CERGA Journal Title and Abstracts September 2015

Contents PAGE

LIST OF JOURNALS CHECKED 3

LIST OF REFERENCES

Alcohol - Anti-social Behaviour 4

Alcohol – Brief Intervention 4

Alcohol Effects 4

Alcohol - Epidemiology and Demography 5

Alcohol - Miscellaneous 5

Alcohol – Parenting 5

Alcohol - Policy 5

Alcohol Screening 6

Alcohol Screening – Brief Intervention 6

Alcohol Services 6

Alcohol Treatment 6

Alcohol and Young People 6

Blood Borne Viruses 7

Co-Morbidity 7

Drug Related Death 7

Epidemiology and Demography 8

Hepatitis C 8

Homelessness 9

Injecting Behaviour 9

Injecting Drug User 9

Miscellaneous 9

Nalaxone 10

Opiate Recovery Treatment 10

Opiate Treatment Services 10

Organisation of Treatment 10

Overdose and Drug Related Deaths 11

Parenting and Young People 11

Prescription Misuse 11

Prevention and Diversionary Activities 11

Recovery 11

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Smoking 11

Smoking Cessation 12

Stigma 12

Treatment Services 12

LIST OF ABSTRACTS 13-65

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Journal Title Volumes and Issues CheckedNumber of issues

per year

Addiction Volume 110, Issue 6[5], Issue 7[1], Issue 8[5], Issue 9[5]

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Addictive Behaviours Volume 48[1], Volume 50[3] 12Alcohol and Alcoholism Volume 50 Issue 4[2], Issue 5[2] 6Alcoholism Clinical & Experimental Research

Volume 39 Issue 5[1], Issue 6[4], Issue 7[2]12

Drug and Alcohol Dependence Volume 152[5], Volume 153[5], Volume 154[7]

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Drugs Education Prevention and Policy

Volume 22 Issue 3[4] 6

Drug and Alcohol Review 6European Addiction Research Volume 21 Issue 6[1] 4-5Harm Reduction Journal April 2015 Volume 12[1], June 2015 Volume

12[1]12

International Journal of Drug Policy Volume 26 Issue 7[3] 6Journal of Substance Abuse Treatment

Volume 56[1]8

The American Journal of Drug and Alcohol Abuse

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Substance Use and Misuse Volume 50 Issue 6[2] 12

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LIST OF REFERENCES

ALCOHOL – ANTI-SOCIAL BEHAVIOUR

1. “Not a good look”: Impossible Dilemmas for Young Women Negotiating the Culture of Intoxication in the United KingdomLin Bailey, Christine Griffin, Avi ShankarSubstance Use & Misuse May 2015:50(6);747–758

ALCOHOL – BRIEF INTERVENTION

2. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trialsJoseph E. Glass, Ashley M. Hamilton, Byron J. Powell, Brian E. Perron, Randall T. Brown, Mark A. IlgenAddiction 2015:110(9);1404-1415

ALCOHOL EFFECTS

3. Theory of Mind Difficulties in Patients with Alcohol Dependence: Beyond the Prefrontal Cortex Dysfunction HypothesisFrançois Maurage, Philippe de Timary, Juan Martin Tecco, Stéphane Lechantre, Dana SamsonAlcoholism: Clinical and Experimental Research 2015:39(6);980-988

4. Adolescent Intermittent Alcohol Exposure: Persistence of Structural and

Functional Hippocampal Abnormalities into AdulthoodMary-Louise Risher, Rebekah L. Fleming, W. Christopher Risher, K. M. Miller, Rebecca C. Klein, Tiffany Wills, Shawn K. Acheson, Scott D. Moore, Wilkie A. Wilson, Cagla Eroglu, H. S. SwartzwelderAlcoholism: Clinical and Experimental Research 2015:39(6);989-997

5. The Moderating Role of Cognitive Capacities in the Association Between Social Norms and Drinking BehaviorsSamuel N. Meisel, Craig R. Colder, Larry W. HawkAlcoholism: Clinical and Experimental Research 2015:39(6);1049-1056

6. Ecological evidence that affect and perceptions of drink effects depend on

alcohol expectanciesHayley Treloar, Thomas M. Piasecki, Denis M. McCarthy, Kenneth J. Sher, Andrew C. HeathAddiction 2015:110(9);1432-1442

7. The Association of Alcohol Severity and Sleep Quality in Problem DrinkersEmily E. Hartwell, Spencer Bujarski, Suzette Glasner-Edwards, Lara A. Ray Alcohol and Alcoholism 2015:50(5);536-541

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ALCOHOL EPIDEMIOLOGY & DEMOGRAPHY

8. Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathologyHoward B. Moss, Risë B. Goldstein, Chiung M. Chen, Hsiao-Ye YiAddictive Behaviors 2015:50;192-198

9. Typology of Alcohol Mixed with Energy Drink Consumers: Motivations for Use

Amy Peacock, Nicolas Droste, Amy Pennay, Peter Miller, Dan I. Lubman, Raimondo BrunoAlcoholism: Clinical and Experimental Research 2015:39(6);1083-1092

10. Injury-Related Mortality Over 12 Years in a Cohort of Patients with Alcohol Use

Disorders: Higher Mortality Among Young People and WomenAnna M. Guitart, Albert Espelt, Yolanda Castellano, Josep M. Suelves, Joan R. Villalbí, M. Teresa BrugalAlcoholism: Clinical and Experimental Research 2015:39(7);1158-1165

ALCOHOL MISCELLANEOUS

11. The impact of extended closing times of alcohol outlets on alcohol-related injuries in the nightlife areas of Amsterdam: a controlled before-and-after evaluationMoniek C.M. de Goeij, Eleonore M. Veldhuizen, Marcel C.A. Buster, Anton E. KunstAddiction 2015: 110(6);955-964

12. Navigating the Alcohol Treatment Pathway: A Qualitative Study from the

Service Users' PerspectiveHelen Gilburt, Colin Drummond, Julia Sinclair Alcohol and Alcoholism 2015:50(4);444-450

ALCOHOL – PARENTING

13. Understanding the Role of Context-Specific Drinking in Neglectful Parenting BehaviorsBridget Freisthler, Jennifer Price Wolf, Michelle Johnson-Motoyama Alcohol and Alcoholism 2015:50(5);542-550

ALCOHOL POLICY

14. The Public Health Responsibility deal: has a public–private partnership brought about action on alcohol reduction?Cécile Knai, Mark Petticrew, Mary Alison Durand, Courtney Scott, Lesley James, Anushka Mehrotra, Elizabeth Eastmure, Nicholas MaysAddiction 2015: 110(8);1217-1225

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ALCOHOL SCREENING

15. Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN StudyPreben Bendtsen, Peter Anderson, Marcin Wojnar, Dorothy Newbury-Birch, Ulrika Müssener, Joan Colom, Nadine Karlsson, Krzysztof Brzózka, Fredrik Spak, Paolo Deluca, Colin Drummond, Eileen Kaner, Karolina Kłoda, Artur Mierzecki, Katarzyna Okulicz-Kozaryn, Kathryn Parkinson, Jillian Reynolds, Gaby Ronda, Lidia Segura, Jorge Palacio, Begoña Baena, Luiza Slodownik, Ben van Steenkiste, Amy Wolstenholme, Paul Wallace, Myrna N. Keurhorst, Miranda G.H. Laurant, Antoni Gual Alcohol and Alcoholism 2015:50(4);430-437

ALCOHOL SCREENING – BRIEF INTERVENTION

16. Identification of smokers, drinkers and risky drinkers by general practitioners Jakob Manthey, Charlotte Probst, Franz Hanschmidt, Jürgen RehmDrug and Alcohol Dependence 2015:154;93-99

ALCOHOL SERVICES

17. Randomized Controlled Trial of Mailed Personalized Feedback for Risky Drinkers in the Emergency Department: The Impact on Alcohol Consumption, Alcohol-Related Injuries, and Repeat Emergency Department PresentationsAlys Havard, Anthony P. Shakeshaft, Katherine M. ConigraveAlcoholism: Clinical and Experimental Research 2015:39(7);1260-1266

ALCOHOL TREATMENT

18. Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: Benzodiazepine dose-escalation with or without propofolAdrian Wong, Neal J. Benedict, Brian R. Lohr, Anthony F. Pizon, Sandra L. Kane-GillDrug and Alcohol Dependence 2015:154;296-299

ALCOHOL & YOUNG PEOPLE

19. Is there a link between per capita alcohol consumption and youth drinking? A time–series analysis for Sweden in 1972–2012Thor Norström, Jonas RaninenAddiction 2015: 110(6);967-974

20. Binge Drinking During Adolescence Disrupts Se Homeostasis and Its Main Hepatic Selenoprotein ExpressionMaría Luisa Ojeda, Rui Manuel Rua, María Luisa Murillo, Olimpia Carreras, Fátima NogalesAlcoholism: Clinical and Experimental Research 2015:39(5);818-826

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BLOOD BORNE VIRUSES

21. The impact of blood-borne viruses on cause-specific mortality among opioid dependent people: An Australian population-based cohort studyClaire M. Vajdic, Sadaf Marashi Pour , Jake Olivier, Alexander Swart, Dianne L. O’Connell, Michael O. Falster, Nicola S. Meagher, Limin Mao, Andrew E. Grulich , Deborah A. Randall, Janaki Amin, Lucinda Burns, Louisa DegenhardtDrug and Alcohol Dependence 2015:152;264-271

22. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programmeAngelos Hatzakis, Vana Sypsa, Dimitrios Paraskevis, Georgios Nikolopoulos, Chrissa Tsiara, Katerina Micha, Anastasios Panopoulos, Meni Malliori, Mina Psichogiou, Anastasia Pharris, Lucas Wiessing, Marita van de Laar, Martin Donoghoe, Douglas D. Heckathorn, Samuel R. Friedman, Don C. Des JarlaisAddiction 2015:110(9);1453-1467

CO-MORBIDITY

23. Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment TrialKatie Witkiewitz, Kevin E. Vowles, Elizabeth McCallion, Tessa Frohe, Megan Kirouac, Stephen A. MaistoAddiction 2015: 110(8);1262-1271

24. Co-occurrence between mental distress and poly-drug use: A ten year prospective study of patients from substance abuse treatmentJasmina Burdzovic Andreas, Grethe Lauritzen, Trond NordfjærnAddictive Behaviors 2015: 48;71-78

25. Recovery from substance use: Drug-dependent people’s experiences with sources that motivate them to changeNatacha Brunelle, Karine Bertrand, Michel Landry, Jorge Flores-Aranda, Catherine Patenaude & Serge BrochuDrugs: Education, Prevention and Policy 2015:22(3);301-307

DRUG RELATED DEATHS

26. Fatal opioid poisoning: a counterfactual model to estimate the preventive effect of treatment for opioid use disorder in EnglandMartin White, Robyn Burton, Shane Darke, Brian Eastwood, Jon Knight, Tim Millar, Virginia Musto, John MarsdenAddiction 2015: 110(8); 1321-1329

27. Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdose among psychologically distressed people who inject drugs? Kim S. Betts, Fairlie McIlwraith, Paul Dietze, Elizabeth Whittaker, Lucy Burns, Shelley Cogger, Rosa AlatDrug and Alcohol Dependence 2015:154;76-84

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EPIDEMIOLOGY & DEMOGRAPHY

28. Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohortShane Darke, Tim Slade, Joanne Ross, Christina Marel, Katherine L. Mills, Maree TesssonAddictive Behaviors 2015: 50; 78-83

29. Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal studyHong Ju, Mark Jones, Gita D. MishraDrug and Alcohol Dependence 2015:152;209-217

30. Hepatitis C virus infection and pain sensitivity in patients on methadone or buprenorphine maintenance therapy for opioid use disordersJudith I. Tsui, Marlene C. Lira, Debbie M. Cheng, Michael R. Winter, Daniel P. Alford, Jane M. Liebschutz, Jianren Mao, Robert R. Edwards, Jeffrey H. SametDrug and Alcohol Dependence 2015:153;286-292

HEPATITIS C

31. Hepatitis C virus treatment as prevention among injecting drug users: who should we cure first?Anneke S. de Vos, Maria Prins, Mirjam E. E. KretzschmarAddiction 2015: 110(6);975-983

32. Estimating the number of people with hepatitis C virus who have ever injected drugs and have yet to be diagnosed: an evidence synthesis approach for ScotlandTeresa C. Prevost, Anne M. Presanis, Avril Taylor, David J. Goldberg, Sharon J. Hutchinson, Daniela De AngelisAddiction 2015: 110(8);1287-1300

33. “Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatmentA.W. Batchelder, D. Peyser, S. Nahvi, J.H. Arnsten , A.H. LitwinDrug and Alcohol Dependence 2015:153;66-71

34. Acquiring hepatitis C in prison: the social organisation of injecting riskCarla Treloar, Luke McCredie2, Andrew R Lloyd and on behalf of the HITS-p investigators Harm Reduction Journal 2015:12;10

35. The common sense model applied to hepatitis C: a qualitative analysis of the impact of disease comparison and witnessed death on hepatitis C illness perceptionStella A. Safo, Abigail Batchelder, Deena Peyser, Alain H. LitwinHarm Reduction Journal 2015:12;20

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36. Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: Implications for reinfection Heather Valerio, David J. Goldberg, James Lewsey, Amanda Weir, Samuel Allen, Esther J. Aspinall, Stephen T. Barclay, Peter Bramley, John F. Dillon, Ray Fox, Andrew Fraseri, Peter C. Hayes, Hamish Innes, Nicholas Kennedy, Peter R. Mills, Adrian J. Stanley, Sharon J. HutchinsonDrug and Alcohol Dependence 2015:154;125-131

HOMELESSNESS

37. Health, perceived quality of life and health services use among homeless illicit drug usersK.K. O’Brien, A. Schuttke, A. Alhakeem, E. Donnelly-Swift, C. Keogh, A. O’Carroll, K. O'Sullivan, R. Galvin, T. FaheyDrug and Alcohol Dependence 2015:154;139-145

INJECTING BEHAVIOUR

38. Going into the groin: Injection into the femoral vein among people who inject drugs in three urban areas of EnglandV.D. Hope , J. Scott, K.J. Cullen, J.V. Parry, F. Ncube, M. HickmanDrug and Alcohol Dependence 2015:152;239-245

39. The Risk Environment of Heroin Use Initiation: Young Women, Intimate Partners, and “Drug Relationships”Paula Mayock, Jennifer Cronly, Michael C. ClattsSubstance Use & Misuse 2015:50(6):771–782

INJECTING DRUG USER

40. Pharmacy-randomized intervention delivering HIV prevention services during the syringe sale to people who inject drugs in New York CityCrystal Fuller Lewis, Alexis V. Rivera, Natalie D. Crawford, Jennifer DeCuir, Silvia AmestyDrug and Alcohol Dependence 2015:153;72-77

MISCELLANEOUS

41. Brain and cognition abnormalities in long-term anabolic-androgenic steroid usersMarc J. Kaufman, Amy C. Janes, James I. Hudson, Brian P. Brennan, Gen Kanayama, Andrew R. Kerrigan, J. Eric Jensen, Harrison G. Pope JrDrug and Alcohol Dependence 2015:152;47-56

42. Drug policy reform and the reclassification of cannabis in England and Wales: A cautionary taleMichael ShinerInternational Journal of Drug Policy 2015:26(7);696–704

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43. Changes in health outcomes as a function of abstinence and reduction in illicit psychoactive drug use: a prospective study in primary careTae Woo Park, Debbie M. Cheng, Christine A. Lloyd-Travaglini, Judith Bernstein, Tibor P. Palfai, Richard Saitz5,7

