajectoriesR. Alati, P. Baker, K.S. Betts, J.P. Connor, K. Little, A. Sanson, C.A. OlssonDrug and Alcohol Dependence 2014:134(1st Jan 2014);178-184 AbstractBackgrounds Parental drinking, harsh parental discipline and adolescent antisocial behaviour have been independently implicated in adolescent alcohol use. Robust prospective studies are required to examine developmental relationships between these factors and their effect on trajectories of alcohol use across adolescence. Methods Data were ascertained at three consecutive adolescent waves (13.5, 15.5 and 17.5 years) from the Australian Temperament Project, a 15-wave (30 year) general population birth cohort in Victoria, Australia. Adolescent alcohol trajectories, adjusted for time-varying measures of parenting and antisocial behaviour, were regressed on time-stable measures of parental alcohol use. The full case analysis comprised 751 individuals with complete data. Results Two distinct alcohol trajectories were identified across the three adolescent waves after adjusting for time-varying factors: a higher and lower drinking group. Both trajectories increased linearly over the study period. Antisocial behaviour was positively associated with both trajectories while harsh parental discipline was positively associated with alcohol use in the lower-use group only. Increased maternal and paternal drinking at 13.5 years placed teenagers at a greater risk of being included in the high-risk trajectory. Conclusion Parental drinking was the strongest predictor of different drinking trajectories in adolescence. This finding underscores the importance of comprehensive public heath approaches that target both parental and adolescent drinking attitudes and behaviour.Keywords: Adolescence; Alcohol; Antisocial behaviour; Parental alcohol use

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BLOOD BORNE VIRUSES

16. Desired Social Distance From People Who Have Hepatitis C Virus: An Exploration Among Staff in Health Care, Dentistry, Drug Treatment, and Tattoo/Body PiercingAlicia Elena Suarez, Deidre RedmondSubstance Use & Misuse 2014:49(4);466–474

Abstract Staff who work in facilities such as health care, dentistry, drug treatment, and tattoo/body piercing are likely to encounter persons with hepatitis C virus (HCV) and be privy to their HCV status. The purpose of this paper is to assess staff comfort with varying levels of intimacy (i.e., social distance) with people who have HCV. We examine how previous contact with persons with HCV and knowledge of HCV including HCV specific training affect desire for social distance. Data are from a 2007 sample of 82 individuals working in health care, dentistry, drug treatment, or tattoo/body-piercing studios located in the Pacific Northwest region of the United States. Multivariate analyses indicate that staff desire social distance from persons with HCV, but contact of certain types reduce desire for social distance. We discuss how the findings have implications for people employed in these fields, as they point to the need to dispel myths and reduce fear among staff working in facilities that may serve persons with HCV.Keywords: social distance; hepatitis; contact; knowledge; stigma; healthcare providers; drug treatment; dentistry; tattoos

17. Education and counseling in the methadone treatment setting improves knowledge of viral hepatitisSandra E. Larios, Carmen L. Masson, Michael S. Shopshire, Jennifer Hettema, Ashly E. Jordan, Courtney McKnight, Christopher Young, Mandana Khalili, Randy M. Seewald, Albert Min, Nicholas Hengl, James L. Sorensen, Don C. Des Jarlais, David C. PerlmanJournal of Substance Abuse Treatment 2014:46(4);528-531 AbstractThe aim of this study was to evaluate the effectiveness of an educational method of providing viral hepatitis education for methadone maintenance patients. Four hundred forty participants were randomly assigned to either a control or a motivationally-enhanced viral hepatitis education and counseling intervention. Viral hepatitis A (HAV), B (HBV), and C (HCV) knowledge tests were administered at baseline, following each of two education sessions (post-education), and at a 3-month follow-up assessment. Results indicated a significant increase in knowledge of HAV, HBV, and HCV over time. No differences were found in knowledge between the intervention groups in knowledge acquisition regarding any of the hepatitis viruses suggesting that a motivational interviewing style may not augment hepatitis knowledge beyond standard counseling. A two-session viral hepatitis education intervention effectively promotes hepatitis knowledge and can be integrated in methadone treatment settings.Keywords: Hepatitis; Education; Methadone; Knowledge

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18. Transitions from injecting to non-injecting drug use: Potential protection against HCV infectionDon C. Des Jarlais, Courtney McKnight, Kamyar Arasteh, Jonathan Feelemyer, David C. Perlman, Holly Hagan, Hannah L.F. CooperJournal of Substance Abuse Treatment 2014:46(3);325-331 AbstractTransitions from injecting to non-injecting drug use have been reported from many different areas, particularly in areas with large human immunodeficiency virus (HIV) epidemics. The extent to which such transitions actually protect against HIV and HCV has not been determined. A cross-sectional survey with HIV and hepatitis C (HCV) testing was conducted with 322 former injectors (persons who had injected illicit drugs but permanently transitioned to non-injecting use) and 801 current injectors recruited in New York City between 2007 and 2012. There were no differences in HIV prevalence, while HCV prevalence was significantly lower among former injectors compared to current injectors. Years injecting functioned as a mediating variable linking former injector status to lower HCV prevalence. Transitions have continued well beyond the reduction in the threat of AIDS to injectors in the city. New interventions to support transitions to non-injecting drug use should be developed and supported by both drug treatment and syringe exchange programs.Keywords: HIV; HCV; Drug use; Substance abuse; Non-injecting drug use; Injecting drug use

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CO-MORBIDITY

19. 12-step facilitation for the dually diagnosed: A randomized clinical trialMichael P. Bogenschutz, Samara L. Rice, J. Scott Tonigan, Howard S. Vogel, Joseph Nowinski, Donald Hume, Pamela B. ArenellaJournal of Substance Abuse Treatment 2014:46(4);403-411

AbstractThere are few clinical trials of 12-step treatments for individuals with serious mental illness and alcohol or drug dependence. This randomized trial assessed the effects of adding a 12-session 12-step facilitation therapy (TSF), adapted from that used in Project MATCH, to treatment as usual in an outpatient dual diagnosis program. Participants were 121 individuals dually diagnosed with alcohol dependence and a serious mental disorder, followed during 12 weeks of treatment and 36 weeks post-treatment. Participants receiving TSF had greater participation in 12-step programs, but did not demonstrate greater improvement in alcohol and drug use. However, considered dimensionally, greater participation in TSF was associated with greater improvement in substance use, and greater 12-step participation predicted decreases in frequency and intensity of drinking. Findings suggest that future work with TSF in this population should focus on maximizing exposure to TSF, and maximizing the effect of TSF on 12-step participation.Keywords: Dual diagnosis; 12-step; Alcohol dependence; Serious mental illness; Clinical trial; Alcoholics Anonymous; Double trouble in recovery

20. Young adults with co-occurring disorders: substance use disorder treatment response and outcomesBrandon G. Bergman, M. Claire Greene, Valerie Slaymaker, Bettina B. Hoeppner, John F. Kelly,Journal of Substance Abuse Treatment 2014:46(4);420-428

