Reducing Intoxication Among Bar Patrons: Some Lessons From Prevention of Drinking and Driving.

Reducing intoxication among bar patrons: some lessons from prevention of drinking and driving.

Addiction. 2013 Jun 25;
Graham K, Miller P, Chikritzhs T, Bellis MA, Clapp JD, Hughes K, Toomey TL, Wells S

Intoxication in and around licensed premises continues to be common, despite widespread training in the responsible service of alcohol and laws prohibiting service to intoxicated individuals. However, research suggests that training and the existence of laws are unlikely to have an impact on intoxication without enforcement, and evidence from a number of countries indicates that laws prohibiting service to intoxicated individuals are rarely enforced. Enforcement is currently hampered by the lack of a standardized validated measure for defining intoxication clearly, a systematic approach to enforcement and the political will to address intoxication. We argue that adoption of key principles from successful interventions to prevent driving while intoxicated could be used to develop a model of consistent and sustainable enforcement. These principles include: applying validated and widely accepted criteria for defining when a person is ‘intoxicated’; adopting a structure of enforceable consequences for violations; implementing procedures of unbiased enforcement; using publicity to ensure that there is a perceived high risk of being caught and punished; and developing the political will to support ongoing enforcement. Research can play a critical role in this process by: developing and validating criteria for defining intoxication based on observable behaviour; documenting the harms arising from intoxication, including risk curves associated with different levels of intoxication; estimating the policing, medical and social costs from intoxicated bar patrons; and conducting studies of the cost-effectiveness of different interventions to reduce intoxication. HubMed – addiction

The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies.

Psychol Med. 2013 Jun 24; 1-14
Lev-Ran S, Roerecke M, Le Foll B, George TP, McKenzie K, Rehm J

Longitudinal studies reporting the association between cannabis use and developing depression provide mixed results. The objective of this study was to establish the extent to which different patterns of use of cannabis are associated with the development of depression using meta-analysis of longitudinal studies. Method Peer-reviewed publications reporting the risk of developing depression in cannabis users were located using searches of EMBASE, Medline, PsychINFO and ISI Web of Science. Only longitudinal studies that controlled for depression at baseline were included. Data on several study characteristics, including measures of cannabis use, measures of depression and control variables, were extracted. Odds ratios (ORs) were extracted by age and length of follow-up.After screening for 4764 articles, 57 articles were selected for full-text review, of which 14 were included in the quantitative analysis (total number of subjects = 76058). The OR for cannabis users developing depression compared with controls was 1.17 [95% confidence interval (CI) 1.05-1.30]. The OR for heavy cannabis users developing depression was 1.62 (95% CI 1.21-2.16), compared with non-users or light users. Meta-regression revealed no significant differences in effect based on age of subjects and marginal difference in effect based on length of follow-up in the individual studies. There was large heterogeneity in the number and type of control variables in the different studies.Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. There is need for further longitudinal exploration of the association between cannabis use and developing depression, particularly taking into account cumulative exposure to cannabis and potentially significant confounding factors. HubMed – addiction

The Prevalence, Predictors, and Associated Health Outcomes of High Nicotine Dependence using Three Measures among US Smokers.

