Search

Little data have been published on specific health indicators for Roma, especially on substance use and related problems, and to our knowledge no data are available for Roma adolescents. The objective was to assess substance use of Roma as compared with non-Roma adolescents. Prevalence of tobacco and illicit drug use, and alcohol intoxication were examined in 225 Roma and 182 non-Roma adolescents. Relationship between substance use and potential risk factors, and ethnicity, was investigated by logistic regression analyses. A matched sample of Roma and non-Roma subjects was also used for additional confirmatory conditional regression analyses. Results indicated a significant association between Roma ethnicity and higher lifetime prevalence of tobacco use, alcohol intoxication, and illicit drugs use. Roma girls as compared with non-Roma girls evidenced a disproportionately higher prevalence of smoking as compared with the difference between Roma and non-Roma boys. Chi square analyses showed for both Roma parents a higher level of tolerant attitude to smoking. The inequalities of the health status in substance use behaviors of the Roma versus non-Roma population, expressed in a more pronounced way in the female Roma population, emerge at an early age, based on our data; they are observable already in the early adolescent and adolescent age groups. [ABSTRACT FROM AUTHOR]

Association between aggression and heavy alcohol use is documented in the literature in various disparate samples and settings. Comparison of trait aggression levels using a uniform methodology across different samples is almost entirely lacking. This study compared trait aggression levels of treated inpatients with severe alcohol-related problems with those of a nationally representative sample of the general adult population using the same methodology. Results indicated that in the patient population the trait aggression levels were substantially higher than in the general population. Because several studies have demonstrated that aggressive personality traits are closely linked with violence after drinking alcohol, our results further highlight the importance of treatment programs in this at-risk population. From a methodological perspective, the higher trait aggression level of inpatients with alcohol-related problems compared with the general population supports the assumption that the underrepresentation of alcoholics in the population surveys may restrict the range in the severity of alcohol use and dependence, and may therefore produce severely biased results in such studies. [ABSTRACT FROM AUTHOR]

Abstract Background The authors present a case illustrating a mechanism leading directly to death which is not rare but has received little attention. Case presentation The case was evaluated by autopsy, investigation of morphine concentration in the blood, and clinical data. The heroin dose causing the 'overdose' death of a young man who had previously been treated a number of times for heroin addiction did not differ from his dose of the previous day taken in the accustomed circumstances. The accustomed dose taken in a strange environment caused fatal complications because the conditioned tolerance failed to operate. The concentration of morphine in the blood did not exceed the level measured during earlier treatment. Conclusion These results are in line with the data in the literature indicating that morphine concentrations measured in cases of drug-related death do not differ substantially from those measured in cases where the outcome is not fatal. A knowledge of the conditioning mechanism can contribute to prevention of fatal cases of a similar type. The harm reduction approach places great stress on preventive intervention based on data related to drug-related death.

Introduction: Attention-deficit hyperactivity disorder is a risk factor of smoking and alcohol drinking in adolescence. Since attention-deficit hyperactivity disorder and smoking and alcohol drinking in adolescence are predictors for the development of substance use disorders in adulthood, it is important to understand the nature of these associations., Aim: The aim of the authors was to investigate associations between attention-deficit hyperactivity disorder symptoms and the joint use of alcohol and nicotine among 9th graders., Method: A representative sample of 944 pupils attending state-run secondary schools in Budapest were recruited. Generalized Linear Mixed Model and logistic regression analyses have been conducted., Results: The prevalence was 29.6% and 41.4% for current smoking and current alcohol drinking, respectively. The prevalence of their concurrent-use was 21.7%. Alcohol drinking and smoking showed a significant positive association with the total scores of Attention-Deficit Hyperactivity Disorder Scale and with the Attention Deficit and Hyperactivity/Impulsivity subscales., Conclusions: The findings highlight the potential importance of attention-deficit hyperactivity disorder in the development of the joint use of these substances.

