Binge or bout? Quantity and rate of drinking by young people in the evening in licensed premises

A sample of 291 people aged 16-25 responded to an interviewer-completed questionnaire seeking information on their quantity and rate of alcohol consumption. The survey was conducted in licensed premises in the centre of a large English city. Analysis revealed that men drank more than women, but adjusting for body size and recommended alcohol intake removed this difference. Most respondents planned to drink far more than recommended upper limits. However, they did so at a moderate rate of intake over many hours and only a minority planned to drink so fast that they would become extremely drunk. “Binge” drinking was typically defined by this sample to be fast and excessive drinking. There was no evidence of a distinct minority of bingers, for intake was a skewed unimodal distribution. Binge drinking is a politically highly charged concept, but is rarely defined with any precision. It is confused with drinking to excess and with drunkenness. This study suggests that drinking rate must be a key part of any competent definition. Study participants were on a drinking “bout” that involved drinking too much for health over 5 or 6 hours, but were not planning to get very drunk. Young people need to be encouraged to drink less even when they are not getting drunk, and warnings about binges and their dire consequences may distract from this message.     

Drugs and the media

“Drugs” are extremely newsworthy: each year they are the subject of literally thousands of items produced by the Australian media. Most of these items are repetitious, stereotypical and narrowly focused on crime, deviance and rectification. Illegal drug consumption by individuals and the efforts of medical and social welfare professionals to eradicate the “problem” so defined are the twin foci of the press and television. Legal substances (including tobacco and alcohol) are interpreted much more ambiguously, and are relatively infrequently the subject of journalistic analysis.

The media systematically ignore the historical, economic and industrial aspects of drug production and consumption.

“Drugs”, although habitually construed as the cause of “human” and “social” problems (and hence as necessitating administrative attention), seem strangely divorced from real political economic determinations. They serve as inexhaustabled pretexts for the proliferation of television current affairs items and newspaper features which seldom resist the image of the confessing, suffering victim. “Hard” news is preoccupied with reiterating the ritual drama of drug seizures and exposes of “organised” crime. Both the press and television educate their audiences to a resigned, alienated passivity.     

The legal status of cannabis

The legal status of cannabis is considered. Currently in Australia its possession, use or sale is completely prohibited. The adverse health effects of cannabis, alcohol and tobacco are compared, and it is concluded that while cannabis is not a “safe” drug, it does not produce an equivalent threat to community health as do alcohol and tobacco. The effectiveness of present laws is questioned and the consequences of legalization outlined. It is recommended that a rationalisation of the laws relating to alcohol, tobacco and cannabis be commenced.     

What is Controlled Drinking?

Different terms have been utilized to define the drinking dispositions of problem drinkers which are neither total abstinence nor overtly harmful. The main terms that have been used are “normal drinking”, “controlled drinking”, “non-problem drinking” and “attenuated drinking”. Each concept is considered and criticized and it is concluded that clinicians and researchers need to be very aware of the overlap that exists between the different definitions. It is concluded that the greatest value that has been achieved from the advent of controlled drinking treatment and the ensuing debate is not that another treatment option has been developed, but that the perception of alcohol related problems has been changed to encompass the drinking of the population as a whole.     

Heroin smoking by “chasing the dragon” in young opiate users in Ireland: stability and associations with use to “come down” off “Ecstasy”

We explored the frequency of commencing opiate use by “chasing the dragon” to “come down” off Ecstasy and the stability of heroin smoking in young opiate takers by assessing 102 subjects in Dublin using a semistructured interview. Ninety-two subjects had used Ecstasy. Of these, 68 reported “chasing” to “come down” off Ecstasy at some point in their history and were found to have used Ecstasy more frequently and in larger amounts. Thirty-six reported that their first experience of using opiates was to “come down” off Ecstasy, 28 citing this as their main reason for commencement.

Eighty-six of the 102 commenced opiates by “chasing” heroin, 61 of whom progressed to injecting after a mean of 2.9 years. This was associated with starting illicit drug use earlier, starting heroin earlier, and a history of using Ecstasy. Implications for service planners in developing responses to illicit drug use among adolescents are discussed.     

