Abstract: Aims: The current study examined the use of methamphetamine (Meth) in relation to HIV risks in a South African community sample.Design and setting: Street intercept methods were used to collect surveys of substance use and sexual behavior from 441 men and 521 women living in a racially mixed township in Cape Town South Africa.Findings: Results showed that 78 (18%) men and 63 (12%) women had used Meth, and 49 (11%) men and 34 (6%) women ever had used Meth in the preceding 6 months. Other than alcohol, cannabis was the most commonly used drug followed by Meth. We found that Meth use was closely associated with other drug use, indicating a pattern of poly‐substance use among Meth users. Recent Meth use was associated with being male, engaging in unprotected intercourse and having multiple sex partners in the previous 6 months. Meth users also demonstrated greater condom use than non‐users, although less than half of all intercourse occasions among Meth users were condom protected.Conclusions: Meth is used by...

Abstract: Aim: To develop a model of why people seek professional treatment for drinking problems, grounded in what clients say about the process at treatment entry.Participants: Three sets of consecutive entrants to the UK Alcohol Treatment Trial, sets commencing at intervals during trial recruitment (total n = 98).Location: Statutory and non‐statutory alcohol problem treatment agencies in three areas of England and Wales.Data: Open‐ended interviews according to a brief interview guide, leading to 400–800‐word post‐interview reports used for analysis (tape recordings used for auditing the interview and analysis process).Analysis: Reports analysed by a team according to grounded theory principles, involving an iterative process with successive refinement of interviewing and analysis with each successive set of data.Findings: A model of professional treatment entry was developed, refined and “tested” with the last set of data. The process of seeking professional treatment was depicted in the model as involving a rea...

Abstract: Aims: The work undertaken aimed to develop an alcohol‐related brief intervention based on the theoretical concepts of the self‐efficacy construct. The brief intervention was to be administered by general nurses in a general hospital setting for patients who were identified as potential problem drinkers.Background: Alcohol‐related brief interventions use methods such as booklets, verbal advice, counselling and behaviour change techniques in an attempt to change alcohol consumption behaviour with the aim of reducing levels of alcohol consumption. Miller and Sanchez () identified self‐efficacy as one of six elements typically included in brief interventions. Nurses have been identified as being in a prime position to administer interventions (Arthur, ). This work provides essential information relating to the specific content of interventions and the processes involved for nurses to fulfil this role.Methods: The intervention was developed following a review of existing related literature.Findings: Using the ...

Abstract: Background: There is growing evidence that the therapeutic alliance is one of the most consistent predictors of retention and outcomes in drug treatment. Recent psychotherapy research has indicated that there is a lack of agreement between client, therapist and observer ratings of the therapeutic alliance; however, the clinical implications of this lack of consensus have not been explored.Aims: The aims of the study are to (1) explore the extent to which, in drug treatment, clients and counsellors agree in their perceptions of their alliance, and (2) investigate whether the degree of disagreement between clients and counsellors is related to retention in treatment.Methods: The study recruited 187 clients starting residential rehabilitation treatment for drug misuse in three UK services. Client and counsellor ratings of the therapeutic alliance (using the WAI‐S) were obtained during weeks 1–12. Retention was in this study defined as remaining in treatment for at least 12 weeks.Results: Client and counsello...

Abstract: Aim: The purpose of this paper was to examine the development of social images or prototypes of cigarette, alcohol, and marijuana users among children in the first through eighth grade using a Guttman unidimensional scaling approach.Methods: Participants were 1,075 first through fifth grade children who completed annual assessments for 4 years.Results: The properties of a Guttman scale consisting of three sequential prototypes, (1) popular, (2) popular and exciting, and (3) popular, exciting and cool, were within acceptable limits for all three substances for second through eighth graders, suggesting that these prototypes were scaleable and represented a single dimension. Prototypes became more positive after the fifth grade and varied by gender. Prototypes, moderated by age and gender, were related to intention to use substances in the future.Conclusion: Findings suggest that children's prototypes of substance users are unidimensional and cumulative for all three substances and that they develop sequenti...

