Same wording, distinct concepts? Testing differences between expectancies and motives in a mediation model of alcohol outcomes.

Per definition, alcohol expectancies (after alcohol I expect X), and drinking motives (I drink to achieve X) are conceptually distinct constructs. Theorists have argued that motives mediate the association between expectancies and drinking outcomes. Yet, given the use of different instruments, do these constructs remain distinct when assessment items are matched? The present study tested to what extent motives mediated the link between expectancies and alcohol outcomes when identical items were used, first as expectancies and then as motives. A linear structural equation model was estimated based on a national representative sample of 5,779 alcohol-using students in Switzerland (mean age = 15.2 years). The results showed that expectancies explained up to 38% of the variance in motives. Together with motives, they explained up to 48% of the variance in alcohol outcomes (volume, 5+ drinking, and problems). In 10 of 12 outcomes, there was a significant mediated effect that was often higher than the direct expectancy effect. For coping, the expectancy effect was close to zero, indicating the strongest form of mediation. In only one case (conformity and 5+ drinking), there was a direct expectancy effect but no mediation. To conclude, the study demonstrates that motives are distinct from expectancies even when identical items are used. Motives are more proximally related to different alcohol outcomes, often mediating the effects of expectancies. Consequently, the effectiveness of interventions, particularly those aimed at coping drinkers, should be improved through a shift in focus from expectancies to drinking motives.

Blood, urine and vitreous isopropyl alcohol as biochemical markers in forensic investigations.

Isopropyl alcohol (IPA) is widely used as an industrial solvent and cleaning fluid. After ingestion or absorption, IPA is converted into acetone by alcohol dehydrogenase. However, in ketosis, acetone can be reduced to IPA. The aim of this study was to investigate blood IPA and acetone concentrations in a series of 400 medico-legal autopsies, including cases of diabetic ketoacidosis, hypothermia and alcohol misuse-related deaths, to illustrate the extent of ketosis at the time of death. Vitreous glucose, blood 3-β-hydroxybutyrate (3HB) and acetoacetate (AcAc) concentrations were also determined systematically. Additionally, vitreous and urine IPA, acetone, 3HB and AcAc concentrations as well as other biochemical markers, including glycated hemoglobin and carbohydrate-deficient transferrin (CDT) were also determined in selected cases. The results of this study indicate that ketosis is characterized by the presence of IPA resulting from the acetone metabolism and that IPA can be detected in several substrates. These findings confirm the importance of the systematic determination of IPA and acetone levels that is used to quantify biochemical disturbances and the importance of ketosis at the time of death.

Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

European Schools Survey Project on Alcohol and other drugs (ESPAD)

ESPAD is a collaborative effort of independent research teams in about forty European countries and the largest cross-national research project on adolescent substance use in the world. Data are collected every fourth year with 1995 as the starting point. The fourth data collection was carried out in 35 countries during the spring of 2007 and the results were published March 26, 2009 The overall purpose of the ESPAD project is to study adolescent substance use in Europe from a comparative and longitudinal perspective. The basic goal is to collect comparable data on the use of alcohol, tobacco and other drugs among students throughout European countries. Data should be collected in cooperation between countries using a strictly standardised methodology, in order to offer as comparable results as possible. In the long run the most important aim is to monitor the of trends of the adolescent substance use in European countries and to compare trends between countries. This includes the mapping of differences and the monitoring of trends for policy purposes as well as the scientific study of the context, predictors and consequences of adolescent substance use. In relation to the EU action plan on drugs and the WHO Europe declaration about young people and alcohol, ESPAD-data can provide information for the evaluation of these charters. It is intended to repeat the surveys every fourth year. All European countries are welcome to join the ESPAD study, in the effort of making the coverage across Europe as complete as possible. Click here to download PDF 2.1mb

Factors associated with favorable drinking outcome 12 months after hospitalization in a prospective cohort study of inpatients with unhealthy alcohol use.

