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Spirituality is a topic of increasing interest to clinicians and researchers interested in addiction. To clarify the way(s) in which the concept of spirituality is understood and employed in practice by clinicians and researchers who publish papers on addiction and spirituality, and to develop a definition or description of spirituality which might receive widespread assent within the field. A descriptive study of 265 published books and papers on spirituality and addiction. The study revealed a diversity and lack of clarity of understanding of the concept of spirituality. However, it was possible to identify 13 conceptual components of spirituality which recurred within the literature. Among these conceptual components of spirituality, ‘relatedness’ and ‘transcendence’ were encountered most frequently. ‘Meaning/purpose’, ‘wholeness (non-)religiousness’ and ‘consciousness’ were encountered less frequently in the papers on addiction and spirituality than in an unsystematically ascertained sample of papers concerned with spirituality in relation to other areas of psychology and medicine. However, biases in the literature are notable. For example, the great majority of publications are from North America and the field is dominated by interest in Twelve-Step and Christian spirituality. Spirituality, as understood within the addiction field, is currently poorly defined. Thirteen conceptual components of spirituality which are employed in this field are identified provisionally and a working definition is proposed as a basis for future research. [ABSTRACT FROM AUTHOR]

Background and aims Prohibitions on producing, distributing and selling cannabis are loosening in various jurisdictions around the world. This paper describes the diversification of cannabis supply laws and discusses the challenges to and opportunities for learning from these changes. Methods We document changes in cannabis supply laws that de jure legalized cannabis production for medical and/or non-medical purposes (excluding industrial hemp) in Australasia, Europe, North America and South America. We also highlight challenges to evaluating these legal changes based on our experiences studying cannabis laws and policies in the United States. Findings As of August 2016, two countries have passed laws to legalize large-scale cannabis production for non-medical purposes at the national (Uruguay) or subnational level (four US states). At least nine other countries legally allow (or will soon allow) cannabis to be supplied for medicinal purposes. Most of the changes in cannabis supply laws have occurred since 2010. The data available in most countries are inadequate for rigorously evaluating the changes in cannabis supply laws. Conclusion The evidence base for assessing changes in cannabis supply laws remains weak. Efforts should focus upon collecting information about quantities consumed and market transactions as well as validating self-report surveys. [ABSTRACT FROM AUTHOR]

Aims This paper aims to identify possible system-level factors contributing to the marked differences in the levels of non-medical prescription opioid use ( NMPOU) and prescription opioid ( PO)-related harms in North America (i.e. the United States and Canada) compared to other global regions. Methods Scientific literature and information related to relevant areas of health systems, policy and practice were reviewed and integrated. Results We identified several but different factors contributing to the observed differences. First, North American health-care systems consume substantially more Pos-even when compared to other high-income countries-than any other global region, with dispensing levels associated strongly with levels of NMPOU and PO-related harms. Secondly, North American health-care systems, compared to other systems, appear to have lesser regulatory access restrictions for, and rely more upon, community-based dispensing mechanisms of POs, facilitating higher dissemination level and availability (e.g. through diversion) of POs implicated in NMPOU and harms. Thirdly, we note that the generally high levels of psychotrophic drug use, dynamics of medical-professional culture (including patient expectations for 'effective treatment'), as well as the more pronounced 'for-profit' orientation of key elements of health care (including pharmaceutical advertising), may have boosted the PO-related problems observed in North America. Conclusions Differences in the organization of health systems, prescription practices, dispensing and medical cultures and patient expectations appear to contribute to the observed inter-regional differences in non-medical prescription opioid use and prescription opioid-related harms, although consistent evidence and causal analyses are limited. Further comparative examination of these and other potential drivers is needed, and also for evidence-based intervention and policy development. [ABSTRACT FROM AUTHOR]