Abstract: Factors associated with relapse to problematic alcohol or illicit drug use were examined in 104 clients enrolled in treatment programmes for substance disorders. Participants were assessed by retrospective self‐report questionnaires to explore the roles of family dysfunction, mood states, primary drug of dependence, demographic variables and various other factors in relation to relapse episodes. Consistent with previous studies, the most commonly cited reason for relapse was negative mood states, followed by external pressure to use, desire for positive mood states, and social/family problems. Reasons for relapse did not differ between clients whose primary drug of dependence was heroin, methamphetamine, or alcohol. Methamphetamine abusers and participants in the drug court programme had the fewest relapses. Co‐morbid psychological disorders were most commonly diagnosed in the alcoholic group, followed by the methamphetamine group and the heroin group. General family functioning retrospectively improved f...

Abstract: This paper examines the relationship between heavy drinking and aggression using quantitative and qualitative data from a Department of Health funded interview study of untreated heavy drinkers living in the largely urban English West Midlands region (n = 403). Interviews consisted of a combination of forced choice questions and semi‐structured discussion. Quantitative data showed high levels of verbal aggression, serious arguments and fights. Significant associations were found between alcohol‐related aggression, lower age, number of very heavy drinking days and lower socio‐economic status. Thematic analysis of qualitative data showed that participants considered alcohol to be heavily implicated in aggressive behaviour, but differences exist between quantitative and qualitative findings in terms of the importance of gender. Participants associated aggression with masculinity and youth, but violence involving women and domestic violence were rarely discussed.

Abstract: Aim: To assess changes in the health‐related quality of life (HRQOL) among opiate users in the first 6 months upon entering a low‐threshold methadone treatment program. Changes were evaluated from the perspectives of both statistical and clinical significance.Design: A prospective cohort study of low‐threshold methadone participants who had completed interviews at baseline and 6 months post enrollment.Participants: 183 opiate users who started low‐threshold methadone treatment between December 2000 and January 2004.Measurements: Data on HRQOL were collected by a trained interviewer using the SF‐36 instrument to determine baseline and 6 months post treatment scale scores.Findings: Statistically significant improvements were found in the study group for seven out of ten SF‐36 scales: role physical, bodily pain, vitality, social functioning, role emotional, mental health and the mental health component summary scale. At an individual patient level, clinically significant improvements were most commonly obser...

Abstract: The current study examines the menstrual cycle–alcohol relationship during 6 months of weekly outpatient sessions as part of a larger treatment outcome study for alcohol‐dependent females Twelve premenopausal women in the clinical trial who were menstruating regularly and not on oral contraceptives kept a daily log of menstruation days, alcohol consumption and cravings Three menstrual cycle phases were defined: menses, premenstrual, and “other” Within subjects repeated measures analyses on the subsample of 12 women showed that, despite a lower average number of cravings, drinking frequency was higher in the premenstruum than the “other” phase in the first 3 months of treatment In addition, according to a self‐report item on a measure given to 96 women in the larger study, 48 (69%) women under the age of 50 endorsed the premenstrual phase of the menstrual cycle as a drinking cue Of these 48, 44% considered it a major drinking cue These preliminary data support the value of continuing to investigate t

Abstract: In the past decade, universities and colleges across the USA have attempted to develop a profile of college student drinkers in order to develop programs and policies for combating high‐risk drinking. Most of these studies have relied on the Core Alcohol and Drug Survey in which students self‐report drinking and behaviors associated with drinking. While the Core survey has undergone multiple validity checks, few researchers have employed official data to validate items in the survey, particularly self‐reported official trouble. The present study employed municipal alcohol‐related arrest reports to determine whether the correlates of arrest resembled correlates associated with self‐reported official trouble from drinking. Overall, group membership patterns from the self‐report item resembled the patterns of alcohol‐related arrest. Further tests using internal Core survey criteria revealed additional validity support for the self‐reported official trouble item.

Abstract: Aim: This paper describes the findings from a survey of self‐reported alcohol, tobacco and drug use among 721 school students aged 15 and 16 years living on the Isle of Man.Design: This venture was part of the 2003 European School Project on Alcohol and Other Drugs, an international survey in 35 countries.Setting and participants: School survey of whole population aged 15 years (n = 721) on the Isle of Man.Measurement: Three hundred and eighty core item questionnaire.Findings: Over 95% of all respondents had consumed alcohol at some point during their lifetime and 78% had experienced being drunk. Twenty‐two per cent had smoked cigarettes on more than 40 occasions, with girls much more likely than boys to smoke. Around 40% had tried an illicit drug at some time, mainly cannabis.Conclusions: Binge drinking and tobacco use in Manx teenagers, especially young women, needs careful monitoring and clearly requires a vigorous public health response.

