The reliability and validity of interview data obtained from 59 narcotic drug addicts.

The responsiveness of motor vehicle death rates of youths aged fifteen through twenty-four to variations in the cost of beers as reflected by differences in State excise tax rates on beer is investigated. Evidence for this age group is provided on the extent to which declining real beer excise taxes have contributed to increases in fatal motor vehicle crashes and on the extent to which increases in real beer taxes can serve as a potent instrument in the antidrinking campaign. The effect of an increase in the legal drinking age on youth motor vehicle deaths is also examined.

The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment. Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined. High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained. The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.

Using geographic information systems to assess spatial patterns of drug use, selection bias and attrition among a sample of injection drug users

This study identified patterns of drug use and HIV risk behaviors in relation to cultural factors among Asian drug users in San Francisco. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants based on content analyses. Compared with Chinese and Vietnamese, Filipino drug users had engaged in riskier behaviors in terms of injection drug use, having sex while on drugs, and having sex with injection drug users (IDUs). Cultural factors such as stigma of injection drug use and fear of needles were cited as reasons for not injecting drugs. Among IDUs, half cited trust as a reason for having shared needles. AIDS prevention programs targeting Asian drug users should consider specific cultural factors among high-risk groups (i.e., Filipinos, immigrants, women, and IDUs).

Prison's second death row

A total of 2500 individuals, aged 14-70 years and living in Castille and Leon (Spain), were surveyed in the spring of 1989 with regard to their drug consumption and patterns of use. 'Lifetime' drug users' rates were 30.0% for cannabis, 5.4% for cocaine, 5.2% for amphetamines, 2.4% for psychedelic drugs, 1.5% for opiates, 1.1% for tranquillizers, and 0.4% for inhalants. 'Regular' drug users were more common among cannabis--2.8% of the surveyed--and less frequent among cocaine, opiates and amphetamine users--0.3% of everyone of the substances mentioned above. 'Lifetime' drug users were more common among males than among females, among singles than among married, in those younger (18-29 years of age) and with work problems. The starting age of drug consumption ranged between the average of 15.6 years of age for those who consumed inhalants and 19.5 for those who consumed cocaine. The results allow a better understanding of the pattern of drug use in Castille and Leon (Spain), as well as the 'high' prevalence of drug use in our region.

Alcohol and other drug (AOD) use is increasingly recognised as having a direct and indirect effect on the transmission of human immunodeficiency virus (HIV). However, there is evidence to suggest that drug- and sex-related HIV risk-reduction interventions targeted at drug users within drug treatment centres or via community outreach efforts can lead to positive health outcomes. This study aimed to test whether a community-level intervention aimed at AOD users has an impact on risky AOD use and sexual risk behaviour. In 2007, in collaboration with a local non-governmental organisation (NGO) in Durban, an initiative was begun to implement a number of harm reduction strategies for injection and non-injection drug users. The NGO recruited peer outreach workers who received intensive initial training, which was followed by six-monthly monitoring and evaluation of their performance. Participants had to be 16 years of age or older, and self-reported alcohol and/or drug users. Peer outreach workers completed a face-to-face baseline questionnaire with participants which recorded risk behaviours and a risk-reduction plan was developed with participants which consisted of reducing injection (if applicable) and non-injection drug use and sex-related risks. Other components of the intervention included distribution of condoms, risk-reduction counselling, expanded access to HIV Testing Services, HIV/sexually transmitted infection care and treatment, and referrals to substance abuse treatment and social services. At follow-up, the baseline questionnaire was completed again and participants were also asked the frequency of reducing identified risk behaviours. Baseline information was collected from 138 drug users recruited into the study through community-based outreach, and who were subsequently followed up between 2010 and 2012. No injection drug users were reached. The data presented here are for first contact (baseline) and the final follow-up contact with the participants. There were no decreases in drug use practices such as use of cannabis, heroin, cocaine and Ecstasy after the intervention with drug users; however, there was a significant reduction in alcohol use following the intervention. While there was a substantial increase in the proportion of participants using drugs daily as opposed to more often, the reduction in the frequency of drug use was not statistically significant. Following the intervention, drug users had significantly fewer sexual partners, but there were no significant differences following the intervention with regard to frequency of sex or use of condoms. Substance use in general and during sex was, however, decreased. While the findings were mixed, the study shows that it is possible to provide HIV risk-reduction services to a population of substance users who are less likely to receive services through community outreach, and provide risk-reduction information, condoms and condom demonstration and other services. More intensive interventions might be needed to have a substantial impact on substance use and substance use-related HIV risk behaviours.

