Determinants Of Drug Use Research Articles

Наркотики в армии: постановка вопроса и попытка переосмысления данной проблемы в мировом масштабе. Часть I

The purpose of the study is to study the determinants (social, moral, behavioral, psychophysiological, purely pathological, etc.) that can motivate military personnel to consume illegal psychoactive substances. An additional goal is the desire to give an objective assessment of the attempts of Western politicians to create a “universal soldier”, and in fact, a kamikaze of the 21st century (“suicide bomber-drug addict”). Research methods: the theoretical and methodological basis of the work is a set of philosophical, criminological, socio-psychological, medical-biological and political science approaches through which the problem of drug addiction in the military environment is studied. The criminological concept of causality and the interdisciplinary approach to the study of drug crime were most widely used in the process of writing this article. Conclusions: despite the fact that military personnel are an organic part of society, drug addiction in the army should be considered as a rather specific social phenomenon. Drug consumption in the military environment (at the micro level) shows an upward trend only in cases where the psychological and pedagogical support of personnel is not carried out professionally enough, and the discipline and microclimate in the team “leave much to be desired.” In general (already at the macro level), the determination of drug use by military personnel is determined by the influence of social, socio-economic, political, cultural (subcultural), psychological (including ethnopsychological) and medical and biological factors. The problems of drug addiction among personnel are more relevant for NATO countries than for Russia (which over many centuries has developed its own, unique approach to educating defenders of the Fatherland). The experiments of Western specialists on “mind control” of military personnel using all kinds of drugs (stimulants) and neurochips deserve close attention. Such activities (directed to harm people) should be recognized as inhumane and illegal. Scientific and practical significance of the study: The scientific novelty and theoretical significance of the research results lies in the fact that it provides a clinical and psychological interpretation of the aggressive and violent behavior of military personnel who abuse psychotropic substances and narcotic drugs (using the example of personnel of the armies of foreign states). The practical significance of this article lies in the fact that the conclusions and recommendations formulated in it can contribute to the development of measures to optimize educational and psychological-pedagogical work with military personnel of the Russian army, for the early identification of persons both distributing prohibited psychoactive substances among colleagues and regularly using them.

Social Media Insecurity and Intimate Partner Violence: Drug Use As an Escape Route

ABSTRACT The study examined social media insecurity and intimate partner violence as determinants of drug use. This prospective cohort study purposively recruited 387 married population with 54 of them re-enrolled in intervention therapy. Multilinear regressions and paired sample t-test were employed. Social media insecurity was an independent predictor of drug use; the higher the level of social media insecurity, the more participants used drugs whereas intimate partner violence did not predict drug use. The paired t-test showed a significant reduction in drug use after the eclectic therapy, which involved integrative coping skills, drug counseling/education and family therapy, aimed at reducing harms.

Inefficacious drugs against covid-19: analysis of sales, tweets, and search engines.

Assess the correlation between the sales of two drugs with no proven efficacy against covid-19, ivermectin and chloroquine, and other relevant variables, such as Google® searches, number of tweets related to these drugs, number of cases and deaths resulting from covid-19. The methodology adopted in this study has four stages: data collection, data processing, exploratory data analysis, and correlation analysis. Spearman's method was used to obtain cross-correlations between each pair of variables. The results show similar behaviors between variables. Peaks occurred in the same or near periods. The exploratory data analysis showed shortage of chloroquine in the period corresponding to the beginning of advertising for the application of these drugs against covid-19. Both drugs showed a high and statistically significant correlation with the other variables. Also, some of them showed a higher correlation with drug sales when we employed a one-month lag. In the case of chloroquine, this was observed for the number of deaths. In the case of ivermectin, this was observed for the number of tweets, cases, and deaths. The results contribute to decision making in crisis management by governments, industries, and stores. In times of crisis, as observed during the covid-19 pandemic, some variables can help sales forecasting, especially Google® and tweets, which provide a real-time analysis of the situation. Monitoring social media platforms and search engines would allow the determination of drug use by the population and better prediction of potential peaks in the demand for these drugs.

Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database.

Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom. Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment. A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication. This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.

