Disaggregating the Burden of Substance Dependence in the United States

Laboratory of Epidemiology, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA.
Alcoholism Clinical and Experimental Research (Impact Factor: 3.21). 03/2011; 35(3):387-8. DOI: 10.1111/j.1530-0277.2011.01433.x
Source: PubMed
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Available from: Howard B Moss
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    • "Tobacco research should be a major focus of a new institute and not the sole purview of the National Cancer Institute (NCI) or National Heart, Lung and Blood Institute (NHLBI) so that the prevention and treatment of tobacco addiction is not subsumed by the study of its general health consequences. Indeed, tobacco is, by far, the most addictive of all the drugs (Table 1), followed by heroin and crack cocaine (percentage of pastyear users with past-year dependence; Grant et al., 2011). It would certainly be unreasonable to expect scientists within NCI and NHLBI to be experts on addiction , and for many, such specialist training would be lacking. "

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    • "indicate that tobacco is, by far, the most addictive of all the drugs, followed by heroin and crack cocaine (percentage of past-year users with past-year dependence) (Grant et al., 2011). It would certainly be unreasonable to expect scientists within NICHD, NIDDK, NCI, and NHLBI to be experts on addiction, and for many, such specialist training would be lacking. "
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    ABSTRACT: Widespread concern about illicit drugs as an aspect of workplace performance potentially diminishes attention on employee alcohol use. Alcohol is the dominant drug contributing to poor job performance; it also accounts for a third of the worldwide public health burden. Evidence from public roadways--a workplace for many--provides an example of work-related risk exposure and performance lapses. In most developed countries, alcohol is involved in 20-35% of fatal crashes; drugs other than alcohol are less prominently involved in fatalities. Alcohol biomarkers can improve detection by extending the timeframe for estimating problematic exposure levels and thereby provide better information for managers. But what levels and which markers are right for the workplace? In this paper, an established high-sensitivity proxy for alcohol-driving risk proclivity is used: an average eight months of failed blood alcohol concentration (BAC) breath tests from alcohol ignition interlock devices. Higher BAC test fail rates are known to presage higher rates of future impaired-driving convictions (driving under the influence; DUI). Drivers in alcohol interlock programmes log 5-7 daily BAC tests; in 12 months, this yields thousands of samples. Also, higher programme entry levels of alcohol biomarkers predict a higher likelihood of failed interlock BAC tests during subsequent months. This paper summarizes the potential of selected biomarkers for workplace screening. Markers include phosphatidylethanol (PEth), percent carbohydrate deficient transferrin (%CDT), gammaglutamyltransferase (GGT), gamma %CDT (γ%CDT), and ethylglucuronide (EtG) in hair. Clinical cut-off levels and median/mean levels of these markers in abstinent people, the general population, DUI drivers, and rehabilitation clinics are summarized for context.
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