AbstractCompared to other life stages, young adulthood (ages 18–24) is characterized by qualitative differences including the highest rates of co-occurring substance use and psychiatric disorders (COD). Little is known, however, regarding young adults' response to substance use disorder (SUD) treatment, especially those with COD. Greater knowledge in this area could inform and enhance the effectiveness and efficiency of SUD care for this patient population. The current study investigated differences between 141 COD and 159 SUD-only young adults attending psychiatrically-integrated residential SUD treatment on intake characteristics, during-treatment changes on clinical targets (e.g., coping skills; abstinence self-efficacy), and outcomes during the year post-discharge. Contrary to expectations, despite more severe clinical profiles at intake, COD patients showed similar during-treatment improvements on clinical target variables, and comparable post-treatment abstinence rates and psychiatric symptoms. Clinicians referring young adults with COD to specialized care may wish to consider residential SUD treatment programs that integrate evidence-based psychiatric services.Keywords: Co-occurring disorders; Dual diagnosis; Young adults; Emerging adults; Addiction; Substance use disorder treatment

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21. Treatment for Outpatients with Comorbid Schizophrenia and Substance Use Disorders: A ReviewDe Witte N.A.J, Crunelle C.L, Sabbe B, Moggi F, Dom G European Addiction Research 2014:20(3);105-114

AbstractAims This review provides evidence of which interventions need to be part of effective outpatient integrated treatment for patients with comorbid schizophrenia and substance use disorders. Methods A total of 14 randomized controlled trials were included. Effect sizes are provided to assess the magnitude of the treatments' efficacy. Results Despite the studies' heterogeneity, we can conclude that certain programs (e.g. Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness ) and specific interventions (e.g. motivational interviewing, family interventions) seem to be effective. Moreover, programs integrating multiple interventions are more likely to be positively related to better outcomes than single interventions. Finally, the lack of difference between effect sizes of assertive community treatment compared to case management suggests that a lower caseload is not necessary for positive treatment outcomes. Conclusion Integrated treatment seems advantageous, although effect sizes are mostly modest. More homogeneous and qualitative sound studies are needed.Keywords:Dual disorder; Schizophrenia; Substance use disorder; Randomized controlled trial; Efficacy

22. Needs assessment of dual diagnosis: A cross-sectional survey using routine clinical dataKhodayar Shahriyarmolki, Tim MeynenDrugs: Education, Prevention, and Policy 2014:21(1);43-49 Abstract Aims Department of Health guidance on dual diagnosis (DD) recommends that services measure local need, and use this to inform service planning. This study aimed to use routine clinical data to estimate the prevalence of DD and unmet treatment need in a community drug and alcohol service, and to appraise the feasibility of using routine data for such purposes.Methods First, a screening checklist was developed to determine whether a particular service-user met DD caseness criteria. Second, the electronic care records of 227 service-users were screened for DD caseness, as well as for documentation of current and/or previous receipt of mental health treatment. Findings Seventy-two percent screened positive for having DD. Of these, around half were not receiving current treatment for their mental health, while 37% had never received mental health treatment. Higher rates of DD were found amongst women and those in treatment for alcohol dependence. Conclusions The findings corroborate previous research showing high prevalences of DD and unmet treatment need within drug and alcohol services in general, and amongst certain high-risk subgroups in particular. The study demonstrates that using routine data to estimate unmet treatment need is feasible within the limited resources available to frontline services.

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DRUG RELATED DEATH

23. Causes of death in a cohort treated for opioid dependence between 1985 and 2005Louisa Degenhardt, Sarah Larney, Deborah Randall, Lucy Burns, Wayne HallAddiction 2104:109(1);90-99

AbstractAims To examine changes in causes of death in a cohort treated for opioid dependence, across time and age; quantify years of potential life lost (YPLL); and identify avoidable causes of death. Design People in New South Wales (NSW) who registered for opioid substitution therapy (OST), 1985–2005, were linked to a register of all deaths in Australia.Setting NSW, Australia. Measurements Crude mortality rates (CMRs), age–sex-standardized mortality rates (ASSRs) and standardized mortality ratios (SMRs) across time, sex and age. Years of potential life lost (YPLL) were calculated with reference to Australian life tables and by calculating years lost before the age of 65 years. Findings There were 43 789 people in the cohort, with 412 216 person-years of follow-up. The proportion of the cohort aged 40+ years increased from 1% in 1985 to 39% in 2005. Accidental opioid overdoses, suicides, transport accidents and violent deaths declined with age; deaths from cardiovascular disease, liver disease and cancer increased. Among men, 89% of deaths were potentially avoidable; among women, 86% of deaths were avoidable. There were an estimated 160 555 YPLL in the cohort, an average of 44 YPLL per decedent and an average of 29 YPLL before age 65 years. Conclusions Among a cohort of opioid-dependent people in New South Wales, 1985–2005, almost nine in 10 deaths in the cohort were avoidable. There is huge scope to improve mortality among opioid-dependent people.Keywords: Ageing; heroin; injecting drug use; mortality; opioid dependence

24. Training family members to manage heroin overdose and administer naloxone: randomized trial of effects on knowledge and attitudesAnna V. Williams, John Marsden, John StrangAddiction 2014:109(2);250-259 AbstractAims To evaluate a heroin overdose management training programme for family members based on emergency recovery procedures and take-home naloxone (THN) administration.Design A two-group, parallel-arm, non-blinded, randomized controlled trial of group-based training versus an information-only control. Setting Training events delivered in community addiction treatment services in three locations in England. Participants A total of 187 family members and carers allocated to receive either THN training or basic information on opioid overdose management (n = 95 and n = 92, respectively), with 123 participants completing the study. Measurements The primary outcome measure was a self-completion Opioid Overdose Knowledge Scale (OOKS; range 0–45) and an Opioid Overdose Attitudes Scale (OOAS; range 28–140) was the secondary outcome measure. Each group was assessed before receiving their assigned condition and followed-up 3 months after. Events of witnessing and managing an overdose during follow-up were also recorded. Findings At follow-up, study participants who had received THN training reported greater overdose-related knowledge relative to those receiving basic information only [OOKS mean difference, 4.08 (95% confidence interval, 2.10–6.06; P < 0.001); Cohen's d = 0.74 (0.37–1.10)]. There

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were also more positive opioid overdose-related attitudes among the trained group at follow-up [OOAS mean difference, 7.47 (3.13–11.82); P = 0.001; d = 0.61 (0.25–0.97)]. At the individual level 35 and 54%, respectively, of the experimental group increased their knowledge and attitudes compared with 11 and 30% of the control group. During follow-up, 13 participants witnessed an overdose with naloxone administered on eight occasions: five among the THN-trained group and three among the controls. Conclusions Take-home naloxone training for family members of heroin users increases opioid overdose-related knowledge and competence and these benefits are well retained after 3 months.Keywords: Attitudes; family members; heroin; knowledge; naloxone; opioid; overdose; randomized; trial

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EPIDEMIOLOGY AND DEMOGRAPHY

25. Drug Misuse Among University Students in the UK: Implications for PreventionTrevor Hugh Bennett, Katy Rose HollowaySubstance Use & Misuse 2014:49(4);448-455

Abstract Aims The aim of the research was to identify the types of drugs currently being used by university students, their involvement in multiple drug misuse and drug combinations, and the consequences of drug misuse in terms of associated harms. Methods The research was based on an email survey of all first- and second-year students registered as undergraduates at a university in south Wales during October 2012. Results The results of the research showed that drug misuse on the university campus studied was widespread in terms of the types and patterns of drug misuse. The most troublesome findings concern the high levels of multiple drug use, the use of some of the most dangerous drugs (including crack and powder cocaine and heroin, as well as ketamine), and the list of recorded harms experienced as a result of drug misuse. Conclusions The article concludes that little attention has been paid outside of the United States to drug use among university students or to interventions designed to prevent it. However, there are signs that government policy in the United Kingdom is beginning to pay attention to the specific problems of drug misuse among university students.Keywords: drug misuse; students; prevention; survey