Addiction 2015:110(9);1476-1483

NALOXONE

44. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution programChristopher Rowe, Glenn-Milo Santos, Eric Vittinghoff, Eliza Wheeler, Peter Davidson, Philip O. CoffinAddiction 2015: 110(8);1301-1310

OPIATE RECOVERY TREATMENT

45. Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome StudyMaree Teesson, Christina Marel, Shane Darke, Joanne Ross, Tim Slade, Lucy Burns, Michael Lynskey, Sonja Memedovic, Joanne White, Katherine L. MillsAddiction 2015: 110(6);986-993

46. Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance TherapyBrandon S. Bentzley, Kelly S. Barth, Sudie E. Back, Garrett Aronson, Sarah W. BookJournal of Substance Abuse Treatment 2015:56;48–53

OPIATE TREATMENT SERVICES

47. Factors associated with substance use treatment completion in residential facilitiesRyan Mutter, Mir M. Ali, Kelley Smith, Alex StrashnyDrug and Alcohol Dependence 2015:154;291-295

48. Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectivesWouter Vanderplasschen, Jan Naert, Freya Vander Laenen & Jessica De MaeyerDrugs: Education, Prevention and Policy 2015:22(3);272-280

ORGANISATION OF TREATMENT

49. The impact of paying treatment providers for outcomes: difference-in-differences analysis of the ‘payment by results for drugs recovery’ pilotThomas Mason, Matthew Sutton, William Whittaker, Tim McSweeney, Tim Millar, Michael Donmall, Andrew Jones, Matthias PierceAddiction 2015: 110(7);1120-1128

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OVERDOSE & DRUG RELATED DEATHS

50. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10Elizabeth Evans, Libo Li, Jeong Min, David Huang, Darren Urada, Lei Liu, Yih-Ing Hser, Bohdan NosykAddiction 2015: 110(6);996-1005

PARENTING AND YOUNG PEOPLE

51. Is Drinking with Parents Associated with High-Risk Drinking among AdolescentsPape H., Rossow I., Storvoll E.E. European Addiction Research 2015:21;291-299

PRESCRIPTION MISUSE

52. Prescription pain reliever misuse prevalence, correlates, and origin of possession throughout the life courseOrion Mowbray, Adam QuinnAddictive Behaviors 2015: 50; 22-27

PREVENTION AND DIVERSIONARY ACTIVITIES

53. Does physical activity protect against drug abuse vulnerability?Michael. T. Bardo, Wilson. M. ComptonDrug and Alcohol Dependence 2015:153;3-13

RECOVERY

54. Producing the ‘problem of drugs’: A cross national-comparison of ‘recovery’ discourse in two Australian and British reportsKari Lancaster, Karen Duke, Alison RitterInternational Journal of Drug Policy 2015:26(7);617–625

55. Recovery definitions: Do they change?Lee Ann Kaskutas, Jane Witbrodt, Christine E. GrellaDrug and Alcohol Dependence 2015:154;85-92

SMOKING

56. Recent trends in children's exposure to second-hand smoke in England: cotinine evidence from the Health Survey for EnglandMartin J. Jarvis, Colin FeyerabendAddiction 2015:110(9);1484-1492

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SMOKING CESSATION

57. Comparison of the characteristics of long-term users of electronic cigarettes versus nicotine replacement therapy: A cross-sectional survey of English ex-smokers and current smokersVictoria A. Nelson, Maciej L. Goniewicz, Emma Beard, Jamie Brown, Kate Sheals, Robert West, Lion ShahabDrug and Alcohol Dependence 2015:153;300-305

STIGMA

58. Visual and narrative representations of mental health and addiction by law enforcementJade Boyd, Susan Boyd, Thomas KerrInternational Journal of Drug Policy 2015:26(7);636–644

59. Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugsKari Lancaster, Laura Santana, Annie Madden, Alison RitterDrugs: Education, Prevention, and Policy 2015:22(3):224–231

60. Intra-group stigma: Examining peer relationships among women in recovery for addictionsAlana J. Gunn & Kelli E. CanadaDrugs: Education, Prevention and Policy 2015:22(3);281-292

TREATMENT SERVICES

61. Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatmentHeather Fitzsimons, Michelle Tuten, Courtney Borsuk, Samantha Lookatch, Lisa HanksDrug and Alcohol Dependence 2015:152;62-67

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LIST OF ABSTRACTS

ALCOHOL – ANTI-SOCIAL BEHAVIOUR

1. “Not a good look”: Impossible Dilemmas for Young Women Negotiating the Culture of Intoxication in the United KingdomLin Bailey, Christine Griffin, Avi ShankarSubstance Use & Misuse May 2015:50(6);747–758

Abstract This paper investigates young women's alcohol consumption in the United Kingdom within a widespread culture of intoxication in relation to recent debates about postfeminism and contemporary femininity. Young women are faced with an “impossible dilemma,” arising from the contradiction between a hedonistic discourse of alcohol consumption and postfeminist discourse around attaining and maintaining the “right” form of hypersexual heterosexual femininity. Drawing on a recent interview study with 24 young white working-class and middle-class women in the South-West of England, we explore how young women inhabit the dilemmas of contemporary femininity in youth drinking cultures, striving to achieve the “right” form of hypersexual femininity and an “optimum” level of drunkenness.Keywords: femininity, gender, consumption, culture, alcohol, postfeminism, night-time economy

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ALCOHOL – BRIEF INTERVENTION

2. Specialty substance use disorder services following brief alcohol intervention: a meta-analysis of randomized controlled trialsJoseph E. Glass, Ashley M. Hamilton, Byron J. Powell, Brian E. Perron, Randall T. Brown, Mark A. IlgenAddiction 2015:110(9);1404-1415

AbstractBackground and aims Brief alcohol interventions in medical settings are efficacious in improving self-reported alcohol consumption among those with low-severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral-specific component, in increasing the utilization of alcohol-related care. Methods A systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health-care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post-treatment alcohol services utilization assessed by self-report or administrative data, which we compared across intervention and control groups.Results Thirteen RCTs met inclusion criteria and nine were meta-analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral-specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non-statistically significant results. Conclusions There is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol-related services.Keywords: Alcohol;brief intervention; meta-analysis;referral to treatment; treatment initiation; treatment utilization

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ALCOHOL EFFECTS

3. Theory of Mind Difficulties in Patients with Alcohol Dependence: Beyond the Prefrontal Cortex Dysfunction HypothesisFrançois Maurage, Philippe de Timary, Juan Martin Tecco, Stéphane Lechantre, Dana SamsonAlcoholism: Clinical and Experimental Research 2015:39(6);980-988 Abstract Background Previous studies have shown that alcohol-dependent (AD) individuals have difficulties inferring other people's emotion, understanding humor, and detecting a faux pas. This study aimed at further understanding the nature of such “Theory of Mind” (ToM) difficulties. Methods A total of 34 recently detoxified AD and 34 paired controls were compared based on 2 nonverbal and video-based false belief tasks. These tasks were designed to identify 3 different types of deficits: (i) a deficit in dealing with the general task demands, (ii) a selective deficit in self-perspective inhibition, and (iii) a deficit in tracking the other person's mental state. (i) and (ii) are compatible with the hypothesis of a prefrontal cortex dysfunction being at the origin of AD individuals’ social difficulties, while (iii) would suggest the possible contribution of a dysfunction of the temporo-parietal junction in explaining the social difficulties. Results Group analyses highlighted that AD individuals performed worse on the 2 false belief tasks than controls. Individual analyses showed, however, that just under half of the AD individuals were impaired compared to controls. Moreover, most of the AD individuals who were impaired showed a deficit in tracking the other person's belief. This deficit was linked to disease-related factors such as illness duration, average alcohol consumption, and craving but not to general reasoning abilities, depression, anxiety, or demographic variables. Conclusions Just under half of the AD individuals tested showed a ToM deficit, and in most cases, the deficit concerned the tracking of other people's mental states. Such a type of deficit has previously been associated with lesions to the temporo-parietal brain areas, indicating that a prefrontal cortex dysfunction may not be the sole origin of the social cognition deficits observed in alcohol dependence.Keywords: Theory of Mind; False Belief; Mentalizing; Prefrontal Cortex; Temporo-Parietal Junction

4. Adolescent Intermittent Alcohol Exposure: Persistence of Structural and Functional Hippocampal Abnormalities into AdulthoodMary-Louise Risher, Rebekah L. Fleming, W. Christopher Risher, K. M. Miller, Rebecca C. Klein, Tiffany Wills, Shawn K. Acheson, Scott D. Moore, Wilkie A. Wilson, Cagla Eroglu, H. S. SwartzwelderAlcoholism: Clinical and Experimental Research 2015:39(6);989-997

Abstract Background Human adolescence is a crucial stage of neurological development during which ethanol (EtOH) consumption is often at its highest. Alcohol abuse during adolescence may render individuals at heightened risk for subsequent alcohol abuse disorders, cognitive dysfunction, or other neurological impairments by irreversibly altering long-term brain function. To test this possibility, we modeled adolescent alcohol abuse (i.e., intermittent EtOH exposure during adolescence [AIE]) in rats to determine whether adolescent exposure to alcohol leads to long-term structural and functional changes that are manifested in adult neuronal circuitry. Methods We specifically focused on hippocampal area CA1, a brain region associated with learning and memory. Using electrophysiological,

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immunohistochemical, and neuroanatomical approaches, we measured post-AIE changes in synaptic plasticity, dendritic spine morphology, and synaptic structure in adulthood. Results We found that AIE-pretreated adult rats manifest robust long-term potentiation, induced at stimulus intensities lower than those required in controls, suggesting a state of enhanced synaptic plasticity. Moreover, AIE resulted in an increased number of dendritic spines with characteristics typical of immaturity. Immunohistochemistry-based analysis of synaptic structures indicated a significant decrease in the number of co-localized pre- and postsynaptic puncta. This decrease is driven by an overall decrease in 2 postsynaptic density proteins, PSD-95 and SAP102. Conclusions Taken together, these findings reveal that repeated alcohol exposure during adolescence results in enduring structural and functional abnormalities in the hippocampus. These synaptic changes in the hippocampal circuits may help to explain learning-related behavioral changes in adult animals preexposed to AIE.Keywords: Hippocampus; Long-Term Potentiation; Dendritic Spines; Adolescence; Ethanol

5. The Moderating Role of Cognitive Capacities in the Association Between Social Norms and Drinking BehaviorsSamuel N. Meisel, Craig R. Colder, Larry W. HawkAlcoholism: Clinical and Experimental Research 2015:39(6);1049-1056 Abstract Background The literature documents 2 related yet distinct social normative influences on adolescent drinking. Descriptive norms refer to perceptions of how much others engage in a particular behavior, whereas injunctive norms refer to the extent to which others approve of a particular behavior. Theoretical formulations suggest that whether descriptive or injunctive norms guide drinking behavior depends on cognitive factors related to executive functioning. Cognitive capacities, specifically inhibitory control (IC) and preplanning, were tested as moderators of the association between social norms and alcohol use using a longitudinal design and community sample of adolescents. Methods This longitudinal study included 387 adolescents and 3 annual waves of data. Behavioral tasks assessed IC (Stop Signal Task) and preplanning (Tower of London) and social norms and drinking were assessed using self-report measures. Results Significant interactions were found for descriptive and injunctive norms with preplanning and descriptive norms with IC. As hypothesized, descriptive norms were stronger prospective predictors of alcohol use at low levels of cognitive preplanning, whereas injunctive norms were stronger prospective predictors at high levels of cognitive preplanning. Descriptive norms prospectively predicted alcohol use at high, but not at low levels of IC. Conclusions These findings highlight the complexity of normative influences and suggest that descriptive and injunctive norms have differential effects on future drinking for individuals with different cognitive capacities.Keywords: Social Norms; Inhibitory Control; Cognitive Preplanning; Adolescent Drinking

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6. Ecological evidence that affect and perceptions of drink effects depend on alcohol expectanciesHayley Treloar, Thomas M. Piasecki, Denis M. McCarthy, Kenneth J. Sher, Andrew C. HeathAddiction 2015:110(9);1432-1442

AbstractAims (1) To compare affective changes over drinking and non-drinking days among frequent drinkers and (2) to evaluate whether drinkers’ expectations influence affective changes and perceived pleasure and relief from drinking. Design Observational study involving ecological momentary assessments collected via electronic diaries during the course of 3 weeks. Setting Drinkers’ usual settings in Columbia, MO, USA.Participants A total of 400 adult, frequent drinkers, aged 18–70 years. Measurements Ecological assessments included morning reports, pre-drinking random prompts, user-initiated first-drink reports and device-prompted follow-ups over drinking episodes. Participants rated positive (enthusiastic, excited, happy) and negative (distressed, sad) affect and perceived pleasure and relief from drinking in real time. A self-report questionnaire completed at baseline evaluated expectancies for enhanced sociability and tension reduction from drinking. Findings Relative to affective changes over non-drinking days, positive affect increased prior to drinking [95% confidence interval (CI) = 0.004, 0.023], and at first drink (95% CI = 0.238, 0.317), whereas negative affect decreased prior to drinking (95% CI = − 0.007, 0.000) and at first drink (95% CI = − 0.154, − 0.098). Sociability expectancies augmented increases in positive affect prior to drinking (95% CI = 0.009, 0.027) and at first drink (95% CI = 0.017, 0.169). Sociability expectancies also enhanced perceived pleasure from first drinks (95% CI = 0.046, 0.318). Tension-reduction expectancies attenuated decreases in negative affect at first drink (95% CI = − 0.133, − 0.029), but augmented perceived relief from first drinks (95% CI = 0.001, 0.304). Conclusions Although theoretical models tend to focus on negative affective outcomes of drinking, changes in positive affect prior to drinking and early in drinking episodes are important for maintaining drinking behavior. Frequent drinkers’ expectations for enhanced sociability or tension reduction from drinking influence their affective experiences over drinking days and perceptions of pleasure and relief from drinking.Keywords: Alcohol; drink appraisals; ecological momentary assessment; expectancies; negative affect; piecewise growth model; positive affect; sociability; tension reduction

7. The Association of Alcohol Severity and Sleep Quality in Problem DrinkersEmily E. Hartwell, Spencer Bujarski, Suzette Glasner-Edwards, Lara A. Ray Alcohol and Alcoholism 2015:50(5);536-541

Abstract Aims The association between alcohol use and sleep problems is well established and clinically meaningful, particularly as predictors of relapse. This study aims to elucidate the relationship between sleep disturbances and alcohol problems in a non-treatment-seeking community sample using an alcoholism problem severity factor. Methods Participants were problem drinkers (N = 295) from the Los Angeles community who had a breath alcohol content (BrAC) of 0.00 g/dl when they completed an in-person assessment battery comprised of measures of sleep quality, anxiety and depression, cigarette smoking, as well as multiple assessments of alcohol use and alcohol use problems. Results A series of hierarchical regressions showed that alcohol problem severity explained a significant amount of variance

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in sleep disturbance beyond demographic, mood and smoking variables. Alcohol problem severity was predictive of the PSQI global score (B = 1.11, P < 0.001), perceived sleep quality factor (B = 0.18, P < 0.001) and daily disturbance factor (B = 0.28, P < 0.001). However, contrary to study hypothesis, alcohol problem severity was predictive of improved sleep efficiency (B = −0.14, P < 0.05). Conclusions In sum, alcohol problem severity may be predictive of sleep disturbances. Given the complex nature of these relationships, further work is needed to develop adequate treatment for sleep disturbance during alcohol recovery. Nonetheless, this study suggests that as alcohol problem severity increases so do sleep problems. Thus, attending to sleep problems at early stages of alcohol problems may be warranted.

