The aim of this conference was to review the pharmacological and molecular basis of the therapeutic properties of marijuana and THC, and to evaluate their clinical applications. Fifty scientists and physicians from the United States, Israel, France, Germany and Sweden gathered for two days to present papers in their areas of expertise.

The prolonged storage of THC in the body, whatever its route of absorption, was again discussed in reference to the persistent properties of this drug, even after its acute effects have dissipated. The marijuana cigarette manufactured and distributed by the National Institute on Drug Abuse for clinical research contains toxic substances in greater amounts than those contained in a tobacco cigarette of the same weight. NIDA has not been able to develop a standard marijuana cigarette with uniform concentrations of THC devoid of tars and other noxious agents. THC, taken orally, has been approved by the FDA for the treatment of vomiting and as an appetite stimulant under the name of “Marinol.’ This drug may be prescribed by physicians; however, it is not as effective as other presently available medications.

The addiction/tolerance mechanisms of THC and marijuana are similar to those induced by opiates, cocaine, nicotine and alcohol. The evidence of persistent, abnormal biochemical alterations (produced by THC in the brain and recorded with PET scans) were presented by scientists from Brockhaven National Laboratory. These were related to the persistent alterations by marijuana of the brain molecular mechanism, which control DNA expression and correlated with changes in memory, attention, awareness, and goal-oriented behavior. THC interacts with ‘receptors’ in brain cells, which are part of a regulatory “anandamide cannabinoid” system that regulates the function of brain cells and their neuro-transmission (signal transduction). Through this mechanism, THC interacts with the receptors to brain neurotransmitters (norepinephrine, dopamine, GABA, acetylcholine), altering the release of these substances. By the same mechanism, THC modifies the effects of many drugs commonly used like psycho-stimulants and psycho-depressant, opiates, alcohol and stimulants: some are enhanced and some are decreased. THC acts as a major ‘deregulator’ of all brain regulation of basic bodily functions. However, unlike ‘anandamide’ and its physiological ligands, THC sticks to the receptor molecule for hours, even days, and disturbs its signalling function in a persistent fashion. This fundamental impairment of the intracellular signalling mechanism can be observed in all cells of vital body organs: brain, heart, lung, kidney, immunity cells, and the reproductive system, carrying the risk of impairing future generations before they are born.

THC receptors identical to those of the brain cells have been identified in cells of the immunity system, of sex organs and of germ cells (gametes). They are present on the head of sperm cells and in the cells of the testes that generate the sperm. These molecular studies confirm those performed in 1976-1978, by researchers at Columbia University who reported that marijuana smokers had decreased sperm count and abnormal forms of sperm. This alteration of sperm was due to the effect of THC on spermiogenesis, the process of sperm formation in the testes. Marijuana is ‘gametotoxic’, toxic to germ cells, and is fetotoxic, impairing foetal development and is in animal species.

Marijuana in the treatment of pain was discussed in a special international panel. The difficulty of separating the subjective perception of pain from its objective measurement was discussed, and it appears to be insuperable to solve; marijuana smoking can actually lower the threshold of pain perception. THC is not an effective all-purpose analgesic when compared to aspirin, Tylenol or opiates. An evaluation of THC and of marijuana smoke in the following conditions was discussed: emesis and vomiting in cancer chemo-therapy (where orally administered THC or marijuana smoking were less effective than alternate medications); glaucoma (where THC and smoked marijuana were not deemed acceptable); use of marijuana and THC have proven unsuitable as sedative or for pain management in anesthesiology; in neurological disorders, epilepsy and multiple sclerosis. In management of the AIDS wasting syndrome, the reported therapeutic results of THC and of marijuana smoke were inconclusive.

The effects of marijuana in psychiatry were evaluated in the following conditions: schizophrenia, alcoholism and acute psychiatric syndromes. Marijuana smoking may trigger some of these ailments or worsen their course.

Dr. Paul C. ]anssen, who has designed some of the most widely used medications in psychiatry, anaesthesia and dermatology, gave a special lecture entitled: How to Search for the Ideal Drugs of the Future.’ He emphasized the importance of obtaining a perfect fit between a drug and a specifically localized receptor in order to obtain the ideal therapeutic effect. Cannabinoids do not seem to possess this property of ideal therapeutic drugs.

International conference held at New York University School of Medicine March 20-21, 1998. (A brief precis from 700 pages!)

Research on youthful drinking has shown that the greatest risks associated with alcohol abuse are related to contextual factors that may potentiate heavy drinking as well as increase risks for adverse consequences. These contextual factors include interacting psychological, interpersonal, and environmental dimensions of alcohol use. However, despite considerable college drinking research to identify these factors, few formal instruments have been produced for measuring excessive drinking in multidimensional contexts. The current study of 197 college students who were cited their first time for breaking university drinking rules focuses on the development and validation of a scale for measuring the likelihood of excessive drinking across an array of psychological, interpersonal and situational contexts resulting in the 23-item Drinking Context Scale (DCS). Three distinct factors emerged defining Convivial drinking, Private Intimate drinking, and drinking as a form of Negative Coping. These three factors explained 61.5 percent of the variance after principal components analysis and Varimaxrotation, showed excellent internal reliabilities, and were moderately intercorrelated. MANOVA analysis demonstrated concurrent validity with the Quality Frequency Index (QFI) and a modified version of the Michigan Alcoholism Screening Test (MAST).

Implications for further research with the DCS are suggested.

Source: O’Hare, T. Addictive Behaviors 22(4):469-477.1997

Administered by Kentucky’s Council on Prevention and Education, CLC worked with five church communities to identify and recruit 11- to 15-year-olds. Over 131 ethnically diverse youths and their families living in rural, suburban, and inner-city areas in Kentucky participated in the program. CLC provided youths with 15 hours of training and parents/caregivers received 55 hours of training on substance abuse issues, communication skills, refusal skills, and family issues. CLC also provided referral services to families that required intervention or other social services. Evaluators found that both parents and children had increased involvement with the church community and an increase in resiliency as they learned about alcohol and drug issues. Youths increasingly declined drug and alcohol use and some inexperienced with drug use delayed initial experimentation with drugs. Participants also increasingly consulted community services for resolving family and personal problems and reported greater communication and bonding between parents and children.

Developed by the Boys and Girls Clubs of America, the Stay SMART program is a drug prevention initiative that utilizes role playing, group activities, and discussions to promote social skills and increase knowledge about the health consequences and prevalence of substance use by youth and adults. The program curriculum calls for 12 sessions, each lasting for an hour or more.
SMART Leaders is a 2-year booster program aimed at reinforcing the skills and knowledge youths learned in Stay SMART. Five booster sessions last 90 minutes and focus on improving self-image, coping with stress, resisting media pressure, and providing education/ discussion modules on alcohol, tobacco, and drugs. Five Boys and Girls Clubs offered the SMART Leaders program to 13-year-old boys and girls of various ethnic/racial backgrounds living in public housing projects in Pennsylvania, Florida, New York, Wisconsin, and Arkansas.

The SMART Leaders booster program was effective in maintaining and furthering gains made in the initial Stay SMART program. Self-reported questionnaires reflected significantly minimized drug-related behavior and fewer misconceptions regarding alcohol and marijuana use than in the control group. Tests also showed an increase in knowledge concerning the health consequences of alcohol, tobacco, and drug use.

The Residential Student Assistance Program in Westchester County, NY, was based on employee and student assistance programs, but designed for adolescents housed in various types of institutions and facilities. Professional student assistance counselors (SACs) were assigned to county correctional facilities, residential treatment centers, foster care facilities, and non-secure residential facilities for juvenile offenders sentenced by the court. SACs provided culturally sensitive substance use prevention and intervention services to African American or Hispanic teenagers who had committed violent or delinquent acts; had been physically, sexually, or psychologically abused; had experienced chronic failure in school; or had experienced mental health problems, including some who had attempted suicide. Evaluations showed a marked decrease in alcohol, marijuana, and tobacco use after the intervention. Seventy-two percent of alcohol users stopped drinking alcohol; 58.8 percent of the marijuana users ceased smoking marijuana; and 26.9 percent of the smokers quit using tobacco.

The Center for Substance Abuse Prevention (CSAP) has long recognized the importance of minimizing risk and maximizing resiliency factors in children’s lives to prevent potential involvement with alcohol and drugs. But, many children live in precarious environments and need all the help they can get in order to lead healthy and productive lives. These children, identified by CSAP as youth at high risk for substance abuse, have one or more of the following factors in common:

• Parents who abuse alcohol and drugs
• Physical, sexual, or psychological abuse
• Truancy
• Teen pregnancy
• Economic disadvantage
• Neighborhood crime and violence
• Pre-adolescent and adolescent gang activity
• Involvement in violence or delinquency
• Suicide attempts or other mental health
problems
• Placement in institutions, foster care, or
runaway/ homeless shelters

In order to learn more about ways to help these youths avoid substance abuse, CSAP initiated its High-Risk Youth Demonstration Grant Program, which was active from 1987 until 1995. CSAP awarded 130 grants to community based organizations, universities, and local agencies in the program’s first year.

Services offered by grantees helped parents, their children, and entire communities learn the skills to resist or cease using alcohol, tobacco, and illicit drugs.

Many programs were successful in reducing the prevalence of substance use among youth in high-risk environments. Furthermore, these demonstration programs underscored the crucial need for young people to be involved in caring and supportive relationships, such as those involving mentors, peer groups, families, and communities. The human connection – the attention and time spent with youth – helps guide children in the right direction and creates buffers that help shield them from their high-risk environments. From the High-Risk Youth Demonstration Grant Program, some programs emerged as models, that is, well implemented, rigorously evaluated, effective programs that could be adapted for use in other communities. Following are brief descriptions of the eight model programs:

Of course, it is difficult to categorise a group of children as to whether they have ever tried drugs; most groups that prevention workers see probably have a mixture of experiences. This, however, still requires the use of prevention strategies. Information and messages on “safer drug use” are not appropriate for children who have never experimented with drugs, nor does it do a service for children who have experimented or are using drugs on a more regular basis. There are no easy answers in prevention to help children who are using drugs, as the roots of drug taking behaviour are multiple and may involve family, social and environmental causes, as well as individual issues. Intervention, including the prevention message, is a helpful and healthier method to help these children. To tell children about “safe” ways to use legal or illegal drugs, however, not only harms them, but also harms society. The implications of this approach have major effects on families, crime rates (including driving under the influence of substances), the medical and legal systems.
It is known from research that if people think it is “normal” to use drugs, use will increase. If society wants to decrease drug use, then it must be socially unacceptable to use drugs. (Johnson, University of Michigan, 1991). Research has shown that increases in perceived risks and disapproval contribute substantially to the decline in actual use. It appears that large proportions of young people do pay attention to new information about drugs, especially risks and consequences. Such information, presented in a realistic and credible fashion, plays a vital part in reducing the demand for a drug (National Institute on Drug Abuse. USA. 1991).

In conclusion, there are currently many problems caused by drug use. The overuse and misuse of legal substances (alcohol, cigarettes, and prescriptions) also have an effect on society. Prevention initiatives regarding these substances are finally being seen as important by most levels of society. Ongoing programmes, training, and social policy help spread prevention of drug use throughout communities, with the proven benefits of increasingly healthy individuals and society.

Source: Life Education International 1997 updated 1999

Prevention is a pro-active range of strategies designed to create and maintain healthy lifestyles. The view of health is a holistic one, including physical, mental, spiritual and social health.
Prevention theory and practice have developed through evaluative research and reflect what is shown to work. To be effective, prevention needs to involve communities (including families, schools, churches) and its systems (e.g. political, police, media). The range of prevention strategies includes providing awareness (for example, media campaigns); information and education about achieving and/or maintaining health including personal and social consequences; a range of alternative healthy activities (e.g. sports, dance, art); and a context of health-promoting social policy. Together, these strategies create social norms in which individuals can develop to their full potential.

Most drug prevention programmes define primary prevention as preventing the onset of drug use before experimentation starts (essentially done at an early age, such as 4-5, and often not addressing drug issues straight away, instead discussing the body, care of it and other health issues). Secondary prevention is done with an older group, who may be experimenting with drug use or who may be at risk – a situation many children will now face. Its aim is to stop the progression of experimentation or more regular drug use. Drug use is not a “normal part of development” for young people. It is something that stunts development. Drug use has harmful effects on people, physically, emotionally, spiritually and socially. Using this model, the third component is treatment, when a person has a drug problem and wants to stop using. People in treatment also need a form of prevention, in this case, defined as relapse prevention, which involves a range of personal and social skills to avoid drug use.

Strategies:
The most effective prevention programmes cover a wide range of issues and skills. These include information on the body and health; decision making, problem solving and stress reduction; communication skills; friendship, peer pressure and how to resist it; alternatives to drug use; identity and self esteem; and drug information (including illegal and legal substances) – all delivered in a developmentally and ethnically appropriate manner. In programmes for children (at schools, youth groups, etc.), a child-centered approach that creates a forum for children to discuss their issues and concerns should be used. Other types of prevention programmes include parent and peer education, as well as training programmes for teachers, health and youth workers. Professional training is an effective and efficient way to increase the amount of prevention work in communities.

A search was made to assess what research has been done in the areas of parent surveys and parent programmes for drug prevention with children – most research on drug prevention education has been done in the late 1970s, early and mid 1980s. In regard to parent surveys, a study entitled ‘Parents’ Attitudes Towards Drugs’ (International Research, Central Office of Information) was done in England and Wales (1985). This survey was the only one found and was administered some time ago. However, it assessed parents’ attitudes, beliefs and knowledge about drugs; whether parents or schools should be doing drug prevention work; how parents would cope if they found their children were using drugs; parental responsibility; whether parents had seen any drug abuse leaflets, ads, or other publicity; and the presence of a drug problem in their areas.

Pertinent findings from this survey included:

45% felt that there was a big drug problem in their area,
58% of parents believed they did not know enough about drugs,
87% said they would take total responsibility if they found out their child was using drugs (10% would take partial responsibility, 1% would not take any and 2% did not know).
A survey of youth attitudes in the same year included the question “If you had problems with drugs and wanted help, who would you turn to?” Of respondents, 56% mentioned one parent or both, specifically:
Mother: 23%
Father: 5%
Parents: 28%
Specific research on parental influence and the need for parental involvement in prevention programming showed the importance of parents. Many of these studies come from America. One study assessed family risk factors for alcohol and other drug use (Kumpfer, 1987). These risk factors included:
Parental dependency and family history of dependency
Parental psychological and social dysfunction
High levels of family conflict
Family social isolation
Special needs/special problem children
Non-nurturant and ineffective parenting
The family has been found to be very much involved in “the initiation, maintenance, cessation and prevention of drug use’ (Coleman, 1980). In assessing adolescent correlates, Young and West (1985) concluded that ‘the family has the greatest influence on alcohol and other drug use.” Family influences were cited as correlated with alcohol use in 52% of the articles reviewed, in 46% of the time in marijuana use, 80% of the time in illicit drug use and in 59% of the studies of general drug use. A 1984 study by Harford found that “both abstinence and drinking in parents are frequently paralleled by abstinence or drinking in their adolescent children.”
It has been found that “children are influenced most by the adults in their lives when they are young, prior to the onset of peer influence. Parents of young children should be aware of what they model for their children” (Benard, et al. 1987). Parents can influence children through even their use of prescription and over the counter medicines (Perkins and McMurtrie-Perkins, 1986). Research indicates that children are at greatest risk of beginning to use alcohol and marijuana before the age of 15, and thus, need to learn resistance skills “preferably before age 9 and no later than age 12. Fortunately, many children at these ages are opposed to drug use and are receptive to parents’ efforts to teach them skills that reinforce their current attitudes.” (Hawkins, et al. 1988).

In a 1987 study by Catalano of 10 to 15 year olds, 36% of 10 year olds, 54% of 13 year olds and 79% of 15 year olds had already refused an offer of alcohol or another drug. These students mentioned their parents most often as the single most important reason for refusing alcohol or other drugs. Hawkins (1988) also found that establishing a clear family position on alcohol and other drugs provides children with the motivation to refuse these offers.

Research on specific parent programmes for preventing drug use in children was difficult to find and one journal stated there is a need for more studies in this area. Family-focused programmes that improve parenting and family management skills are seen as promising prevention strategies for alcohol and other drug use. One reason for this is that parents “can be trained to be effective change agents and their effect will be enduring and powerful” Kumpfer (1988) and Alvy (1985) believed that parent training is “a necessary component of any comprehensive prevention plan that can affect a wide range of social and health problems.” Most successful programmes train parents by addressing effective parenting through groupwork, videos/films, games, manuals, and exercises. Practice in the home is encouraged to reinforce skills.

Bry (1985), after reviewing research on the topic, concluded that “family involvement is very important, if not essential, for positive outcomes in prevention programmes. She found that when families are included in school programmes, risk factors can be reduced and early signs of problems can be reversed. A l986 study showed that three months of targeted family problem solving training reduced drug use and a correlate (school-failure) by the end of a 16 month follow-up, while control group behaviours in this study remained the same.

From existing studies, it has been shown that when parents do attend a drug prevention education programme, they are responsive. It has been found that parents will change their approach to parenting, but behaviour has not been examined. Very few studies have examined changes in children as a result of parent training, but those that tested the children have shown reductions in their use of tobacco and alcohol (National Institute on Drug Abuse: Bry. 1983).

In some studies, even the parents reduced their use of tobacco and drugs (National Institute on Drug Abuse: Flay and Sobel, 1983). Also, it has been found that school-based efforts will be more successful if combined with a parent component (National Institute on Drug Abuse: Leukefeld, 1988).

Many different research designs have shown the effectiveness of parent training in reducing problem behaviours in children (1988). Parent training can help reduce children’s behaviours that are precursors of drug use and increase positive behaviours such as school achievement, social skills and family involvement (Stouthamer-Loeber, 1986).

Three other studies were found that examined parent programmes. However, in all cases, the parent programme was a component of more comprehensive programming and was not individually assessed. For example, a 1987 study examined a school programme which included parent groups to learn about the drug problem and monitor their children’s behaviour, community meeting with key community members; coalitions and work in schools (teacher education, prevention curricula and policy). This comprehensive programme was found to decrease drug related incidents in the school and improve academic achievement.

Another prevention project including parent education and organisation, school-based education for children, mass media programming, community organisation and health policy was assessed in 1989 (Pentz, Dwyer, et al). There were 42 schools that participated and were assessed. Findings showed that prevalence rate for cigarettes, alcohol and marijuana were significantly lower at the one-year follow-up study. The net increase in drug use prevalence in schools receiving prevention programming was half that of other schools.

Finally, “Family Effectiveness Training” was assessed in 1989 (Szapocznik, Santisteban, et al) and looked at families who had the risk factors for developing a drug abusing adolescent. Results showed that families undergoing this training had greater improvement than did control groups on measures of family functioning, problem behaviour by adolescents and child self concept. Results were maintained at a six-month follow-up study.

Source: Susan Kaplin, Research Officer. Life Education Centres. April 1992 updated 1997.

Documents the harm to young people from marijuana use. The Denver-area teenagers studied were in delinquency/substance abtise treatment and most were dependent on marijuana, although most reported behavior problems predated, and were not initially caused by, drug use. Most of the dependent youth had let marijuana control their lives, interfering with school, home, and work situations and with driving. Three-quarters of the dependent young people spent much time in getting, using or recovering from the effects of marijuana. Two-thirds had given up important activities to use or acquire marijuana. Most of these dependent children experienced withdrawal symptoms when they tried to quit marijuana. Among other findings of this study:

Marijuana is a strong reinforcer of itself, propelling further use.
Among the dependent youth, even moderate marijuana use commonly led to dependence. For those who had used marijuana at least 6 times, 83% developed dependence.
Progression in marijuana use was significantly more rapid than for alcohol.
An anti-drug prevention organization recently compiled an extensive bibliography of studies showing marijuana’s harm. This is available from DNE/Strategic Intelligence upon request.
Aside from the harm caused by marijuana directly, its role as a “gateway drug” has been well established. Marijuana use is of particular concern because, for some, it is a forerunner of use of other drugs with their attendant problems. Documentation of the association of marijuana with abuse of more serious drugs was reported in the June 1997 Bulletin. One study showed that the earlier a person starts using marijuana, the more likely it is that they will at least experiment with other drugs. This is shown in the graph below and suggests that the longer marijuana use can be prevented, the better the chance for a drug-free life.
Risk of using other drugs varies directly with how young a person is when they start using marijuana

Source:Recent research conducted at the University of Colorado and published in Drug and Alcohol Dependence
How Marijuana Use Relates to Other Drug Use
(Based on Federal Drug Use Figures)

Editor, – Recently we have become aware that drug misusers are using a variety of cannabis known as skunk. Some users have described a considerable psychotic experience after use of relatively small quantities. In November 1994 we surveyed 50 drug misusers attending the methadone programme of the Glasgow drug problem service, asking them about their reported use and experiences of skunk. Eight reported having used skunk, of whom four reported having experienced psychotic symptoms after its use. Three of those who described psychotic experiences agreed to further assessment. All three admitted to regular misuse of cannabis in addition to their prescribed methadone (with one admitting to occasional misuse of benzodiazepines) and so were experienced in the effects of cannabis. All denied concomitant use of other hallucinogens, and none described any important psychiatric history.
All three described psychotic experiences after smoking one “regular sized joint.” These consisted of paranoid delusions and visual illusions in all three cases, visual and auditory hallucinations in two cases, and pronounced derealisation and depersonalisation together with thought broadcast in one case. Two users described associated severe anxiety. The experience lasted for a variable period (half an hour, one day, and three days).

All three subjects believed that the skunk that resulted in the psychotic experience originated from the Netherlands rather than Britain.
Skunk is derived from a variety of cannabis plants that have been selectively cross bred to produce high yielding varieties. While the tetra hydrocannabinol content of “normal” cannabis is up to about 5% by weight, skunk may yield IO-15%, with an even higher content being reported from the Netherlands.

Doctors should be aware of the increasing availability of varieties of cannabis yielding a high content of tetrahydrocannabinol and that psychotic episodes may be precipitated by consumption of what would previously have been considered to be relatively small quantities.

Source: A S Wylie -Senior registrar in general psychiatry and substance misuse Gartnavel General Hospital, Glasgow G12 OYN – R T A Scott Medical director, SJ Burnett Research officer Glasgow Drug Problem Service, Ruchill Hospital, Glasgow G20 9NB – Published in British Medical Journal Vol. 311 8 July 1995

Cerebral Atrophy In Young Cannabis Smokers – a letter:

Sir, -The paper by Dr. Campbell and his colleagues (Dec. 4, p. 1219) is of great importance, and there are other reasons expecting that gross irreversible brain damage may occur in young drug-addicts. It is both astonishing and I think reprehensible that we are still quite unable to spell-out either the temporary or the irrecoverable damage to the brain that results from drug addiction. Dr. Campbell refers to other causes of brain decay in young people. Here it may be relevant to add that gross brain damage may result not only from obvious cerebral anoxia, but also in exceptional types of “battle exhaustion”. It seems possible that the taking of drugs during a period of severe physiological fatigue might be particularly harmful, and it would certainly be interest to know if drug-addicts are liable to develop a variety of Parkinsonism, such as occasionally follows battle exhaustion. It may also be worth noting that I think that the outbreak of “encephalitis lethargica” in the 1920s, which had similar after-effects was never proved to be due to an infection. The need for vigorous research programme is painfully obvious.

Source: W. Ritchie Russell, Oxford.
Sir,-Your leader (Dec. 4, p.1240) is excessively cautious. Dr. Campbell and his colleagues (p.12 19) do not claim proof, but their evidence is amply sufficient to justify the continuation and strengthening of every possible measure to suppress cannabis. You may agree with this, but, regrettably, you do not say so.
Source: F.J. Nattrass, Litter Cocklands, Burford, Oxford

Summary:
Evidence of cerebral atrophy was demonstrated by air encephalography in ten patients with histories of consistent cannabis smoking over a period of 3-11 years. The average age of the patients was 22 years; all were males. Amphetamines and lysergide (LSD) had also been taken, but in much smaller amounts. Measurements of the lateral and third ventricles were significantly different from those in thirteen controls of a similar age-group.

Introduction:
Personality changes and mental illness have been reported in chronic cannabis smokers of previously normal personality. Addicts often have impairment of recent memory, vegetative symptoms, and a tendency to reversed sleep rhythm suggesting organic brain damage. If organic brain damage were confirmed, this would clearly lead to a different approach to the problem of increasing drug abuse.

This study was prompted by the finding of cerebral atrophy on air encephalography in four young patients referred to one of the researchers (A. M. G. C.) for neurological investigation of headache, memory loss, or behaviour change. A common factor in all four histories was prolonged heavy cannabis smoking. Amphetamines and lysergide (LSD) had also been taken, but in very much smaller amounts. Since no recognised cause of the cerebral atrophy was apparent, neurological and radiological investigation of other cannabis smokers seemed indicated.

Patients:
The first four cases were unselected routine admissions for investigation of neurological symptoms. The next five were under treatment by one of the researchers (M. E.) for drug abuse, and were referred for detailed investigations of cerebral function, including air encephalography. They were selected because of known long-standing-cannabis smoking; two had been attending a drug-addiction centre for some time and the other three were the next cases which presented to psychiatric outpatients with histories of long standing cannabis smoking. The tenth patient was admitted as an emergency with a drug overdose and had a 6-year history of drug abuse with heavy cannabis intake. All these cases were given a full clinical examination and were investigated by air encephalography.

It was fully explained to the patients that the test was to assess possible brain damage with a view to ultimate prognosis, and the patients willingly consented to this investigation, which was done under local anesthesia and sedation.

Discussion:
Significant cerebral atrophy is rare in young people. It may happen after head injury but can be attributed to this only when there has been post-traumatic amnesia of several hours or evidence of focal neurological damage at the time of the injury. None of the patients who had had minor head injuries (cases 1, 3, and 4) would have satisfied these criteria, and it is not considered that their head injuries played a part in the enlargement of the ventricular system. Other causes for cerebral atrophy include head injury at birth, especially in prolonged labour or in conditions causing anoxia; and some cases may also be due to hypoplasia rather than atrophy, and differentiation may not be possible. Severe infections in childhood when encephalitis has supervened, congenital syphilis, and toxoplasmosis may cause atrophy, as may congenital or acquired vascular lesions. Other causes include hereditary disease such as Huntington’s chorea. Diffuse demyelinating conditions can produce quite rapid cerebral atrophy in the second and third decade. It must be stressed that cerebral atrophy indicates irreversible brain damage.

No such causes for cerebral atrophy were found in this series of ten drug addicts.
The brains of monkeys given isotope-labelled cannabinoids intravenously showed concentration of the drug in the frontal lobes and cortex, geniculate bodies, cerebellum, caudate nuclei, and putamen – all structures near the third and lateral ventricles. After 24 hours the drug had spread uniformly throughout the brain. The fat solubility of the cannabinoids make it likely that they would accumulate in nervous tissue, with its high fat content.

There is a very interesting parallel between the picture shown by encephalitis lethargica and that of chronic abuse of cannabis and LSD This was evidenced in some the cases by a reversal of sleep rhythms, hallucinations, and mental changes.

Source: A. M G. CAMPBELL, Department of Neurology, Bristol Royal United Hospitals; M. EVANS, Department of Psychiatry, Whitchurch Hospital, Cardiff J. L. G. THOMSON, Department of Radiology, Frenchay Hospital, Bristol; M J. WILLIAMS, Department of Medicine, Bristol Royal Infirmary. Lancet, December 4, 1971

On June 22, 1998, ‘Wired for Addiction’ was presented as part of NIDA’s Frontiers in Neuroscience seminar series. The theme of these presentations centered on the neuronal remodeling that emerges after repeated substance use and withdrawal, with particular emphasis on the possibility of altered cognitive function as a consequence of the neural remodeling. Presentations were made by Drs. Ann Graybiel, Tony Grace, John Marshall, Janet
Neisewander, and Regina Carelli, and a summary and discussion was presented by Dr. Steve Grant of NIDA. Brief summaries of two presentations follow.

