Addiction Research and Theory

Published by Informa Healthcare
Online ISSN: 1606-6359
Publications
Posterior probability distribution for Scotland's number of current injectors in 2006: by using all four data sources and by using three only.
Article
Using Bayesian capture-recapture analysis, we estimated the number of current injecting drug users (IDUs) in Scotland in 2006 from the cross-counts of 5670 IDUs listed on four data-sources: social enquiry reports (901 IDUs listed), hospital records (953), drug treatment agencies (3504), and recent Hepatitis C virus (HCV) diagnoses (827 listed as IDU-risk). Further, we accessed exact numbers of opiate-related drugs-related deaths (DRDs) in 2006 and 2007 to improve estimation of Scotland's DRD rates per 100 current IDUs. Using all four data-sources, and model-averaging of standard hierarchical log-linear models to allow for pairwise interactions between data-sources and/or demographic classifications, Scotland had an estimated 31700 IDUs in 2006 (95% credible interval: 24900-38700); but 25000 IDUs (95% CI: 20700-35000) by excluding recent HCV diagnoses whose IDU-risk can refer to past injecting. Only in the younger age-group (15-34 years) were Scotland's opiate-related DRD rates significantly lower for females than males. Older males' opiate-related DRD rate was 1.9 (1.24-2.40) per 100 current IDUs without or 1.3 (0.94-1.64) with inclusion of recent HCV diagnoses. If, indeed, Scotland had only 25000 current IDUs in 2006, with only 8200 of them aged 35+ years, the opiate-related DRD rate is higher among this older age group than has been appreciated hitherto. There is counter-balancing good news for the public health: the hitherto sharp increase in older current IDUs had stalled by 2006.
 
Article
Research suggests that there may be differences between individuals diagnosed with alcohol dependence and individuals diagnosed with opioid dependence on co-morbid mental health problems (e.g., personality disorders, mood disorders, etc.). The current study examined whether there were differences in early maladaptive schemas, which are theorized to underlie mental health problems, among women diagnosed with alcohol dependence or opioid dependence who were seeking treatment for their substance use (N = 420). Results showed that opioid dependent women scored higher on 2 of the 18 early maladaptive schemas, particularly the schemas of dependence and punitiveness. Overall, these findings suggest that early maladaptive schemas may be largely consistent across women diagnosed with alcohol or opioid dependence. Implications of these findings for future research and treatment are discussed.
 
Article
Whether people believe that they have control over their behaviors is an issue that is centrally involved in definitions of addiction. Our research demonstrates that believing in free will - that is, believing that one has control over one's actions - has societal implications. Experimentally weakening free will beliefs led to cheating, stealing, aggression, and reduced helping. Bolstering free will beliefs did not change participants' behavior relative to a baseline condition, suggesting that most of the time people possess a belief in free will. We encourage a view of addiction that allows people to sustain a belief in free will and to take responsibility for choices and actions.
 
Article
This article contributes to a growing body of literature that emphasizes the social nature of drug use, abuse and addiction. Current discourses of addiction tend to focus on the individual while limiting attention on the social environment and the role of sociality. We seek to contribute a more intuitive, insiders’ perspective of the drug trajectory and a broader conceptualization of addiction. Drawing from our qualitative study on 100 current and former methamphetamine users in the suburbs of Atlanta, Georgia (USA), we examined the trajectories of methamphetamine use to provide greater insight on what influences drug initiation, progression, cessation and relapse from the users’ perspective. Findings show that the entire drug trajectory is intertwined with, and impacted by, sociality for the majority of drug users in our sample. Moreover, the findings of our study increase our understanding of multiple routes to recovery. We join the call for greater attention to drug use and addiction as a social behavior and future research that focuses more on the role of sociality among drug users.
 
Article
OBJECTIVE: Sustained abstinence can be enhanced by providing an alcohol and drug free living environment. However, residential treatment programs are time-limited and expensive and there is a need for more practical housing options. METHOD: The present study examined 323 individuals who entered: (1) an 8-week residential treatment program (n=23), (2) sober living houses (SLHs) associated with outpatient treatment (n=55), or (3) freestanding SLHs not affiliated with formal treatment (n=245). A repeated measures design examined problem areas at baseline, 6 months, and 12 months. RESULTS: At follow up all 3 programs showed significant reductions in severity of alcohol and drug problems or maintenance of low baseline severity. Residents in the different types of houses varied on several baseline measures and made different types of improvements. CONCLUSION: Addiction recovery systems should recognize the potential utility of sober living houses and examine the types of houses needed in specific communities. Additional research should focus on common and unique therapeutic factors within programs that affect outcome.
 
Article
Much of the existing risk factor literature focuses on identifying predictors of low-levels of substance use versus higher-levels of substance use. In this paper, we explore more nuanced patterns of alcohol, tobacco, and other drug (ATOD) use during late adolescence. Our aims were to: 1) identify subgroups of youth with qualitatively different patterns of ATOD use; and 2) explore whether membership among qualitatively distinct, high-risk classes could be predicted based on early adolescent risk factors. Data came from a selected subsample of the National Longitudinal Survey of Youth (n = 1,689). Predictors were measured when youth were about 12 years old; ATOD use was assessed when youth were aged 17 years. Results showed that adolescent ATOD use is not a homogenous behavior. Four distinct classes of adolescent ATOD users were derived. Each class had a qualitatively distinct and discriminable pattern of ATOD use. Ecological predictors were shown to differentiate between latent classes, with peer factors playing a particularly important role in differentiating between high-risk and higher-risk users. Implications for prevention and limitations are discussed.
 
