Drug Abuse

Kevin Lewis

March 28, 2010

Consequences of eliminating federal disability benefits for substance abusers

Pinka Chatterji & Ellen Meara
Journal of Health Economics, March 2010, Pages 226-240

Using annual, repeated cross-sections from national household surveys, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation. We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity-score methods to address differences in observed characteristics between likely substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias. In the short-run (1997-1998), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes. In the later period after the policy change (1999-2002), the rate of SSI receipt rose, and short-run gains in labor market outcomes diminished.


The effects of binge drinking on college students' next-day academic test-taking performance and mood state

Jonathan Howland, Damaris Rohsenow, Jacey Greece, Caroline Littlefield, Alissa Almeida, Timothy Heeren, Michael Winter, Caleb Bliss, Sarah Hunt & John Hermos
Addiction, April 2010, Pages 655-665

Aim: To assess the effects of binge drinking on students' next-day academic test-taking performance.

Design: A placebo-controlled cross-over design with randomly assigned order of conditions. Participants were randomized to either alcoholic beverage [mean = 0.12 g% breath alcohol concentration (BrAC)] or placebo on the first night and then received the other beverage a week later. The next day, participants were assessed on test-taking, neurocognitive performance and mood state.

Participants: A total of 196 college students (≥21 years) recruited from greater Boston.

Setting: The trial was conducted at the General Clinical Research Center at the Boston Medical Center.

Measurements: The Graduate Record Examinations(c) (GREs) and a quiz on a lecture presented the previous day measured test-taking performance; the Neurobehavioral Evaluation System (NES3) and the Psychomotor Vigilance Test (PVT) measured neurocognitive performance; and the Profile of Mood States (POMS) measured mood.

Findings: Test-taking performance was not affected on the morning after alcohol administration, but mood state and attention/reaction-time were affected.

Conclusion: Drinking to a level of 0.12 g% BrAC does not affect next-day test-taking performance, but does affect some neurocognitive measures and mood state.


The effect of alcohol on sexual risk-taking among young men and women

Young-Hee Cho & Sherry Span
Addictive Behaviors, forthcoming

The current study investigated the effects of alcohol and gender on the intentions of engaging in sexual risk-taking. Young adults (101 men, 99 women) were randomly assigned to the alcohol, placebo, or no-alcohol conditions. Participants listened to an audio-taped scenario that presented a romantic situation between a man and a woman who had just met. Participants were asked to imagine that they were one of the individuals in the scenario and then judged their intentions to engage in sexual risk-taking. Similar previous studies (e.g., Abbey, Saenz, & Buck, 2005) employing a vignette in which the couple had known each other prior to the romantic encounter found that intoxicated individuals reported a greater willingness to engage in sexual activity than those in the placebo and control groups. In contrast, the current study's results showed that intoxicated and placebo-treated women reported a greater intention of engaging in sex than sober women (b = 4.92, t = 2.42, p < 05). Conversely, intoxicated and placebo-treated men reported less willingness to engage in sex than sober men (b = -4.66, t = -2.14, p < .05). Neither alcohol nor gender predicted participants' intention to use a condom if they chose to engage in sex. However, those who used condoms more frequently were more likely to report intending to use a condom in this scenario (b = -1.60, t = -2.17, p < .05). The results demonstrated the complex processes underlying the effects of alcohol on engaging in casual sex, by revealing a gender-specific psychological effect of alcohol.


Death and prices: The political economy of Russia's alcohol crisis

Daniel Treisman
Economics of Transition, April 2010, Pages 281-331

Most experts agree that alcohol abuse has been a major cause of Russia's soaring mortality rate. But why have ever more Russians been drinking themselves to death? Some attribute this to despair in the face of painful economic change. I present evidence that, in fact, the surge in alcohol-related deaths - and premature deaths in general - was fuelled by a dramatic fall in the real price of vodka, which dropped 77 percent between December 1990 and December 1994. Variation in vodka prices - both over time and across Russia's regions - closely matches variation in mortality. Although market competition and weak excise collection help explain the fall in prices, the main reason appears to be populist price regulation during inflationary periods.


