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Background: Recently, social movements across the world have demanded reforms to education systems and other institutions. Although such movements have affected large numbers of people across multiple countries, we know little about the impacts they have had on population health. We focus on one example: the massive strikes and collective occupation of secondary schools across Chile, which occurred contemporaneously with a large increase in marijuana use among students in this age group. We aimed to evaluate the causal effects that the 2011 Chilean school strikes had on adolescent substance use, including the initiation of marijuana use and the use of alcohol and marijuana.Methods: School-level, aggregated panel design using data from the National Drug Surveys among Secondary Students from 2005 to 2015 for students in grades 9-12. We used a fixed-effects difference-in-difference model to estimate the effect of school occupations on prevalence of self-reported indicators of drug use.Results: Reported marijuana use doubled between 2009 and 2013 among Chilean adolescents. After controlling for secular trends in outcomes and for school characteristics, there was no evidence of increased marijuana initiation, alcohol and marijuana use, or of an increase in heavy use among adolescents being directly attributable to school strikes and occupations in 2011.Conclusions: The 2011 Occupy school movement in Chile had no detectable causal effect on substance use among Chilean adolescents. The increase in marijuana use from 2009 to 2013 seems to be part of broader social changes occurring among the school-age population. [ABSTRACT FROM AUTHOR]

Background Vaccination coverage with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine in pregnancy or immediately postpartum has been low. Limited data exist on rigorously evaluated interventions to increase maternal vaccination, including Tdap. Tailored messaging based on the Elaboration Likelihood Model (ELM) framework has been successful in improving uptake of some public health interventions. We evaluated the effect of two ELM-based vaccine educational interventions on Tdap vaccination among pregnant African American women, a group of women who tend to have lower vaccine uptake compared with other groups. Methods We conducted a prospective randomized controlled trial to pilot test two interventions – an affective messaging video and a cognitive messaging iBook – among pregnant African American women recruited during routine prenatal care visits. We measured Tdap vaccination during the perinatal period (during pregnancy and immediately postpartum), reasons for non-vaccination, and intention to receive Tdap in the next pregnancy. Results Among the enrolled women (n = 106), 90% completed follow-up. Tdap vaccination in the perinatal period was 18% in the control group; 50% in the iBook group (Risk Ratio [vs. control group]: 2.83; 95% CI, 1.26–6.37), and 29% in the video group (RR: 1.65; 95% CI, 0.66–4.09). From baseline to follow-up, women’s reported intention to receive Tdap during the next pregnancy improved in all three groups. Among unvaccinated women, the most common reason reported for non-vaccination was lack of a recommendation for Tdap by the woman’s physician. Conclusions Education interventions that provide targeted information for pregnant women in an interactive manner may be useful to improve Tdap vaccination during the perinatal period. However, larger studies including multiple racial and ethnic groups are needed to evaluate robustness of our findings. Trial Registration: clinicaltrials.gov Identifier: NCT01740310 . [ABSTRACT FROM AUTHOR]

Exercise training, associated with therapeutic education, is the main axis of cardiac rehabilitation (CR) programs. The aim of this study was to review the literature for descriptions of the various assessments of exercise tolerance used to prescribe exercise intensity during CR. A secondary objective was to attempt to formulate a rational practice with these assessments in CR programs. [ABSTRACT FROM AUTHOR]

Education programs are a central element of Australian harm reduction drug policy. Considered less judgmental and more effective than the punitive policies of Australia's past, harm reduction drug education is premised on the goal of reducing 'risks' and harms associated with illicit drug use rather than an elimination of use per se. In this article I analyse two sets of key texts designed to reduce drug related harm in Australia: harm reduction teaching resources designed for classroom use and social marketing campaigns that are targeted to a more general audience. I identify two significant accounts of young people's drug use present in Australian harm reduction drug education: 'damaged mental health' and 'distress'. I then draw on some of Deleuze and Guattari's key concepts to consider the harm reducing potential these accounts may have for young people's drug using experiences. To demonstrate the potential limitations of current drug education, I refer to an established body of work examining young people's experiences of chroming. From here, I argue that the accounts of 'damaged mental health' and 'distress' may work to limit the capacity of young drug users to practice safer drug use. In sum, current Australian harm reduction drug education and social marketing may be producing rather than reducing drug related harm. [ABSTRACT FROM AUTHOR]

