Dose
Observed Transition from Opioid Analgesic Deaths towards Heroin
Nabarun Dasgupta et al.
Drug and Alcohol Dependence, December 2014, Pages 238–241
Background: In the United States, overdose mortality from controlled substances has increased over the last two decades, largely involving prescription opioid analgesics. There has been speculation on a transition away from prescription opioid use towards heroin, however the impact on overdose deaths has not been evaluated.
Methods: Time series study of North Carolina residents, 2007 through 2013. Monthly ratio of prescription opioid-to-heroin overdose deaths. Non-parametric local regression models used to ascertain temporal shifts from overdoses involving prescription opioids to heroin.
Results: There were 4,332 overdose deaths involving prescription opioids, and 455 involving heroin, including 44 where both were involved (total n = 4,743). A gradual 6-year shift toward increasing heroin deaths was observed. In January, 2007, for one heroin death there were 16 opioid analgesic deaths; in December, 2013 there were 3 prescription opioid deaths for each heroin death. The transition to heroin appears to have started prior to the introduction of tamper-resistant opioid analgesics. The age of death among heroin decedents shifted towards younger adults. Most heroin and opioid analgesic deaths occurred in metropolitan areas, with little change between 2007 and 2013.
Conclusions: The observed increases in heroin overdose deaths can no longer be considered speculation. Deaths among younger adults were noted to have increased in particular, suggesting new directions for targeting interventions. More research beyond vital statistics is needed to understand the root causes of the shift from prescription opioids to heroin.
----------------------
Trends in licit and illicit drug-related deaths in Florida from 2001 to 2012
Dayong Lee et al.
Forensic Science International, December 2014, Pages 178–186
Background: Florida, the epicenter of the recent prescription drug epidemic in the United States, maintains a statewide drug mortality surveillance system. We evaluated yearly profiles, demographic characteristics, and correlation between drug trends to understand the factors influencing drug-induced mortality.
Methods: All drug-related deaths reported to the Florida Medical Examiners Commission during 2001-2012 were included (n = 92,596). A death was considered “drug-related” if at least one drug was identified in the decedent. Depending on its contribution to death, a drug could be listed as a causative agent or merely present, but not both.
Results: Rate of drug-caused deaths was 8.0 per 100,000 population in 2001, increasing to 17.0 in 2010 and then decreasing to 13.9 in 2012. Benzodiazepines had the highest mortality rate in 2010, although <10% were solely due these drugs. Opioid-caused mortality rate also peaked in 2010 and started to decline (-28%) in 2010-2012. The heroin-caused mortality rates were negatively correlated with opioids and benzodiazepines (ρ’s ≥ -0.670; P ≤ 0.034). Ethanol- and cocaine-mortality rates stabilized to 3.0-3.1 and 2.8-3.0 per 100,000 over 2009-2012, respectively. Amphetamines, zolpidem, and inhalants-caused deaths were on the rise with rates of ≤0.6 per 100,000.
Conclusions: Overall declines in benzodiazepine- and opioid-caused deaths in 2011-2012 may have been related to Florida's attempts to regulate prescription drug abuse. This period, however, was also marked by a rise in heroin-caused mortality, which may reflect growing use of heroin as an alternative. Increases in amphetamines, zolpidem, and inhalants-induced mortality are an additional public health concern.
----------------------
Medical Marijuana Laws and Suicides by Gender and Age
Mark Anderson, Daniel Rees & Joseph Sabia
American Journal of Public Health, December 2014, Pages 2369-2376
Objectives: We estimated the association between legalizing medical marijuana and suicides.
Methods: We obtained state-level suicide data from the National Vital Statistics System’s Mortality Detail Files for 1990–2007. We used regression analysis to examine the association between medical marijuana legalization and suicides per 100 000 population.
Results: After adjustment for economic conditions, state policies, and state-specific linear time trends, the association between legalizing medical marijuana and suicides was not statistically significant at the .05 level. However, legalization was associated with a 10.8% (95% confidence interval [CI] = −17.1%, −3.7%) and 9.4% (95% CI = −16.1%, −2.4%) reduction in the suicide rate of men aged 20 through 29 years and 30 through 39 years, respectively. Estimates for females were less precise and sensitive to model specification.