Abstract: Aims: To evaluate the outcome at 24 weeks following a community‐based treatment programme using buprenorphine maintenance among male opiate users in Dimapur, Nagaland ( India).Design: Quasi‐experimental prospective follow‐up study.Participants: Fifty‐four male current opiate users were recruited following fulfilment of inclusion criteria from a community. All users seeking treatment met the DSM III‐R criteria for opioid dependence.Methods: All subjects received buprenorphine (1.2–1.8 mg sublingually per day) from a community clinic and attended psychosocial sessions. Measurements included an assessment of demographic and clinical variables, Addiction Severity Index (ASI), retention in treatment, drug use at baseline and follow‐up at 24 weeks.Findings: The mean age of sample was 26.3±4.1 years, with a mean duration of opioid use of 4.0±3.8 years. The retention rate was 81.5% at 24 weeks. Scores on the Addiction Severity Index decreased and injecting use reduced. No adverse events were reported.Conclusion: ...

Abstract: Aims: The aim of this study was to determine whether injecting drug users (IDUs) living in hostels for the homeless were more likely to engage in blood‐borne virus associated injecting risk behaviour than those living elsewhere.Design: Four‐hundred‐and‐fifty‐three IDUs who had commenced injecting post‐1995 were recruited from community settings in Glasgow and interviewed during 2001–02 using a structured questionnaire (quantitative component). Respondents who had commenced injecting post‐1998 were also invited to participate in an in‐depth interview to explore contextual factors that influence injecting risk behaviour (qualitative component).Results: Individuals interviewed during the qualitative component of the study reported witnessing prolific sharing of needles and syringes (n/s) in hostels. Multi‐factorial logistic regression found that hostel residence was independently associated with injecting with a n/s previously used by a friend, acquaintance or family member (OR 1.58, 95% CI 1.01–2.49), passi...

Abstract: Aim: To explore the process of self‐detoxification from opioid drugs in a sample of patients attending a UK‐based drug treatment service.Background: Detoxification is an essential first step in moving from dependence on opioids to abstinence. Although waiting times for treatment in the UK have recently been decreasing, clinical services are unlikely to be able to treat everyone with substance misuse problems. Therefore it is surprising that users' attempts at self‐detoxification have received relatively little research attention.Method: Ninety eight patients attending an outpatient opioid detoxification service in Birmingham completed a structured questionnaire that elicited a description of their previous attempts to stop using opioid drugs.Results: Information was collected about the reasons for attempting self‐detoxification, reasons for deciding not to access a treatment service, the psychological and physical strategies employed, and the factors involved in relapse back to drug use. The sample had in...

Abstract: 'Booting' and 'flushing' are terms used to describe an injecting behaviour in which the plunger is pulled back and the fluid (mostly blood and perhaps blood only) is re-injected. The behaviour differs from 'registering', which occurs before the drug is injected. Booting/flushing can produce subcutaneous and venous damage, and increases the risk for the spread of blood-borne viruses when used equipment is passed on to other injectors. The purpose of the study was to explore the extent of flushing, the context of flushing and IDUs' self-reported reasons for flushing. Data were collected through semi-structured interviews with 59 IDUs in Northern Ireland, who were recruited through various strategies. Respondents' ages ranged from 22 to 50 years and females comprised 34% of the sample. Mean length of injecting career was 8.3 years. A total of 46% reported flushing on a regular basis during some or most of the injecting career. The results showed that flushing occurs for different reasons and, in comparison with research conducted elsewhere, is not associated solely with cocaine or speedball injection. Interventions designed to reduce the extent of flushing must take into account the various reasons for the behaviour.

Abstract: This study examined whether disharmony within one's family of origin is a risk factor for the children of problem drinkers in adult life. The responses to a postal questionnaire of 39 adults who experienced difficulties in childhood around parental drinking were assessed for any associations that existed between their remembering disharmony (between their parents, between their parents and themselves, and within the family generally) in their childhood and their current experience of shame as measured by the Experience of Shame Scale (Andrews, Qian, & Valentine, British Journal of Clinical Psychology, 2002, 41, 29–42). Shame vulnerability was therefore assumed to be representative of adult distress. The participants were attracted to the study by advertisements placed in the Manchester Evening News and Big Issue in the North. The analyses used in this study were the non‐parametric Mann–Whitney U test and the Spearman correlation coefficient test. Disharmony did emerge as being quite significantly associat...

