吗啡相关情境线索的形成及效应表达的神经基础——海马与基底外侧杏仁核在其中的作用

Drug-associated cue-induced relapse to drug seeking causes most difficulties of therapy for drug addiction. Addicts are exposed to two forms of environmental stimuli during drug-taking: contextual stimuli (e.g. a house in which the drug is consumed) and discrete stimuli (DS, e.g. a crack pipe or a syringe for drug). These stimuli become contextual cues and discrete cues, respectively. The incentive value of contextual cues plays a great role in opiates relapse. Compared with drug self-administration model, conditioned place preference (CPP) reflects the approach behavior for drug cues, not concerned with acquisition of operant behaviors. The present study aimed to investigate the role of basolateral amygdala (BLA) and hippocampus in the effect of opiates-related contextual cues using CPP model. Establishing DS-dependent or contextual cues-dependent CPP, the effect of BLA or hippocampus inactivation prior to training phase on acquisition of contextual cues-opiates association was evaluated. Inactivation prior to test phase was used to evaluate roles of BLA and hippocampus in expression of contextual cues-dependent morphine CPP. The main results were as follows: Inactivation of BLA or dorsal hippocampus selectively impaired acquisition of contextual cue-dependent CPP, but inactivation of ventral hippocampus had no impact on acquisition of either DS-dependent or contextual cue-dependent morphine CPP. Inactivation of BLA selectively inhibited expression of contextual cue-depended CPP. Inactivation of ventral hippocampus inhibited expression of both DS-dependent and contextual cue-dependent morphine CPP. These results suggest that BLA and dorsal hippocampus contribute to contextual cue association with opiates but not DS-opiates association. BLA and ventral hippocampus play important roles in incentive value of contextual cues. The present study provides more information for the neurological substrates underlying contextual cues associated with opiates.

慢性海洛因成瘾者的冲动性和行为抑制缺陷脑机制

In recent years, the deficit of inhibition has become an important reason for explaining addiction. Response inhibition resembles the compulsive drug seeking behavior and it is the basement of addiction inhibition deficits. However, there were no enough evidence for the relationship between addiction and response inhibition deficits and the results of the neuro mechanisms studies remains unclear. Few studies has focused on the exploring the heroin users. Among those paradigms for study response inhibition deficits, stop signal is a very suitable model for the representation of compulsive drug seeking, but only a few researches has worked on this paradigm. In this study, we selected about 100 heroin abusers and had behaviour and neuro imaging scannings for investigating the response inhibition deficits. The behaviour researches found: first, the chronic heroin users had longer reaction time than control group and this reaction time were not affected by stop signals in heroin users. Second, heroin users had less waiting time than control group and they were more impulsive but less flexibility. Their erro monitoring and flexibale adjustment ability decreased. Third, the SSRT of heroin users was significantly longer than control group. These results suggested that the inhibition of heroin users were impaired. Further investigation showed that the SSRT of heroin users had positive correlation of four factor scores of ASI and the macro correlation coefficient was factor three of drug use. This correlation suggested that drug use was the main reason of inhibition deficits. fMRI results mainly focused on the ANOVA analysis for group difference. First, there was no intensity difference in M1 and SMA brain areas between the two groups. Second, heroin users had less activation in right dorsalateral prefrontal cortex, right inferior prefrontal cortex and anterior cingulated cortex, while in bilateral striatum and amygdala, heroin users had more activation than control group. The right prefrontal cortex was indentified as the main inhibition brain area. The anterior cingulated cortex has relationship with erro monitoring and amygdale was an important brain area for impulsivity and emotion control. The network of these brain areas was envovled in impulsivity and inhibition and it was suggested the mainly damaged network for heroin users’ disinhibition. We also investigated the gray matter changes of heroin users and found that chonic heroin use made their gray matter density decreased in prefrontal cortex (including bilateral dorsalateral prefrontal cortex, obital frontal cortex, inferior prefrontal cortex) and anterior cingulated cortex. The gray matter density in these brain regions had negative correlation with drug use duration. In conclusion, we indentified the disinhibition of heroin users and its neuro mechanism. Their compulsivity brain areas had more activation than control group and their inhibition brain areas had less activation than normal control. On the other side, the biological mechanism of this activation changes was the gray matter density decrease in these brain areas.