26. Intergenerational Continuity of Substance UseKelly E. Knight, Scott Menard, Sara B. SimmonsSubstance Use & Misuse 2014: 49(3);221–233

Abstract Guided by rigorous methodology and a life-course perspective, the goal of this research is to address a gap in current knowledge on whether, when, and how strongly intergenerational continuity of substance use exists when examining age-equivalent and developmentally specific stages of the life course. Annual self-reported substance use measures were analyzed from a prospective, longitudinal, and nationally representative sample that originally consisted of 1,725 respondents and their families, who were then interviewed over a 27-year period from 1977 to 2004. Findings from multilevel random-intercept regression models provide support for intergenerational continuity when substance use occurs in emerging adulthood but not when limited to adolescence. Implications, limitations, and future research directions are discussed.Keywords: alcohol use; marijuana use; drug use; substance use; intergenerational continuity; intergenerational transmission; adolescence; emerging adulthood; life course; methodology

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27. The Patterns of Drug and Alcohol Use and Associated Problems Over 30 Years in 397 MenMarc A. Schuckit, Tom L. Smith, Jelger A. KalmijnAlcoholism: Clinical and Experimental Research 2014:38(1);227-234

Abstract Background Alcohol and drug use disorders (AUDs and SUDs) and their combination are relatively common and often occur together. However, the relationships of potential early life correlates of alcohol and drug disorders to the combined diagnoses have rarely been evaluated in long-term prospective studies or in populations at high risk of one of these diagnoses but not the other. Methods Data were analyzed from 397 males (half with an alcohol-dependent father) who had no AUDs or SUDs at age 20 and who were followed approximately every 5 years for 3 decades. Early life correlates and the course of AUDs, SUDs, and combined disorders were evaluated for 4 groups of subjects based on subsequent alcohol and/or drug diagnoses. Results While the overall rates of the development of AUDs and SUDs were 41 and 21%, respectively, the rates of the second substance-related diagnosis were almost 2-fold higher for individuals who had the first condition. Among potential risk factors, scores for externalizing traits were elevated for men with AUDs, SUDs, and their combination, but a low level of response (low LR) to alcohol was associated only with the risk of AUDs, even when observed in the context of SUDs. The same earlier life characteristics that related to AUDs and to SUDs also related to the combination of these diagnoses in the same person. Finally, in this prospective study, subjects with both AUDs and SUDs had a more severe course than subjects with either condition alone. Conclusions This prospective evaluation of a group at high risk of AUDs confirmed the selective impact of the low LR on the risk of AUDs, the relationship of externalizing characteristics to both AUDs and SUDs and confirmed the more severe clinical course for both conditions when seen together.Keywords: Alcoholism; Drug Dependence; Comorbidity; Level of Response to Alcohol; Externalizing Clinical Course

28. Alcohol Consumption, Heavy Drinking, and Mortality: Rethinking the J-Shaped CurveAndrew D. Plunk, Husham Syed-Mohammed, Patricia Cavazos-Rehg, Laura J. Bierut, Richard A. GruczaAlcoholism: Clinical and Experimental Research 2014:38(2);471-478

Abstract Background High average daily consumption of alcohol has been associated with elevated mortality risk, but more moderate consumption, relative to abstinence, has been associated with reduced mortality risk. However, average daily consumption can be complicated to assess, limiting its usefulness in both research and clinical practice. There are also concerns that average consumption fails to capture the risk associated with certain drinking patterns, such as heavy episodic drinking. This study assessed mortality associated with drinking pattern, operationalized as the frequency of both heavy and nonheavy drinking occasions.

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Methods Data from the 1997 to 2001 administrations of the National Health Interview Survey (NHIS; n = 111,511) were paired with the current release of the NHIS Linked Mortality Files, which provided mortality follow-up data through the end of 2006. We estimated the impact of drinking pattern on all-cause mortality, operationalized as the frequency of heavy (5+ drinks) and nonheavy (<5 drinks) drinking occasions. Other covariates in the model included survey wave, sex, age, race/ethnicity, ratio of family income to poverty threshold, educational attainment, body mass index, and smoking status.Results Over a third of past-year drinkers reported heavy drinking. Mortality risk increased steadily as heavy drinking frequency increased; daily heavy drinkers exhibited an almost 2-fold risk of death compared with abstainers (p < 0.001). Regular nonheavy drinking was associated with decreased mortality, similar to the “J-shaped curve” highlighted in past research on alcohol mortality; this potential protective effect peaked around 2 nonheavy occasions per week. Conclusions Any heavy drinking likely elevates mortality risk, and substantial health benefits could be realized by reducing heavy drinking occasions or limiting overall drinking. Heavy and nonheavy drinking frequencies are valid targets for clinical screening and could be helpful in assessing risk and promoting less harmful drinking behavior.Keywords: Alcohol-Related Mortality; Drinking Pattern; Binge Drinking; Moderate Drinking

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HEPATITIS C

29. Chronic hepatitis C virus infection is associated with all-cause and liver-related mortality in a cohort of HIV-infected patients with alcohol problemsDaniel Fuster, Debbie M. Cheng, Emily K. Quinn, David Nunes, Richard Saitz, Jeffrey H. Samet, Judith I. TsuiAddiction 2014:109(1);62-70 AbstractAims To assess the association between hepatitis C virus (HCV) infection and overall and liver-related death in human immunodeficiency virus (HIV)-infected patients with alcohol problems. Design We analyzed data from a cohort of HIV-infected adults with current or past alcohol problems enrolled between 2001 and 2003, searching for causes of death until 2010 using the National Death Index. Setting and participants Participants were HIV-infected adults with current or past alcohol problems, recruited in Boston, MA from HIV clinics at two hospitals, homeless shelters, drug treatment programs, subject referrals, flyers and another cohort study with comparable recruitment sites. Measurements The primary and secondary outcomes were all-cause and liver-related mortality, respectively. The main independent variable was hepatitis C virus (HCV) RNA status (positive versus negative). Mortality rates and Kaplan–Meier survival curves were calculated by HCV status for both overall and liver-related mortality. Cox proportional hazards models were used to assess the association between HCV infection and overall and liver-related death, adjusting for alcohol and drug use over time. Findings A total of 397 adults (50% HCV-infected) were included. As of 31 December 2009, 83 cohort participants had died (60 HCV-infected, 23 HCV-uninfected; log-rank test P < 0.001), and 26 of those deaths were liver-related (21 HCV-infected, five HCV-uninfected; log-rank test P < 0.001). All-cause and liver-related mortality rates were 4.68 and 1.64 deaths per 100 person-years for HCV-infected patients and 1.65 and 0.36 per 100 person-years for those without HCV, respectively. In the fully adjusted Cox model, HCV infection was associated with both overall [hazard ratio (HR) = 2.55, 95% confidence interval (CI) = 1.50–4.33, P < 0.01], and liver-related mortality (HR = 3.24, 95% CI = 1.18–8.94, P = 0.02]. Conclusion Hepatitis C virus infection is associated independently with all-cause and liver-related mortality in human immunodeficiency virus-infected patients with alcohol problems, even when accounting for alcohol and other drug use.Keywords: Hepatitis C; HIV; mortality; alcohol