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ALCOHOL EPIDEMIOLOGY & DEMOGRAPHY

8. Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathologyHoward B. Moss, Risë B. Goldstein, Chiung M. Chen, Hsiao-Ye YiAddictive Behaviors 2015:50;192-198 AbstractIntroduction Alcohol dependence (AD) presents with substantial clinical heterogeneity, including concurrent use of non-alcohol drugs. Here, we examine specific patterns of concurrent non-alcohol substance use during the previous year among a nationally representative sample of adults with DSM-IV AD, and estimate their population prevalence in the U.S. We then evaluate alcohol use behavior and comorbid psychopathology among respondents with AD according to their patterns of concurrent non-alcohol substance use. Methods These analyses utilized data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analyses classified respondents with AD into four clinically meaningful patterns of concurrent substance use: (1) use of alcohol only; (2) use of alcohol and tobacco only; (3) use of alcohol, tobacco and cannabis; and (4) use of alcohol, tobacco, cannabis, cocaine, and other illicit drug(s). Results Among AD respondents, the most prevalent pattern was the use of alcohol and tobacco only (weighted percentage, 32.4%), followed by the use of alcohol only (weighted percentage, 27.5%). AD respondents who used alcohol, tobacco, cannabis, cocaine, and other illicit drug(s) (weighted percentage, 25.3%) manifested the most severe pattern of alcohol consumption, and had significant overrepresentations of major depression, panic, and other anxiety disorders as well as paranoid, schizotypal, borderline, antisocial, and histrionic personality disorders compared with those who used alcohol alone. Conclusions Specific patterns of concurrent substance use convey important information regarding the clinical presentation and prognosis for AD. In particular, concurrent use of illicit drugs over the past year by AD individuals was associated with greater severity and comorbid psychopathology. These data suggest the need for pragmatic trials of AD interventions that take into account patterns of substance use behavior in addition to an AD diagnosis.Keywords: Alcohol dependence; Polysubstance use; Drug use; Alcohol use; Psychopathology

9. Typology of Alcohol Mixed with Energy Drink Consumers: Motivations for UseAmy Peacock, Nicolas Droste, Amy Pennay, Peter Miller, Dan I. Lubman, Raimondo BrunoAlcoholism: Clinical and Experimental Research 2015:39(6);1083-1092 Abstract Background Previous research on alcohol mixed with energy drinks (AmED) has shown that use is typically driven by hedonistic, social, functional, and intoxication-related motives, with differential associations with alcohol-related harm across these constructs. There has been no research looking at whether there are subgroups of consumers based on patterns of motivations. Consequently, the aims were to determine the typology of motivations for AmED use among a community sample and to identify correlates of subgroup membership. In addition, we aimed to determine whether this structure of motivations applied to a university student sample. Methods Data were used from an Australian community sample (n = 731) and an Australian university student sample (n = 594) who were identified as AmED consumers when completing an online survey about their alcohol and ED use.

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Participants reported their level of agreement with 14 motivations for AmED use; latent classes of AmED consumers were identified based on patterns of motivation endorsement using latent class analysis. Results A 4-class model was selected using data from the community sample: (i) taste consumers (31%): endorsed pleasurable taste; (ii) energy-seeking consumers (24%): endorsed functional and taste motives; (iii) hedonistic consumers (33%): endorse pleasure and sensation-seeking motives, as well as functional and taste motives; and (iv) intoxication-related consumers (12%): endorsed motives related to feeling in control of intoxication, as well as hedonistic, functional, and taste motives. The consumer subgroups typically did not differ on demographics, other drug use, alcohol and ED use, and AmED risk taking. The patterns of motivations for the 4-class model were similar for the university student sample. Conclusions This study indicated the existence of 4 subgroups of AmED consumers based on their patterns of motivations for AmED use consistently structured across the community and university student sample. These findings lend support to the growing conceptualization of AmED consumers as a heterogeneous group in regard to motivations for use, with a hierarchical and cumulative class order in regard to the number of types of motivation for AmED use. Prospective research may endeavor to link session-specific motives and outcomes, as it is apparent that primary consumption motives may be fluid between sessions.Keywords: Alcohol; Energy Drink; Caffeine; Latent Class Analysis; Motive; Risk

10. Injury-Related Mortality Over 12 Years in a Cohort of Patients with Alcohol Use Disorders: Higher Mortality Among Young People and WomenAnna M. Guitart, Albert Espelt, Yolanda Castellano, Josep M. Suelves, Joan R. Villalbí, M. Teresa BrugalAlcoholism: Clinical and Experimental Research 2015:39(7);1158-1165

Abstract Background The goal of this study was to estimate excess death due to external causes among 18- to 64-year-olds with alcohol use disorder (AUD) who were treated at public outpatient treatment centers, and the time elapsed from treatment initiation to death.Methods We conducted a retrospective longitudinal study among 7,012 outpatients aged 18 to 64 years who began treatment for AUD between 1997 and 2007. Deaths due to external causes (intentional and unintentional injuries) were monitored until the end of 2008. Person-years (PY) of follow-up and crude mortality rates (CMRs) were calculated for all study variables, for each sex, and for 2 age groups (18 to 34 and 35 to 64 years). Standardized mortality ratios (SMRs) were estimated by age group and sex. Survival was analyzed using the Kaplan–Meier method and Cox regression. Results We recorded 114 deaths due to external causes. The CMR was 2.7 per 1,000 PY (95% confidence interval [CI]: 2.2 to 3.2), with significant gender differences only among younger individuals (CMR for males = 3.9 per 1,000 PY [95% CI: 2.2 to 5.5] and CMR for females = 2.8 per 1,000 PY [95% CI: 0.1 to 5.6]). Unintentional injury was the most common cause of death (n = 65), of which acute poisoning (n = 25; 38.5%) and traffic accidents (n = 15; 23.1%) were the most prevalent. Suicide accounted for 91.8% (n = 49) of deaths from intentional injuries. The excess of mortality between the AUD group and the general population (SMR) was 9.5 higher than in the general population (95% CI: 7.9 to 11.4), with significant differences between genders (SMR = 6.1 [95% CI: 4.9 to 7.5] in males and SMR = 20.4 [95% CI: 13.9 to 29.9] in females). Approximately 35% of deaths among individuals aged <35 years and 60% among women occurred within a year of initiating treatment. Conclusions This study highlights the importance of excess of mortality among people with AUD and patients' vulnerability during

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the initial years of treatment. Preventing premature deaths due to external causes among women and younger patients with AUD is a priority.Keywords: Alcohol-Related Disorders; Premature Mortality; Causes of Death; Excess Mortality

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ALCOHOL MISCELLANEOUS

11. The impact of extended closing times of alcohol outlets on alcohol-related injuries in the nightlife areas of Amsterdam: a controlled before-and-after evaluationMoniek C.M. de Goeij, Eleonore M. Veldhuizen, Marcel C.A. Buster, Anton E. KunstAddiction 2015: 110(6);955-964 AbstractBackground and aims The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol-related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. Design A controlled before-and-after evaluation to compare changes in alcohol-related injuries between intervention and control areas. Setting Central district of Amsterdam, The Netherlands. Participants Alcohol-related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). Measurements Alcohol-related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. Findings After 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00–5.59 a.m., weekend days, men, individuals aged 25–34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. Conclusions A 1-hour extension of alcohol outlet closing times in some of Amsterdam's nightlife areas was associated with 34% more alcohol-related injuries.Keywords: Alcohol outlets; alcohol-related injuries; ambulance attendance; Amsterdam; controlled before-and-after evaluation; extended closing times; nightlife area

12. Navigating the Alcohol Treatment Pathway: A Qualitative Study from the Service Users' PerspectiveHelen Gilburt, Colin Drummond, Julia Sinclair Alcohol and Alcoholism 2015:50(4);444-450

AbstractAims Provision of effective treatment for dependent drinkers has been identified as a priority in England yet evidence suggests that access is problematic and there are low levels of retention. This qualitative study explores how the alcohol treatment system is experienced by service users, identifying barriers and facilitators that influence treatment outcomes.Methods A total of 20 semi-structured face-to-face interviews were conducted with patients from community alcohol treatment services in three London boroughs in 2012. Interviews were undertaken one year after initially entering treatment. A thematic analysis was conducted, with the results further abstracted to relate them to specific aspects of the treatment journey. Results Patients journeys were characterized by a perceived lack of control leading to help-seeking, with treatment outcomes influenced by an individuals' self-efficacy and the capabilities and skills of staff in actively engaging and supporting patients on the journey. A focus of services on the detoxification process and fragmented care pathways

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impacted negatively on engagement. Conclusions Current alcohol care pathways require significant levels of motivation and self-efficacy to navigate that few patients possess. Pathways need to better reflect the capacity and capabilities of patients to be successful in supporting recovery.

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ALCOHOL – PARENTING

13. Understanding the Role of Context-Specific Drinking in Neglectful Parenting BehaviorsBridget Freisthler, Jennifer Price Wolf, Michelle Johnson-Motoyama Alcohol and Alcoholism 2015:50(5);542-550

Abstract Aims Child neglect is the most common form of child maltreatment, yet little is known about how drinking context may be related to particular subtypes of child neglect. This study examines the relationship between parental drinking in multiple contexts and the use of supervisory and physical neglectful. Methods A sample of 2152 parents of children 12 years or younger in 50 cities in California was obtained using a computer-assisted telephone interview. Past-year prevalence of child neglect was measured using the Multidimensional Neglectful Behavior Scale. Information was collected on past month or past-year frequency of having at least one drink in five contexts, continued drinking measures (e.g. number of drinks after the first drink) and sociodemographics. Data were analyzed using multilevel random effects logit models. Results Frequency of drinking in various contexts was related to different neglect subtypes. Specifically, frequency of drinking with friends was positively related leaving a child home alone when an adult should be present. Parents who drank more frequently with family were less likely to leave their child home alone in the past year yet more likely to unsafely monitor their child in the past year. Drinking at parties more often was related to being more likely to leave a child alone in a car sometime during the past year.Conclusions That no single drinking context is universally problematic for supervisory and physical neglect suggests that different social mechanisms may underlie the relationships observed between different drinking contexts and neglect subtypes.

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ALCOHOL POLICY

14. The Public Health Responsibility deal: has a public–private partnership brought about action on alcohol reduction?Cécile Knai, Mark Petticrew, Mary Alison Durand, Courtney Scott, Lesley James, Anushka Mehrotra, Elizabeth Eastmure, Nicholas MaysAddiction 2015: 110(8);1217-1225 AbstractBackground and Aims The Public Health Responsibility Deal (RD) in England is a public–private partnership involving voluntary pledges between industry, government and other organizations, with the aim of improving public health. This paper aims to evaluate what action resulted from the RD alcohol pledges. Methods We analysed publically available data on organizations’ plans and progress towards achieving key alcohol pledges of the RD. We assessed the extent to which activities pledged by signatories could have been brought about by the RD, as opposed to having happened anyway (the counterfactual), using a validated coding scheme designed for the purpose. Results Progress reports were submitted by 92% of signatories in 2013 and 75% of signatories in 2014, and provided mainly descriptive feedback rather than quantifiable performance metrics. Approximately 14% of 2014 progress reports were identical to those presented in 2013. Most organizations (65%) signed pledges that involved actions to which they appear to have been committed already, regardless of the RD. A small but influential group of alcohol producers and retailers reported taking measures to reduce alcohol units available for consumption in the market. However, where reported, these measures appear to involve launching and promoting new lower-alcohol products rather than removing units from existing products. Conclusions The RD is unlikely to have contributed significantly to reducing alcohol consumption, as most alcohol pledge signatories appear to have committed to actions that they would have undertaken anyway, regardless of the RD. Irrespective of this, there is considerable scope to improve the clarity of progress reports and reduce the variability of metrics provided by RD pledge signatories.Keywords: Alcohol; evaluation; pledge; public health; public-private partnership; voluntary agreement

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ALCOHOL SCREENING

15. Professional's Attitudes Do Not Influence Screening and Brief Interventions Rates for Hazardous and Harmful Drinkers: Results from ODHIN StudyPreben Bendtsen, Peter Anderson, Marcin Wojnar, Dorothy Newbury-Birch, Ulrika Müssener, Joan Colom, Nadine Karlsson, Krzysztof Brzózka, Fredrik Spak, Paolo Deluca, Colin Drummond, Eileen Kaner, Karolina Kłoda, Artur Mierzecki, Katarzyna Okulicz-Kozaryn, Kathryn Parkinson, Jillian Reynolds, Gaby Ronda, Lidia Segura, Jorge Palacio, Begoña Baena, Luiza Slodownik, Ben van Steenkiste, Amy Wolstenholme, Paul Wallace, Myrna N. Keurhorst, Miranda G.H. Laurant, Antoni Gual Alcohol and Alcoholism 2015:50(4);430-437

AbstractAims To determine the relation between existing levels of alcohol screening and brief intervention rates in five European jurisdictions and role security and therapeutic commitment by the participating primary healthcare professionals. Methods Health care professionals consisting of, 409 GPs, 282 nurses and 55 other staff including psychologists, social workers and nurse aids from 120 primary health care centres participated in a cross-sectional 4-week survey. The participants registered all screening and brief intervention activities as part of their normal routine. The participants also completed the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ), which measure role security and therapeutic commitment. Results The only significant but small relationship was found between role security and screening rate in a multilevel logistic regression analysis adjusted for occupation of the provider, number of eligible patients and the random effects of jurisdictions and primary health care units (PHCU). No significant relationship was found between role security and brief intervention rate nor between therapeutic commitment and screening rate/brief intervention rate. The proportion of patients screened varied across jurisdictions between 2 and 10%. Conclusion The findings show that the studied factors (role security and therapeutic commitment) are not of great importance for alcohol screening and BI rates. Given the fact that screening and brief intervention implementation rate has not changed much in the last decade in spite of increased policy emphasis, training initiatives and more research being published, this raises a question about what else is needed to enhance implementation.