Background: The Drug Use Disorders Identification Test (DUDIT) was developed for problematic substance use screening, and for a more detailed assessment of problematic use, the Drug Use Disorders Identification Test-Extended (DUDIT-E) was additionally developed., Purpose: Examining the psychometric properties of DUDIT and DUIT-E across diverse settings in populations of young drug users., Methods: We examined the psychometric characteristics of these instruments across various settings in populations of young substance users differing in substance use severity and treatment status. Data were collected from three clinically relevant groups (n = 259) as well as a control sample of college students (n = 109)., Results: Reliability analyses indicated good internal consistency for both instruments; high intraclass correlations further indicated good test-retest reliability. Differences among study groups were significant on the DUDIT scale and all DUDIT-E subscales (p < 0.01), with the target groups exhibiting higher scores compared to controls. A two-factor solution was identified for the factor structure of DUDIT., Conclusion: The Hungarian version of DUDIT and DUDIT-E can effectively identify substance use problems among young users.

Introduction: Smoking occurs frequently during pregnancy, thereby putting mother and child at health risks. Low socio-economic status is a risk factor for smoking., Aim: To investigate the relationship between smoking and low income in teenage and adult pregnancy, which is an important measure of poor socioeconomic status., Method: The authors used subject-level data from the US NSDUH database, which contains information on pregnancies and smoking., Results: Teenage pregnancy is associated with higher, whereas adult pregnancy with lower prevalence of smoking, compared to the age-matched female population. The association between income and smoking is age-dependent. Among adults there is an inverse relationship (high income -- low-risk of smoking), while in teenage pregnancy smoking increases with income., Conclusions: To investigate in teenage and adult pregnancy the relationship between smoking and low income, which is an important measure of poor socio-economic status. Higher socioeconomic status may be associated with risky behaviour, thereby increasing both the risk of smoking and early pregnancy.

The objective of this study was to investigate trait-aggression, depression and suicidal behavior of drug dependent patients with and without ADHD symptoms. The cross sectional survey was conducted in outpatient drug centers in Hungary. The Adult Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (AQ), the European Version of the ADolescent Assessment Dialogue (EuroADAD), and the Beck Depression Inventory (BDI) were used for measures. GLM analyses, adjusting for age and gender, indicated that patients who screened positive for ADHD (ADHD+ group) had significantly higher severity of overall trait aggression, as well as physical and verbal aggression than patients who did not (ADHD negative group). The highest severity of aggression was observed when the ADHD+ status co-occurred with heroin use, while the lowest severity of aggression was detected when ADHD- status co-occurred with the use of marijuana. ADHD+ patients showed a marked increase in depression symptoms, suicidal ideation, suicidal attempts as well as self-injuries associated with suicidal attempts. Considering the substantial costs of aggression and suicide from a societal perspective and from the point of view of the individual sufferer, our results highlight the importance of the diagnostic investigation of ADHD in the treatment of drug dependent patients., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Data in gender differences in aggression among alcohol and drug dependent subjects are lacking, and no published data are available about gender differences among various subtypes of substance using populations. The goal of this cross-sectional study was to investigate gender differences with regard to types of trait aggression in substance dependent young populations (age: 20-35 years) compared to the general population., Methods: Subjects were selected from two clinical samples with a diagnosis of alcohol and drug dependence as well as from a representative sample of the general population. Trait aggression was measured by the four individual subscales of the Buss Perry Aggression Questionnaire (physical-PA, verbal aggression-VA, hostility-H and anger AN) whereas alcohol and drug use were characterized by the AUDIT and EuroADAD scales, respectively., Results: Alcohol and drug dependent subjects showed higher severity on all four subscales of trait aggression compared to the general population. The male-female difference was the highest in the cannabis group. General Linear Model analysis for PA indicated a significant main effect of gender (higher PA for males, p=0.034) with no interaction between substance dependence and gender. For VA, no main effect or interaction for gender was found. Effect sizes for gender difference indicated that while males and females were similar in the control group in the severity in H and A, the level of H and AN was substantially higher in females than in males in the clinical group. These differences between the two genders reached statistical significance in the marijuana group, where female subjects showed a significantly higher severity in these two domains., Conclusions: Compared to the normal sample chronic substance use is associated with higher scores on certain factors of trait aggression, including hostility and anger, in females than in males. Our data suggest that aggression in substance dependent females is more provocable by chronic use of alcohol and drugs than in males., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: The Adolescent Drug Abuse Diagnosis (ADAD) has been a gold standard for assessing drug use and associated problems in adolescents. Criticism of the instrument has been increasing. A new instrument, the European Adolescent Assessment Dialogue (EuroADAD) that builds on ADAD's strengths but seeks to address its limitations is now available, but has not been subjected to comprehensive psychometric evaluation., Objective: To examine the psychometric properties of the EuroADAD across various settings in adolescent populations who developed or were at a high risk of developing substance use and psychosocial adaptation problems., Participants and Settings: Three of the samples were collected in Hungary, including: institutionalized youths from juvenile residential facility (n = 295); adolescents from outpatient psychiatry facility (n = 278), and controls (n = 59). An additional sample was collected in the Netherlands, and consisted of adolescent boys from an independent residential institution for youth with severe behavioral problems (n = 51)., Procedure: The EuroADAD was administered by trained interviewers. Data were collected through face-to-face interviews and self-report questionnaires., Results: Reliability: the intraclass correlation was high for all domains of the EuroADAD; reliability analyses indicated good test-retest reliability, and internal consistency., Validity: difference among study samples was significant (p < 0.05) for the majority of the domains, with juvenile institution and psychiatric outpatient subjects exhibiting higher severity in most areas compared to controls. The Hungarian and Dutch samples were comparable, expect for the legal domain, due to the higher severity of behavioral problems in the Dutch sample. Several domains of the instrument, including 'alcohol', 'drugs' and 'legal' showed an association with trait aggression as measured by the Buss-Perry Aggression Questionnaire and with Novelty Seeking on the Cloninger Temperament and Character Inventory., Conclusion: Based on the pattern and significance of group differences, and correlations with other measures, the scale has good criterion, and convergent and discriminant construct validity. The EuroADAD is a reliable and valid tool for the assessment of alcohol and drug use, and related psychosocial problems in adolescents., (Copyright © 2011 S. Karger AG, Basel.)

