Drug and Alcohol Review

Introduction and Aims. Alcohol is an established risk factor for liver cirrhosis. It remains unclear, however, whether this relationship follows a continuous dose–response pattern or has a threshold. Also, the influences of sex and end‐point (i.e. mortality vs. morbidity) on the association are not known. To address these questions and to provide a quantitative assessment of the association between alcohol intake and risk of liver cirrhosis, we conducted a systematic review and meta‐analysis of cohort and case–control studies. Design and Methods. Studies were identified by a literature search of Ovid MEDLINE, EMBASE, Web of Science, CINAHL, PsychINFO, ETOH and Google Scholar from January 1980 to January 2008 and by searching the references of retrieved articles. Studies were included if quantifiable information on risk and related confidence intervals with respect to at least three different levels of average alcohol intake were reported. Both categorical and continuous meta‐analytic techniques were used to model the dose–response relationship. Results. Seventeen studies met the inclusion criteria. We found some indications for threshold effects. Alcohol consumption had a significantly larger impact on mortality of liver cirrhosis compared with morbidity. Also, the same amount of average consumption was related to a higher risk of liver cirrhosis in women than in men. Discussion and Conclusions. Overall, end‐point was an important source of heterogeneity among study results. This result has important implications not only for studies in which the burden of disease attributable to alcohol consumption is estimated, but also for prevention. [Rehm J, Taylor B, Mohapatra S, Irving H, Baliunas D, Patra J, Roerecke M. Alcohol as a risk factor for liver cirrhosis: A systematic review and meta‐analysis. Drug Alcohol Rev 2010]

Stress‐ and drug‐related cues are major factors contributing to high rates of relapse in addictive disorders. Brain imaging studies have begun to identify neural correlates of stress and drug cue‐induced craving states. Findings indicate considerable overlap in neural circuits involved in processing stress and drug cues with activity in the corticostriatal limbic circuitry underlying both affective and reward processing. More recent efforts have begun to identify the relationships between neural activity during stress and drug cue exposure and drug relapse outcomes. Findings suggest medial prefrontal, anterior and posterior cingulate, striatal and posterior insula regions to be associated with relapse outcomes. Altered function in these brain regions is associated with stress‐induced and drug cue‐induced craving states and an increased susceptibility to relapse. Such alterations can serve as markers to identify relapse propensity and a more severe course of addiction. Efficacy of pharmacological and behavioral treatments that specifically target stress and cue‐induced craving and arousal responses may also be assessed via alterations in these brain correlates.

Increasingly, it seems, legal and political debates regarding the granting of new liquor licences are turning to the issue of whether the number and density of alcohol outlets makes a difference in rates of alcohol consumption and alcohol‐related harm. But what is the state of the evidence on this question? In this Harm Reduction Digest Livingston, Chikritzhs and Room review the research literature on the effects of density of alcohol sales outlets on alcohol consumption and alcohol‐related problems; suggest a new way of conceptualising the relationships; and discuss the implications for reducing alcohol‐related harm.

Introduction and Aims. Alcohol is a key component of identity exploration for many young people, yet few studies have investigated identity construction in relation to problematic drinking. Increases in youth alcohol consumption have coincided with expanding use of communications technologies, particularly social networking sites (SNS), which have altered traditional conditions of identity construction. It has been found young people often engage with alcohol in the SNS environment by portraying themselves as binge drinkers. The current study applied an innovative approach to identity construction (the photographic essay) to provide insight into the portrayal of ‘alcohol‐identity’ on Facebook.

Design and Methods. One hundred and fifty‐eight university students completed a range of alcohol measures before providing access for researchers to view their Facebook profiles to operationalise their alcohol‐identity according to autophotographic methodology.

Results. Participants utilised a variety of photographic and textual material to present alcohol as a component of their identity on Facebook, with over half having selected an alcohol‐related profile image. Alcohol‐identity predicted alcohol consumption and problematic alcohol‐related behaviours as measured by questionnaires used to reliably identify alcohol‐related problems in university students. Almost 60% reported potentially problematic alcohol use according to the Alcohol Use Disorders Identification Test.

