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Subst Abuse Treat Prev Policy [journal]
- Depressive symptoms and alcohol correlates among Brazilians aged 14 years and older: a cross-sectional study. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jul 15; 9(1):29.
The associations between depressive symptoms and alcohol-related disorders, drinking patterns and other characteristics of alcohol use are important public health issues worldwide. This study aims to study these associations in an upper middle-income country, Brazil, and search for related socio-demographic correlations in men and women.A cross-sectional study was conducted between November 2005 and April 2006. The sample of 3,007 participants, selected using a multistage probabilistic sampling method, represents the Brazilian population aged 14 and older. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and alcohol dependence was assessed using the Composite International Diagnostic Interview. Associations assessed using bi-variate analysis were tested using Rao-Scott measures. Gender specific multinomial logistic regression models were developed.Among the participants with alcohol dependence, 46% had depressive symptoms (17.2% mild/moderate and 28.8% major/severe; p < 0.01); 35.8% (p = 0.08) of those with alcohol abuse and 23.9% (p < 0.01) of those with a binge-drinking pattern also had depressive symptoms. Alcohol abstainers and infrequent drinkers had the highest prevalence of major/severe depressive symptoms, whereas frequent heavy drinkers had the lowest prevalence of major/severe depressive symptoms. In women, alcohol dependence and the presence of one or more problems related to alcohol consumption were associated with higher risks of major/severe depressive symptoms. Among men, alcohol dependence and being >=45 years old were associated with higher risks of major/severe depressive symptoms.In Brazil, the prevalence of depressive symptoms is strongly related to alcohol dependence; the strongest association was between major/severe depressive symptoms and alcohol dependence in women. This survey supports the possible association of biopsychosocial distress, alcohol consumption and the prevalence of depressive symptoms in Brazil. Investing in education, social programs, and care for those with alcohol dependence and major/severe depressive symptoms, especially for such women, and the development of alcohol prevention policies may be components of a strategic plan to reduce the prevalence of depression and alcohol problems in Brazil. Such a plan may also promote the socio-economic development of Brazil and other middle-income countries.
- The national alcohol helpline in Sweden: an evaluation of its first year. [Journal Article]
- Subst Abuse Treat Prev Policy 2014; 9(1):28.
Telephone helplines are easily available and can offer anonymity. Alcohol helplines may be a potential gateway to a more advanced support protocol, and they may function as a primary support option for some. However, although telephone helplines (quitlines) make up an established evidence-based support arena for smoking cessation, few studies have described such telephone-based alcohol counseling.This study describes the basic characteristics of callers (n = 480) to the Swedish Alcohol Helpline during its first year of operation, and assesses aspects of change in alcohol behavior in a selected cohort of clients (n = 40) willing to abstain from anonymity and enter a proactive support protocol.During the study period, 50% of callers called for consultation regarding their own alcohol use (clients), a third called about relatives with alcohol problems, and the others called for information. The clients' average age was 49 years, and half were females. The clients' average AUDIT score at baseline was 21 (std. dev. =7.2). Approximately a quarter had scores indicating hazardous alcohol use at baseline, while the others had higher scores. In a follow-up pilot study, the average AUDIT score had decreased from 21 to 14. While clients reporting more severe alcohol use showed a significant decrease at follow-up, hazardous users exhibited no change during the study period.The study indicates that telephone helplines addressing the general public can be a primary-care option to reduce risky alcohol use. A randomized controlled study is needed to control for the effect of spontaneous recovery.
- The aetiology and trajectory of anabolic-androgenic steroid use initiation: a systematic review and synthesis of qualitative research. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jul 2; 9(1):27.