Abstract: Background: In Australia, the burden of alcohol-attributable harm falls most heavily on young people. Prevention is important, and schools have long been seen as appropriate settings for pre-emptive interventions with this high risk group. This paper evaluates the effectiveness, in relation to alcohol harm prevention, of the Drug Education in Victorian Schools (DEVS) programme, nine months after implementation. This intervention dealt with both licit and illicit drugs, employed a harm minimisation approach that incorporated interactive, skill based, teaching methods and capitalised on parental influence through home activities. Methods: A cluster randomised, controlled trial of the first ten lessons of the DEVS drug education programme was conducted with year eight students, aged 13–14 years. Twenty-one secondary schools in Victoria, Australia were randomly allocated to receive the DEVS programme (14 schools, n =1163) or the drug education usually provided by their schools (7 schools, n =589). Self-reported changes were measured in relation to: knowledge and attitudes, communication with parents, drug education lessons remembered, proportion of drinkers, alcohol consumption (quantity multiplied by frequency), proportion of student drinkers engaging in risky consumption, and the number of harms experienced as a result of alcohol consumption. Results: In comparison to the controls, there was a significantly greater increase in the intervention students’ knowledge about drugs, including alcohol (p ≤0.001); there was a significant change in their level of communication with parents about alcohol (p =0.037); they recalled receiving significantly more alcohol education (p <0.001); their alcohol consumption increased significantly less (p =0.011); and they experienced a lesser increase in harms associated with their drinking (p ≤0.001). There were no significant differences between the two study groups in relation to changes in attitudes towards alcohol or in the proportion of drinkers or risky drinkers. There was, however, a notable trend of less consumption by risky drinkers in the intervention group. Conclusions: A comprehensive, harm minimisation focused school drug education programme is effective in increasing general drug knowledge, and reducing alcohol consumption and harm. [Copyright &y& Elsevier]

Abstract: Background: In an effort to increase effective intervention following opioid overdose, the New York State Department of Health (NYSDOH) has implemented programs where bystanders are given brief education in recognizing the signs of opioid overdose and how to provide intervention, including the use of naloxone. The current study sought to assess the ability of NYSDOH training to increase accurate identification of opioid and non-opioid overdose, and naloxone use among heroin users. Methods: Eighty-four participants completed a test on overdose knowledge comprised of 16 putative overdose scenarios. Forty-four individuals completed the questionnaire immediately prior to and following standard overdose prevention training. A control group (n =40), who opted out of training, completed the questionnaire just once. Results: Overdose training significantly increased participants’ ability to accurately identify opioid overdose (p <0.05), and scenarios where naloxone administration was indicated (p <0.05). Training did not alter recognition of non-opioid overdose or non-overdose situations where naloxone should not be administered. Conclusions: The data indicate that overdose prevention training improves participants’ knowledge of opioid overdose and naloxone use, but naloxone may be administered in some situations where it is not warranted. Training curriculum could be improved by teaching individuals to recognize symptoms of non-opioid drug over-intoxication. [Copyright &y& Elsevier]

Abstract: Background: This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine. Methods: A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China. Results: Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine. Conclusions: There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context. [Copyright &y& Elsevier]

The article discusses a study which used the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) System, a system of programs that monitors drug abuse across addiction disorders, to analyzed the health effects of adolescent prescription drug abuse. According to the authors, the study revealed that adolescents' misuse of prescription drugs leads to increased cases of hospitalizations while the authors recommend improving interventions and educational programs.

Abstract: Background: Despite concerns regarding youth drug use and ‘standards’ of drugs education in British schools, little is known about young people''s routine experiences of drugs education at school, or schools’ other priorities, policies and practices relating to drugs. Methods: Qualitative data were collected through semi-structured interviews with students aged 14–15 (N =50) and teachers (N =10) at four schools in England. We used thematic content analysis to explore: young people''s accounts of drugs education at secondary school and what they have learnt from this; and students’ and teachers’ accounts of schools’ wider policies and practices relating to drugs. Results: A recurring theme was that students reported having received little or no drugs education; the majority could not remember having had any at their secondary school. These students were not the ‘drugwise’ youth described in the normalisation thesis and young people wanted their school to provide them with more information. Teachers recognised that schools’ drugs policies were rarely implemented in practice and that drugs education was not a priority. Schools also appear to be adopting new strategies based on surveillance and targeting to control students’ drug use. In some cases referrals to a drugs counsellor were coercive and appeared to merely replace classroom-based drugs education. Conclusion: This study provides further evidence of the gap between drug policies and practice. It may be possible to increase the priority given to comprehensive drugs education and supportive drugs policies by modifying the incentive structures that schools work within. New targeted responses are unlikely to be effective at reducing drug-related harm at a population level because of the small number of students reached, and can be stigmatising. Further research is needed to explore schools’ focus on surveillance and targeted control rather than universal education, and to examine interventions that might ensure schools implement adequate drugs education. [Copyright &y& Elsevier]

