Evaluating the resource allocation index as a potential fMRI-based biomarker for substance use disorder.

BACKGROUND: There is a lack of neuroscience-based biomarkers for the diagnosis, treatment and monitoring of individuals with substance use disorders (SUD). The resource allocation index (RAI), a measure of the interrelationship between salience, executive control and default-mode brain networks (SN, ECN, and DMN), has been proposed as one such biomarker. However, the RAI has yet to be extensively tested in SUD samples. METHODS: The present analysis compared RAI scores between individuals with stimulant and/or opioid use disorders (SUD; n = 139, abstinent 4-365 days) and healthy controls (HC; n = 56) who had completed resting-state functional magnetic resonance imaging (fMRI) scans within the context of the Tulsa 1000 cohort. First, we used independent component analysis (ICA) to identify the SN, ECN, and DMN and extract their time series data. Second, we used multiple permutations of automatically identified networks to compute RAI as reported in the fMRI literature. RESULTS: First, the RAI as a metric depended substantially on the approach that was used to define the network components. Second, regardless of the selection of networks, after controlling for multiple testing there was no difference in RAI scores between SUD and HC. Third, the RAI was not associated with any substance use-related self-report measures. CONCLUSION: Taken together, these findings do not provide evidence that RAI can be used as an fMRI-derived biomarker for the severity or diagnosis of individuals with SUD.

What happens to agreement over time? A longitudinal study of self-reported substance use compared to saliva toxicological testing among subsidized housing residents.

The agreement between self-reported and toxicologically verified substance use provides important information about the validity of self-reported use. While some studies report aggregate agreement across follow-up points, only a few have examined the agreement at each time point separately. An overall rate of agreement across time may miss changes that occur as people progress through a research study. In this study, a sample of 644 adults (43.8% male, 32.6% White, 57.0% Black, 90.2% ages 36+) residing in subsidized housing was used to determine the agreement between self-reported use and saliva toxicological testing for marijuana, cocaine, PCP, amphetamine, and methamphetamine at three different time points. Agreement between saliva toxicological testing and self-report ranged between 84.2% and 94.3% for different substances over time. Higher rates of agreement were found for cocaine than had been reported by previous studies. Statistically significant differences in the odds ratios of concordance over time (baseline, 6-month, and 12-month follow-up) were found for marijuana and the combined category for PCP, amphetamine, and methamphetamine. Our findings suggest that oral fluid drug tests generally withstand community field assessments and result in relatively high levels of agreement for marijuana, cocaine, PCP, amphetamine, and methamphetamine use, when compared to self-report. Because of the ease of sample collection and low chance of adulteration, we conclude that saliva testing is a viable method for toxicological confirmation of substance use behavior in this setting.

In Vitro Assessment of Nasal Insufflation of Comminuted Drug Products Designed as Abuse Deterrent Using the Vertical Diffusion Cell.

In vitro evaluation of abuse deterrent formulations (ADFs) is a challenge since real abuse situations are variable and ADF technology is evolving. Specifically, an assessment of an ADF to deter nasal insufflation would be valuable. In this study, a vertical diffusion cell (VDC) was used to evaluate polyethylene oxide (PEO)-based tablets manipulated by three different forces. The commercially available products Oxycontin®, an ADF, Opana®, and metoprolol tartrate tablet formulations made in our laboratory were studied. Particle size distribution and percent recovery of manipulated tablets were measured. Grinding produced the lowest recovery and the smallest particle size distribution. Drug release was examined using a VDC by placing the dry comminuted particles on an enclosed wetted cellulose membrane. Dispensing dry particles on a VDC is atypical but includes some key features associated with an abuse situation where once the particles are snorted, the moisture in the nasal mucosa activates hydration and swelling of the polymers in the formulation, retarding drug release. Drug release from OxyContin®, Opana®, and metoprolol tablets were analyzed for the cutting, grinding, and milling modes of abuse. The analysis showed that in most cases, the mode of abuse produced different particle sizes with different release rates. Statistically different release rates were observed for metoprolol tablets made with different molecular weight PEO and with different porosities. These results indicate that within detection limits, the VDC can be used to quantitate release differences due to various modes of abuse used in this study.