To our knowledge, there has never been a systematic review and synthesis of the qualitative literature on the trajectory and aetiology of nonmedical anabolic-androgenic steroid (AAS) use.We systematically reviewed and synthesized qualitative literature gathered from searches in PsycINFO, PubMed, ISI Web of Science, Google Scholar, and reference lists of relevant literature to investigate AAS users' ages of first use and source(s), history prior to use, and motives/drives for initiating use. We adhered to the recommendations of the UK Economic and Social Research Council's qualitative research synthesis manual and the PRISMA guidelines.A total of 44 studies published between 1980 and 2014 were included in the synthesis. Studies originated from 11 countries: the United States (n = 18), England (n = 8), Australia (n = 4), Sweden (n = 4), both England and Wales (n = 2), and Scotland (n = 2). One study each originated from Brazil, Bulgaria, Canada, France, Great Britain, and Norway. The majority of AAS users initiated use before age 30. Sports participation (particularly power sports), negative body image, and psychological disorders such as depression preceded initiation of AAS use for most users. Sources of first AAS were mainly users' immediate social networks and the illicit market. Enhanced sports performance, appearance, and muscle/strength were the paramount motives for AAS use initiation.Our findings elucidate the significance of psychosocial factors in AAS use initiation. The proliferation of AAS on the illicit market and social networks demands better ways of dealing with the global public health problem of AAS use.
- Public spending for illegal drug and alcohol treatment in hospitals: an EU cross-country comparison. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jun 30; 9(1):26.
In view of the current economic crisis and the resulting austerity measures being implemented by governments across Europe, public expenditure for substance abuse treatment has increasingly become a subject of discussion. An EU cross-country comparison would allow an estimation of the total amount of public resources spent on substance abuse treatment, compare various substance abuse treatment funding options, and evaluate the division of expenditures between alcohol and illegal drugs. The purpose of this study is to estimate the public spending of EU countries for alcohol and illegal drug abuse treatment in hospitals.Our study uses a uniform methodology in order to enable valid cross-national comparisons. Our data are drawn from the Eurostat database, which provides anno 2010 data on government spending for the treatment of illegal drug and alcohol abuse in 21 EU member states. The cross-country comparison is restricted to hospitals, since data were unavailable for other types of treatment providers. The systematic registration of in- and outpatient data is essential to monitoring public expenditures on substance abuse treatment using international databases.Total public spending for hospital-based treatment of illegal drug and alcohol abuse in the 21 EU member states studied is estimated to be 7.6 billion euros. Per capita expenditures for treatment of illegal drug abuse vary, ranging from 0.1 euros in Romania to 13 euros in Sweden. For alcohol abuse, that figure varied from 0.9 euros in Bulgaria to 24 euros in Austria. These results confirm other studies indicating that public expenditures for alcohol treatment exceed that for illegal drug treatment.Multiple factors may influence the number of hospital days for alcohol or illegal substance abuse treatment, and expenditures fluctuate accordingly. In this respect, we found a strong correlation between gross domestic product (GDP) per capita and public expenditures per hospital day. The prevalence of problematic (illegal or legal) drug use in a country did not correlate significantly with the number of hospital days. Other factors must be included in the analysis of public expenditures for the treatment of substance abuse, such as the drug policy in a given country and the social norms regarding alcohol consumption.
- Health professional students' perceptions regarding their role in tobacco control: findings from the Global Health Professional Students Survey, Pakistan, 2011. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jun 23; 9(1):25.
An important way of reducing tobacco use is to train the health professional (HP) students to assist in tobacco cessation by educating patients and public. In order to shape their thoughts for the desired role, it is vital to understand their existing perceptions regarding HP's role in tobacco control. Thus, the aim of our study was to find out the perceptions of Pakistani HP students regarding their future role in tobacco control, and examine factors associated with negative perceptions.Secondary data analysis of the Global Health Professional Students Survey, Pakistan, 2011 was performed. Study population included 3445 health professional students in third year of graduate level programs. The dependent variable (perceptions of HP students), was developed using four questions from the survey. Students who did not regard HP's role in tobacco control were labeled as having negative perceptions. Logistic regression analyses were conducted to analyze association between HP students' perceptions and various socio-demographic, attitudinal and knowledge related factors; and were reported as adjusted odds ratios with 95% confidence interval.We found that 44.8% (n = 1542) of students do not regard HPs as role model for their patients and public, and perceive that HPs do not play an important part in patient's quitting tobacco use. These negative perceptions were associated with male sex (OR = 1.25, 95% CI 1.02 - 1.53, p value 0.028), and poor knowledge about tobacco cessation techniques (OR = 1.32, 95% CI 1.12 - 1.55, p value < 0.001). Negative perceptions were also associated with their attitudes towards ban on: tobacco advertisements (OR = 1.67, 95% CI 1.13 - 2.48, p value 0.010); and tobacco use at public places (OR = 1.60, 95% CI 1.26 - 2.03, p value < 0.001).The role of HPs for tobacco control is fairly under-perceived by HP students, and the undesired negative perceptions are associated with male sex, poor knowledge about tobacco use cessation techniques and negative attitudes towards legislative control. A comprehensive approach, focusing on these aspects should be adopted to train HPs, in order to utilize them as an effective manpower for tobacco control.