汉语句子和语篇韵律层级边界的认知加工及其ERP效应

The aim of the present study was to explore whether the CPS (Closure Positive Shift) which reflected prosodic processing will be elicited when listeners perceived different hierarchical prosodic boundaries in Chinese sentence and discourse (Quatrain). In addiction, the similarity and difference in amplitude, onset latency and scalp distribution between these CPS were investigated. The nature of the CPS and its relationship to acoustic parameters was also explored systematically. The main results and conclusions of the present study were: (1) Phonological phrase boundaries and intonational phrase boundaries in Chinese sentences both elicited the CPS; however, phonological word boundaries can't evoke it. The CPS induced by phonological phrase boundaries was earlier than the one related to intonational phrase boundaries in onset latency, and the amplitude was also somewhat lower. When the pauses in the vicinity of these two boundaries were removed, the onset latency difference disappeared while amplitude in the new conditions was also lower. This indicates that whenever listeners segment sentence into phrases, the CPS will be elicited. Besides, pause was not the decisive factor to elicit the CPS, but can modify its onset latency and amplitude effectively. (2) The different hierarchical prosodic boundaries in seven character quatrain including phonological phrase boundaries, intonational phrase boundaries and sentence pair boundaries elicited the CPS respectively. Furthermore, just like in the sentence level, onset latency of the CPS induced by the prosodic boundaries in the discourse was also influenced by the length of pause: the shorter the pause was, the earlier the onset latency. For the comparison between the CPS evoked by the same and different hierarchical prosodic boundaries, its amplitude was influenced by the extent to which prosodic representations were activated. Thus, the condition of the CPS elicitation was extended to the prosodic bounaries in discourse, and further indicated that it was influenced by acoustic parameters. (3) No matter what task the participants completed, just like word detection or rythem matching task, the CPS will be evoked. However, its amplitude was larger in the anterior region, when listeners completed the word detection task which needed more attention and higher load of working memory. The present result indicated that the elicitation of the CPS was not influenced by the task the participants completed, but different task influence its scalp distribution. (4) The final syllable of the sentence and quatrain can't elicit the CPS, but a P300-like positive component. Although the scalp distribution was similar to the CPS, it was much higher in amplitude. The present result suggested that only the prosodic boundaries reflecting not only the closure of the former prosodic unit but also integrating the later one will elicit the CPS.

PLCß介导的钙调腺苷酸环化酶在突触可塑性相关基因转录中的作用和FE65对海马依赖学习及LTP的调节

Gene regulation is required for activity-dependent changes in synaptic plasticity and remodeling. The metabotropic glutamate receptors (mGluRs) contribute to different brain functions, including learning/memory, mental disorders, drug addiction, and persistent pain in the CNS. We found that Gp I mGluRs activate PLCß through Gq and then lead to activation of several calcium-dependent signaling pathways, including ERK, which play an important role in gene transcription. These findings support a calcium-dependent role for Gq in release of Calcium and activation of calcium-stimulated adenylyl cyclases I in activity-dependent transcription in response to application of group I metabotropic glutamate receptors agonist and may provide insights into group I mGluRs-dependent synaptic plasticity through MAP kinases signaling. Moreover, the present study investigated the transcription-dependent changes of Arc in response to the activation of group I mGluRs and suggested the central role of ERK1/2 in group I mGluR-mediated Arc transcription. Further, we selected APP-interaction protein FE65 to investigate the mechanism of transcription-related process in synaptic plasticity. FE65 is expressed predominantly in the brain, and interacts with the C-terminal domain of β-amyloid precursor protein (APP). We examined hippocampus-dependent memory and in vivo long-term potentiation (LTP) at the CA1 synapses with the isoform-specific FE65 knock-out (p97FE65-/-) mice. p97FE65 knock-out mice showed impaired short-term memory for both TDPA and CFC when tested 10min after training, which is transcription-independent. Consistently, at the Schaffer collateral-CA1 synapses, p97FE65 knock-out mice showed defective early phase LTP. These results demonstrate novel roles of FE65 in synaptic plasticity, acquisition, and retention for certain forms of memory formation.

