Comorbidity for Alcohol Use Disorders and Drug Use in Mexican-Origin Groups: Comparison of Data From National Alcohol Surveys in the U.S. and Mexico

The comorbidity, separately, of alcohol dependence and consequences of drinking with illicit drug use is compared between Mexicans and Mexicans Americans, using data from the 1995 and 2000 U.S. National Alcohol Surveys (n = 830) and the 1998 Mexico National Household Survey on Addictions (n = 3313). Among drinkers, comorbidity was significantly more prevalent among Mexican Americans than among Mexicans and was positively associated with level of acculturation among Mexican Americans. Although data may not be generalizable, they are important for a better understanding of cultural influences on the development of comorbid substance abuse conditions among Mexicans immigrating to the United States and their substance abuse treatment needs.     

Chronic Drug Use and Crime

This paper used bivariate and multivariate analyses to estimate the relationships between chronic drug use and various measures of criminal activity. The data for these analyses were derived from the 1993 (1) and 1995 (2) National Household Surveys on Drug Abuse (NHSDA). Measures of criminal justice system contact and criminal activity included ever arrested, arrested during the previous year, commission of a predatory crime (e.g., assault, fighting) during the previous year, and commission of a property crime (e.g., theft, property damage, car theft, breaking and entering) during the previous year. The analysis was conducted separately for males, females, and age groups, and it distinguished between chronic drug users, nonchronic drug users, and nondrug users. The results consistently showed a significant linear relationship between criminal activity and frequency of drug use. These findings have implications regarding the potential reduction in predatory and property crime that could occur from a decrease in drug use. Significant differences in criminal behavior between chronic drug users and other cohorts may signal a critical need to develop targeted interventions for this particular type of drug user.     

Self-Reported Drug and Alcohol Use and Attitudes Toward Drug Testing in High Schools With Random Student Drug Testing

Many schools implement random student drug testing (RSDT) programs as a drug prevention strategy. This study analyzes self-report surveys of students in eight secondary schools with well-established RSDT programs, comparing students who understood they were subject to testing and students who understood they were not subject to testing. Students subject to testing reported significantly less marijuana and other illegal drug use than students in the same schools who were not subject to testing, and also had more positive attitudes toward testing. Alcohol use, which was not tested for in seven of the eight schools, did not differ between groups. This study provides evidence that awareness of eligibility for drug testing in schools with well-established RSDT programs is associated with lower rates of drug use.     

不合理用药问题及干预研究

本文概述了不合理用药的相关问题，分析了造成不合理用药的原因，重点阐述了合理用药的干预方法，决策过程及干预研究的实施。     

Nurturing for Careers in Drug Use and Crime: Conduct Norms for Children and Juveniles in Crack-Using Households

A very sizable proportion of juvenile delinquents and adult criminals come from backgrounds and family kin systems having deviant parents or kin. This paper provides a focus upon the child-rearing practices directly observed by trained ethnographer during a case study of one highly criminal, drug-using household/kin network. The concrete expectations (and actual practices)–called conduct norms–with which the household adults respond to (or “nurture”) children and juveniles are delineated. While children are taught to “pay attention” to what adults do, adults typically model various deviant activities and rarely engage in conventional behaviors. Drug-using, and especially crack-using, men and women are expected not to raise (or financially support) children born to them; other kin expect to raise children of such unions. Children are not expected, nor able, to develop strong affective bonds with any household adults, and receive little or no psychological parenting. Adults do not take strong measures to protect children/juveniles from harm, and often adults are a major source of harm. In many ways the conduct norms in such crack-using households are well designed to “nurture” those persons who will be antisocial as children, delinquents as juveniles, and become criminals, drug misusers, and prostitutes in adulthood–and who have very few chances to become conventional adults. [Translations are provided in the International Abstracts Section of this issue.]     

对医院用药中药物相互作用问题的思考

目的:提高对药物相互作用的认识,促进合理用药。方法:对我国医院用药中药物相互作用存在的问题进行分析。结果与结论:我国对合理用药中的药物相互作用认知度较低,需从多角度加强药物相互作用研究;转变认知理念,引起各级政府部门和医药人员重视;推行临床药师制,重构药学服务模式;扩宽研究领域,加强药物相互作用机制和中西药相互作用研究;加快信息化建设,组建药物相互作用数据库;扩大普及教育,提高社会公众的药物知识等。     