Social host liability for minors and underage drunk-driving accidents

Angela Dills
Journal of Health Economics, March 2010, Pages 241-249

Social host laws for minors aim to reduce teenage alcohol consumption by imposing liability on adults who host parties. Parents cite safety reasons as part of their motivation for hosting parties, preferring their teens and their teens' friends to drink in a supervised and safe locale. Both sides predict an effect of social host liability for minors on alcohol-related traffic accident rates for under-aged drinkers; the effects, however, work in opposite directions. This paper finds that, among 18-20 year olds, social host liability for minors reduced the drunk-driving fatality rate by 9%. I find no effect on sober traffic fatalities. Survey data on drinking and drunk driving suggest the declines resulted mostly from reductions in drunk driving and not reductions in drinking.


Using a novel alternative to drug choice in a human laboratory model of a cocaine binge: A game of chance

Suzanne Vosburg, Margaret Haney, Eric Rubin & Richard Foltin
Drug and Alcohol Dependence, forthcoming

Human laboratory studies have shown that, once initiated, cocaine self-administration is difficult to disrupt using non-drug alternatives. This inpatient study examined whether binge self-administration of cocaine could be altered by an immediate, non-drug reinforcer. Ten cocaine-dependent participants completed 5 consecutive laboratory session days with 2 sessions per day (a model binge), 9 days where cocaine was not available, and subsequent 2 laboratory session days where cocaine was again available (a second model binge). In each laboratory session, participants could choose to either self-administer smoked cocaine or play a game of chance by drawing a pre-determined number of balls from a bingo wheel. Balls were worth monetary amounts from $0 to $20. Participants' choice to smoke cocaine varied as a function of number of balls drawn. Thus, this game of chance served as an alternative reinforcer to smoking cocaine. Choice varied lawfully as a function of the number of opportunities to earn money indicating that an immediate behavioral alternative can reduce cocaine self-administration after initiation of use. The current model could be used to evaluate whether behavioral and pharmacological manipulations shift choice from cocaine to a non-drug alternative.


Neural Mechanisms of Reproduction in Females as a Predisposing Factor for Drug Addiction

Valerie Hedges, Nancy Staffend & Robert Meisel
Frontiers in Neuroendocrinology, forthcoming

There is an increasing awareness that adolescent females differ from males in their response to drugs of abuse and consequently in their vulnerability to addiction. One possible component of this vulnerability to drug addiction is the neurobiological impact that reproductive physiology and behaviors have on the mesolimbic dopamine system, a key neural pathway mediating drug addiction. In this review, we examine animal models that address the impact of ovarian cyclicity, sexual affiliation, sexual behavior, and maternal care on the long-term plasticity of the mesolimbic dopamine system. The thesis is that this plasticity in synaptic neurotransmission stemming from an individual's normal life history contributes to the pathological impact of drugs of abuse on the neurobiology of this system. Hormones released during reproductive cycles have only transient effects on these dopamine systems, whereas reproductive behaviors produce a persistent sensitization of dopamine release and postsynaptic neuronal responsiveness. Puberty itself may not represent a neurobiological risk factor for drug abuse, but attendant behavioral experiences may have a negative impact on females engaging in drug use.


Adolescents' Perceptions of Cigarette Brand Image: Does Plain Packaging Make a Difference?

Daniella Germain, Melanie Wakefield & Sarah Durkin
Journal of Adolescent Health, April 2010, Pages 385-392

Purpose: To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.

Methods: We used a 5 (degree of plain packaging and graphic health warning) × 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.

Results: When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.

Conclusions: Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced.


The role of education in the production of health: An empirical analysis of smoking behavior

Steven Tenn, Douglas Herman & Brett Wendling
Journal of Health Economics, forthcoming

We estimate the effect of education on smoking. Our estimation strategy "differences out" the impact of unobserved characteristics correlated with education by exploiting education differences between similarly selected groups one year apart in their life cycle. Individuals with a given age, education, and student status in the current and previous year are compared to their counterparts born one year later with the same age, education, and student status in the following and current year. We find that an additional year of education does not have a causal effect on smoking. Unobserved factors correlated with education entirely explain their cross-sectional relationship.