While many studies focused on the serious inequalities in the biological (sex, age) and social (education, occupation, place of residence) predictors of smoking in the world, there is a scarcity of such studies with regard to Hungary. Despite increasing evidence for smoking-related morbidity and mortality, health perception of the Hungarian population is unreasonably optimistic. This study investigated biological and social predictors of smoking in relation to the smoking prevalence, as well as health perception in relation to current smoking and to age of onset of smoking. The study period lasted from 1990 to 2008. Individual data bases from 15 representative population based studies, collected in the above study period, served as empirical data for the investigation. The entire sample included 30,352 individuals. After pooling the databases, a meta-analysis was performed using GLIMMIX, GLM and logistic regression models. Our results revealed an increase in the prevalence of daily smoking between 1990 and 2008; the increase was substantially higher among women than men. Low education, unemployment and a high number of residents per households increased the likelihood of daily smoking; current smoking and early age of onset of smoking increased the likelihood of perceiving the health situation as poor. These smoking trends draw attention to the inefficiency of the previous tobacco policies and prevention practices; they also urge prompt professional and policy interventions in the global national tobacco strategy in Hungary.

Background: The SCID-I structured clinical interview based on the DSM-IV-TR criteria is widely used in internationally, but the reliability and validity of its Hungarian version has not been investigated. This paper presents the results of the first validity and reliability study of the Hungarian version of the SCID-I/NP's (Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition) Anxiety Disorders module., Methods: The language adaptation of the diagnostic interview and of the user's guide was conducted in accordance with the WHO recommendations., Measures: SCID-I/NP Overview and Screening module; SCID-I/NP Module F: Anxiety Disorders; Tests providing external validity: Beck Anxiety Inventory (BAI), Adult ADHD Self-Report Scale (ASRS), Buss-Perry Aggression Questionnaire (AQ), Alcohol Use Disorders Identification Test (AUDIT). The study sample consisted of 741 patients attended at three GP's offices. The trial's duration was two months., Statistical Analyses: GLM analysis, Chi-square test, Fisher's exact test, Kappa and weighted Kappa statistics., Results: Results showed a significant interrater-agreement between the rater pairs. For screening modules yealding negative results, the false-negative analysis indicated a subthreshold positive diagnosis in one case. External validity analyses showed significant discrepancies in terms of gender, marital status and past psychiatric treatments among the three sample groups including those with diagnosis present, subthreshold diagnosis, diagnosis absent. In terms of the psychometric scales, we found significant differences on the BAI and the ASRS in these groups. In the case of AQ we found significant differences in total score and in the factors of hostility and anger: the diagnosis present group showed significantly elevated severity values compared to the other two groups., Conclusions: The Anxiety Disorders Module of the SCID-I/NP is suitable for detecting anxiety disorders in non-psychiatric population, and hence enables the early admission for treatment.