Chronic exposure to psychomotor stimulants may rewire your brain
Exposure to amphetamine and cocaine induces gene expression in cortico-basal ganglia circuits. Chronic intermittent exposure to the same drugs down-regulates some of the inducible change. After a course of chronic intermittent treatment and withdrawal of the drug, a subsequent challenge with the drug induces new patterns of gene expression in cortico-basal ganglia circuits. The repeated administration and withdrawal of cocaine induces both immediate early gene (lEG) expression after drug challenge in neurons that are not activated acutely, and an increase in the size of the area in which this response in observed. These findings raise the possibility that prolonged exposure to psychomotor stimulants produces enduring changes in brain wiring.

Ann Graybiel, Ph.D., Massachusetts Institute of Technology:

Neuronal interactions within the limbic system of rats: Alteration during amphetamine sensitization
Amphetamine exerts differential actions on neurons in the nucleus accumbens when given acutely versus repeatedly. The studies show that repeated amphetamine administration causes an increase in electrical coupling among nucleus accumbens neurons, which appears to be driven by an increase in prefrontal corticoaccumbens afferent activation. It is proposed that such a condition would lead to alteration of information flow within this system, resulting in a perseverance of behavioral action that may contribute to drug-seeking behavior in humans.

Anthony Grace, Ph.D., University of Pittsburgh

Abstract:
The study evaluated the auditory/verbal and visual/spatial memory of 10 cannabis-dependent adolescents and compared the results with performance of 17 subjects in two control groups. The control groups included 8 adolescent drug abusers who had not been long-term users of cannabis and another 9 adolescents who had never abused any drug. All three groups were matched by age, IQ, and absence of previous learning disabilities. Adolescents with a history of frequent alcohol or phencyclidine were excluded from entering the study. A battery of seven neuropsychololgical tests was administered initially to all subjects and a parallel test battery was administered 6 weeks thereafter. Significant differences between the cannabis-dependent group and the two control groups were obtained initially on the Benton Visual Retention Test (F[2.24]=6.04) and the Wechsler Memory Scale Prose Passages (F[2.23]=7.04). After 6 weeks of supervised abstention from intoxicants, subjects in the cannabis-dependent group showed some significant improvement on the Wechsler Memory Scale Prose Passages and on the Benton Visual Retention Test; however, the improvement failed to achieve statistical significance. It was concluded that cannabis-dependent adolescents have selective short-term memory deficits that continue for at least 6 weeks after the last use of marijuana.

Source: Richard H. Schwartz, Department of Pediatrics, Georgetown University, Medical School, Washington D.C., USA; 1989.

To assess long-term trends in cigarette smoking according to the combined influence of sex and education, this study examined smoking prevalence in sucessive U.S. birth cohorts. Data from nationally representative surveys were examined to assess smoking prevalence for six successive 10-year birth cohorts stratified by race, ethinicity, sex, and educational attainment. Substantial declines in smoking prevalence were found among men who had a high school education or more, regardless of race or ethinicity, and slight declines women of the same educational background were revealed. However, little change was found in smoking prevalence among men of all race/ethnic groups with less than high school education, and large increases were found among women with the same years of schooling, espcially if they were white or African American. These data suggest that persons of low educational attainment have yet to benefit from ther policies and education about the health consequences of cigarette smoking.

Source: Escobedo, L.G.; Peddicord, J.P.
American Journal of Public Health 86(2):231-236, 1996

In the office dictionary the word next to ‘educate’ is ‘edulcorate’ – meaning to sweeten up; to make more palatable . In the search for acceptance for drugs messages, especially by youth, we sometimes run the risk of adding too much sweetener whilst leaving out what may be found bitter to the taste. Nowhere is this more true than with cannabis. The media have had a love affair with ‘pot’ for years now, and even much of the nationally-available drugs literature is sanguine about this ‘pernicious weed’. Not content with taking the lowest common denominator of harm, there is a tendency to open the dialogue by listing the perceived ‘benefits’ of a drug’s misuse. Of course the risk of ‘edulcoration’ can apply to any field of endeavour in regard to drugs. Over-zealous treatment workers are as much at risk of propagandising their position as are harm reduction workers or even – perish the thought – prevention workers. The perennial battle for a slice of the (tiny) funding cake adds to this tendency. The truth, as ever lies (to quote the Blessed Paddy Ashdown) “somewhere in-between”. If ever we were to see a united drugs profession – without the aid of a powerful telescope – it would probably include an acceptance by all concerned that they have been guilty of hyperbole, and the respective roles of each sector could be more constructively interlinked to reach a common good of minimum drug misuse plus sensitive and effective interventions for these who do misuse, to whatever extent. For the present, sadly it has to be recognised that common goals are still some way off.

Smokers should be banned from leaving the office to smoke more than three cigarettes a day, employers say. Doctors have also accused smokers of ruining the image of companies by dragging on fags outside front doors of buildings. Research indicates two million employees (in Australia) smoke about seven cigarettes a day at work, spending on average 70 minutes off the job. Employers Chamber general manager, Ian Harrison said it should no longer be tolerated.

Source: Adelaide Sunday Mail, p17, 8/3/98

All disposable cigarette lighten should be child-proof, says Alliance MP Grant Gillon, a former firefighter. The fire that killed 3-year-old Kane Julius in Wainuiomata on April 6 may have been caused by the boy or another child playing with a cigarette lighter Media reports had only focussed on the combustible building materials, he said, “On average two people each year died as a result of fires caused by lighters, and most of these were started by children”, he said. “Australia has banned the sale of any disposable cigarette lighters which are not child safe, yet New Zealand has no such laws.” The Australian standard meant that at least two hand movements were needed to ignite a lighter. A further fire in Auckland over Easter that killed two 3 year old twins, was also attributed to non-child-proof cigarette lighters. In response Consumer Affairs Minister Robyn Macdonald has promised to investigate what can be done.

Source: NZ HeraId 9/4/98 pA5

The Grammy award winning pop group Boyz II Men is running a 60-second public service video before each concert on their latest tour. The video shows the singers coughing in a smoke-filled room, unable to sing. Then the thick haze of smoke clears, and they sing in perfect harmony. The singers have been bothered by second hand smoke during performances, particularly overseas.

Source: USA Today, 9/4/98

A Queensland University study of 5000 pregnant women has found a correlation between smoking and poverty. The three year study measured smoking against income levels, with the lowest earners defined as those who attract an income of $4,144 a year and the highest above $21,639 a year. Two thirds of the lowest income group smoked before pregnancy compared with 46 per cent of middle income earners and 39 per cent of higher income earners. Young and impoverished single mothers are more likely to be heavy smokers with half of the lowest income earners puffing during pregnancy. And 14 per cent of them are such serious smokers that during pregnancy they light up more than 20 cigarettes a day.

Source: British Medical Journal 7135:316

A UK report draws attention to the dangers of passive smoking for young children. Mothers who smoke double the risk of sudden infant death syndrome (cot death) (odds ratio 2.08) and if both parents smoke the odds ratio rises to 3.79 Parental smoking increases the risk of asthma attacks and respiratory symptoms in schoolchildren, although at a lower risk than for infants. Maternal smoking had a greater effect than paternal smoking. The pooled odds ratio where children were exposed to two parents smoking were 1.52 for asthma exacerbation, 1.40 for wheeze and 1.61 for cough. (i.e. 61 percent risk increase over that of a baby with neither parent smoking).

Source: The Observer, 1/3/98

63 percent of smokers who underwent surgery to clear blocked blood vessels continued to smoke even though smoking after the surgery “substantially reverses any benefit gained from the procedure.” In the editorial accompanying the study, doctors are urged to use the treatment of heart disease as a ‘window of opportunity’ for persuading patients to change unhealthy behaviours such as smoking.

Source: Washington Post. 10/3/98 p5 in NZ Smokefree News (12) 23/3/98

Smoking degrades sperm quality according to a report in the current issue of the journal, Fertility and Sterility.

(Philippine Daily Enquirer, p13, 21/3/98)

Women who smoke run a greater risk of developing heart problems and dying from a heart attack than male smokers, according to a recent medical report. The number of women smokers has risen during the past 30 years and makes it possible to make meaningful comparisons of male and female risks. A Danish study of 24,000 people over 12 has found that the relative risk of death from a heart attack is higher for female smokers. The researchers also found that all former smokers reduced the risk of heart disease by as much as 50%, one year after quitting.

(Reported in Sydney Morning Herald, p3, 4/4/98)

A British study of teenage attitudes to smoking has revealed that girls do not start smoking to control weight, as commonly thought, but to appear mature and to attract older boyfriends. The research, carried out at the University of Sussex, found a relationship with smoking behaviour and concern with thinness but that this was extremely small. The main attraction of smoking to youngsters is that it is “cool” and “rebellious”.

Smokers were perceived as being sociable, exciting and party-going, whereas non-smokers were seen as sensible and quiet.’ The teenagers surveyed were well aware of the health risks of smoking but regarded it as cool to have a disregard for “old age” and long-term-health

(Reported in The Independent 24/3/98)

The European Conference, Health, Society and Alcohol, held in Paris, December 12-14, 1995, was a meeting point between science and policy. Science informed the policy process. As a tool for policy implementation, the Conference adopted the European Charter on Alcohol, a set of ethical principles and strategies for action. Of a number of important issues that frame policy three deserve mention. First, market forces, as opposed to health and social policy decisions, are increasingly influencing the policy debate. Second, existing policy options to reduce alcohol-related harm are unlikely to lead to an increased risk of coronary heart disease among older age groups. And third, policy developments and changes in drinking patterns in countries of southern Europe are an important driving force in European policy on alcohol.

Source: Anderson, P Addiction 92(S1):S3-S6, 1997 Availability: Carfax Publishing Corporation, Abingdon, Oxfordshire, England 0X13 3UE

The risk for developing substance dependence is increased in the prison milieu, due to stress factors, to the availability of drugs, and to an over-representation of persons dependent on drugs among the prison population. Recent overviews on projects for primary prevention against substance abuse in European countries are summarized and some evaluation results are discussed (especially prevention programs in the school milieu and in community settings). The main messages are that knowledge and attitudes can be improved, but, with unreliable impact on consumption behavior, short programs are not effective and most programs cannot adequately reach those who are most in need for them. These messages have to be considered when it comes to prevention in the prison milieu. The specific prevention goals for prison populations are identified, and selected strategies mentioned (including control measures, therapeutic measures, and harm reduction measures). Evaluation of such prevention strategies and programs is rare; a few examples are given. More pilot projects are recommended, focusing on relapse prevention for those already dependent, adequate networking with after-care and other agencies outside, and active participation by inmates in order to improve compliance with the program.

Source: Uchtenhagen, A. International Journal of Drug Policy 8(1):56-61, 1997
Availability: Reprints are available from the publisher

The use of Ecstasy in combination with other drugs is an increasing diagnostic and treatment problem for A&E staff, a study has revealed. The records of all patients tending A&E at St Thomas’ Hospital London were studied over a 15 month period. The notes of those who were suspected of having used Ecstasy, or methylenedioxymethamphetarnine, were systematically reviewed. They found 48 cases all in the 15-30 age group. Most presented in the early hours at weekends, The average number of tablets taken was two, and 40% of the patients had taken drugs before. However, half of them had taken another substance at the same time, usually amphetamines or cocaine. A wide range of clinical features were noted. The most common are detailed below. The most serious complications were in patients who had taken more than one drug. The authors say the problems caused in A&E by dance drugs are increased by multiple drug ingestion.

Symptoms of Ecstasy use alone or in combination. Most common symptoms with Ecstasy use alone:

Strange/unwell/dizzy/weak 44 %
Palpitations 37 %
Nausea or vomiting 31 %
Panic/anxiety/restlessness 31 %
Hot/cold 25 %
Abdominal pain 15 %
Most common symptoms with Ecstasy and other drugs/alcohol:
Collapsed/Loss of consciousness 31 %
Strange/unwell/dizzy/weak 25 %
Nausea or vomiting 19 %
Palpitations 19 %
Panic/anxiety/restlessness 12 %
Headache 12 %
Shaking 12 %
Source: Williams H., Drareau L, Taylor L., et al. (1998)
“Saturday night fever” Ecstasy related problems in a London accident and emergency department journal of Accident and Emergency Medicine 15: 5. 322-325

Background
3.4 methylenedioxymethamphetamine (MDMA, ‘Ecstasy”) is a popular recreational drug that selectively damages brain serotonin (5-HT) neurons in animals at doses that closely approach those used by humans. We investigated the status of brain 5-HT neurons in MDMA users.

Methods
The study enrolled 14 previous users of MDMA who were currently abstaining from use and 15 controls who had never used MDMA. It used positron emission tomography (PET) with the radioligand carbon-11-labelled McN-5652, which selectively labels the 5-NT transporter. It analysed whether there were differences in 5-HT transporter binding between abstinent MDMA users and participants in the control group. Blood and urine samples were taken and tested to check for abstinence.

Findings
MDMA users showed decreased global and regional brain 5-HT transporter binding compared with controls. Decreases in 5-HT transporter binding positively correlated with the extent of previous MDMA use.

Interpretation
Quantitative PET studies with a ligand selective for 5-HT transporters can be used to assess the status of 5-HT neurons in the living human brain. The study shows direct evidence of a decrease in a structural component of brain 5-NT neurons in human MDMA users.

Source: U D McCann, Z Szabo, U Scheffel, R F Dannals, GA Ricaurte – Biological Psychiatry Branch, National Institute of Mental Health,- Bethesda, Maryland, USA (U D McCann MD); and Departments of Radiology (Z Szabo MD, U Scheffel ScD, R F Dannals PhD) and Neurology (G A Ricaurte MD), Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA – published: The Lancet Vol 352, Oct 98. (Correspondence to: Dr G A Ricaurte)

Recreational use of 3,4 methylenedioxyethylamphetamine (MDMA), more commonly known as “ecstasy” (and a variety of other names including “XTC”, “Adam” or “E”), is now well established. In Britain upwards of 500,000 people are said to use the drug each week (Harris Poll (1992) for “Reportage”, BBC2, 22 Jan 1993).

MDMA is a ring-substituted amphetamine with psychoactive properties. First synthesised in 1914 from methylenedioxyamphetamine (MDA), itself a drug of misuse (known as the “love drug”), it has been used in psychotherapy and was originally used as an appetite suppressant. The drug has ceased to be used medicinally and is now an established part of the illegal drug scene. It is banned in most countries. In the UK it is a class A drug as defined in Schedule 2 of the Misuse of Drugs Act 1971. It has no medicinal use in the UK and cannot be prescribed.

As well as MDA and MDMA, another variant, methylenedioxyethylamphetamine (MDEA, known as “eve”), which is similarly proscribed, is commonly encountered. All have similar pharmacological effects.
In the UK, MDMA is often taken by young people at discos and rave parties. Both involve dancing, but especially at the latter there is vigorous repetitive dancing in crowded rooms with a hot and humid atmosphere. The dangers of this activity are recognised to a certain extent as rooms to “chill out” are often available for people to rest in after periods of exertion. Toxic effects and the occasional death following ring substituted amphetamine misuse have been reported but postmortem data are lacking. In this paper we report on deaths associated with ring substituted amphetamine misuse and detail the postmortem findings.

Seven deaths have been investigated by the University of Sheffield Department of Forensic Pathology in the past three years, which were associated with ring substituted amphetamine misuse. All of the subjects were white men, between 20 and 25 years of age. Three of the victims collapsed at a rave or disco, two were found in bed, one in a collapsed state and one dead, one collapsed in the street, and one was admitted to hospital with progressive jaundice.

Abstract
Aims – To study the postmortem pathology associated with ring substituted amphetamine (amphetamine derivatives) misuse.

Methods
The postmortem findings in deaths associated with the ring substituted amphetamines 3,4-methylenedioxymethyl-amphetamine (MDMA, ecstasy) and 3,4-methylenedioxyethylamphetamine (MDEA, eve) were studied in seven young white men aged between 20 and 25 years.

Results
Striking changes were identified in the liver, which varied from foci of individual cell necrosis to centrilobular necrosis. In one case there was massive hepatic necrosis. Changes consistent with catecholamine induced myocardial damage were seen in five cases. In the brain perivascular haemorrhagic and hypoxic changes were identified in four cases. Overall, the changes in four cases were the same as those reported in heat stroke, although only two cases had a documented history of hyperthermia. Of these four cases, all had changes in their liver, three had changes in their brains, and three in their heart. Of the other three cases, one man died of fulminant liver failure, one of water intoxication and one probably from a cardiac arrhythmia associated with myocardial fibrosis.

Conclusions
These data suggest that there is more than one mechanism of damage in ring substituted amphetamine misuse, injury being caused by hyperthermia in some cases, but with ring substituted amphetamines also possibly having a toxic effect on the liver and other organs in the absence of hyperthermia.

C M Milroy J C Clark A R W Forrest Department of Clinical Chemistry, Royal Hallamshire Hospital, Sheffield – Department of Forensic Pathology, University of Sheffield
Source: (J Clin Pathol 1996;49:149-.153)

In a study of 6,000 high school students in New York State, Cornell University researchers found that the odds of drinking, smoking, and using marijuana were 40 percent lower among students who had participated in a school-based substance abuse prevention program in grades 7-9 than among students who had not. In 1995 near1y one out of five seniors reported complete abstinence from drugs. This represents an increase of almost 250 percent since 1980. Also in 1995, 12.8 million Americans used an illegal drug within the past month. A decrease of nearly 50 percent since 1979.

Source: Substance Abuse and Mental Health Services Administration: Prevention Works!
The 1997 National Household Survey on Drug Abuse found that the rates of use of marijuana, psychotherapeutics, cocaine, hallucinogens, and inhalants in the total population age 12 and older did not change between 1996 and 1997.
Source: White House Drug Policy Website

Researchers examined relationships among perceived alcohol availability, drinking location, alcohol consumption, and drinking problems. Subjects were 3,372 adolescent drinkers, ages 16-18, who participated in the Communities Mobilizing for Change on Alcohol Project baseline survey. Mixed-model regression was employed to identify predictors of alcohol consumption and drinking consequences. Perceived alcohol availability was significantly associated with higher levels of alcohol consumption for males. Drinking in a public location, such as a bar, restaurant, or party was marginally associated with higher levels of alcohol consumption for females. Results underscore the importance of youth alcohol accessibility.

Source: Jones-Webb, R.; Toomey, T.L.; Short, B.; Murray, D.M.; Wagenaax A., et al.
Substance Use & Misuse 32(10)1261-1285, 1997
Availability: Marcel Dekker Journals, 270 Madison Avenue, New York, NY 10016

This article reports the results of a study of substance use, measured by self-reports and hair test results, and delinquency among arrested youths entering a service intervention program. The results highlight important relationships between their alcohol and drug use and involvement in delinquency in the year prior to their interviews. The research and service implications of these findings are discussed.

Source: Dembo R.; Pacheco, K.; Schmeidler J.; Fisher, L.; Cooper, S. Journal of Child & Adolescent Substance Abuse 6(2):1-25, 1997
Availability: The Haworth Press, Inc., 10 Alice Street, Binghamton, NY 13904-1580

Implications for preventing drug-related behavior among youths

The rise in drug-related behavior (DRB) among youths represents a major public health concern. The interaction of DRB and other risk factors predicting delinquency and disease among youths has led to more interest in the implications for using persuasive communication in the mass media for drug prevention. Advancements in communications technology offer promising alternatives for delivering drug prevention on a large scale. The efficacy of anti-drug public service announcements (PSAs) for preventing DRB among youths is discussed.

Source: Davis. N. Journal of Child & Adolescent Substance Abuse 6(2):49-56, 1997
Availability: Haworth Press. 10 Alice Street, Binghamton, NY 13904

This study examines the extent to which alcohol and drug use is related to violent and nonviolent criminal activity among adolescent males. Based on data collected from 312 youthful offenders at a public juvenile facility, the findings reveal that in comparison to marijuana and heroin, alcohol use is more strongly and consistently associated with both violent and nonviolent offenses. When other factors are introduced into the analysis, the results show that while an adolescent’s criminal history and racial identity are relatively more important in predicting criminal activity overall, the effect of substance use (especially alcohol and marijuana) continues to be present.

Source: Dawkins, M. Adolescence 32(126):395-405, 1997
Availability: Marvin P Dawkins, Department of Sociology Coral Gables FL 33124

Breeding ground for chemical dependence or for immunity against substance abuse?

Dr. Robert DuPont is a strong proponent of an “active commitment to observing and enforcing the drug and alcohol laws on college campuses, including in college dormitories.”

According to DuPont, the combination of vulnerable youth in an environment of almost non-existent social controls results in a uniquely threatening setting for substance abuse. Although many colleges and universities are beginning to reconsider their responsibilities with respect to the personal lives of their students, DuPont contends that numerous institutions of higher learning, especially many of “the most prestigious, continue to hide behind the concept that their students are responsible for their own decisions and behavior.” Moreover, he argues that these colleges and universities “treat drug and alcohol use as a personal matter, focusing on ‘responsible choices’ and the distinction between ‘use’ and ‘abuse” rather than the inherent dangers to the individual and to society.

To combat substance abuse in the college environment, DuPont believes that it is necessary to foster and develop a student commitment to lifestyles that reject the usage of what he terms “recreational pharmacology.” He stresses that before this ideology can produce positive behavioral changes, it needs to be “rooted in the deep and enduring values of colleges to promote the full physical, intellectual, and spiritual development of students.” DuPont contends that modern scientific research surrounding the processes and effects of drug addiction, and the many tragic drug-related incidents of the past two decades illustrate that the out-dated values of the 1960’s can no longer be accepted or applied to the present-day situation. Leaving drug usage decisions to the individual is no longer intellectually justifiable, and “reflects a reckless abdication of the principle of caring for one’s fellow human beings.” Finally, DuPont criticizes some university faculty and administrators for being reluctant to part with the more liberal values of earlier decades. Ironically, he believes that many college students are more willing to accept a less tolerant and more restrictive attitude to drug and alcohol usage than their educators.

Source: Dr. Robert L. DuPont, Georgetown University Medical School, President, Institute for Behavior and Health, 6191 Executive Blvd., Rockville, Maryland 20852 (301) 468-8980

It is important to distinguish between experimental and problem drug use. While more than a third of 16 year old students in the UK say they have tried at least one illegal drug, only a very small percentage go on to develop problem drug use which is of most concern.

Key risk factors for problematic drug use are:

• a chaotic home life
• lack of mutual attachment between child and parent
• parental drug use
• poor academic achievement by young people and their parents
• low socio-economic status

Key behavioural risk factors are:

• poor social skills
• being unusually shy or aggressive
• association with deviant peers
• anti-social behaviour

Researchers and practitioners assign a crucial role to the family in the development or prevention of drug-related behaviours. The family is seen to exercise influence in a variety of ways:

Close family relationships. The closeness of the parent-child bond is found to protect against problem drug use by encouraging mutual parent-child trust, effective communication, positive self-perception and choice of friends who resist involvement in general anti-social behaviours, including drug use. Poor communication, poorly defined or stated expectations of behaviour and inconsistent or harsh discipline can all predict substance misuse. Parents have a very powerful influence as role models for their children, who tend to follow what their parents do rather than what they say. Parents, however, very often don’t realise the power of their influence, a situation which has potentially profound implications. This seems to be a key area in which parents need education.

Family management. Parents who lack effective management skills are less well equipped to deal with family crises, to reward or punish appropriately, to develop positive social behaviours in their children or to protect them from negative influences. Also parenting skills tend to be passed on down the generations. There are positive signs from research that with the right training, parents can provide an environment in which children can develop a whole range of abilities including self-confidence, self mastery and positive behaviours, all of which can offset negative peer influences.

Parental supervision. Parents knowing where their children are and what they are doing can delay or prevent the onset of drug use. Surrogate parent figures in after-school programmes or recreation activities can also be effective. The influence of this supervision can be direct in keeping children away from drugs, or indirect by reducing contact with drug-using peers. Parental monitoring can be improved through parent training programmes, but clearly parents need booster courses particularly during the child’s transition into adolescence.

Parent vs. peer influences. Parents and peers may be mutually influential and emphasising the power of peer pressure may lead parents to underestimate their own effect. Although parental influence does wane at particular stages of a child’s development, research indicates that they do affect the child’s behaviour in the long term. A debate continues on the relative influence on adolescent drug use of peer influence as opposed to peer selection. In summary, there are a lot of influences in a child’s life and family and parents are one bit of a jigsaw. However there is no doubt that families do have a very important role and that this offers valuable opportunities for drugs prevention. The latter part of the paper looks at the evaluations the team has carried out with five DPI parent projects and identifies key issues in their success. The research shows that almost every element of projects involving parents – building local credibility, recruiting parents, assessing needs, meeting some of these needs, and evaluating the impact on children – requires a considerable amount of time. Much of the success seen in the projects evaluated can be attributed to the efforts of project workers in establishing a trusting relationship with parents, with local schools and community agencies. The team’s research so far has identified the following strategies for success:

Build effective partnerships at the outset. Financial partnerships, profes-sional support, contact with parent groups are all crucial.
Be imaginative in recruiting parents through school. Build credibility, for example by getting an enthusiastic teacher to help, and use creative ways to involve parents, such as getting children to put on a performance built around drugs prevention activity.
Take plenty of time to establish the profile and credibility of your project when recruiting in the community.
Parents are more likely to get involved in projects with more general labels which avoid the potential stigma of drugs, such as “Living with Teenagers” or “Keeping your child happy, healthy and safe”

Conclusion: Children are exposed to a range of substance use behaviours from their parents, other adults, peers and the mass media. Perceptions of what is considered normal behaviour in the home may encourage or discourage young people from drug misuse.

Source: The authors – Richard Velleman, Willm Mistral and Lora Sanderling are all members of the University of Bath. Bath Mental Health Care NHS Trust Joint R&D unit. – Published in ‘Evaluating Effectiveness: Drugs Prevention Research Conference’

The team which was responsible for evaluating the DPI’s projects working with parents has an unequivocal message in this paper:

parents and family environment have a strong influence on the drug-taking behaviour of their children.
parents can be educated and supported to produce a positive influence, delaying or preventing drug misuse by their children.

This study determined the effect of environmental tobacco smoke exposure on the health of 17,448 U.S. children. The main outcome measures were rates of respiratory illnesses and all illnesses, and the morbidity due to these illnesses, in children exposed to environmental tobacco smoke in the home daily compared with those in children not exposed in the home. The analyses controlled for age, socioeconomic status, race, family size, sex, season, and region of the country. Children who were exposed to environmental tobacco smoke had a higher incidence of acute respiratory illnesses (relative risk (RR) = 1.10, 95 percent confidence interval (CI) 0.95 to 1.26) and all chronic respiratory diseases (RR = 1.28, 95 percent CI 0.99 to 1.65) than children who were not exposed, although both CIs included unity, and chance cannot be ruled out as being responsible for these findings. Children who were exposed to environmental tobacco smoke had, on average, 1.87 more days of restricted activity (95 percent CI 0.20 to 3.54), 1.06 more days of bed confinement (95 percent CI 0.20 to 1.92), and 1.45 more days of school absence (95 percent CI 0.40 to 2.50) per year than children who were not exposed. The authors conclude that environmental tobacco smoke exposure in the home, which is completely preventable, is an important predictor of increased morbidity in children.