Addiction. 2013 Jun 25;
Schnoll RA, Goren A, Annunziata K, Suaya JA

Using the Fagerström Test of Nicotine Dependence (FTND), the Heaviness of Smoking Index (HSI), and the time-to-first-cigarette (TTFC), this study estimated prevalence, evaluated optimal scale cut-offs, identified predictors, and assessed potential impact on health, productivity, and healthcare use of high nicotine dependence among US smokers.This cross-sectional study used 2011 National Health and Wellness Survey data (n = 50,000).Nicotine dependence, demographic data, measures of health, productivity, and healthcare use, and health attitudes were assessed.The prevalence of high nicotine dependence ranged from 23% (TTFC < 5 minutes) to 63.6% (TTFC < 30 minutes). Based on diagnostic accuracy, the cut-offs for high nicotine dependence using HSI and TTFC varied according to FTND cut-off: if FTND > 4, then HSI > 3 and TTFC < 30 minutes represented optimal cut-offs; if FTND > 5, HSI > 4 and TTFC < 5 minutes represented optimal cut-offs. Across all measures, high nicotine dependence was significantly related to being male, single, age 45-64, and Caucasian; lower education; lack of health insurance; under/unemployment; comorbid respiratory or cardiovascular disease, diabetes, or psychiatric illness; and lower rates of exercise and concern for weight control. Controlling for demographic variables and comorbid physical and psychiatric illness, high nicotine dependence, measured by FTND, HSI, or TTFC, was significantly associated with reduced mental and physical quality of life, reduced workplace productivity and more health care use.High nicotine dependence is associated with lower quality of life, lower work productivity, and higher health care use. The Heaviness of Smoking Index and the time-to-first-cigarette can provide useful screening measures of nicotine dependence in clinical and research settings. HubMed – addiction

Influence of Affective Manipulations on Cigarette Craving: A Meta-Analysis.

Addiction. 2013 Jun 25;
Heckman BW, Kovacs MA, Marquinez NS, Meltzer LR, Tsambarlis ME, Drobes DJ, Brandon TH

Retrospective self-report and observational studies have yielded inconsistent findings regarding the capacity of negative affect (NA) to increase smoking motivation among dependent samples. Controlled laboratory studies offer an alternative paradigm for testing the role of affective state upon smoking motivation. The aim of the current study was to quantify cue-provoked cravings produced by affective manipulations in the published literature, and to identify theoretical and methodological moderators.We conducted a systematic literature search to identify experimental studies that manipulated NA or positive affect (PA), and assessed post-manipulation craving. Separate random effects meta-analyses examined NA and PA cues as predictors of self-reported craving. Self-reported affect (NA and PA), nicotine deprivation, gender, nicotine dependence, order of cue presentation, single vs. multi-item craving assessment, and affect induction method were tested as moderators of affective cue-induced craving.NA manipulations produced a medium effect (g = .47; CI = .31 – .63) on craving, but no main effects were found for PA manipulations (g = .05; CI = -.09 – .20) on craving. Self-reported NA moderated the extent to which NA and PA manipulations elicited craving (p’s < .02 for each). That is, more effective NA manipulations produced greater cravings, and PA manipulations reduced cravings when they reduced NA.Laboratory studies indicate that negative affect, but not positive affect, is a situational determinant of cravings to smoke among dependent smokers. Adverse emotional states increase craving to smoke among dependent smokers, but positive emotional states do not consistently reduce craving to smoke. HubMed – addiction

Multiple behavioural impulsivity tasks predict prospective alcohol involvement in adolescents.

Addiction. 2013 Jun 25;
Fernie G, Peeters M, Gullo MJ, Christiansen P, Cole JC, Sumnall H, Field M

We investigated reciprocal prospective relationships between multiple behavioural impulsivity tasks (assessing delay discounting, risk-taking, and disinhibition) and alcohol involvement (consumption, drunkenness, and problems) among adolescents. We hypothesised that performance on the tasks would predict subsequent alcohol involvement, and that alcohol involvement would lead to increases in behavioural impulsivity over time.Cross-lagged prospective design in which impulsivity and alcohol involvement were assessed five times over two years (once every six months, on average).Classrooms in secondary schools in North West England.Two hundred and eighty seven adolescents (51% Male) who were aged 12 or 13 at study enrolment.Participants reported their alcohol involvement and completed computerized tasks of disinhibition, delay discounting, and risk-taking at each assessment. Cross-sectional and prospective relationships between the variables of interest were investigated using cross-lagged analyses.All behavioural impulsivity tasks predicted a composite index of alcohol involvement six months later (all ps < .01), and these prospective relationships were reliable across the majority of time points. Importantly, we did not observe the converse relationship across time: alcohol involvement did not predict performance on behavioural impulsivity tasks at any subsequent time point.Several measures of impulsivity predict escalation in alcohol involvement in young adolescents, but alcohol use does not appear to alter impulsivity. HubMed – addiction