Abstract: Risk perception, perceived behavioral control of obtaining ecstasy (PBC-obtaining), current ecstasy dependence, and recent depression have been associated with past ecstasy use, however, their utility in predicting ecstasy use has not been demonstrated. This study aimed to determine whether these four modifiable risk factors could predict ecstasy use after controlling for socio-demographic covariates and recent polydrug use. Data from 601 ecstasy users in the National Institute on Drug Abuse-funded TriCity Study of Club Drug Use, Abuse and Dependence were analyzed using multivariate logistic regression. Participants were interviewed twice within a 2-week period using standardized instruments. Thirteen percent (n =80) of the participants reported using ecstasy between the two interviews. Low risk perception, high PBC-obtaining (an estimated ecstasy procurement time <24h), and current ecstasy dependence were statistically associated with ecstasy use between the two interviews. Recent depression was not a significant predictor. Despite not being a target predictor, recent polydrug use was also statistically associated with ecstasy use. The present findings may inform the development of interventions targeting ecstasy users. [Copyright &y& Elsevier]

Abstract: Introduction: Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups. Methods: Item response theory (IRT) and multiple indicators–multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN) (N =383). Participants were recruited from six community-based methadone maintenance treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist. Results: IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms had moderate to high discrimination in distinguishing drug users between severity levels. “Withdrawal” identified the most severe symptom of the cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence. Conclusions: Study results suggest that self-reported symptoms of cocaine and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users. [Copyright &y& Elsevier]

Abstract: Replacement therapy with the synthetic μ-opioid agonist methadone is an efficacious treatment for opioid abuse. While much is known about methadone''s pharmacology, its discriminative stimulus properties remain largely unexplored. The present study sought to establish methadone discrimination in rats. Moreover, some research suggests that route of administration alters the discriminative stimulus of methadone. Thus, the present study also compared intraperitoneal (i.p.) and subcutaneous (s.c.) routes of administration. Male Sprague–Dawley rats were trained to discriminate 3.0mg/kg methadone (i.p.) from vehicle in a two-lever discrimination procedure. Generalization tests were conducted with a variety of compounds administered i.p. and s.c. Methadone fully substituted for itself, yielding ED50s of 1.5mg/kg (i.p.) and 0.2mg/kg (s.c.). Naltrexone (i.p.), an opioid antagonist produced a dose-dependent reduction in methadone-appropriate responding. The methadone stereoisomers fully substituted for methadone when given s.c.; however, when administered i.p., (+) and (−) methadone produced partial and no substitution, respectively. Heroin fully generalized to methadone regardless of administration route, while morphine fully substituted when given s.c., but not i.p. The kappa-agonist U50-488 failed to generalize to methadone with either route of administration. These results demonstrated that methadone''s discriminative stimulus is mediated through μ-opioid receptor activity and is similar to that of commonly abused opioids (heroin, morphine). Additionally, route of administration produced differential results for many of the drugs tested, suggesting decreased drug bioavailability following i.p. administration due to hepatic first pass metabolism. Taken together, these results suggest that methadone''s shared subjective effects with abused opioids, as well as its unique metabolic properties contribute to its efficacy in opioid maintenance therapy. [Copyright &y& Elsevier]