Article
The purpose of this study is to determine the association of receptivity to media models of smoking and nicotine dependence among South African adolescents from four ethnic groups. A stratified random sample of 731 adolescents aged 12 to 17 years (mean=14. 55, SD=1.68) was drawn from Johannesburg, South Africa. A structured questionnaire was administered to the participants in their homes by trained interviewers. Receptivity to media models of smoking was assessed with a three-item Likert scale. The dependent variable, nicotine dependence, was assessed with the Fagerström Test for Nicotine Dependence (FTND). Regression analyses showed a positive relationship between media receptivity and nicotine dependence, with control on demographic variables and hours of TV watched by the adolescent. This relationship was found to be strongest among White adolescents and weakest among Black adolescents. Though equally receptive to media models of smoking, Black adolescents have lower FTND scores than their peers from other South African ethnic groups. This may be related to the low prevalence of images in South Africa depicting Black people smoking cigarettes. Cultural norms against smoking among Black adolescents may also serve as a protective factor.
 
Article
Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and acceptability of a targeted cessation intervention developed for AN youth. Intervention components were informed by prior focus groups assessing treatment preferences among AN youth, a social cognitive theoretical framework and feedback obtained from a teen advisory group. The intervention consisted of a weekend program where youth traveled by small airplane from their villages to stay overnight with other adolescents who quit tobacco use together. The program included recreational activities, talking circles, personal stories from elders and teen advisors, and cognitive behavioral counseling. Two intervention pilots were conducted from October 2010 to January 2011 using a non-randomized, uncontrolled study design with assessments at baseline and six-week follow-up. One village in Western Alaska was selected for each pilot with a targeted enrollment of 10 adolescents each. Participants were recruited for each pilot within five days, but recruitment challenges and ''lessons learned'' are described. The first pilot enrolled nine adolescents (all female) aged 13-16 years; all nine attended the intervention program and 78% (7/9) completed follow-up. The second pilot enrolled 12 adolescents (eight females, four males) aged 12-17 years, of which seven attended the intervention program. Six of these seven participants (86%) completed follow-up. In both pilots, participants rated the intervention as highly acceptable. A targeted cessation intervention was feasible and acceptable to AN youth. The intervention will be tested for efficacy in a subsequent randomized controlled trial.
 
Article
Research examining the relationship between readiness to change and alcohol consumption among college students is inconsistent. The purpose of the present study was to extend these findings, using two different measures of readiness to change. We hypothesized a curvilinear effect would occur such that the relationship between readiness to change and alcohol use would be relatively low for students low and high on readiness to change, whereas the relationship would be relatively high for those with moderate levels of readiness to change. Data were collected from two studies: Study 1 consisted of 263 undergraduate students and Study 2 consisted of 245 undergraduates participating in either intercollegiate or recreational athletics at three US universities. In Study 1, we examined the association between both linear and quadratic scores on a readiness to change measure and alcohol use. In Study 2, we examined the relationship between scores on a stage of change measure that included subscales indicative of different levels of readiness to change and alcohol use. The pattern of relationships supported the existence of an effect where the highest levels of alcohol use occurred among those with scores representing moderate levels of readiness to change.
 
Article
Rural areas and American Indian reservations are hotspots for the use of crystal methamphetamine ("meth") in the United States, yet there is little ethnographic data describing meth use in these areas. This study draws upon three years of ethnographic work conducted with American Indian and White youth in Appalachia during the height of the meth epidemic. It describes how historical, cultural, and socioeconomic processes influence vulnerability to meth use in Appalachia, and highlights the role of social relationships and meaning-making in facilitating desistance and recovery from meth use. The first section shows how crystal meth filled a particular functional niche in the lives of many young men, alleviating boredom and anomie linked to recent socioeconomic changes and labor opportunities in the region, and intersecting with local understandings of masculinity and forms of military identity. Here, ethnographic and interview data converge to illustrate how social role expectations, recent socioeconomic change, and meth's pharmacological properties converge to create vulnerability to meth use in Appalachia. The second section draws upon two American Indian narratives of desistance. These youth described recently severed social relationships and acute feelings of social isolation during the initiation of meth use. Both also described dramatic close calls with death that facilitated their eventual desistance from use, involving repaired social relationships and the establishment of new lives and hope. These interviews illustrate how changes in social relationships were linked with both initiation and desistance from meth use, and how religious interpretations of near-death experiences structured narratives of cessation and redemption.
 
Article
Coaches can exert a considerable influence on the lives of their athletes. However, little is known about the influence of athletic coaches on athlete drinking behaviors. This study extends research on drinking influences in student-athletes. The relationship between athletic coaches and athlete drinking behaviors were examined. First-year college students (N=362) who had played high school sports were assessed on their relationships with their coaches as well as their alcohol use and problems. Findings revealed significant associations among the approval of and relationship with their athletic coaches and student drinking behaviors. These findings are discussed in the context of involving coaches in comprehensive strategies to reduce athlete drinking.
 
Article
Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking. We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status. A stratified random sample of adult health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). Using MANCOVAs and adjusting for health-related attitudes, values, and practices, we examined gender differences in relationships between alcohol consumption and health. More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers. Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.
 
Article
Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care. Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care. A stratified random sample of health-plan members completed a mail survey, yielding 7884 respondents (2995 male/4889 female). We linked survey data to 24 months of health-plan records to examine relationships between alcohol use, gender, health-related attitudes, practices, health, and service use. In-depth interviews with a stratified 150-respondent subsample explored individuals' reasons for seeking or avoiding care. Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher BMI, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care. Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.
 