Liver Disease and Fibrosis Assessment in Substance Use-Related Disorders.

Substance users have the highest prevalence of hepatitis C virus (HCV) infection but have rarely been treated, largely because of their mistrust of the health care system, misconceptions about the consequences of the infection, and concerns regarding interferon-related side effects. With the development of highly efficacious, interferon-free therapeutic regimens without significant side effects, the concept of colocating HCV and substance use treatment would appear to be highly feasible. This process has been further facilitated by widespread clinical adaptation of noninvasive assays for fibrosis assessment, which could be performed routinely in substance use treatment facilities. The most commonly used noninvasive fibrosis assessment methods are serum marker indexes and transient elastography, both of which are very accurate in detecting cirrhosis or the absence of fibrosis, but much less successful in identifying intermediate fibrosis stages. The effect of drugs of abuse on the liver is not completely understood or sufficiently studied. There are no indications that heroin and cocaine affect fibrosis progression, but some recreational drugs (eg, alcohol and cannabis) can induce hepatic injury. In addition, knowledge gaps exist on the effect of impaired liver function on metabolism or transport of agents used to treat substance disorders as well as their interactions with HCV antivirals.

Assessment of Hepatic Impairment and Implications for Pharmacokinetics of Substance Use Treatment.

Although the liver is the primary site of metabolism and biliary excretion for many medications, data are limited on the liver's pharmacokinetic abilities in cirrhosis. Cirrhosis develops through collagen deposition, eventually culminating in end-stage liver disease that compromises hepatic drug metabolism. Consequently, the US Food and Drug Administration (FDA) recommends evaluating the pharmacokinetics of medications in subjects with hepatic impairment if hepatic metabolism constitutes more than 20% of their elimination or if they have a narrow therapeutic range. A variety of noninvasive indices and radiologic procedures can be employed to assess hepatic drug metabolism and excretion. The Child-Pugh score is the most commonly used scale for assessing hepatic impairment among drugs submitted for US FDA approval. The score, originally developed to guide operative mortality in patients undergoing hepatic resection, has not been modified since its inception 5 decades ago. Furthermore, the score was not originally intended to be a guide for potential dose modification in patients with hepatic impairment. These reasons, in combination with the availability of a variety of new imaging modalities and an enhanced understanding of hepatic biology, should foster the development of novel methods to assess the effect of hepatic impairment on liver drug metabolism.

Assessment of rates of recanting and hair testing as a biological measure of drug use in a general population sample of young people.

AIMS: We investigate the extent of and factors associated with denial of previously reported cannabis and other illicit drug use, and assess the potential of hair testing for measuring substance use in general population samples. DESIGN: Birth cohort study. SETTING: United Kingdom, 1991-present. PARTICIPANTS: A total of 3643 participants who provided hair and self-report measures of cannabis and other illicit drug use in the Avon Longitudinal Study of Parents and Children (ALSPAC) at age 18 years. MEASUREMENTS: Denial of ever use of cannabis and other illicit drugs at age 18 following previously reported use. Positive hair drug tests for cannabis and other illicit drugs, and expected numbers of false positives and false negatives based on expected sensitivity and specificity. FINDINGS: Cannabis and other illicit drug use was reported by 1223 and 393 individuals, respectively, before age 18 years. Of these 176 (14.4%) and 99 (25.2%), respectively, denied use at age 18. Denial of cannabis use decreased with the reporting of other substances and antisocial behaviour. Cannabis and other illicit drug use at age 18 was reported by 547 (22.5%) and 203 (8.4%) individuals, respectively. Of these, 111 (20.3%) and 13 (6.4%) were hair-positive for cannabis and other illicit drugs, respectively. Based on hair testing for cannabis use we expect 0 [95% confidence interval (CI) = 0-169] false positives and 394 (95% CI = 323-449) false negatives compared to observed 362 potential false positives and 436 potential false negatives based on self-report. In hair-positive individuals, reporting the use of other substances and antisocial behaviour decreased the odds of a negative self-report. CONCLUSIONS: Hair analysis provides an unreliable marker of substance use in general population samples. People who report more frequent substance use before age 18 are less likely to later deny previous substance use at age 18 than people who report occasional use.