The relationship between physical abuse in childhood and suicide attempts in adulthood has long been known. However, the phenomenon has not been examined in patients who are undergoing treatment for alcoholism. In this study we seek an answer to the questions of whether exposure to physical abuse in childhood predisposes to violence, which in turn increases the likelihood of suicidal behavior in adulthood. The sample studied comprised 172 patients with alcohol dependence and with data for childhood physical abuse, trait aggression and lifetime suicide attempts. The measuring instruments used for the investigation were the European Addiction Severity Index, the Buss and Perry Aggression Questionnaire and the Janus Questionnaire. Generalized Linear Model analysis revealed a significant gender-dependent association between physical abuse by the parents suffered in childhood and later suicide attempts. In females, childhood victimization by parents increased the likelihood of suicide attempts by approximately 15 times; in males, the increase was about twofold. Association of suicide attempts with the overall level of trait aggression also significantly interacted with gender. In females, the increase in the level of total scores of the trait aggression from 0 to 50 points (approximately the mean level in the study population) elevated the likelihood of the suicide attempts by almost ninefold, whereas the analogous increase in males was about threefold. The results draw attention to the importance of preventing suicide in clinical populations of alcohol-dependent patients.

Objective: Whereas the association between heavy alcohol use and physical aggression (PA) is documented in alcohol dependent patients and the general population, comparison studies between populations treated for alcohol dependence and general population are lacking. In this study the nature of association between heavy drinking and PA was explored both in alcohol dependent inpatients and the general population., Method: Three hundred thirty inpatients with alcohol dependence and 1199 adult subjects representing the general population were examined with PA score of Buss-Perry Aggression Questionnaire and the AUDIT scores. Relationship between PA and AUDIT total score was investigated with ANCOVA analysis., Results: Significant association was found between alcohol use and PA in the ANCOVA analyses in both the inpatient and the control (general population) samples. At lower severity of alcohol use (total AUDIT score<8) the clinical sample showed a substantially higher severity of PA than the control sample, but at higher severity of alcohol use the control sample displayed a higher score of PA compared to the clinical sample., Conclusions: Clinical and general populations may need different risk management strategies in order to address their needs in rationalistic way.

Aggressive and hostile behaviours and anger constitute an important problem across cultures. The Buss-Perry Aggression Questionnaire (AQ), a self-rating scale was published in 1992, and has quickly become the gold-standard for the measurement of aggression. The AQ scale has been validated extensively, but the validation focused on various narrowly selected populations, typically, on samples of college students. Individuals, however, who are at risk of displaying aggressive and hostile behaviours may come from a more general population. Therefore, it is important to investigate the scale's properties in such a population. The objective of this study was to examine the factorial structure and the psychometric properties of the AQ scale in a nationally representative sample of the Hungarian adult population.A representative sample of 1200 subjects was selected by a two-step procedure. The dimensionality and factorial composition of the AQ scale was investigated by exploratory and confirmatory factor analyses. Since spurious associations and increased factorial complexity can occur when the analysis fails to consider the inherently categorical nature of the item level data, this study, in contrast to most previous studies, estimated the correlation matrices subjected to factor analysis using the polychoric correlations. The resulting factors were validated via sociodemographic characteristics and psychopathological scales obtained from the respondents. The results showed that based on the distribution of factor loadings and factor correlations, in the entire nationally representative sample of 1200 adult subjects, from the original factor structure three of the four factors (Physical and Verbal Aggression and Hostility) showed a good replication whereas the fourth factor (Anger) replicated moderately well. Replication further improved when the sample was restricted in age, i.e. the analysis focused on a sample representing the younger age group, comparable to that used in the original Buss-Perry study. Similar to the Buss-Perry study, and other investigations of the AQ scale, younger age and male gender were robustly related to physical aggression. In addition, level of verbal aggression was different between the two genders (with higher severity in males) whereas hostility and anger were essentially the same in both genders.In conclusion, the current study based on a representative sample of adult population lends support to the use of the AQ scale in the general population. The authors suggest to exclude from the AQ the two inverse items because of the low reliability of these items with regard to their hypothesized constructs., (Copyright (c) 2007 John Wiley & Sons, Ltd.)

