Alcohol Addiction: One Entity or Different Entities? A DSM-4-Based Attempt Toward a Geographicization of Alcohol Addiction and Abuse.

AIM: To examine whether in Europe perceptions of 'alcoholism' differ in a discrete manner according to geographical area. METHOD: Secondary analysis of a data set from a European project carried out in 2013-2014 among 1767 patients treated in alcohol addiction units of nine countries/regions across Europe. The experience of all 11 DSM-4 criteria used for diagnosing 'alcohol dependence' and 'alcohol abuse' were assessed in patient interviews. The analysis was performed through Multiple Correspondence Analysis. RESULTS: The symptoms of 'alcohol dependence' and 'alcohol abuse', posited by DSM-IV, were distributed according to three discrete geographical patterns: a macro-area mainly centered on drinking beer and spirit, a culture traditionally oriented toward wine and a mixed intermediate alcoholic beverage situation. CONCLUSION: These patterns of perception seem to parallel the diverse drinking cultures of Europe.

A Commentary on the Limits of Alcoholic Beverage Policies.

Providing one set of policy measures for all countries as if they were a single, homogeneous entity does not appear to be evidence-based, according to recent research on the effectiveness of alcoholic beverage control policies. Contextual and cultural determinants-social, economic, demographic, cultural and political-appear to be major factors of influencing change in drinking trends, drinking patterns and drinking-related harms. The variable interplay between contextual determinants and alcohol control policy measures implies diverse impacts on consumption and harm according to time, and to the different countries and groups of countries. In addition, epidemiology research manifests some limitations when applied to alcohol drinking and results are transferred from one culture to another. The conditions of individual cultures and countries should be considered when planning and evaluating alcohol control policies.

Mindfulness: and drug users as well as non-users questing among the unresolved.

"Mindfulness"-(focused attention)-in substance use intervention is explored as a concept, process, tool, and a Way, as a narrative, considering selected unresolved critical issues.

A commentary about the AMPHORA study: selected caveats, comments, and considerations about its conditions of diversity, uncertainty, and unpredictability.

This point-of-view commentary explores a selected range of issues relevant to alcoholic beverage drinking and nondrinking patterns documented by the AMPHORA European study which, with hind-sight, limits its generalizability, with fore-sight are generally inadequately considered and documented and, with ordinary insight, are not likely to affect the ongoing and future behaviors of policy making and sustaining stakeholders whatever their sources of influence and whatever the levels and quality of evidence-informed data, information, and derived knowledge.

Evaluation of tumor measurements in oncology: use of film-based and electronic techniques.

PURPOSE: To evaluate the variability in bidimensional computed tomography (CT) measurements obtained of actual tumors and of tumor phantoms by use of three measurement techniques: hand-held calipers on film, electronic calipers on a workstation, and an autocontour technique on a workstation. MATERIALS AND METHODS: Three radiologists measured 45 actual tumors (in the lung, liver, and lymph nodes) on CT images, using each of the three techniques. Bidimensional measurements were recorded, and their cross-products calculated. The coefficient of variation was calculated to assess interobserver variability. CT images of 48 phantoms were measured by three radiologists with each of the techniques. In addition to the coefficient of variation, the differences between the cross-product measurements of tumor phantoms themselves and the measurements obtained with each of the techniques were calculated. RESULTS: The differences between the coefficients of variation were statistically significantly different for the autocontour technique, compared with the other techniques, both for actual tumors and for tumor phantoms. There was no statistically significant difference in the coefficient of variation between measurements obtained with hand-held calipers and electronic calipers. The cross-products for tumor phantoms were 12% less than the actual cross-product when calipers on film were used, 11% less using electronic calipers, and 1% greater using the autocontour technique. CONCLUSION: Tumor size is obtained more accurately and consistently between readers using an automated autocontour technique than between those using hand-held or electronic calipers. This finding has substantial implications for monitoring tumor therapy in an individual patient, as well as for evaluating the effectiveness of new therapies under development.

[Fast spin echo MRI techniques. Contrast characteristics and clinical potentials]. / Techniques d'IRM en fast spin echo. Caractéristiques de contraste et potentiels cliniques.