30. ‘Not just Methadone Tracy’: transformations in service-user identity following the introduction of hepatitis C treatment into Australian opiate substitution settingsJake Rance, Carla Treloar, on behalf of the ETHOS Study GroupAddiction 2014:109(3);452-459 AbstractAims To explore identity transformation among service users attending opiate substitution therapy (OST) clinics following the introduction of hepatitis C (HCV) care and treatment.Design An interview-based substudy of the Australian ETHOS (Enhancing Treatment for Hepatitis C in Opiate Substitution Settings) project. Setting Three OST clinics and one community health centre (operating a public OST) in New South Wales, Australia. Participants were interviewed at the recruitment sites. Participants The sample consisted of

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57 OST service users concurrently living with HCV, 16 staff, including specialist HCV clinicians, and three peer-support workers, employed on the ETHOS project. Measurements Semi-structured interviews. Findings Service-user participants largely welcomed the introduction of HCV treatment as a practical, clinical intervention that also intimated a more comprehensive, holistic form of care. Negative stereotypes characteristic of OST settings—of limited, routinized clinical exchanges and minimal social-care interaction—were unsettled, opening up the possibility of new relations between staff and service users. The shift in the dynamic of the clinical encounter to address health in addition to dependence appeared to catalyse transformative possibilities not only for the therapeutic alliance but also for service-user understandings of self and identity. Conclusion Trial introduction of HCV care and treatment in selected Australian opiate substitution therapy (OST) clinics may have facilitated alternative, ‘non-addict’ identities to emerge from a clinical setting where the stigmatizing figure of ‘the drug user’ has traditionally prevailed.Keywords: Australia; hepatitis C treatment; integrated care; opiate substitution therapy; qualitative research; treatment identities

31. “It gives me a sense of belonging”: Providing integrated health care and treatment to people with HCV engaged in a psycho-educational support groupSusan Woolhouse, Emily Cooper, Angela PickardInternational Journal of Drug Policy 2013:24(6);550-557 AbstractBackground Injection drug use (IDU) increases the risk of contracting hepatitis C virus (HCV) yet very few people living with HCV access effective, and potentially curative, treatments. The East Toronto Hepatitis C Program (ETHCP) was developed in 2006 and provides health care, treatment and support to people living with HCV who have complex mental health, physical health and psychosocial needs. The program is anchored in a 16–18 week psychosocial support group located within one of the 3 participating community-based health clinics. The objective of this study was to explore the experiences of individuals engaged in the ETHCP psycho-educational group. Methods This phenomenological qualitative study consisted of semi-structured in-depth interviews with twenty randomly selected program participants. Results The three dominant themes that emerged from the analysis were program structure, group cohesion and group as agent for change. The ETHCP “one-stop shopping” model provided a stable foundation allowing for the development of group cohesion. Group cohesion was marked by the formation of intense relationships creating a safe and non-judgmental environment where participants could self-reflect, make social connections and feel cared for and accepted. Three types of relationships characterized group cohesion: relationship to self, relationships with individual group members and relationship to group as a whole. Within the nurturing group environment, participants could challenge themselves and others, ultimately enabling change. Conclusion The results of our qualitative study suggest that it is the formation of strong group cohesion that facilitated participants’ behavioural change, regardless of their level of substance use. The structure of the group provided stability and was characterized by consistent weekly meetings, knowledge exchange and the provision of multiple services in one location. The support from peers and staff allowed participants to develop personal goals. Participants began to see themselves in a new and changed way; expressing this change in a variety of positive behaviours.Keywords: Hepatitis C virus; Psycho-educational group; Substance abuse; Interprofessional care; Group cohesion; Qualitative research

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32. Hepatitis C prevention education needs to be grounded in social relationshipsSuzanne Fraser, Carla Treloar, Joanne Bryant, Tim RhodesDrugs: Education, Prevention, and Policy 2014:21(1);88-92

Abstract Most hepatitis C transmission occurs through the sharing of equipment used for injecting drugs, and in many settings, the majority of equipment sharing occurs between sexual partners. Despite this, few health promotion materials directly address sexual partnerships, couples or social relationships in general. This blindspot is one example of the ways in which prevention education in the area of drug use would benefit from careful rethinking. Focusing on the case of Australia, we argue that hepatitis C prevention education insufficiently acknowledges or mobilize social relationships, social dynamics and social contexts in its efforts to prevent hepatitis C transmission. This can lead it to reproduce the conditions for the very problems it seeks to solve. We further argue that hepatitis C prevention education is insufficiently attentive to its own social location, drawing too little on stakeholder expertise. Its effectiveness relies upon its social context, including the collaborative input and engagement of affected communities and other stakeholders. Better recognizing this would produce a stronger foundation for developing prevention strategies. As we conclude, this social foundation for hepatitis C prevention could be articulated into national, collaboratively developed guidelines on effective communication in hepatitis C and injecting drug use risk.

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INJECTING BEHAVIOUR

33. Dependent heroin use and associated risky behaviour: The role of rash impulsiveness and reward sensitivityLakal O. Dissabandara, Natalie J. Loxton, Shavindra R. Dias, Peter R. Dodd, Mark Daglish, Alfreda StadlinAddictive Behaviors 2014:39(1);71-76 AbstractImpulsive temperament has long been considered as a risk factor for substance use disorders (SUD). Considering the heterogeneity of impulsivity, a biologically-based 2-factor model incorporating reward sensitivity and rash impulsiveness facets, has been proposed. Here we report how these two facets of impulsiveness could be associated with different aspects of dependent heroin use and associated risky behaviour. Two hundred and ninety three dependent heroin users and 232 non-users were assessed on reward sensitivity, rash impulsivity, and the related trait of punishment sensitivity. After adjusting for multiple comparisons, heroin users were found to be more rash-impulsive and reward-sensitive than non-users (p < 0.001). Within users, rash impulsivity was associated with high risk behaviour including escalating heroin consumption, injecting heroin use, hazardous drinking, low treatment-seeking and risky sexual behaviour. Reward sensitivity was uniquely associated with early onset of drug use. While greater impulsivity is a common trait in drug users compared with non-users, the use of a 2-factor model of impulsivity provides additional information regarding specific aspects of drug initiation and maintenance that can be targeted in the prevention and treatment of heroin dependence.Keywords: Heroin dependence; Personality; Reward; Impulsivity

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METHADONE MAINTENANCE TREATMENT

34. Interim versus standard methadone treatment: A benefit–cost analysisRobert P. Schwartz, Pierre K. Alexandre, Sharon M. Kelly, Kevin E. O'Grady, Jan Gryczynski, Jerome H. JaffeJournal of Substance Abuse Treatment 2014:46(3);306-314 AbstractA benefit–cost analysis was conducted as part of a clinical trial in which newly-admitted methadone patients were randomly assigned to interim methadone (IM; methadone without counseling) for the first 4 months of 12 months of methadone treatment or 12 months of methadone with one of two counseling conditions. Health, residential drug treatment, criminal justice costs, and income data in 2010 dollars were obtained at treatment entry, and 4- and 12-month follow-up from 200 participants and program costs were obtained. The net benefits of treatment were greater for the IM condition but controlling for the baseline variables noted above, the difference between conditions in net monetary benefits was not significant. For the combined sample, there was a pre- to post-treatment net benefit of $1470 (95% CI: −$625; $3584) and a benefit–cost ratio of 1.5 (95% CI: 0.8, 2.3), but using our conservative approach to calculating benefits, these values were not significant.Keywords: Benefit–cost; Methadone treatment; Interim methadone