Drug use Among Undergraduates in Maiduguri, Northeast Nigeria

Background: Drug use among students is a public health problem and the academic consequences cannot be overemphasized. Objectives: This study aimed to determine the prevalence and the pattern of drug use among undergraduates in Maiduguri and to identify the predictors. Methods: This cross-sectional study was conducted among students of tertiary institutions in Maiduguri Metropolis, Nigeria. Data were collected using the WHO Student Drug Use questionnaire. The data collected with the survey instrument included sex, age, studentship, and job status in the past 12-months and various drugs used. Descriptive statistics such as frequency, mean and standard deviation were initially used to describe the study data. Chi-Square and Fisher’s exact tests were used to test for significant difference, while multivariate logistic regression was used to identify determinants of drug use with a P-value < 0.05 taken as significant Results: The overall prevalence of the past 12-months drug use was 14.3%. Tobacco (9.6%) followed by alcohol (8.1%) was the most frequently used drug. Being a university student (odds ratio = 1.88 [1.23 - 2.89]) compared to polytechnic student, being a male (1.55 [1.04 - 2.31]) compared to female, aged 26 - 35 years (1.48 [0.95 - 2.31]) compared to 18 - 25 years were significantly more likely to use drugs. Additionally, being a part-time student in the past 12-months (2.16 [1.11 - 4.21]) compared to no studentship status in the past 12 months, and having a paid part-time jobs in the past 12-months (2.11 [1.36 - 3.27]) compared to none were significantly more likely to use drugs. Conclusions: Our study revealed that a considerable proportion of students of higher education institutions in Nigeria use drugs. Drug use has grave implications for these students and may result in mental health disorders and poor academic performance. This highlights the importance of an effective drug prevention policy in higher education institutions.

A quantitative analysis of socioeconomics of illicit drug use for improving targeted interventions in Hong Kong

Illicit drug use is a critical and challenging issue globally, but there is a lack of thorough understanding of the underlying mechanisms of drug use, which is essential for policy interventions, in many threatened places. This study aims to explore the socioeconomic determinants of drug use to support policy design in Hong Kong and other regions with similar issues. Multiple linear regression models and fixed-effects models are employed to examine the socioeconomic determinants of drug use based on the most comprehensive data on drug use and population in Hong Kong from 1991 to 2016. The estimates show that demographic and socioeconomic characteristics are important predictors of illicit drug use. The highest rate of drug use is observed for people aged between 20 and 30, as well as for those with primary education. Compared with males, the female drug use rate is 15 (or 46) per 10,000 people lower for the newly (or previously) addicted cases. A 10% increase in monthly income is associated with a 14% drop in drug use rate at the district level. The average annual expenditure on drug use is USD 32.6 million in Hong Kong. Drug policies shall pay more attention to these at-risk groups, and shall consider more financial support to lower the drug use rates.

Determinants of Women\u2019s Drug Use During Pregnancy: Perspectives from a Qualitative Study

IntroductionDrug use during pregnancy can have negative effects on maternal and child health. However, there is a dearth of data regarding drug use among pregnant women in Kenya, where illicit drug use is on the rise. In this paper, we report factors influencing women’s decisions to use drugs during pregnancy.MethodsIn 2015, we conducted in-depth interviews and focus group discussions with 45 women who inject drugs and five key stakeholders involved in provision of services to people who use drugs in coastal Kenya. Inductive thematic analysis was conducted to draw out themes related to key determinants of drug use during pregnancy.ResultsFour key themes emerged outlining determinants of drug use during pregnancy: (i) the use of drugs to cope with the stress of unexpected pregnancy, (ii) the continued drug use during pregnancy to manage withdrawal, (iii) the dual effect of pregnancy on drug use either as a facilitator or as a moderator of drug use, and (iv) the role of male intimate partner in influencing women’s drug use during pregnancy.ConclusionOur paper reports women’s drug use during pregnancy and the factors influencing this phenomenon. To safeguard the health and well-being of pregnant women and their unborn children, there is a need for education and awareness raising, implementing couple-based harm reduction approaches to leverage on positive male influences, improving availability of drug treatment, and provision of family planning interventions for women who use drugs.