Assessment of subunit-dependent direct gating and allosteric modulatory effects of carisoprodol at GABA(A) receptors.

Carisoprodol is a widely prescribed muscle relaxant, abuse of which has grown considerably in recent years. It directly activates and allosterically modulates α1ß2γ2 GABAARs, although the site(s) of action are unknown. To gain insight into the actions of carisoprodol, subunit-dependent effects of this drug were assessed. Whole-cell patch clamp recordings were obtained from HEK293 cells expressing α1ß2, α1ß3 or αxßzγ2 (where x = 1-6 and z = 1-3) GABAARs, and in receptors incorporating the δ subunit (modeling extrasynaptic receptors). The ability to directly gate and allosterically potentiate GABA-gated currents was observed for all configurations. Presence or absence of the γ2 subunit did not affect the ability of carisoprodol to directly gate or allosterically modulate the receptor. Presence of the ß1 subunit conferred highest efficacy for direct activation relative to maximum GABA currents, while presence of the ß2 subunit conferred highest efficacy for allosteric modulation of the GABA response. With regard to α subunits, carisoprodol was most efficacious at enhancing the actions of GABA in receptors incorporating the α1 subunit. The ability to directly gate the receptor was generally comparable regardless of the α subunit isoform, although receptors incorporating the α3 subunit showed significantly reduced direct gating efficacy and affinity. In extrasynaptic (α1ß3δ and α4ß3δ) receptors, carisoprodol had greater efficacy than GABA as a direct gating agonist. In addition, carisoprodol allosterically potentiated both EC20 and saturating GABA concentrations in these receptors. In assessing voltage-dependence, we found direct gating and inhibitory effects were insensitive to membrane voltage, whereas allosteric modulatory effects were affected by membrane voltage. Our findings demonstrate direct and allosteric effects of carisoprodol at synaptic and extrasynpatic GABAARs and that subunit isoform influences these effects.

Behavioural and neurochemical assessment of salvinorin A abuse potential in the rat.

RATIONALE: Salvinorin A is a recreational drug derived from Salvia divinorum, a sage species long used as an entheogen. While salvinorin A has potent hallucinogenic properties, its abuse potential has not been assessed consistently in controlled behavioural and neurochemical studies in rodents. OBJECTIVE: This study aimed to assess salvinorin A abuse potential by measuring its capacity to establish and maintain self-administration behaviour and to modify dopamine (DA) levels in the nucleus accumbens (NAcc) of rats. RESULTS: Male Lister Hooded (LH) and Sprague-Dawley (SD) rats were allowed to self-administer salvinorin A (0.5 or 1.0 µg/kg/infusion) intravenously 2 h/day for 20 days under a continuous schedule of reinforcement and lever pressing as operandum. LH rats discriminated between the active and inactive levers but did not reach the acquisition criterion for stable self-administration (≥12 active responses vs ≤5 inactive responses for at least 5 consecutive days). SD rats discriminated between the two levers at the lower dose only but, like LH rats, never acquired stable self-administration behaviour. Systemic salvinorin A increased extracellular DA in the NAcc shell of both LH (at ≥40 µg/kg) and SD rats (at ≥5 µg/kg), but injection into the ventral tegmental area (VTA) induced no significant change in NAcc DA concentration in LH rats and only brief elevations in SD rats. CONCLUSIONS: Salvinorin A differs from other commonly abused compounds since although it affects accumbal dopamine transmission, yet it is unable, at least at the tested doses, to sustain stable intravenous self-administration behaviour.