In this paper we report on findings from a qualitative study of marijuana use by adolescents in two communities in British Columbia, Canada. During 2005 and 2006, 45 interviews were carried out at schools with students aged 13–18, with an aim of understanding how adolescents perceive their experiences with marijuana to be shaped by gender. While it has been established that patterns of use differ for girls and boys, there is relatively little qualitative research addressing marijuana smoking as gendered social practice. Drawing from contemporary social theories of gender our analysis explores the normative functions of gender discourse within adolescents' narratives, situating their descriptions of marijuana use within the context of the research interview and within the social contexts of drug use. The results highlight the challenges we encountered in asking about gender during one-to-one interviews, juxtaposed with examples from the narratives that illustrate how boys and girls use marijuana as a way of “doing” gender. To conclude, we suggest how our findings can inform the design of gender-specific health messaging on adolescent marijuana use. [Copyright &y& Elsevier]

Abstract: Researchers have been at the forefront of applying new costing methods to drug abuse treatment programs and innovations. The motivation for such work has been to improve costing accuracy. Recent work has seen applications initiated in establishing charts of account and cost accounting for service delivery. As a result, researchers now have available five methods to apply to the costing of drug abuse treatment programs. In all areas of costing, there is room for more research on costing concepts and measurement applications. Additional work would be useful in establishing studies with activity-based costing for both research and managerial purposes. Studies of economies of scope are particularly relevant because of the integration of social services and criminal justice in drug abuse treatment. In the long run, managerial initiatives to improve the administration and quality of drug abuse treatment will benefit directly from research with new information on costing techniques. [Copyright &y& Elsevier]

Psychoactive substance use by students is common in many countries, obliging schools to deliver drug education. However, some jurisdictions do not prepare teachers for engaging their students in honest, knowledge-based education. This article looks at the history and queries the purposes of contemporary drug education. It compares current approaches to drug education with those of other “vice” issues addressed in the history of public schools, such as sex education and temperance education. It critically challenges the question of knowledge definition and production related to psychoactive substances. Finally, some of the theoretical groundings on which to base teacher education for drug education are considered. [Copyright &y& Elsevier]

Objective To investigate the social mental state of drug addicts in a compulsive drug abuse treatment center; evaluate the effectiveness of integrated program for the prevention of abuse relapse and improvement of drug addicts' psychological health. Methods The study subjects were addicts from the Wuhan Compulsive Drug Abuse Treatment Center between October 2003 and June 2004, who satisfied the inclusion criteria. A non-randomized control-intervention study design was adopted. Volunteers willing to take part in intervention were put into the intervention group with their full awareness and willingness to prevent drug abuse relapse. The control group was composed of the addicts who were willing to prevent relapse and to be followed up after their discharge. Results The effectiveness of the integrated intervention program in promoting addicts' psychological health: before the intervention, the scores of Self-Rating Anxiety Scale (SAS), the positive and negative dimensionahties of Simple Coping Style Questionnaire (SCSQ) and Chinese Perceived Stress Scales (CPSS) had no significant differences between the intervention group and the control group. After the intervention, except that the SCSQ's positive dimensionality in the intervention group was significantly higher than that in the control group, other indices in the intervention group were lower. Before and after the intervention, the psychological health level in both the groups was lower than that in the normal population; there were significant differences between addicts and normal subjects in regards with all of the indices above. Conclusion Drug abuse was associated closely with addicts' social mental factors. The integrated intervention program can alleviate anxiety and stress, reduce co-morbid mental disorders and effectively improve their coping style. In conclusion, the program can promote addicts' psychological health significantly. [ABSTRACT FROM AUTHOR]

Abstract: Antisocial personality disorder (APD) is associated with increased problem severity in treatment-seeking opioid-dependent patients. Treatment studies have reported mixed results but generally show that patients with APD make progress that is often comparable to drug-dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. This study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid-dependent patients with APD. Subjects (N = 100) met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid dependence and APD using a structured clinical interview and were randomly assigned to either an experimental condition (n = 51), which used a highly structured contingency management intervention, or a control condition (n = 49), which reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to drug-dependent patients with APD. [Copyright &y& Elsevier]

Abstract: Acupuncture stimulation elicited a composite of sensations termed deqi that is related to clinical efficacy. Neurobiological studies have identified the hypothalamus as an important component in mediating the deqi. Functional changes in hypothalamus persist after abstinence in addicts. We investigated the activation in the hypothalamus associated with acupuncture stimulation in healthy volunteers and heroin addicts by fMRI. Cortisol level and psychophysical responses, including the deqi sensation (an acupuncture effect of needle-manipulation), anxiety, and sharp pain, were also assessed. The activation of the hypothalamus was more robust in the addicts than that in the healthy subjects during acupuncture stimulation. The deqi scores of the heroin addicts were significantly higher than those of the healthy subjects during acupuncture treatment. An acupuncture sensation scale predicted the activation of the hypothalamus associated with the deqi sensation. [Copyright &y& Elsevier]