Source: Mannino, D.M.; Siegel, M.; Husten, C.; Rose, D.; Etzel, R. Tobacco Control 5(1): 13-18, 1996

This article describes and evaluates the impact of Boys & Girls Clubs recently installed in residential public housing developments. Because most prevention interventions to date have been school-based, this study marks a development in prevention interventions for problem behavior among youth at high-risk. The evaluation compares sites without Boys & Girls Clubs to sites with both previously and recently installed Boys & Girls Clubs. The results show that public housing developments with Boys & Girl Clubs have less drug-related activity measurably \ fewer damaged and unoccupied units, and increased parental involvement in youth activities.

Source: Schinke, S.P.; Orlandi, M.A.; and Cole, K.C.
Journal of Community Psychology CSAP Special Issue:1 18-128. 1992

Imaging studies in humans suggest that the amygdala plays an important role in craving elicited by cocaine and cocaine-conditioned environmental stimuli. The research examined the relationship between neurochemical changes in the amygdala and cocaine-seeking behavior following exposure to a cocaine-paired environment or a cocaine priming injection. It measured cocaine-seeking behavior by assessing the persistence of lever-pressing in the absence of cocaine reinforcement in animals previously trained to press a lever for cocaine infusions. Lever-pressing under these conditions is thought to reflect the incentive motivational properties of cocaine and cocaine-associated stimuli. It first investigated whether the pattern of changes in cocaine-seeking behavior corresponded with changes in concentrations of dopamine in dialysates obtained from the amygdala during the course of cocaine withdrawal.

There were concomitant changes in cocaine-seeking behavior and dialysate dopamine following the cocaine priming injection, but not following exposure alone to the cocaine self-administration environment. It next investigated changes in Fos protein expression as a general marker for neuronal activation. Exposure to the cocaine self-administration environment, but not the cocaine priming injection, elicited Fos expression in the basolateral nucleus of the amygdala, nucleus accumbens shell, and cingulate cortex. In contrast, the cocaine priming injection, but not the environmental stimuli, elicited Fos expression in the central nucleus of the amygdala and dorsolateral caudate-putamen.

The findings suggest that different neural mechanisms mediate cocaine-seeking behavior elicited by cocaine conditioned environmental stimuli and those elicited by a priming injection of cocaine. Increases in extracellular dopamine may be critical for the induction of cocaine-seeking behavior elicited by cocaine but may not be elicited by cocaine-conditioned environmental stimuli.

Source: Janet Neisewander, Ph.D., Arizona State University

Repeated administration of methamphetamine (m-AMPH) can induce long-lasting changes in brain function, including (I) regulatory events related to the phenomena of tolerance, sensitization, and craving, and (II) injurious effects associated with prolonged exposure to this stimulant drug. The ability of repeated m-AMPH administration to injure the dopamine terminals of the neostriatum is well characterized; this injury is a consequence of the drug-induced overflow of both glutamate and dopamine within the caudate-putamen.

The involvement of striatal glutamate in these effects of repeated m-AMPH treatments suggests a progressive recruitment of the corticostriatal projections during repeated drug exposure. Evidence that cerebral cortical neurons are activated, and that some of them degenerate, during the course of repeated m-AMPH administration is provided by studies of immediate early gene expression, quantification of glutamate receptors, and cellular markers for cortical neuron degeneration. Degenerating cortical neurons include pyramidal and stellate cells in layers III and IV of parietal cortex. As the neuronal degeneration occurs in concert with the intense stimulant-induced stereotypical behaviors, it is possible that the behavior itself may drive the circuits that trigger the injured neurons, promoting further damage. The implications of this progressive alteration in cortical and striatal circuits for the progress of amphetamine self-administration are discussed.Extracts from Wired for Addiction’ Frontiers in Neuroscience – June 1998 John Marshall, Ph.D., University of California at Irvine

In a workshop at the August 1997 10th Annual National Prevention Network (NPN) Research Conference, in Philadelphia, Nancy Chase and Fred Garcia defined the kinds of media reaching today’s youth. These include such obvious sources as television and movies and the Internet, as well as message delivery vehicles not always looked at as media, such as T-shirts, video games, and the lyrics of popular music. DHHS Secretary Donna Shalala responds to the question of why so many of today’s kids engage in substance abuse by pointing out that “…young people are bombarded with mixed messages about drugs, alcohol, and tobacco from the environment…” The reach and impact of media in the environment is growing daily. While the NPN members on hand were familiar with the issue generally, they were impressed by a collection of recent videotaped clips of commercials and news programs shown during the workshop. They also learned that the American Psychological Association estimates that the typical child sees about 10,000 acts of violence each year on television. And the workshop leaders pointed out that these same youth are exposed to music that “glamorizes illicit drug use, underage drinking, and violence.” A surprisingly long and varied list of products depicts the marijuana leaf, often with a pro-marijuana message.

Faced with the challenge of countering such powerful forces, media literacy offers opportunities to strengthen and add to other prevention efforts: Media campaigns and other prevention strategies are important steps in reducing substance abuse among adolescents. It is simply not possible to reach all young people with compelling and frequent enough messages about the dangers of alcohol, tobacco, and illicit drugs. Dollar for dollar, substance abuse prevention forces can never hope to match, much less outspend, corporate marketing in the media. But media literacy may adjust the balance in favor of prevention at relatively small cost by helping young people “analyze, evaluate, and understand the direct and subtle themes of a media message.”

To be media literate, in the workshop’s words, “is to understand that the message was produced by someone with an agenda to sell, persuade, or change attitudes or behaviors.” Thus, “media literacy is the skill to ‘deconstruct’ the message and understand the messenger’s motives.” In theory the idea of letting someone else pay to produce a message, which, through media literacy can become an effective prevention teaching tool, is bound to be appealing. But how well does it work? Garcia and Chase cited a 1996 study that found that students who have acquired media literacy skills will counter-argue alcohol ads months or years after exposure.

At the University of Washington, Erica Weintraub Austin reported that third graders had immediate as well as delayed effects from viewing and discussing a videotape about television advertising and looking at alcohol ads. The workshop presenters conclude from this and other studies that “teachers of media literacy may indeed be inoculating students against the appeals of sophisticated alcohol and tobacco advertising.” Garcia and Chase also emphasize that media literacy is not media bashing, but treats media as a tool that can be used, misused, and abused. Nor, they told the gathering of State prevention directors, is media literacy a silver bullet. But the media industries need to be seen as a part of the solution toward healthier, safer communities. And media literacy is a prevention strategy to address both public health and public safety concerns. It’s also an excellent alternative activity for youth, since it is involving, engaging and compelling.

Source: Workshop in Aug-1997 – 10th Annual National Prevention Network Research Conference – Philadelphia USA – Reported in Prevention Pipeline Nov/Dec 1997

A universal program, the Seattle project is a school-based intervention for grades one through six that seeks to reduce shared childhood risks for delinquency and drug abuse by enhancing protective factors. The multicomponent intervention trains elementary school teachers to use active classroom management, interactive teaching strategies, and cooperative learning in their classrooms. At the same time, as children progress from grades one through six, their parents are provided a training session called ‘How To Help Your Child Succeed in School’, a family management skills training curriculum called ‘Catch ‘Em Being Good’, and the ‘Preparing for the Drug-Free Years’ curriculum. The interventions are designed to enhance opportunities, skills, and rewards for children’s prosocial involvement in both school and family settings, thereby increasing their bonds to school and family and commitment to the norm of not using drugs. Long-term results indicate positive outcomes for students who participated in the program: reductions in antisocial behaviour, improved academic skills, greater commitment to school, reduced levels of alienation and better bonding to prosocial others, less misbehavior in school, and fewer incidents of drug use in school.

Source: Hawkins et al. 1992

Strengthening Families is a selective multicomponent, family-focused program that provides prevention programming for 6-10-year-old children of substance abusers. The program began as an effort to help substance-abusing parents improve their parenting skills and reduce their children’s risk factors. The program has been culturally modified and found effective (through independent evaluation) with African-American, Asian/Pacific Islander, and Hispanic families. The Strengthening Families program contains three elements: a parent training program, a children‘s skills training program, and a family skills training program. In each of the 14 weekly sessions, parents and children are trained separately in the first hour. During the second hour, parents and children come together in the family skills training portion. Afterward, the families share dinner and a film or other entertainment. Parent training improves parenting skills and reduces substance abuse by parents. Children‘s skills training decreases children’s negative behaviors and increases their socially acceptable behaviors through work with a program therapist. Family skills training improves the family environment by involving both generations in learning and practising their new behaviors. This intervention approach has been evaluated in a variety of settings and with several racial and ethnic groups. The primary outcomes of the program include reductions in family conflict, improvement in family communication and organization, and reductions in youth conduct disorders, aggressiveness, and substance abuse.

Source: Kumpfer et al. 1996

AAPT is a universal classroom program designed for fifth grade students, with booster sessions conducted in the seventh grade. It includes two primary strategies. Resistance skills training is designed to give children the social and behavioral skills they need to refuse explicit drug offers. Normative education is specifically designed to combat the influences of passive social pressure and social modeling effects. It focuses on correcting erroneous perceptions about the prevalence and acceptability of substance use and on establishing conservative group norms. In the research design, the students received either information about consequences of drug use only, resistance skills only, or resistance skills training in combination with normative education. Results showed that the combination of resistance skills training and normative education prevented drug use; resistance skills training alone was not sufficient.

Source: Donaldson et al. 1994

The follow-up results of a six-year study by the Institute for Prevention Research at Cornell University Medical College provide important new evidence that drug abuse prevention programs conducted in school classrooms work. In a large-scale study involving nearly 6,000 students from 58 schools in New York state, students who received a skills-based prevention program in junior high school were found to have significantly lower odds of smoking, drinking, and using marijuana at the end of high school. This is the first scientifically rigorous study to show conclusively that a school-based drug abuse prevention program can produce meaningful reductions in drug use lasting over the critical junior and senior high school years.

The study was conducted by researchers at Cornell University Medical College’s Institute for Prevention Research with funding from the National Institute on Drug Abuse. The research team was led by Dr. Gilbert J. Botvin, professor public health and psychiatry. Schools were first grouped according to their rates of drug use and then randomly assigned to either receive the prevention program or to serve as controls. The prevention program, called Life Skills Training, taught students self-management skills and general social skills as well as information and skills for resisting pro-drug use influences. Students received the prevention program during the 7th, 8th, and 9th grades. Final follow-up data were collected at the end of the 12th grade.

Students receiving the prevention program had less tobacco, alcohol, and drug use at the end of the study than control students who did not receive the prevention program. The odds of smoking, drinking immoderately, or using marijuana were significantly lower for the students who received the prevention program during grades seven, eight, and nine. For these students, the odds of smoking, drinking, or using marijuana were up to 40 percent lower than for controls. Not surprisingly, the prevention program was less effective for students whose teachers taught only part of the program. On the other hand the strongest prevention effects were found for students who received at least 60 per cent of the drug abuse prevention program.

In addition to assessing the long-term impact of the prevention program on the use of individual substances, the effectiveness of the program was also assessed in terms of polydrug use (defined as the use of two or more drugs by the same individual.) A criticism of previous prevention studies is that they have only demonstrated an impact on relatively low levels of drug involvement – for example, the occasional use of cigarettes. This study directly deals with this issue by looking at the impact of the prevention program on the regular (weekly or more) use of cigarettes, alcohol, and marijuana. The odds of using all three substances on a regular basis were up to 60 percent lower for the students who received the prevention program than for controls.

Two forms of the prevention program were tested. One involved providing teachers conducting the program with special training and feedback by project staff. The other gave teachers a videotaped version of the training and no feedback. All teachers assigned to teach the prevention program were given a teacher’s manual and student guides for each year of the program. The teacher’s manual contained 12 units designed to be taught in 15 class periods. Each unit included an overall goal and specific student objectives as well as detailed lesson plans spelling out the material that should be covered with step-by-step instructions. The student guide contained information related to each of the program units and classroom activities along with workbook assignments intended to supplement classroom material.

Teachers in the schools assigned to receive training and feedback attended a one-day workshop that taught them about the causes of drug abuse and the reasons for using this particular prevention method. They were also taught how each of the classroom sessions should be conducted. During the time they were teaching the prevention program, members of the project staff periodically watched the teachers conducting the program in the classroom and whenever necessary gave them feedback and advice on how to teach the prevention program more effectively. The teachers in the other group received the same prevention materials and videotapes for each year of the program offering the same material as the training workshops. Although teachers in this group were also periodically observed while teaching the prevention program, they did not receive any feedback or advice.

Both prevention groups had significantly lower odds of using drugs by the end of the study. However, when results were examined with respect to the most serious patterns of drug use – using two or three drugs once a week or more – as expected, the prevention program was more effective for the students whose teachers received the training workshop and ongoing support from the Cornell researchers.

The results of this study have several practical implications for developing more effective drug abuse prevention programs:

Prevention programs should contain components that make students aware of the actual rates of drug use and the fact that only a small percentage of adolescents use drugs in order to correct the misperception that “everybody’s doing it.”

Prevention programs should teach skills for resisting pro-drug use social influences.
They should also teach a variety of general life skills for helping adolescents deal with the challenges of adolescent life. These include self-improvement skills such as goal-setting and self-reinforcement, skills for making decisions and solving problems, skills for thinking critically and analyzing media messages, skills for coping with anxiety, skills for communicating effectively, skills for meeting people and making friends, and general assertiveness skills.

Even if a prevention program previously found to be effective is being taught, it will only be effective if it is properly implemented. Because there are many competing demands on the school schedule, it is sometimes difficult to teach drug abuse prevention programs in their entirety. However, this and other studies show that there is a direct relationship between how much of the prevention program is implemented and its effectiveness. If prevention programs are only partially implemented, they are not likely to reduce drug use or drug use risk. Similarly, changing a prevention program known to be effective by modifying program components or adding new ones that have not yet been tested can render the prevention program ineffective.

Drug abuse prevention programs must be taught over a prolonged period of time. Prevention programs that are only one year long or do not contain two or more years of booster sessions are not likely to produce lasting reductions in a drug use. In fact, evaluations of prevention programs not including booster sessions have shown that initial reductions in drug use decrease after about a year and disappear totally after about two or three years.

In order to have maximum effectiveness, training and support from prevention experts should be obtained whenever possible.

The prevention program tested in the Cornell study was effective whether teachers received a formal training workshop and ongoing consultation and support or only received a training videotape. However, with respect to more serious drug use, it was most effective when teachers received formal training and periodic consultation and support.

Researchers have been searching for effective prevention programs for more than two decades now. The goal of a prevention program that could actually produce measurable reductions in drug use behavior has been elusive. Prevention approaches that relied on teaching factual information about the dangers of drug use have consistently been shown to be ineffective, as have a variety of other prevention approaches. Prevention programs that teach students how to resist social influences to use drugs have produced short-term reductions in cigarette smoking and, to a lesser extent, alcohol and marijuana use. Several long-term follow-up studies have raised questions about the ability of these approaches to pro duce lasting reductions in drug use.

The results of the Cornell study provide important new information that prevention works. The right kind of program, when properly implemented with junior high school students and with four years of booster sessions, can produce prevention effects that last at least until the end of high school. A prevention program that teaches general skills for dealing with life as well as skills and information for resisting social influences to use drugs can significantly reduce the chances that junior high school students will experiment with drugs. It can also reduce the likelihood that these same students will develop more serious patterns of drug use by the end of high school . With this study, it is clear that drug abuse prevention has come of age.

Source: Western Center News – June 1994 – Western Regional Center for Drug-Free Schools and Communities – published in ‘The Challenge’ vol. 6 No.1.

The long term effectiveness of DARE was assessed by contrasting drug use and other DARE related attitudinal variables among 356 12th grade students who received the program in 6th grade with 264 others who did not receive it. There was a significant relationship between earlier participation in DARE and less use of illegal, more deviant drugs (e.g. inhalants, cocaine and LSD). This effect was significant for males. Long term effects of DARE that were not perceptible after 3 years appeared among the males after six years when they were senior in high school. A possible explanation for this ‘sleeper effect’ is that the effectiveness of DARE was ‘suppressed’ until after the follow-up in 9th grade. This effect may not have arisen for the young women due at least partially to the fact that so few of them in either the DARE or control condition were using these hard drugs.

Richard L. Dukes et. al., University of Colorado, 1996.

3,150 11th grade students participated in the survey; some had participated in the D.A.R.E. programme at elementary, junior and senior high school levels. 11th grade students were selected as the study population because they were old enough to have been confronted with opportunities to use alcohol, marijuana and hard drugs. This study found that D.A.R.E. did influence students attitudes and behaviours about substance abuse. The differences reported here were all statistically significant, and in a positive direction. All in all D.A.R.E. reduced substance use, increased peer resistance, encouraged communication with parents and other responsible adults, and increased positive views of the police.

J. Donnermeyer PhD and G. H. Phillips PhD, Ohio University.

Parents play a key role in their children’s education and social development and therefore can be influential in educating their children about drugs. Despite this, there has been little research done to date that explores parents’ perceptions. This paper reports research from questionnaires, which sampled 947 parents of 14-to 16-year-olds; telephone inter views of 60 of these responses; and 6 focus groups of primary and secondary school parents. The issues explored included parent’s concerns, needs, and knowledge of drug issues in respect to their children as well as parents’ perspective on drug education. The results show that parents are concerned about drugs in relation to their children, and they report that drugs are easily available to young people and a part of the present youth culture. The study revealed that parents are largely misinformed about the drug situation and request accurate and up-to-date information. They are unaware of their children’s school drug policies and programs and feel the need for easier access to relevant services. Parents rate drug education as important and report that such education should begin during late primary school age. Parents predominantly want their children to be taught the ‘Just Say No’ message. Finally, issues of communication about drugs, between parents and their children, were raised. A number of implications of the results for drug education are presented.

Source: Mallick, J.; Evans, R; Stein, G., Drugs: Education, Prevention and Policy, 5(2):169- 176, 1998. Availability: International Periodical Publishers, Carfax Company, P0. Box 25, Abingdon, Oxfordshire 0X14 EUE, United Kingdom.

This edition of Prevention Works lists some studies, which look at the gateway/addiction theory of progressive drug misuse. The implications for prevention are clear – Early use of nicotine, alcohol and marijuana is a predictor of later use of cocaine (etc. …)

Predicting continued use of marijuana among adolescents: the relative influence of drug-specific and social context factors.

Bailey SL. Flewelling RL. Rachal JV Journal of Health and Social Behavior1992:33:51-66

Compared with people who used only one gateway drug (tobacco, alcohol and marijuana), children who used all three are 77 times more likely to use cocaine.
Children who smoke daily are 13 times more likely to use heroin than children who smoke less often.

Compton DR. Dewey WL. Martin BR. Advances in Alcohol and Substance Abuse. 199O:9:129-147. [Cannabis dependence and tolerance production]

Children who use marijuana are 85 times more likely to use cocaine than non-marijuana users. 90% of children who used marijuana, smoked or drank first. Children who drink are 50 times more likely to use cocaine than non drinkers.

Children who use gateway drugs – tobacco, alcohol and marijuana are up to 266 times more likely to use cocaine than those who don’t use any gateway drugs.
Study concludes nearly 90% of cocaine users smoked, drank and used marijuana

Center on Addiction and Substance Abuse at Columbia University (CASA), Oct. 27, 1994.

A 12- year-old who smokes is 30 times more likely to have used illicit drugs than a child of the same age who doesn’t smoke. This analysis proves that, for too many children cigarettes are a drug of entry into the world of illicit drugs

Center on Addiction and Substance Abuse at Columbia University (CASA), March 10, 1994.

Marijuana’s role as a gateway drug to serious drug use appears to have increased.

Golub A. Johnson BD. The Shifting Importance of Alcohol and Marijuana as Gateway Substances among Serious Drug Abusers. J. Stud Alcohol 1994:55:607-614.

Very few try illicit drugs other than marijuana without prior use of marijuana.

Kandel DB. Yamaguchi K. Chen K. Stages of Progression in Drug Involvement from Adolescence to Adulthood: Further Evidence for the Gateway Theory, J Stud. Alcohol; 1992:447-457.

Study describes cannabis dependence. Impaired cognitive skills and functioning were documented in chronic cannabis users.

Lundqvist. Life Science, Vol. 56 pp 2145 -2155.

Brain event-related measures normalize during acute marijuana intoxication. suggesting a basis for the physical dependence component of marijuana use.

Solowij et at. Life Sciences, Vol. 56 pp 2127-2134. 1995.

The chronic use of cocaine. particularly when used with marijuana, sets up craving behavior by depleting brain dopamine and norepinephrine.

Mirochnik, et at. Pediatrics 99:555-559,1997.

A 12-step treatment approach for marijuana (cannabis) dependence.

Miller NS, Gold MS. Pottash AC. Journal of Substance Abuse Treatment. 1989; 6:24 1-250.

“The most common kind of clove cigarettes contains 40 percent shredded clove buds and 60 percent tobacco. The major component of clove buds is eugenol, a substance that can promote lung infections and provoke asthma attacks. The amount of nicotine in a clove cigarette is less than that in a regular cigarette, but there’s enough nicotine to do the damage for which it has earned it’s well deserved, abominable reputation.

Source: Dr. Paul Donohue Senior Observer Canada 1998

Prof. Henian Ofan Jie Feng, Xiaohung Hou, Mingwel Zhao, Xiaojing Zhao, Yuan Zhang, Ying Wang, Zhenglun Zhu and Wanzheng Pel

Abstract
This analysis of cigarette smoking and cancer of female reproductive system covers 115 cases of carcinoma of cervix, 75 ovarian carcinoma, 53 gestational trophoblastic neoplasm (GTN), 28 endometrjal carcinoma and 375 age matched controls. It shows that cigarette smoking is associated with carcinoma of the cervix and ovary, giving the relative risks (RR) as 4.4 and 2.8 respectively.
Husband smokers were more common in the carcinoma of cervix group than the controls, reflecting the risk of passive smoking and cancer.

Source: Department of Obstetrics and Gynecology, People’s Hospital, Beijing Medical University, Beijing, China.

Introduction
Several reviews of the substance abuse prevention literature have concluded that social-influence-based prevention programmes can significantly delay the onset of tobacco, alcohol, and other drug use and slow the rate of increase in substance use prevalence among entire populations of early adolescents. Less is known about the capacity of these and other primary prevention programmes to effect decreases in substance use. This is an important question, since some youth have already begun to experiment with drugs by the time that usual primary prevention programmes have reached them. Youth exhibiting early drug use relative to their peers are considered at higher risk for later drug use and abuse. The few studies that have investigated the effect of primary prevention programmes on those who have already begun using tobacco or other drugs have yielded equivocal results and have not systematically evaluated maintenance of decreases in use. The purpose of this study was to evaluate the secondary prevention effects of a primary prevention programme in reducing cigarette, alcohol, and marijuana use among baseline users.

Abstract
Objectives. This study investigated the secondary prevention effects of a substance abuse primary prevention programme.
Methods. Logistic regression analyses were conducted on 4 waves of follow-up data from sixth- and seventh-grade baseline users of cigarettes, alcohol, and marijuana taking part in a school-based programme in Indianapolis.
Results. The programme demonstrated significant reductions in cigarette use at the initial follow-up (6 months) and alcohol use at the first 2 follow-ups (up to 1.5 years). Models considering repeated measures also showed effects on all 3 substances.
Conclusions
Primary prevention programmes are able to reach and influence high-risk adolescents in a non-stigmatizing manner.
Discussion
Primary prevention programmes have been criticized for affecting future occasional users but not youth at the highest risk for drug abuse (e.g., current users). In this study, we reported 3.5-year follow-up effects of a primary prevention programme in decreasing drug use among adolescents who were users at either sixth or seventh grade. With a very conservative criterion to define decreased use, the results indicate that the programme did effect reductions in use, especially cigarette and alcohol use. These secondary prevention effects were significant for cigarette users at the 6-month follow-up and marginally significant at the 2.5-year follow-up. Effects were also found among baseline alcohol users through the 1.5-year follow-up. Consistent with other prevention studies, the effect sizes were small for cigarettes (range: .05-.31) and alcohol (range: .08-.24) and medium for marijuana (range: .38-.58). Although no significant effects were detected among baseline marijuana users, it is important to note that the programme group consistently demonstrated greater reductions in all 3 substances across all follow-ups, except marijuana at the 3.5-year follow-up. When the secular trend was also considered, the Midwestern Prevention Project consistently showed significant secondary prevention effects on cigarette, alcohol, and marijuana use.

There are several methodological limitations to this study. For example, a possible threat to the validity of the findings was the reliance on self-reported drug use. However, extensive research conducted on the validity of self-reported smoking dispels this concern, especially if a bogus pipeline activity is built into the procedures for data collection, as was done in the present study. Another possible limitation is that measurements were limited to a fixed point in time (previous month) from year to year, thus leaving open the possibility that the last reported use level may have been an under-estimate of actual normal use patterns. However, given that this study was fully randomized, the programme and control groups should have been equal in regard to their validity estimates of the point prevalence of drug use measured.

This research suggests that social-influence-based primary prevention programmes can have an impact on not only students who are nonusers at baseline but also those who have begun to use drugs. The advantage of such a primary prevention programme is that it may reach and affect a ‘silent’, not-yet-identified, high-risk population of early drug users in a nonstigmatizing , nonlabeling fashion at an age when youth are more easily persuaded (treating the young users, in effect, like nonusers contemplating use).

Source: Chih-Ping Chou, PhD, et al. American Journal of Public Health, June 1998, Vol.88, No6

Some people are born to smoke, and find nicotine pleasurable from their first puff, according to the latest issue of the journal, Addiction. Researchers from the University of Michigan Medical School found that some people are destined to become smokers because they are more sensitive to the nicotine buzz.

(Courier Mail, 6/4/98 p2)

The cigar that juts from the mouth of Orson Welles as he eyes Kermit the frog in The Muppet Movie, a children’s film, may have been a gift from Philip Morris. Newly released internal company documents show that the company supplied the film makers with tobacco products. Similar deals were made for Crocodile Dundee, Who Framed Roger Rabbit?, Die Hard and dozens of other films which had huge youth audiences.
The arrangements continued until at least 1998 despite pledges by the film industry not to deal with tobacco companies. Philip Morris has long said it does not target children, but critics believe that deals like these have helped the company circumvent legal bans against such advertising. “A kid coming away from the movies today will have the impression that everyone smokes,” said Professor Stanton Glantz from the University of California The documents detailing the Philip Morris movie deals were among millions released during the State of Minnesota’s continuing lawsuit against the tobacco industry.

(Daily Telegraph, 3013/98)

Australian film, Muriel’s Wedding has been named as one of the worst offenders in cinema’s smoking hall of shame. The worst was Kevin Costner’s Waterworld. The British Health Education Authority found that there has been a massive jump in smoking scenes between 1990 and 1995. Cigarette brands were appearing six times as often. The tobacco industry has denied making a special effort to get their products into the mouths of stars.

(Herald Sun, p33, 20/2/98 NZ)

The incidence of smoking in top grossing movies has increased during the 1990s, and dramatically exceeds real smoking rates, according to a new University of California San Francisco study. After declining over three decades, smoking in movies has returned to levels comparable to those observed in the 1960s, before the issuance of the first Surgeon General’s report on smoking and health in 1964. The report appears in the new issue of Tobacco Control, a scientific journal published by the British Medical Association. The presentation of smoking in films remains pro-tobacco with only 14 percent of tobacco screen-time presenting adverse social or health effects of tobacco use. The researchers found that in movies from the 1960s, tobacco was used about once for every five minutes of film time. In films from the 1970s and 1980s, tobacco was used about once every 10 to 15 minutes, but in movies from the 1990s, tobacco was used an average of every three to five minutes. “The use of tobacco in films is increasing and is reinforcing misleading images that present smoking as a widespread and socially desirable activity,” according to the authors. These portrayals may encourage teenagers – the major movie audience to smoke. “Films continue to present the smoker as one who is typically white, male, middle class, successful and attractive a movie hero who takes smoking for granted,” the researchers report. “As in tobacco advertising, tobacco use in the movies is associated with youthful vigour, good health, good looks, and personal and professional acceptance.