Based on partial RF echo planar principles, Fast Spin Echo techniques (FSE) were implemented on high field systems. These methods produce image quality and contrast which resemble to conventional spin echo (SE) techniques. By reducing acquisition times by factors between 1.4 and 16 over SE methods, FSE allows for several imaging options usually prohibitive with conventional spin echo (SE) sequences. These include fast scans (especially breath-hold acquisitions); improved T2 contrast with longer TR intervals; increased spatial resolution with the use of larger image matrices and/or smaller fields of view; and 3D volume imaging with a 3D multislab FSE technique. Contrast features of FSE techniques are directly comparable to those of multiple echo SE sequences using the same echo spacing than FSE methods. However, essential contrast differences existing between the FSE sequences and their routine asymmetric dual SE counterpart can be identified. Decreased magnetic susceptibility effects and increased fat signal present within T2 weighted images compared to conventional dual SE images are due to the use of shorter echo spacings employed in FSE sequences. Off-resonance irradiation inherent to the use of a large number of radio frequency pulses in shown to results in dramatic magnetization contrast transfer effects in FSE images acquired in a multislice mode.

Radiographic progression of ankylosing spondylitis after up to two years of treatment with etanercept.

OBJECTIVE: To investigate the effect of etanercept therapy on radiographic progression in patients with ankylosing spondylitis (AS). METHODS: Patients with AS who had previously participated in a 24-week randomized, double-blind, placebo-controlled trial of etanercept therapy were enrolled in a 72-week open-label extension. Radiographs of the cervical and lumbar spine from patients who received etanercept (25 mg twice weekly) for up to 96 weeks were compared with radiographs from patients in a large prevalence cohort (Outcome Assessments in Ankylosing Spondylitis International Study [OASIS]) who had not been treated with anti-tumor necrosis factor alpha (anti-TNFalpha) agents. Radiographs obtained at 2 time points up to 96 weeks apart from patients in both study populations were digitized and read by 2 independent readers who were blinded with regard to patient group and sequence. The primary end point was the 96-week change in the modified Stoke AS Spine Score (mSASSS). RESULTS: A total of 257 patients treated with etanercept were compared with 175 unselected patients from the OASIS study. There was no significant difference in the change in the mSASSS from baseline among patients who received etanercept (mean +/- SD 0.91 +/- 2.45) versus those from the OASIS group (0.95 +/- 3.18). CONCLUSION: Unlike other inflammatory rheumatic diseases such as rheumatoid arthritis and psoriatic arthritis, structural progression in AS seems to be independent of TNF, despite the fact that TNF is responsible for the signs and symptoms due to inflammation in this disease.

Harm and risk reduction: history, theories, issues, and implications.

Harm reduction is explored, historically, in terms of ideologies, concepts, processes, types, stakeholders, legal, policy, service delivery, and ethical considerations and their micro and macro consequences. Necessary critical conditions underpinning ideologies and programs throughout their life cycle are examined, as are selected unresolved issues and paradoxes. Importantly, harm reduction can inadvertently result in distancing drug users (DUs) from mainstream ("normed") care by institutionalizing specialized care for DUs who remain "marginalized" from the community at large. Also, harm reduction can become harm production when program staff, who should be foster autonomy and self-care in partnership with DUs, are co-opted into becoming social control agents acting on compliant, passive, pathologized, and dehumanized stereotypes - Them.

Intervention models for adaptation in a world of chemicals: a values approach.

A schema is presented designed to help intervention agents and agencies plan and carry out programs to facilitate individual and group adaptation to and within a world of an increasing variety of types of chemicals through selected value foci.

Substance use intervention failure: a point of view or how the cure becomes the disease or an ode to experts on incurability or masking the disease, mitigating someone's pain but providing no basic cure/solution.

Substance use intervention, both in the private and public sectors, continues to be associated with failure. This paper makes the assumption that: 1) there is a need to systematically consider and explore FAILURE in its various parameters (definitions, characteristics, forms, shapes, potencies, densities, directions, tempos, levels, phases, meanings, and adhesiveness), sources, and "demands" in the broad area of substance use intervention; 2) we can learn from failure (categorizing its processes and outcomes, selecting foci for intervention, and failure's "veracity," status, transmittability and potential/actual usability over time); and 3) we should continue to repeat this process until there is little need to do so. As times and definitions change, there will never be an end to failure or the need to learn from failure. Failure is considered as a value, and having value, on a multidimensional, dynamic gradient (minimal to maximal), being describable, discernable, catagorizable, understandable, while being-culture-site-ideologically bound/influenced. Exploring FAILURE offers us-in our various substance use intervention roles-the opportunity to learn from what we have done and to more appropiately plan, implement, and assess what we may want and/or need to know and to do. Examples are given of ongoing sources of built-in substance use intervention failure.

Treating the drug user: considering the "demands" of therapeutic technologies and their implications for treatment planning, implementation, and outcome.