ABSTRACT While individual studies from several South American countries have shown driving while intoxicated to be a problem, there are no objective systematically collected alcohol-associated driving data obtained in most South American countries. This limits their ability to implement and enforce targeted prevention strategies, evaluate whether proven prevention efforts from North America (particularly the United States and Canada) can be transferred to the South, and to sustain momentum for the improvement of road safety by demonstrating that previously implemented legal and policy changes are effective. The aim of this paper is to discuss the abysmal differences that exist between northern and southern American countries regarding the current status of driving while intoxicated prevention strategies-their implementation, impacts and effects-using Brazil as a case example. We propose a three-pronged approach to close this northern-southern American gap in driving while intoxicated prevention and intervention: (a) systematic collection on road traffic crash/injury/death as well as risk factor data, (b) passage of laws without loopholes requiring compliance with blood alcohol concentration testing and (c) provision of appropriate training and equipment to the police in concomitance with vigilant enforcement. Resources and energies must be put towards data collection, implementation of prevention strategies and enforcement in order to decrease the unacceptably high rates of these preventable driving while intoxicated deaths. [ABSTRACT FROM AUTHOR]

North America features some of the world's highest consumption levels for controlled psychoactive prescription drugs (PPDs; e.g. prescription opioids, benzodiazepines, stimulants), with non-medical use and related harms (e.g. morbidity, mortality) rising in key populations in recent years. While the determinants, characteristics and impacts of these 'use' problems are increasingly well documented, little is known about the 'supply' side of non-medical PPD use, much of which is facilitated by 'diversion' as a key sourcing route. This paper provides a select review of the phenomenon of PPD diversion in North America, also considering interventions and policy implications. A conceptual and empirical review of select-peer- and non-peer-reviewed research literature from 1991 to 2010 focusing upon PPD diversion in North America was conducted. The phenomenon of PPD diversion is heterogeneous. Especially among general populations, a large proportion of PPDs for non-medical use are obtained from friends or family members. Other PPD diversion routes involve 'double doctoring' or 'prescription shopping'; street drug markets; drug thefts, prescription forgeries or fraud; as well as PPD purchases from the internet. The distinct nature and heterogeneity make PPD diversion a complex and difficult target for interventions. Prescription monitoring programs (PMPs) appear to reduce overall PPD use, yet their impact on reducing diversion or non-medical use is not clear. Law enforcement is unlikely to reach PPD diversion effectively. Effective reduction will probably require reductions in overall PPD consumption volumes, although such will need to be accomplished without compromising standards of good medical (e.g. pain) care. [ABSTRACT FROM AUTHOR]

Comments on the privatization or deregulation of liquor retailing in North America. Relationship between alcohol availability and alcohol consumption; Impact of Iowa's privatization of liquor retailing.

The article offers news briefs related to addiction as of 2016. The unregulated cannabidiol (CBD) market in Great Britain has been halted by the UK Medicines and Healthcare Products Regulatory Agency (MHRA). The public is supporting minimum unit pricing (MUP) for alcohol products in Great Britain. A World Health Organization (WHO) report has found that the alcohol-attributable mortality burden has increased slightly in Europe since 1990.

The author comments on the paper "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran, which addresses the lack of policies regarding drinking and driving. According to her, lack of data or laws is not a problem in Brazil but lapses in the enforcement of existing laws is. She refers to several studies on drunk driving and suggests acquiring a better understanding of the problem through research and monitoring.