Assessment of the abuse liability of a dual orexin receptor antagonist: a crossover study of almorexant and zolpidem in recreational drug users.

BACKGROUND: Dual orexin receptor antagonists (DORAs) enable initiation and maintenance of sleep in patients with primary insomnia. Blockade of the orexin system has shown reduction of drug-seeking behavior in animal studies, supporting the role of orexin antagonism as a novel approach for treating substance abuse. Since hypnotics are traditionally associated with misuse, a lack of abuse liability of DORAs would offer significant benefits over current therapies for sleep disorders. METHODS: In this randomized, crossover, proof-of-concept study, single oral doses of the DORA almorexant (200, 400, and 1,000 mg) were administered to healthy subjects with previous non-therapeutic experience with central nervous system depressants and were compared with placebo and single oral doses of zolpidem (20 and 40 mg), a benzodiazepine-like drug. Subjective measures of abuse potential (visual analog scales [VAS], Addiction Research Center Inventory, and Subjective Drug Value) and objective measures (divided attention [DA]) were evaluated over 24 h post-dose in 33 evaluable subjects. RESULTS: Drug Liking VAS peak effect (E max; primary endpoint) was significantly higher for all doses of almorexant and zolpidem compared with placebo (p<0.001). Almorexant 200 mg showed significantly less 'Drug Liking' than both zolpidem doses (p<0.01), and almorexant 400 mg had smaller effects than zolpidem 20 mg (p<0.05), while almorexant 1,000 mg was not different from either zolpidem dose. Results were similar for other subjective measures, although almorexant generally showed smaller negative and perceptual effects compared with zolpidem. Almorexant also showed less cognitive impairment compared with zolpidem on most DA endpoints. CONCLUSION: This study in humans investigating single doses of almorexant is the first to explore and show abuse liability of a DORA, a class of compounds that is not only promising for the treatment of sleep disorders, but also of addiction.

Could a continuous measure of individual transmissible risk be useful in clinical assessment of substance use disorder? Findings from the National Epidemiological Survey on Alcohol and Related Conditions.

OBJECTIVE: Toward meeting the need for a measure of individual differences in substance use disorder (SUD) liability that is grounded in the multifactorial model of SUD transmission, this investigation tested to what degree transmissible SUD risk is better measured using the continuous Transmissible Liability Index (TLI) (young adult version) compared to alternative contemporary clinical methods. METHOD: Data from 9535 18- to 30-year-olds in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions, a U.S. representative sample, were used to compute TLI scores and test hypotheses. Other variables were SUDs of each DSM-IV drug class, clinical predictors of SUD treatment outcomes, treatment seeking and usage, age of onset of SUDs and substance use (SU), and eligibility for SUD clinical trials. RESULTS: TLI scores account for variation in SUD risk over and above parental lifetime SUD, conduct and antisocial personality disorder criteria and frequency of SU. SUD risk increases two- to four-fold per standard deviation increment in TLI scores. The TLI is associated with SUD treatment seeking and usage, younger age of onset of SU and SUD, and exclusion from traditional clinical trials of SUD treatment. CONCLUSIONS: The TLI can identify persons with high versus low transmissible SUD risk, worse prognosis of SUD recovery and to whom extant SUD clinical trials results may not generalize. Recreating TLI scores in extant datasets facilitates etiology and applied research on the full range of transmissible SUD risk in development, treatment and recovery without obtaining new samples.

The association between social marginalisation and the injecting of alcohol amongst IDUs in Budapest, Hungary.