149例药品不良事件不合理用药分析和干预对策

目的:分析导致药品不良反事件(ADE)的不合理用药因素,提出相应的干预对策,促进临床合理用药。方法:在浙江省药品不良反应监测网络预警平台中检索海盐县所有医疗机构2010年1月～2012年6月上报的ADR/ADE报表,筛选出ADE报表,分析其不合理用药。结果:共检索到1 050例ADR/ADE报表,其中ADE报表149份,占14.19%;严重ADE报表18例,占12.08%(18/149)。ADE成因有不合理使用抗菌药、无适应证用药、用法用量不合理等。结论:不合理用药是发生ADE的重要原因,应加强干预,提升合理用药水平,以减少药源性疾病的发生。     

我院退药事件的分析与干预措施

目的：查找医院门诊患者退药原因,探讨如何减少退药现象。方法收集医院门诊药房2012年5月至2013年4月退药371起,统计和分析退药科室、所退药品的类别和退药原因,并有针对性地采取干预措施。结果退药处方率为0.22%,患者自己要求退药占最大比例,检查取消占第2位。对造成80%责任的前6项因素实施干预,常态化后退药事件大大减少。结论医院发生的退药事件有一定的地域特点,通过提高患者用药的服务水平,与临床加强沟通,加强培训和退药事件的干预等措施可减少退药事件发生。     

从处方分析的滞后性谈如何对不合理用药进行实时和有效干预

目的:探讨对不合理用药进行实时、有效干预的方法。方法:结合我院实际,分析不合理用药的临床表现、危害及产生原因,以处方统计分析的滞后性为切入点,总结其干预方法。结果与结论:产生不合理用药的原因复杂多样,应综合各种方法加以治理。进行处方分析可发现不合理用药的特点与具体表现,但对其进行干预较滞后,必须实时干预方能奏效。     

Circumstances Surrounding Needle Use Transitions among Injection Drug Users: Implications for HIV Intervention

Injection drug users (IDUs) are at increased risk of infection with the human immunodeficiency virus (HIV). Intervention programs aimed at reducing the spread of HIV in this population typically incorporate a range of risk reduction strategies, including encouragement to move from injection to noninjection. However, very little is known about the factors associated with needle use transitions, either spontaneous or in response to intervention. We report a study in which a cohort of IDUs were asked about the reasons they stopped and restarted injection. Of 855 IDUs, 179 (21%) had had at least one 12-month period of noninjection since they first injected. Almost one-half of the reasons given for stopping injecting related to personal crises, characterized by major shifts in attitude to drugs and/or life more generally, and often generated by pressures in significant relationships. Concerns about HIV were cited by only one respondent. Many of the factors associated with transition out of needle use in the study population are not readily amenable to intervention. The implications of this for HIV risk reduction programs are discussed.     

临床药师干预临床不合理用药的效果评价

目的：评价临床药师干预临床不合理用药的效果。方法：通过对处方和病历作回顾性调查,发现不合理用药问题,实施相应干预措施,对比干预前与干预后临床合理用药情况。结果及结论：我院合理用药水平有显著性提高,临床药师参与临床合理用药,干预措施有效。     

临床安全合理用药决策支持系统干预不合理用药医嘱效果评价

目的 为促进临床合理用药提供参考。方法 借助临床安全合理用药决策支持系统对干预前(2015年)全院患者住院医嘱用药合理性进行审查。根据审查结果制订干预措施,并将该系统嵌入医院信息系统(HIS),干预后(2016年)进行临床合理用药规范,并再次对全院住院患者医嘱进行审查,比较干预前后的效果。结果 干预后不合理医嘱比例显著降低(P<0.05);不合理医嘱中,抗菌药物和辅助用药不合理比例极高,干预前分别占28.85%(26587份)和21.12%(18256份),干预后为30.32%(6812份)和18.10%(4066份);干预后,抗菌药物使用率、使用强度、联合使用率,患者人均用药种数,无适应证、无用药指征或药品选用不合适的比例,以及辅助药物无适应证或无用药指征和用法用量不合适的发生率均显著降低(P<0.05),辅助药物占消耗品总金额比例也显著降低(P<0.05)。结论 建立临床合理用药监测系统评价分析方法与研究模式,可进一步完善医院不合理用药干预措施研究体系,促进临床合理用药。     

Alcohol and Drug Use and Aberrant Drug-Related Behavior Among Patients on Chronic Opioid Therapy