我国购彩者认知偏差和成瘾倾向量表编制及其关系探讨

我国彩票事业发展20年以来，随着电脑型彩票销量的迅速增长，由彩票引发的问题行为逐渐引起社会普遍关注。相关研究发现，认知偏差是问题购彩发展和维持的一个重要影响因素，本研究在编制适用于我国购彩者的认知偏差和成瘾倾向量表的基础上，考察购彩者的认知偏差以及认知偏差对成瘾倾向的影响作用。 研究结果如下： 1． 在购彩者深度访谈和文献查阅的基础上，编制购彩者认知偏差量表和成瘾倾向量表，经过项目分析、信效度分析、探索性因素分析和验证性因素分析，结果显示各项指标基本符合统计学要求。 2． 行为分析和量表得分显示，我国电脑型彩票购买者存在一定程度的认知偏差，包括沉没成本、过度自信、关系错觉、控制幻想、赌徒谬误等等。 3． 认知偏差的高低与年龄、受教育程度、参与的游戏种类、购彩经历、购彩动机等因素有关。年龄越大、受教育程度越低的购彩者认知偏差得分越高；以中大奖为购彩动机的购彩者认知偏差高于奉献爱心者，以娱乐为动机的购彩者认知偏差得分最低。 4． 认知偏差对购彩成瘾倾向的影响作用显著，其中控制幻想和关系错觉对成瘾倾向具有直接影响，而赌徒谬误和乐观预期对成瘾倾向的间接影响通过控制幻想和关系错觉起作用。

海洛因成瘾者决策障碍及其行为机制的研究----短视行为及冲动、强迫和药物在决策中的作用

Addiction can be investigated from the perspective of decision making. Addicts usually make incorrect decisions when facing drug-related cues or they are driven to drugs, resulting in repeated drug seeking and taking. The present study adopted temporal discounting as behavioral task and on the basis of the fact that heroin addicts discounted more steeply than health participants (addicts preferred to choose immediate but smaller reward, regarded as myopia) which was consistent with previous research, three questions was raised and being concentrated on in this study. The first question was whether the character of myopia would be revealed in a somewhat complicated task? We designed a card game in which the participants were tested whether they would play the trump card in order to win a trick but not the whole game. Addicts played the trump card significantly earlier than controls did, indicating they focused on immediate single trick but not the game. Moreover, the performance in the card game and temporal discounting correlated significantly, suggesting addicts would display myopic decision not only in simply task like temporal discounting but also in task more complicated and similar to daily-life decision. Secondly, the present study adopted various kinds of temporal discounting tasks. In previous research, temporal discounting gain task was usually adopted. In the present study, we also adopted temporal discounting loss task. In either gain or loss task, there are two delayed amounts. Results showed in each decision condition addicts made poorer performance compared with control but in larger amount condition, addicts actually improved their decision performance. Meanwhile, addicts did not show loss aversion due to their close discount rates in gain and loss task while for controls, the discount rates were much lower in loss task than those in gain task. Thus we demonstrated that addicts were insensitive to negative outcomes by the method of temporal discounting. Finally, we investigated three mechanisms which exerted impacts on decision making. We adopted Go/NoGo task to test impulsivity and found addicts commits more errors (higher impulsivity) than controls did. We also designed a behavioral task which could be used to test drug-related compulsive behavior on human participants. Results showed addicts produced stereotyped key-pressing behavior when presented with drug-related cues. Furthermore, it was found participants with higher impulsivity displayed poorer performance in decision making but addicts with higher compulsivity only made poorer performance in smaller amount decision and the correlation between compulsivity and decision making was relative weak. In order to investigate the role of susceptibility and effect of drugs, we adopted years of abusing heroin as the indictor and discovered addicts with longer history of heroin abusing made poorer performance in smaller amount condition than addicts with shorter history. Also, the earlier the addicts began to use drug, the worse they would do in the smaller amount decision. The results here indicated drug itself could exert impact on decision making in certain condition. The present study revealed three characters of heroin addicts from the aspect of decision making: (1) focusing upon current benefit due to they preferred to choose immediate gain and delayed loss; (2) showed no loss aversion compared with healthy participants (3) inability to inhibit inappropriate response particularly when facing drug-related cue. These characters contribute to the facts that addicts seek and take drugs repeatedly while ignoring the negative consequences caused by abusing drugs.