Discussion and Conclusions. Findings suggest that portraying oneself as a drinker is considered by many young people to be a socially desirable component of identity in the SNS environment, perpetuating an online culture that normalises binge drinking. Ready‐made Facebook photo essays provide an alternate method of accessing problematic alcohol use, supplementing self‐report measures.[Ridout B, Campbell A, Ellis L. ‘Off your Face(book)’: Alcohol in online social identity construction and its relation to problem drinking in university students. Drug Alcohol Rev 2012;31:20–26]

Introduction. This paper reviews epidemiological information about methamphetamine production and use in North America. Methods. Information is drawn from a range of sources, including, but not limited to, historical accounts, peer‐reviewed papers, population surveys and large national databases. Results. Methamphetamine and amphetamine use in North America is characterised by geographic variations, with different types of the drug, different routes of administration and different types of users at various times. Unlike some other drug use patterns in North America, the nature of methamphetamine use in Canada, Mexico and the United States has been linked closely in terms of production and supply of the drug. According to their national household surveys, the annual prevalence for ‘speed’ use in Canada was 0.8% in 2004, 0.3% for ‘anfetaminas’ and 0.1% for ‘metanfetaminas’ in Mexico in 2002, and 1.4% for ‘stimulants’ in the United States in 2006. Discussion. Although the data sources in the three North American countries are not consistent in methodology, terminology or frequency of reporting, all show similar trends. The type of stimulant most used has shifted from non‐medical use of pharmaceutical amphetamine to use of powder methamphetamine and then to use of ‘ice’. The indicators show the problem is greatest in the western parts of the countries and is moving eastward, but the decreased availability of pseudoephedrine may have a significant impact on the nature of the epidemic in the future. Nevertheless, use of methamphetamine poses a number of risks for users and specialised treatment resources for these various populations are needed.

In this Harm Reduction Digest two observers and scholars of the 2001 Portuguese drug policy reform consider divergent accounts of the reform which viewed it as a ‘resounding success’ or a ‘disastrous failure’. Acknowledging from their own experience the inherent difficulties in studying drug law reform, Caitlin Hughes and Alex Stevens take the central competing claims of the protagonists and consider them against the available data. They remind us of the way all sides of the drug policy debates call upon and alternatively use or misuse ‘evidence’ to feed into discussions of the worth, efficacy and desirability of different illicit drug policies. In doing so they provide pause for thought for those of us who operate as drug policy researchers and drug policy advocates.

Simon Lenton

Co‐editor, Harm Reduction Digest

Introduction and Aims. Research in adolescents has shown that parental warmth and control are important factors in drug use. The present study focused upon investigating perceived parental warmth and control in a sample of post‐adolescent ecstasy/polydrug users, and investigating their relationship to severity of drug use. Design and Methods. A total of 128 (65 male) ecstasy/polydrug users, 51 (17 male), cannabis‐only users and 54 (13 male) non‐users were recruited from a university population. All participants completed the parenting styles and drug use questionnaires. Results. Compared to non‐users, a greater proportion of ecstasy/polydrug users characterised their parents' style as neglectful. The modal style endorsed by non‐users was authoritative. Those who rated their parents' style as authoritative had significantly lower lifetime consumption and average dose of ecstasy relative to those describing their parents as neglectful. Again, relative to those describing their parents as neglectful, participants from authoritarian backgrounds had significantly smaller lifetime consumption of ecstasy and cocaine and significantly smaller average doses of cannabis, ecstasy and cocaine. Contrary to expectation, there was no significant association between perceived parental warmth and the severity of ecstasy use. Discussion and Conclusions. The present study is, to our knowledge, the first to quantify drug use, and relate it to perceived parental practices in a post‐adolescent sample of ecstasy/polydrug users. The results provide further support for the relationship between perceived parental control and drug use.

Introduction and Aims. In the past decade, methamphetamine has become increasingly a drug of concern globally. The purpose of this study is to describe the changing trends in treatment admissions for methamphetamine abuse in Cape Town, South Africa and to highlight the implications of these changes for policy, practice and research. Design and Methods. Data were collected on admissions for drug abuse treatment through a regular monitoring system involving drug treatment centres and programmes in Cape Town every 6 months as part of the South African Community Epidemiology Network on Drug Use (SACENDU). A one‐page form was completed by treatment centre personnel to obtain demographic data, the patients' primary and secondary substances of abuse, the mode, frequency and age of first use of substance and information on prior treatment. Results. The results indicate that between 2004 and 2006 a dramatic increase in treatment admissions for methamphetamine abuse occurred, a large proportion of the methamphetamine patients are adolescents and that the drug is almost exclusively smoked. Discussion and Conclusions. The rapid increase in admissions for methamphetamine abuse is of great concern, particularly as the drug has a number of serious, often chronic, side effects and that a large proportion of the patients are adolescents. The implications for public health are discussed.

In this Harm Reduction Digest Paul Dietze and John Fitzgerald provide another possible way of understanding what has come to be referred to as Australia's heroin ‘drought’. They examine evidence from Melbourne, Victoria and suggest that the apparent downturn in heroin availability in 2000 may, in part, be the result of an end of a heroin ‘glut’ and that perceptions of this phenomenon may be coloured by the development of more sophisticated indicators of the heroin market. They conclude with claims that the reasons for the reduction in drug consumption and adverse health outcomes, such as those attributed to interdiction, are thus premature