Health and addiction harm of violence related to drinking is a very important aspect of the recent research studies. The social exchange theory, the family systems approach of alcoholism, the psychopharmacological model, the economic motivational model, and the tripartitate conceptual framework of Goldstein focus on the phenomenon within different causal contexts. According to recent studies approximately half of the cases is related to the alcohol consumption. Especially the binge drinking can facilitate violence. The problem is moderated by social, cultural, and ethnic specialties. The likelihood of alcohol related aggression increases in a rapidly changing society. Exposure to drinking related violence is frequent among women with pregnancy.

Opiate substitution treatment, commonly referred to as maintenance treatment, was introduced in the United States and Europe in the 1960s. This column discusses approaches to opioid maintenance treatment in Europe and focuses on the introduction of methadone maintenance treatment in Hungary. Although persons have received methadone maintenance in Hungary since 1987, consensus guidelines were not adopted until 1998 and were not confirmed by the Hungarian parliament until 2000. Hungary encountered initial difficulties in introducing methadone maintenance, and it is hoped that Hungary's joining the European Union in 2004 will help to make opiate substitution treatment more widely available.

Determining the prevalence of reckless drinking indicates the degree of the problem in the population at risk and can provide an opportunity to prevent the development of harmful effects. The authors assessed the prevalence of hazardous drinking in Hungary by applying the Alcohol Use Disorders Identification Test (AUDIT), which is widely used in international research and has good reliability indicators, as well as other psychopathological measures in a nationally representative sample (N=1200). 32.9% of the male drinkers (N=449) and 10% of the female drinkers can be regarded as being at risk. Applying the 8-point screening criteria of the AUDIT, it was found that 8.3% of the total sample can be regarded as drinkers at serious risk. This rate was 14.6 % for men and 2.7 % for women. Men scored significantly higher than women in all items of the questionnaire. Consumption of alcohol was markedly higher among men aged 45-64 years, in contrast with the younger age groups and the group over 64 years. In the case of women, we found significantly higher average total scores for the youngest age group (18-29 years) compared to the older age groups. The Hungarian prevalence data found in the present research project do not differ significantly from the earlier findings of Hungarian and international studies.

The CAGE scale, which was developed in the 1970s and consists of four items designed to screen alcoholism and related problems, has not yet been adapted for Hungary. In a research project carried out in a nationally representative sample, the authors tested the validity of CAGE, comparing the results with another widely used screening test (AUDIT). The reliability and validity of the CAGE test is regarded to be excellent. Comparing the diagnostic reliability of the two instruments, we found that 94% of the subjects were classified by these scales similarly into problem and non-problem drinking groups. According to the CAGE test 85 persons (7.1%) were classified as problem drinkers, compared to 99 persons in the case of AUDIT. On the basis of the study, we recommend the use of CAGE for the quick screening of severe clinical cases among middle-aged or older persons, in whom direct questions concerning drinking habits may provoke resistance.