Social determinants of drug use among older people with HIV/AIDS in Tehran

ABSTRACT Background: Substance use is one of the most important health problems in the world, few studies have looked at the social determinants of substance use. Therefore, the purpose of this study was to examine the social factors associated with drug use in older people with HIV/AIDS in Tehran, Iran. Methods: This descriptive and cross-sectional study was conducted during September to November 2018 in the city of Tehran, capital of Iran. The study population included 160 HIV-positive people with above 60 years of age. All variables of bivariate analysis in the p value of less than 0.2 were entered the logistic regression analysis to determine the adjusted effect and the adjusted odds ratio (aOR) of drug use. Results: The mean age ± standard deviation (SD) of the participants was 65.6 ± 6.6 years. Of 160 older people diagnosed with HIV who participated in this study, 23.1% (CI95%: 16%, 29%) were reported to use drugs. In the final multivariable regression model, the men (AOR = 12.23, 95% CI 1.43–104.10 p < .01), married ones (AOR = 11.86, 95% CI 1.51–93.26 p < .01), those with incomes between $ 100–200 (AOR = 36.16, 95% CI 3.50–372.71 p < .01), those with incomes higher than $ 200 a month (AOR = 4.61, 95% CI 1.17–18.06 p < .01) and those who had imprisonment records (AOR = 10.19, 95% CI 3.10–33.52 p < .01) were reported to use more drugs. Conclusion: Our findings provide critical information for policymakers to allocate resources and develop approaches for the prevention and treatment of HIV in order to address the future needs of older drug addicts diagnosed with HIV/AIDS. Based on our findings, it seems that appropriate interventions should be designed and directed to prisons and prisoners in order to reduce access to drugs or to isolate addicted detainees from non-addicts, and to provide psychological counseling for men and married people.

Working at heights: patterns and predictors of illicit drug use in construction workers

Employee drug use poses a serious risk to health and safety in male-dominated industries yet patterns and determinants of drug use in construction are not well understood. This study assessed prevalence rates and predictors of Australian construction workers’ use of cannabis, cocaine and meth/amphetamine. Workers (N = 511) completed a survey that assessed use of the three drug types; alcohol use; general health and mental health; job stress and the workplace cultural norms for each drug. Hierarchical binary logistic regressions examined predictors. Use of each drug over the past 12 months was two–five times higher than the national averages. Higher alcohol consumption was a consistent predictor across drug types and younger age and poorer general health were predictive of cannabis and cocaine use. Higher psychological distress was associated only with cannabis use. Workplace availability, descriptive and injunctive norms were significant predictors of cocaine use. The findings highlight concerning patterns of drug use in construction, particularly high levels of cocaine, with serious implications. The influence of cocaine workplace availability and norms highlight the importance of the workplace culture. Multi-component approaches involving culture change and individual-level responses that target vulnerable workers are required to minimize risk from drug-related harm.

Percieved Psychosocial Factors as Determinants of Drug Use and Abuse among Public Secondary School Youths in Osun State, Nigeria

Youths comprise the huge percentage of the world population. This stage is mostly influenced by social interaction with peer group, access to social media, parental background among others. In the light of this, the study was designed to investigate perceived psychosocial factors as determinants of drug use and abuse among public secondary schools youths in Osun State, Nigeria. The survey research design was adopted and simple random sampling technique was used to select two-hundred (200) participants. The research instrument tagged ‘Perceived Psychosocial Factors on Drug Questionnaire (PPFDQ) was used for data collection. The gathered data were analysed with the aid of inferential and descriptive statistical tools. The empirical outcomes indicated that family influence, peer group, gender quality, traumatic life events and frustrations, availability and accessibility as well as media roles are some of the perceived psychosocial factors that influenced youths’ drug use and abuse and that the religious inclination and gender traits of the youth was insignificant to the patterns and problems connected with drug use and abuse among them. Establishment of counselling unit within the school, avoidance of over castigation on academic performance by parents and teachers and maintenance of religious standard to mention a few were suggested in terms of recommendations.