烟草依赖者的注意偏向研究

Relapse has been a great challenge in clinical treatment and experimental studies of drug addiction. Recent studies suggest that psychological dependence may play a major role in addiction relapse, even more important than physiological dependence. Then a fundamental question arises: how to measure the psychological dependence? How to examine whether an addict has psychologically quitted when leaving drug rehabilitation centers? Self-report, a commonly used evaluation approach, is inevitably vulnerable to various cognitive influences, particularly in explicit tasks. Therefore, an objective index is necessary to evaluate the subliminal psychological drug dependence level. The objective of the current study was to develop such a psychological paradigm to probe the unaware attentional bias of in smoking addicts. Experiment 1 adapted the interocular suppression technique of binocular rivalry to study the attentional bias to cigarette pictures in smokers and age-matched nonsmoker. Results show that the smokers demonstrated similar attentional bias in both visible and unaware conditions, while non-smokers showed attentional bias only in the visible condition, and there was a significant interaction between experiment conditions and subject groups. These results provide compelling evidence for addiction-specific attentional bias in cigarette smokers, by minimizing the influence of confounding conscious factors. Furthermore, attentional bias of smokers in unawareness state was negatively correlated with their cigarette dependence levels, while their pre-test cigarette craving levels was positively correlated with their attnetional bias in the visible condition. This pair of correlations further demonstrated the advantages of unawareness state in disclosing stable dependence states, therefore supporting the effectiveness of the paradigm used in this study. Another interesting finding of Experiment 1 is that non-smokers also showed attentional bias in the visible condition. To exclude the possibility that the attentional bias found in experiment 1 was task-specific, experiment 2 adapted the most commonly-used visual dot probe task with smoking scenes as in relevant reference. The result in experiment 1 was well replicated, i.e., nonsmokers in experiment 2 also showed significant attentional bias to smoking-related stimuli, We interpenetrate this interesting finding as an effect of environmental influence, as the participants of the current study live in a highly smoking-exposed and smoking-encouraged environment, which is quite different with the participants of studies reported in the literature. A series of questionnaires and scales administered in the current study indeed show that most smokers smoked due to influence of the environment. They also acknowledged that smoking as an important media of social communication in China, and even considered that away from the smoking environment would effectively help them to quit. The current study also found that the disgust level towards cigarette pictures and smoking-related scenes of non-smokers was positively correlated with their attnentional bias in the visible condition of experiment 1. It is likely that in a highly smoking-encouraged environment, the remaining few on-smokers have severe disgust to cigarettes and smoking scenes; and their attentional bias might be caused by disgust avoidance. In conclusion, the current study represents the first study showing the existence of unaware attentional bias to smoking related stimuli in cigarette smokers by applying the interocular suppression paradigm, providing a reference to study of dependence of other drugs. The current study also found that our non-smoking participants also showed attentional bias to smoking related stimuli, which may be due to the possible influence of highly smoking-exposed environment of our participants.