The correlation between being a subject to physical abuse in childhood and violent and suicidal behaviour in adulthood has long been proved. The present research was aimed at answering the question whether an abuse event suffered in childhood creates a tendency to aggressive and suicidal behaviour in adulthood, and whether a correlation exists between these two forms of behaviour. The study sample consisted of 235 clinically treated alcoholics. The instruments used for the investigation were the European Addiction Severity Index (EuropASI), the Buss and Perry Aggression Questionnaire, and the Janus Questionnaire. The most important findings suggest that persons who were physically abused in childhood by their parents were more likely to strike or beat someone in the course of their lives (Chi(2) =9.79, p<0.001). Within the most aggressive group, 18 % had not suffered physical abuse in childhood, while 81% had been abused (Chi(2) =13.25, p<0.001). If the subject had been physically abused, struck or beaten, that person later in his life also abused, struck or beat someone (Pearson r=.397). Physical abuse in childhood perpetrated by parents shows a significant relationship with suicide attempts later in life (Chi(2) =9.73, p<0.01). The more aggressive the group to which a patient belongs, the more likely it was that he had attempted to commit suicide (Chi(2) =9.99, p<0.01). These results draw attention to the importance of preventing suicide and treating aggression in alcoholics involved in clinical treatment.

The authors examined the effect of personal involvement (drinking, violent behaviour) on beliefs concerning the causal connections between drinking alcohol and aggressive behavior. The sample of the study comprised 1200 persons representative of the population over 18 years of age and was selected by a two-step, group stratified sampling method. The measuring instruments used for the study were the questionnaire on alcohol-aggression beliefs applied by Paglia and Room, the Buss and Perry Aggression Questionnaire, and the sociodemographic characteristics of gender, age and education. Analyses using multivariate regression models showed that aggressive behaviour, particularly verbal and physical aggression, and heavy drinking significantly influence the belief of a causal connection between alcohol and aggression. The more a person drinks and the more aggressive he becomes, the more likely he is not to believe the opinion that drinking leads to aggression. Women and older people have a stronger belief in the causal role played by alcohol in aggressive behaviour. These results draw attention to the importance of the cognitive effect of personal involvement. Heavy drinking and aggressivity can prevent a person from recognizing the danger that drinking can have aggressive, criminal consequences. This relationship can be used well in clinical and criminological practice of crime prevention strategy for patients treated with drinking problems and facing proceedings or condemned for criminal actions. The findings of the study also raise a theoretical consideration that the theory of social learning is not a sufficient explanatory model for the connections between drinking and aggression.

We attempted a Hungarian adaptation of the European version (EuropASI) of the widely used Addiction Severity Index (ASI) within the frame of a multi-stage quality development programme. The ASI is characterised by good reliability and validity indicators. The empirical background for our research was the data obtained from ASI ratings for 266 alcohol- and drug-using patients presenting for treatment in addiction medicine clinics in different regions of the country. The reliability indicators for measurement tool rating (interrater) and time (test-retest) were high, with the exception of the correlation value for employment and support. The internal consistency of the test was good. The degree of correlation between the individual items did not exceed that found internationally. The psychometric results corresponded to the results obtained in foreign investigations. The Hungarian version of the ASI can be regarded as a useful and reliable measuring tool that can be used to identify the problems of addiction patients and to assess treatment efficacy., (Copyright 2005 S. Karger AG, Basel)

There is an increasing attention to the research of the treatment efficiency of drug users and abusers. Some measure tools (Addiction Severity Index, Opiate Treatment Index) have been developed for last years. Use of these methods is limited by the relative long duration (one hour) of the interview. The Maudsley Addiction Profile (MAP) is used in more European countries because of it's easy implementation. In this study the authors have focused on the Hungarian adaptation of the MAP. 103 heroin addicts were selected on the basis of the degrees of social integration and participation in any treatment programs. The MAP offers reliable data on the substance use, health risk behaviors and personal-social functioning regarding the last 30 days before the investigation. The data of this study strengthen the reliability and applicability of the MAP. This result is in accord with a previous study of the authors and other international studies. The MAP is very sensitive for the differences of various drug using groups. Scales and problem areas of the MAP seem to be reliable and easily treatable. This interview approach has proven a very useful tool in both research and clinical practice.

