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Over time, there have been considerable changes in the variety, availability, production, distribution, and use and user(s) of psychoactive substances, the meaning of substance use and its impact on users and their social or physical environment(s). This article reviews the mechanisms of introduction of psychoactive substances such as alcohol, tobacco, coffee, tea and cannabis to populations and communities that did not have them before. It considers the historical tension between early adopters who greet new substances with various levels of enthusiasm in their eagerness to enjoy what they believe to be the benefits of using these substances, and those focused on what they believe to be the negative aspects of use, who decry these new substances with horror. With more nonusers than users in the population, social policies tend to be directed at preventing, restricting, or punishing selected use, users and .drugs., using controls and interventions such regulation, incarceration, death sentence, treatment, prevention, legalization, taxation, among others. Whatever their intent or wished-for impact, all had consequences that produced additional, unplanned for, and (often) negative effects. This paper will consider some of these sequences as they occurred historically with other substances in light of the current shift to legalization and normalization of cannabis, noting the mechanisms of use, controls, and consequences of some types of formal interventions and give some attention to how and what we can learn from our experiences in order to plan ahead and become better prepared to successfully deal with the ‘unexpecteds’ of that well-known ‘hell’ paved with good intentions. [ABSTRACT FROM PUBLISHER]

Since its inception, the addictions field has had a history of failure: failures in conceptualizations, in treatment, in interventions, in policies, in process as well as outcome assessment. Certain actions and activities have had a less than stellar effect which may lead to feelings of personal failure among practitioners, the tagging of processes and programs as being failures when they are not so, as well as an identification of the person being intervened with, by self and others, as being a failure or loser. This paper discusses how to define success and failure and the need to identify both the short(er) and long(er) term, as well as temporary and permanent effects, including the implications of using binary (success or failure; success and failure) and nonbinary (and in addition) categories of assessment. The need to clarify expectations and to establish goals and measurable effects are noted. Being open to accepting results which may be personally disappointing, initially, but which offer opportunities for needed changes may lead to new developments in the field and the establishment of better interventions. [ABSTRACT FROM AUTHOR]

We examined the nature and extent of health problems in drug user patients initially treated in emergency departments and who were subsequently admitted to all hospitals in Ontario, using data from the Hospital Medical Records Institute (HMRI). The modified standardized morbidity ratio (modified SMR) is introduced to improve the measurement and visual display of reduced morbidity as well as excess morbidity. During 1985-86, about 75% of drug user patients entered hospital through the emergency department. There were 5077 emergency patients with primary drug use-related diagnoses and 9827 with secondary drug use-related diagnoses. Cases with poisoning diagnosis made up over 80% of all drug use cases treated in emergency departments. Cases with non-dependent abuse of drugs accounted for 8-12% of emergency drug user patients, whereas those with drug dependence accounted for about 3% of emergency drug user patients. These patients had more than three times the comorbidity experience of all hospital patients. They had excess comorbidity due to mental disorders, infectious and parasitic disorders, and injury and poisoning diagnoses. However, they had reduced comorbidity due to complications of pregnancy, childbirth, and the puerperium and from congenital anomalies and conditions originating in the perinatal period. Cocaine patients were more likely to have infectious parasitic diseases and diseases of the skin and subcutaneous tissue, while amphetamine patients were more likely to have diseases of the digestive system and of the musculo-skeletal system and connective tissue. [ABSTRACT FROM AUTHOR]

We explore the links between substance use, misuse, addiction, and dependency 1 and sexuality, sexually transmitted diseases (STD), human immunodeficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) to increase our awareness of their interdependence and to identify new ways to perceive, judge, and intervene (or not to) with associated problems. We consider the sociocultural and economic context in which these behaviors occur; the impact these behaviors have on one another; the personal opinions and attitudes; the religious, moral, or political beliefs and agendas; the physiological and fiscal constraints; and theories of rational decision-making and psychological motivation that act to increase or reduce the incidence of these behaviors and their sequellae, while hindering or facilitating prevention, harm reduction, and treatment interventions. Mechanisms of epidemic spread of STDS/HIV/AIDS are presented in the Appendix. Each of these terms are loaded “container concepts” that are culture-bound and stakeholder-driven and whose dimensions are less than consensus-based. They represent a range of meanings, uses, and misuses in an ongoing politicalized area of human and systemic functioning and adaptations. [ABSTRACT FROM AUTHOR]