35. Methadone diversion as a protective strategy: The harm reduction potential of ‘generous constraints’Magdalena Harris, Tim RhodesInternational Journal of Drug Policy 2013:24(6);e43-e50 AbstractMethadone maintenance treatment is evidenced as a successful harm reduction initiative in regard to the prevention of blood borne viruses and other injecting related harms. This is attributable to reductions in heroin use and injecting equipment sharing incidents, yet the means by which these are achieved are rarely elaborated. Methadone diversion is predominantly presented in a negative light; associated with overdose and other harms. In our qualitative London-based study with 37 people who inject drugs, 35 on substitution therapies, we found that methadone self regulation and diversion played a prominent role in helping participants to manage their drug use, prevent withdrawal, cement social relationships, and inadvertently protect against hepatitis C transmission. The ability of participants to enact these ‘indigenous harm reduction strategies’ was constrained to various degrees by their treatment dosing protocols. In this article we explore the strategies participants enacted with methadone, the role of ‘generous constraints’ in this enactment and the associated production and reduction of risk. In order to reengage people who inject drugs with harm reduction interventions, it is necessary for initiatives to take stock of the indigenous strategies that individuals are already utilising and – in the case of methadone self regulation – support them by the implementation of more generous constraints.Keywords: Methadone; Diversion; Harm reduction; Hepatitis C; Risk; Self regulation

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36. What is low threshold methadone maintenance treatment?Carol Strike, Margaret Millson, Shaun Hopkins, Christopher SmithInternational Journal of Drug Policy 2013:24(6);e51-e56

AbstractBackground Low threshold methadone maintenance (MMT) was developed for clients who do not have abstinence as a treatment goal. We explored how MMT programs in Canada defined low threshold and the challenges they faced. Methods Using semi-structured interviews, we collected data from clients (n = 46), nurses/counsellors (n = 15) and physicians (n = 9) at three low threshold MMT programs. All participants were asked to define low threshold MMT and describe how it was implemented in practice. Interviews were taped, transcribed, verified and analysed using an iterative thematic coding technique. Results Low threshold MMT was defined by an explicit rejection of abstinence from opiates and other drugs as an over-arching treatment goal. In the absence of guidelines defining a set of practices as low threshold, programs implemented practices they believed would reduce barriers to admission and help retention. There was not always agreement between professional groups or across the programs regarding these practices. For physicians, there was a tension between accepting poly-drug use during treatment as a means to improve retention, with an obligation to do more good than harm for their patients. Missed prescribing appointments generated few to severe consequences and revealed differential focus on reducing barriers versus encouraging client ‘ownership’ of treatment. Differences of opinion regarding appropriate urine drug testing practices revealed power dynamics between medical and non-medical staff. Conclusion Our findings show that there are potentially more ways to reduce barriers to MMT than those presented in the current literature. Our findings are important given the growing number of people with opiate dependence across the world and calls to increase access to MMT. To fully develop the low threshold model, it will be important to evaluate what policies and practices can achieve the goals of reducing barriers to admission and improving retention in treatment.Keywords: Methadone maintenance; Low threshold; Program policies; Harm reduction; Canada

37. Work and the journey to recovery: Exploring the implications of welfare reform for methadone maintenance clientsMark Monaghan, Emma WincupInternational Journal of Drug Policy 2013:24(6);e81-e86 AbstractBackground An emphasis on welfare reform has been a shared concern of recent UK governments, with the project of transforming the provision of welfare gathering pace over the past six years. Replicating active labour market policies pursued across the globe, successive governments have used welfare-to-work programmes as mechanisms to address worklessness. Since 2008, problem drug users (PDUs) have been added to a list of groups for whom intervention is deemed necessary to encourage, enable, and sometimes coerce them into paid employment. This approach is underpinned by three beliefs relating to paid work: it sustains recovery, has a transformative potential and should be the primary duty of the responsible citizen. Using policy developments in the UK as a case study, the article explores the implications for methadone maintenance clients of connecting drug policy (premised on the belief that work is central to recovery) with welfare policy (which at present is preoccupied with reducing worklessness). Methods A critical analysis of policy

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documents, including drug strategies, Green and White papers and welfare reform legislation, alongside a review of relevant academic literature. Results The ‘work first’ approach which underpins current labour market activation policies in the UK and elsewhere is insufficiently flexible to accommodate the diverse needs of PDUs in recovery, and is particularly particular problematic when combined with a ‘social deficit’ model which concentrates on individual rather than structural barriers to employability. The use of payment-by-results mechanisms to provide employment services, coupled with the use of sanctions for those who do not engage, is likely to be particularly problematic for methadone maintenance clients. Conclusion Welfare reform in the UK is likely to undermine the recovery of methadone maintenance clients. Further research is urgently needed to explore its impact on this sub-group of PDUs, alongside comparative studies to determine best practice in integrating drug and welfare policies.

38. Predictors of non-prescribed opioid use after one year of methadone treatment: An attributable-risk approach (ANRS-Methaville trial)Caroline Lions, M. Patrizia Carrieri, Laurent Michel, Marion Mora, Fabienne Marcellin, Alain Morel, Bruno Spire, Perrine Roux, the Methaville study group Drug and Alcohol Dependence 2014:135(1st Feb 2014);1-8

AbstractBackground The effectiveness of methadone as an opioid maintenance treatment (OMT) for opioid dependence has been widely demonstrated. However many patients continue to use other opioids while on methadone treatment. Studies assessing avoidable cases of continued non-prescribed opioid use during methadone treatment are sparse. Methods At 12 months of treatment (M12), 158 subjects had available data on opioid use, measured using the Opiate Treatment Index. We identified variables associated with non-prescribed opioid use at M12, using a univariate logistic regression and two multivariate models, one incorporating only pre-treatment variables, the second adding the in-treatment variables. We also calculated attributable fractions for risk factors. Results At M12, 32.3% of the patients had used non-prescribed opioids during the previous month. A good patient–physician relationship was the most influential factor associated with not using non-prescribed opioids after one year. Living with a heroin user after one year of treatment, using cocaine during treatment and hazardous alcohol consumption at enrolment were all associated with an increased risk of non-prescribed opioid use at M12. Analysis of attributable fractions indicated that living with a heroin user at M12 accounted for 21% of patients reporting non-prescribed opioid use at M12, while the lack of a good relationship with the physician accounted for 26%. Conclusions The attributable risk approach suggests that continued non-prescribed opioid use by a considerable proportion of individuals could potentially be reduced by improving patient–physician relationships, enhancing care for co-dependent patients and encouraging patients to modify their social network.Keywords: Methadone treatment; Physician–patient relation; Attributable-risk factors; Non-prescribed opioid use

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NEW PSYCHOACTIVE SUBSTANCE

39. Are “Legal Highs” Users Satisfied? Evidence from Online Customer CommentsChristophe-Alain Bruneel, Christian Ben Lakhdar, Nicolas G. VaillantSubstance Use & Misuse 2014:49(4);364-373