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ALCOHOL SCREENING – BRIEF INTERVENTION

16. Identification of smokers, drinkers and risky drinkers by general practitioners Jakob Manthey, Charlotte Probst, Franz Hanschmidt, Jürgen RehmDrug and Alcohol Dependence 2015:154;93-99 AbstractBackground Identification of risky substance users by general practitioners (GPs) is important for providing brief interventions or to refer cases to specialized care, but detection rates of risky users are low, with alcohol users being identified less frequently than smokers.Methods We compared GPs’ assessment and patient self-report concerning tobacco use, number of cigarettes smoked daily, alcohol use, alcohol use disorder, and different risky use definitions of 8476 primary care patients from six European countries. Further, we carried out a logistic regression predicting the GPs perception of the patients’ alcohol problems.Results GPs identified 88.4% (95% confidence interval (CI): 87.1–89.6%; κ = 0.84, 95% CI: 0.83–0.86) of all self-reported smokers but only 64.6% (95% CI: 63.2–65.9%; κ = 0.35, 95% CI: 0.33–0.37) of all current drinkers, while they were unable to judge the drinking status of every ninth patient. The GPs’ estimation of number of cigarettes smoked daily was slightly lower than the self-report (Δ = 0.23 cigarettes/day, p < .001) but both measures were correlated with each other. Of all risky drinkers, defined as having alcohol-related problems or showing risky drinking patterns, 28.7% (95% CI: 25.9–31.4%; κ = 0.34, 95% CI: 0.31–0.37) were perceived as having problems with alcohol by the GPs. Patients’ self-reported health and social consequences, as well as drinking patterns predicted the GPs’ perception of alcohol problems. Conclusions GPs were more accurate in identifying smokers than drinkers. Concerning risky drinkers, GPs failed to diagnose a sizeable proportion but were able to detect other drinkers whom common recognition approaches had not recognized.Keywords: Tobacco; Smoking; Alcohol; Binge drinking; General practitioner; Screening

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ALCOHOL SERVICES

17. Randomized Controlled Trial of Mailed Personalized Feedback for Risky Drinkers in the Emergency Department: The Impact on Alcohol Consumption, Alcohol-Related Injuries, and Repeat Emergency Department PresentationsAlys Havard, Anthony P. Shakeshaft, Katherine M. ConigraveAlcoholism: Clinical and Experimental Research 2015:39(7);1260-1266

Abstract Background Due to the difficulty encountered in disseminating resource-intensive emergency department (ED)-based brief alcohol interventions into real-world settings, this study evaluated the effect of a mailed personalized feedback intervention for problem drinking ED patients. At 6-week follow-up, this intervention was associated with a statistically significant reduction in alcohol consumption among patients with alcohol-involved ED presentations. This study aimed to evaluate the effects of this intervention over time. Methods A randomized controlled trial was conducted among problem drinking ED patients, defined as those scoring 8 or more on the Alcohol Use Disorders Identification Test. Participants in the intervention group received mailed personalized feedback regarding their alcohol consumption. The control group received no feedback. Follow-up interviews were conducted over the phone, postal survey, or email survey 6 weeks and 6 months after baseline screening, and repeat ED presentations over 12-month follow-up were ascertained via linked ED records. Results Six-month follow-up interviews were completed with 210 participants (69%), and linked ED records were obtained for 286 participants (94%). The intervention had no effect on alcohol consumption, while findings regarding alcohol-related injuries and repeat ED presentations remain inconclusive. Conclusions Further research in which the receipt of feedback is improved and a booster intervention is provided is recommended.Keywords: Alcohol; Emergency Department; Brief Intervention; Feedback; Rural

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ALCOHOL TREATMENT

18. Management of benzodiazepine-resistant alcohol withdrawal across a healthcare system: Benzodiazepine dose-escalation with or without propofolAdrian Wong, Neal J. Benedict, Brian R. Lohr, Anthony F. Pizon, Sandra L. Kane-GillDrug and Alcohol Dependence 2015:154;296-299

AbstractBackground Severe cases of alcohol withdrawal syndrome (AWS) may not resolve despite escalating doses of benzodiazepines (BZDs). Benzodiazepine-resistant alcohol withdrawal (RAW) is a subset of severe alcohol withdrawal defined by the requirement of ≥40 mg of diazepam administered within one hour. Use of adjunct agents, such as propofol, may be beneficial to minimize BZD adverse effects and improve symptom control. While limited evidence suggests propofol as an effective adjunct in AWS through improved sedation, evidence is currently lacking for the addition of only propofol to BZDs for management of RAW. Methods Retrospective review of adult patients from January, 2009 to March, 2012 with RAW. Patients were categorized into BZD dose-escalation only or BZD plus propofol. The primary endpoint was time to resolution of AWS. Secondary endpoints included safety outcomes associated with medication use. Results Of 1083 patients with severe AWS, 66 RAW patients (n = 33 BZD only, n = 33 BZD plus propofol) met inclusion. Median time to AWS resolution was 5.0 and 7.0 days for BZD only vs. BZD plus propofol (p = 0.025). Duration of mechanical ventilation, ICU and hospital length of stay were significantly higher with propofol (p = 0.017, <0.001 and <0.001, respectively). Ten patients required intervention for management of propofol-induced adverse reactions. Conclusions: The addition of propofol for RAW treatment is associated with significant increases in clinical care. While randomized, prospective evaluations are necessary to determine the cause of this association, our data suggests use of adjunctive propofol therapy in RAW is associated with longer and more complicated hospital admissions.Keywords: Alcohol withdrawal; Benzodiazepines; Propofol; Resistant alcohol withdrawal; Severe alcohol withdrawal

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ALCOHOL & YOUNG PEOPLE

19. Is there a link between per capita alcohol consumption and youth drinking? A time–series analysis for Sweden in 1972–2012Thor Norström, Jonas RaninenAddiction 2015: 110(6);967-974 AbstractAims To estimate the relationship between per capita alcohol consumption and youth drinking in Sweden during the last 40 years and to estimate the relationship between female and male youth drinking during the 40-year study period. Design, setting, participants and measurements Per capita alcohol consumption was proxied by official sales data, supplemented by data on unrecorded consumption. Youth consumption was measured by a question on heavy episodic drinking (HED) included in an annual school survey of alcohol and drug habits among Swedish 9th -grade students (15–16 years of age). The annual samples comprise approximately 5000 individuals (with roughly equal numbers of boys and girls) with response rates in the range 80–93%. The study spans the period 1972–2012. Autoregressive integrated moving average (ARIMA) time–series analysis was used to estimate the relation between per-capita alcohol consumption and youth drinking. Ocular inspection of the time–series data suggested a stronger synchronization between the two series in the early period, before the mid-1990s, than in the later period, indicating a structural shift in the relation at issue. We therefore conducted period specific time–series analyses with 1995 as the year of division. Results There was a statistically significant relation between per capita alcohol consumption and HED among youth for 1972–94. A 1% increase in per capita alcohol consumption was associated with an increase in HED of 1.52% (P = 0.008). The estimate for 1995–2012 (0.12) was well below statistical significance (P = 0.580). The estimated elasticity of the association between boys’ and girls’ HED during 1972–94 was close to unity (0.98, P < 0.001), suggesting proportional changes in boys’ and girls’ drinking. When controlling for per capita consumption, the association was halved (to 0.55) but still significant in table 3 (P = 0.045). Conclusions Adult and youth drinking in Sweden were synchronized closely during the two last decades of the 20th century, but youth drinking developed an independent trajectory shortly before 2000.Keywords: Alcohol; collectivity of drinking cultures; population drinking; Sweden; time–series analysis; youth

20. Binge Drinking During Adolescence Disrupts Se Homeostasis and Its Main Hepatic Selenoprotein ExpressionMaría Luisa Ojeda, Rui Manuel Rua, María Luisa Murillo, Olimpia Carreras, Fátima NogalesAlcoholism: Clinical and Experimental Research 2015:39(5);818-826

Abstract Background Binge drinking (BD) is the most common ethanol (EtOH) intake consumption model among teenagers, but little is known about its effects on the liver. During its hepatic metabolism, acute alcohol exposure produces a great amount of reactive oxygen species which contributes to alcohol-induced liver injury. Selenium (Se) plays a key role in antioxidant defense as it forms part of selenoproteins, such as the antioxidant glutathione peroxidases (GPxs) or the selenoprotein P (SelP), synthesized mainly in liver. Chronic EtOH consumption decreases both Se deposits and this tissue's antioxidant activity. Methods Two BD administration routes (oral and intraperitoneal) were used in adolescent rats to analyze Se

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homeostasis; the main hepatic selenoproteins’ expression: GPx1, GPx4, and SelP, and their biological roles related to oxidation. Their relationship with inflammatory processes was also determined by analyzing the expression of the transcriptional factor nuclear factor-kappa beta (NF-κB). Results It has been demonstrated for the first time that BD in adolescents alters Se homeostasis regardless of the administration route employed, despite the fact that the BD oral group ingested less Se in diet. This decrease of Se in serum and liver is directly related to a decrease in serum GPx3 and hepatic GPx1 activity, contributing to the oxidative imbalance found. The depletion of Se detected in liver affects GPx1 expression and, surprisingly, GPx4 expression. This could be related to the lower expression of the transcriptional factor NF-κB in the liver, a key player in the regulation of inflammatory processes. Conclusions Due to the above, and to find whether a Se supplementation therapy improves these situations, it would be interesting to explore in more depth the relationship between Se, the high oxidation found, and the depressed immune response reported in BD adolescents.Keywords: Adolescence; Binge Drinking; GPx Activity; Liver; NF-κB; Selenoproteins

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BLOOD BORNE VIRUSES

21. The impact of blood-borne viruses on cause-specific mortality among opioid dependent people: An Australian population-based cohort studyClaire M. Vajdic, Sadaf Marashi Pour , Jake Olivier, Alexander Swart, Dianne L. O’Connell, Michael O. Falster, Nicola S. Meagher, Limin Mao, Andrew E. Grulich , Deborah A. Randall, Janaki Amin, Lucinda Burns, Louisa DegenhardtDrug and Alcohol Dependence 2015:152;264-271 AbstractBackground Blood-borne viruses (BBV) are prevalent among people with opioid dependence but their association with cause-specific mortality has not been examined at the population-level. Methods We formed a population-based cohort of 29,571 opioid substitution therapy (OST) registrants in New South Wales, Australia, 1993–2007. We ascertained notifications of infection and death by record linkage between the Pharmaceutical Drugs of Addiction System (OST data), registers of hepatitis C (HCV), hepatitis B (HBV) and human immunodeficiency virus (HIV) diagnoses, and the National Death Index. We used competing risks regression to quantify associations between notification for BBV infection and causes of death. BBV status, age, year, OST status, and OST episodes were modelled as time-dependent covariates; sex was a fixed covariate. Results OST registrants notified with HCV infection were more likely to die from accidental overdose (subdistribution hazard ratio, 95% Confidence Interval: 1.7, 1.5–2.0), cancer (2.0, 1.3–3.2) and unintentional injury (1.4, 1.0–2.0). HBV notification was associated with a higher hazard of mortality due to unintentional injury (2.1, 1.1–3.9), cancer (2.8, 1.5–5.5), and liver disease (2.1, 1.0–4.3). Liver-related mortality was higher among those notified with HIV only (11, 2.5–50), HCV only (5.9, 3.2–11) and both HIV and HCV (15, 3.2–66). Registrants with an HIV notification had a higher hazard of cardiovascular-related mortality (4.0, 1.6–9.9). Conclusions Among OST registrants, BBVs are a direct cause of death and also a marker of behaviours that can result in unintended death. Ongoing and enhanced BBV prevention strategies and treatment, together with targeted education strategies to reduce risk, are justified.Keywords: Mortality; Opioid dependence; Pharmacotherapy; Opioid substitution therapy; Blood-borne viruses

22. Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programmeAngelos Hatzakis, Vana Sypsa, Dimitrios Paraskevis, Georgios Nikolopoulos, Chrissa Tsiara, Katerina Micha, Anastasios Panopoulos, Meni Malliori, Mina Psichogiou, Anastasia Pharris, Lucas Wiessing, Marita van de Laar, Martin Donoghoe, Douglas D. Heckathorn, Samuel R. Friedman, Don C. Des JarlaisAddiction 2015:110(9);1453-1467 AbstractAims To (i) describe an intervention implemented in response to the HIV-1 outbreak among people who inject drugs (PWIDs) in Greece (ARISTOTLE programme), (ii) assess its success in identifying and testing this population and (iii) describe socio-demographic characteristics, risk behaviours and access to treatment/prevention, estimate HIV prevalence and identify risk factors, as assessed at the first participation of PWIDs. Design A ‘seek, test, treat, retain’ intervention employing five rounds of respondent-driven sampling.

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Setting Athens, Greece (2012–13). Participants A total of 3320 individuals who had injected drugs in the past 12 months. Intervention ARISTOTLE is an intervention that involves reaching out to high-risk, hard-to-reach PWIDs (‘seek’), engaging them in HIV testing and providing information and materials to prevent HIV (‘test’) and initiating and maintaining anti-retroviral and opioid substitution treatment for those testing positive (‘treat’ and ‘retain’). Measurements Blood samples were collected for HIV testing and personal interviews were conducted. Findings ARISTOTLE recruited 3320 PWIDs during the course of 13.5 months. More than half (54%) participated in multiple rounds, resulting in 7113 visits. HIV prevalence was 15.1%. At their first contact with the programme, 12.5% were on opioid substitution treatment programmes and the median number of free syringes they had received in the preceding month was 0. In the multivariable analysis, apart from injection-related variables, homelessness was a risk factor for HIV infection in male PWIDs [odds ratio (OR) yes versus no = 1.89, 95% confidence interval (CI) = 1.41, 2.52] while, in female PWIDS, the number of sexual partners (OR for > 5 versus one partner in the past year = 4.12, 95% CI = 1.93, 8.77) and history of imprisonment (OR yes versus no = 2.76, 95% CI = 1.43, 5.31) were associated with HIV. Conclusions In Athens, Greece, the ARISTOTLE intervention for identifying HIV-positive people among people who inject drugs (PWID) facilitated rapid identification of a hidden population experiencing an outbreak and provided HIV testing, counselling and linkage to care. According to ARISTOTLE data, the 2011 HIV outbreak in Athens resulted in 15% HIV infection among PWID. Risk factors for HIV among PWID included homelessness in men and history of imprisonment and number of sexual partners in women.Keywords: HIV outbreak; intervention; prevalence; PWIDs; respondent-driven sampling; risk factors

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CO-MORBIDITY

23. Pain as a predictor of heavy drinking and any drinking lapses in the COMBINE study and the UK Alcohol Treatment TrialKatie Witkiewitz, Kevin E. Vowles, Elizabeth McCallion, Tessa Frohe, Megan Kirouac, Stephen A. MaistoAddiction 2015: 110(8);1262-1271 AbstractAims To test the association between pain and heavy drinking lapses during and following treatment for alcohol use disorders (AUD). Design Secondary data analysis of data from two clinical trials for AUD. Setting and participants Participants included 1383 individuals from the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study in the United States [69.0% male, 76.8% non-Hispanic White average age = 44.4, standard deviation (SD) = 10.2] and 742 individuals from the UK Alcohol Treatment Trial (UKATT) in the United Kingdom [74.1% male, 95.6% White, average age = 41.6 (SD = 10.1)]. Measurements Form-90 (a structured assessment interview) was used to assess the primary outcome: time to first heavy drinking day. The Short Form Health Survey and Quality of Life measures were used to assess pain interference and pain intensity.Findings Pain was a significant predictor of heavy drinking lapses during treatment in UKATT [odds ratio (OR) = 1.19, 95% confidence interval (CI) = 1.08, 1.32, P = 0.0003] and COMBINE (OR = 1.12, 95% CI = 1.03, 1.21, P = 0.009), and was a significant predictor of heavy drinking lapses following treatment in COMBINE (OR = 1.163, 95% CI = 1.15, 1.17, P < 0.00001). After controlling for other relapse risk factors (e.g. dependence severity, self-efficacy, temptation, psychiatric distress), pain remained a significant predictor of heavy drinking lapses during treatment in UKATT (OR = 1.19, 95% CI = 1.06, 1.34, P = 0.004) and following treatment in COMBINE (OR = 1.44, 95% CI = 1.07, 1.92, P = 0.01).Conclusions Among people treated for alcohol use disorder, being in physical pain appears to predict heavy drinking lapses during or after treatment.Keywords: Alcohol relapse; alcohol treatment outcomes; COMBINE study; latent transition analyses; pain; United Kingdom Alcohol Treatment Trial

24. Co-occurrence between mental distress and poly-drug use: A ten year prospective study of patients from substance abuse treatmentJasmina Burdzovic Andreas, Grethe Lauritzen, Trond NordfjærnAddictive Behaviors 2015: 48;71-78 AbstractIntroduction Longitudinal research investigating psychiatric trajectories among patients with poly-drug use patterns remains relatively scant, even though this specific population is at elevated risk for multiple negative outcomes. The present study examined temporal associations between poly-drug use (i.e. heroin, cannabis, tranquilizers, and amphetamines) and mental distress over a 10-year period. Methods A clinical cohort of 481 patients was recruited from substance use treatment facilities in Norway, and prospectively interviewed 1, 2, 7 and 10 years after the initial data collection at treatment admission. At each assessment participants completed a questionnaire addressing their substance use and mental distress. Longitudinal growth models were used to examine whether, and if so, how, levels of drug use were associated with the level and rate of change in mental distress over time.