- A universal harm-minimisation approach to preventing psychostimulant and cannabis use in adolescents: a cluster randomised controlled trial. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jun 18; 9(1):24.
Psychostimulants and cannabis are two of the three most commonly used illicit drugs by young Australians. As such, it is important to deliver prevention for these substances to prevent their misuse and to reduce associated harms. The present study aims to evaluate the feasibility and effectiveness of the universal computer-based Climate Schools: Psychostimulant and Cannabis Module.A cluster randomised controlled trial was conducted with 1734 Year 10 students (mean age = 15.44 years; SD = 0.41) from 21 secondary schools in Australia. Schools were randomised to receive either the six lesson computer-based Climate Schools program or their usual health classes, including drug education, over the year.The Climate Schools program was shown to increase knowledge of cannabis and psychostimulants and decrease pro-drug attitudes. In the short-term the program was effective in subduing the uptake and plateauing the frequency of ecstasy use, however there were no changes in meth/amphetamine use. In addition, females who received the program used cannabis significantly less frequently than students who received drug education as usual. Finally, the Climate Schools program was related to decreasing students' intentions to use meth/amphetamine and ecstasy in the future, however these effects did not last over time.These findings provide support for the use of a harm-minimisation approach and computer technology as an innovative platform for the delivery of prevention education for illicit drugs in schools. The current study indicated that teachers and students enjoyed the program and that it is feasible to extend the successful Climate Schools model to the prevention of other drugs, namely cannabis and psychostimulants.Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12613000492752.
- Differential long-term outcomes for voluntary and involuntary transition from injection to oral opioid maintenance treatment. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jun 8; 9(1):23.
The most widely used maintenance treatment for opioid dependency is substitution with long-acting oral opioids. Treatment with injectable diacetylmorphine provides an opportunity for patients to stabilize and possibly transition to oral treatment, if clinically indicated. The aim of this study was to explore outcomes of individuals that received injectable diacetylmorphine and voluntarily transitioned to oral methadone.Design and methods: The North American Opiate Medication Initiative was a randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (or hydromorphone) to oral methadone for long-term opioid-dependency. Treatment was provided for 12-months with an additional 3 months for transition and weaning. Participants were followed until 24-months from randomization. Among the participants randomized to injectable treatments, a sub-group voluntarily chose to transition to oral methadone (n = 16) during the treatment period. Illicit heroin use and treatment retention were assessed at 24-months for those voluntarily and involuntarily transitioning (n = 95) to oral methadone.At 24-months, the group that voluntarily transitioned to oral methadone had higher odds of treatment retention (adjusted odds ratio = 5.55; 95% confidence interval [CI] = 1.11, 27.81; Chi-square = 4.33, df = 1, p-value = 0.037) than the involuntary transition group. At 24-months, the adjusted mean difference in prior 30 days of illicit heroin use for the voluntary, compared to the involuntary group was -5.58 (95% CI = -11.62, 0.47; t-value = -1.83, df = 97.4, p-value = 0.070).Although the results of this study were based on small groups of self-selected (i.e., non-randomized) participants, our data underlines the critical importance of voluntary and patient-centered decision making. If we had continued offering treatment with diacetylmorphine, those retained to injectable medication may have sustained the achieved improvements in the first 12 months. Diversified opioid treatment should be available so patients and physicians can flexibly choose the best treatment at the time.Trial registration: Clinical Trial Registration: NCT00175357.
- An evaluation of long-term changes in alcohol use and alcohol problems among clients of the Swedish National Alcohol Helpline. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 Jun 3; 9(1):22.