Abstract This article describes the results of a clustering analysis of more than 2,100 comments posted by online purchasers of “Legal Highs” on five websites in 2012. The aim is to investigate the reasons for satisfaction/dissatisfaction on the part of legal highs users. Our results show that the reasons for satisfaction depend on the price/quality ratio and the real effects of the product (compared to illicit drugs). Dissatisfaction seems to stem from the disparity between the advertising of the product and its real quality. We conclude that online purchasers are certainly illicit drug users who consider legal highs as substitution products.Keywords: legal highs, herbal highs, Internet, online shop, user satisfaction

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OPIATE TREATMENT

40. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trialYih-Ing Hser, Andrew J. Saxon, David Huang, Al Hasson, Christie Thomas, Maureen Hillhouse, Petra Jacobs, Cheryl Teruya, Paul McLaughlin, Katharina Wiest, Allan Cohen, Walter LingAddiction 2014:109(1);79-87 AbstractAims To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence. Design, settings and participants This secondary analysis included 1267 opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks. Measurements The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24-week trial. Findings The treatment completion rate was 74% for MET versus 46% for BUP (P < 0.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60 mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30–32 mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.52–0.76, P < 0.01] among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (i) BUP [versus MET, hazard ratio (HR) = 1.61, CI = 1.20–2.15], (ii) lower medication dose (<16 mg for BUP, <60 mg for MET; HR = 3.09, CI = 2.19–4.37), (iii) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (iv) being younger, Hispanic and using heroin or other substances during treatment.Conclusions Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids.Keywords: Buprenorphine; methadone; opiate dependence; treatment outcomes

41. Disseminating contingency management: Impacts of staff training and implementation at an opiate treatment programBryan Hartzler, T. Ron Jackson, Brinn E. Jones, Blair Beadnell, Donald A. CalsynJournal of Substance Abuse Treatment 2014:46(4);429-438 AbstractGuided by a comprehensive implementation model, this study examined training/implementation processes for a tailored contingency management (CM) intervention instituted at a Clinical Trials Network-affiliate opioid treatment program (OTP). Staff-level training outcomes (intervention delivery skill, knowledge, and adoption readiness) were assessed before and after a 16-hour training, and again following a 90-day trial implementation period. Management-level implementation outcomes (intervention cost,

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feasibility, and sustainability) were assessed at study conclusion in a qualitative interview with OTP management. Intervention effectiveness was also assessed via independent chart review of trial CM implementation vs. a historical control period. Results included: 1) robust, durable increases in delivery skill, knowledge, and adoption readiness among trained staff; 2) positive managerial perspectives of intervention cost, feasibility, and sustainability; and 3) significant clinical impacts on targeted patient indices. Collective results offer support for the study's collaborative intervention design and the applied, skills-based focus of staff training processes. Implications for CM dissemination are discussed.Keywords: Contingency management; Dissemination; Implementation science

42. Does age at first treatment episode make a difference in outcomes over 11 years?Felicia W. Chi, Constance Weisner, Christine E. Grella, Yih-Ing Hser, Charles Moore, Jennifer MertensJournal of Substance Abuse Treatment 2014:46(4);482-490 AbstractThis study examines the associations between age at first substance use treatment entry and trajectory of outcomes over 11 years. We found significant differences in individual and treatment characteristics between adult intakes first treated during young adulthood (25 years or younger) and those first treated at an older age. Compared to their first treated older age counterparts matched on demographics and dependence type, those who entered first treatment during young adulthood had on average an earlier onset for substance use but a shorter duration between first substance use and first treatment entry; they also had worse alcohol and other drug outcomes 11 years post treatment entry. While subsequent substance use treatment and 12-step meeting attendance are important for both age groups in maintaining positive outcomes, relationships varied by age group. Findings underline the importance of different continuing care management strategies for those entering first treatment at different developmental stages.Keywords: Substance use treatment; Outcome trajectories; Young adulthood; Life course

43. A qualitative study of the adoption of buprenorphine for opioid addiction treatmentCarla A. Green, Dennis McCarty, Jennifer Mertens, Frances L. Lynch, Anadam Hilde, Alison Firemark, Constance M. Weisne, David Pating, Bradley M. AndersonJournal of Substance Abuse Treatment 2014:46(3);390-401

AbstractQualified physicians may prescribe buprenorphine to treat opioid dependence, but medication use remains controversial. We examined adoption of buprenorphine in two not-for-profit integrated health plans, over time, completing 101 semi-structured interviews with clinicians and clinician–administrators from primary and specialty care. Transcripts were reviewed, coded, and analyzed. A strong leader championing the new treatment was critical for adoption in both health plans. Once clinicians began using buprenorphine, patients' and other clinicians' experiences affected decisions more than did the champion. With experience, protocols developed to manage unsuccessful patients and changed to support maintenance rather than detoxification. Diffusion outside addiction and mental health settings was nonexistent; primary care clinicians cited scope-of-practice issues and referred patients to specialty care. With greater diffusion came questions about long-term use and safety. Recognizing how implementation processes develop may suggest where, when, and how to best expend resources to increase adoption of such treatments.

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Keywords: Diffusion of technology; Buprenorphine; Opioid addiction; Qualitative research; Medication adoption; Implementation research

44. Substance abuse treatment and the stages of change, by Gerard J. Connors, Carlo C. DiClemente, Mary Marden Velasquez, & Dennis M. DonovanRobin DavidsonDrugs: Education, Prevention, and Policy 2014:Early Online of Issue 2,1-1: Posted online 25th October 2013 No abstract available

45. The diversion and injection of a buprenorphine-naloxone soluble film formulation Briony Larance, Nicholas Lintzeris, Robert Ali, Paul Dietze, Richard Mattick, Rebecca Jenkinson, Nancy White, Louisa DegenhardtDrug and Alcohol Dependence 2014:136(1st Mar 2014);21-27

AbstractBackground We compared the diversion and injection of a new formulation of buprenorphine, a buprenorphine-naloxone film product (BNX film), with buprenorphine-naloxone tablets (BNX tablets), mono-buprenorphine (BPN) and methadone (MET) in Australia. Methods Surveys were conducted with people who inject drugs regularly (PWID) (2004–2012) and opioid substitution treatment (OST) clients (2012, N = 543). Key outcome measures: the unsanctioned removal of supervised doses, diversion, injection, motivations, drug liking and street price. Levels of injection among PWID were adjusted for background availability of medication using sales data. Doses not taken as directed by OST clients were adjusted by total number of daily doses dispensed. Results Among out-of-treatment PWID, levels of injection for BNX film were comparable to those for MET and BNX tablet formulations, adjusting for background availability; BPN injecting levels were higher. Among OST clients, recent injecting of one's medication was similar among clients in all OST types; weekly or more frequent injection of prescribed doses was reported by fewer BNX film clients (3%; 95% CI: 1–6) than BPN clients (11%; 95% CI: 3–17), but at levels similar to those observed among MET and BNX tablet clients. The proportion of BNX film doses injected was lower than that for BPN and BNX tablets, and equivalent to that for MET. The majority of BNX film doses injected by OST clients were unsupervised doses, although some injection of supervised doses of BNX film did occur. The median price of all buprenorphine forms on the illicit market was the same. Conclusions Non-adherence and diversion of the BNX film formulation was similar to MET and BNX tablet formulations; BPN had higher levels of all indicators of non-adherence and diversion.Keywords: Opioid substitution therapy; Methadone; Compliance; Abuse liability; Post-marketing surveillance

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PRESCRIPTION AND OTC DEPENDENCE