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Results Results from the longitudinal growth models showed a co-occurrence between active poly-drug use and mental distress, such that there was a dose–response effect where mental distress increased both in magnitude and over time with the number of drugs used. Reduction in mental distress during the 10-year study period was evident only in the no-drug use condition. Use of multiple drugs and mental distress appear strongly co-related over time. Conclusions Pre-treatment assessment should carefully identify individuals manifesting poly-drug use and mental disorders. Treatment and follow-up services should be tailored to their specific needs.Keywords: Prospective clinical study; Longitudinal trajectories; Co-occurrence between mental distress and poly-drug use

25. Recovery from substance use: Drug-dependent people’s experiences with sources that motivate them to changeNatacha Brunelle, Karine Bertrand, Michel Landry, Jorge Flores-Aranda, Catherine Patenaude & Serge BrochuDrugs: Education, Prevention and Policy 2015:22(3);301-307

AbstractRecovery from drug abuse is a complex process in which motivation is central. The focus of this article is on drug-dependent people's experiences with sources that influence their motivation to change. The sample in our study was comprised of 127 drug-dependent adults identified in criminal courts, hospital emergency departments and Health and Social Services Centres in Quebec (Canada). Two-third of the sample consisted of men of 38 years old on average. Semi-structured interviews and thematic content analyses were conducted. The results from the participants’ point of view regarding their recovery experience indicate that certain sources of influence may help increase or maintain motivation. These sources can be personal or service-related. Caseworkers may help increase or maintain drug-dependent people’s motivation for change by being humble, patient and empathetic, and by making efforts to collaborate with other caseworkers in various services, at every step, including detection and referral, of the service trajectory.

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DRUG RELATED DEATHS

26. Fatal opioid poisoning: a counterfactual model to estimate the preventive effect of treatment for opioid use disorder in EnglandMartin White, Robyn Burton, Shane Darke, Brian Eastwood, Jon Knight, Tim Millar, Virginia Musto, John MarsdenAddiction 2015: 110(8); 1321-1329 AbstractAim A counterfactual model was used to estimate the number of fatal opioid-related poisonings prevented by public treatment services for opioid use disorder (OUD) in England between April 2008 and March 2011. Methods Patient OUD treatment episode data recorded by the English National Drug Treatment Monitoring System were linked to data on opioid deaths recorded by the Office for National Statistics. The source population was the official estimate of non-medical opioid users (aged 15–64 years; approximately 260 000 each year). The target population was all individuals (aged 15–64 years) treated for OUD in the study period (n = 220 665). The outcome measure was fatal opioid-related poisoning (opioid death). The opioid death rate [per 100 person-years (PY)] and mortality rate ratios (MRR) were computed for study year, age group (15–24, 25–34, 35–64 years) and for three treatment-related states: time spent ‘prior to treatment’, ‘during treatment’ and ‘after treatment’. Results Between April 2008 and March 2011, there were 3731 opioid deaths in the study: 741 during treatment (0.20 per 100 PY; referent category); 2722 prior to treatment [0.77 per 100 PY; MRR = 3.76, 95% confidence interval (CI) = 3.18–4.44]; and 268 after treatment (0.41 per 100 PY; MRR = 1.99, 95% CI = 1.64–2.41). By counterfactual estimation, national OUD treatment services prevented an average of 880 opioid deaths each year (95% CI = 702–1084). Conclusions Between April 2008 and March 2011, a counterfactual model shows that the English public treatment system for opioid use disorder prevented an average of 880 deaths each year from opioid-related poisoning. Counterfactual models of mortality prevention can be used for outcome and performance monitoring of substance use disorder treatment systems.Keywords: Counterfactual model; fatal opioid poisoning; opioid use disorder; treatment

27. Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdose among psychologically distressed people who inject drugs? Kim S. Betts, Fairlie McIlwraith, Paul Dietze, Elizabeth Whittaker, Lucy Burns, Shelley Cogger, Rosa AlatDrug and Alcohol Dependence 2015:154;76-84

AbstractBackground This study investigates whether the type, nature or amount of polysubstance use can explain the increased risk of non-fatal overdose among people who inject drugs with severe psychological distress. Methods Data came from three years (2011–2013) of the Illicit Drug Reporting System (IDRS), an annual sentinel sample of injecting drug users across Australia (n = 2673). Structural Equation Modelling (SEM) was used on 14 drug types to construct five latent factors, each representing a type of polysubstance use. Tests of measurement invariance were carried out to determine if polysubstance use profiles differed between those with and without severe psychological distress. Next, we regressed non-fatal overdose on the polysubstance use factors with differences in the relationships tested between

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groups. Findings Among those with severe psychological distress a polysubstance use profile characterised by heroin, oxycodone, crystal methamphetamine and cocaine use was associated with greater risk of non-fatal overdose. Among those without severe psychological distress, two polysubstance use profiles, largely characterised by opioid substitution therapies and prescription drugs, were protective against non-fatal overdose. Conclusion The types of polysubstance use profiles did not differ between people who inject drugs with and without severe psychological distress. However, the nature of use of one particular polysubstance profile placed the former group at a strongly increased risk of non-fatal overdose, while the nature of polysubstance use involving opioid substitution therapies was protective only among the latter group. The findings identify polysubstance use profiles of importance to drug-related harms among individuals with psychological problems.Keywords: Polysubstance use; Non-fatal overdose; Psychological distress; Structural equation modelling

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EPIDEMIOLOGY & DEMOGRAPHY

28. Patterns and correlates of alcohol use amongst heroin users: 11-year follow-up of the Australian Treatment Outcome Study cohortShane Darke, Tim Slade, Joanne Ross, Christina Marel, Katherine L. Mills, Maree TesssonAddictive Behaviors 2015: 50; 78-83 Abstract Introduction The study aimed to determine long-term alcohol use patterns and correlates amongst heroin users. Methods Longitudinal cohort. 11-year post-baseline follow-up of the Australian Treatment Outcome Study cohort. Results At 11-year follow-up, 431 (70%) participants were interviewed. Alcohol was used in the preceding month by 56%, with 27% reporting daily use and 11% heavy daily drinking. Alcohol use patterns showed remarkable consistency across waves, with the proportion who drank in the preceding month ranging between 49 and 56%, with no significant trend across time. Daily drinking ranged between 20 and 27%, and heavy daily drinking between 7 and 12%. Both declined slightly from baseline to 3-year follow-up, but by 11 years were at levels similar to baseline. Compared to female referents, males were more likely to drink (OR 1.6, CI 1.3–2.1, p < .05), to drink daily (OR 1.8, CI 1.4–2.4, p < .05) and to drink heavily (OR 1.7, 1.1–2.5, p < .05). Compared to those not in enrolled in a drug treatment programme, those enrolled were significantly less likely to drink (OR 0.7, CI 0.5–0.8, p < .05) and to drink daily (OR 0.6, 0.5–0.8, p < .05). Compared to those who did not drink heavily, heavy drinking was associated with a higher likelihood of recent overdose (OR 1.6, CI 1.0–2.4, p < .05), of criminality (OR 1.9, 1.3–2.7, p < .001), and with lower SF12 physical (mean difference − 3.0, CI − 4.7 to − 1.4, p < .001) and mental (− 2.4, CI − 4.3 to − 0.5, p < .001) health scores. Conclusions There were consistently high levels of both abstinence and regular drinking, with drinking patterns staying relatively stable across the decade. From the clinical perspective, the high rates of heavy drinking are of particular relevance, given the observed associations with a poorer clinical profile.Keywords: Alcohol; Heroin; Cohort; Harm; ATOS

29. Illicit drug use, early age at first use and risk of premenstrual syndrome: A longitudinal studyHong Ju, Mark Jones, Gita D. MishraDrug and Alcohol Dependence 2015:152;209-217 AbstractBackground Premenstrual syndrome (PMS) is common among women of reproductive age. Limited studies have investigated the long-term association between illicit drug use and PMS. Methods The 1973–1978 cohort from the Australian Longitudinal Study on Women's Health, a prospective cohort study, was followed up for 13-year from 2000 to 2012. Data were collected through self-reported questionnaires on all variables, including PMS, illicit drug use and a range of sociodemographic, lifestyle, reproductive and psychological factors. Results When the women were 22–27 years of age, over 40% use illicit drug in the last 12 months, 9% first used drug before age 15 years and approximately 35% reported PMS. Over the study period, the prevalence of drug use in the last 12 months declined whereas that of PMS remained fairly stable except an increase when they were 34–39 years old. Generalised estimating equations analysis showed that, compared to never drug users, significantly higher odds of reporting PMS were detected for illicit drug use in the last 12 months: multiple drugs (odds ratio (OR) 1.31, 95% confidence interval (CI) 1.21, 1.43), exclusive marijuana (OR

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1.23, 95% CI 1.08, 1.40). A higher odds of PMS was identified for age at first drug use before 15 years (OR 1.20, 95% CI 1.03, 1.40). Conclusions Illicit drug use in the last 12 months, especially early age at first use and multiple drug use, is associated with increased risk of PMS. However current study is unable to prove causality.Keywords: Premenstrual syndrome; PMS; Illicit drugs; Substance use; Longitudinal studies

30. Hepatitis C virus infection and pain sensitivity in patients on methadone or buprenorphine maintenance therapy for opioid use disordersJudith I. Tsui, Marlene C. Lira, Debbie M. Cheng, Michael R. Winter, Daniel P. Alford, Jane M. Liebschutz, Jianren Mao, Robert R. Edwards, Jeffrey H. SametDrug and Alcohol Dependence 2015:153;286-292 AbstractBackground Patients with opioid use disorders on opioid agonist therapy (OAT) have lower pain tolerance compared to controls. While chronic viral infections such as HCV and HIV have been associated with chronic pain in this population, no studies have examined their impact on pain sensitivity. Methods We recruited 106 adults (41 uninfected controls; 40 HCV mono-infected; and 25 HCV/HIV co-infected) on buprenorphine or methadone to assess whether HCV infection (with or without HIV) was associated with increased experimental pain sensitivity and self-reported pain. The primary outcome was cold pain tolerance assessed by cold-pressor test. Secondary outcomes were cold pain thresholds, wind-up ratios to repetitive mechanical stimulation (i.e., temporal summation) and acute and chronic pain. Multivariable regression models evaluated associations between viral infection status and outcomes, adjusting for other factors. Results No significant differences were detected across groups for primary or secondary outcomes. Adjusted mean cold pain tolerance was 25.7 (uninfected controls) vs. 26.8 (HCV mono-infection) vs. 25.3 (HCV/HIV co-infection) seconds (global p-value = 0.93). Current pain appeared more prevalent among HCV mono-infected (93%) compared to HCV/HIV co-infected participants (76%) and uninfected controls (80%), as did chronic pain (77% vs. 64% vs. 61%, respectively). However, differences were not statistically significant in multivariable models. Conclusion This study did not detect an association between HCV infection and increased sensitivity to pain among adults with and without HIV who were treated with buprenorphine or methadone for opioid use disorders. Results reinforce that pain and hyperalgesia are common problems in this population.Keywords: Opioid-related disorders; Pain; Chronic pain; Hyperalgesia; Hepatitis C; HIV

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HEPATITIS C

31. Hepatitis C virus treatment as prevention among injecting drug users: who should we cure first?Anneke S. de Vos, Maria Prins, Mirjam E. E. KretzschmarAddiction 2015: 110(6);975-983

AbstractBackground and Aims Treatment of injecting drug users (IDU) for hepatitis C virus (HCV) infection may prevent onward transmission. Treating individuals who often share injecting equipment is most likely to prevent new infections. However, these high-risk IDU are also more likely to become re-infected than low-risk IDU. We investigated to which group treatment is best targeted. Design We modelled the expected benefits per treatment of one chronically HCV-infected IDU in a population of low- and high-risk IDU. The benefits of treating one low- or one high-risk IDU were compared. Measurements Benefits included the probability for the treated IDU to become and remain uninfected, as well as the expected number of prevented infections to others (i.e. we quantified the total expected decrease in chronic infections). Findings We found a threshold in HCV-RNA prevalence above which treating low-risk IDU, and below which treating high-risk IDU, resulted in the greatest benefits. This threshold was at 50% of exchanged syringes being HCV contaminated. When 42% of IDU engaged in high-risk behaviour (borrowing and lending out syringes 7.3 times more frequently than low-risk IDU), the corresponding threshold of HCV-RNA prevalence among IDU was at 32%. Larger-risk heterogeneity led to a lower corresponding threshold among IDU. A combination of HCV treatment and 50% risk reduction was best directed at high-risk IDU for prevalence among syringes up to 59%. The threshold was marginally sensitive to changes in disease and treatment variables. Conclusions When more than half of all exchanged syringes in a population of injecting drug users (IDU) are contaminated by hepatitis C virus, it is most efficient to treat low-risk IDU first. Below this threshold, it is most efficient to treat high-risk IDU first.Keywords: HCV; HCV prevention; injecting drug use; mathematical modelling; risk heterogeneity; treatment as prevention

32. Estimating the number of people with hepatitis C virus who have ever injected drugs and have yet to be diagnosed: an evidence synthesis approach for ScotlandTeresa C. Prevost, Anne M. Presanis, Avril Taylor, David J. Goldberg, Sharon J. Hutchinson, Daniela De AngelisAddiction 2015: 110(8);1287-1300 AbstractAims To estimate the number of people who have ever injected drugs (defined here as PWID) living in Scotland in 2009 who have been infected with the hepatitis C virus (HCV) and to quantify and characterize the population remaining undiagnosed. Methods Information from routine surveillance (n = 22 616) and survey data (n = 2511) was combined using a multiparameter evidence synthesis approach to estimate the size of the PWID population, HCV antibody prevalence and the proportion of HCV antibody prevalent cases who have been diagnosed, in subgroups defined by recency of injecting (in the last year or not), age (15–34 and 35–64 years), gender and region of residence (Greater Glasgow and Clyde and the rest of Scotland). Results HCV antibody-prevalence among PWID in Scotland during 2009 was estimated to be 57% [95% CI=52−61%], corresponding to 46 657

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[95% credible interval (CI) = 33 812–66 803] prevalent cases. Of these, 27 434 (95% CI = 14 636–47 564) were undiagnosed, representing 59% [95% CI=43−71%] of prevalent cases. Among the undiagnosed, 83% (95% CI = 75–89%) were PWID who had not injected in the last year and 71% (95% CI = 58–85%) were aged 35–64 years. Conclusions The number of undiagnosed hepatitis C virus-infected cases in Scotland appears to be particularly high among those who have injected drugs more than 1 year ago and are more than 35 years old.Keywords: Evidence synthesis; hepatitis C; people who inject drugs; prevalence