影响吗啡动物行为效应的因素及其机制

Credible and stable animal behavioral models are necessary to research the mechanisms of addiction in vivo, especially to study the relationship between memory or stress and drug addiction, which has been one of the focuses in this field. So the object of this study was to observe the influences of several factors on the behavioral effects of morphine shown in the paradigms of conditioned place preference (CPP) and locomotor activity (LA), and to explore the effects of adrenalectomy on LA induced by morphine in rats. In addition, the cortexes of rats were examined, which were exposed to chronic administration of several doses of morphine with or without foot shock. Moreover, a new behavioral model was built to quantify the motivation of drug seeking. The results showed that CPP was more sensitive to low dose of morphine than to high dose. The period of experiment could be shortened by increasing the training times everyday, whereas in this way the dose of morphine should be low enough to avoid the impact between the near two exposures to morphine. Effects of chronic administration of morphine on LA in rats were dose- and time- dependent, which supplied evidence to choose parameters in other behavioral models. The results obtained by the simplified LA paradigm showed that hyperactivity of low dose of morphine following hypoactivity, and naloxone had no effects on LA but blocked the locomotion effects of morphine. Obvious effects of morphine on LA of rats might depend on a reasonable level of plasma corticosterone, which may determine individual vulnerability to drug addiction. Stress may also potentiate the vulnerability by aggravating damage to cortex of rats induced by drug dose-dependently, which is suggested by the results of histological examination. The result that frontal and temporal cortexes and hippocampus were injured suggests that there may be a close relationship between memory and drug addiction. It was showed that the new behavioral model on the basis of Morris water maze might be used to quantify the motivation of drug-craving.

Interazioni neurotrasmettitoriali nel meccanismo d’azione della cocaina: ruolo della serotonina e dell’adenosina

The putative 5-HT6 receptor agonist ST1936 has been shown to increase extracellular dopamine (DA) in the n.accumbens (NAc) Shell and in the medial prefrontal cortex (PFCX). These observations suggest that 5-HT6 receptors modulate DA transmission in mesolimbic and mesocortical terminal DA areas. To investigate the behavioral counterpart of this interaction I studied in rats the effect of 5-HT6 receptor blockade on cocaine stimulated overflow of DA in dialysates from the PFCX and from the NAc Shell and on cocaine i.v. selfadministration. Pretreatment with the 5-HT6 antagonist SB271046 reduced cocaine-induced increase of dialysate DA in the NAc Shell but not in the PFCX and impaired i.v. cocaine selfadministration. These suggest that 5-HT6 receptors play a role in cocaine reinforcement via their facilitatore interaction with DA projections to the NAc Shell. This 5-HT/DA interaction might provide the basis for a new pharmacotherapeutic strategy of cocaine addiction. Caffeine is one of the psychoactive substances most widely used as adulterant in illicit drugs, such as cocaine. Animal studies have demonstrated that caffeine is able to potentiate cocaine actions, although the enhancement of the cocaine reinforcing property by caffeine is less reported, and the results depend on the paradigms and experimental protocols used. In the present study I examined the ability of caffeine to enhance the motivational and rewarding properties of cocaine using the intravenous self-administration paradigm in rats. Additionally, the role of caffeine as a primer cue during extinction was evaluated. To this end, we assessed in naïve rats: 1) the ability of the combination of cocaine (0,125 mg/kg/infusion) and caffeine (0,0625 mg/kg/infusion) to maintain self-administration in fixed ratio (FR) and progressive ratio (PR) schedules of reinforcement compared with cocaine and caffeine alone; 2) the effect of caffeine in the maintenance of responding in the animals exposed to the combination of the drugs during cocaine extinction. Cocaine and the combination of cocaine and caffeine were self-administered on a FR and PR schedules of reinforcement, and the responding for the combination of the drugs was higher than cocaine alone. Caffeine was not reliably self-administered, but was able to maintain a drug-seeking behavior in rats previously exposed to cocaine plus caffeine. These findings suggest that the presence of caffeine enhances the reinforcing effects of cocaine and the motivational value of the drug. Our results highlight the role of active adulterants commonly used in illicit street drugs.