A leaked internal memo from British American Tobacco allegedly shows Britain’s biggest tobacco company knew nearly 20 years ago that the sales of its products depended on their addictiveness.
The 1979 document is in 10,000 released in a lawsuit brought by Medicaid, the US state health organisation. It details executives looking for a new “socially acceptable addictive product, likely to include nicotine or a substitute for it, that did not need to be lit – to eliminate the need for inhalation and the danger of passive smoking”… “We also think that consideration should be given to the hypothesis that the high profits additionally associated with the tobacco industry are directly related to the fact that the customer is dependent on the product.” The industry has never admitted publicly that cigarettes are addictive.

(British Medical Journal, 21/2/98)

There are a number of complex and inter-relating factors that predispose young people to smoke, and these vary among individuals and among populations. However, years of research have identified certain factors that commonly play a role in smoking initiation. These include high levels of social acceptability for tobacco products, exposure and vulnerability to tobacco marketing efforts, availability and ease of access, role modeling by parents and other adults, and peer group use.

Minimising of risk
Adolescents frequently experiment with new behaviours, but don’t often take into serious consideration the long-term consequences. Some youths who are exposed to tobacco messages from an early age come to accept the notion that tobacco provides certain psychological benefits which will help them through adolescence. For them, the risks of tobacco use, which are perceived to be remote, are outweighed by the immediate psychological benefits. Young people tend to underestimate the addictiveness of nicotine and the difficulties associated with quitting, tending to believe that it is easier for young people to quit than adults.

Exposure to tobacco advertising and promotion
The role of advertising is critical to the adolescent’s conditioning process. In advertisements, tobacco users are portrayed as glamorous, popular, independent, adventurous, and macho. By selecting brands that present these images, young people may feel that they are internalising these characteristics. Children’s attitudes and behaviour regarding tobacco are influenced by advertising. Thus, tobacco advertising subverts the understanding and ability of young people to make a free, informed choice whether or not to smoke. Advertising also leads teens to believe that smoking is more common than may actually be the case, particularly among their peers.

Modeling of adults
Children perceive smoking to be an adult behaviour and children may often take up smoking in an attempt to appear more grown-up. Studies show that young children are influenced by parents who smoke, forming more positive attitudes towards smoking than those living with non-smoking parents. This association was found in children as young as three years old; In one study, twice as many children of smokers say that they want to smoke compared to children of non-smokers. Adolescent children of parents who successfully quit smoking are also much less likely to smoke compared to those of parents who do smoke. Adults should be made aware of the impact of their own smoking behaviour on the future smoking behaviour of children. It is essential for adult smoking to be reduced and marginalised as part of comprehensive strategy to decrease smoking among young people.

Peer pressure
Exposure to peers who smoke increases the risk of adolescents starting to smoke. However, it appears that this influence is particularly important after the adolescent has already become susceptible to smoking. Indeed, the effect, of peers is most noticeable in the transition from experimental smoking to addiction.

(WHO – web site)

Because adolescent smoking can predispose teen-agers to later illegal drug use, social policies which reduce tobacco use by teens may provide one of the most effective ways to reduce future illegal drug use. Any nation that seeks to prevent marijuana, heroin, and cocaine use, but neglects smoking by adolescents is pursuing ineffective social policy. However, the primary reason to avoid tobacco use is not because of its gateway function, but because of the tremendous morbidity and mortality it directly causes. Tobacco use kills more than 20 times as many Americans each year as all illegal drugs combined. The very term — “gateway drug” — is unfortunate because it implies smoking is dangerous only because it leads to the “bad drugs.” Nevertheless, existence of cigarette gateway drug function gives society a significant additional reason to address tobacco use. Health advocates must acknowledge that the massive public health problem of smoking is a low priority for a significant segment of society. However, many people in this group possess strong feelings regarding the need to combat the use of illegal drugs. Educating these people on how tobacco use predisposes individuals to use “hard drugs” may convince them to address effectively adolescent tobacco issues by implementing appropriate tobacco control policies. Similarly, many political leaders who are strong vocal critics of illegal drugs are simultaneously firm supporters of the tobacco industry. Increased public under standing of tobacco’s gateway drug function makes it increasingly difficult for politicians to neglect the issue of adolescent tobacco use. Elimination of adolescent tobacco use will not solve the intractable problem of illicit drug use. No single strategy can accomplish that goal. Successful reduction of the problem consists of sustained multifaceted strategies combined in a “total system approach.” An important component of a total system approach for reducing use of marijuana, crack, heroin and other illicit drugs involves acknowledging tobacco’s powerful gateway drug function and implementing adequate policies that reduce adolescent tobacco use.

Source: Gordon B. Lindsay. PhD, Associate Professor.
Brigham Young University 229E RB, Provo, UT 84602:
and Jacquie Raine, PhD, Assistant Professor,
Central Arkansas University Dept. of Health Sciences,
Box – 5016, Conway. AR 72035.
– Published in Journal of School Health • April 1997, Vol. 67, No. 4

In the past, professionals assumed gateway drug function was caused by social and psychological factors. Recent discoveries in brain neurophysiology suggest a strong pharmacologic component to nicotine’s gateway drug function. Addiction researchers note that tobacco use increases the level of the neurotransmitter dopamine in the brain. Drug induced higher levels of dopamine partially explain why psychoactive drugs such as nicotine, alcohol, cocaine, or heroin are addictive.

Serendipitous findings by researchers at the Brookhaven National Laboratory provided an additional neuropharmacologic explanation for nicotine addiction as well as its gateway drug function. Researchers discovered that tobacco use causes a reduction in the enzyme monoamine oxidase B or MAO-B which is responsible for the breakdown of dopamine. Smokers had 40% less MAO-B than nonsmokers or former smokers. Reduction in this critical enzyme may explain why nicotine addiction is so difficult to break. Smoking creates a cycle where reduction in MAO-B causes more dopamine, which causes greater pleasure for smoking, which leads to more smoking, which causes less MAO-B. Smoking-induced reduction of MAO-B appears to cause a synergist effect with the dopamine-stimulating effect of smoking by slowing the breakdown of this pleasure-enhancing neurotransmitter.

By the same mechanism, smoking may enhance the pleasure that results from using heroin, cocaine, alcohol, and other psychoactive drugs. According to the Brookhaven researchers, if tobacco use can increase dopamine levels in the brain by inhibiting MAO-B, “it would give a neuropharmalogic basis to the proposal that cigarettes are a ‘gateway drug’.” according to an article in the March 11. 1996 issue of Time on “How smokers get hooked.” These researchers believe nicotine may create a biochemical pathway or channel so that the next drug becomes more pleasurable than it would otherwise.” Thus, an adolescent who regularly uses tobacco will undergo brain chemistry adaptations. These brain chemistry changes heighten the pleasurable effects of taking other drugs, and the reinforcement increases the likelihood that the adolescent will become addicted to other substances. As evidence that tobacco use facilitates development of other addictions, up to 90% of individuals in drug rehabilitation programs for alcohol or illicit drugs concurrently use and are addicted to nicotine. Smoking rates for the general population approach 25%. The pharmacologic ability of tobacco to facilitate development of dependence to other drugs may partially explain why nicotine use nearly always occurs in people addicted to other drugs.

Analysis of the etiology for adolescent substance use emphasizes the major role of social influences. Peer pressure, norm perceptions, advertising, and other social factors constitute major determinants of adolescent substance use and non-use. Membership in groups can influence dramatically how much or little pressure one gets to use drugs. A teen’s lifestyle decisions also have the effect of channeling youth into different peer groups. Membership in peer groups is a dynamic process. The same friends a child “hangs out with” in third grade often are not the same people as a child’s friends in high school. A child’s response to repeated offers from peers to smoke can be a pivotal event. The decision to smoke or not smoke influences which peer group a child joins. The child who smokes at age 12 more likely will be channeled into a group of friends where members use marijuana at age 16.

A number of other social/behavioural models explain the social dynamics of tobacco’s gateway drug function. The Theory of Reasoned Action emphasizes the crucial role “subjection norms” play in adolescent behaviour. Teens are influenced tremendously by what they perceive everyone else to be doing. Both drug-using and non-drug-using teens over-estimate the prevalence of substance use among teens, but adolescents who belong to a peer group where smoking is the norm may hold even greater norm misperceptions regarding substance use. From the perspective of a teen who belongs to a group where smoking is the norm, it may appear that “everybody is doing it” when it comes to illegal drugs. This “internal peer pressure” born of norm misperceptions facilitates use of illicit drugs.

The importance of “enabling factors” as defined by the PRECEDE/PROCEED health promotion model also becomes apparent in peer groups. The child who uses tobacco and belongs to a peer group where smoking is the norm simply experiences greater availability of and accessibility to drugs. Adolescents in peer groups that smoke are likely to receive more offers to use illegal drugs and experience many socially reinforced opportunities to do so. Most importantly, this availability occurs at a much younger age when the child is more susceptible to peer influence. Social Learning Theory also contributes to understanding the social dynamics of nicotine’s gateway drug function. Adolescents in a tobacco-using peer group will be coached on the “how tos” of illicit drug use. The unhealthy behaviours of peers who are veteran drug users will be modeled and learned by novices of illicit drug use. An adolescent’s willingness to use cigarettes often is socially reinforced and approved by members of the peer group. This peer approval provides a powerful influence and reinforcer. Young people socially reinforced for using tobacco likely will use illicit drugs to maintain the same social reinforcement they received by using a gateway drug. Substance use can become a defining element of membership in a group and a factor that enhances comradery. Cigarettes also can become an expression of independence from authority. When parents or school officials criticize cigarette use, the topic may become a bone of contention that generates other expressions of a rebellious “I’ll do as I want” attitude. This feeling may predispose a teen-ager to use illicit drugs as a further statement of personal freedom from authority. Again, adolescents’ willingness to smoke channels them into a group where friends socially reinforce defiant attitudes and behaviours.

The Health Belief Model postulates that health and risk-taking decisions are based partially on individual perceptions of personal susceptibility to an adverse condition. Decisions also are based on beliefs regarding seriousness of the condition. The initial decision to accept the risk involved with tobacco use makes it easier to progress to the risk associated with illicit drug use. Psychologists refer to the progression of drug-taking involvement as a “developmental sequence.” The initial decision to use tobacco makes the risk involved with using other drugs seem less severe. For example. injecting heroin might be perceived as a near suicidal risk for a nonsmoker. However, for people who smoked cigarettes for years. despite knowledge of their harmful effects, using heroin may seem only slightly more dangerous than behaviours they currently engage in and have thus far survived. Therefore, tobacco may act as a risk perception stepping stone which reduces perceived severity of the dangers involved with illegal drug use.

Similarly, tobacco may undermine the “perception of personal susceptibility” portion of the Health Belief Model. Youthful users of tobacco who fail to see any immediate lethal consequences from their use likely conclude the purported dangers of tobacco as greatly exaggerated. They may conclude that the health warnings against illicit drug use are exaggerated or that they are somehow not susceptible to the adverse effects of drug use. This belief enhances the likelihood of using illegal drugs.

Issues of risk perception apply to legal risks as well as health risks. Adolescent purchase, possession, and use of tobacco is illegal in every state. In Social Learning Theory terminology, as teen-agers break tobacco-related laws they develop “self-efficacy perceptions” in their ability to break substance abuse laws. The Health Belief Model suggests these adolescents simultaneously are creating the belief that breaking substance abuse laws is not serious and their likelihood of punishment is low. These perceptions about tobacco laws may erode the deterrent effect of laws prohibiting use of illicit drugs.

One way to reconcile beliefs regarding severity and personal susceptibility of drug use involves rationalizing the behaviour. Decisions that violate personal beliefs regarding what is wise. right, and appropriate can create “cognitive dissonance”. Rationalization provides a psychological defense mechanism to justify the behaviour. Comments such as “We all got to go sometime.” “I could get killed in a car wreck tomorrow.” or “Grandpa smoked and lived to be 80” are examples of rationalizations, individuals who use these rationalizations to justify cigarette use might easily transfer these psychological defense mechanisms to legitimize use of illicit drugs.

Studies indicate nearly 90% of regular smokers get addicted to nicotine. Researchers show surprise at how rapidly nicotine addiction is acquired among teen smokers. Cigarettes represent teenagers’ first personal experience with the phenomenon of true drug addiction, and most teen smokers freely acknowledge being “hooked.” Adolescent nicotine addicts observe that life goes on despite their dependence on cigarettes. This situation causes adolescents to develop a lower risk perception of drug addiction in general. Addiction to a drug comes to be considered neither abnormal nor risky. Spending significant amounts of discretionary income for drugs also acquires a sense of normalcy.

Perhaps the simplest explanation for tobacco’s gateway drug function involves what teenagers learn when they smoke cigarettes. According to one source, “. . .the gateway drug phenomenon is simply an example of practice conditioning, that leads to the development of learned behaviour. Children who experiment with and later use gateway drugs are, in effect, practising the wrong social skills and learning the wrong behaviours. They then apply these conditional behaviours to other more sinister functions…” Adolescent cigarette smokers acquire and practice a number of skills that make it easier to use illicit drugs. First, they learn to administer drugs by mastering the complex behaviour of smoking. Marijuana, crack, and to a lesser extent, opiates are introduced into the body through smoking. The veteran adolescent smoker overcomes the body’s initial negative reaction of acute irritation, coughing, and nausea that result when one first inhales smoke. Extensive use by adolescents of low-tar, filtered brands facilitates acquisition of smoking behaviour. The bodies of adolescent smokers adapt or become desensitized so smoking marijuana does not create the initial adverse reaction in a veteran cigarette smoker that a nonsmoker experiences when beginning marijuana use. The veteran smoker also becomes comfortable and familiar with the process of lighting up, handling, holding, inhaling, and exhaling, which are ritualistic learned behaviours that accompany illicit drug use. Veteran adolescent tobacco users also acquire the ability to ‘unit dose” so not too much or too little of the psychoactive drug is administered. Smokers quickly learn to deliver the desired therapeutic dose by adjusting the number of puffs taken, degree of inhalation, and duration of holding smoke in the lungs. Mastery of these nicotine dose regulator skills facilitate the ability to use and get high on other drugs.

Teenagers who smoke cigarettes often do so in violation of parental wishes, school rules, and state laws. This practice fosters development of skills to conceal cigarette use. The behaviour of masking signs of use such as breath odor, denying use and lying to parents or officials also are practiced. These same skills can be useful for a rookie illegal drug user.
Nicotine users learn that moods and feelings can be modulated or altered by using drugs. Cigarette smokers discover that these chemical lifts are immediate and do indeed make one feel better. Conversely, adolescent smokers who learn to cope with boredom and stress by taking chemical shortcuts may be less likely to develop acceptable, healthy coping skills to deal with life’s challenges. Their deficiency of healthy coping skills and their direct experience with nicotine’s stress reduction function predisposes them to behaviour patterns of using other substances for mood altering purposes.

Abstract: Research has shown that adolescent users of tobacco are much more likely to progress to use of illicit drugs than are nonusers of tobacco. This article suggests potential psychosocial reasons for the progression based on principles of Learning Theory, Theory of Reasoned Action, Health Belief Model, and Cognitive Dissonance. In addition, a neuropharmacologic causal mechanism is discussed. The existence of tobacco’s gateway function has important implications in (the nation’s) efforts to reduce illicit drug use and adolescent smoking.

Gateway drugs — drugs of entry — serve as stepping stones to illicit drug use. Tobacco use in particular has proved a strong and consistent predictor of subsequent illegal drug use. Not all adolescent cigarette smokers progress to using marijuana or cocaine, but a strong statistical link exists between tobacco use and progression to illegal drugs. Research indicates it is incredibly rare for a “hard core” drug user to bypass the initial behaviour of cigarette use prior to using illicit drugs. Nicotine has been described as an “almost essential precursor” and a “necessary intermediate” to the use of marijuana and other drugs. Studies documented the link between adolescent smoking and illegal drug use. These studies indicate tobacco use consistently precedes illicit drug use, and the association shows a clear dose response pattern. The more adolescents smoke, the more likely they are to use illegal drugs. The statistical link between adolescent smoking and subsequent illegal drug use has been described by researchers as a “striking quantitative relationship” and a “dramatic association”. The contrast particularly becomes impressive when illegal drug use prevalence rates of adolescent daily cigarette smokers are compared to nonsmokers. Results vary, depending on which illegal drug is being studied, frequency of use (daily, monthly, ever) and the grades included in the study. One study showed the relative risk for illicit drug use among one pack or more daily teen smokers consistently at 10 to 30 times greater than for nonsmokers. Surveys by the U.S. Dept. of Health and Human Services demonstrated that young daily smokers were 114 times more likely to have used marijuana than those who had not smoked. Much of the statistical link between smoking and illegal drug use results from an indirect association where both behaviours share a common etiology caused by other psychosocial and environmental factors. However, an increasing number of researchers suggest the link between adolescent smoking and subsequent illicit drug use also results from causal mechanisms. While studies document a statistical association between the two behaviours, few propose theoretical models to explain potential causal mechanisms for the association. Yet, several potential psychosocial and neuropharmacologic causal mechanisms promote tobacco’s gateway drug function.

Results of tests for drug use in 21 big cities in the US are found in the ADAM Report. The conclusion says that: By any measure, the level of recent drug use among 1997 ADAM arrestees is significant. Every site reported that a majority of its male adult arrestees tested positive for at least one drug. The same is true for female adult arrestees in 19 out of 21 sites where data was collected. There are differences in trends for specific drugs and segments of persons arrested.
The 1996 national Survey of Inmates in Local Jails in the U.S. showed that
A. 82% of all jail inmates in 1996 said they had ever used an illegal drug, up from 78% in 1989.
B. The percentage ever using drugs regularly went from 58% in 1989 to 64% in 1996.
C. 55% used drugs in the month before the offense, vs. only 44% in 1989.
D. 36% were using drugs at the time of the offense, up from 27%.
E. 16% said they committed the crime for drug money, up a little from the 13% in 1989.

Arrestee Drug Abuse Monitoring Program

The current study examined the effects of socioeconomic status (SES) on adolescent marijuana use using data from a national longitudinal survey of subjects aged 11 to 17 (N = 1,725). Both direct and indirect measures of SES (e.g., Hollingshead’s measure of SES. urbanicity. neighborhood problems) were used to determine the extent to which SES predicts marijuana use among adolescents. For males, our study found a nonlinear relationship between the Hollingshead measure and marijuana use that had not been identified in previous research. For females, the Hollingshead measure was nonsignificant when alcohol use and having friends who use marijuana were added to the model. This finding suggests that the effects of SES on marijuana use may be mediated by alcohol use and friends’ use of marijuana. Weekly alcohol users were much more likely than nonusers to initiate marijuana use for both males (Odds ratio [OR] =18.28. Confidence interval [CI] = 4.93-67.81) and females (OR = 11.75, CI = 3.22-42.86). Other significant variables for both sexes included having a job, having friends who use marijuana, and having used some alcohol in the past year. For males, grade point average (GPA). commitment to friends. urbanicity time spent with friends, and peer strain were also significant predictors of initial marijuana use. For females. prior victimization and low school aspirations were significant. In sum, our findings suggest that psychosocial risk factors for marijuana use are substantially different for males than for females and that future researchers need to test for nonlinear relationships between SES and adolescent substance use.
Source: Miller, D.; Miller T. – Addictive Behaviors 22(4):479-489. 1997

The present study investigated the reasons university students have for not drinking on those occasions when they choose not to drink and whether those reasons differ with students’ differing levels of alcohol consumption. Volunteer participants for the study were students (158 males, 245 females) from a mid-South State University. These students anonymously answered questions about the quantity and frequency of their alcohol consumption, and on this basis, four alcohol consumption level groups were formed (80.4 percent of the sample) in addition to abstainers (19.6 percent of the sample). Each student also responded to the question, “on those occasions when you DO NOT drink (or drink very little), what is the MAIN reason you make that decision?”

A chi-square test of independence indicated that reason for not drinking was significantly related to alcohol consumption level group, and separate chi-square tests for goodness-of-fit revealed distinctly different reasons given for not drinking depending on the group’s alcohol consumption level. Light drinkers endorsed religious-moral reasons significantly more often than the other groups, moderate drinkers chose safety reasons, while heavy drinkers indicated expense as their main reason for not drinking. The results of this unique study can help shape social and legislative policies for alcohol abuse prevention and intervention by indicating strategies that target the beliefs of the various alcohol consumption levels.

Source: Slicker. EK. Journal of Alcohol and Drug Education 42(2):83-102, 1997

Much of the push toward drug testing has come from the federal government. In 1982, the Navy began the first broad-scale random drug testing after an aircraft accident aboard the USS Nimitz uncovered widespread drug use about the ship. The practice soon spread to other branches of the military. Then drug testing was introduced in safety-sensitive government agencies such as the Nuclear Regulatory Commission, and mandated for government contractors with contracts worth more than $25,OOO.

Several horrific accidents spurred drug testing in the transportation industry. In 1987, two trains collided in Chase, Md., causing 16 deaths, and it was later revealed that one of the trains engineers had been smoking marijuana before the collision. And in 1991, eight people were killed in a New York subway train crash; the train’s driver later tested positive for alcohol.

These incidents led to the passage of the Omnibus Transportation Employee Testing Act of 1991 which required the Department of Transportation to mandate drug and alcohol  testing of employees in safety-sensitive transportation positions in private companies.

A snapshot of how drug testing works comes from Tom Warner, president of three D.C-based plumbing, heating and air conditioning companies that together employ 92 workers.  He wasn’t pushed to his drug-testing policy because of any big disaster. Instead, it was little things such as recurring minor accidents and foolish mistakes.  He remembers one experienced technician, for example, who had used his bare hands on a sewer-contaminated piece of machinery, rather than use his gloves. “It wasn’t something a rational person would do” he recalled thinking at the time.

Warner decided to introduce drug testing, and the first results startled him.  About half of a group of new trainees failed. as did the worker who had failed to use his safety gloves. Some drug users quit rather than be tested. Warner decided to clean out the problem workers by simply firing people who tested positive for drug use.  They are invited to reapply after one year and will be rehired if they pledge to remain drug-free.  Few drug users either apply or reapply now, Warner said. “It’s known we’re a drug-free company,”  he said. “People who do drugs want to do drugs — and want to be in a place where they can.” The percentage of major firms requiring employee drug tests has escalated in the past decade, … and the percentage of employees who test positive has declined significantly.

Construction workers are among the category of employees reporting the highest usage rate of Illegal drugs. Percentage of employees, 18-49, reporting use of illicit drugs in the past month :-
 

With little public debate, big corporations have adopted what amounts to zero-tolerance policy toward illicit drug use, at least by new employees. Almost all of the nation’s fortune 200 companies for example have instituted drug-testing programs in the past decade.

Surveys by the American Management Association, a trade group whose members are disproportionately large companies, estimates that about three-quarters of their members do drug testing – most on a pre-employment basis but with a growing number testing their workers randomly as well. Employees who institute drug testing believe it causes the rate of employee drug use to fall. Indeed, according to statistics released last month by Smith Kline Beecham Clinical Laboratories in Collegeville, Pa. positive drug-test results have plummeted to 5 percent, from 18.1 percent in 1987. Workers in safety-sensitive positions have the best records, according to the firm’s statistics, with only 3.5 percent testing positive for illegal drugs. But how did workplace drug testing become so pervasive so quickly? The answer seems to be that corporations saw many benefits especially in reducing the incidence of drug-related accidents in the workplace, and almost no drawbacks. Indeed, except from civil libertarians. there have been few public protests. The spread of testing has been extraordinarily rapid. particularly at big companies that offer good pay, health insurance, benefits and pension plans. In 1983, only six firms out of the Fortune 200 were testing their workers for drugs, but by 1991, 196 of the 200 largest companies were doing it, said employment lawyer Mark De Bernardo, executive director of the D.C-based institute for a Drug-Free Workplace, an employer group. “To go from six to 116 of the Fortune 200 in only eight years, that’s really revolutionary,” De Bernardo said. “Typically the wheels in Corporate America don’t turn that fast. This was a movement that spread from CEO to CEO”.  De Bernardo said the trend was propelled by industry concerns about safety issues, absenteeism, productivity and liability for accidents, and its growth was hastened by waves of government regulation advocating drug crackdowns. “Now”, he said, “it has spread outward to businesses of almost every size around the country, the notable exceptions being Hollywood and Wall Street”.

“People who use drugs don’t apply at a company they know drug-tests said Dale Masi, a professor of social work at the University of Maryland at Baltimore and president of Masi Research Consultants, a D.C-based firm that advises major corporations on how to handle substance-abuse problems in the workplace. Companies know that if their competitors do it, they have to do it, or they will get all the users” Masi explained. “The individual with behavioral problems goes to the place of least resistance, and that happens to be in small businesses,” said Harold Green, president of Chamberlain Contractors Inc., a Laurel-based paving company. He instituted a drug-testing program 15 years ago, after a marijuana smoking employee was involved in a serious truck accident. He fired the driver then established a drug treatment and employee assistance plan, including drug testing, that was one the first of its kind in the country.  When Green set up his drug-testing plan, it was nearly unprecedented, particularly among small firms like his.

Many observers and critics considered it jarringly invasive to ask job hunters or employees to urinate in a cup to prove themselves drug-free. But such criticisms were gradually overwhelmed by a louder chorus of support.

The Swedish epidemic of intravenous amphetamine injection, which started in 1945, was surveyed annually in Stockholm from 1965 to 1987. During that period, approximately 250.000 arrestees were examined for needle marks from intravenous drug injections that they presented in their cubital regions. The progression or regression of the epidemic was gauged by calculating the percentage of addicts (marked with needle scars) among the population arrested for any kind of criminal or civil offense. This epidemiological study using an objective marker demonstrated that a permissive drug policy leads to a rapid spread of drug use. A restrictive policy not only checks the spread of addiction but brings about a considerable reduction in the rate of current consumption. The restrictive policy is based on a general consensus of social refusal of illicit drug use, and strict law enforcement. All countries which have adopted this model such as China, Japan, Korea, Singapore and Taiwan have succeeded in controlling epidemics of amphetamine or heroin addiction. By contrast, Western industrialized nations which have accepted permissive policies have seen their epidemics of drug addiction grow steadily since World II War and erode their democratic institutions. The author concludes that such a trend may only be reversed by adopting a restrictive model validated by epidemiological and historical facts.

The survey also demonstrated that teens who use one substance are far more likely to use another. The powerful correlations among teens who smoke, drink and use marijuana and expect to use an illegal drug in the future make it essential for parents. principals and teachers to focus on all substances in their prevention efforts.” said Califano.

• 63% of smokers got drunk at least once a month compared with 10% of teens who never smoked
• 9% of smokers also have smoked marijuana compared with 14% of teens who have never smoked.
• 45% of pot smokers also smoked a cigarette in past month compared to 3% of non-pot smokers.
• 60% of pot smokers also drank alcohol in the past month compared with 15% of non-pot smokers.
• 6% of pot smokers get drunk at least once a month compared with 6% of non-pot smokers, and 40% are likely to use an illegal drug in the future compared with 11% of non-pot smokers.