The nature and extent of treated health problems in patients with problems related to the use of alcohol and drugs (including both licit and illicit drugs) were compared with the morbidity levels of all patients treated for all conditions in Canada. The morbidity experience of all patients with alcohol or drug (A/D) diagnoses treated as inpatients (n=52,200 cases) in all Ontario hospitals in 1985–1986 (based on Hospital Medical Records Institute [HMRI] data) was compared with that of the total population of all inpatients treated in all Canadian hospitals using age-sex standardized morbidity ratios (SMR) and adjusting for multiple diagnoses. Of A/D cases, 32% were admitted with a primary A/D diagnosis and 68% with a secondary A/D diagnosis; 17% of A/D cases had multiple A/D diagnosis. On average, cases with a primary A/D diagnosis had 29% more diagnoses per case than all cases treated in Ontario. SMRs were highest for cases with diagnoses relating to the use or misuse of licit drugs (SMR = 13.32 and 3.51 for those with primary and secondary drug diagnoses, respectively), intermediate for illicit drug cases (SMR = 8.87 vs. 4.74 for primary and secondary diagnoses, respectively), and lowest for patients with alcohol diagnoses (SMR = 6.68 and 4.12 for primary and secondary diagnoses, respectively). Excess morbidity for alcohol cases affected more diagnostic categories and body systems, being at a higher level than for drug cases. Alcohol or drug cases had particularly high SMRs for mental disorders, infectious and parasitic conditions, and injury and poisoning diagnoses. Alcohol or drug cases had reduced reproductive morbidity: for complications of pregnancy, childbirth, and the puerperium, SMR = 0.04 to 0.24 for cases with primary A/D diagnoses and SMR = 0.12 to 0.89 for those with secondary A/D diagnoses. Cases with drug diagnoses had a considerable reduction in SMR for certain conditions originating in the perinatal period: SMR = 0.0 for cases with primary drug diagnoses and SMR = 0.0 for secondary illicit drug diagnoses cases and SMR = 0.18 for secondary licit drug diagnoses cases. [ABSTRACT FROM AUTHOR]

Those who work in the addiction field usually use the pharmacological or medical model, psychological theories of behavior, or operate within the confines of a criminal justice perspective. Contributions from the field of sociology arc limited to use of the methods of sociological investigations, primarily population surveys, which, typically, are used to identify groups at-risk for specific types of drug use. Surveys have identified illicit drug use as, predominantly, a problem of young males, whereas prescription drug use is predominantly a problem of middle-aged and older women in industrialized countries. Experts in addiction have accused sociologists who study addiction of being "atheoretical." Paradoxically, in the sociology field, the most highly cited article is Merton's theory of addiction. This article will examine the contributions of sociological theory to our understanding of addiction, including social definitions of "the problem of addiction" and mechanisms to account for individual drug use within a social context that defines it as problematic. Key Words: Addiction; Problem deflation; Problem inflation; Sociological theory and addictions; Sociology. [ABSTRACT FROM AUTHOR]

Despite evidence of the antiquity and ubiquity of psychoactive substance use, much of the literature is devoted to addiction in minority ethnocultural subgroups. When researchers study drug use in isolated “primitive” communities, they consider drug use to serve as a mechanism of social integration; when they study drug use in ethnocultural subgroups in contact with mainstream society, they consider drug use as a marker, or sometimes as a cause of social disorganization. The implicit assumption appears to be that addiction and race, ethnicity, or other minority ethnocultural subgroup membership are linked, and more prevalent and/or more problematic in minorities, further problematizing the status of minorities. Empirical studies identified through ETOH, the U.S. National Institute of Alcohol and Alcoholism (NIAAA)'s Internet-accessible computerized database, were subjected to content analysis of their abstracts (nabs = 44) as well as actual reports (nrep = 40). It was found that the content of neither abstracts nor actual reports supported the contention that there was a greater prevalence of drug use, drug-use-associated problems, or drug-use-enhancing attitudes in minority ethnocultural subgroups when compared to mainstream society (, d.f. = 3, n.s., and , d.f. = 2, n.s. respectively). Researchers need to be aware of possible implicit assumptions about the relation between ethnicity and addiction. [ABSTRACT FROM AUTHOR]

Deals with a study which provides an insight into the treatment wants of heroin users. Main formal goals of the medical system; Need to modulate policy changes until they meet the needs of both individuals and society.

A variety of interventions, both therapeutic and preventive, have been used to control, reduce or eliminate substance use and misuse and their attendant problems. Yet, despite years of ever more sophisticated and expensive ways of responding to the use and misuse of a variety of legal and illegal substances, addiction continues to be experienced as a major social problem that plagues users, their families and communities, therapists and clinicians, policymakers, and the public. In view of a recidivist treatment population and finite resources, this paper considers whether and to what extent treatments and other interventions used for planned interventions with alcohol- and drug-use related problems work. It examines both clinical treatment outcomes and broad-based population prevention interventions, and reviews their underlying rationales. Finally, it identifies a number of areas that must be addressed if we are to improve the situation. These areas include a lack of agreement on what is meant by the problem of “addictions,” how successful interventions are to be defined and measured so that better interventions can be applied in the future, as well as integrating the processes of quality and appropriateness into the planning, implementation and assessment of effective, needed substance use intervention. [Translations are provided in the International Abstracts Section of this issue.] [ABSTRACT FROM AUTHOR]