BACKGROUND: Prevalence of unhealthy alcohol use among medical inpatients is high. OBJECTIVE: To characterize the course and outcomes of unhealthy alcohol use, and factors associated with these outcomes. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 287 medical inpatients with unhealthy alcohol use. MAIN MEASURES: At baseline and 12 months later, consumption and alcohol-related consequences were assessed. The outcome of interest was a favorable drinking outcome at 12 months (abstinence or drinking "moderate" amounts without consequences). The independent variables evaluated included demographics, physical/sexual abuse, drug use, depressive symptoms, alcohol dependence, commitment to change (Taking Action), spending time with heavy-drinking friends and receipt of alcohol treatment (after hospitalization). Adjusted regression models were used to evaluate factors associated with a favorable outcome. KEY RESULTS: Thirty-three percent had a favorable drinking outcome 1 year later. Not spending time with heavy-drinking friends [adjusted odds ratio (AOR) 2.14, 95% CI: 1.14-4.00] and receipt of alcohol treatment [AOR (95% CI): 2.16(1.20-3.87)] were associated with a favorable outcome. Compared to the first quartile (lowest level) of Taking Action, subjects in the second, third and highest quartiles had higher odds of a favorable outcome [AOR (95% CI): 3.65 (1.47, 9.02), 3.39 (1.38, 8.31) and 6.76 (2.74, 16.67)]. CONCLUSIONS: Although most medical inpatients with unhealthy alcohol use continue drinking at-risk amounts and/or have alcohol-related consequences, one third are abstinent or drink "moderate" amounts without consequences 1 year later. Not spending time with heavy-drinking friends, receipt of alcohol treatment and commitment to change are associated with this favorable outcome. This can inform efforts to address unhealthy alcohol use among patients who often do not seek specialty treatment.

Reliability and validity of the Alcohol Use Disorders Identification Test (AUDIT) imbedded within a general health risk screening questionnaire: results of a survey in 332 primary care patients.

BACKGROUND: Self-administered, general health risk screening questionnaires that are administered while patients wait in the doctor's office may be a reasonable and timesaving approach to address the requirements of preventive medicine in a typical 10-min medical visit. The psychometric characteristics of the Alcohol Use Disorders Identification Test (AUDIT) incorporated within a health questionnaire (H-AUDIT) have not been examined. METHODS: The reliability and validity of the self-administered AUDIT were compared between the H-AUDIT and the AUDIT used as a single scale (S-AUDIT) in 332 primary care patients. RESULTS: No major demographic or alcohol use characteristics were found between the 166 subjects who completed the H-AUDIT and the 166 individuals who completed the S-AUDIT. The test-retest reliability of the 166 subjects who completed the H-AUDIT [estimated by Spearman correlation coefficient at a 6-week interval (0.88), internal consistency (total correlation coefficients for all items ranged from 0.38 to 0.69; Cronbach alpha index 0.85), and the sensitivity and specificity of the H-AUDIT were used to identify at-risk drinkers' areas under receiver operating characteristic (0.77) and alcohol-dependent subjects' areas under receiver operating characteristic (0.89)] was similar to the same measurements obtained with the 166 individuals who completed the S-AUDIT. CONCLUSIONS: The AUDIT incorporated in a health risk screening questionnaire is a reliable and valid self-administered instrument to identify at-risk drinkers and alcohol-dependent individuals in primary care settings.