Abstract: This study compares the provision of HIV testing in a nationally representative sample of correctional agencies and community-based substance abuse treatment programs and identifies the internal organizational-level correlates of HIV testing in both organizations. Data are derived from the Criminal Justice Drug Abuse Treatment Studies'' National Criminal Justice Treatment Practices Survey. Using an organizational diffusion theoretical framework [Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: The Free Press], the impact of Centralization of Power, Complexity, Formalization, Interconnectedness, Organizational Resources, and Organizational Size on HIV testing was examined in correctional agencies and treatment programs. Although there were no significant differences in the provision of HIV testing among correctional agencies (49%) and treatment programs (50%), the internal organizational-level correlates were more predictive of HIV testing in correctional agencies. Specifically, all dimensions, with the exception of Formalization, were related to the provision of HIV testing in correctional agencies. Implications for correctional agencies and community treatment to adopt HIV testing are discussed. [Copyright &y& Elsevier]

Abstract: This study, based upon epidemiological survey data from the United States (U.S.) National Household Surveys on Drug Abuse (NHSDA) from 2000 to 2001, presents new estimates for the risk of developing a hallucinogen dependence syndrome within 24 months after first use of any hallucinogen (median elapsed time ∼12 months). Subgroup variations in risk of becoming hallucinogen dependent also are explored. Estimates are derived from the NHSDA representative samples of non-institutionalized U.S. residents ages 12 and older (n =114,241). A total of 2035 respondents had used hallucinogens for the first time within 24 months prior to assessment. An estimated 2–3% of these recent-onset hallucinogen users had become dependent on hallucinogens, according to the NHSDA DSM-IV computerized diagnostic algorithm. Controlling for sociodemographic and other drug use covariates, very early first use of hallucinogens (age 10–11 years) is associated with increased risk of hallucinogen dependence (p <0.01). Excess risk of developing hallucinogen dependence was found in association with recent-onset use of mescaline; excess risk also was found for recent-onset users of ecstasy and of PCP. This study''s evidence is consistent with prior evidence on a tangible but quite infrequent dependence syndrome soon after the start of hallucinogen use; it offers leads that can be confirmed or disconfirmed in future investigations. [Copyright &y& Elsevier]

Abstract: Aims: Methods for the training and fidelity monitoring of behavioral interventions in multi-site addictions research are reviewed, including five published studies and seven ongoing studies sponsored by the National Institute on Drug Abuse-funded Clinical Trials Network. Methods: Methods are categorized and reviewed consistent with a technology model of treatment delivery. Topics include: therapist selection, training, certification, and supervision; selection, training, and certification of supervisors; scales and processes used for monitoring of the quality of treatment; and processes followed to provide new training for replacement staff once trials have begun. Results: The review reveals both a wide array of procedures and emerging standards for multi-site trials. Methodological weakness was observed with respect to limited empirical support for many adherence scales, little or no evaluation of supervisory processes, and no evaluation of re-training practices. Conclusions: Methods used in multi-site trials are important not only to ensure validity of those trials, but also to inform the wider dissemination of empirically based treatment into community agencies. Studies examining noted weaknesses are needed. Training and fidelity models that delegate responsibility to participating sites appear most relevant for establishing best practices for dissemination of behavioral interventions. The effectiveness of these distributed training and supervision models should be subjected to empirical study at a level of rigor comparable to the evaluation of their corresponding treatments. [Copyright &y& Elsevier]

Abstract: The extent to which dependence occurs with or without abuse is important because of the potential for underestimation and biased estimates of drug dependence in surveys that rely on abuse as a screening method for dependence. The purpose of this paper was to present the prevalence of DSM-IV drug dependence with and without drug abuse in a nationally representative sample, as well as in subgroups defined by sex, age and race/ethnicity. Among all respondents with current drug dependence, 22.0% did not additionally meet criteria for abuse (19.5% among males and 27.8% among females). Current drug dependence without abuse was especially common among females age 45–64 (52.6% of all cases). Among those with lifetime diagnoses of drug dependence, a small proportion overall, 5.0% had no symptoms of abuse, with the highest proportion again found among females aged 45–64 (19.5% of all cases). The use of drug abuse as a screening method for drug dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting many types of research. Dependence with and without abuse may represent heterogeneous phenotypes for genetic and gene-environment research, which should be explored. [Copyright &y& Elsevier]

