Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries.

OBJECTIVES: Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS: This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS: The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS: This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Road safety impact of extended drinking hours in Ontario.

PURPOSE: On 1 May 1996, Ontario, Canada amended the Liquor Licence Act to extend the hours of alcohol sales and service in licensed establishments from 1 to 2 a.m. The purpose of this study was to evaluate the road safety impact of extended drinking hours in Ontario. METHOD: A quasi-experimental design using interrupted time series with a nonequivalent no-intervention control group was used to assess changes. The analyzed data sets are total and alcohol-related, monthly, traffic fatalities for Ontario, for the 11-12 p.m., 12-1 a.m., 1-2 a.m. and 2-3 a.m. time windows, for Sunday through Wednesday nights and for Thursday through Saturday nights, for 4 years pre- and 3 years post-policy change, compared to neighbouring regions of New York and Michigan. RESULTS: The blood alcohol concentration positive driver fatality trends reflected downward trends for Sunday-Wednesday 12-2 a.m. and Thursday-Saturday 1-2 a.m. for Ontario and downward trends for Thursday-Saturday 12-1 a.m. and 2-3 a.m. for New York and Michigan after the extended drinking hour policy change. Ontario total fatality data showed similar trends to the Ontario blood alcohol positive trends. CONCLUSIONS: The multiple datasets converge in suggesting little impact on BAC positive fatalities with extension of the closing hours. These observations are consistent with other studies of small changes in alcohol availability.

Being "at fault" in traffic crashes: does alcohol, cannabis, cocaine, or polydrug abuse make a difference?

OBJECTIVE: To compare associations of alcohol, cannabis, and cocaine abuse and traffic crash risk for "at fault" crashes and all crashes. DESIGN: A historical cohort study. SETTING: Toronto, Ontario. Patients or subjects: Subjects beginning treatment at the Centre for Addictions and Mental Health (CAMH) in 1994 for abuse of alcohol, cannabis, cocaine, and all combinations of these substances (n = 590, with 411 drivers). A control group consisted of 518 records from the Ontario registry of registered drivers, frequency matched for age and sex and residence. INTERVENTIONS: CAMH subjects took part in therapeutic programs. Pre-intervention (11 115 driver-years) and post-intervention intervals (8550 driver-years) were defined and compared. MAIN OUTCOME MEASURES: Crash and collision rates, adjusted relative risks (ARRs) of crash involvement and of "at fault" crashes were computed using Poisson regression to control for variations in time at risk, age, and sex of participants. RESULTS: Pre-treatment, significant ARRs of 1.49 to 1.79 for all crashes were found for abusers of cannabis, cocaine, or a combination. ARRs increased by 10%-15% for "at fault" crashes. Post-treatment, all associations were very modest for all abuse types. Only younger and male drivers had a significantly increased risk, which was stronger for "at fault" than for all crashes. CONCLUSIONS: Abuse of cannabis and cocaine pre-treatment was more strongly related to "at fault" crashes than to all crashes. Interaction between these substances means that the effects of combined abuse cannot be predicted from simple main effects.

The relationship between alcohol use and mortality rates from injuries: a comparison of measures.

Per capita consumption of alcohol has traditionally been considered to be the leading indicator of population levels of alcohol problems. However, some recent research suggests that this relationship may be weakening, and that drinking pattern measures may be preferable to per capita consumption as problem-level indicators. We compared the ability of per capita alcohol consumption and survey-based measures of alcohol use to predict deaths from injuries in Ontario, Canada, for the period 1977-1996. Per capita consumption and percentage of daily drinkers were significantly related to injury mortality, but percentage of drinkers and percentage of episodic heavy drinkers (those who drank five or more drinks on a drinking occasion) were not. Of the measures we examined, per capita consumption was the strongest indicator of mortality rates from injuries. However, the survey-derived measure of percentage of daily drinkers was similar to per capita consumption in ability to predict problem levels.

The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review.

In this review evidence on the impact of introducing or lowering legal blood alcohol limits on traffic safety measures is examined. There is substantial variability in the types and rigour of methods used to evaluate these legislative measures, and thus not surprisingly there is variability in the results observed. In most but not all cases where an evaluation of an introduced or lowered legal limit has been conducted, some beneficial effect on traffic safety measures has been reported. These effects are in some cases relatively small, and in other cases may be temporary. In some jurisdictions, lasting reductions in collision rates have been reported. Available evidence suggests that where beneficial effects are observed they are due to general deterrence, and not restricted only to drivers at blood alcohol concentrations (BAC) specifically affected by the legal change.

