The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia

The aim of this study was to document the frequency of the management of illicit drug, alcohol and tobacco problems in general practice in Australia. Data from the Bettering the Evaluation and Care of Health (BEACH) study of general practice, April 1998 to March 2003, were analysed. BEACH is an ongoing national study of general practice in Australia. Each year a random sample of approximately 1000 general practitioners (GPs) participate, each providing details of 100 patient encounters. Samples are drawn from the Medicare data held by the Health Insurance Commission. Patient demographic breakdowns, medication, other treatment, referrals and other medical procedures ordered were examined for all problems labelled by GPs as illicit, alcohol and tobacco problems. Annually in Australia, it was estimated that 615 000 GP encounters—or 0.6% of all encounters—involved the management of illicit drug use problems presumably most commonly for problematic heroin use. Despite a much higher population prevalence of use and use disorders, the management of alcohol or tobacco use problems was less common, with 0.4% and 0.3% of encounters, respectively, comprising treatment of these problems. Clear demographic differences existed across the groups. The management of problems also differed, with illicit drug use problems more likely to involve provision of medication, and alcohol and tobacco treatment more likely to involve counselling and/or health advice. Despite higher rates of alcohol and tobacco use problems among patients seeing GPs in Australia, the rate of treatment for such problems was relatively lower than it was for illicit drug use problems. More efforts need to be directed towards assisting GPs to identify and target problematic alcohol and tobacco use among their patients. [Degenhardt L, Knox S, Barker B, Britt H, Shakeshaft A. The management of alcohol, tobacco and illicit drug use problems by general practitioners in Australia. Drug Alcohol Rev 2005;24:499-506]     

Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use

Alcohol, tobacco and illicit drug use together pose a formidable challenge to international public health. Building on earlier estimates of the demonstrated burden of alcohol, tobacco and illicit drug use at the global level, this review aims to consider the comparative cost-effectiveness of evidence-based interventions for reducing the global burden of disease from these three risk factors. Although the number of published cost-effectiveness studies in the addictions field is now extensive (reviewed briefly here) there are a series of practical problems in using them for sector-wide decision making, including methodological heterogeneity, differences in analytical reference point and the specificity of findings to a particular context. In response to these limitations, a more generalised form of cost-effectiveness analysis (CEA) is proposed, which enables like-with-like comparisons of the relative efficiency of preventive or individual-based strategies to be made, not only within but also across diseases or their risk factors. The application of generalised CEA to a range of personal and non-personal interventions for reducing the burden of addictive substances is described. While such a development avoids many of the obstacles that have plagued earlier attempts and in so doing opens up new opportunities to address important policy questions, there remain a number of caveats to population-level analysis of this kind, particularly when conducted at the global level. These issues are the subject of the final section of this review. [Chisholm D, Doran C, Shibuya K, Rehm J. Comparative cost-effectiveness of policy instruments for reducing the global burden of alcohol, tobacco and illicit drug use. Drug Alcohol Rev 2006;25:553 - 565]     

Mental health and alcohol, drugs and tobacco: a review of the comorbidity between mental disorders and the use of alcohol, tobacco and illicit drugs

This paper reviews some major epidemiological studies undertaken in high-income countries during the last 15 years which have reported the prevalence of mental disorders and substance use disorders and their relationship. Comorbidity between mental and substance use disorders is highly prevalent across countries. In general, people with a substance use disorder had higher comorbid rates of mental disorders than vice versa, and people with illicit drug disorders had the highest rates of comorbid mental disorders. There is a strong direct association between the magnitude of comorbidity and the severity of substance use disorders. While causal pathways differ across substances and disorders, there is evidence that alcohol is a casual factor for depression, in some European countries up to 10% of male depression. Policies that reduce the use of substances are likely to reduce the prevalence of mental disorders. Treatment should be available in an integrated fashion for both mental and substance use disorders. There is a need to expand the evidence base on comorbidity, particularly in low-income countries.     