BACKGROUND: Alcohol injecting may cause intense irritation, serious vein damage, and additional risks. What little is known about alcohol injecting points to the potential role of social marginalisation. METHODS: Injecting drug users (N=215) were recruited between October 2005 and December 2006 in Budapest, Hungary from non-treatment settings. Multivariate logistic regression models identified correlates of lifetime alcohol injecting. RESULTS: About a quarter (23%) reported ever injecting alcohol-only 3% reported injecting alcohol in the past 30 days. In multivariate analysis, six variables were statistically significantly associated with ever injecting alcohol: male gender, being homeless, ever sharing cookers or filters and injecting mostly in public places showed a positive association, whilst Roma ethnicity and working at least part time showed a negative association. CONCLUSIONS: Our study suggests that alcohol injecting is more of a rare event than a so far undiscovered research and prevention priority. Still, providers of harm reduction services should be aware that alcohol injecting happens, albeit rarely, especially amongst socially marginalised IDUs, who should be counselled about the risks of and discouraged from alcohol injecting.

A double-blind, placebo-controlled assessment of the safety of potential interactions between intravenous cocaine, ethanol, and oral disulfiram.

BACKGROUND: A majority of cocaine addicts have a comorbid alcohol use disorder. Previous studies demonstrated efficacy of disulfiram in the treatment of cocaine dependence among patients with comorbid alcohol use disorder or opioid dependence. However, the cardiac risks of a disulfiram-ethanol reaction (DER) in individuals who drink, when coupled with the cardiac effects of cocaine, could result in significant toxicity or lethality due to the 3-way drug interaction. AIMS: This study examined the safety of combining cocaine (30 mg i.v.) and ethanol (0.4 g/kg i.v.) in disulfiram-treated (0, 250, and 500 mg/d, p.o.) cocaine-dependent research volunteers. RESULTS: The results showed that disulfiram did not enhance the cardiovascular effects of cocaine and may have reduced the subjective high from cocaine. In contrast, ethanol produced adverse ECG changes including QTc prolongation and a DER consisting of hypotension, tachycardia, nausea, and flushing in disulfiram-treated subjects. The severity of the DER was related to disulfiram dose and the trial with 500 mg/d was stopped prematurely due to safety concerns. The DER-related hypotension and tachycardia seen with ethanol infusion alone in disulfiram-treated subjects, was not exacerbated when combined with cocaine. In fact, cocaine tended to counteract the ethanol-related hypotension though it did exacerbate the tachycardia in two of seven subjects. CONCLUSIONS: Though conclusions are limited by the moderate doses of cocaine, ethanol, and disulfiram tested, the data do suggest that the risks of the moderate use of cocaine and ethanol in individuals treated with moderate doses of disulfiram (≤ 250 mg/d) may not be as problematic as some may assume.

Interest in low-threshold employment among people who inject illicit drugs: implications for street disorder.

BACKGROUND: Income generation opportunities available to people who use illicit drugs have been associated with street disorder. Among a cohort of injection drug users (IDU) we sought to examine street-based income generation practices and willingness to forgo these sources of income if other low-threshold work opportunities were made available. METHODS: Data were derived from a prospective community recruited cohort of IDU. We assessed the prevalence of engaging in disorderly street-based income generation activities, including sex work, drug dealing, panhandling, and recycling/salvaging/vending. Using multivariate logistic regressions based on Akaike information criterion and the best subset selection procedure, we identified factors associated with disorderly income generation activities, and assessed willingness to forgo these sources of income during the period of November 2008 to July 2009. RESULTS: Among our sample of 874 IDU, 418 (48%) reported engaging in a disorderly income generation activity in the previous six months. In multivariate analyses, engaging in disorderly income generation activities was independently associated with high intensity stimulant use, as well as binge drug use, having encounters with police, being a victim of violence, sharing used syringes, and injecting in public areas. Among those engaged in disorderly income generation, 198 (47%) reported a willingness to forgo these income sources if given opportunities for low-threshold employment, with sex workers being most willing to engage in alternative employment. CONCLUSION: Engagement in disorderly street-based income generation activities was associated with high intensity stimulant drug use and various markers of risk. We found that a high proportion of illicit drug users were willing to cease engagement in these activities if they had options for causal low-threshold employment. These findings indicate that there is a high demand for low-threshold employment that may offer important opportunities to reduce drug-related street disorder and associated harms.