For parents who believe they have little influence over their adolescents, teens say their parents do influence them in resisting drugs, while friends influence those teens most who decide to use drugs:

• 43% of teens who never smoked marijuana cite their parents as having the most influence over their decision not to smoke pot; 31% credit themselves.
• 50% of teens who smoked marijuana cite their friends as most influential; 30% cite themselves.

In middle school 36% of students and 33% of teachers say the drug problem is getting worse compared to 10% of principals; in high school. 51% of students and 41% of teachers say it is getting worse compared with 15% of principals.

In high school. 50% of teachers and 48% of principals believe a team can smoke pot every weekend and still do well in school compared to 23% of teens.

71% of high school students think more than half the students tried pot: only 27% of principals and 26% of teachers do.

There is a dramatic difference between substance use by teens that attend religious services at least four times a month and those who attend less than once a month:

Only 8% who attend religious services at least tour times a month smoked cigarettes compared to 22% who attend less than once a month.

Only 13% who attended four times or more have smoked marijuana compared to 39% who attended less than once a month.

Only 20% who attend four times or more say at least half their friends drink compared to 38% who attend less than once a month.

Only 49% who attend four times or more know a friend or classmate who has used illegal drugs like acid, cocaine or heroin compared to 62% who attend less than once a month.

45% who never smoked pot rely most on their parents’ opinion compared to 21% who smoked it.

17% who never smoked pot hang out with friends after school compared to 1% who smoked pot.

By tradition Sweden has had very restrictive drug policy, the exception being between 1965 and 1967 when a number of doctors were allowed to prescribe drugs to addicts: 200 were allowed to inject themselves with stimulants or opiates. There was an increase in drugs on the black market and in criminal activity among addicts. There was a return to the restrictive policy at the end of the 1960s and it has never been reinforced since then.

Cannabis has always been treated on the same level as other narcotics. No action has ever been taken to decriminalise cannabis. A sentence of several years in prison is the norm for a narcotics felony.

Surveys of l6 yr. olds and conscripts (18-19) have shown a decline in the proportion of young persons having ever tried drugs. In 1971 the percentage was 15% dropping to about 4% in 1991. 90% involved the use of cannabis.

Abuse of cannabis has now extended to the older age groups. as has abuse of opiates and stimulants. Conviction in the 25-39yr age group rose from 22% in 1975 to 56% in 1989. It appears that many of these addicts have carried their habits from the 1960s and 70s to treatment and rehabilitation.

The Swedish Addiction Perspective in Global Perspective was the first country in Europe to be affected by drug abuse of an epidemic type immediately after the Second World War. The intravenous injecting of amphetamines started in 1945 and was surveyed annually in Stockholm from 1965 to 1987 250000 arrests (for any offence) were examined for needle marks in their cubital regions.

The epidemiological study used an objective marker and from these results concluded that a permissive drugs policy leads to the rapid spread of drug use, a restrictive policy not only checks it but also reduces the rate of consumption. This restrictive policy was based on a general consensus of social refusal to tolerate illicit drug use, and strict law enforcement. It remains the most closely studied and documented drug epidemic.

Epidemics often spread very rapidly and show exponential growth. For example. in Sweden the number of users doubled every 13 months during the 20 years from 1946 to 1965; in England the number of heroin addicts doubled every 16 months from 1959 to 1968.

In 1946 a young Swede learned the techniques of intravenous injection in the USA and introduced it into a small ‘bohemian’ coterie in Stockholm. It had spread outside this circle in 1949 and to Gothenburg in 1956. to Finland in 1965. to Denmark in 1966, Norway in 1967 and to Germany in 1972.

The author of this report Prof. Nils Bejerot. an epidemiologist, assumed that injection into a vein, a breach of the normal mode of drug taking, was so extreme that it must co-exist with other criminal activity. He therefore instructed nurses to commence in. 1965 the inspection of the veins of all arrestees in Stockholm (practically all intravenous drug users turn up eventually). The investigation still continues. In the 3 years following the introduction in 1965 of the ultra-liberal drug policy the proportion of intravenous drug users among the arrested clientele had risen from 20% to 40% In 1969 with the extra-restrictive policy in place, the epidemic was checked for the first time: it culminated in 1972 when large syndicates were broken up. However, demand was still there and the introduction of heroin heralded a new phase of the drug-taking  epidemic. Finally, in 1976, when 60% of all arrestees were found to be drug-abusers the epidemic was stabilised. With some minor increases in the severity of drug legislation the figure appears to remain constant at 40%.

References
1. Swedish Drug Policy in General. In Cannabis Physiopathology. Epidemiology, Detection.’ Nahas G & Latour C (eds) CRC Press. 1993.
2. Bejerot N. Drug Abuse and Drug Policy. Acta Psychiatr. Scand. Suppl. 256. Copenhagen, 1975.
3. Narkotikaboken, Socialstyrelsen Redovisar 1988. National Board of Health and Welfare. Stockholm. 1988.
4. Report 91. ‘Trends in Alcohol and Drug Use in Sweden’. The Swedish Council for Information on Alcohol and Other Drugs (CAN). Stockholm 1991.
5. Bejerot N. The Swedish Addiction Epidemic in Global Perspective. In ‘Cannabis: Physiopathology, Epidemiology. Detection) Nahas G & Latour C (eds). CRC Press. 1993. Bejerot N. ‘Drogue et Societe. Massoa Paris 1990.

Japan has one of the lowest drug abuse and crime rates of any industrialised nation. It also has some of the stiffest laws. After the Second World War it faced an epidemic of amphetamine use and in the early 1960s problems with heroin. A combination of strong law enforcement, stigmatisation of drug users and rehabilitation was successful in overcoming these problems.
After the Second World War Japan’s military stocks of amphetamines went astray, abuse started among artists, musicians, ‘bohemians’ and prostitutes but quickly spread. Not enough was done initially to combat this and it soon escalated.
In 1954, 2 million of the population of 100 million was using tablets. but the epidemic was ended by the enforcement of strict laws. Possession incurred a sentence of 3-6 months: 1 to 3 years was the sentence for pushing and 5 years for illicit manufacture. Convicts were closely monitored on release and immediate restrictions imposed on anyone who relapsed. 55600 arrests were made in 1954 but by 1958 this had dropped to 271 and the epidemic was over.
Measures had been taken against 15% of intravenous users and it seems others were discouraged by fear of arrest. This policy was carried out with broad political consensus and massive public support.

References
1. A Brief Account of Drug Abuse and Countermeasures in Japan Pharmaceutical Affairs Bureau, Ministry of Health and Welfare. Japan. 1972
Masaaki Kato. “An epidemiological analysis of the fluctuation of drug dependence in Japan”, The international Journal of Addictions. 4 (4). Dec. 1969
2. Bejerot N. ‘Drogue et Societe. Masson, Paris 1990. ‘Cannabis: Physiopathology. Epidemiology, Detection.’ Nahas G & Latour C (eds). CRC Press. 1993.

Italy has rescinded some ‘soft’ laws relaxing to possession and use of heroin following record addiction rates and overdose deaths.

Reference
1. Wall St Journal. January 22 1990

During the Franco era Spain had some of the harshest drug laws in Europe but in 1983 the Socialist government changed them to the most lenient. A spurt in heroin, cocaine and other drugs use and trafficking, with accompanying problems of crime and social disruption. still plagues the country.
Spain is a major trans-shipment point for drugs. Parents presented a drug report which shamed the government into enacting and strengthening the drug laws.

Reference
1. Wall St Journal. January 22 1990

Australian Data from the Queensland Criminal Justice Dept in 1993 shows that, in only 3 years after decriminalisation of cannabis in 1987 there was a 21 to 3-fold increase in its use in South Australia compared to other states.  Adelaide is reckoned the drug capital of Australia with use of LSD, amphetamines and ecstasy up to 3 times greater than Sydney.

Comparing the use of cannabis in the Australian Capital Territory  (ACT) with New South Wales after the ACT trivialised penalties for use to a $100 fine, as against $2000 in NSW. Adolescent male use was found to be 55% higher and female adolescent use 83% higher than in NSW.

References
1. Cannabis and the Law in Queensland Advisory Committee on Illicit Drugs. July 1993
2. Attitude, ABC TV May 1993
3. A.C.T. Board of Health Schools Student Survey. 1991: Years 7-11.

United States of America
At the turn of the century cocaine, heroin and marijuana were in use legally and widely promoted. Between 1907 and 1917 thc murder rate rose by 300% Cocaine and opium addiction rates in these early years rivaled those of today and the effects led to pub1ic outcry.
In 1914 these drugs were made illegal and by 1940 the number of addicts had dropped from 250,000 to 50,000. Between 1923 and 1939 the rate of opium addiction fell 90%, apparently simply as a result of a strict drug policy which dramatically reduced exposure factors.

The US experimented briefly with decriminalisation of marijuana in the period 1975 to 1978. This resulted in a statistically significant increase in the reported number of marijuana-related visits to hospital emergency departments compared to metropolitan areas where decriminalisation had not been implemented.

By 1979 use of all drugs in the US was very high but between then and 1991, largely due to the efforts of parents, the number of users dropped from 23 million to 14 million, a 60% reduction sustained over a 12-year period. Use of cannabis halved, daily use fell by 75% and the use of cocaine fell by 50%. A wide-ranging and successful collaboration between Customs & Excise. Police. educationists, social workers and parents and the young people themselves reinforced the idea that the use of drugs is not normal and is socially unacceptable However, since 1991 a relaxation of this strategy has seen an increase in the problem.

In the state of Arizona Proposition 200 authorised doctors to issue prescriptions for drugs such as marijuana, heroin, LSD and PCP. It encouraged the immediate release of 1032 prison inmates sentenced for drugs offences and prohibited prison sentences for drug offences until the third conviction. A poll carried out between January 27th and 31st  1997 by Dr. Bruce Merrill (Prof. Of Mass Communications and Director of the Walter Cronkite School. Arizona State University) overwhelmingly supports the conclusion that Arizona residents believe the enactment of Proposition 200 has led to dangerous unintended consequences 85% of registered voters in Arizona believe that Proposition 200 needs to be changed.  60% of registered voters believe it should be repealed.

References
1. Musto, David F. “The American Disease – Origins of Narcotic Contr6l’. OUP New York 1987 especially pp 70-73
2. US Bureau of the Census. Historical Statistics of the United States Colonial Times to 1970. Part One. Washington DC. 1975
3. See ref 1: especially pp 91. 115. Also Wall St Journal June 11th  1986. p30: Parade July 31st  1988
4. See ref 1. Also Wilson. James Q. “Against the Legalisation of Drugs”, Commentary February 1990, pp 21-28
5. Bejerot. N. ‘Drogue et Societe. Masson Paris 1990 ‘Cannabis: Physiopathology. Epidemiology, Detection.’ Nahas G & Latour C (eds). CRC Press. 1993.
6. Model. KE. The Effect of Marijuana Decriminalisation on Hospital Emergency Room Episodes 1975-1978. Journal of the American &Statistical Association. 88: 737-747. 1993
7. Rosenthal. MS. Report from North America. In “Cannabis: Physiopathology, Epidemiology. Detection.’ Nahas G & Latour C (eds). CRC Press~ 1993
8. News Release from the Office of Maricopa County Attorney, 301 West Jefferson, Phoenix, Arizona 85003

Trends in drug use in various countries are reported in a number of sources; some current examples are given in this item:

In Australia marijuana is the most popular illicit drug, followed by amphetamines. While cocaine is not readily available in Australia, heroin is, especially among the arrestee population. Nineteen percent of youth in detention centers and 40 percent of adult prisoners have used heroin at least once in their lifetime.

Marijuana is the drug of choice in Canada’s cities – 48 percent of youth aged 15-19 in British Columbia use marijuana, and 61 percent of treatment clients in Toronto reported marijuana as a major problem. In addition, powder cocaine and crack use were reported as serious problems in several cities.

Cocaine is the most common drug of abuse among treatment clients in Mexico, followed by marijuana and inhalants.

In South Africa, marijuana and methaqualone are the most frequently abused substances, often used in combination. There are also reports that crack cocaine, powder cocaine, and heroin uses are increasing.

As a result of a brief heroin shortage in 1996, many addicts in Thailand began injecting the drug, and there are reports of lower purity heroin being diluted with barbiturates and benzodiazepines. In addition, methamphetamine use continues to be popular, especially among students, and the number of methamphetamine laborites in Thailand has increased.
 

Mentoring can best be described by the classic example of the Big Brother/Big Sister Program. In the Big Brother/Big Sister Program, an adult volunteer mentor commits to developing a supportive relationship with a youth who is between 6 and 16 years old. Although older youth can mentor younger ones, mentoring programs most typically rely on adult mentors. Informal mentoring may happen as part of any youth/adult interaction, but mentoring programs seek to purposefully structure mentor/mentee relationships to maximize success. Mentoring may be a component of treatment or intervention, but mentoring for prevention involves youth who have not experienced significant ATOD problems. Often the youth chosen to participate are considered to be “at-risk” due to having limited access to their parents.

Mentoring is strongly rooted in resiliency theory and research. The goal is to “bond” each youth (via a caring, enjoyable relationship) to a positive role model who gives the youth encouragement and support for healthy activities and development.  Key studies of eight Big Brother / Big Sister programs by an organization called ‘Public/Private Ventures’ in the early 1990’s differentiated successful ‘developmental’ mentor/mentee relationships from less effective ‘prescriptive” relationships. In the less effective ‘prescriptive” relationships, adults sought to guide or direct youth, apparently leading to alienation in those youth rather than the success of the developmental, supportive relationships. (Mentors need to strike a balance between a non-prescriptive approach and the identifying of behaviours which need to be observed, and a [brotherly] discussion of these boundaries). These studies found very substantial effects toward decreased likelihood of mentored youth initiating alcohol or other drug use, in comparison to a control group.  Bonnie Benard (1996) summarizes research-based characteristics of effective mentoring relationships as follows:
 

• Relationships have sufficient intensity and duration (regular weekly contacts, three-four hours per meeting. longer than one year in duration, etc.)
• Sustained relationships are those in which the mentor sees him/herself as a friend: not as a teacher or preacher. Success is based on the mentors belief that he or she is there to meet the developmental needs of youth—to provide supports and opportunities the youth does not otherwise have.
• Mentors center their involvement and expectations on developing a reliable trusting relationship and expand the scope of their efforts as the relationship strengthens.
• Mentors place top priority on having the relationship enjoyable and fun to both partners, listen non-judgmentally, look for the youth’s interests and strengths, and incorporate the youth into the decision-making process around their activities.
• From a resiliency perspective, mentors provide the three protective factors of a caring relationship that conveys positive expectations and respect, and that provides ongoing opportunities for participation and contribution, and see risks existing in the environment, not in the youth.
• Relationships are fundamentally based on the belief that the development of a caring, trusting, respectful reciprocal relationship is a key to reducing risks, enhancing protection, and promoting positive youth development in any system.

The following list includes elements of an effective mentoring program. In any community based prevention, one can better assist those involved in the implementation  of mentoring programs by promoting these elements:
 

• Encourage quality relationships. Support efforts to build on research-based findings associated with successful mentoring relationships.
• Screen mentors. Use thorough volunteer screening methods that filter out adults who are unlikely to make a lasting commitments or might pose a safety risk to the youth.
• Train mentors. Conduct mentor training that promotes caring relationships, conveying a  deep belief in a youth’s innate resilience. Train on communication and limit-setting skills, tips on relationship-building, and recommendations on the best way to interact with a young person.
• Make careful matches. Ensure a good match between the youth and mentor expectations and program goals. Conduct interviews with mentors that explain the type and depth of a mentoring relationship and commitment expectations. Consider youth preferences, their family, and the volunteer, as well as use a professional case manager to analyze which volunteer would work best with which youth.
• Establish structure and a process. Build a program structure and process, supervised by case managers/youth workers. Ensure that case managers supervise each match through quality contact with the parent/guardian, volunteer, and youth in an ongoing/consistent manner and provides help as needed. Use staff to provide “back-up” stability and continuity in a mentoring relationship, especially so that youth are not left alone if their mentor leaves.
• Create a communication process. Ensure that a communication and feedback loop is established for youth and adults to discuss needs, progress, and problems.
• Support social activities/ATOD-free events. Support the relationship and activities of youth and adults by providing community-based activities and events that are ATOD-free. Be a resource/volunteer in activities and educational programs.
• Meet mentor needs. Respond to a mentor’s needs, as well as the youth’s needs to support the mentoring relationship.
• Involve families. Communicate clear expectations about family involvement in the mentoring program. Build in opportunities for the families of the youth and adult to become involved in activities.

A study of an interactive alcohol-prevention program for college students shows a significant decrease in total drinking and binge-drinking episodes among participants.

Inflexxion Inc., a Newton, Mass-based healthcare technology research and development company, conducted a random, controlled clinical trial of its MyStudentBody.com (MSB-Alcohol) personalized drinking prevention and education program. The study, conducted from January to August 2002, involved 265 students ages 18 to 24 from five colleges and universities in Boston, Mass. All of the participants met the criteria for binge drinking. The research showed that all of the participants reported significant decreases in alcohol use compared to a control group. In addition, the number of binge-drinking episodes decreased during the study period. Results were especially noticable among women.

“These results demonstrate that a more confidential, self-directed computer intervention has meaningful impact on those students who have been hardest to reach with traditional approaches,’ said Sarah Lord, Ph.D., director of college health programs at Inflexxion. MSB-Alcohol is designed to reduce alcohol-related risk behaviours. College students who use the program complete a confidential risk-assessment profile and then receive tailored feedback about their risks for alcoholism and related problems. The MSB-Alcohol program is currently available at 23 colleges and universities.
Source: Alcoholism and Drug weekly, April 2003

Doctors, due to the demanding nature of their jobs, are stressed. In July 1997, we assessed the lifestyles of junior house officers (residents) in 18 National Health Service (NHS) Trust hospitals in the north east of England, UK, who had been surveyed during the second year of their medical course.

We contacted 114 house officers 1 year after graduation from Newcastle University; 90 (51 women) agreed to participate. Anonymous information was, obtained by a self-completed questionnaire, administered on site by one investigator (D B). The questionnaire was similar to that used in our previous surveys of students with the addition of the 30 item general health questionnaire (GHQ)[2] and job satisfaction component of the occupational stress indicator.[3]
Among the 93% who drank alcohol, over 60% of both sexes exceeded recommended safe limits. The main reason given for drinking was “pleasure” (91.7% men and 97.9% women). More than 35% of men and 19% of women were currently using cannabis with over 11% taking it regularly (weekly or monthly). Use of hallucinogenic mushrooms, lysergic acid diethylamine (LSD), ecstasy, amyl nitrate, cocaine, and amphetamines was also reported: 13% (M) and 10% (F) reported current use of one or more of these drugs. “Pleasure” was also the main reason for illicit drugs (76.0% in both sexes).
On the hospital anxiety and depression scale, 21% of men and 45% of women had anxiety scores of 8 or more, indicating possible pathological anxiety. On the GKQ, 36% scored over the threshold score of 4. Scores for the OSI component suggested some were dissatisfied with their job. 58% of men and 51% of women reported sleeping on average 7-8 hours per night whilst 42% and 49% slept 5-6 hours per night. 8% of men and 18% of women complained of difficulty getting to sleep and 23% and 53% were slow to become fully awake. Significant negative correlations were found between OSI and anxiety scores (r = -0.246; p = 0.02) and between OSI and depression (r = -0.363; p = 0.0001), but none between alcohol or drug use and anxiety or occupational stress.

This study shows that most of the house officers surveyed drink excessive amounts of alcohol; many use cannabis and take other illicit drugs. Alcohol drinking had increased in both men and women, compared with when they were second-year medical students; mean (SD) 19-6 (13.1) units/week range 2-67, median 18 for men; 11.8 (90) units/week, range 1-43, median 10 for women.[4] High scores for anxiety and mental ill health were related to work pressures, but unrelated to the use of alcohol or illicit drugs. These results are comparable with our previous studies of 3075 UK university students from all faculties [1] and of 785 second-year medical students from seven UK medical schools.[5] Both these student populations showed high levels of alcohol consumption and drug use and high anxiety scores unrelated to alcohol or drug use. It is unlikely that these lifestyles apply only to house officers in the north east of England. The current drinking habits, illicit drug use and stress in some junior doctors is of concern not only for their own well being, but also how they may affect patient care. It is possible to reduce the stress of house officers? Should routine or random drug and alcohol screening programmes be considered? There is no evidence that such schemes would be workable or appropriate in the UK National Health Service, but mandatory urine screening is undertaken in the UK army and some UK industries, and for doctors in the USA.

Needle exchange programs (NEPs) are designed to prevent human immunodeficiency virus (HIV) transmission among Injecting drug users. Although most studies report beneficial effects in terms of behavior modification, a direct assessment of the effectiveness of NEPs in preventing HIV infection has been lacking. A cohort study was conducted to assess the association between risk behaviors and HIV seroprevalence and seroincidence among injecting drug users in Montreal, Canada. The association between NEP use and HIV Infection was examined in three risk assessment scenarios using intensive covariate adjustment for empirical confounders: a cross-sectional analysis of NEP use at entry as a determinant of seroprevalence, a cohort analysis of NEP use at entry as a predictor of subsequent seroconversion, and a nested case-control analysis of NEP participation during follow-up as a predictor of seroconversion. From September 1988 to January 1995, 1,599 subjects were enrolled with a baseline seroprevalence of 10.7%. The mean follow-up period was 21.7 months. The adjusted odds ratio for HIV seroprevalence in injection drug users reporting recent NEP use was 2.2 (95% confidence interval 1.5-3.2). In the cohort study, there were 89 incident cases of HIV infection with a cumulative probability of HIV seroconversion of 33% for NEP users and 13% for nonusers (p <0.0001). In the nested case-control study, consistent NEP use was associated with HIV seroconversion during follow-up (odds ratio = 10.5. 95% confidence interval 2.7-41.0). Risk elevations for HIV infection associated with NEP attendance were substantial and consistent in all three risk assessment scenarios in our cohort of injecting drug users, despite extensive adjustment for confounders. In summary, in Montreal, NEP users appear to have higher seroconversion rates then NEP nonusers.

Objective: to describe prevalence and incidence of HIV-1, hepatitis C virus (HCV) and risk behaviours in a prospective cohort of injecting drug users (IDU).

Setting: Vancouver, which introduced a needle exchange programme (NEP) in 1988, and currently exchanges over 2 million needles per year.

Design: IDU who had injected illicit drugs within the previous month were recruited through street outreach. At baseline and semi-annually, subjects underwent serology for HIV-1 and HCV, and questionnaires on demographics, behaviours and NEP attendance were completed. Logistic regression analysis was used to identify determinants of HIV prevalence.
Results: Of 1006 IDU, 65% were men, and either white (65%) or Native (27%). Prevalence rates of HIV-1 and HCV were 23 and 88%, respectively. The majority (92% had attended Vancouver’s NEP, which was the most important syringe source for 78%. Identical proportions of known HIV-positive and HV-negative IDU reported lending used syringes (40%) Of HIV negative IDU. 39% ,.. borrowed used needles within the previous 6 months. Relative to HIV-negative lDU, HIV-positive IDU were more likely to frequently inject cocaine (72 versus 62%; p <0.001). Independent predictors of HIV-positive serostatus were low education, unstable housing, commercial sex, borrowing needles, being an established IOU, injecting with others, and frequent NEP attendance. Based on 24 seroconversions among 257 follow-up visits, estimated HIV incidence was 18.6 per 100 person-years (95% confidence interval, 11.1—26.0).

Conclusions: Despite having the largest NEP in North America, Vancouver has been experiencing an ongoing HIV epidemic. Whereas NEP are crucial for sterile syringe provision, they should be considered one component of a comprehensive programme including counseling, support and education.

At the Department of forensic Medicine in Stockholm various studies on drug-related mortality are carried out. One important object is to create a register of deaths related to illicit drug use in the Stockholm area. This register includes users of heavy drugs chiefly amphetamine and heroin.

However, in recent years a number of cases were found with tetrahydrocannabinol but no other illicit drugs, in blood or cannabinoids in urine.
At closer investigation, it appeared that manners of death among the cannabis users were unexpectedly violent compared to the ways of death among other drug addicts. The proportion of suicides, 10 out of 24, was particularly high. This finding was remarkable, since cannabis use is not generally associated with violence.
The literature contains several descriptions of delusional states, paranoid symptoms and personality disturbances in cannabis users . These abnormal mental states are of comparatively short duration, usually lasting for just a few hours. Even first-time users may be affected.

These so-called cannabis psychoses are not very frequent and are often induced by long periods of intensive cannabis use. It is uncertain whether or not these psychoses can be separated from schizophrenia or other known paranoid states . The entity distinguishing cannabis psychosis from other mental disorders is the significant subsidence of the symptoms after some days or a few weeks. In most cases, the patient recovers totally but remains at risk for relapse in connection with repeated cannabis use. In case studies of cannabis psychoses, it is not uncommon to see descriptions of violent and destructive outbursts, suicide attempts and assaults on other persons, often with major violence. In a Swedish follow-up study of conscripts with a history of cannabis use, an excess mortality was noted 15 years after conscription. The excess mortality from suicides was particularly high, and the share of suicides increased in proportion to the magnitude of the cannabis abuse.

During these four years, a total of 13,417 medico-legal autopsies were made on males and females of all ages (about 26% after violent deaths). A total of 1.9 million people resided in the service area in 1987; of these, about 1.6 million lived in Stockholm county and 668,810 in the city of Stockholm. Information about deceased persons was obtained from police reports and was, when possible, supplemented with information from clinical journals, families and friends as well as from social workers. Complete autopsies were carried out, with few exceptions, when the blood tests analyses concerning HIV-infection were positive The autopsies were supplemented with histological investigations. Toxicological analyses were made, with the purpose of disclosing the presence of alcohol, barbiturates, tranquilizers, opiates, central stimulants and cannabis, as suggested by autopsy findings, past history, police records, or circumstances of death. Toxicological analyses were also carried out when insufficient information about the circumstances of death was at hand, for instance in cases of violent death, or when the postmortem findings were inconclusive, and also when information about unusual behaviour or symptoms was available.

RESULTS
During the four-year period of 1987-1990, cannabis was found to be the only narcotic drug in postmortem samples in 24 cases; in 8 of these, cannabis was the only finding, while alcohol, alcohol and medicinal drugs, or only medicinal drugs was demonstrated together with cannabis in 10, 5 and 1 instance, respectively. The number of deaths among these 24 cannabis users during the study period is shown in Figure 1.

There were 23 males and 1 female, 20-43 years of age (mean age 29.6 years). About two thirds (15) of the persons in this series were, at the time of death, under the influence of alcohol.

Figure 1. Numbers of cannabis user deaths in Stockholm 1987-1990

Figure 2. Manners of death among 24 cannabis users in comparison to the same number randomly selected alcohol users, amphetamine and heroin users’ deaths. N = Natural deaths. A = Accidental deaths. S = Suicides. H = Homicides. U = Undetermined deaths.

Among the 24 cannabis users, only one died from a non-violent cause, while the remaining 23 (96%) died as a result of violence, compared to a total of 26% of the entire number of 13,417 investigated postmortems during the same period (Table I). No stigmata which could be indicative of cannabis use were noted at the postmortems. None of the cannabis users had blood tests that were positive for HIV.