PHA urges 'freshers' to be smart and know their alcohol limits

As 'fresher's week' commences, the Public Health Agency is encouraging students across Northern Ireland to avoid binge drinking and to know their limits if they do choose to drink alcohol.Enjoying new freedoms, at college or university, means taking care of yourself and others and, if you choose to drink, staying within safe alcohol limits. Owen O'Neill, PHA Health and Social Wellbeing Improvement Manager for drugs and alcohol, said: "Some young people may drink more when they leave home, or join their friends in college or university for the first time. They might think that, as young people, they don't have to take care with alcohol, but staying within the safe drinking limits is important for everyone who drinks. Excessive and binge drinking can have lasting effects on health, such as damage to the liver, heart, brain and stomach. Drinking too much can also increase the risk of accidents and antisocial behaviour as well as sexually transmitted infections and unplanned pregnancy"."We would also strongly advise against drinking games. Although they are regarded as a 'bit of fun', in reality they can be very dangerous. As an extreme form of binge drinking, where large quantities of alcohol are consumed in a very short time, drinking games can result in alcohol poisoning, leading to brain damage, coma or death. The PHA encourages students to enjoy their new student life, but urges them to be aware of their alcohol intake and drink responsibly, especially throughout fresher's week, with the many cheap drink promotions currently available."Daily alcohol limits are recommended by the government in order to avoid the risks of excessive and binge drinking in any one session. These are:Men: No more than 3 to 4 units of alcohol a day and no more than 21 units over the course of the week.Women: No more than 2 to 3 units of alcohol a day and no more than 14 units over the course of the week.Examples of units:Can of extra strong lager - 4 unitsBottle of lager - 1.5 unitsPint of standard lager - 2.5 unitsPint of premium larger - 3 unitsSmall pub bottle of wine - 2.25 units70cl bottle of wine - 7 to 10 unitsStandard 275ml of alcopops - 1.5 to 1.8 units70cl bottle of alcopops - 3.75 to 4.5 unitsPub measure of spirits - 1.5 unitsPint of cider - 3 unitsPint of stout - 2.5 unitsIf you do choose to drink alcohol:DON'T:Ever drink and driveDrink on an empty stomachMix alcohol with other drugsDrink in rounds as this may speed up your drinkingLeave your drinks unattendedDO:Take sips rather than gulpsAlternate each alcoholic drink with a non alcoholic drink e.g. water or a soft drinkSet yourself a limit and try to stick to it (refer to daily alcohol limits) Take frequent breaks from drinking to give your body time to recoverTell friends and family where you are going and who you will be withRemember, that for each unit you drink over the daily limit, the risk to your health increases. It's important to spread the units throughout the week - you can't 'save up' your units for the weekend or your holiday. It is also important to drink plenty of water, ideally matching the amount of alcohol you have consumed.So students make smart choices this term - drink sensibly and know your limits!For further information on sensible drinking and alcohol units visit the Public Health Agency's website www.knowyourlimits.info

A Prevalence Study of Drug use by Young People in a Mixed Suburban Area

This report aims to determine the levels and patterns of drug use, including tobacco and alcohol, among young people in the Kilbarrack area. Questionnaires were sent to students from all primary and secondary schools in the target area, and were also sent to young people in the area who had already left school. The survey showed that 24% of respondents had smoked tobacco at some stage in their lives, with 25% listed as current smokers. Older students reported higher tobacco use, with over 40% of 16-18 year olds currently smoking. Alcohol was the drug most widely used by respondents, with 76% of all students having taken it at some stage in their lives. Prevalence of current alcohol use was higher in older children, with 84% of 16-18 year olds currently drinking as opposed to 61% of 13-15 year olds and 17% for 10 to 12 year olds. Cannabis was the most widely used illicit drug, with 37% of respondents using the drug at some stage. The next most widely used drug was inhalants, with 16% having used them at some stage, with 6% having used cocaine at some stage in their lives; the same proportion had used it within the last 12 months. There little or no significant evidence of heroin use. The report recommends prevention programmes that ensure that young people have other things in their lives other than alcohol/ drugs, such as a comprehensive range of properly resourced sporting and youth work in the community.This resource was contributed by The National Documentation Centre on Drug Use.