Alcohol Regulation and Crime

Christopher Carpenter & Carlos Dobkin
NBER Working Paper, March 2010

We provide a critical review of research in economics that has examined causal relationships between alcohol use and crime. We lay out several causal pathways through which alcohol regulation and alcohol consumption may affect crime, including: direct pharmacological effects on aggression, reaction time, and motor impairment; excuse motivations; venues and social interactions; and victimization risk. We focus our review on four main types of alcohol regulations: price/tax restrictions, age-based availability restrictions, spatial availability restrictions, and temporal availability restrictions. We conclude that there is strong evidence that tax- and age-based restrictions on alcohol availability reduce crime, and we discuss implications for policy and practice.


The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

Anne McCartt, Laurie Hellinga & Bevan Kirley
Journal of Safety Research, forthcoming

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed. Results: MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21. Among fatally injured drivers ages 16-20, the percentage with positive BACs declined from 61 percent in 1982 to 31 percent in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18-20) and among young teenagers not directly affected (ages 16-17). Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking. Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.


Is cannabis a gateway to hard drugs?

Hans Olav Melberg, Andrew Jones & Anne Line Bretteville-Jensen
Empirical Economics, June 2010, Pages 583-603

The gateway hypothesis proposes that use of cannabis directly increases the risk of consuming hard drugs. We test this controversial, but influential, hypothesis on a sample of cannabis users, exploiting a unique set of drug price data. A flexible approach is developed to identify the causal gateway effect using a bivariate survival model with shared frailty estimated using a latent class approach. The model suggests two distinct groups; a smaller group of "troubled youths" for whom there is a statistically significant gateway effect that more than doubles the hazard of starting to use hard drugs and a larger fraction of youths for whom previous cannabis use has less impact.


Person-environment interaction in the prediction of alcohol abuse and alcohol dependence in adulthood

Karl Hill, David Hawkins, Jennifer Bailey, Richard Catalano, Robert Abbott & Valerie Shapiro
Drug and Alcohol Dependence, forthcoming

Background: Behavioral disinhibition (externalizing/impulsivity) and behavioral inhibition (internalizing/anxiety) may contribute to the development of alcohol abuse and dependence. But tests of person-by-environment interactions in predicting alcohol use disorders are needed. This study examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence at age 27.

Methods: This study used longitudinal data from a community sample of 808 men and women interviewed from ages 10 to 27 in the Seattle Social Development Project. Zero-order correlations followed by a series of nested regressions examined the relationships between individual characteristics (behavioral disinhibition and behavioral inhibition/anxiety) and environment (good vs. poor family management practices during adolescence) in predicting alcohol abuse and dependence criterion counts at age 27.

Results: Behavioral disinhibition and poor family management predicted increased likelihood of both alcohol abuse and alcohol dependence at age 27. Behavioral inhibition/anxiety was unrelated to both outcomes. Youths high in behavioral disinhibition were at increased risk for later alcohol abuse and dependence only in consistently poorly managed family environments. In consistently well-managed families, high levels of behavioral disinhibition did not increase risk for later alcohol abuse or dependence.

Conclusions: Behavioral disinhibition increases risk for alcohol abuse and dependence in early adulthood only for individuals who experience poor family management during adolescence. Interventions seeking to reduce environmental risks by strengthening consistent positive family management practices may prevent later alcohol abuse and dependence among individuals at risk due to behavioral disinhibition.


Trends in the Genetic Influences on Smoking

Jason Boardman, Casey Blalock & Fred Pampel
Journal of Health and Social Behavior, March 2010, Pages 108-123

Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General's Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time.


Financial Strain and Smoking Cessation Among Racially/Ethnically Diverse Smokers

Darla Kendzor, Michael Businelle, Tracy Costello, Yessenia Castro, Lorraine Reitzel, Ludmila Cofta-Woerpel, Yisheng Li, Carlos Mazas, Jennifer Irvin Vidrine, Paul Cinciripini, Anthony Greisinger & David Wetter
American Journal of Public Health, April 2010, Pages 702-706.