Ruolo e limiti del contratto negli assetti familiari in funzione successoria

The Article 457 c.c. expressly excludes the contract by the sources of the succession. Moreover, the article 458 c.c., apart from the initial brief aside dedicated to the institute of the family pact, agrees nullity of the agreements with whom someone decides its own succession as well as those with which the future successor could decide about his rights or renounce to them about a succession not yet open. However, for a long time, the Italian doctrine wonders about the role of the contract within the succession law. It feels, in fact, the need to expand the private autonomy within the inheritance that is excessively sacrificed by the prohibition of succession agreements and by the norms for the protection of legitimate heirs. The reasons which led the legal science to these conclusions are based on different events, both social and economic, that push the interpreter to a modernization of dogmatic categories with which he can represent the succession mortis causa. In addiction, it is necessary to underline the crisis of the agreements mortis causa due to this economical and social events: as a matter of fact, the will, as the only way to give the assets post mortem, revealed itself incomplete and extremely severe compared to the new social needs. In fact, increasingly the way to give the assets happens out of the inheritance and despite to the institutions designed by the law. For these reasons, in order to adapt the system of succession to modern economic and social needs, the doctrine has identified, within the system, institutions of a contractual nature in order to better achieve the interests of private, obviating the limits assigned to the shop last will. And recently, in this context, our legislator has introduced the institution of the family pact (art. 768 bis et seq. c.c.), that is the agreement through “the entrepreneur transfers, in whole or in part , the company, and the holder of equity investments transfers, in whole or in part, its shares, to one or more descendants". While, however, part of the doctrine encourages the provision of tools that enable a person to have in advance of his succession, on the other hand there are those who promote the centrality of the will within our legal system and calls for the revitalization in respect of its vast potential is not always adequately exploited. This research aims to verify whether the contract can find importance within the phenomenon of succession for the inter vivos transfer of family assets and if the same has the characteristics to be considered a working alternative to the will. In the present work will be analyzed, in addition, some of the institutions that the doctrine has considered alternatives to the will and particularly the institution of the family pact. The survey will also be directed to the limits that the private autonomy and the legislator met in the use of the contractual instrument, limits that are mostly originated by the rules and principles of the law of succession.

Identifying novel molecular mechanisms of ghrelin receptor signalling underlying neural control of food intake: interaction with stress and impulsivity

The gut-hormone, ghrelin, activates the centrally expressed growth hormone secretagogue 1a (GHS-R1a) receptor, or ghrelin receptor. The ghrelin receptor is a G-protein coupled receptor (GPCR) expressed in several brain regions, including the arcuate nucleus (Arc), lateral hypothalamus (LH), ventral tegmental area (VTA), nucleus accumbens (NAcc) and amygdala. Activation of the GHS-R1a mediates a multitude of biological activities, including release of growth hormone and food intake. The ghrelin signalling system also plays a key role in the hedonic aspects of food intake and activates the dopaminergic mesolimbic circuit involved in reward signalling. Recently, ghrelin has been shown to be involved in mediating a stress response and to mediate stress-induced food reward behaviour via its interaction with the HPA-axis at the level of the anterior pituitary. Here, we focus on the role of the GHS-R1a receptor in reward behaviour, including the motivation to eat, its anxiogenic effects, and its role in impulsive behaviour. We investigate the functional selectivity and pharmacology of GHS-R1a receptor ligands as well as crosstalk of the GHS-R1a receptor with the serotonin 2C (5-HT2C) receptor, which represent another major target in the regulation of eating behaviour, stress-sensitivity and impulse control disorders. We demonstrate, to our knowledge for the first time, the direct impact of GHS-R1a signalling on impulsive responding in a 2-choice serial reaction time task (2CSRTT) and show a role for the 5-HT2C receptor in modulating amphetamine-associated impulsive action. Finally, we investigate differential gene expression patterns in the mesocorticolimbic pathway, specifically in the NAcc and PFC, between innate low- and high-impulsive rats. Together, these findings are poised to have important implications in the development of novel treatment strategies to combat eating disorders, including obesity and binge eating disorders as well as impulse control disorders, including, substance abuse and addiction, attention deficit hyperactivity disorder (ADHD) and mood disorders.