The Swedish National Alcohol Helpline was developed with the intention to provide an easily available, low threshold service to hazardous and harmful alcohol users in the community. The primary aim of this study was to describe the 12-month outcome of a cohort of clients and to evaluate whether these varied as a function of the intensity of exposure to the intervention.The alcohol use and alcohol problems of a cohort of 191 clients accessing the service between 1 April 2009 and 1 February 2011 were assessed by telephone survey at the time of the first call and after 12 months. Change in AUDIT score between baseline and follow-up was used as primary outcome. Intensity of exposure was defined by number of counselling sessions.At 12-month follow-up, respondents had significantly reduced their AUDIT score to half of the baseline values, and one third of the participants were abstinent or consumed alcohol at a low-risk level. Participating in more than one counselling session as compared to one session was associated with a tendency to shift to a lower AUDIT zone at follow-up among women.The Alcohol Helpline provides a viable community service for harmful and hazardous alcohol users. Future randomized studies including other treatment or control conditions are warranted in order to strengthen our preliminary conclusion of possible effectiveness of the counselling provided at the helpline, as well as to explore further the role of gender in moderating the treatment's effect.
- Implementing stakeholder-informed research in the substance abuse treatment sector: strategies used by Connections, a Canadian knowledge translation and exchange project. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 May 29; 9(1):21.
Researcher-stakeholder collaboration has been identified as critical to bridging research and health system change. While collaboration models vary, meaningful stakeholder involvement over time ("integrated knowledge translation") is advocated to improve the relevance of research to knowledge users. This short report describes the integrated knowledge translation efforts of Connections, a knowledge translation and exchange project to improve services for women with substance abuse problems and their children, and implementation barriers and facilitators.Strategies of varying intensities were used to engage diverse stakeholders, including policy makers and people with lived experience, and executive directors, program managers, and service providers from Canadian addiction agencies serving women. Barriers to participation included individual (e.g., interest), organizational (e.g., funding), and system level (e.g., lack of centralized stakeholder database) barriers. Similarly, facilitators included individual (e.g., perceived relevance) and organizational (e.g., support) facilitators, as well as initiative characteristics (e.g., multiple involvement opportunities). Despite barriers, Connections' stakeholder-informed research efforts proved essential for developing clinically relevant and feasible processes, measures, and implementation strategies.Stakeholder-researcher collaboration is possible and robust integrated knowledge translation efforts can be productive. Future work should emphasize developing and evaluating a range of strategies to address stakeholders' knowledge translation needs and to facilitate sustained and meaningful involvement in research.
- A qualitative exploration of attitudes towards alcohol, and the role of parents and peers of two alcohol-attitude-based segments of the adolescent population. [JOURNAL ARTICLE]
- Subst Abuse Treat Prev Policy 2014 May 24; 9(1):20.
An earlier study using social marketing and audience segmentation distinguished five segments of Dutch adolescents aged 12-18 years based on their attitudes towards alcohol. The present, qualitative study focuses on two of these five segments ('ordinaries' and 'ordinary sobers') and explores the attitudes of these two segments towards alcohol, and the role of parents and peers in their alcohol use in more detail.This qualitative study was conducted in the province of North-Brabant, the Netherlands. With a 28-item questionnaire, segments of adolescents were identified. From the ordinaries and ordinary sobers who were willing to participate in a focus group, 55 adolescents (30 ordinaries and 25 ordinary sobers) were selected and invited to participate. Finally, six focus groups were conducted with 12-17 year olds, i.e., three interviews with 17 ordinaries and three interviews with 20 ordinary sobers at three different high schools.The ordinaries thought that drinking alcohol was fun and relaxing. Curiosity was an important factor in starting to drink alcohol. Peer pressure played a role, e.g., it was difficult not to drink when peers were drinking. Most parents advised their child to drink a small amount only. The attitude of ordinary sobers towards alcohol was that drinking alcohol was stupid; moreover, they did not feel the need to drink. Most parents set strict rules and prohibited the use of alcohol before the age of 16.Qualitative insight into the attitudes towards alcohol and the role played by parents and peers, revealed differences between ordinaries and ordinary sobers. Based on these differences and on health education theories, starting points for the development of interventions, for both parents and adolescents, are formulated. Important starting points for interventions targeting ordinaries are reducing perceived peer pressure and learning to make one's own choices. For the ordinary sobers, an important starting point includes enabling them to express to others that they do not feel the need to drink alcohol. Starting points for parents include setting strict rules, restricting alcohol availability at home and monitoring their child's alcohol use.