CAUSE AND MANNER OF DEATH AMONG 25 CANNABIS-ASSOCIATED DEATHS DURING THE FOUR YEAR PERIOD 1987-1990

The manners of death among 24 cannabis users were compared with those in the same number of users of alcohol, amphetamine and heroin (Figure 2); a similar distribution for alcohol users and amphetamine users was noted. There were obvious differences between cannabis users and heroin users, with suicides dominating for cannabis users, while deaths of undetermined origin, following collapse in connection with intravenous drug administration, predominated among heroin users.

Accidental deaths
Eight of the 24 cannabis users died in accidents, 7 males and one female, ranging in age from 22 to 43 years (mean 32.5 years). Two users died of alcohol intoxication. At the time of death, the concentrations of THC in the blood were only 0.8 and 2.0 ng/g. One male with 0.5 ng THC/g blood and 2.7 g ethanol/l blood died from drowning after suddenly loosing his balance and falling into the water. Five cannabis users died in traffic accidents, 3 as drivers of motor vehicles, and 2 as passengers with cannabis-influenced drivers. One of the deceased car drivers had 30 ng THC/g blood (and no other drug), while the remaining 4 traffic accident victims had 1-4 ng THC/g blood in combination with alcohol (0.3, 0.9, 2.8 and 3.2 g/1), in two cases also with low concentrations of chlormezanon and paracetamol. In one of the automobile accidents, high speed ( 3 times exceeding the speed limit through central Stockholm) preceded collision with another car; in another, the cannabis influenced driver passed another car, at twice the speed limit, and just continued to drive on the left side of the road until he collided with a car coming from the opposite direction. In the two others, the drivers were not able to keep their cars on the road in a minor curve; and in yet another, the car was simply driven into a ditch.

This study developed a Reasons for Drinking Scale (RFD) with three factorially derived subscales, Social Camaraderie, Mood Enhancement, and Tension Reduction, among a university student sample. These scales were then compared to a measure of alcohol expectancies, the Alcohol Expectancy Questionnaire (AEQ), as predictors of several measures of alcohol use. The RFD accounted for more of the variance on all alcohol measures than the AEQ. Results are discussed in terms of reasons for drinking as a more direct assessment of cognitive motivations for drinking than outcome expectancies.

From our years of experience in working with drug users and their friends and families, we know that many users come to a point in their lives where they really want to quit. Sadly this is not always easy and many become dejected when they first try to give up using and fail. Your relationship with your drug of choice is like a friendship or a love affair. – you need the drug not only physically, but emotionally. You know it’s causing you problems – health, money and relationships. OK – at times briefly it makes you feel good – but there is a payback – you often feel bad, lonely, angry, afraid despairing. Walking away from a friend you have been very attached to is painful; some would even describe it as a kind of bereavement, but take heart – others have been at this point too – and, given help, they have eventually stopped using and are now leading drug-free and happy lives.

For anyone reading this page who is currently using tobacco, alcohol, cannabis, ecstasy, speed, cocaine, crack or heroin and who feels that life is chaotic, that they simply cannot continue to use drugs but are scared of trying to get off, or worried about failing – we would ask you to first contact a self-help group and then possibly consider residential or non-residential rehab. Throughout the world there are agencies and organisations dedicated to helping people give up drugs and get a life. We list on this site a few places where you can get advice and help on-line, and you can always check the telephone directory for local groups in your home town.

A SPECIAL MESSAGE FOR POT USERS

Cannabis (or marijuana, pot, blow, hash, dope etc.) is the most-used drug after tobacco and alcohol. Many who use this drug begin when they are very young – and they mistakenly believe it will be a relatively harmless substance. Quite often parents of new young users will have smoked pot in the 60s or 70s and will not worry too much about the ‘experimentation’ of their children. However, 30 and 40 years ago the THC content of joints was much lower – sometimes as low as 0.5%, but nowadays, typically, a joint contains 5-7% THC – and some kinds of genetically modified marijuana (like ‘skunk’) can be up to 25%+ – hardly the same substance.

Those of us who have worked with users will know that the earlier they begin to use the more problematic their use becomes. During the teen years young people are learning and preparing for life in the adult world. They need to learn how to become independant from their parents, how to deal with their emerging sexuality, how to cope with disappointments and frustrations without stamping their feet like a 5 year old, how to learn the skills of negotiation and compromise, how to control anger and so on. When 13/14 year old cannabis users face disappointment they quickly learn that smoking a joint will (temporarily) help, when they cannot face other problems they can take refuge in another joint … and so on. The result is that these young people fail to mature in the way nature intended – and when they seek help at age 20 or 25 to get off drugs, counsellors find an individual with the physical body of an adult and the emotional age of 13/14 years. Behaviour which is acceptable to others in a 13 year old is not acceptable in a 20 year old. This may explain why research show that pot users are more likely to have many more relationships and broken marriages and are less likely to be able to hold down a job except for short periods.

From the 1930s right up to the 1950s, cigarette smoking was seen to be glamorous and smart. Old films showed actors lighting up frequently and advertisements even suggested that cigarettes were good for you. We now know differently. What’s more we know that even back then the tobacco industry had research that showed nicotine was harmful – but these research studies were hushed up and not made public. At the University of Mississippi they now have over 13,000 research papers about cannabis – and none of them give it a clean bill of health. We now know that this substance is far from benign – as the strength of genetically modified cannabis has increased so have the side effects. THC is fat soluble – it affects all the organs in your body, it affects your emotions, your moods, your drive, your productivity, your memory, your attitudes and your thinking (see the cannabis page on this website). And yet young people are being let to believe that cannabis is harmless, could be used for medicine, should be legalised, and ‘everybody’ is doing it. The media (television, newspapers, films, pop music even advertisments) give pro-pot messages constantly; NDPA Director Peter Stoker, has observed that this is part of a propaganda process which might be termed ‘The Beast with Six Eyes’ – first trivialise the use of pot, then glamourise it, sympathise with users, normalise use, decriminalise and finally legalise.

Young people are confused by these mixed messages – and if they are led to believe that pot is harmless, if they pick up leaflets which tell them ‘pot makes you feel relaxed and makes you giggle’, if they are told pot is not addictive (untrue), if they find hundreds of websites promoting pot – then some may decide to try for themselves. In both Britain and the USA the numbers of young people who try pot are around 46-50% — but they do not all continue use. Sadly, of those who do continue to use, a sizeable proportion will become addicted and at some time in their lives needs help to quit. In the USA over 100,000 people every year contact hospital emergency rooms asking for help because of problems from cannabis use. Also, the website for Marijuana Anonymous, a site for people experiencing marijuana problems, received more than 350,000 hits last year.

So – remember – you can quit – many others before you have done so. Help is available. Stop using, and after two years of being clean you will being to notice a huge improvement in your life – you’ll be able to remember more, you’ll sleep better, eat better, smell better. You’ll save money, your family and friends will stop nagging you to quit, you’ll drive better and more safely, you won’t have to worry about being arrested, you’ll get fewer fungus infections, fewer coughs and throat infections, your reactions will speed up.

You don’t need drugs to have a good time, you will never regret quitting!

RELAPSE PREVENTION

For those of you who may have been users for many years, relapse can be a problem. You may have won the first battle – stopping use – but there may well be times when you are at risk of using again. Joining a self-help group will give you the support you need, the following points may well help you too:

1. Cravings may continue on and off for a long time after you cease use.

2. Cravings can be triggered by various experiences – for example remembering that you had used in this particular place when re-visiting.

3. Any occasional use – just one joint – will keep the triggers strong – so abstinence is the quickest way to reduce craving and the only way to ensure you will stay clean.

4. After a while it is important to de-sentitise yourself to triggers – being able to face the situation and not get high will eventually extinguish the craving.

5. Returning to the places where you used to score or use (certain pubs, clubs, houses of friends who used with you) may trigger cravings months or even years – so take great care.

6. You may even need to change your friends – or at least only meet ‘using’ friends in public places where smoking a joint would be impossible. Don’t expect using friends to help you stay clean either – they are more likely to urge you to join them and you will need to stay strong in your resolve. Remember that over time you will find it easier and easier to stay clean, even when you are with others whom you know still use.

7. You might slip up – if you do use, it is very important to get back on track at once – don’t use one slip up as an excuse to ‘use tonight and I’ll quit again tomorrow’.

8. Have a plan of action to deal with negative feelings. If you are sad, angry, lonely, guilty, in pain, bored, fearful or anxious you will be tempted to escape by resorting to a joint. A good friend or mentor from a self-help group at the end of a phone will be invaluable.

9. Don’t get into any discussion with others about how good it was to get high, or what a great time you had on a particular week-end etc.

10. Don’t play music you used to get high to ! Get rid of those CDs or tapes.

11. Be extra careful when you have money in your pocket.

12. Take up new hobbies or interests and seek the company of others who do not do drugs.

The following websites may also help you to quit.

www.marijuana-anonymous.org
www.acde.org/youth
www.4addictions.com

We hope this information will help you – we wish you luck in your endeavours to get a life without drugs and we congratulate you on your decision to quit!

Australia’s top psychiatry body has attacked the State Government for failing to educate West Australians on the dangers of cannabis and amphetamines, saying the harmful impacts of the drugs had been ignored for too long.

Dr Oleh Kay, WA head of the Royal Australian and New Zealand College of Psychiatrists, said cannabis continued to have severe effects on mental health and the Government had neglected to warn the public of its dangers.

But Dr Kay believed prosecuting cannabis users was not the answer, arguing there was a fine balance between the harm inflicted by cannabis use and harm caused to a person’s life prospects by a criminal conviction. His comments came after the Australian Medical Association’s WA branch last week branded the State’s soft cannabis laws a dismal failure. It demanded much higher fines and an overhaul of “inadequate” education programs to dispel what it believed was a myth that marijuana was harmless.

Dr Kay said police resources would be stretched to breaking point if they were forced to prosecute petty cannabis users and there was no point in having laws that could not be enforced. Instead, he implored Health Minister Jim McGinty to pour money into an education program aimed at highlighting the harmful effects of cannabis.

“We have cut cigarette smoking down significantly in Australia, not by making cigarette smoking illegal but largely by a public education campaign,” Dr Kay said.
The fault in the Government’s policy about drug abuse in WA is that too little is put in the direction of public education, educating people about the risks that are associated with marijuana and with amphetamines. Clearly in terms of public health measures there has to be an issue of primary prevention, of educating people and of them being able to make an appropriate decision. How much education have you seen about marijuana and amphetamines? Certainly a lot less than tobacco and substantially less than alcohol,” he said.

The Government is reviewing its controversial cannabis laws, which decriminalised cannabis use and have been the subject of heated political debate. The review is expected to be tabled in Parliament in November. Premier Alan Carpenter said last week the Government’s policy was producing good results and it would not bow to the demands of every interest group or the rhetoric of a particular sector.

Dr Kay said the public must be made aware that cannabis use was the cause of psychiatric disorders, including schizophrenia, bipolar disorder, anxiety and depression. We are talking about vulnerable population groups that are particularly at risk, those that have a predisposition to developing serious psychiatric illnesses but there is also the issue of lung disease associated with smoking cannabis,” he said.

Source: http://www.thewest.com.au August 2007

A new federal report concludes the younger children are when they first use marijuana, the more likely they are to use cocaine and heroin and become dependent on drugs as adults. The report, “Initiation of Marijuana Use: Trends, Patterns and Implications”, found that 62 percent of adults age 26 or older who initiated marijuana before they were 15 years old reported that they had used cocaine in their lifetime. More than 9 percent reported they had used heroin and 53.9 percent reported non medical use of psychotherapeutics. This compares to a 0.6 percent rate of lifetime use of cocaine, an 0.1 percent rate of lifetime use of heroin and a 5.1 percent rate of lifetime non medical use of psychotherapeutics for those who never used marijuana. Increases in the likelihood of cocaine and heroin use and drug dependence are also apparent for those who initiate use of marijuana at any later age. The report is based on the 1999 and 2000 National Household Surveys on Drug Abuse and was released today in Miami by Drug Czar John Walters and Charles G. Curie, Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is part of the U.S. Department of Health and Human Services (HHS).

The report found that 18 percent of people age 26 and older who began using marijuana before age 15, met the criteria for either dependence or abuse of alcohol or illicit drugs, compared to 2.1 percent of adults who never used marijuana. Among past year users of marijuana who had first used marijuana before age 15, 40 percent met the criteria for either dependence or abuse of alcohol or illicit drugs. White House Office of National Drug Control Policy Director John Walters stated, “every day in this country, more than 3 000 people, most of them under the age of 18, use marijuana for the first time. Their early marijuana use exposes them to risks of drug dependencies, long term physical and cognitive consequences, and social problems. We must keep our young people out of harm’s way by educating them on the dangers of marijuana use, preventing initiation of the drug, and getting them help if they have already starting using it.” Overall, the report found an estimated 2.0 million Americans aged 12 or older indicated they used marijuana for the first time in 1999. This was fewer than the 2.5 million new users in 1998, but still above the number, 1.4 million new users, found in 1989 and 1990.

SAMHSA Administrator Curie said, “among recent initiates of marijuana nearly three quarters had first used between the ages of 13 and 18. More than a quarter initiated before age 15. These findings are of grave concern because studies show smoking marijuana leads to changes in the brain similar to those caused by cocaine, heroin and alcohol. Heavy marijuana abuse impairs the ability of young people to retain information during their peak learning years when their brains are still developing.”

Prior use of alcohol or cigarettes was highly correlated with becoming a new marijuana user. Among persons aged 12 to 25 who had never used marijuana, those who had smoked cigarettes were an estimated 6 times more likely than nonsmokers to initiate marijuana use within 1 year. Alcohol users were an estimated 7 to 9 times more likely than nonusers to start using marijuana within a year. Daily cigarette smoking was associated with a twofold increase in risk for marijuana initiation.

Source: SAMHSA News, www.samhsa.com. Aug 2002

No wonder so many people have trouble balancing checkbooks. Blame that pot smoking some of you did in school, suggests a new study by three economists who examined the relationship between standardized scores and marijuana use. These researchers collected survey data from about 20 000 people who were in the 10th and 12th grade early 1990s. The information included students’ scores on standardized math and verbal tests, as well as questions about drug use. They found that, controlling for other factors, the periodic use of marijuana “remains statistically associated a 15 percent reduction in performance on standardized math tests,” though verbal test scores did not seem to be affected, reported Rosalie Liccardo Pacula and Jeanne S. Ringel of the Rand Corp. and Karen E. R University of Michigan.

Source: www.washingtompost.com. Sep 2003

More evidence has emerged that long-term users of the drug Ecstasy may have permanent changes in the way their brains work. In particular, using the drug may be killing cells which produce a vital mood chemical called serotonin. But it is not yet confirmed whether the loss of these cells has an adverse effect on brain health. The latest clues come from an autopsy of a 26-year-old Canadian – a long-term heavy user of Ecstasy – who died of an overdose of a different drug. When his brain was tested, it was found to have between 50% and 80% less serotonin than the brain of other patients.

While the researchers, from the Centre for Addiction and Mental Health in Toronto, concede it is difficult to draw conclusions from a single case, they say the finding is significant. Dr Stephen Kish said: “This is the first study to show that this drug can deplete the level of serotonin in humans.” Serotonin is a neurotransmitter chemical, released by nerve cells in the brain, which controls mood, pain perception, sleep, appetite and emotion. A massive release of serotonin stimulated by Ecstasy is widely thought to be the principal mechanism of the drug.

Ecstasy hangover
Additionally, the “Ecstasy hangover” – feelings of excessive tiredness and irritability, alongside an inability to think clearly – is thought to be caused by an over-depletion of the chemical as the drug ceases to have an effect. The man whose brain was the subject of the study started using Ecstasy once a month at the age of 17. In the last few years of his life, he used it four or five nights a week at nightclubs, usually including a three-day weekend “binge” during which he took six to eight tablets. It is still uncertain whether a low level of serotonin in those who take Ecstasy is due to the action of the drug, or whether naturally occurring deficits in the chemical make you more likely to take it. Studies on animals given the drug suggest the former is more likely. Dr Philip Robson, a senior research fellow in psychiatry at Oxford University, said: “We simply don’t know what the long term effects of losing these nerve cells is.”

Source: Dr. Stephen Kish Centre Addiction and Mental Health, Toronto, July 2000

Clubbers who take ecstasy are 25% more likely to have a mental health disorder, compared to the general population, a survey has found. The UK average is one in five. Its findings back up previous scientific concerns over a link between ecstasy and mental health problems.
Ecstasy users are also twice as likely to have seen a doctor about a mental health problem compared to the rest of the population. Half of them asked about depression, which scientists believe could be linked to use of the Class A drug. But one in 10 users believed that taking ecstasy had made their lives worse overall. Both ecstasy and cocaine have been linked with mental health problems such as paranoia, panic attacks and depression.

Widespread drug use
The extent of drug use amongst clubbers is graphically illustrated by the fact 97% of 1 000 people surveyed said they had tried both E and cannabis at least once. Eleven per cent have tried heroin.
Mixmag estimates 1.5m people take ecstasy every weekend. But it says consumption has dropped by 13% among regular users. Ecstasy use had resulted in unplanned sex for one in three, one in 100 of which resulted in pregnancies. Half said their performance at work had been affected because of the drug. But the survey also found clubbers had developed a novel way of ensuring Ecstasy got into their bloodstream as quickly as possible – by taking it as a suppository. One in 15 surveyed by Mixmag admitted they had taken the drug in this way, a 200% increase compared to last year. Inserting it into the rectum allows the body to absorb it more quickly because of the large number of blood vessels in the anus.

Cocaine
Cocaine use fell 4%, though 45% of those surveyed said they still took the drug on a regular basis. Almost a third of cocaine users reported suffering a nosebleed after snorting the drug. Drug use appeared to be linked closely with high levels of alcohol use. More than a third of men who responded to the survey spent more than four nights a week in the pub. All respondents were three-and-a-half times more likely to injure themselves on alcohol than on ecstasy. They were also two-and-a-half times more likely to end up in the local casualty department. The survey also showed one in three said they had been violent on alcohol, compared with one in 10 on ecstasy. Twice as many had driven on ecstasy than on alcohol but drink drivers had a higher accident rate.

Source: Mixmag Survey. Dr Adam Winstock, National Addiction Centre University, Kent, Jan 2002

Memory problems that plague many order people can affect ecstasy users in their mid-twenties, say British psychologists. They found that ecstasy damages prospective memory – remembering things to be done in the future. They were showing the kind of deficits you might expect to find in much older people, Tom Heffernan, at the University of Northumbria, told New Scientist. “There are problems with asking people with memory problems to fill in these kind of questionnaires’ he says. But, if anything, they would be prone to under-reporting these kind of events.”

Why am here?
Heffernan studied 40 adults in their early or mid-twenties who took ecstasy at least 10 times a month for up to five years. He found significant impairments in everyday measures of three kinds of prospective memory. The ecstasy users and a group of non-drug users completed questionnaires asking about memory lapses during the previous week and month. The questionnaires probed short-term habitual memory (such as forgetting to switch off an alarm clock in the morning) long-term episodic memory (such as forgetting to pass on messages) and internally-cued memory (such as forgetting what you have come into a room to do). Even when the team controlled for the use of other drugs known to impair memory, such as marijuana, the regular ecstasy users recorded significantly more memory lapses than the non-drug users.

Cognitive health
Previous studies have found that ecstasy impairs other types of memory, such as short-term retention of a list of words. Researchers suspect that ecstasy may be damaging neurons that make serotonin, a neurotransmitter involved in memory. There is a belief that soft drugs – which many consider ecstasy to be – should be legalised when in fact research, including our own, suggests that regular use can have a very damaging effect on your cognitive health, say Heffernan. Whether the memory impairments are long term is not yet clear, he says. This research was presented at the British Psychological Society’s Centenary Conference in, Glasgow, UK.

Source: Author Tom Heffernan. Published on NewScientist.com, March 2001

Ecstasy and cannabis can cause memory loss and impair a person’s ability to conduct a conversation, research shows. A study found drug users often drifted off in the middle of sentences and would repeat a joke or story they had told already. The more cannabis people used, the more they lapsed in their everyday memory, scientists conclude. The findings come from one of the largest studies carried out into the impact of recreational drugs on psychological function. However, it is not representative of all drug takers and involved more than 700 people taking part in an online questionnaire. The snapshot survey looked at drug taking habits and whether they affected people’s ability to remember simple tasks.

Ecstasy users reported similar memory lapses to those taking cannabis. Dr Andrew Scholey, a psychologist from the University of Northurabria, said: The more they had taken ecstasy in the past, the more their long term prospect of memory failed. “This was down to the amount they had used, not the frequency. “The other thing we recorded was the number of errors they made when submitting the questionnaire. “The more people had taken ecstasy, the more errors they made on the form.”

Brain damage
The research team suggest ecstasy targets the frontal lobes of the brain, which are related to memory and organising responses. People with frontal lobe damage caused by accidents often find difficulty concentrating and are More easily distracted, research shows. Psychologists are intrigued that ecstasy users continue to take the drug, despite knowing it is damaging their brain. Dr Scholey said: “It’s bizarre. People are aware of what’s happening to them in terms of deteriorating mental function and don’t seem to do anything about it.” The team recognises the weaknesses of the study. Scholey said: “We have to be cautious in interpreting these types of data. “We are relying on self reports of memory failures in groups with memory problems.

‘However, it’s difficult to see why cannabis and ecstasy users would try to exaggerate these psychological problems.” The study was devised and conducted by UK scientists from the universities of Newcastle, Northumbria, Teeside, East London and Westminster. The majority of those who took part in the questionnaire (75%) were aged between 21 and 25. About 80% came from Europe and 16% were from the USA.

Source: BBC News, 14 March 2002

Physicians should consider the possibility of cocaine use as a culprit when young adults are brought to emergency rooms for nontraumatic chest pains, according to researchers at the UT Southwestern Medical Center at Dallas. Chest pain is the most common complaint of cocaine users, and in 1999 cocaine use was cited in 30 percent of all drug-related emergency department visits. In a review article published in today’s issue of The New England Journal of Medicine, Drs. Richard Lange and L. David Hillis report on the cardiovascular complications associated with cocaine use and effective treatments. “Death from cocaine abuse is on the rise in the United States,” said Hillis, who is vice chairman of internal medicine. “Early identification and understanding of cocaine-related cardiovascular complications are essential to their proper management.”

Lange and Hillis suggest that emergency medical physicians consider cocaine use in young patients with conditions such as arrhythmias, heart attack, inflammation of the heart muscle or dilated cardiomyopathy, a heart defect characterized by increased thickness of the wall of the left ventricle.

In 1999 an estimated 25 million Americans admitted that they had used cocaine at least once; 3.7 million had used cocaine in the past year; and 1.5 million were current users. In addition, medical examiners report that cocaine is the most frequent cause of drug-related deaths. Both Lange and Hillis have published extensively and made novel observations regarding cocaine-related heart disease.

In 1990 the researchers reported that beta-blockers, which are commonly administered to patients with chest pain, were not only ineffective but also detrimental in patients with cocaine-related chest pain. In a 1991 study Hillis and Lange reported that nitroglycerin, which dilates and relaxes blood vessels, had a beneficial effect on patients with cocaine-related chest pains. In 1994 the researchers found that verapamil hydrochloride, a calcium blocker, alleviated cocaine-induced constricted blood vessels. ‘Most cocaine-related chest pains are due to the fact that the blood vessels have been constricted,’ Hillis said. “The most effective treatment for this is nitroglycerin or calcium blockers.”

Source: Authors Dr. Richard Lange and L. David Hillis, published in The New England Journal of Medicine

In the first such case in New Jersey, federal authorities yesterday charged an Atlantic County man with possessing a large amount of the hallucinogen ‘Foxy Methoxy,’ which is said to be similar to ecstasy.
It was one of the largest such seizures in the nation. Foxy is so new and seizures so rare that nationwide statistics are not readily available, Ed Childress, a spokesman for the federal Drug Enforcement Administration in Washington, said yesterday. Every bit as rare, authorities said, is the manner in which they got hold of the drugs: The defendant, from Absecon, notified them and led them straight to the stash. The man is in federal custody and undergoing psychiatric evaluation.
Foxy began appearing at all-night dance parties in 1999, and municipal police departments began seize amounts in 2001 Only a handful of large seizures have followed.

Source: www.momstell.com, Oct 2003

Cocaine use among young adults in Britain is expanding faster than anywhere else in Europe according to a new Drug misuse report. The annual report from the Lisbon based European Monitoring Centre for Drugs and Drug Addiction, giving figures for 2000, shows that 5% of people in England and Wales between the ages of 16 and 29 took the drug at some point during the previous 12 months compared with 1% in 1996.

“Overall, the drug situation in the United Kingdom is very stable, but we have seen a sharp increase in the use of cocaine as it becomes more acceptable on the recreational scene, said Mike Trace, the United Kingdom’s former deputy drugs ‘tsar’ who now chairs the centres management board. Throughout Europe cannabis remains the most popular illegal drug. While 30% of British adults and 25% of Danes have smoked a cannabis cigarette at some point in their lives, just 10% of Finns have done so.

Source: The 2002 Annual Report on the State of the Drugs Problem in the European Union and Norway Reported in BMJ 2002; 325:794

Monkeys exposed to cocaine during pregnancy give birth to Infants whose brains contain fewer than half the neurons needed in the cerebral cortex.

Source: Author M.S.Lidow and Zan-Min Song, Published in Journal of Comparative Neurology Vol 435, Issue 3, 2001

According to a new study by the National Centre on Addiction and Substance Abuse: Alcohol is the leading drug abused by U.S. teens. Under age drinkers account for 19.7 percent of alcohol consumed in U.S. 78 percent of high school students have tried alcohol. 30 percent of them admit to binge drinking at least once a month. Average age of first drink among 12-to-20-year-olds is 14.

Source: www.CNN.com, Feb 2003

Addiction specialists at Harvard University think they have found one reason that cocaine users seem to get sick so often; The drug restricts production of a body protein that triggers immune responses. Doctors have often noted that cocaine users suffer more infections, including the AIDS virus. One theory holds that this is because cocaine users are more likely to engage in dangerous behaviour such as unsafe sex. But a study published in this months Journal of Clinical Endocrinology and Metabolism suggests that cocaine also has a direct effect on the body’s infection-fighting chemistry. The study is one of a handful in the U.S. in which doctors injected human volunteers, rather than rats, with cocaine.

Source: ONDCP News Briefing, Reported in The Wall Street Journal June 2003

Researchers have now discovered another danger of cocaine use. For the first time, scientists have found cocaine significantly accelerates HIV infection. After infecting mice with the HIV virus, UCLA researchers injected half with liquid cocaine daily, while the other half received a placebo injection. Researchers counted the HIV-infected cells after 10 days and found a 200-fold increase in AIDS viral load in mice injected with cocaine compared to those that did not receive the drug. Gayle Baldwin, MD., from the UCLA AIDS Institute, says, ‘In only two weeks, the drug radically stimulated the production and spread of HIV.” In addition, mice with cocaine in their system had more than double the number of HIV-infected cells than cocaine-free mice.

Another significant finding shows a nine-fold decrease in immune cells in the cocaine-exposed mice. Dr. Baldwin says the drug increased HIV’s efficiency so much it nearly destroyed the immune cells HIV targets to destroy the immune system. She says, “Not only did the drug double the number of HIV-infected cells, it produced a nine-fold plunge in the number of T-cells that fight off the virus.” Researchers believe the animal study could lead to additional studies to examine the effects of diet, alcohol and other drugs on the spread of HIV infection.