Objective: To better identify individuals on chronic opioid therapy (COT) at high risk for aberrant-drug related behavior (ADRB). We examine whether patients with low level alcohol and drug use have similar characteristics to those with alcohol and drug disorders. We then examined the relationship of alcohol and drug use to ADRBs among COT patients. Methods: The sample was 972 randomly selected COT patients (age 21–80 years old) from a large health system in Northern California, USA, and interviewed in 2009. Logistic regression models were used to model the dependent variables of: alcohol use, illicit drug use, alcohol disorders, illicit drug disorders, and ADRBs. Results: The odds of daily/weekly alcohol use were lower for those with a high daily opioid dose (120+ mg/day vs. <20 mg/day) (OR = 0.32, p < 0.010). Illicit drug disorders were associated with depression (OR = 2.31, p < .001) and being on a high daily opioid dose (OR = 5.51, p < .01). Participants with illicit drug use had higher odds of giving (OR = 2.57, p < 0.01) and receiving opioids from friends or family (OR = 3.25, p < 0.001), but disorder diagnoses were not associated with ADRBs. Conclusions: Findings reinforce that illicit drug use should be of high concern to clinicians prescribing opioids, and suggest it should be considered separately from alcohol use and alcohol disorders in the evaluation of ADRBs. Frequent alcohol use is low, but not uncommon, and suggests a need to discuss specific issues regarding safe use of opioids among persons who use alcohol that may differ from their risk of drug use.     

基本药物制度下的合理用药探讨

目的：探讨基本药物制度下的合理用药情况。方法：通过对基本药物制度的分析,目前不合理用药的原因的分析．提出促进合理用药的相应意见。结果与结论：建立并完善基本药物制度．促进合理用药。     

合理用药监测工作干预门诊用药效果分析

目的：了解合理用药监测工作干预门诊用药的效果,为制定有效的干预措施提供参考。方法：随机抽取干预前后的处方各3 600张,统计分析各项合理用药指标。结果：干预后每次就诊平均用药品种数由2.68种下降为2.07种;抗菌药使用比例下降9.78%;注射剂使用比例下降5.5%;不合理用药处方下降3.05%。结论：全面、有效的干预措施在促进门诊合理用药方面具有可操作性和可实现性。     

Predictors and Outcome of Aftercare Participation of Alcohol and Drug Users Completing Residential Treatment

This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between and at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.     

Screening and Brief Intervention Enter Their 5th Decade

SUMMARY

About 40 years since the first controlled study, screening and brief intervention (SBI) are being disseminated into practice. But many unanswered questions remain. Studies in this special issue address what we know and don't know about alcohol and drug SBI, cost-effectiveness, patient preferences, education for clinicians, quality performance measures, “no-contact” SBI, predictors of behavior change, and methodological concerns with the SBI literature. The best evidence for efficacy of SBI is that it can lead to decreased consumption in primary care patients with non-dependent unhealthy alcohol use. But further research is needed on brief drug screening tools, efficacy of SBI for drugs, effectiveness in real world settings, integration of SBI for alcohol and drugs with other health behaviors, effects of SBI on alcohol and drug consequences, effects on dependence among those not seeking help, and on how to best disseminate the efficacious elements of SBI into practice.     

Motives for and Against Injecting Drug Use Among Young Adults in Amsterdam: Qualitative Findings and Considerations for Disease Prevention

To elucidate injection initiation and risky injection practices among young drug users (YDUs) in Amsterdam, this study identifies self-reported motives for injecting and not injecting to inform interventions to be targeted at issues personally relevant for this population. A qualitative study was performed using in-depth interviews to obtain retrospective drug use histories. Recruitment took place both directly (by street outreach, outreach at methadone outposts) and indirectly (by respondent-driven sampling). The study started in the year 2001 and included 50 YDUs, aged 18–30, of which 18 had a history of injecting. Reasons for not starting injection were fears of needles, overstepping a limit, damage to appearance, fears of missing veins and causing abscesses, and illnesses. Reasons for starting injection were stronger effect or rush, curiosity, economy, knowing injectors, and perceived lack of danger to health. Motives for injecting and not injecting can differ widely individually. Some strong motives are hardly addressed by prevention programs and should inform new prevention initiatives. Users’ own motives for not injecting should be promoted, whereas their motives for initiation should be counter-balanced with factual information.     

Alcohol Consumption-Related Antigay Aggression: Theoretical Considerations for Individual- and Societal-Level Interventions

A substantial literature has identified risk factors for intoxicated aggression and the mechanisms by which these effects are exerted. This theoretical and empirical foundation is a valuable resource for the development of treatment inventions. In contrast, a comparable literature is not available to guide development of clinical interventions for intoxicated antigay aggression. To address this gap in the literature, the present article (1) identifies risk factors and mechanisms pertinent to alcohol consumption-related antigay aggression, (2) advances predictions regarding how alcohol will increase antigay aggression, and (3) reviews societal- and individual-level considerations for intervention based upon these hypotheses.