Conclusions: Suicides among men aged 20 through 39 years fell after medical marijuana legalization compared with those in states that did not legalize. The negative relationship between legalization and suicides among young men is consistent with the hypothesis that marijuana can be used to cope with stressful life events. However, this relationship may be explained by alcohol consumption. The mechanism through which legalizing medical marijuana reduces suicides among young men remains a topic for future study.
----------------------
Subjective Beliefs, Deterrence, and the Propensity to Drive While Intoxicated
Yiqun Chen & Frank Sloan
NBER Working Paper, November 2014
Abstract:
This study investigates causal effects of changes in subjective probabilities of being pulled over and involved in accidents if driving while intoxicated on individuals’ drinking and driving choices. We also examine how hypothetical changes in perceptions of sanction severity affect drunk driving by experiments randomizing the harshness of punishments. We find that higher perceived risks of being pulled over and involved in accidents deter drinking and driving. However, deterrence is limited to persons who are alcohol addicted, lack self-control over drinking, and are more impulsive. No deterrent effect of harsher legal punishments is found on individuals’ drunk driving choices.
----------------------
Is Smoking Inferior? Evidence from Variation in the Earned Income Tax Credit
Donald Kenkel, Maximilian Schmeiser & Carly Urban
Journal of Human Resources, Fall 2014, Pages 1094-1120
Abstract:
In this paper we estimate the causal income elasticity of smoking participation, cessation, and cigarette demand conditional upon participation. Using an instrumental variables (IV) estimation strategy, we find that smoking appears to be a normal good among low-income adults: Higher-instrumented income is associated with an increase in the number of cigarettes consumed and a decrease in smoking cessation. The magnitude and direction of the changes in the income coefficients from our OLS to IV estimates are consistent with the hypothesis that correlational estimates between income and smoking-related outcomes are biased by unobservable characteristics that differentiate higher-income smokers from lower-income smokers.
----------------------
Are risk factors for drug use and offending similar during the teenage years?
Elizabeth Aston
International Journal of Drug Policy, forthcoming
Background: This paper explores whether at different stages of the developmental cycle of adolescence, drug use and offending are associated with a similar set of risk factors relating to: socio-structural position, informal social control, deviant peer group contexts, and deviant lifestyle behaviours.
Methods: Multivariate regression was used to analyse data from the Edinburgh Study of Youth Transitions and Crime (ESYTC) self-report questionnaire.
Results: Early in the teenage years drug use was associated with a similar set of factors to offending. These include weak bonds to parents and teachers, and deviant lifestyle behaviours. However, later in the teenage years there were differences, e.g. drug use was associated with higher socio-economic status and importance of school, and a number of factors which were associated with offending were not associated with drug use, e.g. parent-child conflict, gang membership and hanging around.
Conclusion: Results show that the factors included here are more appropriate to understanding offending than drug use. Different risk factors are associated with drug use and offending in the older, but not younger teens. It is argued that later in the teenage years drug use should be understood and addressed differently to offending. This is particularly important given the tendency for the ‘drugs problem’ to increasingly be dealt with as a ‘crime problem’ (Duke, 2006).
----------------------
Gambling Prevalence Rates among Immigrants: A Multigenerational Examination
Alyssa Wilson et al.
Addictive Behaviors, March 2015, Pages 79–85
Introduction: The present study employed data from Waves I and II of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) to compare gambling prevalence rates across gender and world regions (e.g., Africa, Asia, Europe, and Latin America).
Methods: Responses from first generation (n = 5,363), second generation (n = 4,826), third generation (n = 4,746), and native-born Americans (n = 19,715) were subjected to a series of multinomial regression analyses, after controlling for sociodemographic variables such as age, gender, race/ethnicity, household income, education level, region of the United States, and urbanicity.
Results: The prevalence of gambling and problem gambling was markedly lower among first-generation immigrants than that of native-born Americans and second and third-generation immigrants. Results also point to inter- and intra-generational dynamics related to gender, age of arrival and duration in United States, and world region from which participants emigrated. Additionally, we found that second-generation immigrants and nonimmigrants were significantly more likely to meet criteria for disordered gambling compared to first-generation immigrants in general.
Conclusions: Compared to first-generation immigrants, male and female immigrants of subsequent generations and nonimmigrants were significantly more likely to report involvement in all problem gambling behaviors examined. Findings suggest that gambling prevalence rates increase across subsequent generations, and are more likely to occur in women than among men.