Article
Basic behavioral and neurobiological research has demonstrated that deficiencies in naturally occurring substance-free rewards are both a cause and a consequence of substance abuse that are due in part to the systematic discounting of delayed substance-free rewards. Existing brief motivational interventions (BMIs) for alcohol abuse do not target this mechanism of change. The goal of this uncontrolled pilot study was to evaluate a behavioral economic Substance-Free Activity Session (SFAS) to traditional alcohol BMIs. Participants were 13 college freshmen who reported two or more heavy drinking episodes (>5/4 drinks in an occasion for men/ women) in the past month. All participants completed a baseline assessment and a BMI that addressed alcohol use. In addition, participants received the SFAS, a 50-min individual session that attempts to increase engagement in constructive alternatives to drinking by enhancing the salience of delayed rewards (academic and career success) and the patterns of behavior (academic and extracurricular engagement) leading to these outcomes. At the 1-month follow-up assessment, participants reported significant reductions in heavy drinking, and moderate to large effect size reductions in weekly drinking and peak blood alcohol levels. The results of this pilot study provide preliminary support for the efficacy of this behavioral economic intervention session as a supplement to traditional alcohol BMIs.
 
Characteristics of Ketamine Users and Non-Users 
Article
This study is the first to examine ketamine use and its association with HIV sexual risk behaviors among a criminal offending population in the United States. Data were collected from 716 inmates as part of the Transitional Case Management (TCM) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses were used to identify differences between ketamine users (n=44) and non-ketamine users (n=672). Three Poisson regression models were used to identify the significant correlates of high risk sexual behaviors in the 30 days prior to incarceration-- (1) number of times had unprotected sex while high, (2) number of times had unprotected vaginal sex, and (3) number of times had unprotected anal sex. Results indicate that ketamine was a significant correlate in all of the Poisson regression models. Findings add to the literature and indicate that ketamine use may be a marker for engaging in HIV risk behaviors among criminal offenders.
 
Article
Little is known about beliefs about quitting and treatment motivation in non-treatment seeking smokers. One hundred eight-eight daily cigarette smokers not currently motivated to quit smoking completed measures of perceived risks and benefits of quitting and motivation to quit. Self esteem related to quitting was positively related to desire to quit, expected success at quitting, confidence in quitting, and motivation to quit. Greater perceived risks of cravings were related to greater expected difficulty of remaining abstinent, and greater perceived risk of increased negative affect was related to decreased expectation of success at quitting, confidence for quitting, and increased expectation for difficulty remaining abstinent. Greater perceived risk of weight gain was related to being less likely to have a goal of complete abstinence. There were no gender, ethnicity, age, or education differences in the relationship of perceived risks and benefits of quitting and motivation. Knowing the risks and benefits that relate to motivation to quit for non-treatment seeking smokers provides the foundation for targeting this group in campaigns to increase quit motivation.
 
Article
The public perceptions of clubs and drugs reveal the existence of two opposing discourses. One, an official discourse, characterizes dance events and taking drugs as spaces of excess risk, which need to be controlled and regulated. The other, as exemplified in accounts of the participants themselves, emphasizes the pleasures and importance of these activities. The dichotomous nature of the discourses is not that surprising as many researchers have noted that adult concerns with youthful practices have been witnessed many times before. What is more surprising is the extent to which a division between perspectives on and approaches to understanding raves and drug use can be found not just in the contrast between official/government approaches and dance event participants, but also within scholarly work. Scholarship on raves, the dance scenes, and club drugs can be divided into two immensely differing traditions: epidemiological and cultural studies approaches. The cultural studies approach acts as a much-needed corrective to the epidemiological research through its introduction of a focus on pleasure, subjectivity, and social context and by more fully attending to youth perspectives. However, the cultural studies scholarship, itself, has important blindspots, particularly in its underemphasis on the role of drugs within the dance and rave scenes. We will argue for a third approach that utilizes the theoretical and methodological strengths of the cultural studies approach, while combining it with perspectives that allow us to comprehend the role that drugs play within these scenes and the roles of pleasure and risk within them.
 
Flow chart respondents T1-T2. 
Article
We examined whether use of snus influenced cognitions in terms of smoking expectancies and smoking prototype perceptions in a direction that could promote smoking initiation, thus highlighting potential causal mechanisms between the use of snus and smoking behavior. A telephone-based longitudinal survey among Norwegian adolescents was conducted with two points of measurement during a 1-year period in 2006-2007. The respondents were divided into four groups: Group 1: snus initiators during the period (N = 54), Group 2: regular snus users (N = 160), Group 3: non-users of snus and cigarettes (N = 376), and Group 4: regular smokers (N = 306). Wilcoxon tests were applied to determine any changes in smoking cognitions from 2006 to 2007. The group of snus initiators (Group 1) reported a significantly higher level of expectancies of smoking to promote negative affect reduction at follow-up, while all other cognitions remained stable. The group of smokers (Group 4) reported on average positive smoking cognitions, and significant changes were observed during the period. However, among regular snus users (Group 2) and non-users (Group 3), there were no significant changes in any of the smoking cognitions. The uptake of snus might influence expectancies of cigarettes to reduce negative affect in a direction facilitating smoking initiation, but the use of snus does not appear to influence the majority of cognitions known to promote smoking initiation among adolescents.
 
Article
The success or failure of programs designed to address alcohol and drug problems can be profoundly influenced by the communities where they are located. Support from the community is vital for long term stability and conflict with the community can harm a program's reputation or even result in closure. This study examined the community context of sober living houses (SLHs) in one Northern California community by interviewing key stakeholder groups. SLHs are alcohol and drug free living environments for individuals attempting to abstain from substance use. Previous research on residents of SLHs showed they make long-term improvements on measures of substance use, psychiatric symptoms, arrests, and employment. Interviews were completed with house managers, neighbors, and key informants from local government and community organizations. Overall, stakeholders felt SLHs were necessary and had a positive impact on the community. It was emphasized that SLHs needed to practice a "good neighbor" policy that prohibited substance use and encouraged community service. Size and density of SLHs appeared to influence neighbor perceptions. For small (six residents or less), sparsely populated houses, a strategy of blending in with the neighborhood seemed to work. However, it was clear that larger, densely populated houses need to actively manage relationships with community stakeholders. Strategies for improving relationships with immediate neighbors, decreasing stigma, and broadening the leadership structure are discussed. Implications for a broad array of community based programs are discussed.
 