Abstract: Although readiness for substance abuse treatment is a potent predictor of short-term clinical response, predictors of readiness are still poorly understood. Predictive models are customarily not predicated on dependence or abuse, but usually focus instead on intrapsychic motivational change or external contextual incentives. Based on a secondary analysis of the drug abuse treatment outcome studies (DATOS) data set for adults and a similar data set for adolescents (DATOS-A), latent variables were constructed to represent readiness for treatment, various psychosocial and behavioral features of substance use, substance-related problems and specific substance use frequency. Identical measures were used for each group. The two groups were then directly compared using a series of constrained covariance structure models. A path model using all hypothesized latent variables, treatment modality and demographics predicted Readiness for treatment in each separate group. Substance problems, a latent variable reflecting cross-substance symptoms of dependence and abuse, was the strongest predictor of Readiness for treatment in both age groups. Health problems and deviant family/peers were also strong predictors of readiness in both age groups. Demographic variables and specific substances used predicted readiness directly and indirectly in an age-specific manner. This study links readiness for substance abuse treatment to the core disorders targeted by that treatment in adults and adolescents for the first time. [Copyright &y& Elsevier]

Abstract: This paper examines the drug-related decisions of a previously under researched group of children; those in their pre-teen and early teenage years. Based on a prospective study of 92 ‘at risk’ children, it explores the reasons which they gave for their use or non-use of illegal drugs. The accounts of those who used drugs on a regular or occasional basis are strongly supportive of the importance of personal choice, emphasising the role of enjoyment and boredom as the main motivating factors. The reasons given for not using drugs included a lack of interest in the activity, fear of the effects of the drug and a concern that drug taking would compromise other valued activities or pursuits. The anticipated reaction of parents, and the extent to which they had internalised parental values on drugs, also appeared to act as an important restraint for some of the children. While there is a vital role for drug education in seeking to influence children''s drug-related decisions, the study''s conclusions also emphasise the significance of parents in this regard. The fact that the overwhelming majority of the children reported using drugs because they enjoyed them or because they were bored also suggests that the provision of alternative activities should be central to any preventive strategy. [Copyright &y& Elsevier]

Abstract: In this paper we estimate the risk of becoming cannabis dependent within 24 months after first use of cannabis and examine subgroup variation in this risk. The study estimates are based on the National Household Survey on Drug Abuse conducted during 2000–2001, with a representative sample of U.S. residents ages 12 and older (n =114,241). A total of 3352 respondents were found to have used cannabis for the first time within a span of up to 24 months prior to assessment. An estimated 3.9% of these recent-onset users developed a cannabis dependence syndrome during the interval since first use (median interval duration ∼12 months). Excess risk of cannabis dependence was found for those with cannabis onset before late-adolescence, those with family income less than US$ 20,000, and those who had used three or more drugs before the first use of cannabis (i.e., tobacco, alcohol, and other drugs). While these findings generally support previous study results, this study''s focus on recent-onset users more closely approximates prospective and longitudinal research on the incidence (risk) of becoming cannabis dependent soon after onset of cannabis use, removing the influence of users with long-sustained or persistent cannabis dependence developed years ago. [Copyright &y& Elsevier]