Alcohol, still the forgotten drug

We examine the impact of three sets of government regulations on the demand for cigarettes by teenagers in the United States. These are: (1) the excise tax on cigarettes, (2) the Fairness Doctrine of the Federal Communications Commission, which resulted in the airing of anti-smoking messages on radio and television from July 1, 1967 to January 1, 1971,and (3) the Public Health Cigarette Smoking Act of 1970, which banned pro-smoking cigarette advertising on radio and television after January 1, 1971.Teenage price elasticities of demand for cigarettes are substantial and much larger than the corresponding adult price elasticities. The teenage smoking participation elasticity equals -1.2, and the quantity smoked elasticity equals -1.4. It follows that, if future reductions in youth smoking are desired, an increase in the Federal excise tax is a potent policy to accomplish this goal. The contention of the proponents of the advertising ban that the Fairness Doctrine failed in the case of teenagers is incorrect. According to our results, the doctrine had a substantial negative impact on teenage smoking participation rates. Extrapolations suggest that the advertising ban was no better or worse a policy than the Fairness Doctrine.

Data are presented on the patterns of drug use and HIV risk-taking of daily amphetamine and opioid injectors among 1245 injecting drug users who were interviewed in Sydney in 1989. About one-third of the sample had injected amphetamines during a typical month of injecting, and 12% were using amphetamines on a daily basis. Daily amphetamine injectors were younger, less well educated, and less likely to have engaged in drug treatment, but they were no more likely than daily opioid users to have shared injection equipment or to have engaged in other behaviour likely to transmit HIV. Although there seemed to be no special cause for concern about HIV risk-taking among amphetamine injectors, there was nonetheless a high prevalence of sharing injecting equipment, with over half of daily amphetamine and heroin injectors having shared in the past several months. In addition, approximately a third of amphetamine injectors were injecting on a daily basis, a pattern of use which increases the risk of developing a severe dependence syndrome, and of experiencing an amphetamine-induced psychosis.

We conducted this study among HIV-infected injection drug users to determine the effect of self-reported alcohol use and prior incarceration at the time of initiating antiretroviral therapy on subsequent HIV-1 RNA suppression. We examined the demographics, recent incarceration history, and drug and alcohol use history from the Vancouver Injection Drug User Study (VIDUS) questionnaire closest to the date of initiating antiretroviral therapy. We linked these data to the HIV/AIDS Drug Treatment Program. There were 234 VIDUS participants who accessed antiretroviral therapy through the Drug Treatment Program from August 1, 1996, to July 31, 2001. In terms of illicit drug use, 196 (84%) reported injecting heroin and cocaine at the time of initiating antiretroviral therapy. Multiple logistic regression revealed that in the 6 months prior to initiating antiretroviral therapy, alcohol use (adjusted odds ratio [AOR] 0.32; 95% CI 0.13-0.81) and incarceration (AOR 0.22; 95% CI 0.09-0.58) were independently associated with lower odds of HIV-1 RNA suppression. Factors positively associated with HIV-1 RNA suppression included: adherence (AOR 1.27; 95% CI 1.06-1.51); lower baseline HIV-1 RNA (AOR 1.30; 95% CI 1.01-1.66); highly active antiretroviral therapy (AOR 4.10; 95% CI 1.56-10.6); months on therapy (AOR 1.1; 95% CI 1.06-1.14). Among HIV-infected injection drug users who were on antiretroviral therapy, any alcohol use and incarceration in the 6 months prior to initiating antiretroviral therapy were negatively associated with achieving HIV-1 RNA suppression. In addition to addiction treatment for active heroin and cocaine use, the identification and treatment of alcohol problems should be supported in this setting. As well, increased outreach to HIV-infected drug users recently released from prison to ensure continuity of care needs to be further developed.

Correction: Due to an error in the online publication of this journal, the publication date of this issue was recorded as 2014. The publication date was corrected to 2015 on 3 rd September 2015. The date on the cover is correct. Background: Although some data existed suggesting that there was high prevalence of drug use among the general population in Kenya with 39-48% of 15-65 year olds having used alcohol and at least one other substance, there was a general absence of comprehensive data on the extent of drug use among Persons With Disability (PWD). The current study therefore sought to fill the gap by establishing the extent and patterns of drug use among PWD. Methods: This was a cross-sectional descriptive study targeting PWD based in learning institutions as well as within the community in three selected regions of Kenya (Nairobi, Coast and Central). A combination of stratified and purposive sampling was used to identify a sample of 486 PWD. Data was collected using a structured questionnaire and quantitatively analysed using descriptive statistics, namely, frequencies and percentages to show the extent and patterns of drug use among PWD. Results: The findings revealed that 35% of the respondents had used some form of drug, with a majority having done so between the ages 15-19 (43.3%). Further, 13.6% had used at least one substance in the past year, 7.4% in the past month and 3.9% had used drugs daily. The type of drug used were alcoholic beverages (28.2%), tobacco products (19.6%), khat (miraa/muguka) (14.8%) and marijuana (9.2%). Conclusion: The findings proved that compared to the general population, the prevalence of drug use among PWD is higher for most of the drugs. The findings point to an urgent need for policies to guide Alcohol and Drug Abuse (ADA) prevention and treatment programmes targeting PWD. International Journal of Prevention and Treatment of Substance Use Disorders 2015;1(3-4):5-17