Objectives: We evaluated the influence of financial strain on smoking cessation among Latino, African American, and Caucasian smokers of predominantly low socioeconomic status.

Methods: Smokers enrolled in a smoking cessation study (N=424) were followed from 1 week prequit through 26 weeks postquit. We conducted a logistic regression analysis to evaluate the association between baseline financial strain and smoking abstinence at 26 weeks postquit after control for age, gender, race/ethnicity, educational level, annual household income, marital status, number of cigarettes smoked per day, and time to first cigarette of the day.

Results: Greater financial strain at baseline was significantly associated with reduced odds of abstinence at 26 weeks postquit among those who completed the study (odds ratio [OR]=0.77; 95% confidence interval [CI]=0.62, 0.94; P=.01). There was a significant association as well in analyses that included those who completed the study in addition to those lost to follow-up who were categorized as smokers (OR=0.78; 95% CI=0.64, 0.96; P=.02).

Conclusions: Greater financial strain predicted lower cessation rates among racially/ethnically diverse smokers. Our findings highlight the impact of economic concerns on smoking cessation and the need to address financial strain in smoking cessation interventions.


Real Use or "Real Cool": Adolescents Speak Out About Displayed Alcohol References on Social Networking Websites

Megan Moreno, Leslie Briner, Amanda Williams, Leslie Walker & Dimitri Christakis
Journal of Adolescent Health, October 2009, Pages 420-422

Adolescents frequently display alcohol references on social networking Websites (SNSs). We conducted focus groups to determine adolescents' interpretations of these displayed alcohol references. Regardless of whether displayed alcohol references represent actual use, adolescents typically interpret these references as representing actual use and acknowledge their potential influence on peer behavior.


Methods of "fake ID" obtainment and use in underage college students

Julia Martinez & Kenneth Sher
Addictive Behaviors, forthcoming

Fake IDs are highly prevalent among underage college students, and are strongly associated with heavy drinking. However it is not currently known how exactly fake IDs are most commonly obtained and used, and how often individuals are caught. Such information could aid law enforcement and school personnel in their enforcement responsibilities, and might further elucidate the extent and means by which students "make ethical compromises" to gain illegal access to alcohol. A cross-sectional online survey of 1,098 underage students at a large Midwestern university indicated that comparable to previous findings, 21.0% reported possessing a fake ID (which was strongly associated with past-month frequent heavy drinking; OR = 4.84, 95% CI = 3.41-6.86). Of those with fake IDs, 93.5% reported having used them, and 29.1% reported having been caught. Greek (i.e., Fraternity/Sorority) members were more likely than others to obtain them through a Greek organization (OR = 8.02, 95% CI = 1.81-35.54). Also, men were more likely than women to buy (OR = 2.74, 95% CI = 1.57-4.77), yet less likely to be given them (OR = 0.53, 95% CI = 0.31-0.90). Future studies might examine whether and how fake ID capture reduces (or exacerbates) drinking over time.


The Methamphetamine Problem in the United States

Rachel Gonzales, Larissa Mooney & Richard Rawson
Annual Review of Public Health, 2010, Pages 385-398

Significant public health problems associated with methamphetamine (MA) production and use in the United States have emerged over the past 25 years; however, there has been considerable controversy about the size of the problem. Epidemiological indicators have provided a mixed picture. National surveys of the adult U.S. population and school-based populations have consistently been used to support the position that MA use is a relatively minor concern. However, many other data sources, including law-enforcement groups, welfare agencies, substance abuse treatment program admissions, criminal justice agencies, and state/county executives indicate that MA is a very significant public health problem for many communities throughout much of the country. In this article, we describe (a) the historical underpinnings of the MA problem, (b) epidemiological trends in MA use, (c) key subgroups at risk for MA problems, (d) the health and social factors associated with MA use, (e) interventions available for addressing the MA problem, and (f) lessons learned from past efforts addressing the MA problem.

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