Abstract: Aim: To assess the feasibility of a peer delivered educational intervention to reduce injecting risk behaviour amongst injecting drug users (IDUs) in Northwest Wales.Methods: A team of 13 current IDUs were recruited to be peer educators. Recruits were regular users of illicit heroin and active within local drug using networks. Over the course of the project they carried out educational interventions amongst their peers. Risk behaviour data was collected throughout the project by the educators.Results: A wide range of educational interventions were carried out by the peer educators. Research data collected by the peer educators indicated high levels of injecting risk. At baseline 80% (95% CI 61–92%) of IDUs questioned reported having used someone else's used needle or syringe in the month prior to interview. Data collected on injecting group size indicated that a small subgroup of individuals injected in the company of a considerable number of other individuals. It was clear that the symptoms of withdrawal...

Abstract: Few studies have explored gender comparisons of psychopathology in substance abusing adolescents. To expand the knowledge base in this area, we assessed 59 adolescents (34 males and 25 females) presenting for inpatient treatment in a university‐based adolescent dual diagnosis program. Subjects were interviewed for psychiatric disorders using the revised Child Schedule for Affective Disorder and Schizophrenia (K‐SADS). The Structured Clinical Interview DSM‐IV (SCID‐R) was used to diagnose substance use disorders. The subjects were primarily Caucasian, ages 12–18. Ninety‐four per cent of the sample used tobacco and females were more likely than males to meet criteria for alcohol abuse or dependence. Disruptive disorders were the most prevalent psychiatric diagnoses in both males and females. However, anxiety disorders were more prevalent in females, and social phobia was the most common anxiety disorder. Both groups had experienced physical and/or sexual abuse; however, there was a trend towards higher inci...

Abstract: Rates of initial health behavior change have not consistently translated into similar rates of behavioral maintenance. Of those who achieve short‐term change, most successfully treated individuals revert back to their old high‐risk behaviors soon after treatment. While motivation for change remains a salient issue throughout the behavior change process, maintenance interventions have neglected to focus on the variability of motivation directly. This article proposes that an audio playback procedure that captures motivational decision‐making themes at their highest, most emotionally laden point and replays that material at later dates, may be an effective way to maintain motivation. Highlighted is the role of motivation in maintaining behavior change, the previous literature on audio and video feedback, and the roles of memory systems, cognitive dysfunction, recall bias, cognitive dissonance, change talk, emotional reprocessing and contextual learning on motivation. Special attention will be paid to addict...

Abstract: This paper presents the findings of an exploratory study designed to investigate what is known about women's experiences of domestic abuse and their impact on treatment outcomes.Aims: To explore whether domestic abuse has an impact on women's access to treatment, retention, relapse, or increase in their substance use.Design: A literature review and key informant interviews.Participants: Thirteen key informants were drawn from a range of agencies working with women using alcohol or drugs in England.Measurement: The empirical research was read using set criteria including: type of treatment setting, single or mixed gender treatment, number in the sample, methods used, and key findings. The key themes were then extracted from the literature. The interviews were recorded, transcribed, and analysed using thematic coding.Findings: Practice‐based evidence suggests women's engagement with and retention in treatment is negatively affected by domestic abuse. Literature‐based evidence is equivocal and limited in sco...

Abstract: Background: We describe incarceration history (jail or prison) among a community‐based sample of young injection drug users (IDU) (age<30 years) in San Francisco, and examine associations between selected socio‐demographic and behavioral characteristics and hepatitis hepatitis C virus (HCV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infections.Methods: Cross‐sectional baseline data from study of street‐recruited young IDU in San Francisco were analyzed.Results: In a sample of 839 young IDU, median age was 22 years, 70% were male, 86% had a lifetime history of incarceration, and 56% had been incarcerated in the prior year. Serologic markers of HBV and HCV infections were significantly higher among those with any history of incarceration (29% and 42% respectively) compared with those with no incarceration history. Variables independently associated with recent incarceration were gender (male), homelessness, increased years of injecting, and a history of having ever borrowed previously ...

Abstract: Aim: The aim of the study is to examine the agreement between self‐reports of drug use pattern and urinalysis data of 112 male intravenous drug users seeking treatment at National Drug Dependence Treatment Centre of All India Institute of Medical Sciences, New Delhi, India.Design: All the male intravenous drug users (n = 112) seeking treatment during the study period were included in the study. Addiction Severity Index Questionnaire was administered, and the agreement between self‐reports of drug use and urine analysis of drugs using gas liquid chromatography was compared.Findings: The data showed that although the primary drug of use was heroin in all the subjects a significant number of them were currently using a combination of buprenorphine, diazepam and pheniramine. The agreement of self‐report and urine analysis varied across the type of drug used. Acceptable agreement was seen with buprenorphine, diazepam, pheniramine and promethazine. The reports of patients on heroin and morphine showed poor agre...