46. Diversion of prescribed opioids by people living with chronic pain: Results from an Australian community sampleJessica Belcher, Suzanne Nielsen, Gabrielle Campbell, Raimondo Bruno, Bianca Hoban, Briony Larance, Nicholas Lintzeris, Louisa DegenhardtDrug and Alcohol Review 2014:33(1);27-32 AbstractIntroduction and Aims There has been an increase in prescription of opioids for chronic non-cancer pain, and concern exists over possible diversion of prescription opioids to the illicit marketplace. Recent media coverage suggests that elderly patients sell their prescribed opioids for additional income. This study investigated the extent to which an Australian community sample of chronic pain patients prescribed opioids reported supplying their prescribed opioids to others. Design and Methods Participants living with chronic non-cancer pain and prescribed opioids for their pain (n = 952) were recruited across Australia via advertisements at pharmacies. A telephone interview included questions about their pain condition and opioid medication. Results Participants had been living with pain for a mean of 14.2 years; most common conditions included chronic back/neck problems and arthritis/rheumatism. Around half (43%) were currently prescribed one opioid, and 55% had been prescribed 2–5 opioids; the most common was oxycodone. Forty-two participants (4%) reported ever supplying prescribed opioids to another person; one participant reported receiving payment. Participants who supplied opioids to others were younger (odds ratio 0.97, 95% confidence interval 0.95–0.99) and engaged in a greater number of aberrant behaviours relating to their opioid medication (odds ratio 1.77, 95% confidence interval 1.45–2.17), including tampering with doses, taking opioids by alternative routes, seeing doctors to obtain extra opioids and refilling prescriptions early. Discussion and Conclusion Few people with chronic non-cancer pain divert their opioids to others. Media reports of elderly patients selling their opioids to supplement their income may be reflective of exceptional cases. Future studies may investigate the extent to which other patient groups divert prescription opioids to the illicit marketplace.Keywords: pharmaceutical opioids; diversion; chronic pain; non-adherence

47. Pill popping problems: The non-medical use of stimulant medications in an undergraduate sampleAndrew R.  Gallucci, Stuart L. Usdan, Ryan J. Martin, Kathleen A. BollandDrugs: Education, Prevention, and Policy 2014:Early Online of Issue 2,1-8: Posted online 28th October 2013

Aims The non-medical use of prescription stimulants (NMUPS) is an emergent health behaviour among undergraduate college students. This study examined the prevalence, primary motivations and risk factors associated with lifetime and current NMUPS among undergraduates. Methods An anonymous survey examining the NMUPS behaviour was administered in-class to a sample of 1020 of traditional undergraduate university students.Findings Findings indicated that 35% of students used a prescription stimulant at least once non-medically during their lifetime and 12% had done so in the previous 30 days. Results also indicated that the majority of current and lifetime non-medical users were motivated to engage in the behaviour to improve or enhance academic performance. Further, multivariate logistic regression analyses revealed that students who engaged in current or lifetime

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NMUPS were more likely to be non-freshmen, affiliated with a Greek organization and diagnosed with attention deficit/hyperactivity disorder (ADHD). Conclusions Efforts to reduce college students from engaging in NMUPS would benefit by targeting specific portions of the student body. These initiatives should include information about how to address academic problems without abusing stimulant medications.

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PREVENTION AND DIVERSIONARY ACTIVITIES

48. Sport participation and alcohol and illicit drug use in adolescents and young adults: A systematic review of longitudinal studiesMatthew Kwan, Sarah Bobko, Guy Faulkner, Peter Donnelly, John CairneyAddictive Behaviors 2014:39(3);497-506 AbstractSport participation can play an important and positive role in the health and development of children and youth. One area that has recently been receiving greater attention is the role that sport participation might play in preventing drug and alcohol use among youth. The current study is a systematic review of 17 longitudinal studies examining the relationship between sport participation and alcohol and drug use among adolescents. Results indicated that sport participation is associated with alcohol use, with 82% of the included studies (14/17) showing a significant positive relationship. Sport participation, however, appears to be related to reduced illicit drug use, especially use of non-cannabis related drugs. Eighty percent of the studies found sport participation associated with decreased illicit drug use, while 50% of the studies found negative association between sport participation and marijuana use. Further investigation revealed that participation in sports reduced the risk of overall illicit drug use, but particularly during high school; suggesting that this may be a critical period to reduce or prevent the use of drugs through sport. Future research must better understand what conditions are necessary for sport participation to have beneficial outcomes in terms of preventing alcohol and/or illicit drug use. This has been absent in the extent literature and will be central to intervention efforts in this area.Keywords: Sport participation; Substance use; Alcohol; Drugs; Adolescence; Youth

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PROFESSIONALS AND SERVICES

49. Healthcare professionals’ regard towards working with patients with substance use disorders: Comparison of primary care, general psychiatry and specialist addiction servicesLeonieke C. van Boekel, Evelien P.M. Brouwers, Jaap van Weeghel, Henk F.L. GarretsenDrug and Alcohol Dependence 2014:134(1st Jan 2014);92-98 AbstractBackground Healthcare professionals are crucial in access to treatment for patients with substance use disorders. However, healthcare professionals often have negative attitudes towards this patient group. Healthcare professionals’ regard for working with patients with substance use disorders was examined and three sectors in which professionals are working were compared. Methods General practitioners (GPs; N = 180), healthcare professionals of general psychiatry (N = 89) and specialists in addiction services (N = 78) filled out a questionnaire in which regard for working with patients with substance use disorders was assessed. ANOVAs were used to compare the sectors and multiple linear regression analysis tested the association of regard with attribution beliefs, emotional reactions and other characteristics of healthcare professionals. Results Regard for working with patients with substance use disorders was different between the three sectors (GPs M = 42.00; general psychiatry M = 48.18; addiction specialists M = 55.41; p = 0.00, ω2 = 0.40). Attribution of personal responsibility and feeling of anger and fear were associated with lower regard scores. More familiarity with substance use problems, higher frequency of working with this patients group and more confidence in substance abuse treatment were positively associated with regard. Social desirability bias was present and was positively related to healthcare professionals’ regard. Conclusions Health care professionals of specialist addiction services showed higher regard for working with patients with substance use disorders compared to professionals of general psychiatry services and GPs. Improvement of education and shared care models in which healthcare professionals are supported by professionals specializing in addiction might address low regard.Keywords: Substance-related disorders; Attitude of health personnel; Stigma; Medical condition regard scale; Cross-sectional study

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RECOVERY

50. Clear rhetoric and blurred reality – The development of a recovery focus in UK drug treatment policy and practiceNeil McKeganeyInternational Journal of Drug Policy, In Press, Corrected Proof, Available online 31 January 2014

AbstractThis paper looks at the transformation of UK drug treatment policy in the priority that is now being given to recovery. The paper explores the factors that helped shape that transformation and notes that in the main the influences were external to those directly involved in delivering drug treatment (research, politicians, media, think tanks) and that whilst the combined influence of these elements succeeded in reframing policy it has left the realm of drug treatment service delivery unclear in a number of key areas including: determining how long drug users should remain in treatment, avoiding relapse, relations between professional drug workers and peer supporters, meeting the diverse needs of drug users including those who are not seeking to become drug free. The paper concludes by considering what kind of initiatives and mechanisms may be needed to ensure a closer alignment between policy and practice within the drug treatment sphere.