Dichotomous variables associated with internal support confrontation scale. 
Article
The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that measures a construct of confrontation defined as warnings about potential harm associated with alcohol and drug use. This analysis describes the characteristics of individuals entering residential recovery homes (N=323) who received confrontation and when it was experienced as supportive. A large proportion reported receiving at least one confrontational statement (80%), most commonly from family/friends (71%). Individuals who did and did not receive confrontation did not differ by demographics, but those receiving confrontation had more recent substance use, higher perceived costs of sobriety and more severe family and psychiatric problems. Differences were noted in confrontation from the criminal justice system versus family/friends. Overall, residents experienced confrontation as supportive regardless of who confronted them. Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.
 
Article
The drug "Ecstasy" has been most commonly associated with raves, or electronic music dance events, and attributed with sexual disinhibition. In an ethnographic investigation of drug use among second-generation Southeast Asian youth in Northern California (2003), respondents described little use of or interest in using Ecstasy; yet in a second study, Ecstasy was the fourth most commonly-used substance. This paper investigates the social contexts for this change in use patterns. Respondents were second-generation Southeast Asian youths and young adults between the ages of 15 and 26 who were currently or recently drug-involved. We compared qualitative data from the two studies and found emerging patterns of meaning and context related to the observed change in use patterns. Ecstasy use among co-resident African American youth within the context of the local "hyphy" hip-hop music subculture had influenced Southeast Asian youths' uptake of the drug, known as "thizz." Respondents referred to the effects of the drug as "thizzin'," described as energizing, disinhibiting, numbing, and emotion enhancing. Reported consequences of "thizzin'" included violence and aggression as well as fun, while sexual disinhibition was rarely mentioned. The meanings assigned to drugs, including the effects ascribed to them, may be relative to the social contexts within which users are exposed to and consume drugs. The findings indicate the susceptibility of youths to local trends in drug use, particularly associated with popular cultural movements and music. Second-generation youths may be particularly susceptible relative to the conditions of their immigration and processes of identity formation unique to them.
 
Ten-Year Drug Use Trends for Reported Users By Age 
Article
From the late 1990s onward, ketamine use among young persons in Hong Kong grew rapidly becoming the drug of choice. This article examines ketamine's attraction in Hong Kong, and in so doing uncover the cultural meaning of ketamine use. The analysis is organized around the emergence and shifts in meanings and experiences of those who initiate and continue to use ketamine. The data stems from a comparative study of the social setting of club drug use in Hong Kong, San Francisco, and Rotterdam. Here we draw from 100 in-depth interviews to examine the experiences of young persons who have used drugs in dance venues in Hong Kong. Our findings indicate that ketamine has become embedded in a distinctively working class youth dance scene, is accessible in terms of supply and cost, shared among a group of friends, and results in a stimulating yet liberating experience beyond that of ecstasy.
 
Article
Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers. Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until becoming ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships. A stratified random sample of health-plan members (7884; 2995 males, 4889 females) completed a mail survey that was linked to 24 months of health-plan records. Data were used to examine relationships between alcohol use, gender, health-related attitudes/practices, health, and prevention-service use. Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher BMI (negative). When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.
 
Article
Ketamine is a dissociative anesthetic with powerful sedative and hallucinogenic properties. Despite the wide variability in reported subjective experiences, no study has attempted to describe the particular factors that shape these experiences. This manuscript is based upon a sample of 213 young injection drug users recruited in New York, New Orleans, and Los Angeles with histories of ketamine use. Qualitative interviews focused on specific ketamine events, such as first injection of ketamine, most recent injection of ketamine, and most recent experience sniffing ketamine. Findings indicate that six factors impacted both positive and negative ketamine experiences: polydrug use, drug using history, mode of administration, quantity and quality of ketamine, user group, and setting. Most subjective experiences during any given ketamine event were shaped by a combination of these factors. Additionally, subjective ketamine experiences were particularly influenced by a lifestyle characterized by homelessness and traveling.
 
Article
This article articulates a subcultural basis to the evolving popularity for different illicit drugs primarily based on empirical research in the United States, especially among inner-city populations. From this perspective, drug use emerges from a dialectic between drug subcultures with individual identity development. The prevailing culture and subcultures affect drugs' popularity by imparting significance to their use. Innovations, historical events, and individual choices can cause subcultures to emerge and change over time. This subcultural view provides insight into the widespread use of licit drug, the dynamics of drug eras (or epidemics), the formation of drug generations, and the apparent "gateway" phenomenon.
 
Article
The continued struggle of addiction recovery support systems suggest that the paradigm of this field needs to continue its evolution, which has increasingly emphasized environments. Field Theory suggests that the products of individual and environmental characteristics be considered rather than a summation of the two. This study examined such interactions in Oxford Houses, a network of democratic, and self-governed addiction recovery homes. This study examined sobriety in experienced houses (average length of residency > six months) compared to less experienced houses (average length of residency ≤ six months) in relation to individual resident characteristics (age, length of residence in an Oxford House, and referral from the criminal justice system). Using multilevel modeling, findings indicated that older residents living in an experienced Oxford Houses were more likely to remain abstinent over time than those in inexperienced homes. Additionally, for inexperienced houses, residents who had been in the Oxford House for a longer period had a higher the probability of abstinence than those that had been in the house for a shorter period of time. Finally, legal referral was related to a lower probability of one-year abstinence but only for those in experienced homes. These types of person-environment interactions point to the need for more research to better understand how person variables interact with environmental variables in the processes of recovery and adaptation to settings, as well as for treatment professionals' consideration of both person and environment when making recovery home referrals.
 