The paper by Caulkins et al. 1 is a thorough description of an exercise using a heterogeneous set of data, developed when estimating the consumption of, and expenditure on, illegal drugs in the United States for the US Office of National Drug Control Policy 2, bringing interesting data on the drug use trends in the country. The authors start their paper with the statement that, apart from the ‘prevalence of drug use (sic), three other numbers are at least as relevant: the number of heavy users, total expenditures, and total amount consumed’. Such a somehow axiomatic assertion needs careful examination. Unfortunately, the expression ‘prevalence of drug use’ means nothing at all. There is a prevalence of many ‘specific patterns (i.e. frequencies and ways) of drug use’, from ‘life-time prevalence’ to ‘prevalence of recent drug use’ and ‘problem prevalence of drug use’. The prevalence of four patterns of drug use is estimated by the authors (‘non-chronic drug use’ and ‘chronic drug use’11 This is a misleading term, as the authors note that ‘chronic (…) has nothing to do with duration of use’; ‘frequent’, then, would probably be more appropriate. broken down into three subcategories according to the number of days of use per month). General population surveys such as the National Survey on Drug Use and Health (NSDUH) 3 can be used for population estimates of high-prevalence phenomena, such as (different types of) marijuana use; for estimates of low-prevalence phenomena (such as the use of other illegal drugs) other methods must be implemented. The authors have chosen to rely heavily on the results of the (US) Arrestee Drug Abuse Monitoring (ADAM) 4 programme, which they use as a source for (basically correlation-based) projections leading to the ‘adjustment’ of the NSDUH results for the prevalence of marginalized patterns of drug use by some 25%. Similarly, the ADAM data are generalized or projected on to the calculations of the expenditures on drugs, and then on to estimates of the total consumption of illegal drugs in the United States. There are several other ways to reach sound estimates of the prevalence of marginalized populations 5, as well as other methods to estimate the total consumption of illegal drugs 6 and probably also of the expenditures on them. However, for me, the main concern raised by the paper is: ‘What is the real meaning of those “numbers” and what is its use in decision making?’. The prevalence of different patterns of drug use is certainly an important source of information: they are the main indicators of people at risk of harm from using each of the drugs, and the people suffering from them. In a regime that prohibits drug use, it also provides an idea about the (non-)effectiveness of law enforcement that is expected to prosecute all drug users under the law. For public health considerations, it would be important to know not only the frequency, but also the route, injecting or otherwise, in combination with other substances or not, etc. However, as the authors use the prevalence indicators rather as a ‘by-product’ of their model of expenditures, they did not need this information. An idea about the amount of drugs consumed probably has a meaning for assessments of the ‘efficacy of law enforcement’ in the country and abroad, but contrary to what the authors assert, the knowledge of this number has little or no meaning for public health planning. What is most problematic is the number on expenditures. At its best, the number should tell us how much ‘drug’ money is available for the use of criminals and to fund terrorism 7. However, there is no justification for the attribution of these resources for crime and terror directly to the drug consumption phenomenon; much more directly, it is ‘prohibition money’. The alcohol revenues that fuelled the criminal explosion in the United States of the 1920–30s were lost to the criminals after 1933, when the ‘noble experiment’ of US alcohol prohibition was repealed, and much of the (violent) criminality was subsequently quickly gone—without the alcohol gone 8. Additionally, it is not clear how much of the (guesstimated) $US100 billion actually remains for the evil groups to use, as expenditures on corruption and the very act of money-laundering represent expensive efforts—but we do not know how expensive 9. Thus, the ‘expenditures number’ suffers not only from considerable uncertainty, as admitted by the authors; it has minuscule information value for security policy (except its use for fundraising for law enforcement where any number large enough would serve the purpose) and no value for drug policy. The authors state rightly that ‘good drug policy needs a foundation in good data’; but they limit themselves to a set of four indicators of sometimes dubious quality and unclear use, and ignore the bulk of the literature focusing on the tools and methods for monitoring and interpreting the complex drug situations that were developed mainly by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA 10, 11) and adopted by the relevant UN body 5, 12. I appreciate some of the novel approaches used in the estimation exercises and the improved insight into the economics of the US drug market. As an epidemiologist, I should probably have raised more questions on the methodology of some of the estimates achieved. However, the format of commentary does not permit a detailed methodological review. I also leave unanswered the main and certainly very interesting question the authors offer to debate: ‘How and why did the US cocaine market contract and the marijuana one expand?’, and the consequences this development has for different aspects of the drug situation in their country. It is because I believe that it is more important to understand more clearly that the primary goal of drug policies should be the protection of public health and that the secondary and related goal is protection of public security. The work of drug scholars should concentrate on its utility for proper decision-making that would be subordinated to those priorities. An abundance of misleading data is worse than its complete absence; one of the important responsibilities of a drug scientist is to explain to decision-makers which indicators are relevant for such efforts—and which are not. The Lisbon Consensus 12 provides good guidance in this. Its key indicators are being implemented increasingly not only by the UN bodies, but also by all European Union Member States and (at least) 30 other countries in eastern and southeastern Europe, Central Asia, Latin America, the Middle East, North Africa and elsewhere. Its gradual adoption would certainly also be of help to the United States, as it clearly needs to improve the understanding of its national drug problem by continuous monitoring of the drug situation. Until such a system is implemented at the federal level, monitoring/surveillance remains probably the only part of addictology (also known as drug abuse science) where the United States has failed to take the global lead. None. The work on this commentary was supported by an institutional grant from Programme No. PRVOUK-PO3/LF1/9.