Accession to the European Union (EU) requires a revision of reporting system(s) and the adaptation of EU compliant measurement tools from the Hungarian side. In this study we try to monitor the Hungarian adaptation process of TDI regarding the European developments in this issue. The second goal of this study was to report on the reliability data of TDI which was assessed in Europe by our team first. 209 users of illicit drugs were sampled. The language adaptation needed a multi-stage translation process. The interrater and test retest reliability of TDI was found to be good. Inconsistency between related questions was not found. The reliability and validity indicators of the TDI in Hungary were acceptable. The protocol is easily applicable (5 minutes) and training is not needed.

Introduction: There have not been any substantive collection of data on cocaine users in Hungary although there were numerous indications that a cocaine problem may exist., Aim: In the frame of the project entitled "Support Needs for Cocaine and Crack Users in Europe" the aim of the authors was to identify the qualitative characteristics of Hungarian cocaine users., Study Group and Methods: In addition to a quantitative study of 210 cocaine users, we selected nine subjects by random sampling and conducted problem-oriented depth interviews with them. Three of the subjects belonged in the party group (weekend use, social integration), three in the scene group (part of the marginal drug-using subculture) and three in the therapy group (undergoing treatment for drug use at the time of the study). The main thread of the interview covered the following main aspects: 1. Drug-using behaviour--reduction, termination or continuation of use; 2. Use of support services; 3. Experiences with addiction medicine services; 4. Support needs., Results: The interviews decide to give up cocaine use when they perceive the disproportionately high costs of cocaine use on the basis of simple cost-benefit calculation. Apart from the existential costs, the main costs include sleep disorder, psychological and psychiatric symptoms and problems (depression, sensitivity, paranoid state, panic, anxiety, sexual disorders, etc.), symptoms reminiscent of serious cardiac disorders (chest pain) and interpersonal problems. They were able to reach professional help by chance, through friends. Cocaine users do not favour state health services, they are mistrustful of the handling of data. For this reason they prefer private doctors. They seek medical help not for detoxification but rather to prevent a relapse, generally for problems arising after withdrawal. Psychological help dominates in the assistance given. Heroin-dependent cocaine users seek help from the staff in the place where methadone treatment is given. Much depends in the management of abstinence on the degree of involvement in the subculture, emotional support, the attitude to work, the extent of disorders arising after withdrawal, and the quality of the personal relationship formed with the doctor. Most cocaine users require complex multi-disciplinary treatment., Conclusion: Cocaine use can be characterised along the dimensions of work, self-image, conspiracy, openness, criminality, basic drug, the negative or positive reinforcing function of cocaine: Dr. Jekyll and Mr. Hyde type, Carmen type, Pinocchio type. The Dr. Jekyll and Mr. Hyde type is characterised by a double life, the Carmen type is the prototype of the sovereign female placing the emphasis on sexuality, the Pinocchio type is a trouble-making, criminal risk-seeker. While some of those within the Dr. Jekyll and Mr. Hyde type are open to help and others do not seek help, the Carmen type is open and the Pinocchio type closed to help unless their legal interests require the opposite.

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities., Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment., Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine., Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days., Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account., (Copyright 2004 S. Karger AG, Basel)

The authors examined the relationship of two dimensions of the theory of social development--vulnerability (predictors, risk factors) and protectivity--in two samples, schoolchildren aged ten to fifteen years and addictive drug users. On the basis of the Hirschi model of protective factors, they found that the most important protective factors (attachment, commitment, involvement, belief) act against substance use. A surprising finding was that among the predictors of the addicts some forms of escape from the family act against the development of drug use, that is, they can be regarded as a protective predictor. The findings of the study draw attention to the complexity of the vulnerability-protectivity relationship and to the need for further research.

Based on surveys and clinical data, it is concluded that the use of illegal drugs is spreading in Hungary. The social composition of drug users is changing and new forms of drugs and uses have appeared, such as heroin use and cocaine snorting. The legal regulation of access to drugs changed in 1993: stricter sentences can be imposed on drug traffickers, while the possibility has been created for drug users to undertake therapy in place of punishment. The Interministerial Committee on Drug Affairs and the Hungarian Association on Drug Use and Addiction have been set up. There are a few scientifically-based prevention programs. A number of clear paradigms have emerged in prevention policy and therapy, although it is not yet possible to see which of these will be confirmed by time and practice.