Smoking frequency and experience when young people first experienced the “pleasure of smoking.” A total of 115 vocational students (age range: 19–29 years; mean age (SD): 22.4 (1.7) years; 102 male and 13 female participants) were surveyed. In all, 42 were current smokers, 10 former smokers, 18 nonsmokers who experimented with smoking, and 45 never-smokers. In all, 53 students (all of the current and former smokers and one nonsmoker who had experimented with smoking) answered they had experienced the “pleasure of smoking.” The average smoking frequency and the lifetime number of cigarettes smoked when respondents first experienced the “pleasure of smoking” are shown above. One subject did not answer regarding his lifetime number of cigarette smoked. aLess than 1 cigarette weekly (score = 1), less than 1 cigarette daily (score = 2), 1–5 cigarettes daily (score = 3), 6–10 cigarettes daily (score = 4), 11–20 cigarettes daily (score = 5), and more than 20 cigarettes daily (score = 6). b1–2 (score = 1), 3–5 (score = 2), 6–9 (score = 3), 10–19 (score = 4), 20–39 (score = 5), and 40 or more (score = 6). These categorizations followed those of the European School Survey Project on Alcohol and Drugs (Hibell et al., 2003).
Hypothetical anticipatory brain activity curve in the course of development of addiction, according to the Paradise Lost theory.
The process of formation of nicotine dependence, according to the Paradise Lost theory.
Article
The neural reward circuit and cognitive distortion play an important role in addiction; however, the relationship between the two has not yet been addressed. In this article, we review recent findings on nicotine dependence and propose a novel hypothesis. Previous research using functional magnetic resonance imaging (fMRI) has shown that while activation of the reward circuit (ventral striatum) appears in response to tobacco-related rewards in nicotine dependence, responses to rewards other than tobacco (e.g. food and money) are reduced. Moreover, this change is observed at the very early stages of smoking, even when a person has smoked fewer than 10 cigarettes in his/her lifetime. Thus, we propose the following hypothesis, called the Paradise Lost theory: given addicts' lower ventral striatal responses to non-tobacco rewards, nicotine addiction disables smokers from sensing the pleasures of ordinary life (the Paradise Lost state). However, since smokers do not notice this, they produce an overestimation of tobacco (cognitive distortion), such that they do not have many pastimes other than smoking or feel that quitting smoking would reduce the happiness and pleasure and increase the difficulty of life. Cognitive distortion thus makes it difficult for smokers to take the initiative to quit smoking and even causes relapse after smoking cessation. This theory furthers our understanding of addiction and could improve our approach to the prevention and treatment of addiction.
 
Consumption categories of the dependent variable 
Descriptive statistics of variables 
Marginal effects after robust multinomial logit regression 
Odds ratios of robust multinomial logit estimation 
OLS illustration of coefficient effects following pooling of alcohol consumption groups in a log wage equation 
Article
Several studies have found protective effects of low/moderate (hereafter “light”) alcohol consumption compared with “abstinence” on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption. It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers. The aim of this paper is to study whether pooled groups risk create bias in the form of misclassification and confounding. The analysis focuses on: ‘former drinker error’ (pooling of lifelong abstainers and former drinkers); ‘former abstainer error’ (pooling of former abstainers and lifelong light drinkers); and ‘former heavy drinker error’ (pooling of light drinkers with and without a history of heavy drinking). Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups. The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers. The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and can therefore not explain the wage penalty of abstinence compared to light drinking.
 
Article
Two instruments measuring conceptually distinct models of alcohol use were administered to a sample of 18 to 22 year-old college drinkers. One instrument assessed social contexts of drinking, defined as a combination of intra personal motivations and immediate environmental variables which influence alcohol use. A second instrument assessed alcohol expectancies, which are the anticipated outcomes or reinforcements obtained from drinking. The results indicated that the social context set accounted for 70 per cent of the variance in a measure of alcohol use intensity, compared to 48 per cent which was accounted for by the expectancy set. Social Facilitation was the single most important context factor related to alcohol intensity. The implications of these findings and future directions for social context research are discussed.
 
Article
This article explores the role of changing images of drug use in rap music from the 1970s to the 1990s. A sample of 341 rap music lyrics were coded for drug mentions, behaviours and contexts; drug attitudes and consequences; and music genres. The results show that from 1979–1997, songs with references to drugs increased over 6-fold; those exhibiting positive attitudes and consequences rose substantially and that references to particular drug types changed significantly. In addition, there were significant changes in the social context of drug use such as increased references to using drugs to signify glamour, wealth and sociability. The article examines potential explanations of the increasing focus on drug use rap music which includes the rise of the drug war; changes in the drug use habits of rappers and listeners; rise of gangsta rap and other rap music genres, and changing social images of drugs in American society.
 
Article
The aim of this article is to assess the extent to which the advent of harm reduction policies brought a reversal of the ‘deviantization’ of heroin users. In order to do so, the analysis will be based on the concept of policy “paradigms” or belief systems. Such a theoretical and methodological choice involves two additional (underlying) objectives. The first is to show how the application of public policy theory can harness a better understanding of the drug issue. The second is to demonstrate that case studies conducted in the drug field may also in turn contribute to useful questioning of both the theoretical basis and design of some policy analysis models. First, the application of the above mentioned approach to drug policy is discussed. The evolution of the different components of British drug policy is then analysed. Finally, amendments to public policy analysis models based on the concepts of paradigms or belief systems are suggested, that may help interpret the evolution of British drug policy after the advent of AIDS and its impact on the social representation of drug users.
 
