Addiction

The Alcohol Use Disorders Identification Test (A UDIT) has been developed from a six‐country WHO collaborative project as a screening instrument for hazardous and harmful alcohol consumption. It is a 10‐item questionnaire which covers the domains of alcohol consumption, drinking behaviour, and alcohol‐related problems. Questions were selected from a 150‐item assessment schedule (which was administered to 1888 persons attending representative primary health care facilities) on the basis of their representativeness for these conceptual domains and their perceived usefulness for intervention. Responses to each question are scored from 0 to 4, giving a maximum possible score of 40. Among those diagnosed as having hazardous or harmful alcohol use, 92% had an AUDIT score of 8 or more, and 94% of those with non‐hazardous consumption had a score of less than 8. AUDIT provides a simple method of early detection of hazardous and harmful alcohol use in primary health care settings and is the first instrument of its type to be derived on the basis of a cross‐national study.

Aims. The cue‐reactivity procedure exposes addicts to a variety of drug‐related stimuli while self‐report of craving and physiological responses are monitored. The present review sought to determine the magnitude and overall pattern of responses typically found in cue‐reactivity research and which, if any, learning‐based model of cue reactivity is best supported by the findings. Design. Meta‐analytical techniques were used to select and evaluate results from 41 cue‐reactivity studies that compared responses of alcoholics, cigarette smokers, cocaine addicts or heroin addicts to drug‐related versus neutral stimuli. Effect sizes were calculated, separately by addict type, for self‐report of craving and physiological responses (heart rate, sweat gland activity and skin temperature). Findings. Across all addict groups, the effect size for craving was +0.92. Alcoholics had a significantly smaller craving effect size (+0.53) compared to other addict groups (+1.18 to +1.29). Relatively smaller effect sizes were found for physiological responses. The general profile of effect sizes across all addict groups was increased heart rate (+0.26) and sweat gland activity (+0.40) and decreased skin temperature (‐0.24) when addicts were presented with drug‐related stimuli. Conclusions. The cuereactivity paradigm can produce a stable profile of significant effects and, therefore, has a number of potential applications for investigating addictive phenomena. The implications of these findings for conditioning‐based models of cue‐reactivity phenomena are discussed.

Relatively brief interventions have consistently been found to be effective in reducing alcohol consumption or achieving treatment referral of problem drinkers. To date, the literature includes at least a dozen randomized trials of brief referral or retention procedures, and 32 controlled studies of brief interventions targeting drinking behavior, enrolling over 6000 problem drinkers in both health care and treatment settings across 14 nations. These studies indicate that brief interventions are more effective than no counseling, and often as effective as more extensive treatment. The outcome literature is reviewed, and common motivational elements of effective brief interventions are described. There is encouraging evidence that the course of harmful alcohol use can be effectively altered by well‐designed intervention strategies which are feasible within relatively brief‐contact contexts such as primary health care settings and employee assistance programs. Implications for future research and practice are considered.

The question of addiction concerns the process by which drug‐taking behavior, in certain individuals, evolves into compulsive patterns of drug‐seeking and drug‐taking behavior that take place at the expense of most other activities, and the inability to cease drug‐taking, that is, the problem of relapse. In this paper we summarize one view of this process, the "incentive‐sensitization" view, which we first proposed in 1993. Four major tenets of the incentive‐sensitization view are discussed. These are: (1) potentially addictive drugs share the ability to alter brain organization; (2) the brain systems that are altered include those normally involved in the process of incentive motivation and reward; (3) the critical neuroadaptations for addiction render these brain reward systems hypersensitive ("sensitized") to drugs and drug‐associated stimuli; and (4) the brain systems that are sensitized do not mediate the pleasurable or euphoric effects of drugs (drug "liking"), but instead they mediate a subcomponent of reward we have termed incentive salience (drug "wanting").

Smoking cessation treatment is now integrated into many health‐care systems and a major research effort is under way to improve current success rates. Until now results from randomized clinical trials have been reported in many different ways, leading to problems of interpretation. We propose six standard criteria comprising the ‘Russell Standard’ (RS). These criteria are applicable to trials of cessation aids where participants have a defined target quit date and there is face‐to‐face contact with researchers or clinic staff, as follows. (1) Follow‐up for 6 months (RS6) or 12 months (RS12) from the target quit date or the end of a predefined ‘grace period’; (2) self‐report of smoking abstinence over the whole follow‐up period allowing up to five cigarettes in total; (3) biochemical verification of abstinence at least at the 6‐month or 12‐month follow‐up point; (4) use of an ‘intention‐to‐treat’ approach in which data from all randomized smokers are included in the analysis unless they have died or moved to an untraceable address (participants who are included in the analysis are counted as smokers if their smoking status at the final follow‐up cannot be determined); (5) following‐up ‘protocol violators’ and using their true smoking status in the analysis; and (6) collecting follow‐up data blind to smokers’ allocation to trial group. We believe that these criteria provide the best compromise between practicability and surrogacy for long‐term cessation and will enable meaningful comparison between studies. There may be good reasons why other outcome criteria would also be reported, and studies that involve interventions with special groups or where there is no designated target quit date or face to face contact would need to adapt these criteria accordingly.