When drugs in the same controlled substance schedule differ in real-world abuse, should they be differentiated in labeling?

The prescription drugs regulated in the most restrictive controlled substance schedule for those with an approved therapeutic use vary widely in their real world risk of abuse and harm. Opioid analgesics have the highest rates of abuse, overdose death, drug abuse treatment needs and societal costs in comparison to other Schedule II drugs. Stimulants for attention-deficit/hyperactivity disorders (ADHD) account for substantially lower rates of abuse, harm, and public health impact. The scheduling of drugs is determined by the World Health Organization, the United States Food and Drug Administration, and other regulatory agencies, through a quasi-public process that relies heavily on pre-marketing studies that are conducted in highly controlled clinical settings. We propose that it is increasingly in the interest of science-based regulation and public health to recognize and communicate differences among drugs based on their real-world abuse and public health harm using surveillance data. Appropriate differentiation through labeling of drugs that will likely remain in the same schedule could provide powerful incentives for drug development and research, would aid prescriber/patient decision making by informing them of real differences across drugs within a schedule, and may also contribute to public health efforts to reduce drug abuse. There are risks of course, that include inadvertent perceptions that drugs labeled to be lower in risk are not taken as seriously as others in the same category. Challenges such as these, however, can be overcome and should not serve as barriers to objective communications regarding a drug's actual risks.

Illegal drug use and the economic recession--what can we learn from the existing research?

BACKGROUND: Much research on the use of amphetamine, cocaine and heroin employs individual level data and analyses variations in drug use by factors like personal characteristics, socioeconomic factors, and the social environment. Less attention is given to how these individual responses inter-relate with key macroeconomic variables. From a drug policy perspective however, it is important to also understand the consequences for drug use and drug users of changes in the macroeconomic conditions. As the world is experiencing an economic recession one would like to know whether it will affect the number of drug users and/or consumption frequency and volume amongst established users. METHODS: There are different channels through which a recession could influence drug consumption; here the main focus is on how an economic downturn may influence drug prices and drug users' incomes. We briefly refer to relevant economic theory before reviewing the research literature. RESULTS: A fall in drug prices and income seem likely. Empirical studies confirm drug users' price responsiveness. Only a few studies have dealt with income elasticity amongst this group. CONCLUSION: As the price and the income effect may pull in opposite directions, the full effect on drug use is difficult to predict. Still, it seems likely that an economic downturn of the current magnitude could increase the use of drugs.

The business cycle and drug use in Australia: evidence from repeated cross-sections of individual level data.

BACKGROUND: This paper examined the implications of the business cycle for cannabis and alcohol use. What little we know about cannabis use suggests that young Americans (teenagers and adults in their early 20s) seem more inclined to use illicit drugs and to use them more frequently with rises in the unemployment rate. In contrast, a more fulsome alcohol literature suggests that participation in drinking is unaffected by the business cycle. Heavy drinkers drink less during economic downturns and their reduced use counteracts the fact that light drinkers might drink a little more. METHOD: Using individual level data from repeated cross-sections of Australia's National Drug Strategy Household Survey (NDSHS), spanning 1991-2007, this study examined the relationship between cannabis and alcohol use of Australians aged 14-49 years and the unemployment rate and real income per capita, two indicators of the business cycle. RESULTS: Australians in their late 20s, 30s and 40s drink less frequently during economic downturns. If unemployment rate rises are accompanied by falls in income per capita, younger Australians will also drink less frequently. Recent participation in cannabis use (within the last year) increases with falls in income per capita regardless of age, although the increase is less marked for young people (14-24 years). Whereas the participation rate of people aged 25-49 years also falls with rising unemployment rates, the participation of younger people increases. Cannabis users younger than 35 will use more frequently as the unemployment rate rises. In contrast, older Australians will use less frequently. CONCLUSION: Australia's recent economic slowdown has been characterised by rising unemployment rates without accompanying falls in income per capita. Based on our findings this slowdown should have encouraged young Australians aged 14-24 years to both drink and use cannabis more frequently. The slowdown would have had little impact on the frequency of drinking of older Australians. However it should have discouraged older Australians from using cannabis, and encouraged people in their late 30s and 40s to use less frequently, whilst encouraging those aged 25-34 years to use more frequently.