Global use of alcohol, drugs and tobacco

Humans have always used drugs, probably as part of their evolutionary and nutritional heritage. However, this previous biological adaptation is unlikely to be so in the modern world, in which 2 billion adults (48% of the adult population) are current users of alcohol, 1.1 billion adults (29% of the adult population) are current smokers of cigarettes and 185 million adults (4.5% of the adult population) are current users of illicit drugs. The use of drugs is determined largely by market forces, with increases in affordability and availability increasing use. People with socio-economic deprivation, however measured, are at increased risk of harmful drug use, as are those with a disadvantaged family environment, and those who live in a community with higher levels of substance use. Substance use is on the increase in low-income countries which, in the coming decades, will bear a disproportionate burden of substance-related disability and premature death. [Anderson P. Global use of alcohol, drugs and tobacco. Drug Alcohol Rev 2006;25:489 - 502]     

Global burden of disease from alcohol, illicit drugs and tobacco

The use of alcohol, tobacco and illicit drugs entails considerable burden of disease: in 2000, about 4% of the global burden as measured in disability adjusted life years was attributable to each alcohol and tobacco, and 0.8% to illicit drugs. The burden of alcohol in the above statistic was calculated as net burden, i.e. incorporating the protective health effects. Tobacco use was found to be the most important of 25 risk factors for developed countries in the comparative risk assessment underlying the data. It had the highest mortality risk of all the substance use categories, especially for the elderly. Alcohol use was also important in developed countries, but constituted the most important of all risk factors in emerging economies. Alcohol use affected younger people than tobacco, both in terms of disability and mortality. The burden of disease attributable to the use of legal substances clearly outweighed the use of illegal drugs. A large part of the substance-attributable burden would be avoidable if known effective interventions were implemented. [Rehm J, Taylor B, Room R. Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev 2006;25:503 - 513]     

A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs

Harm reduction is both a policy approach and used to describe a specific set of interventions. These interventions aim to reduce the harms associated with drug use. Employing a strict definition of harm reduction, evidence for the efficacy and effectiveness of alcohol, tobacco and illicit drug harm reduction interventions were reviewed. Systematic searches of the published literature were undertaken. Studies were included if they provided evaluation data (pre-post, or control group comparisons). More than 650 articles were included in the review. The majority of the literature concerned illicit drugs. For alcohol, harm reduction interventions to reduce road trauma are well-founded in evidence. Otherwise, there is limited research to support the efficacy and effectiveness of other alcohol harm reduction interventions. For tobacco, the area is controversial but promising new products that reduce the harms associated with smoking are being developed. In the area of illicit drugs there is solid efficacy, effectiveness and economic data to support needle syringe programmes and outreach programmes. There is limited published evidence to date for other harm reduction interventions such as non-injecting routes of administration, brief interventions and emerging positive evidence for supervised injecting facilities. There is sufficient evidence to support the wide-spread adoption of harm reduction interventions and to use harm reduction as an overarching policy approach in relation to illicit drugs. The same cannot be concluded for alcohol or tobacco. Research at a broad policy level is required, especially in light of the failure by many policy makers to adopt cost-effective harm reduction interventions. [Ritter A, Cameron J. A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs. Drug Alcohol Rev 2006;25:611 - 624]     

Alcohol, tobacco and illicit drug use amongst nurses: a Scottish study

This paper examines patterns of self-reported alcohol, tobacco and illicit drug use amongst a representative sample of 600 qualified nurses in the Lothian Region of Scotland. General levels of alcohol use were not exceptional. Even so, levels of tobacco smoking and the use of illicit drugs were higher than for the general population. Female psychiatric nurses were significantly more likely than female medical or surgical nurses to smoke tobacco, to drink heavily and to have experienced adverse alcohol-related consequences.     

