Empowering family and friends: a new approach to the secondary prevention of addiction

This paper presents a typology and transactional model of how close relatives cope with excessive drinking, drug-taking or gambling in the family. These are illustrated with four examples taken from a series of research projects in which relatives have been interviewed to understand better how they react and respond. Such information is the groundwork for a World Health Organization initiative to help primary health care workers respond to the needs of relatives. The philosophy behind this initiative, and the steps that primary health care workers might take, are outlined. It is proposed that such workers can help close relatives to find the best coping methods in their circumstances, and that this approach might constitute an important, and hitherto neglected, form of secondary prevention.     

The development of guidelines for drug and alcohol dependence treatment: affecting policy and practice

The rationale and methodology behind the Australian Quality Assurance Project is described. The Project aimed to develop guidelines for treatment content based on three sources of information: research findings, current practice and expert opinion. The issue of the gap between research and practice is discussed, as well as the role of dissemination in altering clinician behaviour.     

A review of the hepatotoxicity of paracetamol at therapeutic or near-therapeutic dose levels, with particular reference to alcohol abusers

The number of published reports associating hepatotoxicity with paracetamol ingestion at therapeutic or near-therapeutic dose levels is small but is, nevertheless, suggestive of a relationship. There is however, mounting evidence that certain groups of patients, such as alcohol-dependent people, patients receiving enzyme-inducing drugs (particularly anti-convulsant and anti-tuberculosis medications) as well as those with certain infectious diseases, are rendered more susceptible to paracetamol-induced hepatotoxicity. Seventy-four case reports where therapeutic or near-therapeutic doses of paracetamol resulted in hepatic injury are reviewed and factors and mechanisms which might explain this apparently increased vulnerability to damage are discussed.     

Using socio-economic differences in knowledge and attitudes to shape community alcohol programmes: experiences from the Kirseberg Project

Community-based public health projects have become increasinglyimportant as a tool for health promotion. This approach hasbeen considered appropriate also in addressing socio-economicdifferences in health, although little is known about socio-economicdifferences in perception of health as a community issue. Ouraim was to study socio-economic differences in awareness andknowledge about the Kirseberg Project and in attitudes towardsthe concept of health as a local community issue. The KirsebergProject was initiated in 1988. The primary prevention aims areto reduce alcohol consumption in the population in order todecrease the incidence of alcohol-related problems. Kirsebergis an area with 10000 inhabitants in the north-eastern partof the city of Malmö (population 230000), Sweden. A sampleof 400 people in the area between the ages of 20 and 75 yearsof age was randomised from the population register and interviewedby telephone. Of the sample, 73.3% responded. Of the respondents,65.2% were aware of the project and 38.6% had knowledge aboutit. Socio-economic differences were found both regarding knowledgeand attitudes. Individuals in the high socio-economic status(SES)-group were better informed about the project than thelow SES-group, more often associated the project with the promotionof the community spirit, tended to give more positive answersto the questions about important local health issues, demonstratedhigher adherence to the social environment issues and were moreinterested in local health promotion activities. Our conclusionis that the socio-economic knowledge differences which werefound in the Kirseberg Project should be seen as shortcomingsin the health educational campaign rather than as a first stepin a determined social process. The issue of how the explicitnotions and the hidden agenda of a health promotion campaigncorrespond with central attitudes and values in different populationgroups in the target community must be carefully investigated.     

Programmes for tobacco and alcohol users in Australian work-places

This article presents findings from a survey of programmes available for tobacco and alcohol users working in 455 of Australia's top 600 companies. Companies were twice as likely to have programmes for smokers (43%) as for problem drinkers (24%) and these programmes were more apparent in large companies. The majority of programmes for smoking were delivered within a health promotion context which included other life-style issues, such as nutrition, exercise, weight management and stress management. Although Employee Assistance Programs (EAPs) were the most commonly available type of work-place programme for excessive drinkers and other drug users, followed by Alcoholics Anonymous and local hospital clinics, only 6% had an EAP for alcohol. Only 21% of programmes for smokers and 12% for excessive alcohol users were evaluated. Around one-quarter of companies knew the costs of smoking programmes, and 9% reported costs of conducting programmes for excessive alcohol consumers.     

Restrictions on tobacco and alcohol use in Australian work-places

In a telephone survey of 455 of the top 600 companies in Australia, around three-quarters reported the existence of restrictions on both smoking and alcohol in the workplace. Forty-six percent of companies had a total ban on smoking at work, 31% had designated limited areas where employees were permitted to smoke, and 23% had no policy on smoking. Seventy-seven percent of companies encouraged a total alcohol-free work environment. The larger the company, the more likely it was to have restrictions on smoking in the work-place, but there was no relationship between the size of the company and alcohol restrictions. Government organizations were more likely to have restrictions on smoking than nongovernment organizations, but this difference was not apparent for alcohol restrictions. The major reasons given for smoking restrictions were related to health and comfort, while those for alcohol were related to work productivity and safety.     

Patterns of family responses to alcohol and tobacco problems

Patterns of family response to drinking and smoking were studied in a sample of 1034 adults in Ontario in 1993. Concerning tobacco smoking, 69% of respondents reported having said something to a relative and 82% to a friend; concerning drinking, 46% had said something to a relative and 65% to a friend. Having said something did not vary much with the respondent's age, educational level and smoking or drinking status, except that current smokers were less likely than others to have said something to a friend or acquaintance, while heavier drinkers were more likely to have said something to a friend or acquaintance, and ex-drinkers were more likely to have said something to a relative. About half of all who had ever smoked reported a family member (57%) or a friend (47%) had said something to them about their smoking, compared with much smaller proportions of ever-drinkers who reported that a family member (14%) or a friend (8%) had ever said anything about their drinking. Both drinking and smoking are recognized by many respondents as imposing burdens on the family. Family members often comment on drinking and smoking, and make suggestions about cutting down or quitting.     

Interstate tourists and the estimation of per capita alcohol consumption

A telephone survey of domestic Australian tourists was conducted to determine the relative contribution they make to estimates of per capita alcohol consumption. The overall drinking patterns of interstate tourists were examined, along with contrasts between those who visit the Northern Territory and those who visit other parts of the country. The results show that drinking generally increased when people were on holiday. Amount of alcohol consumed did not differ by destination, but destination did distinguish the prevalence of holiday drinkers and the amounts of alcohol usually consumed by tourists when they are at home. The self-reported reasons for increased or decreased drinking by people when they are on holidays are also presented. The implications of these various findings for the calculation of per capita consumption estimates for the Northern Territory and other jurisdictions are discussed.     

Neovascular glaucoma. Current management

Neovascular glaucoma is one the most difficult forms of glaucoma to treat successfully. Recent advances modifying filtration surgery can result in up to 77% success. Utilization of anterior and posterior segment photocoagulation can maintain an open angle in up to 80% of eyes when they are treated prior to angle closure by peripheral anterior synechiae. Destruction of the ciliary body can be performed more selectively utilizing argon and ruby lasers. This paper presents a rational approach to the management of neovascular glaucoma incorporating these recent advances.