A study of the current prescribing and drug utilization pattern in Ophthalmology Department of a tertiary care teaching hospital

Background: The aim was to study the current prescribing and drug utilization pattern in Ophthalmology Department of a tertiary care teaching hospital. Drug utilization study is a part of pharmaco-epidemiological exercise quantifying the extent, nature and determinants of drug use in a population. Periodic audit of drug usage pattern forms an essential tool to ascertain the role of drug in a society, increase therapeutic efficacy and improve cost effectiveness of the therapy. It is an introspective and critical instrument providing positive impact on health care delivery to the patient. With this background, the present study was carried out to analyze the prescription pattern and drug utilization by measuring the WHO drug use indicators in ophthalmology department of a tertiary care teaching hospital.Methods: The prescriptions of 961 outpatients were included and analyzed using a predesigned case record form OPD prescription of each patient. Patient and prescription related parameters were analyzed.Results: Prescription analysis showed that the average number of drugs per prescription was 1.85. The drugs were prescribed in the form of eye drops (67.42%), followed by ointments (14.37%), capsules (15.45%), and tablets (2.71%). The dosage form and frequency of drug administration was indicated for all of the drugs prescribed, the duration of treatment for 60.97% of the drugs prescribed. Antimicrobial agents and tear substitute together constituted above 50% of all the drugs. Percentage of drugs prescribed by generic name and from NEDL was 31.62% and 37.22%, respectively. Patient’s knowledge of correct dosage was 70.44%.Conclusions: This study showed that there is scope for improvement in prescribing patterns in areas of writing generic names of drugs, essential drugs, writing legible and complete prescriptions.

Drug use among men who have sex with men in Ireland: Prevalence and associated factors from a national online survey

BackgroundLittle is known about the prevalence and determinants of drug use among men who have sex with men (MSM) in Ireland. The aims of this study were to measure the prevalence of recreational drug use among MSM in a national sample, and to identify sub-groups of MSM who may benefit from targeted preventive interventions. MethodsThe MSM Internet Survey Ireland (MISI) 2015 was a community-recruited, nationally-promoted, self-completed online survey for MSM. MISI 2015 included standardised questions on recreational drugs, poppers, and drugs associated with chemsex (i.e. crystal methamphetamine, GBL/GHB, mephedrone, ketamine). Multivariable-adjusted logistic regression was used to identify factors associated with use of these substances. ResultsIn the previous year, 36% of MSM used recreational drugs, 33% used poppers, and 7% used drugs associated with chemsex. Five percent were diagnosed HIV-positive. Recreational drug users were significantly younger than non-users (median = 27 vs. 32 years; p < 0.001); popper users were significantly older than non-users (median = 34 vs. 28 years; p < 0.001). The odds of recreational drug use were higher among MSM diagnosed HIV-positive (vs. never tested; AOR 2.27, 95%CI 1.39–3.70). Use of poppers, and use of drugs associated with chemsex, were also higher among MSM diagnosed HIV-positive (vs. never tested; AOR 3.77, 95%CI 2.41–5.90, and AOR 5.87, 95%CI 3.08–11.18 respectively). ConclusionsThe prevalence of recreational drug use is higher among MSM than in the general population in Ireland, and it is particularly high among MSM diagnosed HIV-positive. Targeted harm reduction messages and preventive interventions are warranted to complement population-based approaches to reducing drug use in this population.

Considering the context: social factors in responses to drugs in humans

Drugs are typically used in social settings. Here, we consider two factors that may contribute to this observation: (i) the presence of other people may enhance the positive mood effects of a drug, and conversely, (ii) drugs may enhance the value of social stimuli. We review evidence from controlled laboratory studies with human volunteers, which investigated either of these interactions between social factors and responses to drugs. We examine the bidirectional effects of social stimuli and single doses of alcohol, stimulants, opioids, and cannabis. All four classes of drugs interact with social contexts, but the nature of these interactions varies across drugs, and depends on whether the context is positive or negative. Alcohol and stimulant drugs enhance the attractiveness of social stimuli and the desire to socialize, and social contexts, in turn, enhance these drugs' effects. In contrast, opioids and cannabis have subtler effects on social interactions and their effects are less influenced by the presence of others. Overall, there is stronger evidence that drugs enhance positive social contexts than that they dampen the negativity of unpleasant social settings. Controlled research is needed to understand the interactions between drugs of abuse and social contexts, to model and understand the determinants of drug use outside the laboratory.