A Process Analysis of Males and Females who Attended a Community Based Addiction Treatment Service: Towards an Expanded Paradigm

A process analysis was conducted in a community - based treatment programme for alcohol abuse. The aims of the study were: to evaluate assessment instruments and measures; to measure change following treatment; to monitor gender differences; to assess the importance of early and current relationships; and to evaluate the effects of therapists. Subjects (n=145, males 83/females 62) completed a semi-structured interview schedule, Severity of Alcohol Dependency Questionnaire (SADQ), Short Alcohol Dependence Data Questionnaire (SADD); General Health Questionnaire (GHQ 12), and Alcohol Problems Questionnaire (APQ). A further three non-standardised self-rated measures were devised by the author. Included was the opportunity to obtain qualitative data. Follow up data was collected at 3, 9 and 15 months following first assessment. The SADD, APQ and consumption measures using detailed drink diaries proved the most relevant assessment measures. Following treatment, there was significant reduction in clients' dependency levels at 3 months, maintained through 9 and 15 months. Key client-rated changes were progress in reducing consumption and alcohol problems leading to a better quality of life and health. Qualitative data augmented these quantitative results. Psychological and acquired cognitive behavioural skills emerged as the main reasons for positive change and the treatment programme was found to have played a significant role in their acquisition. It appears that addressing marital problems can lead to a reduction in alcohol dependency levels. Gender analysis showed that males and females were similar in demographic characteristics, alcohol history details and dependence levels. It was concluded that the differences found did not necessitate different treatment programmes for women. Early family relationships were more problematic for females. Therapist performance varied and that variance was reflected in their clients' outcomes.This resource was contributed by The National Documentation Centre on Drug Use.

A Survey of Employees Attitudes Towards Drug Testing in the Workplace

In light of the recent publication of the safety, Health & Welfare at Work Bill 2004, which is set to target the construction industry in particular, the number of Irish employers implementing drug testing programmes in the workplace is set to increase. Little is known, however, about attitudes of Irish workers towards various aspects of drug testing. In order to address this matter, the author presents the findings of a cross-sectional survey of 148 construction trade apprentices in relation to their attitudes towards aspects of workplace drug testing. The extent to which their attitudes varied according to their levels of illegal drug use and alcohol use was also investigated. The results indicate that under some circumstances, testing is approved of. However, attitudes towards most aspects of drug testing are characterised by extreme variability. For example, nearly items were rejected by some respondents and accepted by others. It can be concluded that even if an employer designed a drug testing programme based on elements viewed more favourably, a substantial proportion of employees would still be likely to hold negative views towards some aspects of the programme. Furthermore, self-reported frequency of alcohol and drug use, particularly cannabis use, was associated to more negative reactions towards drug testing. Implications for implementing drug testing programmes in the workplace are discussed. The results of this study are intended to give employers an increased understanding of workers' attitudes towards drug testing programmes and to aid the development of effective substance-abuse prevention services.This resource was contributed by The National Documentation Centre on Drug Use.

Alcohol Action Ireland's conference - presentations.

Session One - Alcohol and Crime in Ireland, Counting the Costs• National Quantitative Research, Director of Alcohol Action Ireland, Fiona Ryan• National and International Context - Dr. Anne Hope• Economic Costs of Alcohol Related Crime - Senior Lecturer, Sean Byrne Session Two - Exploring Responses to Alcohol and Crime• Garda Juvenile Diversion Program - Superintendent, Colette Quinn• HSE South - Health Promotion Officer, Sandra Coughlan Session Three - Hidden Harm - Sexual and Domestic Violence and Alcohol• Rape Crisis Network Ireland - Cliona Saidlear• SAFE Ireland - Director, Sharon O’ Halloran• Alcohol Concern - Director, Christine Toft• Men Overcoming Violence (MOVE) - CEO, Thomas Bibby• Head of Crime Reduction Branch, Martine Mc Killop & Belfast Community Safety Partnership, Stevie LaveryThis resource was contributed by The National Documentation Centre on Drug Use.