Background and Aims: Adaptations with different modes of delivery and target addictions have found highly divergent rates of success for Community Reinforcement Approach and Family Training (CRAFT). This study aims to clarify which (1) treatment components and (2) participant characteristics contribute to rates of identified patient (IP) treatment entry. Method: Systematic review of CRAFT evaluation studies of all designs (controlled and uncontrolled) with data synthesis and narrative analysis of addiction treatment services and university research departments in North America and Europe. Results: A total of 691 concerned significant others (CSOs), predominately female spouses/parents, participating in 20 distinct treatment conditions from 14 studies. The main outcome of IP treatment entry rate reported by CSOs up to 12 months after starting CRAFT with key predictors/correlates including IP addiction, IP–CSO relationship, CRAFT modality and integration of treatment for IP. Meta‐analysis found CRAFT to be twice as effective as controls/comparison groups. Multi‐modality treatment, including both individual and group sessions, yielded the highest IP treatment entry rates (77 and 86%), with progressively lower rates for individual (12.5–71%), group (60%) and self‐directed workbook (13.3–40%) modalities. While all five studies targeting gambling addiction had consistently low rates (12.5–23%), other treatment components, including therapist training, treatment fidelity and integrating treatment for the IP, were implicated. Conclusions: Adaptations of Community Reinforcement Approach and Family Training for different delivery modalities and addictions have yielded widely varying rates of treatment engagement for the identified patient, with those offering the most comprehensive support to the concerned significant other, including individual and group sessions, having highest levels of engagement success. [ABSTRACT FROM AUTHOR]

Commentary to: Understanding and learning from the diversification of cannabis supply laws [ABSTRACT FROM AUTHOR]

The author comments on "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran about the status of control and prevention of driving while intoxicated (DWI) in Brazil. Although he agrees with the study, he highlights that Mothers Against Drunk Driving (MADD) group of victims of DWI has been an extreme force for change in U.S. cultural views on DWI. He also mentions the importance of working with communities and advocacy groups.

The author comments on the article "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran. She highlights the points addressed by the authors of the study regarding aspects lacking in Brazil and notes that the issue of advocacy and active popular support is not taken into consideration by the study. She opines that active participation as a critical factor to tackle the state of affairs of drinking and driving rates.

Aims To describe mortality from diseases, conditions and injuries where alcohol was a necessary cause in selected countries in the Americas. Design A descriptive, population-based study. Setting The data come from 16 countries in North, Central and South America for the triennium 2007-09 (latest available data). Participants/Cases A total of 238 367 deaths were analyzed. Measurements We calculated age-adjusted and age-specific mortality rates by sex and country using the Pan American Health Organization ( PAHO) mortality database. Findings The annual average of deaths where alcohol was a necessary cause in the 16 countries was 79 456 (men comprised 86% and women 14%). People aged 40-59 years represented 55% overall. Most deaths were due to liver diseases (63% overall) and neuropsychiatric disorders (32% overall). Overall age-adjusted rates/100 000 were higher in El Salvador (27.4), Guatemala (22.3), Nicaragua (21.3) and Mexico (17.8) and lower in Colombia (1.8), Argentina (4.0) and Canada (5.7). The age groups at the highest risk were 54-59 to 64-69 years in most countries. In Guatemala, El Salvador and Nicaragua the rates increased earlier, among those aged 30-49 years. Male rates were higher than female rates in all countries, but the male : female ratio varied widely. Conclusions Diseases, conditions or injuries where alcohol is a necessary cause are an important cause of premature mortality in the Americas, especially among men. Some countries show high risk of dying from this group of causes. [ABSTRACT FROM AUTHOR]

Aims To examine cannabis use among mid-adolescents in 31 countries and associations with per-capita personal consumer expenditure (PCE), unemployment, peer factors and national rates of cannabis use in 1999. Design, participants and measurement Nationally representative, self-report, classroom survey with 22 223 male and 24 900 female 15-year-olds. Country characteristics were derived from publicly available economic databases and previously conducted cross-national surveys on substance use. Findings Cannabis use appears to be normative among mid-adolescents in North America and several countries in Europe. The life-time prevalence of cannabis use was 26% among males and 15% among females and was lowest for males and females in the former Yugoslav Republic (TFYR) of Macedonia: 2.5% and to 2.5%, respectively; and highest for males in Switzerland (49.1%) and in Greenland for females (47.0%). The highest prevalence of frequent cannabis use (more than 40 times in life-time) was seen in Canada for males (14.2%) and in the United States for females (5.5%). Overall, life-time prevalence and frequent use are associated with PCE, perceived availability of cannabis (peer culture) and the presence of communities of older cannabis users (drug climate). Conclusions As PCE increases, cannabis use may be expected to increase and gender differences decease. Cross-national comparable policy measures should be developed and evaluated to examine which harm reduction strategies are most effective. [ABSTRACT FROM AUTHOR]