A Study of drug utilization and clinical outcomes in indoor patients of hypertensive disorders of pregnancy

Background: Hypertensive disorders of pregnancy are an important determinant of drug use during pregnancy. The aim of study was to assess the clinical outcome and evaluate drug utilization according to WHO core drug prescribing indicators in hypertensive disorders of pregnancy.Methods: This prospective, observational study in a tertiary care hospital was conducted in 150 pregnant women with hypertensive disorders of pregnancy from January 2014 and December 2014 who fulfilled the inclusion criteria. Antepartum and intrapartum care and the maternal and perinatal outcome were noted. The data was analyzed to evaluate clinical outcome and drug utilization according to WHO core drug use indicators.Results: Gestational hypertension was most common among hypertensive disorders of pregnancy seen in 62/150 (41.3%) women. The most common symptom was headache (48%) while sign noted was edema (69%). A total of 66% women had preterm delivery and 42% babies weighed less than 2.5 kg. Average number of drugs per encounter was 9.7. Percentage of drugs prescribed by generic name and from essential drug list was 64% and 79% respectively. The most commonly used drugs were vitamins and minerals prescribed in 100% patients followed by antihypertensive drugs (92%). The most common antihypertensive used were calcium channel blockers and anticonvulsant was magnesium sulphate.Conclusions: There was increased maternal and perinatal morbidity and operative intervention among pregnant women with hypertensive disorders of pregnancy. Most of the drugs were used appropriately and were in accordance with standard guidelines. The important problems identified were inappropriate use of antimicrobials, use of sublingual nifedipine and use of brand names in 1/4th of prescriptions.

The Scope, Quality and Safety Requirements of Drug Abuse Testing

The aim of this review is to inform about the scopes and requirements of drug abuse testing. Drug abuse testing is one of the tools for determination of drug use. It must fulfill the quality and safety requirements in judgmental legal and administrative decisions. Drug abuse testing must fulfill some requirements like selection of the appropriate test matrix, appropriate screening test panel, sampling in detection window, patient consent, identification of the donor, appropriate collection site, sample collection with observation, identification and control of the sample, specimen custody chain in preanalytical phase; analysis in authorized laboratories, specimen validity tests, reliable testing METHODS, strict quality control, two-step analysis in analytical phase; storage of the split specimen, confirmation of the split specimen in the objection, result custody chain, appropriate cut-off concentration, the appropriate interpretation of the result in postanalytical phase. The workflow and analytical processes of drug abuse testing are explained in last regulation of the Department of Medical Laboratory Services, Ministry of Health in Turkey. The clinical physicians have to know and apply the quality and safety requirements in drug abuse testing according to last regulations in Turkey.

Theory of Planned Behavior on The Psycho-Social Determinants of Drug Use Among Adolescents in Samarinda, East Kalimantan

Background: Drug abuse is serious global health problem. Drug users aged 10-59 years in Indonesia has been increasing steadily. According to data from National Board for Drug Abuse (Badan Narkotika Nasional, BNN), the prevalence of drug users in East Kalimantan was 59,195 (3.07%) of population aged 10-59 years of 1,930,936 people. This study aimed to investigate the psycho-social determinants of drug use among adolescents in Samarinda, East Kalimantan, using Theory of Planned Behavior.Subjects and Method: This was an analytical observational study with cross-sectional design. The study was carried out at Badan Rehabilitasi Tanah Merah, Samarinda, East Kalimantan, from July to August, 2017. A sample of 150 adolescents were selected for this study by fixed disease sampling, including 50 adolescent drug users, and 100 adolescent non drug users. The dependent variable was drug use. The independent variables were intention, attitude, subjective norm, perceived behavior control, peer group, parenting style, and family harmony. The data were collected by pre-tested questionnaire and analyzed using path analysis.Results: Drug use was directly determined by strong intention (b= 2.18; 95% CI= 1.22 to 3.14; p<0.001), negative attitude (b= 1.79; 95% CI= 0.76 to 2.82; p=0.001), low subjective norm (b= 1.13; 95% CI= 0.09 to 2.17; p= 0.034), and weak perceived behavior control (b= 2.83; 95% CI= 1.48 to 4.19; p<0.001). Intention was determined by weak perceived behavior control (b= 1.18; 95% CI = 0.14 to 2.22; p<0.001). Subjective norm was determined by family harmony (b= 2.03; 95% CI= 0.96 to 3.09; p<0.001), authoritarian parenting style (b= 1.25; 95% CI= 0.15 to 2.36; p=0.026), and peer group (b= 1.46; 95% CI= 0.37 to 2.54; p=0.009).Conclusion: Drug use is directly determined by intention, attitude, subjective norm, and perceived behavior control. Family harmony, authoritarian parenting style, and peer group affect drug use indirectly.Keywords: drug use, Theory of Planned Behavior, path analysisCorrespondence: Syukma Rhamadani Faizal Nur. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami No.36 A, Surakarta 57126, Central Java, Indonesia. Email: faizalrhamadani@gmail.com. Mobile: +6281253121828.Journal of Health Promotion and Behavior (2017), 2(3): 272-281https://doi.org/10.26911/thejhpb.2017.02.03.07