Changing perspectives on alcohol and drug problems

An outline is presented of the extent of the drug and alcohol problem in Australian today and the relative contribution of legal and illicit drugs is discussed. The impact of these problems on clinical practice is highlighted and the importance of detection and benefit of intervention emphasised. The different perspectives with which health professionals approach these problems are presented in an historical overview, and modern concepts of drug (and alcohol) “dependence” and related “disabilities” are described.     

"Just using old works": injecting risk behaviour in prison

A minority of injecting drug users engage in high risk injecting behaviours when in prison. In the United Kingdom between a quarter and a third of injectors who enter prison inject when in prison, and of these about three-quarters share needles and syringes. In the present study, 44 drug injectors who had been released from prison for no longer than 6 months were recruited and interviewed in three geographical areas in England. Interviewees were asked to recount their experiences of drug use during their most recent period of imprisonment. The majority of interviewees were male (38/44), had a mean age of 28 years, with a mean age of 16 years at first drug use, were primarily opiate users (39) and had multiple imprisonments. All respondents reported drug use when imprisoned and drug injecting was reported by 16 interviewees. Most injected at irregular intervals and at a reduced level, compared with injecting when in the community. Nine reported using needles and syringes that others had previously used. When considering other injecting equipment, more sharing occurred than was actually reported. Much re-use of equipment was viewed simply as “using old works”. The sharing of “cookers” and “filters”, and drug sharing by “backloading” and “frontloading” were common. The concept of “sharing” tended to be understood by respondents as related to the use of tools of injection (needles and syringes rather than other equipment); the use of tools in the act of injection (rather than for mixing drugs); proximity (multiple use of needles and syringes in the presence of others); temporality (shorter time elapse between consecutive use of needles and syringes previously used by another) and source (hired rather than borrowed or bought). We conclude that syringe sharing is an integral part of drug use and drug injecting in prison. Many of those interviewed displayed a restricted understanding of what denotes syringe sharing. Our data reinforce the need for interventions and initiatives to be developed within prisons to deal with the considerable risk posed by continued injecting drug use.     

Case management and behavioral contracting. Components of rural substance abuse treatment

This article presents a model of case management with rural clients entering drug and alcohol treatment. As part of a larger treatment protocol called Structured Behavioral Outpatient Rural Therapy, behavioral contracting is combined with strengths perspective case management to help rural clients motivate themselves to engage and complete drug and alcohol treatment. This combined approach is designed to continually communicate and teach an “A-B-C” cognitive-behavioral approach to problem-solving and change. While not a panacea for addressing the myriad problems facing clients with drug use problems, such an approach promises to improve “treatment as usual” formats, which often ignore the formidable obstacles to human change experienced by rural clients and clinicians.     

Effects of brief counselling among male heavy drinkers identified on general hospital wards

Although the prevalence of heavy alcohol consumption among patients of general hospitals is well documented, no study has yet reported an effect of counselling on the ward in reducing the level of consumption among such patients after discharge. This study was designed to evaluate brief counselling to reduce alcohol consumption among male heavy drinkers identified on general hospital wards. Male patients were screened on wards of four teaching hospitals in Sydney, Australia. Identified heavy drinkers (n = 174) showing predominantly low levels of alcohol dependence were allocated to one of two forms of brief counselling (skills-based counselling or brief motivational interviewing) or to a non-intervention control group. Blind follow-up for 123 patients (71%) was carried out approximately 6 months after discharge from hospital and self-reports of alcohol consumption were compared with collateral sources of information. Patients who received counselling showed a significantly greater mean reduction in a quantity-frequency measure of weekly alcohol consumption than controls but there were no significant differences in reduced consumption between the two intervention groups. However, patients who were deemed “not ready to change” showed greater reductions if they had received brief motivational interviewing than if they had received skills-based counselling. The implications of these findings for counselling male in-patients to reduce alcohol consumption are discussed.     