33. “Hepatitis C treatment turned me around:” Psychological and behavioral transformation related to hepatitis C treatmentA.W. Batchelder, D. Peyser, S. Nahvi, J.H. Arnsten , A.H. LitwinDrug and Alcohol Dependence 2015:153;66-71 AbstractBackground Hepatitis C (HCV) is a significant public health problem that primarily affects current and former substance users. However, individuals with a history of substance use are less likely to have access to or engage in HCV care. Psychological and behavioral barriers prevent many HCV-infected individuals from initiating or engaging in HCV treatment. This study aimed to investigate the psychological and behavioral experiences of current and former substance users receiving HCV treatment within a combined methadone and primary care clinic in the United States. Methods We conducted 31 semi-structured qualitative interviews with opioid-dependent adults enrolled in an integrated HCV treatment program within a methadone maintenance clinic in the Bronx, NY. We used thematic analysis, informed by grounded theory, and inquired about perceptions of HCV before and after initiating HCV treatment, reasons for initiating HCV treatment, and the decision to participate in individual versus group HCV treatment. Results Participants described psychological and behavioral transformation over the course of HCV treatment. These included reductions in internalized stigma and shame related to HCV and addiction, increases in HCV disclosure and self-care, reductions in substance use, and new desire to help others who are living with HCV. Conclusions Integrating HCV treatment with methadone maintenance has the potential to create psychological and behavioral transformations among substance using adults, including reductions in HCV- and addiction-related shame and improvements in overall self-care.Keywords: Hepatitis C; Injection drug use; Methadone maintenance; Shame; Internalized stigma

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34. Acquiring hepatitis C in prison: the social organisation of injecting riskCarla Treloar, Luke McCredie2, Andrew R Lloyd and on behalf of the HITS-p investigators Harm Reduction Journal 2015:12;10

Abstract  Aim The potential for transmission of hepatitis C virus (HCV) in prison settings is well established and directly associated with sharing of injecting and tattooing equipment, as well as physical violence. This study is one of the first to examine the circumstances surrounding the acquisition of HCV in the prison setting via inmates’ own accounts. Method This is a sub-study of a cohort of prison inmates in New South Wales, Australia. Cohort participants were inmates who had reported ever injecting drugs and who had a negative HCV serological test within 12 months prior to enrolment. Cohort participants were monitored every 3 to 6 months for HCV antibodies and viraemia and via behavioural risk practices questionnaire. Participants with a documented HCV seroconversion were eligible to participate in in-depth interviews with a research nurse known to them. Results Participants included six inmates (four men, two women) with documented within-prison HCV seroconversion. Participants reported few changes to their injecting practices or circumstances that they attributed to HCV acquisition. Participants believed that they were sharing syringes with others who were HCV negative and trusted that others would have declared their HCV status if positive. Some participants described cleaning equipment with water, but not with disinfectant. In a departure from usual routine, one participant suggested that he may have acquired HCV as a result of using a syringe pre-loaded with drugs that was given to him in return for lending a syringe to another inmate. Participants described regret at acquiring HCV and noted a number of pre- and post-release plans that this diagnosis impacted upon. Conclusions Acquiring hepatitis C was not a neutral experience of participants but generated significant emotional reactions for some. Decisions to share injecting equipment were influenced by participants’ assumptions of the HCV status of their injecting partners. The social organisation of injecting, in trusted networks, is a challenge for HCV prevention programs and requires additional research. Keywords: Prison; Hepatitis C; Injecting drug use; Incidence; Australia; Harm reduction; Qualitative; Needle exchange

35. The common sense model applied to hepatitis C: a qualitative analysis of the impact of disease comparison and witnessed death on hepatitis C illness perceptionStella A. Safo, Abigail Batchelder, Deena Peyser, Alain H. LitwinHarm Reduction Journal 2015:12;20

Abstract Background Hepatitis C virus (HCV) accounts for 15,000 deaths in the United States yearly because people living with HCV are not identified in time to seek treatment, are ineligible for or refuse treatment, or face structural impediments to obtaining treatment such as lack of access to health care or lack of insurance. People who inject drugs (PWID) comprise a large proportion—estimates of up to 60–70 %—of current and new HCV infected individuals and face many barriers to completing HCV treatment. Methods We conducted 30 qualitative semi-structured interviews of current and former PWID seeking HCV treatment at an opioid-agonist treatment facility in New York City. We used thematic analysis, informed by grounded theory, to examine perceptions of HCV and decisions to initiate HCV treatment. We analyzed the themes that emerged via the common sense model (CSM) of illness perception theoretical framework. Results Using thematic analyses, two major themes

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emerged related to engagement in HCV treatment. First, participants independently compared HCV to HIV, and in so doing, emphasized the potential fatality of HCV and the need for treatment. Second, participants described witnessing others suffer or die from untreated HCV and expressed how these recollections impacted their desire to undergo treatment themselves. Together, these themes contributed to the way participants perceived HCV and informed their decisions to initiate treatment. Both themes reflect the CSM’s “self-regulation” process, which posits that understanding the causes and consequences of an illness impacts one’s ability to seek treatment to overcome this illness state. Conclusions This paper offers insight into how clinicians can better understand and utilize HCV illness perceptions to evaluate willingness to engage in HCV treatment among PWID considering antiviral treatment modalities. Keywords: Hepatitis C (HCV); HIV/AIDS; Illness perception; Treatment barriers; People who inject drugs (PWID); Substance use

36. Evidence of continued injecting drug use after attaining sustained treatment-induced clearance of the hepatitis C virus: Implications for reinfection Heather Valerio, David J. Goldberg, James Lewsey, Amanda Weir, Samuel Allen, Esther J. Aspinall, Stephen T. Barclay, Peter Bramley, John F. Dillon, Ray Fox, Andrew Fraseri, Peter C. Hayes, Hamish Innes, Nicholas Kennedy, Peter R. Mills, Adrian J. Stanley, Sharon J. HutchinsonDrug and Alcohol Dependence 2015:154;125-131

AbstractBackground People who inject drugs (PWID) are at the greatest risk of hepatitis C virus (HCV) infection, yet are often denied immediate treatment due to fears of on-going risk behaviour. Our principal objective was to examine evidence of continued injecting drug use among PWID following successful treatment for HCV and attainment of a sustained viral response (SVR). Methods PWID who attained SVR between 1992 and June 2012 were selected from the National Scottish Hepatitis C Clinical Database. Hospitalisation and mortality records were sourced for these patients using record linkage techniques. Our primary outcome variable was any hospitalisation or death, which was indicative of injecting drugs post-SVR. Results The cohort comprised 1170 PWID (mean age at SVR 39.6y; 76% male). The Kaplan Meier estimate of incurring the primary outcome after three years of SVR was 10.59% (95% CI, 8.75–12.79) After adjusting for confounding, the risk of an injection related hospital episode or death post-SVR was significantly increased with advancing year of SVR: AHR:1.07 per year (95% CI, 1.01–1.14), having a pre-SVR acute alcohol intoxication-related hospital episode: AHR:1.83 (95% CI, 1.29–2.60), and having a pre-SVR opiate or injection-related hospital episode: AHR:2.59 (95% CI, 1.84–3.64). Conclusion Despite attaining the optimal treatment outcome, these data indicate that an increasing significant minority of PWID continue to inject post-SVR at an intensity which leads to either hospitalisation or death and increased risk of reinfection.Keywords: Hepatitis C; Sustained viral response; People who inject drugs; Reinfection; Record linkage

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HOMELESSNESS

37. Health, perceived quality of life and health services use among homeless illicit drug usersK.K. O’Brien, A. Schuttke, A. Alhakeem, E. Donnelly-Swift, C. Keogh, A. O’Carroll, K. O'Sullivan, R. Galvin, T. FaheyDrug and Alcohol Dependence 2015:154;139-145

AbstractIntroduction Drug misuse has been identified as a significant problem in homeless populations. This study examines aspects of physical and mental health, perceived quality of life and health service use among homeless illicit drug users and compares these to non-drug users. Methods Participants were recruited through health clinics across Dublin. A questionnaire assessed participants’ drug use, health and well-being, health behaviours and use of health services. Descriptive statistics are presented for the entire cohort and drug users separately. Logistic regression analysis was used to examine the relationship between drug use and (i) multimorbidity, (ii) anxiety and/or depression, (iii) perceived quality of life and (iv) use of health services. Results Of 105 participants recruited, 35 (33%) were current drug users. Current and previous drug users were significantly more likely to have multimorbidity than those who had never taken drugs (OR 4.86, 95% CI 1.00–23.66). There was no significant difference between drug users and non-drug users in the prevalence of anxiety and/or depression. Drug users were five times more likely than non-drug users to have a low perceived quality of life (OR 5.2, 95% CI 1.7–16.0). Health service utilization was high, although some services were used less by drug users (e.g., dentist and psychiatric outpatient services) while others were used more often (e.g., phoneline services and day care centres). Conclusion This study highlights the high levels of drug use in this population and the negative impact of drug use on health and perceived quality of life of a homeless population in Dublin.Keywords: Homeless; Drug user; Mental health; Perceived quality of life; Health service use

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INJECTING BEHAVIOUR

38. Going into the groin: Injection into the femoral vein among people who inject drugs in three urban areas of EnglandV.D. Hope , J. Scott, K.J. Cullen, J.V. Parry, F. Ncube, M. HickmanDrug and Alcohol Dependence 2015:152;239-245 AbstractBackground There have been increasing concerns about injection into the femoral vein – groin injecting – among people who inject drugs in a number of countries, though most studies have been small. The extent, reasons and harms associated with groin injecting are examined. Method Participants were recruited using respondent driven sampling (2006–2009). Weighted data was examined using bivariate analyses and logistic regression. Results The mean age was 32 years; 25% were women (N = 855). During the preceding 28 days, 94% had injected heroin and 13% shared needles/syringes. Overall, 53% reported ever groin injecting, with 9.8% first doing so at the same age as starting to inject. Common reasons given for groin injecting included: “Can’t get a vein elsewhere” (68%); “It is discreet” (18%); and “It is quicker” (14%). During the preceding 28 days, 41% had groin injected, for 77% this was the only body area used (for these “It is discreet” was more frequently given as a reason). In the multivariable analysis, groin injection was associated with: swabbing injection sites; saving filters for reuse; and receiving opiate substitution therapy. It was less common among those injecting into two body areas, and when other people (rather than services) were the main source of needles. Groin injection was more common among those with hepatitis C and reporting ever having deep vein thrombosis or septicaemia. Conclusions Groin injection was common, often due to poor vascular access, but for some it was out of choice. Interventions are required to reduce injecting risk and this practice.Keywords: People who inject drugs; Femoral vein; Risk behaviours; Bacterial infections; Viral infections

39. The Risk Environment of Heroin Use Initiation: Young Women, Intimate Partners, and “Drug Relationships”Paula Mayock, Jennifer Cronly, Michael C. ClattsSubstance Use & Misuse 2015:50(6):771–782

Abstract This paper examines young women's initiation to heroin use in the context of an intimate relationship based on data from a small-scale ethno-epidemiology of heroin use in Ireland, 2007–2009. The epidemiological sample included 120 young people, and life history interviews were conducted with a sub-sample of 40 youth aged 16–25 years. A detailed analysis of the “risk environment” of young women's heroin initiation highlights a complex interplay between women's agency and intimate partner influence. It is argued that dichotomous representations of women as victims or emancipated consumers do not adequately capture the complexity of women's initiation journeys. The study's limitations are noted and implications for drug use prevention and harm reduction strategies are discussed.Keywords: young women, heroin initiation, risk environment, ethno-epidemiology, life history interviewing, Ireland

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INJECTING DRUG USER

40. Pharmacy-randomized intervention delivering HIV prevention services during the syringe sale to people who inject drugs in New York CityCrystal Fuller Lewis, Alexis V. Rivera, Natalie D. Crawford, Jennifer DeCuir, Silvia AmestyDrug and Alcohol Dependence 2015:153;72-77 AbstractBackground Pharmacy syringe access may be an opportunity to provide HIV prevention resources to persons who inject drugs (PWID). We examined the impact of a pharmacy-randomized intervention to reduce injection risk among PWID in New York City. Methods Pharmacies (n = 88) were randomized into intervention, primary control, and secondary control arms. Intervention pharmacies received in-depth harm reduction training, recruited syringe customers who inject drugs into the study, and provided additional services (i.e., HIV prevention/medical/social service referrals, syringe disposal containers, and harm reduction print materials). Primary control pharmacies recruited syringe customers who inject drugs and did not offer additional services, and secondary control pharmacies did not recruit syringe customers (and are not included in this analysis) but participated in a pharmacy staff survey to evaluate intervention impact on pharmacy staff. Recruited syringe customers underwent a baseline and 3-month follow-up ACASI. The intervention effect on injection risk/protective behavior of PWID was examined. Results A total of 482 PWID completed baseline and follow-up surveys. PWID were mostly Hispanic/Latino, male, and mean age of 43.6 years. After adjustment, PWID in the intervention arm were more likely to report always using a sterile syringe vs. not (PR = 1.24; 95% CI: 1.04–1.48) at 3-month follow-up. Conclusions These findings present evidence that expanded pharmacy services for PWID can encourage sterile syringe use which may decrease injection risk in high HIV burdened Black and Latino communities.Keywords: Persons who inject drugs (PWID); HIV prevention; Structural interventions; Pharmacies; Risk behaviour

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MISCELLANEOUS

41. Brain and cognition abnormalities in long-term anabolic-androgenic steroid usersMarc J. Kaufman, Amy C. Janes, James I. Hudson, Brian P. Brennan, Gen Kanayama, Andrew R. Kerrigan, J. Eric Jensen, Harrison G. Pope JrDrug and Alcohol Dependence 2015:152;47-56

AbstractBackground Anabolic-androgenic steroid (AAS) use is associated with psychiatric symptoms including increased aggression as well as with cognitive dysfunction. The brain effects of long-term AAS use have not been assessed in humans. Methods This multimodal magnetic resonance imaging study of the brain compared 10 male weightlifters reporting long-term AAS use with 10 age-matched weightlifters reporting no AAS exposure. Participants were administered visuospatial memory tests and underwent neuroimaging. Brain volumetric analyses were performed; resting-state fMRI functional connectivity (rsFC) was evaluated using a region-of-interest analysis focused on the amygdala; and dorsal anterior cingulate cortex (dACC) metabolites were quantified by proton magnetic resonance spectroscopy (MRS). Results AAS users had larger right amygdala volumes than nonusers (P = 0.002) and reduced rsFC between right amygdala and frontal, striatal, limbic, hippocampal, and visual cortical areas. Left amygdala volumes were slightly larger in AAS users (P = 0.061) but few group differences were detected in left amygdala rsFC. AAS users also had lower dACC scyllo-inositol levels (P = 0.004) and higher glutamine/glutamate ratios (P = 0.028), possibly reflecting increased glutamate turnover. On a visuospatial cognitive task, AAS users performed more poorly than nonusers, with the difference approaching significance (P = 0.053). Conclusions Long-term AAS use is associated with right amygdala enlargement and reduced right amygdala rsFC with brain areas involved in cognitive control and spatial memory, which could contribute to the psychiatric effects and cognitive dysfunction associated with AAS use. The MRS abnormalities we detected could reflect enhanced glutamate turnover and increased vulnerability to neurotoxic or neurodegenerative processes, which could contribute to AAS-associated cognitive dysfunction.Keywords: Anabolic-androgenic steroids; Magnetic resonance imaging; Magnetic resonance spectroscopy; Amygdala; Scyllo-inositol; Glutamate

42. Drug policy reform and the reclassification of cannabis in England and Wales: A cautionary taleMichael ShinerInternational Journal of Drug Policy 2015:26(7);696–704