Alcohol consumption and injury risk: a case-crossover study in Sydney, Australia

Introduction and Aims. Alcohol contributes to traumatic outcomes that kill or disable at a relatively young age, resulting in the loss of many years of life or disability. Harm from alcohol consumption can result from chronic or acute alcohol use. The aims of this study are to determine the prevalence of alcohol‐related injury and contextual factors contributing to injury risk in an ethnically diverse population of Sydney. Design and Methods. The study was undertaken in emergency departments of six hospitals between 2005 and 2006 and used a case‐crossover design. The 1599 attendees surveyed (response rate 64.2%) were aged over 14 years and had presented with an injury to the emergency department. Results. Attendees were predominantly male, young, 40% spoke a language other than English at home and 17% had been drinking in the 6 h prior to their injury. Those born overseas drank at lower levels than their Australian born counterparts. The risk of sustaining an injury was 1.42 times greater in attendees consuming alcohol compared with those who had not. At very high intake levels (>90 g) the risk of injury was statistically significant for both men and women (men odds ratio: 1.88, 95% confidence interval: 1.46–2.42; women odds ratio: 1.89, 95% confidence interval: 1.04–3.43). Drinking at a licensed premise and drinking alone or with a group of people also significantly increased the risk of injury. Discussion and Conclusions. The results support current Australian policy concerning alcohol but indicate that further restrictions and increased warnings for the community may be warranted.[Williams M, Mohsin M, Weber D, Jalaludin B, Crozier J. Alcohol consumption and injury risk: a case‐crossover study in Sydney, Australia. Drug Alcohol Rev 2011;30:344–354]     

Caffeine,tobacco, alcohol and drug consumption among medical students in Barcelona

Summary A survey of medical students was conducted at the Universitat Autònoma de Barcelona in 1974. Out of 1029 students, 808 present at lectures (78.5%) returned properly completed questionnaires. These showed that mean caffeine consumption was 8.3 g per month and increased with the length of stay at the university. Tobacco consumption (general mean, 190 cigarettes per month, 216 for males and 150 for females) and alcohol consumption (8.8 litres/year for males and 4.1 litres/year for females) also increased with time spent at university. Alcohol consumption was not as high as in the general population. Amphetamine consumption was very high (22% of students had taken amphetamines on more than one occasion in the six months prior to the survey). Marihuana and hashish were by far the most commonly used drugs (9.6%), the use of these drugs being much less common than at other European universities. The use of harder drugs was very limited. Appraisal of alcohol, tobacco and amphetamine abuse is necessary, since the authorities have not employed adequate measures to stop or limit them.     

Associations between tobacco smoking and illicit drug use among methadone-maintained opiate-dependent individuals

Tobacco chippers are individuals who smoke regularly yet are not nicotine dependent. In the present study, the authors examined the prevalence of tobacco chipping among methadone-maintained opiate abusers. Furthermore, the authors examined associations between tobacco and illicit substance use by comparing heavy smokers, tobacco chippers, and nonsmokers. Results demonstrate that tobacco chipping occurs among methadone-maintained individuals. Illicit substance use, measured through urine toxicology, was found to increase in a stepwise fashion from nonsmokers, to chippers, to heavy smokers. Smoking status (nonsmoker, chipper, heavy smoker) proved a more powerful predictor of cocaine and opiate use than daily methadone dose. Findings lend support to existing evidence suggesting associations between tobacco and opiate and cocaine use and strongly suggest that smoking cessation should be offered to all methadone-maintained individuals.     

美沙酮维持治疗受治者偷吸情况及其影响因素分析

目的：了解美沙酮维持治疗受治者毒品偷吸情况及影响因素,为进一步采取有效措施提高治疗效果提供依据。方法：对治疗时间20d以上的知情同意的受治者进行横断面问卷调查和尿液吗啡定性检测,并结合门诊记录信息进行分析.结果：毒品偷吸率54．2％（96／177）。Logistic回归分析结果显示无固定工作、接受治疗时间短、吸毒时间长和有注射吸毒史等是影响偷吸的可能因素。结论：受治者在治疗期间偷吸毒品是较常见的现象,应加强思想教育和心理辅导、增加激励机制和社会帮教等提高维持时间,减少偷吸率。