Abstract: Background: This study compared measures of drinking pattern at baseline, and subsequent cardiovascular harm in a longitudinal study.Method: In Winnipeg, Manitoba, Canada, a community sample of 1154 adult men and women was interviewed at baseline in 1990 and 1991, then followed with all‐cause surveillance. Cox proportional hazards regressions were used to assess the “time to event” for morbidity or mortality from coronary heart disease (CHD), hypertension, or other cardiovascular disease. Surveillance was through a 10‐year series of documented physician visits, hospital discharges and deaths, classified by diagnosis. Drinking pattern was defined as either ⩾8 drinks (80–120 g of alcohol or more) at a sitting in the past 12 months, a report of feeling the effects, or ⩾5 usual drinks/day.Results: There were 104 individuals with CHD events in the data. When ⩾8 drinks at a sitting was the predictor, there were significant hazards for CHD among both men and women [hazard ratio (HR) = 2.32 and 1.07; p = 0.004 an...

Abstract: The “attraction paradigm” proposed that demographic and experiential homogeneity will lead to effective group working, whereas disparity will have the opposite effect. There is evidence to suggest that demographically and experientially homogenous peer and volunteer health care workers (who may have had similar substance misuse and other experiences to the client groups with which they are working) contribute effectively towards positive health care outcomes. Professional health care workers, on the other hand, are not likely to be as demographically and/or experientially homogenous and have been shown to have negative attitudes towards substance misuse service users. It is suggested that by employing the arts, literature and music in substance misuse education, professional health care workers will be exposed to vivid and stark accounts of those experiences that they otherwise might not have, thus improving attitudes and perhaps, clinical outcomes.

Abstract: Background: In the UK dexamphetamine has been used widely as a treatment for amphetamine users. We sought to study the effects of illicit amphetamine use on pregnancy, and to evaluate the safety an...

Abstract: Non‐completion rates for inpatient drug detoxification programmes vary between 25–50%. Non‐completion is associated with poorer longer‐term outcomes for substance dependence. Little research has been undertaken on the relationship between early childhood difficulties and completion of treatment. This study investigates whether there is an independent association between early maladjustment and adherence within an inpatient detoxification programme. Data was collected using a case notes study of all patients admitted to an inpatient drug dependency unit (n = 289) over a 1‐year period. Serious maladjustment was found to be significantly associated with non‐completion of the inpatient programme. The clinical implications of this finding are discussed.

Abstract: Aims: To investigate the psychosocial and environmental factors contributing towards the association between tobacco smoking and alcohol dependence.Methods: Twenty‐three pairs of alcohol‐dependent people were matched for age and gender and compared for sociodemographic and clinical characteristics.Results and conclusion: There was a statistically significant difference in social class between the two groups. There was no significance difference between the groups for any of the other clinical variables including severity of alcohol dependence, liver toxicity tests or presence of dissocial personality disorder.

Abstract: There is a lack of non‐pharmacological options for the treatment of people with substance misuse problems. However, service users often mention their use of steam rooms and home baths to help aid their problem of detoxification and aid relaxation of muscle cramps. These anecdotes prompted this current review, to establish whether spa bathing is used for this purpose and whether there is any evidence of its effectiveness. The review was carried out in 2003 and includes a literature review together with written and oral responses from individuals and organizations. The review provided an overview of the extent of uses of spa bathing and describes a variety of examples.

Abstract: Aims: To identify factors that predict attendance for the start of treatment following assessment, and factors that predict retention in treatment, at a specialist alcohol treatment clinic.Participants: The sample consisted of 419 consecutive clients (272 male and 147 female) who had attended for assessment over a two‐year period and had chosen out‐patient care. These included 141 who did not attend treatment (non‐starters), 106 who attended only once (starters), and 172 who attended more than one session (retainers).Design: We recorded factors that previous research or clinical experience suggested might influence attendance, including: demographic factors, clients' support and mental state, substance use and aspects of clinical practice.Analysis: Univariate analyses and multiple logistic regression analyses were conducted to identify factors predicting whether clients attended the first treatment session and whether they continued to remain in treatment.Findings: Clients most likely to start treatment f...