AbstractWhen the legal classification of cannabis was downgraded in 2004 it represented the most significant liberalisation of British drug law in more than 30 years. Paradoxically, however, this apparently progressive reform led to an intensification of police efforts targeting minor possession offences and its failure was confirmed in January 2009 when the decision to downgrade cannabis was reversed. This article documents the impact that reclassification had on law enforcement activities and seeks to explain why it failed to deliver a more progressive approach. Drawing on official statistics, the analysis charts the process of net-widening that followed the reform, identifying a sharp increase in the number of people caught in the criminal justice net for minor possession offences. While police targeting of such offences

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was an unintended consequence of performance targets, broader political influences were also at play. The contradictions and reversals involved in the reclassification of cannabis, it is argued, can be readily understood in terms of the broader politics of crime and control and the ‘structured ambivalence’ of state responses.Keywords: Cannabis policing, Drug reform, The politics of crime control

43. Changes in health outcomes as a function of abstinence and reduction in illicit psychoactive drug use: a prospective study in primary careTae Woo Park, Debbie M. Cheng, Christine A. Lloyd-Travaglini, Judith Bernstein, Tibor P. Palfai, Richard Saitz5,7

Addiction 2015:110(9);1476-1483 AbstractAims To test (1) whether abstinence and reduction in illicit psychoactive drug use were associated with changes in health outcomes in primary care patients and (2) whether these associations varied by drug type. Design Secondary analysis of data from a randomized controlled trial that tested a brief intervention for drug use in primary care patients (589 enrolled, 574 completed a 6-month assessment). Analyses were conducted overall and stratified by the most commonly self-identified main drugs (marijuana, cocaine and opioids).Setting and Participants Patients who screened positive for illicit drug use at an urban primary care clinic in Boston, Massachusetts, USA. Measurements Differences in past-month main drug use at baseline and 6-month outcome were categorized as continued or increased use, decreased use without abstinence and abstinence. Primary outcomes were 6-month changes in drug use consequences [Short Inventory of Problems scores (range 0–45)], depressive symptoms and health-related quality of life (HRQol). Findings Abstinence was associated with a greater decrease in adverse drug use consequences than continued or increased use among the full sample and cocaine and opioids subgroups (adjusted means, full sample: –8.11 versus –0.05, P < 0.001; cocaine: –13.33 versus +1.09, P < 0.001, opioids; –16.84 versus –2.10, P < 0.001). Differences were not significant between those who decreased use compared with those who continued or increased use. There were no significant associations between drug use and depressive symptoms or HRQol. Neither abstinence nor decreased use was associated significantly with consequences in the marijuana subgroup. Conclusions Among primary care patients in the United States who use illicit psychoactive drugs, abstinence but not reduction in use without abstinence appears to be associated with decreased adverse drug use consequences.Keywords: Abstinence; cocaine; consequences of drug use; marijuana; opioids; primary care; reduction in drug use

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NALOXONE

44. Predictors of participant engagement and naloxone utilization in a community-based naloxone distribution programChristopher Rowe, Glenn-Milo Santos, Eric Vittinghoff, Eliza Wheeler, Peter Davidson, Philip O. CoffinAddiction 2015: 110(8);1301-1310 AbstractAims To describe characteristics of participants and overdose reversals associated with a community-based naloxone distribution program and identify predictors of obtaining naloxone refills and using naloxone for overdose reversal. Design Bivariate statistical tests were used to compare characteristics of participants who obtained refills and reported overdose reversals versus those who did not. We fitted multiple logistic regression models to identify predictors of refills and reversals; zero-inflated multiple Poisson regression models were used to identify predictors of number of refills and reversals. Setting San Francisco, California, USA. Participants Naloxone program participants registered and reversals reported from 2010 to 2013. Measurements Baseline characteristics of participants and reported characteristics of reversals. Findings A total of 2500 participants were registered and 702 reversals were reported from 2010 to 2013. Participants who had witnessed an overdose [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI) = 1.53–2.66; AOR = 2.73, 95% CI = 1.73–4.30] or used heroin (AOR = 1.85, 95% CI =  1.44–2.37; AOR = 2.19, 95% CI = 1.54–3.13) or methamphetamine (AOR = 1.71, 95% CI = 1.37–2.15; AOR = 1.61, 95% CI = 1.18–2.19) had higher odds of obtaining a refill and reporting a reversal, respectively. African American (AOR = 0.63, 95% CI = 0.45–0.88) and Latino (AOR = 0.65, 95% CI =  0.43–1.00) participants had lower odds of obtaining a naloxone refill, whereas Latino participants who obtained at least one refill reported a higher number of refills [incidence rate ratio (IRR) = 1.33 (1.05–1.69)]. Conclusions Community naloxone distribution programs are capable of reaching sizeable populations of high-risk individuals and facilitating large numbers of overdose reversals. Community members most likely to engage with a naloxone program and use naloxone to reverse an overdose are active drug users.Keywords: Harm reduction; heroin; methamphetamine; naloxone; opiates; overdose; substance use

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OPIATE RECOVERY TREATMENT

45. Long-term mortality, remission, criminality and psychiatric comorbidity of heroin dependence: 11-year findings from the Australian Treatment Outcome StudyMaree Teesson, Christina Marel, Shane Darke, Joanne Ross, Tim Slade, Lucy Burns, Michael Lynskey, Sonja Memedovic, Joanne White, Katherine L. MillsAddiction 2015: 110(6);986-993

AbstractAims To determine the long-term mortality, remission, criminality and psychiatric comorbidity during 11 years among heroin-dependent Australians. Design Longitudinal cohort study. Setting Sydney, Australia. Participants A total of 615 participants were recruited and completed baseline interviews between 2001 and 2002. Participants completed follow-up interviews at 3, 12, 24 and 36 months post-baseline, and again at 11 years post-baseline; 431 (70.1%) of the original 615 participants completed the 11-year follow-up.Measurements Participants were administered the Australian Treatment Outcome Study (ATOS) structured interview, addressing demographics, treatment history, drug use, heroin overdose, criminality, health and mental health at all interviews. Overall, 96.1% of the cohort completed at least one follow-up interview. Findings At 11 years, 63 participants (10.2%) were deceased. The proportion of participants who reported using heroin in the preceding month decreased significantly from baseline (98.7%) to 36-month follow-up (34.0%; odds ratio = 0.01; 95% confidence interval = 0.00, 0.01) with further reductions evident between 36 months and 11 years (24.8%). However, one in four continued to use heroin at 11 years, and close to one-half (46.6%) were in current treatment. The reduction in current heroin use was accompanied by reductions in risk-taking, crime and injection-related health problems, and improvements in general physical and mental health. The relationship with treatment exposure was varied. Major depression was associated consistently with poorer outcome.Conclusions In an 11-year follow-up of patients undergoing treatment for heroin dependence, 10.2% had died and almost half were still in treatment; the proportion still using heroin fell to a quarter, with major depression being a significant predictor of continued use.Keywords: Cohort; criminality; heroin; longitudinal; mortality; psychiatric comorbidity

46. Patient Perspectives Associated with Intended Duration of Buprenorphine Maintenance TherapyBrandon S. Bentzley, Kelly S. Barth, Sudie E. Back, Garrett Aronson, Sarah W. BookJournal of Substance Abuse Treatment 2015:56;48–53

AbstractPatients with opioid use disorders frequently discontinue opioid maintenance therapy (OMT) prematurely, reducing retention and possibly limiting the efficacy of OMT. The current study is a cross-sectional survey of patients (N = 69) enrolled in buprenorphine maintenance therapy (BMT). We examined patient demographics, BMT characteristics (e.g., dose, time in BMT), and patient perspectives regarding intended duration of BMT. In addition, patients’ reasons for continuing or discontinuing BMT were investigated. Results revealed that the majority (82%) of participants reported wanting to continue BMT for at least 12 months. Age at first drug use, time in BMT, concern about pain, and concern about relapse were all positively associated with intended duration of BMT. The following were negatively associated with intended duration of BMT: recent discussion with a treatment provider about BMT discontinuation, prior attempt to discontinue BMT, concern about withdrawal

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symptoms, experiencing pleasurable effects from taking buprenorphine, and perceived conflicts of BMT with life, work, or school obligations. The most common reasons for wanting to continue BMT included concerns about withdrawal symptoms, relapse, and pain. Although preliminary, the findings highlight key issues with regard to patients’ perspectives of BMT. The results of this study provide information that may be useful in improving OMT programs and treatment outcomes.Keywords: Buprenorphine, Opioid use disorder, Opioid maintenance therapy, Treatment cessation, Patient perspectives

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OPIATE TREATMENT SERVICES

47. Factors associated with substance use treatment completion in residential facilitiesRyan Mutter, Mir M. Ali, Kelley Smith, Alex StrashnyDrug and Alcohol Dependence 2015:154;291-295

AbstractPurpose Individuals in residential treatment often face many challenges, which can include limited education, unstable housing, difficulty participating in the workforce, and severe substance use problems. We analyzed factors associated with substance use treatment completion. We focused on factors that can be influenced by health care system changes resulting from the Affordable Care Act (ACA). Data and methods We used the 2010 Treatment Episode Data Set – Discharges (TEDS-D), which is made available by the Substance Abuse and Mental Health Services Administration (SAMHSA). We analyzed factors associated with substance use treatment completion using logistic regression.Results Individuals in residential treatment were often unemployed or not in the labor force, had prior substance use treatment episodes, used more than one substance, and were uninsured. Factors associated with treatment completion included older age, greater education, employment, criminal justice referral, not being homeless, and private insurance.Conclusion The expansion in private insurance coverage as a result of the ACA may result in more treatment completion in residential settings. Changes to the Medicaid program resulting from the ACA, including coverage of substance use treatment as an essential health benefit and greater support for housing, education, and employment, may also contribute to more residential discharges ending in treatment completion.Keywords: Substance use; Residential treatment; Treatment completion

48. Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users’ experiences and perspectivesWouter Vanderplasschen, Jan Naert, Freya Vander Laenen & Jessica De MaeyerDrugs: Education, Prevention and Policy 2015:22(3);272-280

AbstractAims Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients’ perspectives and personal experiences. This study aims to assess opiate users’ satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods The study sample consisted of 77 opiate-dependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients’ subjective experiences, in addition to some quantitative measures. Findings About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions Compared with other stakeholders’ perspectives or traditional outcome indicators, service users’ subjective experiences shed an

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alternative light on the impact of opiate dependence and OST on individuals’ daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services.

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ORGANISATION OF TREATMENT

49. The impact of paying treatment providers for outcomes: difference-in-differences analysis of the ‘payment by results for drugs recovery’ pilotThomas Mason, Matthew Sutton, William Whittaker, Tim McSweeney, Tim Millar, Michael Donmall, Andrew Jones, Matthias PierceAddiction 2015: 110(7);1120-1128 AbstractAims To estimate the effect on drug misuse treatment completion of a pilot scheme to pay service providers according to rates of recovery. Design A controlled, quasi-experimental (difference-in-differences) observational study using multi-level random effects logistic regression. Setting Drug misuse treatment providers in all 149 commissioning areas in England in the financial years 2011–12 and 2012–13. Participants Service users treated in England in 2011–12 and 2012–13. Intervention and comparators Linkage of provider payments to performance indicators in eight pilot commissioning areas in England compared with all 141 non-pilot commissioning areas in England. Measurements Recovery was measured by successful completion of treatment (free from drugs of dependence) and engagement with services was measured by rates of declining to continue with treatment. Findings Following the introduction of the pilot scheme, service users treated in pilot areas were 1.3 percentage points [odds ratio (OR) = 0.859; 95% confidence interval (CI) = 0.788, 0.937] less likely to complete treatment compared with those treated in comparison areas. Service users treated in pilot areas were 0.9 percentage points (OR = 2.934; 95% CI = 2.094, 4.113) more likely to decline to continue with treatment compared with those treated in comparison areas. Conclusions In the first year of the pilot ‘Payment by Results for Drugs Recovery’ scheme in England, linking payments to outcomes reduced the probability of completing drug misuse treatment and increased the proportion service users declining to continue with treatment.Keywords: Difference-in-differences; drugs policy; multi-level modelling; pay-for-performance; payment-by-results; performance measurement; policy analysis; random effects; unintended consequences

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OVERDOSE & DRUG RELATED DEATHS

50. Mortality among individuals accessing pharmacological treatment for opioid dependence in California, 2006–10Elizabeth Evans, Libo Li, Jeong Min, David Huang, Darren Urada, Lei Liu, Yih-Ing Hser, Bohdan NosykAddiction 2015: 110(6);996-1005 AbstractAims To estimate mortality rates among treated opioid-dependent individuals by cause and in relation to the general population, and to estimate the instantaneous effects of opioid detoxification and maintenance treatment (MMT) on the hazard of all-cause and cause-specific mortality. Design Population-based treatment cohort study. Setting Linked mortality data on all individuals first enrolled in publicly funded pharmacological treatment for opioid dependence in California, USA from 2006 to 2010. Participants A total of 32 322 individuals, among whom there were 1031 deaths (3.2%) over a median follow-up of 2.6 years (interquartile range = 1.4–3.7). Measurements The primary outcome was mortality, indicated by time to death, crude mortality rates (CMR) and standardized mortality ratios (SMR). Findings Individuals being treated for opioid dependence had a more than fourfold increase of mortality risk compared with the general population [SMR = 4.5, 95% confidence interval (CI) = 4.2, 4.8]. Mortality risk was higher (1) when individuals were out-of-treatment (SMR = 6.1, 95% CI = 5.7, 6.5) than in-treatment (SMR = 1.8, 95% CI = 1.6, 2.1) and (2) during detoxification (SMR = 2.4, 95% CI = 1.5, 3.8) than during MMT (SMR = 1.8, 95% CI = 1.5, 2.1), especially in the 2 weeks post-treatment entry (SMR = 5.5, 95% CI = 2.7, 9.8 versus SMR = 2.5, 95% CI = 1.7, 4.9). Detoxification and MMT both independently reduced the instantaneous hazard of all-cause and drug-related mortality. MMT preceded by detoxification was associated with lower all-cause and other cause-specific mortality than MMT alone. Conclusions In people with opiate dependence, detoxification and methadone maintenance treatment both independently reduce the instantaneous hazard of all-cause and drug-related mortality.Keywords: Administrative data; detoxification and maintenance treatment; longitudinal design; mortality; opioid dependence

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PARENTING AND YOUNG PEOPLE

51. Is Drinking with Parents Associated with High-Risk Drinking among AdolescentsPape H., Rossow I., Storvoll E.E. European Addiction Research 2015:21;291-299 AbstractBackground/Aims What are the implications of drinking with parents (DWP) on adolescents' drinking behavior? We expanded the meagre body of research on this controversial issue by assessing the association between the frequency of DWP and adolescent high-risk drinking, taking a number of parental factors into account. Method Data stemmed from a subsample of 14-17-year-old current drinkers (n = 7,616) who participated in a cross-sectional Norwegian school survey (response rate: 84%). Results One in four reported DWP during the past year. The higher the frequency of DWP, the higher was the prevalence of high-risk drinking. Parental drunkenness, permissive alcohol-related parenting, and indicators of suboptimal parenting more generally also correlated with DWP. After controlling for these confounders, only frequent DWP remained significantly associated with high-risk drinking. Conclusions DWP was related to adolescent high-risk drinking, yet the association was in part attributable to parents' drinking and parenting style. The risk of involvement in high-risk drinking was about the same for adolescents reporting no DWP and infrequent DWP, while it was significantly elevated among those reporting frequent DWP. This study thus demonstrated that the frequency of DWP matters and that parents who drink with their adolescent children differ from other parents in important ways.Keywords: Adolescents; Drinking with parents; Underage heavy drinking; Alcohol-related parenting; General parenting style