Facteurs déterminant la consommation des médicaments de la rue en milieu urbain

Résumé Une étude transversale à visée descriptive et analytique sur la consommation des médicaments de la rue en milieu urbain a été réalisée à Adjamé/Abidjan (Côte d’Ivoire). Son but était de contribuer à la lutte contre la consommation des médicaments de la rue par la mise en évidence des facteurs favorisant leur utilisation. Ce travail décrit, les caractéristiques sociodémographiques des consommateurs de médicaments de la rue, détermine le type de médicaments achetés dans la rue, et identifie les facteurs influençant l’achat de ces médicaments. Au terme de cette étude qui a porté sur 300 personnes, il ressort que la consommation des médicaments de la rue est un phénomène de grande ampleur de par sa prévalence (72 %) dans la population enquêtée. Les consommateurs étaient en majorité des sujets jeunes (32 %) à prédominance de sexe masculin, exerçant pour la majorité (52 %) dans le secteur informel. Plus de la moitié des consommateurs (58 %) avaient un revenu mensuel de moins de 50 000 FCFA, et n’avaient pas d’assurance maladie. La principale raison évoquée par les utilisateurs était le faible coût de ces produits (69 %). Les médicaments achetés dans la rue étaient d’une grande variété avec une prédominance d’antalgiques (75 %), d’antipaludiques (72 %) et d’antibiotiques (48 %). Devant la méconnaissance médicale et thérapeutique des vendeuses et vendeurs de ces médicaments exposant les consommateurs à de graves risques sanitaires, nous préconisons le renforcement de la sensibilisation des populations, la promotion des médicaments génériques essentiels et l’amélioration de leur accessibilité.

Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context.

BackgroundUsing our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reduction and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression;MethodsA qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers;ResultsAll client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples' agency, and homelessness;ConclusionsHarm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An intersectional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/health, addictions, including harm reduction and methadone maintenance treatment.

Behavioral economic analysis of cue‐elicited craving for alcohol

Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug's value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure. One-way within-subjects design. Human laboratory environment. Heavy drinkers (n = 92) underwent exposures to neutral (water) cues followed by personalized alcohol cues. Participants were assessed for craving, alcohol demand, affect, and salivation following each exposure. Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (O(max)), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized P(max)). Craving was significantly correlated with demand measures at levels ranging from 0.21-0.43. These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol-related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.

Type, scope und quality of drug utilization

Drug utilization research examines the quantitative and qualitative aspects of drug utilization. These include the medical, social and psychological factors and consequences of drug use in relation to specific patient groups and specific population groups, as well as the population in general (EURO-DURG-Resolution 1997). The present article puts particular emphasis on the methodological aspects and the public health perspectives involved in this search. A major goal of drug utilization research is the improvement of drug therapy as administered by physicians and pharmacists and the assessment of drug use in the population as a whole, encompassing both prescription-based and self-administer medication. In addition, drug utilization research also fulfills an important public health role in a welfare state by monitoring and controlling drug expenditure, by providing data that serve to answer health policy questions and by contributing to the management and planning of public health politics. Drug search makes use of 2 data sources. On the one hand, case-related (prescription-related) mass data (e.g. drug index) or prescriptions and medical records for patient groups held by specific institutions (e.g. IMS data, utilization observations), on the other hand, personal but anonymous prescription information and medical records taken from unselected natural populations (e.g. survey data from statutory health insurance institutions). Comparing drug utilization data for population groups in various regions, both national and international as well as between medical institutions, sociodemographic groups and diagnostic profiles will help to provide information on the medical, economical and social determinants of drug use and provide a base for health policies.