Nicotine dependence and withdrawal in alcoholic and nonalcoholic ever-smokers

We compared nicotine dependence and withdrawal in male alcoholic and control ever-smokers, controlling for relevant demographic and clinical variables. Alcoholics were more likely to meet criteria for moderate or severe nicotine dependence and endorse more nicotine dependence symptoms. Symptoms reported more frequently by alcoholics included: (a) using nicotine in larger amounts or over a longer time than intended; (b) continued use despite problems caused or exacerbated by nicotine; (c) marked tolerance; and (d) experiencing characteristic nicotine withdrawal symptoms. Alcoholics also smoked more heavily. Other than “headaches,” and “decreased heart rate,” alcoholics consistently endorsed nicotine withdrawal symptoms at a higher rate. After controlling for demographic and clinical variables and level of nicotine dependence, only “feel depressed” differed significantly between groups. Our research supports previous findings suggesting that nicotine dependence is more severe in those with a history of alcohol dependence. As a result, alcoholics may experience greater discomfort from nicotine withdrawal upon smoking cessation.     

Elevated urinary excretion of metallothionein due to environmental cadmiun exposure

Metallothionein, a low molecular weight cadmium-binding protein, has been determined for the first time in urine of “itai-itai” disease patients and other Japanese women environmentally exposed to cadmium. On a group basis, the urinary metallothionein levels of “itai-itai” disease patients and suspected patients were significantly higher than that of women living in a cadmium-polluted area. Women living in a non-polluted area excreted significantly less metallothionein than women living in a cadmium-polluted area. A similar trend was observed for urinary β₂-microglobulin, a non-specific index of renal tubular dysfunction. However, mean levels of urinary cadmium in the “itai-itai” disease patients, suspected patients and women living in the cadmium-polluted area were similar. It is suggested that if, in addition to β₂-microglobulin and cadmium, metallothionein is used as another index of cadmium exposure, monitoring of renal tubular dysfunction caused by cadmium may be more effectively carried out.     

The “New” Drug-Free Therapeutic Community: Challenging Encounter of Classic and Open Therapeutic Communities

In view of a rapidly changing society, reflected in many changes within the drug-free Therapeutic Communities (TCs), the question has been raised: “What can and cannot be changed in this modality?” This question was addressed at a European conference of experienced therapeutic community workers, who concluded that many changes have occurred and will continue to occur, but some basic concepts should be preserved. The changes inherent in postmodern society are examined here in an effort to foresee their impact on the evolution of the TC. Necessary changes and additions are discussed.     

Binding of H-acetylcholine and C-γ-aminobutyric acid to subcellular fractions of the brains of differentially-housed mice

Subcellular fractions prepared from the brains of mice subjected to conditions of differential housing (“isolation” and “aggregation”) for 35–37 days provided evidence for envronmentally-induced changes in the “binding” of acetylcholine (ACh) and γ-aminobutyric acid (GABA) to cerebral structures. Using homogenizing fluids containing 4 mM NaCl ± 4 mM LiCl or 40 mM NaCl ± 40 mM LiCl, it was shown that: (1) the binding of ACh and GAA are qualitatively different in mouse brain; (2) Li⁺ affects GABA binding to a greater extent than that of ACh; (3) less GABA binds to particulate fractions containing nerve endings prepared from the brains of “isolated” mice than to those prepared from the brains of “aggregated” mice. Addition of LiCl to homogenizing media served to increase the significance of differences in GABA binding found between brain fractions from “isolated” and “aggregated” mice.     

A case of late-onset crack dependence and subsequent psychosis in the elderly

While rapidly spreading “crack” addiction is a major concern in our community, current research in this area is focused mainly on adolescents and young adults. We discuss a case of crack addiction developing for the first time in an elderly person and subsequent complications. We believe no such cases have been previously reported. We hope this will be helpful to practicing clinicians and stimulate research to understand cocaine and crack abuse patterns in the elderly.     