Aims  To compare alcohol use among US and Canadian college students. Design  Results of the 1999 College Alcohol Study and the 1998 Canadian Campus Survey are compared. Setting  One hundred and nineteen nationally representative US 4‐year colleges and universities in 40 states and 16 nationally representative Canadian 4‐year universities. Participants  Randomly selected students under 25 years (12 344 US and 6729 Canadian). Measurements  Self‐reports of alcohol use and heavy alcohol use. Findings  The prevalence of life‐time and past year alcohol use is significantly higher among Canadian students than US students (92% versus 86%, 87% versus 81%). The prevalence of heavy alcohol use (typically consuming five or more drinks in a row for males/four or more for females) among past‐year and past‐week drinkers is significantly higher among US students than Canadian students (41% versus 35%, 54% versus 42%). In both countries younger students and students living at home with their parents are less likely to be heavy drinkers; students who report first drunkenness before the age of 16 are more likely to be heavy drinkers in college. Conclusion  Programs aimed at students' heavy alcohol use should target freshman at entry or earlier. Since students living with their parents are less likely to be heavy drinkers, parents may play a potentially important role in prevention efforts. The patterns of drinking in both countries may be influenced by the legal minimum drinking age. However, the relationship is complex and must be viewed in the context of other variables such as chronological age. [ABSTRACT FROM AUTHOR]

Aim. To provide an overview of recent privatization/deregulation experiences in North America and other settings, in order to draw conclusions about the impacts that might be expected from such changes on rates of alcohol consumption and related problems. Methods. Critical review of research evidence on the effect of changes in availability, particularly changes in physical availability and economic availability that typically accompany privatization of alcohol retail monopolies. Findings. Deregulation/privatization experiences commonly involve higher density of outlets, longer hours or more days of sale, changes in price, a strong orientation to commercial aspects of alcohol sales and the introduction of new vested economic interests into alcohol management arrangements in the jurisdiction. In many instances these changes in access to alcohol are accompanied by an increase in the per capita rates of consumption. In the short term changes in prices are likely to either increase or demonstrate opposite patterns for beverages with different base prices. Longer-term patterns point to a decline in real price with privatization, which very probably stimulates per capita alcohol sales. Conclusion. The existing evaluation literature on the subject of privatization has tended to focus on examining the net short-term results in terms of alcohol consumption levels. Overall, there are too few studies employing adequate statistical methodologies to explore the underlying causes of changing alcohol consumption and alcohol-related harm. Finally, seven specific suggestions that may assist future studies are discussed. [ABSTRACT FROM AUTHOR]

The most prevalent behavioral health disorder among youth involved in the criminal justice system is a conduct disorder. Given the high rate of early mortality found by Border and colleagues for youth with a conduct disorder, an expansion of evidence‐based treatments for youth involved in criminal justice is a public health priority. [ABSTRACT FROM AUTHOR]

Commentary to: Understanding and learning from the diversification of cannabis supply laws [ABSTRACT FROM AUTHOR]

Commentary to: Understanding and learning from the diversification of cannabis supply laws [ABSTRACT FROM AUTHOR]

The authors discuss aspects of the medical prescription use of opioid (PO) and PO-related harms in population heath. They highlight several factors contribute to the PO dependence including socio-demographic, education and socioeconomic status. The authors cites the impact of PO-related harms and the availability of clinical PO use guidelines in the healthcare system.

The article reflects the opinion of the author on the problems brought about by the prevalence of cocaine addiction in North America. The author stressed that the devastating traits of the cocaine epidemic problem are that its users eventually encounter health and social problems as the consequence of their addiction. The author added that it is saddening fact that less effort have been done to curb cocaine addiction problem.