----------------------
DRD4 and susceptibility to peer influence on alcohol use from adolescence to adulthood
Sylvie Mrug & Michael Windle
Drug and Alcohol Dependence, December 2014, Pages 168–173
Background: The long allele of DRD4 is associated with greater susceptibility to peer influences on alcohol use in young adulthood, but it is unclear whether this increased susceptibility extends to other developmental periods. This study examined the interactive effects of DRD4 polymorphism and friends’ alcohol use from adolescence to adulthood.
Methods: Participants (N = 340; 59% female; 98% White) reported on their own and their friends’ alcohol use at four time points between mean ages 17 and 33. Autoregressive cross-lagged models evaluated reciprocal relationships between friends’ alcohol use and participants’ own alcohol use and frequency of heavy drinking over time. Multigroup modeling tested differences in model paths and covariances across high vs. low risk DRD4 polymorphisms.
Results: Alcohol use at age 33 was predicted by previous friends’ alcohol use and correlated with current friends’ alcohol use only for carriers of the DRD4 long allele. Regardless of DRD4 genotype, friends’ alcohol use at age 17 predicted greater alcohol use and more frequent heavy drinking at age 23. Alcohol use and/or heavy drinking predicted greater friends’ alcohol use at later time points for both genotype groups across adolescence and adulthood.
Conclusions: The long allele of DRD4 is associated with increased susceptibility to peer influences on alcohol use in young adulthood, but not earlier in development. Adults with the long allele of DRD4 may benefit from interventions educating them about this risk and equipping them with strategies to reduce affiliations with and influence of drinking friends.
----------------------
Olfactory Aversive Conditioning during Sleep Reduces Cigarette-Smoking Behavior
Anat Arzi et al.
Journal of Neuroscience, 12 November 2014, Pages 15382-15393
Abstract:
Recent findings suggest that novel associations can be learned during sleep. However, whether associative learning during sleep can alter later waking behavior and whether such behavioral changes last for minutes, hours, or days remain unknown. We tested the hypothesis that olfactory aversive conditioning during sleep will alter cigarette-smoking behavior during ensuing wakefulness. A total of 66 human subjects wishing to quit smoking participated in the study (23 females; mean age, 28.7 ± 5.2 years). Subjects completed a daily smoking diary detailing the number of cigarettes smoked during 7 d before and following a 1 d or night protocol of conditioning between cigarette odor and profoundly unpleasant odors. We observed significant reductions in the number of cigarettes smoked following olfactory aversive conditioning during stage 2 and rapid eye movement (REM) sleep but not following aversive conditioning during wakefulness (p < 0.05). Moreover, the reduction in smoking following aversive conditioning during stage 2 (34.4 ± 30.1%) was greater and longer lasting compared with the reduction following aversive conditioning during REM (11.9 ± 19.2%, p < 0.05). Finally, the reduction in smoking following aversive conditioning during sleep was significantly greater than in two separate control sleep experiments that tested aversive odors alone and the effects of cigarette odors and aversive odors without pairing. To conclude, a single night of olfactory aversive conditioning during sleep significantly reduced cigarette-smoking behavior in a sleep stage-dependent manner, and this effect persisted for several days.
----------------------
Parent–Offspring Similarity for Drinking: A Longitudinal Adoption Study
Matt McGue et al.
Behavior Genetics, November 2014, Pages 620-628
Abstract:
Parent–offspring resemblance for drinking was investigated in a sample of 409 adopted and 208 non-adopted families participating in the Sibling Interaction and Behavior Study. Drinking data was available for 1,229 offspring, assessed longitudinally up to three times in the age range from 10 to 28 years. A single drinking index was computed from four items measuring quantity, frequency and density of drinking. As expected, the mean drinking index increased with age, was greater in males as compared to females (although not at the younger ages), but did not vary significantly by adoption status. Parent–offspring correlation in drinking did not vary significantly by either offspring or parent gender but did differ significantly by adoption status. In adopted families, the parent–offspring correlation was statistically significant at all ages but decreased for the oldest age group (age 22–28). In non-adopted families, the parent–offspring correlation was statistically significant at all ages and increased in the oldest age group. Findings imply that genetic influences on drinking behavior increase with age while shared family environment influences decline, especially during the transition from late-adolescence to early adulthood.