Source: Author Dr. G. Baldwin. Published in Journal of Infectious Diseases, 2002

Effects of cocaine on the coronary arteries
A study published in the American Heart Journal, commences with the following statement: “A number of studies have documented myocardial ischemia and infarction associated with cocaine use.” The authors did not think that a recreational dose of cocaine, though it increased heart rate by 30 beats and blood pressure by 20/10 mm hg, was significant enough to cause the well-documented sudden cardiac arrest associated with even small doses of cocaine. They noted that Cardiovascular toxicity is broad (cocaine use) ranging from acute aortic dissection or rupture to stoke. Important cardiac complications include sudden death, acute reversible myocarditis, dilated cardiomyopathy, life-threatening arrhythniias, and myocardial ischemia and infarction’. The study found that cocaine causes the diameter of the coronary artery to constrict while at the same time increasing the heart’s need for oxygen. Additionally, they found that cocaine creates a milieu that is favourable to thrombosis (blood clotting). Their conclusion was that these effects, coupled with changes in blood platelets, all worked together to contribute to cardio-vascular problems associated with cocaine use.

Source: Effects of cocaine on the coronary arteries, BS Benzaquen et al, American heart journal, 1 September 2001 (volume 142 issue 3 Pages 402-410 DOI: 10.1067/mhj.2001.117607)

Cocaine toxic effect on endothelium-dependent vasorelaxation: an in vitro study on rabbit aorta
This study examined the toxic effect of cocaine on the vascular system of rabbit hearts. The authors commented that “These findings contribute to clarifying the toxicological profile of cocaine on the vascular target, providing a further explanation for cocaine’s capacity to induce vascular disorders.”

Source: Author G.I. Togna et al. I Toxicology Letters 123 (2001) 43-50

Cocaine induced hypokalaemic periodic paralysis
A recent report in a medical journal discusses ‘episodes of paralysis after engaging in a cocaine binge,’ and states that the use of cocaine has been associated with a number of psychiatric, medical and neurological complications.

Source: Author Lajara-Nanson, Journal Neurol Neurosurgery and Psychiatry, 73:86-95,2002.

Epidemic Crack Cocaine Use Linked with Epidemics of Genital Ulcer Disease and Heterosexual HIV Infection in the Bahamas
A crack cocaine epidemic in the Bahamas, which began in 1982, was found to be the primary factory leading to an epidemic of Genital Ulcer Disease (GUD) and heterosexual HIV infection in that country. By 1999 the Bahamas had the highest rate of reported AIDS in the northern hemisphere. The authors wrote: “The important role of crack cocaine use in facilitating transmission of STD… among inner-city populations in the United States has been repeatedly described. Several studies have shown the risk behaviours associated with use of cocaine, and an increased risk of transmission has been demonstrated to be a consequences of trading sex for drugs. The phenomenon of crack cocaine-enhanced transmission of STD, including HIV infection, has not yet been extensively documented outside North America and the Caribbean. Nonetheless, recognition of this association in North America has alerted other countries to be vigilant in avoiding the crack cocaine epidemic.”

Source: Author Gomez et al, Sexually Transmitted Diseases – May 2002

Cocaine Use, Hypertension, and End-State Renal Disease
A number of recent studies have noted a correlation between kidney failure (end-stage renal disease – ESRD), high blood pressure (hypertension – HTN) and the use of cocaine. In the U.S., Medicare, funded by federal tax dollars, covers the cost of dialysis and transplantation. This study evaluated 193 black patients from two urban hemodialysis units. The authors noted that “Cocaine use among blacks has increased nearly 100% since 1985, now accounting for approximately 23% of U.S. cocaine use. Cocaine use has been linked to HTN, cardiac and cerebrovascular events and acute renal failure, but only recently to chronic renal failure. 113 of the subjects had HTN-ESRD and of those 49 had used cocaine, either alone or in combination with other drugs.

Source: Author Norris et al, American Journal of Kidney Diseases, Vol 28, No. 3, (September),: pp523-528,2001

The operator of the Baltimore Light Rail train that ploughed into a steel barrier at Baltimore Washington International Airport on Feb 13, injuring 22 passengers, tested positive for cocaine after the crash, transportation officials said yesterday: Sam Epps, who had worked for the Maryland Mass Transit Administration for 25-years, was fired Feb 17. He told investigators he was under the influence of prescription drugs at the time of the crash, MTA officials said. The next day, agency officials said, they received the drug test results that showed Epps was under the influence of cocaine.

Source: Reported in Washington post Feb 24th 2000

Researchers determined that women who use cocaine during pregnancy risk affecting the brain structure of their children. In studying the brains of rhesus monkeys, researchers at the University of Maryland found that prenatal cocaine use could result in the loss of more than half of the brain cells in the infant’s cerebral cortex. The highest level of the brain, the cerebral cortex is responsible for such functions as sensation, voluntary muscle movement, thought, reasoning, and memory.

“This is the first study that clearly shows the possibility that cocaine may affect the brain structure. It shows that it could happen,” said Dr. Michael Lidow, one of the study’s authors. “This is a warning sign. For the study, four monkeys were born to mothers who were given 20mg/kg of cocaine per day during the second trimester of pregnancy. Four other monkeys received no cocaine. Researchers found that that the cerebral cortex in the monkeys whose mothers received cocaine contained 60 percent fewer neurons and was about 20 percent smaller than that of the monkeys who received no cocaine.

Lidow said additional research is needed to determine how the study’s findings may apply to humans.

Source: Author Dr. M. Lidow. Published in the Journal of Comparative Neurology. June 2001

More teenagers are using cocaine and regularly smoking and drinking, but an increasing number are also wearing seat belts and refusing to ride with a driver who’s been drinking. Those results were released yesterday in a survey conducted by the Centres for Disease Control and Prevention.

The survey examined the behaviour of 13 600 high school students across the country. The survey found injury and violence-related behaviours have fallen, but lads still regularly smoke and drink – nearly half said they’d consumed more than one alcoholic beverage more than once in the month before the survey.

Source: Survey by centre for Disease Control and Prevention June 2002

Using cocaine, in particular crack cocaine, can result in a fatal tear in the major blood vessel leaving the heart. While cases of aortic dissection are rare, Dr. Priscilla Y. Hsue of the University of California at San Francisco said researchers at San Francisco General Hospital found an unusually high incidence of the condition among cocaine users.

In reviewing all cases of aortic dissection at the hospital over the past 20 years, researchers found that 14 of the 38 cases were directly related to cocaine use. All but one patient had used the drug in the form of crack cocaine. The condition is fatal unless the patient receives prompt emergency surgery. Hsue recommended that doctors and nurses be aware of aortic dissection in cocaine users with chest pain.

Source: Presented at American Heart Association Scientific Sessions 2001 conference, Anaheim, California. Nov 2001

Cocaine damages or even kills the very brain cells that trigger the “high” felt by users of the drug, scientists said today. This first direct evidence of cocaine-induced damage to key cells in the brain’s “pleasure centre” could help explain many aspects of cocaine addiction. It might also aid the development of new anti-addiction drugs and increase understanding of other disorders involving the same brain cells, such as depression.

The American study was performed at the University of Michigan Health System and the VA Ann Arbor Healthcare System. Leader researcher Karley Little said: “This is the clearest evidence to date that the specific neurons cocaine interacts with don’t like it and are disturbed by the drug’s effects”. The study involved post-mortem brain tissue samples from cocaine abusers and control subjects. The samples were from 36 known cocaine abusers and 35 non-drug users of similar age, sex, race and causes of death. The team looked at the cells of the brain that release a pleasure-signalling chemical called dopamine. They analysed overall dopamine levels as well as the amount of a protein called VMAT2 which interacts with dopamine.

The researchers found levels of dopamine and the VMAT2 protein were significantly lower in cocaine users than control subjects. They also found levels tended to be lowest in cocaine users with depression. The research gives the strongest indication yet that dopamine neurons are harmed by cocaine use. Dopamine triggers the actions required to repeat previous pleasures and helps us work, feel emotions and reproduce. It is also involved in a drug users “high’ as cocaine causes levels to build up and so the pleasure signals are repeated over and over. Long-term effects of cocaine on the dopamine system could contribute to addicts’ cravings and account for their decreased motivation, stunted emotions and uncomfortable withdrawal symptoms. Professor Little said the study highlighted the fragility of dopamine neurons and ‘the vicious cycle that cocaine use can create’.

Source: Author Professor K. Little et al. Published in the American Journal of Psychiatry, Jan 2003

Cocaine use “is even more dangerous than we had previously known”. Cocaine causes blood to thicken by increasing the number of red blood cells, and by triggering an increase in a protein that causes platelets to stick together. The ‘double whammy’ can cause clotting that can lead to heart attacks and strokes. A previous study, released in June, showed cocaine users are 24 times more likely to have a heart attack during the first hour after taking the drug. The new study may help explain why.

This study measured changes in the blood of 21 people for an hour after they sniffed a moderate amount of cocaine, or received it intravenously. Red blood cell counts increased 4-6% on average after individuals ingested the drug, due to constriction of the spleen. Cocaine causes the constricting by pumping more red blood cells into the system, Siegel said. The thickened blood must circulate through already-constricted vessels, creating a potentially dangerous situation, Siegel said. Previous studies have shown that cocaine use causes blood vessels to narrow. The study suggests that anticoagulants may be useful in treating cocaine-induced chest pains, Siegel said. He said it provides further warning to athletes who might use cocaine, or substances with a similar effect, in an attempt to enhance performance. While the study’s small sample size made the conclusions preliminary, “we’re very confident that both of these observations are real, he said. The study also found an average 40% increase in a blood protein known as the von Willebrand factor in subjects who received cocaine intravenously. The von Willebrand factor promotes clotting by causing platelets to stick together.

Dr. Steve Frohwein, a cardiologist and assistant professor at the Emory University School of Medicine in Atlanta said several factors – such as infection, cancer or other toxins – can lead to clotting. “Cocaine just stimulates a well-known cascade of events,’ said Frohwein, who was not involved in the study.

Source: Author Dr. Arthor Seigal et al McLean Hospital Boston. published in archives of Internal medicine Sep 1999

Hemorrhagic strokes are significantly more likely to occur in recent cocaine users than in individuals who do not use cocaine, and the mortality rate is also significantly greater.

Dr. Anil Nanda and colleagues, from the Louisiana State University Health Sciences Center in Shreveport, compared stroke outcomes in 16 patients with positive toxicology tests for cocaine with outcomes in 38 patients who had not used cocaine, eight of the cocaine users (50%) had a hemorrhagic stroke compared with just one patient (3%) in the control group. The cocaine users were between 18 and 48 years of age, while the non using group was ‘slightly older,” Dr. Nanda said. Neurosurgical interventions for removal of the aneurysms were completed in all but one of the patients during the 6-year study. The researchers report satisfactory outcomes at 30 days post event in 83% of controls, while just 31% of cocaine users achieved a satisfactory outcome. The mortality rate was 56% for the cocaine users compared with just 2.7% in controls, Dr. Nanda said. The patient groups showed no significant difference in history of hypertension or smoking.
“We need to create a stronger awareness that cocaine does cause strokes”
Source: Dr. Anil Nanda et al, Louisiana State University Shreveport, Reported in 68th annual meeting American Association of Neurological Surgeons California, April 2000

Cocaine may be one of the toughest addictions to cure because it triggers a build up of a protein that persists in the brain and stimulates genes that intensify the craving for the drug, new research suggests. Scientists at the Yale School of Medicine were able to isolate the long-lived protein, called Delta-FosB, and show that it triggered addiction when released to a specific area of the brains of genetically engineered mice. The protein (pronounced fawz-bee) isn’t produced in the brain until addicts have used cocaine several times, or even for several years. But once the build up begins, the need for the drug becomes overpowering and the user’s behaviour becomes increasingly compulsive.
“It’s almost like a molecular switch,” said Eric Nestler, who led the research. ‘Once it’s flipped on, it stays on, and doesn’t go away easily.” The findings were called “elegant” and “brilliant’ by other researchers who said it offered the first concrete proof that drug use triggers a specific long-term change in brain chemistry.

Nestler and his colleagues combined genetic and biochemical research to isolate the Delta-FosB protein and the area of the brain it affected, then did behavioural studies on the mice. Once the level of Delta-FosB accumulates, it begins to regulate genes that control a region of the brain called the nucleus accumbens. an area involved in addictive behaviour and pleasure responses. They speculated that Delta-FosB also activates other genes that produce biochemical compounds called glutamates, which carry messages in brain cells. Receptors in the brain cells become highly sensitive to glutamate, particularly in the nucleus accumbens. To test the theory, they inserted a gene associated with glutamate into the nucleus accumbens of experimental mice. Those mice showed a ‘dramatic increase in cocaine sensitivity, they reported. “This is a major advance in our understanding of addiction,’ said Francis White, chairman of cellular and molecular pharmacology at Finch University of Health Sciences in Chicago.

Other researchers were more cautious, noting that addiction is a complex process in humans because it is linked to learning and multiple chemical pathways in the brain. “It’s not clear to me that there’s a separate molecular pathway that’s going to be assignable to drug abuse and not interfere with other learning,’ said Gary Aston-Jones of the University of Pennsylvania School of Medicine. The craving for cocaine can be so powerful, a recovered addict who has avoided the drug for years may start feeling his or her heart race just by seeing something associated with drug use, such as a $100 bill or a familiar street corner, Aston-Jones said. “You want to knock out the memory for the drug but you don’t want to knock out the memory for the way home,” he said. Steve Hyman, director of the National Institute of Mental Health, said the study also indicated the build up of the Delta-FosB protein might be a factor with other drugs, including amphetamine, morphine, heroin and nicotine.

Source: Yale school of Medicine published in Nature Sept 1999

Researchers found that repeated exposure to cocaine causes a genetic change that leads to altered levels of a specific brain protein called cyclin-dependent kinase 5 (Cdk5). Previous research found that Cdk5 regulates the action of dopamine, a chemical messenger in the brain associated with cocaine’s pleasurable ‘rush’ and with addiction to cocaine and other drugs. Scientists discovered that delta-FosB, a protein, triggers increases in Cdk5 levels. These results suggest that delta-FosB-mediated changes in Cdk5 levels and the resulting alterations in dopamine signalling in brain cells contribute to adaptive changes in the brain related to cocaine addiction,’ said Dr. James Bibb of Rockefeller University in New York City, N.Y., who was involved in the study.

“This research provides a valuable insight into the step-by-step molecular adaptations that the brain makes in response to drugs,” said Dr. Alan I. Leshner, director of NIDA. “These adaptations result in long-term changes at the cellular level that are involved in the development of addiction.”

Source: Dr James Bibb et al Rockefeller University New York city published in Nature March 2001

The huge number of Jamaican women coming into Britain with their stomachs full of cocaine is pushing the already overcrowded female prison system to breaking point. More than 10% of the women currently in prison. Jamaican drug mules who swallowed rubber wraps of cocaine and boarded flights to this country. A Guardian investigation has established that the long sentences being served by the 450 Jamaican couriers are stretching resources to the limit while failing to act as a deterrent to the desperate women prepared smuggle drugs. The crisis has deepened since July, when a glut of women prisoners were sentenced before the courts summer recess. Women are regularly being moved around as prisons try to find them cells and overcrowding blamed for the unprecedented number of suicides within female jails: 17 women have taken their own life since August last year.
Source: Guardian.co.uk Oct 2003

Apart from having mood elevating properties, cocaine is capable of causing myocardial infarction, arrhythmia, sudden death, stroke, seizures, bowel necrosis, and numerous other complications… the full extent of the effects of cocaine on the kidney, however, has become apparent more recently. Additionally, van der Woude noted: “A retrospective study has suggested that cocaine exposure in utero leads to an increased incidence of hypospadia and an increased incidence of renal (kidney) tract abnormalities.

Source: Van der Woude Nephrol Dial Transplant (2000) 15 : 299 – 301

A new British study finds that one in four individuals who visit an emergency room were drinking alcohol around the time of their injury.
The study by Dr. Noelle Murphy and colleagues at Raigmore Hospital in Inverness, Scotland, looked at 600 patients aged 10 and older who visited the emergency room during an eight-week period. Saliva tests of 122 patients – including seven between the ages of 10 and 17 – showed evidence of alcohol consumption. Of those 122 patients, 120 said their injury occurred the day before their emergency-room visit; 19 admitted drinking alcohol prior to the injury, and 14 said they did not drink any alcohol until after the injury occurred. Further research into the injuries found that 94% of the patients who had harmed themselves had alcohol in their blood, while alcohol was present in half of the patients who had been assaulted.

The researchers emphasized that emergency-medicine departments “may be an ideal base for detection and intervention services geared towards minimizing alcohol-related harm.” They added that the findings indicate that intervention efforts may be needed not only for problem drinkers, who represented only a fraction of the emergency-room visitors, but also for the “much larger group of light and moderate drinkers whose drinking patterns may increase the risk of injury or illness.

Source: Author Dr. Noelle Murphy, Emergency Medicine Journal. July 2001

New research concludes that previous studies on the health benefits of moderate alcohol drinking may be flawed, Healthscout reported Sept. 14.
According to researchers in Japan, many of the previous studies erroneously grouped ex-drinkers in with life-long abstainers, inflating the apparent protective effects of alcohol. Dr. Yoshitaka Tsubono, lead author or the study of 25 000 Japanese men aged 40 to 64, explained that people who quit drinking have a higher risk of dying than those who never drank. When former drinkers were factored into the study, the Japanese researchers concluded that moderate drinkers do not have a lower mortality rate than teetotallers.

While previous studies have shown that moderate drinking lowers blood pressure by increasing levels of HDL, known as the good cholesterol Tsubono noted that, “Many, but not all, of these studies showing the decreased risk of total morality associated with moderate drinking have a methodological problem in that they do not separate never-drinkers and ex-drinkers. Ex drinkers might have quit drinking due to ill health and had higher mortality than never-drinkers.”

“The main endpoint of this study is all-cause mortality rather than coronary heart disease,” said Tsubono, a research associate with the Tohoku University Graduate School of Medicine in Sendai, Japan. Our findings should caution researchers and the public to reconsider the existing evidence and the popular notion that moderate drinking is good for general health.”

Source: Author Dr. Yoshitaka Tsubono, published issue of the Journal of the American Medical Association Sep 2001

Government figures show that in the late 1990s, alcohol-related deaths in England significantly increased . According to the government-funded report by the national advocacy group Alcohol Concern the number of alcohol-related deaths increased from 3,853 in 1994 to 5,508 in 1999.
The data indicates that twice as many Britons are addicted to alcohol than other drugs. The report found that one person in 13 is dependent on alcohol, compared to one in 26 addicted to either illegal or prescription drugs. The report also noted that government spending on alcohol prevention and treatment in England and Wales was about $1.45 million, compared to the $132.6 million spent on issues pertaining to illegal drugs.

“The sheer breadth and scale of the problems reinforce the need for urgent joined-up action at a national level,” said Alcohol Concern Director Eric Appleby. ‘What we need is a coordinated strategy that concentrates on prevention of harm, and tackles alcohol misuse on all fronts – education, public campaigns, community safety, counselling, and treatment.”

Source: Reported by associated Press Nov 2001

The number of children being born with foetal alcohol syndrome (FAS) is rising, with an estimated 5 000 FAS babies born each year. According to the Centres for Disease Control and Prevention (CDC), cases of foetal alcohol syndrome are up six-fold since the mid-1980s. Furthermore, about 50 000 babies each year have disabilities stemming from maternal use of alcohol during pregnancy. Children born with FAS suffer stunted growth and facial deformities, attention and behaviour problems, and, in some cases, mental retardation. Foetal alcohol syndrome is the leading known cause of mental retardation.

Experts point out that children never outgrow FAS. As a result, each afflicted child will cost $1.4 million over his or her lifetime in institutional and medical costs. Louise-Floyd, acting chief for the CDCs Foetal Alcohol Branch said waning education about FAS and increased publicity about the health advantages of certain types of alcohol has resulted in women viewing alcohol as more benign than other drugs. “They think, ‘If I’m not using heroin or cocaine like the people down the street, if I just using beer, that’s OK,” Mitchell says.

Source: Louise Floyd, Center for Disease Control Sept 2001

Frequent binge drinkers make up only 19% of the college population, yet account for 68% of alcohol consumed by college students.
Source: Harvard School of Public Health College Alcohol Study.

Non-binge drinkers represent 57% of the college population and only consume 9% of the alcohol.
Source: Harvard School of Public Health College Alcohol Study.

The 1997 Harvard School of Public Health College Alcohol Study found that among college drinkers, 28% reported being drunk three or more times in the past month compared to 23% in 1993.
Source: Centre for Substance Abuse Research (CESAR)/University of Maryland, October 5, 1998

Nearly half of all college students binge drink (five or more drinks at a time for men, four of more for women). On a national scale (USA), this is about three million students.
On campuses where more than 70% of the student body binge drinks, 87% of the students report experiencing problems such as physical assault, sexual harassment and impaired sleep and study time.
Source: Wechsler, Henry et al. “;Health and Behavioural Consequences of Binge Drinking in College”; Journal of the American Medical Association, Vol. 272, No. 21(1994) pp. 1672-1677

As many as 360 000 of the USAs 12 million undergraduates will eventually die from alcohol-related problems, many of which began in college. This is more than the number who will get MAs and PhDs combined.
Source: Eigan, Lewis. Alcohol Practices, Policies and Potentials of American Colleges and Universities. An OSAP White Paper. Office for Substance Abuse Prevention, Rockville, MD, February, 1991

A family history of alcoholism places a person at greater risk of developing alcohol problems. Children of alcoholics also tend to exhibit other types of behavioural and emotional problems. The neurotransmitter serotonin is believed to regulate many behaviours and emotions. Genetic variation in the serotonin transporter gene may partially determine overall levels of serotonergic function. Children of alcoholics (COAs) have a high risk of developing alcoholism, simply by virtue of their family history of alcoholism. Many studies have found that COAs also tend to exhibit high levels of behavioural and emotional problems. Researchers explore biochemical basis of two aspects of ‘behaviours of under control.’ Their findings indicate that behavioural disinhibition (BD), such as impulsive aggression, and negative affect (NA), such as depression and anxiety, may be genetically influenced through the regulation of a neurotransmitter called serotonin (5-HT). “Serotonin’s primary role appears to be that of an inhibitor,” explained Geoffrey R. Twitchell, Postdoctoral Fellow at the UCLA Integrated Substance Abuse Programs and lead author of the study. “Dysfunction in 5-HT neurotransmission has been found in individuals who exhibit problems with behavioural and affective control.

For example, 5-HT deficits have been observed in antisocial alcoholics who exhibit BD, such as aggressiveness and difficulty controlling alcohol consumption. The relationship between 5-HT dysfunction and impulsive aggression in non-alcoholic groups has also been reliably documented. In addition, many studies have found 5-HT dysfunction in individuals who exhibit increased NA, as indicated by depression and anxiety. Depressed and highly anxious individuals are often treated with 5-HT enhancing medications such as selective serotonergic reuptake inhibitors.”
“Exactly how a serotonergic dysfunction relates to BD and NA is the realm of great speculation, “commented Robert O. Pihl, professor of psychology and psychiatry at McGill University. “Because serotonergic dysfunction seems related to an exceedingly wide range of behaviours, a likely explanation is that of a regulatory role for many biochemical systems in the brain. A speculative analogy has serotonin acting much like the maestro of an orchestra, able to meld disparate sections in order to produce music rather than cacophonous noise. Thus, without appropriate modulation — which we assume is supplied by serotonin — individuals will overreact to emotional stimuli.”

Knowing of the strong association between serotonergic dysfunction and behavioural disorders such as alcoholism, aggressiveness and depression, researchers wanted to further examine genetic variations in the serotonin transporter gene (5-HTTLPR) Genetic variation in 5-HTTLPR is related to efficiency in 5-HT reuptake, one aspect of 5-HT functioning. The long (LL) variation or genotype has been associated with an increased number and function of 5-HT transporters (the 5-HT structure that recycles synaptic 5-HT back into the pre-synaptic neuron) when compared to the short (SS) or the short/long (SL) genotypes. An increased functionality of the 5-HT transporter has the effect of reducing the amount of 5-HT available in the synapse. Decreased synaptic 5-HT has the effect of decreasing overall 5-HT functioning. Some psychiatric genetic studies had previously documented a relationship between the SS variant of 5-HTTLPR and alcohol dependence, depression, anxiety, and the personality trait neuroticism (which is also a marker of NA) Some studies of alcoholics, however, have found a relationship between the LL variant of 5-HTTLPR and low levels of response to alcohol, alcohol dependence, and antisocial alcoholism. For the current study, researchers examined 47 families classified by the fathers’ alcoholism subtype (The data were taken from a larger, ongoing longitudinal family study on risks for developing alcoholism and other problems).

The authors found that the LL genotype of 5-MTTLPR was associated with both BD and NA in COAs. In addition, significantly more LL than SS/SL genotype children reported they had already consumed alcohol. “This finding,” said Twitchell, “supports the hypothesis that behavioural and emotional problems in COAs, which put them at increased risk for later development of alcoholism, may be genetically regulated in part by the 5-HT transporter. In other words, the 5-HTTLPR genotype may serve as a marker for vulnerability for COAs. “The results of this study are fascinating,” said Pihl. “Although we have learned to cautiously view genetic studies that attempt to explain behaviour; this one makes sense. It suggests an overactive transporter gene which could result in a deficiency of serotonergic synaptic functioning. This is another strong piece of evidence in this evolving story. However,” he added, “there remain gaps in our knowledge. We continue to be in a state much like what Newton described when he said ‘we are finding interesting pebbles while the great ocean of truth lays undiscovered before us.’” Twitchell hopes to move beyond those pebbles one day. “Our group plans to follow these children over time with complete psychosocial assessments at three-year intervals into adulthood,” he said. “Our finding of higher rates of alcohol consumption in LL genotype children as young as a mean age of 10.88 years is important because it suggests that this liability manifests early in one’s life course. Those with a family history of alcoholism may want to be aware of their increased risk and monitor their alcohol use accordingly.”

Source: Authors Geoffrey R Twitchell et al Reported in Alcoholism: Clinical and Experimental Research, July

Long-term abstinence from alcohol reverses some of the structural changes in the brain associated with heavy consumption, according to a report in the November issue of Alcoholism: Clinical and Experimental Research. Chronic alcohol abuse brings changes in the grey and white matter of the brain readily visible by magnetic resonance imaging, as well as possible metabolic consequences discernible through magnetic resonance spectroscopy (MRS), the authors explain.

Dr. Dieter J. Meyerhoff and colleagues from the Veterans Affairs Medical Center and the University of California at San Francisco compared quantitative MRI and MRS results from 12 recovering alcoholics and eight actively heavy drinking (AHD) subjects. Recovering alcoholics had significantly greater white matter volume in the frontal lobes than did the AHD subjects, the authors report, whereas white matter volumes in the other regions examined were lower. Among recovering alcoholics, frontal white matter volume percentages showed a positive correlation with duration of abstinence from alcohol.

In contrast, the report indicates, white matter lesions occupied lower volumes in recovering alcoholics than in AHD subjects in all areas except the frontal lobes. Cortical grey matter volume was higher in the orbital frontal pole and somatosensory cortex of recovering alcoholics, the researchers note, but lower in the anterior cingulate. As measured by MRS, the metabolites of N-acetyl-aspartate, creatine, and choline did not differ between the two groups.

Source: Author Dr. Dieter J Meyerhoff University of California Reported in Alcohol Clin Exp Res 25: 1673-1682. 2001

A blood alcohol concentration (BAC) indicates both a level of intoxication and severity of toxicity. Nicotine can significantly reduce the peak BAC among newborn rodents. People who drink and smoke at the same time may consume more alcohol to achieve a desired level of intoxication. The more alcohol consumed to attain ‘intoxication’ in the presence of nicotine, the greater the build up of toxic agents in the system. Mixing alcohol with other drugs over the counter, prescription, legal or illegal is a recipe for damage. The concurrent use of aspirin and alcohol, for example, leads to more severe effects on foetal brain development than the use of alcohol alone. Heartburn medications such as Tagamet and Zantac slow the activity of a stomach enzyme that is responsible for breaking down alcohol, thereby leaving organ systems exposed to alcohol’s toxic effects for an extended period of time. Alcohol and cocaine together exert more cardiovascular toxicity than either drug alone; they also produce a compound called cocaethylene, similar to cocaine but more lethal. Now a study confirms the damaging interaction of alcohol and nicotine.