Recessions and the participation of youth in the selling and use of illicit drugs.

BACKGROUND: There has been limited research on how recessions (or more generally, the strength of the economy) affect drug use and the related outcome of drug selling. This is especially important, given the current economic crisis. This paper aims to use a conceptual framework, previous research, and new research to predict how the current economic crisis may be affecting youth drug selling and drug use. METHODS: A conceptual framework to understand how a recession could affect youth drug selling and drug use is presented, along with a review of the literature on empirical investigations on how the strength of the economy affects these behaviours among teenagers. In addition, new analyses for young adults are presented. RESULTS: The conceptual framework postulates that a recession would have direct positive effects on the prevalence of youth drug selling but ambiguous direct effects on youth drug use. The conceptual framework also postulates that drug selling and drug use are inter-connected at the individual level and the aggregate level. Thus, any effect of a recession on one would likely affect the other in the same direction. The limited empirical evidence indicates that both drug selling and drug use among youth are higher when the economy is weaker. CONCLUSIONS: The current economic crisis will likely increase both youth drug selling and drug use relative to what they would have otherwise been.

Economic constraint and modes of consumption of addictive goods.

BACKGROUND: To see how economic recession, or, more generally, how increased economic constraint amongst drug users may impact their behaviour regarding the mode of drug consumption. METHODS: The theoretical framework is the theory of rational addiction - drug users are considered to be rational and well-informed about the way they use drugs and the consequences of using them. Surveys in the specialist literature dealing with the potential changes in the economic context of drugs users, and with the mechanisms of the bioavailability of psychoactive substances are examined in order to highlight one of the strategies drug users can implement to circumvent economic problems - namely a change in the mode of administration. An examination of ethnographic studies and French data are also used to test our assumptions. RESULTS: Changes in the mode of drug consumption can be the result of a maximization behaviour. Injection is the most effective way to reach a maximum bioavailability of substances. There is evidence in favour of the hypothesis that in times of economic recession, when the economic resources of drug users can decrease, they may prefer injection to other modes of administration in order to maximize the effect of what they have purchased. CONCLUSION: In times of economic recession, harm reduction policy has to be reinforced as injection behaviour can increase. As a result, economic and social policies should be an integral consideration for health policy issues.

Sociodemographic correlates of transitions from alcohol use to disorders and remission in the São Paulo megacity mental health survey, Brazil.

AIMS: To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population. METHODS: Data are from a probabilistic, multi-stage clustered sample of adult household residents in the São Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available. RESULTS: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse. CONCLUSION: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.

Organizational factors associated with the use of contingency management in publicly funded substance abuse treatment centers.

A promising area within technology transfer studies is the identification of organizational factors that influence the adoption of treatment innovations. Although studies have identified organizational factors associated with the adoption of pharmacological innovations, few studies have examined organizational factors in the adoption of psychosocial innovations, among which contingency management (CM) is a significant practice. Using data from a sample (N = 318) drawn from the population of publicly funded treatment centers in the United States, this study modeled organizational factors falling in the domains of structural characteristics, workforce variables, values and norms, and patient characteristics associated with the use of CM. Organizations were more likely to use CM if they embrace a supportive therapeutic approach, are research friendly, offer only outpatient levels of care, or serve drug-court patients. Implications for studying the diffusion and implementation of evidence-based psychosocial interventions are discussed.