Continued confusion regarding the actual and potential interface between technical issues (techniques/therapies) and ideological-theoretical considerations (treatment as a planned change process) results in built-in failure in the treatment of drug users. Only a limited number of currently available "therapies" are generally used for planned treatment intervention or for institutionalized reflexive reactions. Limited consideration has been given to the planning and implementation "demands" of a selected number of critical variables which affect the "therapies" currently in use and/or which can be chosen to be used. This note is designed as a catalytic cognitive resource to facilitate changing this situation by exploring some of the factors associated with this self-defeating, self-fulfilling prophecy.

Drug misuse/abuse intervention: a schematic tool for decision making and planning.

A catalytic conceptual tool is presented to facilitate the concerned reader's decision making with regard to personally developing and/or participating in more effective drug misuse/abuse intervention efforts. The reader is asked to consider and select the interface between 16 areas of potential intervention, 4 sources of drug abuse typologies, and 6 foci for intervention which is most suitable to his/her roles, skills, interests, and concerns.

Self-help drug misuse intervention: a schema.

A self-help schema is presented which delineates the minimal factors that should be considered in the development or maintenance of any self-help effort. The schema is simply a skeleton which is to be filled out by the specific needs of a given effort within a given context. Its importance lies in the hope that it may serve as a catalyst for the creation of useful and usable self-help models which are also evaluatable.

The process of self-help: the community's role.

A series of concepts and definitions of community and self-help are presented for use in the development of models for intervention in which clarity in the community's role will reinforce self-help ventures.

Drug education: a primer.

A review of the increasing literature describing various drug education efforts and programs suggests that few of the critical issues presented in this article have been considered in program planning and implementation. Second, research has demonstrated that although drug education programs can increase drug knowledge relatively easily, it is more difficult to modify attitudes; that is, changes in knowledge are not paralleled by changes in attitudes. Third, many, if not most, programs have been found to have no effect upon drug use. A number of programs have reported reduced drug use, while a few others have reported increased drug use. Fourth, there is no evidence that greater knowledge about drugs per se stimulates their use. The fact that drug users know more about drugs than nonusers doesn't mean that knowledge leads to use. It has been suggested (Stuart, 1974) that drug education might stimulate use by (1) providing students with facts that overcome beliefs which inhibit use, (2) changing attitudes that prevent use, (3) encouraging students to think of themselves as potential users by virtue of having been included in drug education programs, and (4) providing specific information which serves to facilitate the use of drugs. One should, of course, consider the obvious possibility that greater knowledge results from use rather than vice versa. Fifth, there appears to be little predictable relationship between values communicated by drug education programs, values held by recipients, value changes and drug use, or abstinence. The same can be said about behavioral styles. When one goes beyond the limitations of drug/drug user stereotypes--to include people and the almost unlimited types and number of available chemical substances which we must learn to adapt to and cope with--one is confronted by the reality that drug education, as currently designed and practiced, may be irrelevant to individual and group needs. Sixth, drug education appears to have little or no effect upon the increased availability of increasing numbers and types of powerful active chemical substance for more and more segments of the population. Drug education is at best a parallel phenomenon to chemical coping, which necessitates drug availability as well as the process of social pharmacology. Seventh, to date drug education has had no predictable effect upon either the mystification or demystification of drugs, drug use, drug users, or abstinence.(ABSTRACT TRUNCATED AT 400 WORDS)

Understanding drug user treatment evaluation: some unresolved issues.

This article reviews a series of issues, concepts, and factors which are critical to any treatment process in terms of a selected number of drug user treatment programs. These programs include the most often used and reported on ones in the literature: methadone maintenance, outpatient (drug-free and general) therapeutic communities, and detoxification. The central thesis of this article is to remind the reader that current evaluation reports, between any number of types of programs, while being statistically seductive, may be conceptually meaningless. What is most often compared may be uncomparable.

Project outreach: an experimental support system intervention program.

A drug use intervention outreach project was developed which relied upon the active participation of health, welfare, employment, rehabilitation, social educational, social-legal control, and national security agencies. A variety of explicit and implicit goals, techniques, and data collection techniques were mutually agreed upon by the agencies in order to confidentially register untreated drug users, alcoholics, and medicinal misusers; to integrate them into treatment; to train staffs of participating agencies; to assess the adaptive functioning of children living with drug-using alcoholic parents and/or siblings; to empirically document substance misuse in one area of Jerusalem, and to develop a model for outreach. Sixty-seven drug users were "discovered", 12 were already in treatment. A number of the project's goals were achieved; others were not. The project is being continued for a second year.