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PRESCRIPTION MISUSE

52. Prescription pain reliever misuse prevalence, correlates, and origin of possession throughout the life courseOrion Mowbray, Adam QuinnAddictive Behaviors 2015: 50; 22-27 AbstractIntroduction While a considerable amount of information is available concerning who is most likely to engage in prescription pain reliever misuse, few studies have examined whether the correlates of pain reliever misuse and sources of pain reliever possession are consistent across the life span. Methods Data from the 2011–2012 National Survey in Drug Use and Health (NSDUH). Multivariate logistic regression examined clinical and social correlates of past-year pain reliever misuse, stratified by age. Additionally, bivariate analyses examined sources of pain reliever possession, and whether these origins differ by age. Results Among respondents, 4.7% reported past-year prescription pain reliever misuse. Prevalence for individuals aged 12 to 17 was 5.9%, 18 to 25 was 10.2%, 26–34 was 7.7%, 35 to 49 was 4.3%, and individuals aged 50 or older was 1.7%. While many social and clinical correlates of pain reliever misuse emerged among younger respondents, these correlates diminished in significance among older adults. Only past-year illicit drug use disorders (marijuana, cocaine, crack cocaine, heroin, and hallucinogen use) was a significant predictor of pain reliever misuse among all age groups. Also, older adults were more likely to report pain reliever possession from multiple medical doctors, whereas younger individuals were more likely to possess pain reliever from friends/relatives or through purchase from a drug dealer/stranger. Conclusions Increased efforts to better screen for illicit drug use and greater efforts to coordinate patient prescription records among medical care providers may be high priorities in developing interventions to reduce rates of misuse of prescription pain relievers, especially among older adults.Keywords: Pain reliever misuse; National survey of drug use and health; Age groups

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PREVENTION AND DIVERSIONARY ACTIVITIES

53. Does physical activity protect against drug abuse vulnerability?Michael. T. Bardo, Wilson. M. ComptonDrug and Alcohol Dependence 2015:153;3-13

AbstractBackground The current review examined recent literature to determine our state of knowledge about the potential ability of physical activity serve as a protectant against drug abuse vulnerability. Methods Both preclinical and clinical studies were examined using either associational or random assignment study designs. In addition to examining drug use as an outcome variable, the potential neural mediators linking physical activity and drug abuse vulnerability were examined. Conclusions Several important conclusions may be drawn. First, the preclinical evidence is solid in showing that physical activity in various forms is able to serve as both a preventive and treatment intervention that reduces drug use, although voluntary alcohol drinking appears to be an exception to this conclusion. Second, the clinical evidence provides some evidence, albeit mixed, to suggest a beneficial effect of physical activity on tobacco dependent individuals. In contrast, there exists only circumstantial evidence that physical activity may reduce use of drugs other than nicotine, and there is essentially no solid information from random control studies to know if physical activity may prevent initiation of problem use. Finally, both preclinical and clinical evidence shows that various brain systems are altered by physical activity, with the medial prefrontal cortex (mPFC) serving as one potential node that may mediate the putative link between physical activity and drug abuse vulnerability. It is concluded that novel neurobehavioral approaches taking advantage of novel techniques for assessing the physiological impact of physical activity are needed and can be used to inform the longitudinal random control studies that will answer definitively the question posed.Keywords: Physical activity; Exercise; Drug abuse; Drug reward; Impulsivity; Stress

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RECOVERY

54. Producing the ‘problem of drugs’: A cross national-comparison of ‘recovery’ discourse in two Australian and British reportsKari Lancaster, Karen Duke, Alison RitterInternational Journal of Drug Policy 2015:26(7);617–625

AbstractThe notion of ‘recovery’ as an overarching approach to drug policy remains controversial. This cross-national analysis considers how the problem of drugs was constructed and represented in two key reports on the place of ‘recovery’ in drug policy, critically examining how the problem of drugs (and the people who use them) are constituted in recovery discourse, and how these problematisations are shaped and disseminated. Bacchi's poststructuralist approach is applied to two documents (one in Britain and one in Australia) to analyse how the ‘problem of drugs’ and the people who use them are constituted: as problematic users, constraining alternative understandings of the shifting nature of drug use; as responsibilised individuals (in Britain) and as patients (in Australia); as worthy of citizenship in the context of treatment and recovery, silencing the assumption of unworthiness and the loss of rights for those who continue to use drugs in ‘problematic’ ways. The position of the organisations which produced the reports is considered, with the authority of both organisations resting on their status as independent, apolitical bodies providing ‘evidence-based’ advice. There is a need to carefully weigh up the desirable and undesirable political effects of these constructions. The meaning of ‘recovery’ and how it could be realised in policy and practice is still being negotiated. By comparatively analysing how the problem of drugs was produced in ‘recovery’ discourse in two jurisdictions, at two specific points in the policy debate, we are reminded that ways of thinking about ‘problems’ reflect specific contexts, and how we are invoked to think about policy responses will be dependent upon these conditions. As ‘recovery’ continues to evolve, opening up spaces to discuss its contested meanings and effects will be an ongoing endeavour.Keywords: Recovery, Drug policy, Australia, Britain, Problematisation, Carol Bacchi

55. Recovery definitions: Do they change?Lee Ann Kaskutas, Jane Witbrodt, Christine E. GrellaDrug and Alcohol Dependence 2015:154;85-92 AbstractBackground The term “recovery” is widely used in the substance abuse literature and clinical settings, but data have not been available to empirically validate how recovery is defined by individuals who are themselves in recovery. The “What Is Recovery?” project developed a 39-item definition of recovery based on a large nationwide online survey of individuals in recovery. The objective of this paper is to report on the stability of those definitions one to two years later. Methods To obtain a sample for studying recovery definitions that reflected the different pathways to recovery, the parent study involved intensive outreach. Follow-up interviews (n = 1237) were conducted online and by telephone among respondents who consented to participate in follow-up studies. Descriptive analyses considered endorsement of individual recovery items at both surveys, and t-tests of summary scores studied significant change in the sample overall and among key subgroups. To assess item reliability, Cronbach's alpha was estimated. Results Rates of endorsement of individual items at both interviews was above 90% for a majority of the recovery elements, and there

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was about as much transition into endorsement as out of endorsement. Statistically significant t-test scores were of modest magnitude, and reliability statistics were high (ranging from .782 to .899). Conclusions Longitudinal analyses found little evidence of meaningful change in recovery definitions at follow-up. Results thus suggest that the recovery definitions developed in the parent “What Is Recovery?” survey represent stable definitions of recovery that can be used to guide service provision in Recovery-Oriented Systems of Care.Keywords: Recovery; Recovered; Remission; Natural recovery; Validity; Reliability

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SMOKING

56. Recent trends in children's exposure to second-hand smoke in England: cotinine evidence from the Health Survey for EnglandMartin J. Jarvis, Colin FeyerabendAddiction 2015:110(9);1484-1492 AbstractAims To examine changes in children's exposure to second-hand tobacco smoke in England since 1998. Design Repeated cross-sectional surveys of the general population in England.Setting The Health Survey for England. Participants A total of 37 038 children participating in surveys from 1998 to 2012, 13 327 of whom were aged 4–15 years, had available cotinine and were confirmed non-smokers. Measurements The proportion of children with smoking parents; the proportion of children living in homes reported to be smoke-free; the proportion of children with undetectable concentrations of cotinine; linear and quadratic trend estimates of geometric mean cotinine across years. Findings By 2012, 87.3% of children lived in a home that was smoke-free {97.2% [95% confidence interval (CI) = 95.9–98.1] when parents were non-smokers, 61.3% (95% CI = 55.5–66.8) when one or both parents smoked}. A total of 68.6% (95% CI = 64.3–72.6%) of children had undetectable cotinine in 2012, up from 14.3% (95% CI = 12.7–16.0%) in 1998. There was a highly significant linear trend across years (with a small but significant quadratic term) to declining geometric mean cotinine in all children from 0.52 ng/ml (95% CI = 0.48–0.57) in 1998 to 0.11 ng/ml (95% CI = 0.10–0.12) in 2012. Children from routine/manual backgrounds were more exposed, but experienced similar gains across years to those from non-manual backgrounds. Conclusions In England, children's exposure to second-hand smoke has declined by 79% since 1998, with continuing progress since smoke-free legislation in 2007. An emerging social norm in England has led to the adoption of smoke-free homes not only when parents are non-smokers, but also when they smoke.Keywords: Children; cotinine; parental smoking; secondhand smoke; smokefree homes; smokefree legislation

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SMOKING CESSATION

57. Comparison of the characteristics of long-term users of electronic cigarettes versus nicotine replacement therapy: A cross-sectional survey of English ex-smokers and current smokersVictoria A. Nelson, Maciej L. Goniewicz, Emma Beard, Jamie Brown, Kate Sheals, Robert West, Lion ShahabDrug and Alcohol Dependence 2015:153;300-305 AbstractBackground Electronic cigarettes (ECs) and nicotine replacement therapy (NRT) are non-combustible nicotine delivery devices being widely used as a partial or a complete long-term substitute for smoking. Little is known about the characteristics of long-term users, their smoking behaviour, attachment to smoking, experience of nicotine withdrawal symptoms, or their views on these devices. This study aimed to provide preliminary evidence on this and compare users of the different products. Methods UK participants were recruited from four naturally occurring groups of long-term (≥6 months) users of either EC or NRT who had stopped or continued to smoke (N = 36 per group, total N = 144). Participants completed a questionnaire assessing socio-demographic and smoking characteristics, nicotine withdrawal symptoms, smoker identity and attitudes towards the products they were using. Results Adjusting for relevant confounders, EC use was associated with a stronger smoker identity (Wald X2(1) = 3.9, p = 0.048) and greater product endorsement (Wald X2(1) = 4.6, p = 0.024) than NRT use, irrespective of smoking status. Among ex-smokers, EC users reported less severe mood and physical symptoms (Wald X2(1) = 6.1, p = 0.014) and cravings (Wald X2(1) = 8.5, p = 0.003), higher perceived helpfulness of the product (Wald X2(1) = 4.8, p = 0.028) and lower intentions to stop using the product (Wald X2(1) = 17.6, p < 0.001) than NRT users. Conclusions Compared with people who use NRT for at least 6 months, those who use EC over that time period appear to have a stronger smoker identity and like their products more. Among long-term users who have stopped smoking, ECs are perceived as more helpful than NRT, appear more effective in controlling withdrawal symptoms and continued use may be more likely.Keywords: NRT use; Electronic cigarettes; Harm reduction; Identity; Smoking cessation; Nicotine withdrawal

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STIGMA

58. Visual and narrative representations of mental health and addiction by law enforcementJade Boyd, Susan Boyd, Thomas KerrInternational Journal of Drug Policy 2015:26(7);636–644

AbstractIn Vancouver, British Columbia, Canada's third largest city, the Vancouver Police Department (VPD), has positioned itself as being at the forefront of mental health regulation. The VPD problematization of the “mental health crisis” in Vancouver draws on discourses of addiction and dangerousness. This is partially achieved by the twinning of mental health with addiction (dual diagnoses) and a focus on illegal drug consumption, and is supported through law enforcement's role as active claims-makers. Consequently, there is a mobilization of resources to identify, discipline, and contain people identified as mentally ill and addicted with little examination of both the textual and visual discourses that serve this purpose. This article addresses this gap through an analysis of the images and discursive framing of people with mental illness and addictions by the VPD in two Vancouver Police Department reports published in 2008 and 2009.Keywords: Mental health and addiction, Policing, Urban space, Visual representation, Textual representation

59. Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugsKari Lancaster, Laura Santana, Annie Madden, Alison RitterDrugs: Education, Prevention, and Policy 2015:22(3):224–231

AbstractAims The way people who inject drugs (PWID) feel about drug policy may be profoundly shaped by lived experience of stigma and the subjectivities made available in policy and practice. Using a community-based participatory research approach, this study investigated why PWID hold particular views, and considered the complexities of how lived experience and opinions about drug policy intersect within this affected community. Methods Three qualitative focus groups were undertaken. Participants were presented with survey results arising from a previous study, and asked to interpret and explain the possible rationales underlying the opinions expressed by their peers. Findings A duality of opinion was identified, borne from lived experience of stigmatisation, which sometimes led PWID to qualify levels of support. By exploring the rationales underlying opinions, a tension emerged between what PWID theoretically know to be effective interventions, and experiences of how policies are delivered. A sense of “within-group” stigma emerged, with sub-groups of users and drug types denoted as more “dangerous” than others. Conclusions This study illustrates how theoretical knowledge and lived experience intersect to inform opinions about drug policy. Through in-depth discussions with the affected community, we are reminded that public opinion research is always an interpretative and sensitive pursuit.Keywords: Community-based participatory research, drug policy, illicit drugs, public opinion, stigma

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60. Intra-group stigma: Examining peer relationships among women in recovery for addictionsAlana J. Gunn & Kelli E. CanadaDrugs: Education, Prevention and Policy 2015:22(3);281-292

AbstractThis grounded theory study explores how women with histories of addiction perceive stigma while in treatment. In-depth interviews were conducted with 30 women participating in a residential drug treatment centre. Previous research has found that support from peers during recovery can be critical to managing illnesses. In fact, researchers have postulated that peers can be a more effective form of support than even family. This study extends existing literature indicating that peer support systems can be supportive, however they can also can be perceived as negative support that impose stigmas. Findings reveal that women perceive stigmas due to how various types of drug use violate societal expectations and conflict with notions of deservingness. Specifically, the “hard users” (i.e. women who use heroin or crack cocaine) perceive stigmas regarding how their drug use violates norms of womanhood. Moreover, the “soft users” (i.e. those who use alcohol or marijuana) perceive stigmas that their drug use is considered undeserving of support. This article explores the factors that contribute to stigma amongst populations who potentially face marginalisation from larger society. Implications for treatment and group work are discussed.

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TREATMENT SERVICES

61. Clinician-delivered contingency management increases engagement and attendance in drug and alcohol treatmentHeather Fitzsimons, Michelle Tuten, Courtney Borsuk, Samantha Lookatch, Lisa HanksDrug and Alcohol Dependence 2015:152;62-67 AbstractObjective This study examined the impact of a low-cost contingency management (CM) delivered by program clinicians on treatment attendance and utilization for patients enrolled in outpatient psychosocial substance abuse treatment. Methods The study used a pre–posttest design to compare substance abuse patients who received Reinforcement-Based Treatment (RBT) plus low cost CM (n = 130; RBT + CM) to patients who received RBT only (n = 132, RBT). RBT + CM participants received a $10 incentive for returning to treatment the day following intake assessment (day one), and a $15 incentive for attending treatment on day five following admission. RBT clients received standard care intervention without the addition of the CM procedures. Groups were compared on proportion of participants who returned to treatment on day one, mean days of treatment attendance, individual sessions attended, and treatment utilization during the first week and the first month following treatment admission. Results Both the RBT + CM and RBT group participants returned to the clinic on day one at high rates (95% versus 89%, respectively). However, the RBT group participants were more likely to attend the intake assessment only (i.e., never return to treatment) compared to the RBT + CM participants. Additionally, the RBT + CM participants attended significantly more treatment days, attended more individual counseling sessions, and had higher rates of overall treatment utilization compared to the RBT participants during the one week and one month following treatment admission. Conclusions Findings support the feasibility and effectiveness of a CM intervention delivered by clinicians for increasing treatment attendance and utilization in a community substance abuse program.Keywords: Contingency management; Treatment retention; Substance abuse; RBT

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