----------------------
Philip Smith et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
Childhood maltreatment is associated with increased likelihood of smoking. The purpose of the current investigation was to compare quitting motives, quit attempts, and quit success between U.S. adult smokers with or without childhood maltreatment (physical or emotional abuse), and those with or without serious psychological distress (SPD). We also examined whether SPD mediated associations between childhood maltreatment and all outcomes. We analyzed data from a 2-wave cohort telephone survey of a national U.S. sample of current cigarette smokers (n = 751). We used generalized path modeling to examine associations between maltreatment/SPD and concerns about smoking, motivation to quit, quit attempts, and smoking cessation (among the overall sample and selecting for those who made at least 1 quit attempt between waves; n = 368). Among women, maltreatment and SPD were associated with lower likelihood of quitting as well as making a successful quit attempt. SPD mediated the association between maltreatment and likelihood of successfully quitting. Women with maltreatment also had stronger concerns about smoking and motivation to quit than those without maltreatment, although there were no differences in actual quit attempts made. Neither childhood maltreatment nor SPD was associated with smoking outcomes among men. Findings suggest that female smokers with a history of childhood maltreatment are motivated to quit smoking; however, they may have more difficulty quitting smoking as a result of SPD.
----------------------
Neighbourhood crime and adolescent cannabis use in Canadian adolescents
Margaretha de Looze et al.
Drug and Alcohol Dependence, forthcoming
Background: Although neighbourhood factors have been proposed as determinants of adolescent behaviour, few studies document their relative etiological importance. We investigated the relationship between neighbourhood crime and cannabis use in a nationally representative sample of Canadian adolescents.
Methods: Data from the 2009/10 Canadian Health Behaviour in School-aged Children (HBSC) survey (n = 9134 14- and 15-year-olds) were combined with area-level data on crime and socioeconomic status of the neighbourhood surrounding the schools (n = 218).
Results: Multilevel logistic regression analyses showed that after individual and contextual differences were held constant, neighbourhood crime related to cannabis use (OR 1.29, CI 1.12–1.47 per 1.0 SD increase in crime). This association was not moderated by parental support nor having cannabis-using friends. The amount of explained variance at the neighbourhood level was 19%.
Conclusions: Neighbourhood crime is an important factor to consider when designing interventions aimed at reducing adolescent cannabis use. Interventional research should examine the effectiveness of community-based interventions that target adolescents through parents and peers.
----------------------
The Impact of Sound in Modern Multiline Video Slot Machine Play
Mike Dixon et al.
Journal of Gambling Studies, December 2014, Pages 913-929
Abstract:
Slot machine wins and losses have distinctive, measurable, physiological effects on players. The contributing factors to these effects remain under-explored. We believe that sound is one of these key contributing factors. Sound plays an important role in reinforcement, and thus on arousal level and stress response of players. It is the use of sound for positive reinforcement in particular that we believe influences the player. In the current study, we investigate the role that sound plays in psychophysical responses to slot machine play. A total of 96 gamblers played a slot machine simulator with and without sound being paired with reinforcement. Skin conductance responses and heart rate, as well as subjective judgments about the gambling experience were examined. The results showed that the sound influenced the arousal of participants both psychophysically and psychologically. The sound also influenced players’ preferences, with the majority of players preferring to play slot machines that were accompanied by winning sounds. The sounds also caused players to significantly overestimate the number of times they won while playing the slot machine.
----------------------
Alcohol Effects on Simulated Driving Performance and Self-Perceptions of Impairment in DUI Offenders
Nicholas Van Dyke & Mark Fillmore
Experimental and Clinical Psychopharmacology, December 2014, Pages 484-493
Abstract:
Drivers with a history of driving under the influence (DUI) of alcohol self-report heightened impulsivity and display reckless driving behaviors as indicated by increased rates of vehicle crashes, moving violations, and traffic tickets. Such poor behavioral self-regulation could also increase sensitivity to the disruptive effects of alcohol on driving performance. The present study examined the degree to which DUI drivers display an increased sensitivity to the acute impairing effects of alcohol on simulated driving performance and overestimate their driving fitness following alcohol consumption. Adult drivers with a history of DUI and a demographically matched group of drivers with no history of DUI (controls) were tested following a 0.65 g/kg alcohol and a placebo. Results indicated that alcohol impaired several measures of driving performance, and there was no difference between DUI offenders and controls in these impairments. However, following alcohol, DUI drivers self-reported a greater ability and willingness to drive compared with controls. These findings indicate that drivers with a history of DUI might perceive themselves as more fit to drive after drinking, which could play an important role in their decisions to drink and drive.