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SMOKING CESSATION 51. Real-world’ effectiveness of smoking cessation treatments: a population studyDaniel Kotz, Jamie Brown, Robert WestAddiction 2014:109(3);491-499

AbstractBackground and aims There is a need for more evidence on the ‘real-world’ effectiveness of commonly used aids to smoking cessation from population-level studies. This study assessed the association between abstinence and use of different smoking cessation treatments after adjusting for key potential confounding factors. Design Cross-sectional data from aggregated monthly waves of a household survey: the Smoking Toolkit Study.Setting England. Participants A total of 10 335 adults who smoked within the previous 12 months and had made at least one quit attempt during that time. Measurements Participants were classified according to their use of cessation aids in their most recent quit attempt: (i) medication (nicotine replacement therapy, bupropion or varenicline) in combination with specialist behavioural support delivered by a National Health Service Stop Smoking Service; (ii) medication provided by the prescribing health-care professional without specialist behavioural support; (iii) nicotine replacement therapy (NRT) bought over the counter; and (iv) none of these. The main outcome measure was self-reported abstinence up to the time of the survey, adjusted for key potential confounders including tobacco dependence.Findings Compared with smokers using none of the cessation aids, the adjusted odds of remaining abstinent up to the time of the survey were 3.25 [95% confidence interval (CI) = 2.05–5.15] greater in users of prescription medication in combination with specialist behavioural support, 1.61 (95% CI = 1.33–1.94) greater in users of prescription medication combined with brief advice and 0.96 (95% CI = 0.81–1.13) in users of NRT bought over the counter. Conclusions After adjusting for major confounding variables such as tobacco dependence, smokers in England who use a combination of behavioural support and pharmacotherapy in their quit attempts have almost three times the odds of success than those who use neither pharmacotherapy nor behavioural support. Smokers who buy nicotine replacement therapy over the counter with no behavioural support have similar odds of success in stopping as those who stop without any aid.Keywords: Behavioural support; bupropion; national household survey; nicotine replacement therapy; smoking cessation; varenicline

52. Reciprocal effects of alcohol and nicotine in smoking cessation treatment studies Nadra E. Lisha, Timothy P. Carmody, Gary L. Humfleet, Kevin L. DelucchiAddictive Behaviors 2014:39(3);637-643 AbstractObjective Smoking and alcohol use are highly related; as such the present study investigated whether alcohol use is associated with failure in tobacco cessation attempts. We first examined the self-reported drinking behavior and smoking over the course of a year at a basic level. Next, we addressed two hypotheses to characterize this relationship at a deeper level: (Hypothesis 1) Alcohol use would be lower for those who attempted to quit smoking (quit for one or more days) during the year compared to those who never quit, and (Hypothesis 2) for those who relapsed to smoking after a quit increases in alcohol consumption would be positively associated with increases in smoking. Method Subjects were participants in two smoking cessation programs. One group of participants (N = 139) was part of a smoking

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cessation study in alcohol dependent smokers in early recovery and the other group of participants (N = 163) was drawn from a smoking cessation study for HIV positive smokers. H1 was tested using t-tests. For H2, a time series analysis examined relationships between smoking and alcohol use within person over a one year period. For H1 and for H2, the analyses utilized bivariate time series procedures. Timeline follow-back data allowed for detailed daily reports of both tobacco and alcohol use. Results In the overall sample, there was no difference in alcohol use between those who stopped smoking and those who never stopped. However, when broken up by study, a difference was found in the alcohol dependent sample such that mean drinks were higher for those who stopped compared to those who never stopped smoking (H1). The results indicated a high number of positive significant cross-correlations between tobacco and alcohol use such that one substance predicted current, as well as past and future use of the alternate substance. Same-day cross-correlations were the most common, and dissipated with time (H2). Conclusions This analysis provided insights into the proximal influence of one substance on the other. Alcohol is related to relapse in smoking cessation attempts. It is important that smoking cessation efforts in alcohol using populations consider alcohol use in treatment.Keywords: Smoking; Drinking; Timeline follow-back; Time series analysis; Smoking cessation

53. Small financial incentives increase smoking cessation in homeless smokers: A pilot studyMichael S. Businelle, Darla E. Kendzor, Anshula Kesh, Erica L. Cuate, Insiya B. Poonawalla, Lorraine R. Reitzel, Kolawole S. Okuyemi, David W. WetterAddictive Behaviors 2014:39(3);717-720 AbstractAlthough over 70% of homeless individuals smoke, few studies have examined the effectiveness of smoking cessation interventions in this vulnerable population. The purpose of this pilot study was to compare the effectiveness of shelter-based smoking cessation clinic usual care (UC) to an adjunctive contingency management (CM) treatment that offered UC plus small financial incentives for smoking abstinence. Sixty-eight homeless individuals in Dallas, Texas (recruited in 2012) were assigned to UC (n = 58) or UC plus financial incentives (CM; n = 10) groups and were followed for 5 consecutive weeks (1 week pre-quit through 4 weeks post-quit). A generalized linear mixed model regression analysis was conducted to compare biochemically-verified abstinence rates between groups. An additional model examined the interaction between time and treatment group. The participants were primarily male (61.8%) and African American (58.8%), and were 49 years of age on average. There was a significant effect of treatment group on abstinence overall, and effects varied over time. Follow-up logistic regression analyses indicated that CM participants were significantly more likely than UC participants to be abstinent on the quit date (50% vs. 19% abstinent) and at 4 weeks post-quit (30% vs. 1.7% abstinent). Offering small financial incentives for smoking abstinence may be an effective way to facilitate smoking cessation in homeless individuals.Keywords: Homeless; Smoking cessation; Financial incentives; Contingency management

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STIGMA

54. Substance, structure and stigma: Parents in the UK accounting for opioid substitution therapy during the antenatal and postnatal periodsAmy Chandler, Anne Whittaker, Sarah Cunningham-Burley, Nigel Williams, Kelly McGorm, Gillian MathewsInternational Journal of Drug Policy 2013:24(6);e35-e42 AbstractBackground Parenting and pregnancy in the context of drug use is a contentious topic, high on the policy agenda. Providing effective support to parents who are opioid dependent, through early intervention, access to drug treatment and parenting skills training, is a priority. However, little is known about opioid dependent parents’ experiences and understanding of parenting support during the antenatal and postnatal periods. This paper focuses on the position and impact of opioid substitution therapy (OST) in the accounts of parents who were expecting, or who had recently had, a baby in the UK. Methods Semi-structured qualitative interviews were held with a purposive sample of 19 opioid dependent service users (14 female, 5 male). Longitudinal data was collected across the antenatal and postnatal (up to 1 year) periods, with participants interviewed up to three times. Forty-five interviews were analysed thematically, using a constant comparison method, underpinned by a sociologically informed narrative approach. Results Participants’ accounts of drug treatment were clearly oriented towards demonstrating that they were doing ‘the best thing’ for their baby. For some, OST was framed as a route to what was seen as a ‘normal’ family life; for others, OST was a barrier to such normality. Challenges related to: the physiological effects of opioid dependence; structural constraints associated with treatment regimes; and the impact of negative societal views about drug-using parents. Conclusion Parents’ accounts of OST can be seen as a response to socio-cultural ideals of a ‘good’, drug-free parent. Reflecting the liminal position parents engaged in OST found themselves in, their narratives entailed reconciling their status as a ‘drug-using parent’ with a view of an ‘ideal parent’ who was abstinent.Keywords: Methadone maintenance treatment; Opioid substitution therapy; Parenting; Pregnancy

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