Drunk driving is one of the more serious negative consequences of alcohol consumption. Since consumption of alcohol is sensitive to the price of alcohol, and the occurrence of drunk driving is sensitive to the level of alcohol consumption, the possibility exists for alcohol pricing policie to be used to reduce drunk driving in the population. This paper reviews the evidence on this possibility in the literature and adds results based on data from the Canadian province of Ontario. Multiple regression analysis of time series data for Ontario from 1972 to 1990 indicate that, controlling for income, the proportion of young males in the population, changes in the minimum drinking age, and other confounding variables, increasing the price of alcohol has a significant effect in reducing alcohol-related motor vehicle accidents (elasticity = -1.2, p < .05) and alcohol-related traffic offenses (elasticity = -0.50, p < .05). Overall, the evidence strongly supports the view that alcohol tax and pricing policies can be used to reduce the extent of drunk driving. [Translations are provided in the International Abstracts Section of this issue.] An earlier version of this paper was presented at the North American Conference on Alcohol and Traffic Safety, Quebec, Canada, 1993, and the Conference on Health and Behaviour, Ontario, Canada, 1994. [ABSTRACT FROM AUTHOR]

Determines if allowing wine sales in corner grocery stores, beginning in 1978 for domestic Quebec wines and then in 1983 for imported wines, led to an increase in alcohol consumption. Increase in alcohol consumption in favor of domestic wine; Lack of fundamental change in the responsiveness of wine consumption to price.

During fiscal year 1983-84, Ontario general hospitals admitted 2651 patients with a primary diagnosis of alcohol dependence or non-dependent use of alcohol but with no secondary diagnoses requiring treatments only available in hospital. These averaged 10.7 days in hospital and the total cost of their hospitalization (excluding medical services) was estimated at $7.4 million. Many of these admissions appear to have been for alcohol detoxication or for psychosocial treatments of alcohol abuse. Because alternative, more cost-effective methods for detoxication and treatment are suggested by the research literature, efforts to use and develop such alternatives in local communities are recommended. [ABSTRACT FROM AUTHOR]

We examined hospital utilization arid use of community facilities for the treatment of alcohol problems in Ontario using Statistics Canada. Hospital Medical Records Institute records, and other administrative records. Between 1974 and 1986 there was a large drop in utilization of hospital services for treatment of alcohol problems. Rates of alcohol inpatient cases in general hospitals dropped by 47% and in mental hospitals by 33%. At the same time, there was an increase in overall availability of hospital beds and bed-days of care for all medical conditions, and no change in the total number of hospital discharges (1.3 million) and occupancy rates (80-85%). Also at the same time, the number of community-based programs for the treatment of alcohol problems increased, as did the number of persons or cases treated by them. This was associated with a drop of inpatient cases treated for alcohol problems in 38 out of 48 counties in Ontario (P < .0005). Multiple regression techniques were used to take into account the effect of the slight decline in overall alcohol consumption in this period. We found that after controlling for changes in alcohol consumption, the addition of one community-based alcohol treatment program was associated with a reduction in the number of cases treated on a hospital inpatient basis for alcohol-related problems, with a short-run drop of 27.1 hospital cases within 1 year of a community facility's availability and a long-run reduction of 52.2 cases. (P < .005). [ABSTRACT FROM AUTHOR]

Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction because its perceived role in the promotion of meaningfulness in the recovery from addiction. Our review of the literature evaluates different domains relative to the relation between addiction, religion, and psychiatric treatment. Spirituality as a protective or precipitating factor for substance use and as a key component of recovery will be debated. Illustrations of its potential and limitations as a component of treatment will be presented. Types of investigation and integration of this dimension in an eventual therapeutic process strictly respecting the needs and specificities of each one will be discussed. [ABSTRACT FROM AUTHOR]

This paper examines the relative effect of both individual and societal factors that impinge directly on smoking behaviour of women and men. The societal factors are cigarettes price, tobacco control legislation, newspaper coverage of tobacco issues, overall economic factors, and social milieu characteristics. Three Canadian provinces are studied, from 1978 to 1995. A repeated cross-section design is used. Data are derived from national surveys and official documents. Results show that smoking occurs in social contexts within which the price of cigarettes appears to have a significant negative impact on the prevalence of smoking and the quantity of cigarettes smoked by men, but no effect on either the prevalence of smoking or the amount smoked by women. More comprehensive and restrictive no-smoking legislation and legislation on youth access to tobacco influence negatively the prevalence of smoking both for men and women. However, these laws do not have the same effects on the number of cigarettes smoked by women and men. Newspaper articles on the other hand, negatively influence smoking prevalence for women and men. As differences are observed in the responsiveness of men and women to tobacco control policies, policymakers and practitioners need to keep in mind that tobacco control policies have to be tailored to the broader context of the lives of women and men. Future work needs also to be done to clarify the interrelationships between social influences on smoking such as price, laws and media, and the relationships between these and intrapersonal and interpersonal factors, as well as other social and cultural factors. [Copyright &y& Elsevier]