Article
Scotland has a new database on drugs-related deaths (DRDs). We review the prior toxicology and demography of Scotland's DRDs in 2000–2007. Each DRD was cross-classified by the presence/absence of heroin (H); methadone (M); diazepam (D); and alcohol (A). Comparisons were made by era (2000–2002, 2003–2005 and 2006–2007), sex and age-group (under 35 years and 35+ years). Data were for 1007 DRDs in 2000–2002 (180 female); 1011 in 2003–2005 (206 female); and 875 in 2006 and 2007 (149 female). DRDs citing diazepam decreased from around half in 2000–2002 to only 18% by 2006 and 2007 (95% CI: 15–21%). The presence of alcohol decreased also, for males, down from 43% of 827 DRDs in 2000–2002 (95% CI: 40–46%) to 35% of 726 DRDs in 2006 and 2007 (95% CI: 31–38%). The presence of heroin and alcohol were positively associated; of heroin and methadone strongly negatively. Alcohol's co-presence was age related: present in 53% of 598 male heroin-DRDs at 35+ years of age but in only 36% of 974 male heroin-DRDs under 35 years of age. Neither methadone nor heroin was present in a third of all female DRDs (183/535) and a fifth of male DRDs (460/2358). In 101 female and 276 male DRDs, none of H, M, D or A was mentioned. Periodically, the toxicology and demography of a country's DRDs should be analysed together, as here for Scotland, to highlight idiosyncrasies or insights. That alcohol's co-presence at heroin-DRDs was age related adds to several reasons for (ageing) heroin injectors to moderate their alcohol intake.
 
Article
We evaluate a method to describe changing substance use patterns in northern Australia's remote Aboriginal communities (Arnhem Land, Northern Territory). Substance use was assessed in random samples in two communities A (n = 194) and B (n = 176). Five Aboriginal health workers made assessments independently of each other in community A. A different group of three health workers made independent assessments in community B. Sub-samples were opportunistically recruited for interview (community A, n = 77; community B, n = 55). In community C, 101 people were interviewed and were also assessed by four local health workers working together. Proportional agreements (kappa-κ statistic) among health workers for a history of substance use and current use, varied from κ = 0.207 for petrol sniffing (P = 0.006) up to κ = 0.749 for cannabis use (P<0.001), all better than would be expected by chance. In communities A and B, agreement between health workers’ consensus and self-reported substance use was weaker (0.103<κ<0.482) probably because of under-reporting in interviews. In community C, where interviews were conducted in a confidential clinic setting, agreement between health workers’ concensus and self-report varied from κ = 0.273 for petrol sniffing (P<0.001) up to 0.819 for tobacco use (P<0.001). Aboriginal health worker consensus classification clarified equivocal self-report data.
 
Article
This study examined the associations between 12-step self-help group participation following substance abuse treatment and abstinence from marijuana use at 1-, 2-, and 5-years post-treatment. These associations were examined among 1288 male patients of the Department of Veterans Affairs who used marijuana within the 3 months prior to admission to treatment and discontinued use at treatment discharge. Consistent with expectation, 12-step self-help group attendance during the 3 months prior to each follow-up was significantly related to corresponding rates of abstinence at each follow-up time point. Additionally, 12-step self-help group attendance predicted more distal marijuana abstinence and recent attendance added to the prediction. Subsidiary analyses indicated that self-help attendance was important both for the maintenance of marijuana abstinence and for the re-initiation of abstinence after a relapse. Results are discussed in relation to better understanding the role of 12-step self-help group attendance in the initiation and maintenance of marijuana abstinence.
 
Article
This study was a nationwide survey of 205 Veterans Affairs (VA) staff on their views of 11 psychotherapy models for posttraumatic stress disorder (PTSD), substance use disorder (SUD), or comorbid PTSD/SUD. For each model, staff rated four key areas: level of implementation, helpfulness overall, helpfulness for PTSD/SUD, and desire for training on it. They also provided quantitative and qualitative information on general questions related to PTSD/SUD treatment. Results indicated that most respondents were already using one or more models, and they reported significantly different ratings of the models in each of the four key areas addressed, with some models quite consistently appearing at the top or bottom of the list. Furthermore, the more the clinicians had implemented a particular model, the more helpful they found it. A factor analysis of the models indicated four factors that appeared related to their content, rather than to how much they were liked. Finally, qualitative comments emphasized a desire for more training on PTSD/SUD topics and models, a broader array of psychotherapies to be implemented in VA, and more guidance on the use of PTSD models in the context of SUD. Results are discussed in terms of methodology, the need for replication, how ratings may have been affected by lack of experience with particular models, and the need for further research on adoption of evidence-based practice models.
 
Article
Adults with substance use disorders (SUD) often have experienced multiple psychological traumas and suffer from posttraumatic stress disorder (PTSD) and complex PTSD impairments (e.g., dissociation, affect dysregulation). Among adult addiction treatment outpatients with self-reported trauma histories, 50% had PTSD alone, 41% had comorbid PTSD and complex PTSD, and 4% had complex PTSD alone. Compared to PTSD alone, comorbid PTSD/complex PTSD was associated with a history of childhood sexual trauma, sexual retraumatization in adulthood, and more severe PTSD and depression symptoms. Patients with alcohol-related SUDs were at increased risk for PTSD, while those with cocaine or opiate SUDs had a reduced risk of comorbid PTSD/complex PTSD. Gender and ethnicity were unrelated to PTSD or complex PTSD except that women were at lower risk than men for PTSD alone. Complex PTSD may warrant clinical and research evaluation, particularly for patients with histories of childhood sexual trauma and retraumatization.
 