醉酒人群CYP2E1基因多态性研究

目的:通过对醉酒人群的CYP2E1基因的检测,获得该基因遗传多态性数据,及其在醉酒人群中的分布。方法:采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)技术,检测CYP2E1基因在154例醉酒样本的等位基因、基因型、基因频率。结果:CYP2E1基因在154例醉酒样本中共检出两种等位基因:等位基因c1和c2,观察到3种基因型c1/c1、c1/c2和c2/c2,基因型频率分别是68.8%、29.2%和1.9%。结论:对醉酒人群的CYP2E1基因的检测实验结果与本课题组先前的研究结果(酒依赖和健康对照组CYP2E1基因多态性)做统计分析。统计结果提示:醉酒人群的CYP2E1基因分布和酒依赖组没有差别,而与健康人群的CYP2E1基因分布存在差异,并且差异有统计学意义(P<0.05)。本研究用饮酒量分组与基因型分组,做统计分析,结果没有统计学意义。     

Motivation for change and psychological distress in homeless substance abusers

This study explores the treatment needs of homeless individuals participating in a large urban day shelter program. Alcohol and drug use, psychological distress, and stage of change were assessed in 100 participants presenting for services. The associations among substance use, risk perception, and readiness to change were examined for alcohol and drugs separately. Participants had high levels of psychological distress compared to “non-patient” samples. Eighty percent had used alcohol in the past 6 months, with 65% of those drinking at higher-risk levels; 60% had used drugs, with 82% in the higher-risk levels. While the majority felt that they drank and/or used drugs “too much”, most were in precontemplation or contemplation stages of change. Intervention efforts for this population should focus on motivation, facilitation through the stages, and the associations between psychiatric symptoms and substance use.     

Unintended impacts of alcohol restrictions on alcohol and other drug use in Indigenous communities in Queensland (Australia)

Background‘Alcohol Management Plans’ (AMPs) with a focus on alcohol restrictions were implemented in 19 discrete Indigenous communities, in 15 Local Government Areas, by the Queensland Government from 2002. Community residents’ perceptions and experiences of the impacts of AMPs on local alcohol and drug use are documented.MethodsA cross-sectional study used quantitative and qualitative survey data collected during 2014–2015 in 10 affected communities. Five had some alcohol available. Five had total prohibition. Participant responses were assessed and compared by prohibition status.ResultsOverall, less than 50% of 1098 participants agreed that: i) the restrictions had reduced alcohol availability in their community and ii) that people were drinking less. Nearly three quarters agreed that binge-drinking had increased, attributed to increased availability of illicit alcohol. There were no statistically significant differences between communities with prohibition and those with some access to alcohol. Participants agreed overall that cannabis use had increased but were more equivocal that new drugs were being used. These views were less frequently reported in prohibition communities.ConclusionsContrary to what was intended, Queensland’s alcohol restrictions in Indigenous communities were viewed by community residents as not significantly reducing the availability and use of alcohol. Furthermore, this was compounded by perceived increases in binge drinking and cannabis use; also unintended. There is a need to strengthen resolve at all levels to reduce the supply of illicit alcohol in restricted areas.     

Perinatal substance abusers: Factors influencing treatment retention

This study investigated the association between two demographic and two psychological variables and treatment retention for 65 perinatal substance abusers. Subjects who lived in the community while attending day treatment were 6.125 times more likely to drop out than subjects who lived in a program-operated shelter (p <.0001). An interaction was found for pregnancy status and antisocial personality disorder (p < .0478). Subjects who were both pregnant and antisocial were 4.876 times more likely to remain in treatment than those who were neither pregnant nor antisocial. Degree of “treatment resistance,” measured by the MMPI Negative Treatment Indicators (TRT) Scale, did not predict dropout. These findings indicate that supportive housing can play an important role in preventing dropout for perinatal substance abusers. Additionally, pregnancy may present a “window” of opportunity for treating a hard to reach population, drug abusing women with comorbid ASP.     

Characterizing “Nonresponsive” Methadone Patients

A review of records at a large urban methadone clinic revealed a substantial group of patients with treatment tenures of at least 6 months whose urinalysis results indicated continued regular use of opiates. In an attempt to characterize these “nonresponsive” patients and to identify their specific treatment needs, we compared them to a group of patients with comparable treatment tenures but whose urinalysis results indicated little or no recent illicit opiate use. Contrary to expectations, opiate use itself was virtually the only feature that clearly distinguished the two groups. “Responders” and “nonresponders” did not differ significantly on measures of psychosocial problem severity in any other area, nor did they differ in their treatment service utilization. Moreover, examination of admission data indicated that the two groups showed similar rates of improvement in the severity of their psychosocial problems in all seven measured areas. The implications of these results for treatment and clinic administration are discussed.