Cannabis use in a Swiss male prison: qualitative study exploring detainees' and staffs' perspectives.

BACKGROUND: Several studies suggest a high prevalence of cannabis use before and during imprisonment, but subjective perspectives of detainees and staff towards its use in prison are lacking. This issue was explored in the framework of an observational study addressing tobacco use in three Swiss prisons in 2009 and 2010 that involved multiple strands (quantitative and qualitative components). This article presents qualitative data on cannabis use collected in one of the settings. METHODS: We used in-depth semi-structured interviews with both detainees and staff to explore their attitudes towards cannabis in one post-trial male Swiss prison. We performed specific coding and thematic analysis for cannabis with the support of ATLAS.ti, compared detainees' and staff's opinions, and considered the results with regard to drug policy in prison in general. RESULTS: 58 participants (31 male offenders, mean age 35 years, and 27 prison staff, mean age 46 years, 33% female) were interviewed. Detainees estimated the current use of cannabis use to be as high as 80%, and staff 50%. Participants showed similar opinions on effects of cannabis use that were described both at individual and institutional levels: analgesic, calming, self-help to go through the prison experience, relieve stress, facilitate sleep, prevent violence, and social pacifier. They also mentioned negative consequences of cannabis use (sleepiness, decreased perception of danger and social isolation), and dissatisfaction regarding the ongoing ambiguous situation where cannabis is forbidden but detection in the urine was not sanctioned. However, the introduction of a more restrictive regulation induced fear of violence, increased trafficking and a shift to other drug use. CONCLUSION: Although illegal, cannabis use is clearly involved in daily life in prison. A clearer and comprehensive policy addressing cannabis is needed, including appropriate measures tailored to individual users. To sustain a calm and safe environment in prison, means other than substance or medication use are required.

Guiding Effective Drug Prevention

This document seeks to explore the nature of prevention work in the world of drugs and alcohol. Furthermore, it seeks to offer practical advice and support to those engaged in prevention work, and to give direction to those embarking on new prevention initiatives.It is a guide to what effective prevention means. The document is primarily for those working with young people; however, many of the principles also apply within an adult context.

Swiss adolescents' and adults' perceptions of cannabis use: a qualitative study.

Few studies have attempted to investigate the nature of adolescents' and adults' conceptions and perceptions of cannabis use. Our objectives were to explore adolescent and adult perception of use and misuse of cannabis, and their opinions and beliefs about the current legal context and preventive strategies. We used focus group discussions with four categories of stakeholders: younger (12-15 year old) adolescents, older (16-19 year old) adolescents, parents of teenagers and professionals working with young people. In some areas (legal framework, role of the media, importance of early preventive interventions), we found consensual attitudes and beliefs across the four groups of participants. In all four groups, participants did not have any consensual vision of the risks of cannabis use or the definition of misuse. In the area of the prevention of cannabis use/misuse, while parents focused on the potential role of professionals and the media, thus minimizing their own educational and preventive role, professionals stressed the importance of parental control and education. Within the Swiss context, we conclude there exists an urgent need for information and clarification of the issues linked with cannabis use and misuse directed at parents and professionals.

High prevalence of drug-resistant tuberculosis and other mycobacteria among HIV-infected patients in Brazil: a systematic review

There is a little-noticed trend involving human immunodeficiency virus (HIV)-infected patients suspected of having tuberculosis: the triple-treatment regimen recommended in Brazil for years has been potentially ineffective in over 30% of the cases. This proportion may be attributable to drug resistance (to at least 1 drug) and/or to infection with non-tuberculous mycobacteria. This evidence was not disclosed in official statistics, but arose from a systematic review of a few regional studies in which the diagnosis was reliably confirmed by mycobacterial culture. This paper clarifies that there has long been ample evidence for the potential benefits of a four-drug regimen for co-infected patients in Brazil and it reinforces the need for determining the species and drug susceptibility in all positive cultures from HIV-positive patients.