----------------------
Darla Kendzor et al.
American Journal of Public Health, forthcoming
Objectives: We evaluated the effectiveness of offering adjunctive financial incentives for abstinence (contingency management [CM]) within a safety net hospital smoking cessation program.
Methods: We randomized participants (n = 146) from a Dallas County, Texas, Tobacco Cessation Clinic from 2011 to 2013 to usual care (UC; cessation program; n = 71) or CM (UC + 4 weeks of financial incentives; n = 75), and followed from 1 week before the quit date through 4 weeks after the quit date. A subset (n = 128) was asked to attend a visit 12 weeks after the scheduled quit date.
Results: Participants were primarily Black (62.3%) or White (28.1%) and female (57.5%). Most participants were uninsured (52.1%) and had an annual household income of less than $12 000 (55.5%). Abstinence rates were significantly higher for those assigned to CM than UC at all visits following the quit date (all Ps < .05). Point prevalence abstinence rates in the CM and UC groups were 49.3% versus 25.4% at 4 weeks after the quit date and 32.8% versus 14.1% at 12 weeks after the quit date. CM participants earned an average of $63.40 ($150 possible) for abstinence during the first 4 weeks after the scheduled quit date.
Conclusions: Offering small financial incentives for abstinence might be an effective means to improve abstinence rates among socioeconomically disadvantaged individuals participating in smoking cessation treatment.
----------------------
Eric Jacobs et al.
Annals of Epidemiology, forthcoming
Purpose: The proportion of cancer deaths in the contemporary U.S. caused by cigarette smoking (the population attributable fraction (PAF)) is not well-documented.
Methods: The PAF of all cancer deaths due to active cigarette smoking among adults 35 and older in the U.S. in 2010 was calculated using age and sex-specific smoking prevalence from the National Health Interview Survey (NHIS) and age and sex-specific relative risks from the Cancer Prevention Study-II (for ages 35-54) and from the Pooled Contemporary Cohort data set (for ages 55 and older).
Results: The PAF for active cigarette smoking was 28.7% when estimated conservatively, including only deaths from the 12 cancers currently formally established as caused by smoking by the U.S. Surgeon General. The PAF was 31.7% when estimated more comprehensively, including excess deaths from all cancers. These estimates do not include additional potential cancer deaths from environmental tobacco smoke or other type of tobacco use such as cigars, pipes or smokeless tobacco.
Conclusions: Cigarette smoking causes a large proportion of cancer deaths in the contemporary U.S. Reducing smoking prevalence as rapidly as possible should be a top priority for U.S. public health efforts to prevent cancer deaths.
----------------------
A Prospective Study of Adolescents’ Nonmedical Use of Anxiolytic and Sleep Medication
Carol Boyd et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
The purpose of this longitudinal study (N = 2,745) was to determine whether adolescents’ recent medical use of anxiolytic or sleep medication was associated with increased incidence of using someone else’s prescription for these classes of medication (nonmedical use). Data were collected from adolescents attending 5 Detroit area secondary schools between December and April in 3 consecutive academic years between 2009 and 2012. Respondents were assigned to the following 3 mutually exclusive groups for the analyses: (1) never prescribed anxiolytic or sleep medication (in their lifetime); (2) prescribed anxiolytic or sleep medication in their lifetime, but not during the study period; or (3) prescribed anxiolytic or sleep medication during the study period. Almost 9% of the sample had received a prescription for anxiolytic or sleep medication during their lifetime, and 3.4% had received at least 1 prescription during the 3-year study period. Compared with adolescents never prescribed anxiolytic or sleep medication, adolescents prescribed these medicines during the study period were 10 times more likely to engage in nonmedical use for reasons such as “to get high” or “to experiment” (adjusted odds ratio [ORadj.] = 10.15; 95% CI [3.97–25.91]), and 3 times more likely to engage in nonmedical use to self-treat anxiety or to sleep (ORadj. = 3.24; 95% CI [1.67–6.29]). Adolescents prescribed anxiolytics during their lifetime but not during the 3-year study were 12 times more likely to use another’s anxiolytic medication, compared with adolescents never prescribed anxiolytics (ORadj. = 12.17; 95% CI [3.98–37.18]). These risk factors have significant implications for later substance use problems.