Aims  To review three topics pertaining to the validity of alcohol self‐reports: factors that influence response accuracy; the relative merits of different self‐report approaches; and the utility of using alternative measures to confirm verbal reports.

Findings  Response behavior is influenced by the interaction of social context factors, respondent characteristics, and task attributes. Although research has advanced our knowledge about self‐report methods, many questions remain unanswered. In particular, there is a need to investigate how task demands interact with different patterns of drinking behavior to affect response accuracy. There is also a continuing need to use multiple data sources to examine the extent of self‐report response bias, and to determine whether it varies as a function of respondent characteristics or assessment timing.

Conclusion  Self‐report methods offer a reliable and valid approach to measuring alcohol consumption. The accuracy of such methods, however, can be improved by research directed at understanding the processes involved in response behavior.

Aims  As part of a larger study to estimate the global burden of disease attributable to alcohol:

to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and

Design, methods, setting  Systematic literature reviews were used to select diseases related to alcohol consumption. Meta‐analyses of the relationship between alcohol consumption and disease and multi‐level analyses of aggregate data to fill alcohol–disease relationships not currently covered by individual‐level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi‐level analyses with prevalence data.

Findings  Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed.

Conclusions  Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.


 Aims. To examine the effectiveness of brief behavioral interventions adapting the principles and techniques of Motivational Interviewing (MI) to four behavioral domains: substance abuse, smoking, HIV risk and diet/exercise. 
Design. We conducted a systematic review of 29 randomized trials of MI interventions. Data on methodological quality were extracted and tabulated. Between‐group behavior change effect sizes and confidence intervals were calculated for each study. 
Findings. Due to varying intervention time lengths, targeted problem behaviors, settings and interventionists' backgrounds and skill levels, outcomes were not combined meta‐analytically. Sixty per cent of the 29 studies yielded at least one significant behavior change effect size. No significant association between length of follow‐up time and magnitude of effect sizes was found across studies. There was substantial evidence that MI is an effective substance abuse intervention method when used by clinicians who are non‐specialists in substance abuse treatment, particularly when enhancing entry to and engagement in more intensive substance abuse treatment treatment‐as‐usual. Data were inadequate to judge the effect of MI in the other domains. Client attribute‐treatment interactions were understudied and the sparse and inconsistent findings revealed little about the mechanism by which MI works or for whom it works best. 
Conclusion. To determine more effectively how well MI works in domains other than substance abuse and for whom it works best in all domains, researchers should study MI with risk behaviors other than substance abuse, while examining both interactions and the theoretical components of MI.

Aims Several decades of research have shown that lesbian, gay and bisexual (LGB) adults are at high risk for substance use and substance use disorders (SUDs). These problems may often start prior to young adulthood; however, relatively little is known about risk for substance use in LGB adolescents. The primary aims of this paper were to conduct a meta‐analysis of the relationship between sexual orientation and adolescent substance use and a systematic review and critique of the methodological characteristics of this literature.

Methods Medical and social science journals were searched using Medline and PsychInfo. Studies were included if they tested the relationship between sexual orientation and adolescent substance use. Eighteen published studies were identified. Data analysis procedures followed expert guidelines, and used National Institutes of Health (NIH)‐sponsored meta‐analysis software.

Results LGB adolescents reported higher rates of substance use compared to heterosexual youth (overall odds ratio = 2.89, Cohen's d = 0.59). Effect sizes varied by gender, bisexuality status, sexual orientation definition and recruitment source. None of the studies tested mediation and only one tested moderation. One employed a matched comparison group design, one used a longitudinal design, and very few controlled for possible confounding variables.

Conclusions The odds of substance use for LGB youth were, on average, 190% higher than for heterosexual youth and substantially higher within some subpopulations of LGB youth (340% higher for bisexual youth, 400% higher for females). Causal mechanisms, protective factors and alternative explanations for this effect, as well as long‐term substance use outcomes in LGB youth, remain largely unknown.