Followup results from the Drug Abuse Treatment Outcome Studies (DATOS) 1-year and 5-year followups were used to describe the long-term outcomes of drug treatment and to further clarify the relationship between treatment duration and post-treatment outcomes in four treatment modalities: outpatient methadone, long-term residential (LTR), outpatient drug free (ODF), and short-term inpatient. Methods replicating those used in earlier analyses of the DATOS 1-year followup of 2,966 patients admitted to treatment in 1991–1993 and those of the Treatment Outcome Prospective Study patients admitted in 1979–1981 were employed. DATOS is a non-experimental longitudinal study conducted within the natural settings of 96 treatment programs in the U.S.A. The study followed patients during and after treatment at specified periods of time. Prevalence of drug use and behaviors were evaluated for the year prior to treatment; and the post-treatment time frames defined by the 1- and 5-year followups. In addition, the multivariate analytic technique of generalized estimating equations was used to examine the relationship of treatment duration and outcomes across both followups while also controlling for patient characteristics and pretreatment levels of behaviors. The 5-year stratified followup sample included 1,393 of the same individuals in the 1-year followup sample. Analyses were restricted to patients participating in both followups. Reductions in prevalence of cocaine use in the year after treatment (compared to the preadmission year) by patients were associated with longer treatment durations (particularly 6 months or more in LTR and ODF). In addition, reductions in illegal activity and increases in full-time employment were related to treatment stays of 6 months or longer for patients in LTR. The DATOS results from the 1-year and 5-year post-treatment followup combined suggest the stability of outcomes of substance abuse treatment. While results are generally consistent with the full 1-year followup, reduced sample size and bias of the sample toward patients with longer treatment retention may have attenuated the findings. [Copyright &y& Elsevier]

In formulating policies for drug offenders, lawmakers must decide concrete questions about such matters as legal jurisdiction, burdens of proof, and reporting of progress information. Although these decisions may seem incidental to treatment and beyond the purview of science, they are based on empirically testable assumptions about the behavior of drug abusers and have a direct bearing on the efficacy of drug treatment interventions. Unfortunately, these assumptions have generally not been subjected to empirical inquiry. As a result, drug policy continues to be crafted by non-scientific advocates and subjected to popular vote by an insufficiently informed public. This article identifies several empirically answerable questions that underlie critical decision points in criminal statutes for drug offenders, reviews the available research evidence relevant to these questions, and encourages drug abuse researchers to conduct studies aimed squarely at informing these policy-relevant decisions. [Copyright &y& Elsevier]

This study evaluated the efficacy of Integrated Family and Cognitive-Behavioral Therapy (IFCBT), a multisystems treatment for adolescent drug abuse, versus a Drugs Harm Psychoeducation curriculum (DHPE). A randomized controlled trial assessed youth and parents at baseline and at 1, 3 and 6-month posttreatment points. Youth participants (N=43) met diagnostic criteria for one or more psychoactive substance use disorders with most youth meeting criteria for alcohol and marijuana use disorders. IFCBT produced significant reductions in posttreatment substance use when compared against DHPE. Throughout the 6-month posttreatment period, youth receiving IFCBT used alcohol an average of 2.03 days each month, which was significantly lower than the average number of 6.06 days that DHPE youth used alcohol during the same period. Similarly, youth receiving IFCBT used marijuana an average of 5.67 days each month during the initial 6 posttreatment months which was also significantly lower than the average number of 13.83 days that DHPE youth used marijuana each month during the same period. IFCBT also reduced rates of any marijuana use and produced significant changes in targeted psychosocial risk and protective factors. IFCBT youth exhibited significantly higher levels of rational problem solving and learning strategy skills, and significantly lower levels of problem avoidance when compared with DHPE youths. IFCBT parents exhibited significantly more adaptive scores on communication, involvement, control, and values/norms indices when compared with DHPE parents. No iatrogenic effects were exhibited among youth in either IFCBT or DHPE conditions on the outcome measures examined. The present study findings suggest that IFCBT is a promising approach for the treatment of adolescents with psychoactive substance use disorders. [Copyright &y& Elsevier]

Thirty-four schools (n=7426 consented sixth graders, 71% of the eligible population) were randomized to conditions to test the hypothesis that Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, is more effective than standard care in deterring and delaying substance use through middle school. Two-year posttest (1-year post-intervention) data were collected from 5691 eighth graders (77% of those who completed the sixth-grade survey and 87% of those who completed the seventh-grade survey). Lifetime and recent (last 30 days) use of five substances or combinations of substances was compared using mixed-model regression to control for school clustering. There were two significant treatment main effects at the end of the eighth grade: lifetime (P=.05) and recent (P<.03) marijuana use were lower in SFA than control schools with pretest usage and salient demographic and psychosocial variables controlled. There was also one significant Treatment×Pretest Usage interaction around binge drinking. Baseline binge drinkers in SFA schools were less likely to report recent binge drinking than students in control schools (P<.01); there were no treatment differences among baseline nonbinge drinkers. Analyses of potential mediators of SFA treatment effects on eighth-grade binge drinking and marijuana use suggested that SFA increased self-efficacy around drug refusal skills, but did not affect behavioral intentions, perceptions of harm, or perceived peer norms. These 2-year (1-year post-intervention) outcomes offer some additional support for SFA effectiveness and the general thrust of school-based, life skills-based prevention programs. The promising sixth- through eighth-grade findings for SFA, a commercially available program, provide a further step in bridging a major gap in the “research to practice” literature: theory-based interventions that have documented behavioral effects have not enjoyed large-scale implementation, while intuition-based programs that have no documented effects still enjoy wide exposure. [Copyright &y& Elsevier]