Resource Curse or Destructive Creation: A Tale of Crony Capitalism in Transition

This paper explores the “resource curse” problem as a counter-example of creative performance and innovation by examining reliance on capital and physical resources, showing the gap between expectations and ex-post actual performance became clearer under conditions of economic turmoil. The analysis employs logistic regressions with dichotomous response and predictor variables, showing significant results.Several findings that have use for economic and business practice follow. First, in a transition period, a typical characteristic of successful firms was their reliance on either capital resources or physical asset endowments, whereas the innovation factor was not significant.Second, poor-performing enterprises exhibited evidence of over reliance on both capital and physical assets. Third, firms that relied on both types of resources tended to downplay creative performance. Fourth, reliance on capital/physical resources and adoption of “creative discipline/innovations” tend to be mutually exclusive. In fact, some evidence suggests that firms face more acute problem caused by the law of diminishing returns in troubled times. The Vietnamese corporate sector’s addiction to resources may contribute to economic deterioration, through a downward spiral of lower efficiency leading to consumption of more resources. The “innovation factor” has not been tapped as a source of economic growth. The absence of innovations and creativity has made the notion of “resource curse” become identical to “destructive creation” implemented by ex-ante resource-rich firms, and worsened the problem of resource misallocation in transition turmoil.

The effect of involuntary job loss on smoking intensity and relapse.

AIMS: To assess the impact of involuntary job loss due to plant closure or layoff on relapse to smoking and smoking intensity among older workers. DESIGN, PARTICIPANTS, SAMPLE: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years beginning in 1992. The 3052 participants who were working at the initial wave and had any history of smoking comprise the main sample. METHODS: Primary outcomes are smoking relapse at wave 2 (1994) among baseline former smokers, and smoking quantity at wave 2 among baseline current smokers. As reported at the wave 2 follow-up, 6.8% of the sample experienced an involuntary job loss between waves 1 and 2. FINDINGS: Older workers have over two times greater odds of relapse subsequent to involuntary job loss than those who did not. Further, those who were current smokers prior to displacement that did not obtain new employment were found to be smoking more cigarettes, on average, post-job loss. CONCLUSIONS: The stress of job loss, along with other significant changes associated with leaving one's job, which would tend to increase cigarette consumption, must outweigh the financial hardship which would tend to reduce consumption. This highlights job loss as an important health risk factor for older smokers.

Reduction of quantity smoked predicts future cessation among older smokers.

AIM: To examine whether smokers who reduce their quantity of cigarettes smoked between two periods are more or less likely to quit subsequently. STUDY DESIGN: Data come from the Health and Retirement Study, a nationally representative survey of older Americans aged 51-61 in 1991 followed every 2 years from 1992 to 1998. The 2064 participants smoking at baseline and the first follow-up comprise the main sample. MEASUREMENTS: Smoking cessation by 1996 is examined as the primary outcome. A secondary outcome is relapse by 1998. Spontaneous changes in smoking quantity between the first two waves make up the key predictor variables. Control variables include gender, age, education, race, marital status, alcohol use, psychiatric problems, acute or chronic health problems and smoking quantity. FINDINGS: Large (over 50%) and even moderate (25-50%) reductions in quantity smoked between 1992 and 1994 predict prospectively increased likelihood of cessation in 1996 compared to no change in quantity (OR 2.96, P<0.001 and OR 1.61, P<0.01, respectively). Additionally, those who reduced and then quit were somewhat less likely to relapse by 1998 than those who did not reduce in the 2 years prior to quitting. CONCLUSIONS: Reducing successfully the quantity of cigarettes smoked appears to have a beneficial effect on future cessation likelihood, even after controlling for initial smoking level and other variables known to impact smoking cessation. These results indicate that the harm reduction strategy of reduced smoking warrants further study.

A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.

Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.