----------------------
Smoking History, and Not Depression, is Related to Deficits in Detection of Happy and Sad Faces
K.K. Meyers et al.
Addictive Behaviors, February 2015, Pages 210–217
Abstract:
Previous research has demonstrated that chronic cigarette smoking and major depressive disorder (MDD) are each associated with cognitive decrements. Further, these conditions co-occur commonly, though mechanisms in the comorbid condition are poorly understood. There may be distinct, additive, or overlapping factors underlying comorbid cigarette smoking and MDD. The present study investigated the impact of smoking and MDD on executive function and emotion processing. Participants (N = 198) were grouped by diagnostic category (MDD and healthy controls, HC) and smoking status (ever-smokers, ES and never-smokers, NS). Participants completed the Facial Emotion Perception Test (FEPT), a measure of emotional processing, and the parametric Go/No-go task (PGNG), a measure of executive function. FEPT performance was analyzed using ANCOVA with accuracy and reaction time as separate dependent variables. Repeated measures MANCOVA was conducted for PGNG with performance measure and task level as dependent variables. Analyses for each task included diagnostic and smoking group as independent variables, and gender was controlled for. Results for FEPT reveal lower overall accuracy was found for ES relative to NS, though MDD did not differ from HC. Post-hoc analyses revealed ES were poorer at identifying happy and sad, but not fearful or angry, faces. For PGNG, poorer performance was observed in MDD relative to HC in response time to Go targets, but there were no differences for ES and NS. Interaction of diagnosis and smoking group was not observed for performance on either task. The results of this study provide preliminary evidence for distinctive cognitive decrements in smokers and individuals with depression.
----------------------
Light-to-Moderate Alcohol Drinking Reduces the Impact of Obesity on the Risk of Diabetes Mellitus
Ichiro Wakabayashi
Journal of Studies on Alcohol and Drugs, November 2014, Pages 1032–1038
Objective: Light-to-moderate alcohol drinking has been shown to reduce the risk of type 2 diabetes, for which obesity is a primary risk factor. The aim of this study was to determine whether drinking alcohol influences the relationship between obesity and hyperglycemia.
Method: The relationships of adiposity indices with hyperglycemia were compared among middle-aged Japanese men (N = 12,627) who were non-, light-to-moderate (<22 g ethanol/day), heavy (≥22 and <44 g ethanol/day), and very heavy (≥44 g ethanol/day) drinkers.
Results: There were significant positive correlations of hemoglobin A1c with body mass index (BMI) and waist-to-height ratio (WHtR), which were significantly weaker in light-to-moderate and heavy drinkers than in nondrinkers but were not significantly different in very heavy drinkers compared with nondrinkers. Odds ratios (ORs) for hyperglycemia in subjects with versus those without high BMI or WHtR were significantly higher than reference level of 1.00 in all the drinker groups and significantly lower in light-to-moderate and heavy drinkers compared with nondrinkers; however they were not significantly different in very heavy drinkers compared with nondrinkers. ORs of the interaction term consisting of alcohol drinking and high adiposity index were significantly lower than the reference level in the light-to-moderate and heavy drinkers (OR with 95% confidence interval: high BMI, 0.61 [0.41, 0.91] in light-to-moderate drinkers and 0.64 [0.48, 0.85] in heavy drinkers; high WHtR, 0.57 [0.38, 0.85] in light-to-moderate drinkers and 0.66 [0.50, 0.88] in heavy drinkers) but were not significantly different from the reference level in very heavy drinkers (high BMI, 0.90 [0.65, 1.25]; high WHtR, 1.04 [0.74, 1.46]).
Conclusions: The associations between obesity and hyperglycemia were weaker in light-to-moderate drinkers than in nondrinkers. Thus, light-to-moderate drinking may reduce the impact of obesity on the risk for diabetes.