Drug prevention in schools is a top priority in most Western countries and several well-designed studies have shown that prevention programs have the potential of reducing drug use in adolescents. However, most prevention programs are not effective and there are no general criteria available for deciding which program is effective and which is not. In this systematic review of the literature, the current scientific knowledge about which characteristics determine the effectiveness of drug prevention programs is examined. Three types of studies are reviewed: meta-analyses (3 studies were included), studies examining mediating variables of interventions (6 studies), and studies directly comparing prevention programs with or without specific characteristics (4 studies on boosters, 12 on peer- versus adult-led programs, and 5 on adding community interventions to school programs). Seven evidence-based quality criteria were formulated: the effects of a program should have been proven; interactive delivery methods are superior; the “social influence model” is the best we have; focus on norms, commitment not to use, and intentions not to use; adding community interventions increases effects; the use of peer leaders is better; and adding life skills to programs may strengthen effects. [Copyright &y& Elsevier]

This article is an autoethnographic exploration of institutionalized responses to uncontrolled substance use informed by medical paradigms. Theoretically, it is situated within a lineage of work in critical drug and Mad studies that challenge assumptions about choice, including - and especially - by interrogating the extent to which choice is an apt conceptual tool for making sense of "addiction." Throughout, I focus on two discrete but analogous events, both of which entailed binging on substances, entering altered states, and being rejected from academic spaces through a lens of biomedicine. My objective in doing so is two-fold: First, I hope to incite what I feel is a long overdue conversation between Mad and critical drug studies in service of theoretical cross-pollination. Second, I wish to outline how codifying people as Mad and addicted can amount to a "cutting out" (Smith, 1978) of relevant extraneous factors that motivate one's deviant actions, including within education institutions whose members research these same identities. I conclude by discussing the implications of this "cutting out" for my and possibly others' academic trajectories. [ABSTRACT FROM AUTHOR]

The multiple disciplines and epistemic communities of the drug research broad landscape outline the context of what we collectively and officially "know" about drug use. While there is a growing body of ethnography with people who use drugs (PWUD), researchers who are themselves out as drug users-and their unofficial expertise-are largely absent. Miranda Fricker's "epistemic injustice" framework (2007) illuminates this knowledge deficit, describing an inability to conceptualize a person's experience due to historic marginalization from the very knowledge-making that defines that experience. The disclosure of lived experience in self-reflexive critique offers an authentic way to explore the complex, intersectional politics of drug use, something that is representationally and critically missing in drug studies. Locating the missing "I" in drug research may help drug studies recognize and interrogate the hegemonies of academic discourses that influence the varieties of lived experience important to drug scholarship. [ABSTRACT FROM AUTHOR]

Until the 1980s, anti-drug education campaigns in the UK were rare. This article examines the reasons behind a policy shift that led to the introduction of mass media drug education in the mid 1980s. It focuses on two campaigns. 'Heroin Screws You Up' ran in England, and 'Choose Life Not Drugs' ran in Scotland. The campaigns were different in tone, with 'Heroin Screws You Up' making use of fear and 'shock horror' tactics, whereas 'Choose Life Not Drugs' attempted to deliver a more positive health message. 'Heroin Screws You Up' was criticised by many experts for its stigmatising approach. 'Choose Life Not Drugs' was more favourably received, but both campaigns ran into difficulties with the wider public. The messages of these campaigns were appropriated and deliberately subverted by some audiences. This historical policy analysis points towards a complex and nuanced relationship between drug education campaigns and their audiences, which raises wider questions about health education and its 'publics'. [ABSTRACT FROM AUTHOR]