Blood alcohol concentration is an important determinant for level of intoxication and severity of toxicity. Results confirm that blood alcohol concentration can be significantly reduced in the presence of nicotine. In a prior study, Chen and his colleagues had found that high doses of nicotine lowered blood alcohol concentrations (BACs) among neonatal rats. In this study, they found that even low nicotine doses have an effect on SACs. In either case, the results indicate that people who drink and smoke at the same time will have to drink more if they want to feel any kind of intoxicating effect. “In the alcohol field, we know that alcohol abusers generally ‘drink to effect’, ” said Susan E. Maier, research assistant professor in the department of human anatomy, College of Medicine, The Texas A&M University System Health Science Center. “This means they drink until they feel an expected level of intoxication from alcohol. It is also known that smokers drink more alcohol than non-smokers, and that people who misuse alcohol are more likely to smoke than those who do not misuse alcohol. The findings from this study suggest a possible reason why this may occur. If nicotine lowers the BAC, more alcohol needs to be consumed in order to achieve that ‘alcohol intoxicating effect’. The consumption of sufficiently more alcohol to reach that ‘high’ may lead to adverse effects on organ systems other than the brain, such as the liver and the heart.

The first step in the metabolism of alcohol is its conversion to acetaldehyde, which belongs to a class of compounds called aldehydes (such as formaldehyde, a disinfectant and preservative). Acetaldehyde is a highly reactive and toxic chemical that can damage the cells of all living things.
Although nicotine reduces a person’s BAC, possibly leading them to drink more, nicotine does not affect the levels of agents such as acetaldehyde. The level of acetaldehyde would likely continue to build up in the system and have an adverse effect on the brain, liver and heart.
Research primarily concerns the effects of substance abuse on the developing brain. So most of my studies uses newborn rat pups. This is the developmental stage that most closely represents the brain-growth equivalent of the human fetus during the third trimester. However, results from adult rats show same effects of nicotine on reducing the BAC. Although Chen was hesitant to equate the nicotine doses used in the rodent study to human use because of the confounding effects of a number of variables (metabolism, smoking habits, smoking preferences, etc.), he did comment on what would have been considered a medium nicotine dose in the study. “There is limited information in the literature,” he said, “to suggest that 1.5 mg/kg/day administered to rats may be equivalent to a human smoking one pack of cigarettes in a day.”

“The best discoveries in science,” said Maier, “are those that come from serendipitous findings, and I believe that the results described in this study fall into that category. What we once thought was coincidence — that smokers drink more alcohol — has suddenly gained a plausible explanation from the results of this study. Despite a plethora of studies examining the effects of each drug alone on various parameters, it is not until the interactive effects of both drugs are examined do exciting and important findings such as these reveal themselves.”

Source: Author Prof Wei-Jung A. Chen Assistant Professor of Anatomy and Neurobiology, Texas University. Reported in Alcoholism: Clinical Experimental Research July 2001

This study examined early behavioural outcomes among young children of alcoholics (COA) as a function of differences in subtype of paternal alcoholism. Participants were 212 children (106 girls and 106 boys, ages 3 through 8) and both of their biological parents. Families were characterised as antisocial alcoholics, non-antisocial alcoholics, and non-alcoholic control. There were significant familial subtype group differences on parent reporting measures of children’s total behaviour problems, externalizing behaviour, internalizing behaviour, and on measures of children’s intellectual functions and academic achievement. In all instances, COAs had poorer functioning controls. In the behaviour problem domain, but not for the domain of intellectual functioning, children from antisocial alcoholic families had problems than children from nonantisocial alcoholic families. In addition subtype effects, boys had higher levels of behaviour problems than girls in three areas, and older children had more internalizing problems than younger children. Maternal functioning pertaining to lifetime alcohol problem involvement and antisocial behaviour also contributed to child subtype differences in internalizing behaviour. Results indicate that, even at very ages, male and female COAs are heterogeneous populations that are distinguishable by way of familial subtype membership, as well as distinguishable from their non-COA peers. Thus, findings underscore the need to consider the heterogeneity of alcoholism when looking at its effects on development.

Source: Puttler LI, et al Department of Psychiatry,Alcohol Research Centre, University of Michigan Ann Arbor, USA
Published in Alcohol Clin. Exp. Research Dec. 22 (9):1962-72. 1988

People who abuse both alcohol and other drugs have the highest risk of injury. The association among alcohol and other drug use and injury is well documented. Alcohol alone is known to be a factor in 60 to 70 percent of homicides, 40 percent of suicides, 40 to 50 percent of fatal motor vehicle crashes, 60 percent of fatal burn injuries, 60 percent of drownings, and 40 percent of fatal falls. Miller and his co-authors examined medical claims data from a database for 1.5 million people with health care coverage provided by 70 large corporations. Specifically, they analysed the injury-claims histories during a three-year period of people who were treated for an alcohol-or drug-related diagnosis.

“We included all medically treated non-work injuries except alcohol and drug poisonings,” said Miller. “This included falls, car crash injuries, assaults, suicide attempts, near-drownings, suffocations, poisonings that were not substance-abuse related, injury deaths in the hospital, among many others. We excluded medical misadventures that resulted in injury. We also excluded injuries treated at the same time that someone was admitted to the hospital primarily for substance-abuse treatment, because some of those injuries might not have been treated in the absence of the substance-abuse treatment. This latter decision considerably lowered our injury counts for substance abusers, making them conservative.’ Despite the conservatism of their injury findings, the researchers found a notable difference in the risk of injury between those who abused alcohol and other drugs and those who did not. Those individuals clinically identified as substance abusers had an elevated risk of injury. Alcohol-and-drug abusers had the highest risk of injury (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and those who did not abuse any drugs (38%). Compared to those without a diagnosed substance-abuse problem, said Miller, alcohol abusers were twice as likely, drug abusers were three times as likely, and alcohol-and-drug abusers were almost four times as likely to be hospitalized for an injury during the three years examined.

“This study provides important evidence regarding the extent of substance abuse disorders and injuries in a population of people who are employed and receive insurance coverage through their employers, said Linda C. Degutis, assistant professor of surgery and public health at Yale University. Each year, she added, substance abuse costs businesses at least $10 billion in absenteeism, injuries, medical liability and health care costs.

Investment in treatment is an effective strategy to reduce these costs,’ said Degutis “Research shows that, following substance abuse treatment, absenteeism, disability days and disciplinary actions all decrease by more than 50%. Adults who complete inpatient alcohol treatment have significantly lower health care utilization than they had prior to treatment. Their use of medical services is cut in half, while they use 60 percent fewer psychiatric services, have a third fewer emergency admissions, and show a 75% reduction in detoxification admissions. However, in order for treatment to occur, the problems must first be identified.”

Both Miller and Degutis noted that health care practitioners – particularly family physicians and trauma personnel – have an invaluable, yet often overlooked, role in detecting, intervening on the behalf of, and referring substance-abusing patients to the appropriate care. Miller said that family physicians have an especially important role in helping older, female substance abusers. “Addiction is a brain disease,” she said “Too often, addiction is treated as a moral issue, or a ‘defect’ in someone’s personality or behaviour or judgement. There are many things that can place someone at risk for developing an addiction, and we now know that it can have a genetic basis, It is a chronic disease, just like heart disease, diabetes, and other diseases. Unfortunately, there is still a great deal of stigma related to addiction and substance abuse, In fact, the very term ‘substance abuse’ somehow implies that the person with an addiction is responsible for the problem. We should not be reluctant to discuss these issues, and should bring them out into the open, just as we have done with diseases such as breast cancer, prostate cancer, and heart disease.”

Source: Miller et al at Pacific Institute for Research and Education Dec 2000

New figures show that more than three million people in the United Kingdom are addicted to alcohol. According to the report from the non-profit organization Alcohol Concern one in 13 adults is dependent on alcohol, which is twice the number of people addicted to other legal and illegal drugs. “The fact that over three million people can’t get through the day without getting a fix of alcohol should surely worry all concerned,” said Eric Appleby, chief executive of Alcohol Concern. Alcoholism is more prevalent among those living in the South East region of Britain, where nearly half a million people are dependent on alcohol.

“The bottom line is that some of the most vulnerable people in our society are not receiving the basic levels of support needed to help them get back on their feet” said Appleby. “For example, there is little prospect of isolated people, living in remote areas, travelling miles to get to their nearest source of help. We need to be more imaginative about treatment models, the way they are delivered and who delivers them”.
The report also found that those with alcohol dependency also have a high rate of mental problems. “For this reason, mental-health service planners and commissioners must include alcohol services in their local service plans” Appleby said.

Source: Reported on BBC March 4, 2003

A recent study on the in-prison drug treatment program at the Richard J. Donovan Correctional Facility in San Diego County found that only 16% of its inmates who also completed an after-care program came back into the system within two years of their release. State wide, the recidivism rate is about 70%.

“You’ll get a lot of complaining in the first 30 to 60 days, then things will settle down, if the programme is good,” said Douglas Anglin, director of the UCLA Drug Abuse Research Centre. When you follow them up five years later, coerced clients, in every well-designed study, they do better than voluntary clients. These are very well-established findings.”

Source: Reported in Join Together May 1999

In 1996 U.S. Federal legislation ended paying disability benefits for drug addiction because it was thought that addicts were using most of the money to purchase drugs. Scott D. Halpern, BS, and C. Crawford Mechem MD. has found that the drug related death rate for those receiving welfare disability and military benefits, is highest at the beginning of the month when these individuals receive their cheques, and tapers off as they use up their allotment.

In the same publication, a commentary on the study by Jeffrey Samet, MD MA, MPH, begins by stating, ‘Any physician who has spent even a short period of time caring for patients in an emergency department recognizes how common substance abuse is among these patients. This phenomenon has been documented in the emergency medicine literature for both psychiatric and medical problems’. Dr. Samet wrote further that the Halpem-Mechem study provided more credibility to the hypothesis that disposable income in the hands of someone with alcohol or drug problems may result in greater consumption of problem substances and stated that he believed “This work raised the possibility of new ways to minimize the harmful consequences of substance abuse by addressing a potential relapse trigger or exacerbating factor, the monthly federal cheque,” thinking, perhaps, about the use of vouchers or a debit card which would work only for specific purchases, a strategy that has been used to curb the misuse and trafficking in food stamps.

Drug use is accompanied by poor decision making, irresponsible behaviour, violence, increased illness, unemployment, and poverty. It is, therefore, understandable why the vast majority of those serving time in jails and prisons are there for crimes committed under the influence of mind-altering and addictive substances.

Source: Scott D. Halpern, BS, and C. Crawford Mechem MD, The American Journal of Medicine, Vol. 110 Apr 1, 2001

Why do men fight? For centuries, philosophers have pondered this question. Some have suggested that aggressive behaviour is part of the male make-up; others claim that fighting is a socially inspired behaviour, a belief that has led to a wide range of child-rearing tactics. Poets and writers of great literature may be disappointed to learn that the aggressive male passions that have caused duels, skirmishes, and wars are the result of reduced levels of serotonin in the brain. Why men? A group of researchers from the University of Akron state the Y chromosome that determines “maleness” (as opposed to the XX in females) governs serotonin levels. When stimulated, serotonin decreases, testosterone increases, and aggression results.

Methodology and results
Resident intruder tests were used to measure the aggression and stress of male and female rats. In a colony of male and female rats a hierarchy is established, with male rats assuming a dominant role over the female rats. Different male and female rats were then introduced into the established colony. Male intruders were attacked 2.6 times and received 1.8 scars over 15 minutes. Female intruders were not the perpetuators or recipients of any attack.
Norepinephrine, dopamine and serotonin were measured by high performance liquid chromatography (HPLC) in various regions of the brain including hypothalamus (VMH), media amygdala (AME), lateral amygdala (ABL), and hippocampus (HPC). Norepinephrine content of VMH, AME, ABL, and HPC was not statistically different between the two sexes. However, values of dopamine in ABL of males were significantly less than corresponding female rats; levels of serotonin in the AME and ABL were also less in males compared to females.

Conclusion
In males, decreased serotonin in the amygdala was associated with increases in aggressive behaviour. Whether this relates only to the presence of the Y chromosome or to a combination of the Y chromosome and male hormone testosterone, remains to be determined.
Source: Authors Jonathon Toot et al , The University of Akron, Ohio presented at an American Psychological Society (APS) conference held October 17-20, 2001.

A new Canadian national study details the relationship between alcohol and other drug addiction and crime, the Canadian Press reported April 30. The three-year study, conducted by the Canadian Centre on Substance Abuse (CCSA), was based on interviews with 10 male and female prisoners in provincial and federal institutions.

According to researchers, 54% of the prisoners who participated in the study were under the influence of alcohol or drugs when they committed their crimes. The study found that alcohol is often behind violent crimes such as murder and assault, while illegal drugs are more commonly associated with break-ins and robberies.

“This report tells us two main things,” said Federal Solicitor General Lawrence MacAutay. “It tells us that drugs and alcohol cause crime – they aren’t just related – and that the cost of this abuse on Canadians is high.”

Michel Perron, head of the CCSA, added that the study “confirms for many people in the field of addictions what we’ve known all along: that the nexus between alcohol, drugs, and crime is very strong This is a huge factor contributing to crime in Canada.”

Source: Join Together Online May 2002

Results from a teen survey show that adolescents who live in violent communities are more likely to use alcohol and other drugs. The survey by researchers at Middleheim Hospital in Antwerp, Belgium, included 3380 teens aged 14 to 17 living in urban regions in Belgium, Russia, and the United States. The researchers found a link between alcohol and other drug use, and teens being either directly threatened with violence or witnessing threats or acts of violence between others. For the survey, violent acts were defined as being mugged or beaten up, attacked with a knife or gun, chased, or wounded. According to the researchers, the more violence teens witnessed, the more likely they were to smoke cigarettes or marijuana, consume alcohol, or use hard drugs.

Dr. Robert Vermeiren, who led the study, said this trend could be a worldwide urban phenomenon. “Prevention and treatment initiatives that target substance use and dependence should focus on the role of community violence as part of their intervention” the authors recommended.

Source: Author Dr. Robert Vermeiren et al Published in Journal of Paediatrics, 111:535-540 March 2003

The number of people killed in road construction zones around Illinois has varied from year to year, but been relentless:
17 in 1999
38 in 2000
36 in 2001
31 in 2002
according to the Illinois Department of Transportation.
Police have been doing a fine job making DUI arrests. Legislators have been doing a fine job passing stricter laws against DUI offenders. Some judges, however, have fallen short when it comes to enforcing those laws. That deserves far more scrutiny than it has received.

Source: http://www.chicagotribune.com

Research published in the journal, Forensic Science International (2001), noted that the profile of individuals dying from the use of illicit substances has changed considerably since the 1960’s, when the use of psychoactive and addictive substances began to find its way into the mainstream population.

The researchers looked at the physical condition of IO individuals whose deaths, attributable to the use of illicit drugs, occurred consecutively from 1995 to 1997, as we as the circumstances at the scene of death. They noted that though the general public and scientific literature has tended to believe that drug users are always neglected, untidy, down-and-outs, found mainly in public restrooms after having died from intoxication, that was not the case with most of these 100 victims. The researchers found that often signs of drug use are not present at death and suggested that ‘Death from drug consumption should be taken into account even it there are no drug-addiction utensils found at the scene, no visible injection marks and no signs of physical neglect.’
On autopsy, 86% were found NOT to be undernourished, and only 11% were found in public places. Interestingly, 63% were tattooed, including seven depicting cannabis leaves, and 95% showed signs of previous injection drug use.

Source: Authors: Michael Bohnert, Minou Hafez Stefan Pollak. Institute Forensic Medicine, University of Freiburg, Germany. ‘The changing phenomenology of drug death over the year’. Forensic Science International 124(2001) 117-123

Drunken driving has pushed Alabama’s highway death toll up to its highest point in four years.

Forty percent of all highway fatalities last year were alcohol-related and most of those wrecks happened Sunday mornings. The critical time was between 1am and 3am on Sundays – about the time most bars close. Alabama alcohol-related highway fatalities increased 10 percent in 2002 over the previous year. They rose from 374 in 2001 to 413 in 2002, according to the Fatality Analysis Reporting System of the National Highways Safety Administration.

Source: http://www.al.com

Nico, a mineral water drink laced with nicotine is being launched in the US, reports the Daily Express. Increasing restrictions on smoking in the was the inspiration behind the product say its manufacturers. The water has eight milligrams of nicotine – the equivalent of about four cigarettes – in every litre. The makers say it is intended as a crutch for smokers trying to quit and as an alternative nicotine hit for those who cannot smoke due to restrictions. However, the Campaign for Tobacco Free Kids warned that Nico could have the potential for being both hazardous and serving as a first step into addiction for children.

Source: Daily Express, 27 May 2002

The health of Scottish women, who have the highest mortality rate in Western Europe, is worsening compared with those of other European nations, with smoking cited as one of the major reasons.

Despite major campaigns to remove the ‘sick man of Europe” label that has dogged Scotland, research shows that women’s health is consistently failing to improve compared with the rest of the UK and countries on the continent.

Professor Leon, an epidemiologist, who last week addressed delegates at a conference by the Royal College of Physicians in Edinburgh on Scotland’s health, compared the mortality rates of Scottish women aged 15 and 74 with 17 other Western European countries. Mortality rates were calculated by the number of deaths per 100 000 of the population.

Source: The Scotsman, 24 May 2002

The Czech Senate rejected a law that would have almost entirely banned tobacco advertising within two years. The Senators opposing the law said it was too broad. Instead, they want measures that mainly protect children and youth, a strategy which is uncannily similar to tobacco industry’s own attempts at self regulation.

The challenge to the ad ban would come as a great disappointment to anti tobacco campaigners in the Czech republic, a country with a high incidence of smoking prevalence and at times misinformed ideas about smoking. Even the prime minister Milos Zeman, declared on television in March 2000 that “by smoking, I contribute to the stability of the state budget. By buying cigarettes I increase state revenues, and I will die of lung cancer, so the state won’t have to pay me a pension.”

Last year, Philip Morris was found to have commissioned a report on the Czech market and sent its findings to the Czech government, suggesting that a smoking population was healthier for the economy due to excise taxes and “healthcare cost savings due to early mortality.” Despite the rejection by senators, the Czech ad ban measure may yet pass if the parliaments lower chamber approves it with a single majority.

Source: Wall Street Journal Europe, 27 May 2002; The Guardian 17 July 2001

Football’s governing body yesterday accused British American Tobacco of duplicity in a major escalation of the row over the company’s use of players and the World Cup to promote cigarette sales. Fifa issued a strongly worded denunciation of the London-based corporation after BAT claimed it had permission to publish pictures of stars and use TV coverage in Malaysia to promote its Dunhill brand. The World Cup has been declared a tobacco-free competition under an accord struck between Fifa and the World Health Organisation, a UN body, with cigarette advertising and sponsorship banned.

Fifa officials admitted the Malaysian League had obtained TV rights from KirchSport two months before the anti-smoking declaration and, embarrassingly, subsequently sold them onto BAT. But Fifa accused BAT of exploiting pictures of stars such as David Beckham and Michael Owen to push Dunhill and wrongly suggesting it was directly linked to the tournament in Korea and Japan. Keith Cooper, Fifa’s director of communications, said: “It is regrettable that this agreement was completed before our own accord with the WHO.

Full Article: http://www.guardian.co.uk/archive/Article/0,4273,44213429,00.html

Source: The Guardian, 25 May 2002

Parents are unaware of the health risks of passive smoking on their children, a new report by ASH has shown, Only a quarter of parents are aware asthma can be a risk. And just 3% of parents identified cot death as a consequence of passive smoking. The survey says the two in five children in the UK who live with at least one smoker are at risk. However, parents in other countries are taking note of the health risks of passive smoking to children. In Australia, for example the proportion of smokers who restricted smoking in their homes rose from 2% in 1989 to 32% in 1997.

ASH’s research manager Amanda Sandford said: “Parents must recognise that passive smoking causes ill-health in children. Parents who smoke must accept there is a risk attached not only to their health, but to their children’s too.” She called for more government campaigns to raise parents’ awareness of the risks to their children of developing illnesses including asthma, bronchitis and glue ear. She said: “Clearly, the best way to eliminate children’s exposure to passive smoking is for parents to stop smoking and to make their homes smoke-free.”

But she said if parents could not or would not stop smoking, they should try to limit their child’s exposure to tobacco smoke. ASH quotes World Health Organization figures which indicates babies are at five times greater risk of cot death if their mothers smoke. Children also have a 20 to 40% increased risk of asthma if they are exposed to tobacco smoke, and a 70% increased risk of respiratory problems if their mother smokes. ASH says 17,000 children are hospitalised every year because of passive smoking. The survey was carried out by SmokeFree London. The questioned 2,000 people, 22% of whom were parents.

Source: BBC Online. May 2001

Cross-sectional study conducted from September 2000 to November 2000 among 30 Japanese men (mean age, 27 years; 15 healthy non-smokers and 15 asymptomatic active smokers) without history of hypertension, diabetes mellitus, or hyperlipidemia. Coronary flow velocity reserve, calculated as the ratio of hyperemic to basal coronary flow velocity induced by intravenous infusion of adenosine triphosphate and measured in each participant before and after a 30-minute exposure to environmental tobacco smoke.

Results
Heart rate and blood pressure responses to adenosine triphosphate infusion were not affected by passive smoking exposure in either group. Passive smoking exposure had no effect on basal coronary flow velocity in either group. Mean (SD) CFVR in non-smokers was significantly higher than that in active smokers before passive smoking exposure (4.4 [0.91] vs 3.6 [0.88] respectively; P =0 .02), while CFVR after passive smoking exposure did not differ between groups (P = 0.83). Passive smoking exposure significantly reduced mean (SD) CFVR in non-smokers (4.4 [0.91] vs 3.4 [0.73] respectively; P<0.001). Conclusions
Passive smoking substantially reduced CFVR in healthy non-smokers. This finding provides direct evidence of that passive smoking may cause endothelial dysfunction of the coronary circulation in non-smokers.

Source: Author R Otuska et al JAMA. 2001; 286:436_441.

The European Commission has published a new directive to ban tobacco advertising Europe-wide. The directive covers TV, radio, internet and print advertising as well as sponsorship of sport and a ban on the promotion of cigarettes at sporting events. The new directive is designed to ban tobacco advertising that crosses borders and therefore excludes advertising in cinemas or on posters. It was the inclusion of the latter which lead to the previous directive being struck down by the European Court of Justice ASH said the new proposals were a “good start but could do better”. John Connolly of ASH said: “Tobacco advertising gets more people smoking, and persuades smokers to keep smoking. This directive is a promising first step towards controlling advertising across the EU. It’s a shame, though that they didn’t take this opportunity to publish something stronger.” ASH and other health groups are pressing for the directive to include ‘brand-stretching’ (indirect advertising) and direct mail.

Source: International Herald Tribune, Daily Express, E Independent, Wall St Journal, 31/5/01

New research clearly shows that longer-term methadone maintenance therapy (MMT), combined with some psychosocial counselling, is a far more effective treatment for heroin addiction than is simply the temporary use of methadone to detoxify patients and reduce drug craving, even when the detoxification is coupled with much more intensive psychosocial therapy.

“The findings from this study clearly indicate that methadone maintenance is an effective treatment for heroin addiction,” says Dr. Alan I. Leshner, NIDA Director. “This is yet another indication that MMT should be used more widely as a treatment option for heroin addicts. Currently, only about 20 percent of the 810 000 diagnosed heroin addicts in the U.S. receive this treatment.” Study director Dr. Sharon Hall says, “The goal of this study was to determine whether short-term methadone-assisted detoxification, when enriched with intensive psychosocial services and aftercare, could provide an effective alternative to MMT. Our results show that no matter how ideologically attractive the notion of a time-limited methadone treatment for heroin abusers, longer-term methadone maintenance treatment is far more effective.”

The researchers interviewed 179 heroin- or cocaine-dependent volunteers monthly, for 12 month after their admission to the study. The volunteers were randomly divided into two groups methadone maintenance treatment group and a methadone detoxification group. The MMT group was eligible for 14 months of methadone maintenance, followed by a 2-month detoxification. Participants in this group were required to attend substance abuse group therapy 1 hour per week for the first 6 months of maintenance, and 1 hour per month of individual therapy.

Patients in the detoxification group received methadone only for the first 180 days of their treatment. During their first 6 months of treatment, the detoxification group was required to attend 2 hours per week of substance abuse group therapy; 1 hour per week of cocaine group therapy (if they had tested positive for cocaine when admitted to the study); a series of 14 1- hour, weekly substance abuse education classes; and 4 weekly individual therapy sessions. This group also received 6 months of aftercare services that included weekly individual and group psychotherapy and liaison services with the criminal justice system, medical clinics, and social service agencies, but no additional methadone after the first 180 days of their treatment.

Study results showed that more patients in the MMT group remained in treatment for longer periods of time (438.5 days vs. 174 days) and had lower heroin use rates than did shorter-term methadone detoxification patients. Of the MMT group, 77 out of 91 patients were still in the study at the 12-month mark, while only 57 of 88 methadone detoxification patients were still in the study. MMT also resulted in a lower rate of drug use-related HIV-risk behaviours and a lower level of criminal activity.

Source: Study Director Dr. Sharon Hall, “ Methadone Maintenance versus 180-day Psychosocially-Enriched Detoxification for Treatment of Opioid Dependence: A Randomized, Controlled Trial,”
The Journal of the American Medical Association (JAMA 2000;283 :1303-13 10) March 2000.

Although methadone maintenance is an effective therapy for heroin dependence, some patients continue to use heroin and may benefit from therapeutic modifications. This study evaluated a behavioural intervention, a pharmacological intervention, and a combination of both interventions.

Methods
Throughout the study all patients received daily methadone hydrochloride maintenance (initially 50 mg/d orally) and weekly counselling.
Following baseline treatment patients who continued to use heroin were randomly assigned to 1 of 4 interventions:
(1) contingent vouchers for opiate-negative urine specimens (n29 patients);
(2) methadone hydrochloride dose increase to 70 mg/d (n=31 patients);
(3) combined contingent vouchers and methadone dose increase (n=32 patients); and
(4) neither intervention (comparison standard; n=28 patients). Methadone dose increases were double blind.

Vouchers had monetary value and were exchangeable for goods and services.
Groups not receiving contingent vouchers received matching vouchers independent of urine test results.
Primary outcome measure was opiate-negative urine specimens (thrice weekly urinalysis).

Results
Contingent vouchers and a methadone dose increase each significantly increased the percentage of opiate-negative urine specimens during intervention.
Contingent vouchers, with or without a methadone dose increase, increased the duration of sustained abstinence as assessed by urine screenings.
Methadone dose increase, with or without contingent vouchers, reduced frequency of use and self-reported craving.

Conclusions
In patients enrolled in a methadone-maintenance program who continued to use heroin, abstinence reinforcement and a methadone dose increase were each effective in reducing use.  When combined, they did not dramatically enhance each other’s effects on any one outcome measure, but they did seem to have complementary benefits.
Source: Author Kenzie et al published in Arch Gen Psychiatry. 2000;57:395-404