Participant flow. 
Article
Little is known about the assessment and treatment of self-stigma in substance abusing populations. This article describes the development of an acceptance based treatment (Acceptance and Commitment Therapy–ACT) for self-stigma in individuals in treatment for substance use disorder. We report initial outcomes from a study with 88 participants in a residential treatment program. The treatment involves 6 h of a group workshop focused on mindfulness, acceptance, and values work in relation to self-stigma. Preliminary outcomes showed medium to large effects across a number of variables at post-treatment. Results were as expected with one potential process of change, experiential avoidance, but results with other potential mediators were mixed.
 
Article
This exploratory study examines whether the attitudes towards change and treatment of untreated non-abstinent substance abusers differ from those of patients undergoing treatment in residential care. The sample (n = 97) consists of untreated, voluntarily and compulsorily treated substance abusers who completed a questionnaire in 2003. Attitudes were measured with scales on e.g. problem recognition, desire for help, treatment readiness and aspects of time perspectives, e.g. past, present and future orientation. The attitudes of the three groups – untreated, voluntarily and compulsorily treated subjects – differed with respect to lifestyle change. Factor analysis of the measures revealed one component of primary interest, general willingness to change. Results show that willingness to change was correlated with other attitudinal characteristics in the three groups. The stability of substance abusers’ motivation is discussed with the focus on different social contexts’ influence on change-compliant attitudes and behaviour.
 
Article
HELP!!! is an interactive, experiential simulation of the health care system that youth with concurrent mental health and addiction issues need to access for help. Using this exercise after a didactic teaching session reinforces the learning, synthesizes the knowledge for application and encourages group discussion and the sharing of participants’ knowledge. This exercise was originally developed to create an opportunity for interprofessional learning groups to experience the gaps and barriers youth encounter as they attempt to navigate the system and to act as a catalyst for creative problem solving and system change. By participating, learners experience a simulation of what youth, family members, and various professionals usually encounter in the system. This exercise elicits key issues for discussion and provides a forum for networking and the initiation of collaborative ventures for healthcare providers.
 
Article
This article discusses various ways in which ethnographic methods were employed in a cohort study of HIV risk and transitions to injecting among non-injecting heroin users (NIUs), or ‘sniffers’, in New York City. In preparation for and in conjunction with an epidemiologic questionnaire survey and biological specimen collection, ethnographic methods were used to explore the meaning of non-injecting and injecting routes of heroin administration for NIUs, how non-injecting heroin use was imbedded in the everyday life of the user, and the relationship of users to the retail markets for heroin. The study utilised different ethnographic techniques to access, sample, and screen heroin ‘sniffers’ for the epidemiologic survey. These techniques included ethnographic accessing, targeted canvassing, and interactive screening. The article concludes that ethnographic methods can be fruitfully integrated with epidemiologic survey research and are necessary for conducting research among non-institutionalised, ‘hidden’ populations of drug users.
 
Article
Mark-Recapture methods of prevalence estimation have been widely used to estimate the local prevalence of injecting drug use, based on the ethical identification and modelling of overlaps between different partial agency populations of drug injectors. Re-application of this technique to estimation of local prevalences of problem drinking has been frustrated by the fact that different local agencies are likely to have different operational definitions of their target problem drinking populations. A feasibility study was conducted to explore the possibility of producing local problem drinking estimates by combining mark-recapture modelling with the use of AUDIT, a screening instrument. Unfortunately, low rates of screening by agencies produced very few overlaps, but after modification to the research design it proved possible to estimate the prevalence of problem drinking as 8.6 % of the local population (95 % CI: 6.0 % to 12.8 %). It is recommended that this approach to population estimation be used for problem drinking populations only where screening of agencies' clients/patients can be centrally directed and resourced and conducted by trained interview teams.
 