AimThis study aimed to examine drug use, drug treatment history and risk behaviour among a sample of Iranian drug users seeking treatment through a general practice clinic in Iran.MethodsReview of medical records and an intake questionnaire at a large general practice in Marvdasht, Iran, with a special interest in drug dependence treatment. Records from a random sample of injecting drug users (IDU), non-injecting drug users (DU) and non-drug using patients were examined.Results292 records were reviewed (34% IDU, 31% DU and 35% non-drug users). Eighty-three percent were males; all females were non-drug users. The mean age of the sample was 30 years. Of the IDU sample, 67% reported sharing a needle or syringe, 19% of these had done so in prison. Of those who had ever used drugs, being 'tired' of drug use was the most common reason for seeking help (34%). Mean age of first drug use was 20 years. The first drugs most commonly used were opium (72%), heroin (13%) and hashish/ other cannabinoids (13%). Three quarters reported having previously attempted to cease their drug use. IDU were more likely than DU to report having ever been imprisoned (41% vs 7%) and 41% to have used drugs in prison.ConclusionThis study has shown that there is a need for general practice clinics in Iran to treat drug users including those who inject and that a substantial proportion of those who inject have shared needles and syringes, placing them at risk of BBVI such as HIV and hepatitis C. The expansion of services for drug users in Iran such as needle and syringe programs and pharmacotherapies are likely to be effective in reducing the harms associated with opium use and heroin injection.

Patients with concomitant psychiatric and substance use disorders are commonly assigned representative payees or case managers to help manage their funds, but money management has not been conceptualized as a theory-based treatment. This randomized clinical trial was conducted to determine the effect of a money management-based therapy, advisor-teller money manager (ATM), on substance abuse or dependence. Ninety patients at a community mental health center who had a history of cocaine or alcohol abuse or dependence were assessed after random assignment to 36 weeks of ATM (N=47) or a control condition in which use of a financial workbook was reviewed (N=43). Patients assigned to ATM were encouraged to deposit their funds into a third-party account, plan weekly expenditures, and negotiate monthly budgets. Substance use calendars and urine toxicology tests were collected every other week for 36 weeks and again 52 weeks after randomization. Patients assigned to ATM had significantly more negative toxicologies for cocaine metabolite over time than patients in the control group, and treating clinicians rated ATM patients as significantly more likely to be abstinent from illicit drugs. Self-reported abstinence from alcohol did not significantly differ between groups. Unexpectedly, patients assigned to ATM were more likely to be assigned a representative payee or a conservator than control participants during the follow-up period (ten of 47 versus two of 43). One patient in ATM assaulted the therapist when his check had not arrived. ATM is an efficacious therapy for the treatment of cocaine abuse or dependence among people with concomitant psychiatric illness but requires protection of patient autonomy and staff safety.