Young Adults’ Recreational Social Environment as a Predictor of Ecstasy Use Initiation: Findings of a Population-Based Prospective Study.

Young adults’ recreational social environment as a predictor of Ecstasy use initiation: findings of a population-based prospective study.

Addiction. 2013 May 14;
Smirnov A, Najman JM, Hayatbakhsh R, Wells H, Legosz M, Kemp R

AIMS: To examine prospectively the contribution of the recreational social environment to Ecstasy initiation. DESIGN: Population-based retrospective/prospective cohort study. SETTING: Data from screening an Australian young adult population to obtain samples of users and non-users of Ecstasy. PARTICIPANTS: A sample of 204 Ecstasy-naïve participants aged 19 to 23 years was obtained, and a 6 month follow-up identified those who initiated Ecstasy use. MEASUREMENTS: We assessed a range of predictors of Ecstasy initiation, including elements of participants’ social environment, such as Ecstasy-using social contacts and involvement in recreational settings. FINDINGS: More than 40% of Ecstasy-naïve young adults reported ever receiving Ecstasy offers. Ecstasy initiation after 6 months was independently predicted by having, at recruitment, many Ecstasy-using social contacts (OR 6.30, 95% CI: 1.60, 24.76), attending electronic/dance music events (OR 5.06, 95% CI: 1.48, 17.27), receiving an Ecstasy offer (OR 4.55, 95% CI: 1.12, 18.45), early cannabis use (OR 8.35, 95% CI: 1.65, 42.23) and psychological distress (OR 7.16, 95% CI: 1.75, 29.18). Adjusted population attributable fractions were highest for Ecstasy-using social contacts (21.4%) and event attendance (18.3%). CONCLUSIONS: In Australia, Ecstasy initiation in early adulthood is predominantly associated with social environmental factors, including Ecstasy-using social contacts and attendance at dance music events, and is less commonly associated with psychological distress and early cannabis use, respectively. A combination of universal and targeted education programs may be appropriate for reducing rates of Ecstasy initiation and associated harms. HubMed – addiction

Cravings as a mediator and moderator of drinking outcomes in the COMBINE Study.

Addiction. 2013 May 14;
Subbaraman MS, Lendle S, van der Laan M, Kaskutas LA, Ahern J

AIMS: Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator. DESIGN: Secondary mediation and moderation analyses of COMBINE study data. SETTING: 11 United States academic sites. PARTICIPANTS: 863 patients randomized to one of four treatment groups: naltrexone (100mg/d; n=209), the Combined Behavioral Intervention (CBI, n=236), naltrexone and CBI combined (n=213), and placebo naltrexone (n=205). MEASUREMENTS: Percent Days Abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, were measured at baseline, week 4 and week 12 using the Obsessive-Compulsive Drinking Scale. FINDINGS: Compared with placebo, naltrexone, CBI, and the combination all increased PDA by an additional 6-10 percentage points for those with high cravings (p<0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were at least partially mediated by cravings; craving reduction explained 48-53% of treatment effects (p<0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks. CONCLUSIONS: The Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) naltrexone + Combined Behavioral Intervention combination may not be more beneficial than either monotherapy because craving reduction is a common mechanism of both. HubMed – addiction

David Nutt: making the medical case for addiction.

Lancet. 2013 Mar 23; 381(9871): 987
Boyce N

HubMed – addiction

The collectivity of drinking cultures: is the theory applicable to African settings?

Addiction. 2013 May 13;
Rossow I, Clausen T

AIMS: Skog’s theory of collective drinking behaviour implies that countries with a strict informal social control of drinking alcohol would not exhibit ‘collective displacement’ of consumption (a linear association between population mean consumption and percentile values across the full range of the distribution), as do countries with less informal social control. This paper aimed to test this hypothesis by examining the alcohol consumption distributions in African countries with a strong informal control of alcohol. DESIGN SETTING, PARTICIPANTS AND MEASUREMENTS: Data on alcohol consumption from the World Health Organization’s general population surveys in 15 African countries were aggregated and analysed with respect to skewedness and collective displacement of the distribution. FINDINGS: The distribution of consumption was strongly positively skewed, with 10-15% of the drinkers consuming more than twice the mean consumption. There was also clear evidence of a collective displacement of the consumption distribution, and the consumption mean was a strong predictor of the distribution percentile values across the full range of the distribution. Correspondingly, consumption mean predicted the prevalence of heavy drinkers. CONCLUSION: The distribution patterns of alcohol consumption in African countries are consistent with those observed previously in industrialized countries. These findings seem to counter Skog’s theory of collective drinking behaviour and support the universality of the observation that the prevalence of problem drinking is linked closely to mean consumption. HubMed – addiction

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