Article
The editorial discusses the different concepts of addictive behaviors. The editorial argues the case for a complex systems model of addiction. "Complex" for obvious reasons, and "systems" after Davies (1992), who argues that alternative explanations for excessive behaviour require "the development of a "system" within which drug use is conceived of as an activity carried out for positive reasons, by people who make individual decisions about their substance use, and who may take drugs competently as well as incompetently". Gambino and Shaffer (1979) have emphasized the difficulties of re-integrating research and practice in the area of addiction. The complex systems model corresponds well to the biopsychosocial approach to addiction. From the perspective of the complex systems model, it is possible to consider the interaction of both the common and the unique elements of any specific individual's situation. This includes psychological, physiological, social and cultural factors that may be particular to any individual. The biological effects of any particular behaviour or drug may have a strong relationship with other biological factors, and with the psychological factors and the social factors which interact together during the addictive process. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Article
Discusses gambling addiction and the concept of "near miss." A gambler may become addicted because of the constant rewards or reinforcements that they are given in the gambling situation. The nature of such reinforcements can be multiple. For instance, they could be financial e.g., winning money, physiological the thrill and the "buzz" of gambling, psychological e.g., raising of self-esteem, peer praise and/or psychosocial e.g., the social meaning of the activity, rites of passage etc. There are also multiple stimuli that may be perceived to be rewarding in specific gambling settings because they produce excitement, arousal, and tension e.g., pre-race and race sequence at the race track, the flashing lights of a slot machine, the spinning roulette wheel, the placing of bets. The basic proposition is that gambling behaviour is maintained by winning and losing sequences within an operant conditioning paradigm. However, there can also be intermediate reinforcers in the guise of "near misses". Gamblers experiencing near misses may take them as encouraging signs by confirming the gambler's strategy and raising hopes for future success (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Article
Theories regarding how exercise can become addictive, and studies of withdrawal from exercise are reviewed. Several physiological mechanisms, including endogenous opioids, catecholamines, and dopamine pathways, have been implicated in exercise dependence. The higher levels of endogenous opioids found following strenuous exercise, has prompted researchers to suggest that a form of autoaddiction to these hormones might be responsible for continued excessive exercising in humans. As well, investigators have suggested that, exercise dependence could be the result of a dependence on the exercise stimulated release of catecholamines, resulting in an overarousal of the sympathetic nervous system. Moreover, the increased stimulation of dopaminergic brain structures by exercise, and the likely involvement of these structures in behavioural and pharmacological addictions, could provide another explanation for exercise-dependent behaviour. Finally, reports of withdrawal symptoms following cessation of regular exercise, has led investigators to propose that exercise can, like pharmacological and other behavioural stimuli, become addictive. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Article
The study identifies and categorizes concepts of addiction among treated and non-treated former alcohol dependents, and their function in the process of recovery from addiction within the post-communist treatment system dominated by the Minnesota model. This qualitative study is based on a media recruited sample of 29 former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. They reported a recovery time of at least 2 years (Mrecovery = 11, SD = 9). In-depth interviews were analysed according to the Problem-Centred Interview method using Atlas.ti software. The applied triangulation procedures ensure reliability and validity of the data collected and the analysis of the narrative accounts. The results of the study show that professional concepts of addiction reconstructed on the basis of narratives from treated respondents resemble the disease model of addiction. A first category of lay concepts of self-changers adopt a medical–moral model of dependence including strong will as a key element of the successful recovery. A second category describes dependence as a symptom of maladaptive social functioning and recovery as a process of understanding one's role in society and fulfilling social expectations. While self-changers relied on one of these lay concepts, treated respondents were confronted with a conflict between lay and professional definition of dependence. It is argued that lack of recognition of lay concepts of addiction by treatment providers may weaken help-seeking and increase drop-out rates. The disease model implies the stability of the status of the alcoholic – which potentially weakens the individual's chance to reach the stage of stable recovery.
 
Article
This review summarizes the literature on psychiatric co-morbidity of substance use. The author overviews general population epidemiological surveys as well as clinical studies, and discusses both DSM axis I and axis II disorders. After presenting epidemiological data the author analyzes the nature of relationship between psychoactive substance use and other mental disorders, and–through examples–four possible models of this relationship are examined. Despite the lack of precisely determined prevalence rates, some definite tendencies could be observed along the consistent results of the studies. Due to methodological problems, however, many questions remain unanswered. Although there are relatively comprehensive studies on psychiatric disorders associated with drug use and drug addiction, the question of causality is relatively unresolved. Theoretically possible relations regarding causality seem to overlap in practice, and in most cases linear type connection is unlikely. It can be concluded that general questions, such as which disorders have a great significance in connection to drug use, can be answered. Additional research is needed, however, to examine the effects of different drug types, race, and gender. Understanding causality also requires further research.
 
Article
The term addiction involves aspects of salience, withdrawal, and conflict or interference with everyday functioning. The present series of studies examined whether high levels of engagement with the Harry Potter (HP) phenomenon could qualify as an addiction. Through use of three surveys posted online, we established that a sizeable portion (though not a majority) of self-described HP fans demonstrated craving for the release of the final book in the series, and experienced some withdrawal symptoms upon finishing the book. HP fandom also produced a disruptive influence on day to day functioning of some fans in a 6 month follow-up. In sum, we found parallels between criteria used to diagnose traditional forms of addiction or dependence and some people's attachment to a phenomenon in popular culture.
 
Article
The recent publication of a series of documents providing guidance for practice in the drug misuse treatment field in the UK (Orange Guidelines, Department of Health, 2007) has raised questions as to the exact role of the 'drug worker'. Guidance from the National Treatment Agency highlights the central role of key working and case management within drug treatment, and NICE guidelines about psychosocial treatments for drug user emphasises the effectiveness of brief and targeted interventions over broader and more humanistic psychological approaches. This will feel like a dramatic change in direction for many staff working in the field, and will not sit easily with many of them. However, such a strategy is part of a series of moves to standardise the quality of drug treatment services in the UK, and support for this broad strategy comes from a well established source. There are two fundamental implications of the model for the delivery of treatment--that lower-level interventions must precede higher-order ones, and second that higher-order needs are unlikely to emerge in the initial contact stages. This has fundamental implications for what we are trying to achieve in drug treatment services and places huge importance on care planning and review as core components of the treatment process. In other words, the major emphasis on comprehensive assessment is misplaced according to a hierarchy of needs model, where needs other than the most urgent are unlikely to emerge. Thus, it is only through treating care planning as treatment that it is realistic to expect a treatment journey to be effective. As clients and workers manage the basic physiological needs, can treatment start to look at issues of safety, then belonging, esteem and addressing more spiritual needs. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
 
Article
This study analyses the relationship between buying addiction and a set of individual factors. The results show that addictive buying is significantly associated with the personal variables considered in our research; what is more, the discriminant analysis carried out suggests a “hierarchy” of defining factors common to those individuals who present a high level of addictive buying: anxiety, depression, and obsessive-compulsiveness are the variables which are most closely linked to this psychological addiction, followed by passive coping, low self-esteem, low conscientiousness, external locus of control, and sensation seeking, respectively. The implications and potential limitations of these findings, as well as some recommendations for future research, are presented.
 
Top-cited authors
Mark D Griffiths
  • Nottingham Trent University
David Best
  • University of Derby
Cristina Jenaro
  • Universidad de Salamanca
Cristina Caballo
  • Universidad de Salamanca
María Gómez Vela
  • Universidad de Salamanca