The direct and indirect relationships between alcohol prevention measures and alcoholic liver cirrhosis mortality.

OBJECTIVE: The objective of this article is to investigate direct and indirect relationships between prevention measures and alcoholic liver cirrhosis mortality in Canadian provinces from 1968 to 1986. METHOD: The data base that was assembled included alcoholic cirrhosis mortality rates, alcohol availability measures (rate of licensed premises, year in which the legal drinking age was reduced), per capita consumption of alcohol, rates of AA members and groups, and economic and demographic measures. This article develops a two-equation analytic model based on the availability theory of alcohol problems and prevention (Single, 1988). The distinction between direct and indirect effects of prevention measures can be made explicitly with this model. RESULTS: Alcohol availability measures, but not AA measures, had a significant direct potential impact on alcohol consumption. AA measures had a significant direct relationship to cirrhosis mortality rates. Alcohol consumption also had a significant direct relationship to cirrhosis mortality, and alcohol availability measures had an important indirect relationship through their influence on per capita alcohol consumption. CONCLUSIONS: While these observations need to be interpreted cautiously, the two-equation model shows promise as an approach to understanding direct and indirect influences on alcohol problems. As expected, AA measures and per capita alcohol consumption demonstrated significant direct relationship to cirrhosis mortality. In addition, important indirect influences of drinking-age changes and rates of licensed premises on cirrhosis mortality were observed through their relationships to per capita alcohol consumption.

Do changes in per capita consumption mirror changes in drinking patterns?

OBJECTIVE: The goal of this study was to examine how well per capita alcohol consumption figures derived from beverage sales data relate to changes over time in survey-based measures of drinking patterns. It was expected that strong associations would be found among these various measures of consumption. METHOD: Data from 12 household surveys conducted in Ontario between 1977 and 1997 provided information on: percentages of drinkers; daily drinkers; those drinking five or more drinks at a sitting weekly; those reporting two or more alcohol-related harms; and average number of drinks per week. These variables were then correlated with per capita consumption. RESULTS: Significant correlations were found only between per capita consumption and percentage of daily drinkers, and between percentage of drinkers and average number of drinks per week. CONCLUSIONS: The relationship of per capita consumption to survey measures of drinking is weak. The absence of consistent associations over time between per capita consumption and survey measures may be attributable to the small number of available data points or to increases in unrecorded consumption. Further research is needed to verify and explain these results.

Do drinking surveys predict changes in population-based alcohol problem indicators?

We examined per capita alcohol consumption and survey-based measures of alcohol use in Ontario in relation to indicators of alcohol problems for the period 1977-1997. Per capita consumption and percentage of daily drinkers were significantly related to problem indicators, but percentage of drinkers and percentage of heavy drinkers were not. Of the measures we examined, per capita consumption was the strongest indicator of alcohol problems.

The impact of programs for high-risk drinkers on population levels of alcohol problems.

AIMS: Historically, treatment programs and related activities for alcoholics or high-risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population-based prevention efforts. In this review we consider evidence that high-risk programs may have an impact on population or aggregate levels of these problems. DESIGN: We first summarize recent reviews of the clinical impact of programs for high-risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate problem levels is examined. Estimates of the potential impact of high-risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies. FINDINGS: There is increasing evidence that high-risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol-related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate effects. CONCLUSIONS: Programs for high-risk drinkers can have beneficial aggregate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems.

On the high road: driving under the influence of cannabis in Ontario.

While cannabis is the most frequently found illegal drug in drivers killed or injured in motor vehicle collisions, little is know about driving under the influence of cannabis (DUIC) in the general population. We report information on the incidence of DUIC in a representative sample of the Ontario adult population. Among all drivers, 1.9% reported DUIC in the previous 12 months. Several factors influenced the likelihood of reported DUIC, including gender, age, marital status and education level. Among cannabis users, DUIC appeared to be a relatively common behaviour; 22.8% reported DUIC, and the probability of the behaviour was significantly influenced by gender and education level. As well, DUIC and drinking-driving were strongly related in this sample. These data underscore the need to obtain more information on this behaviour, including a more complete understanding of any risks involved.

Reasons for living versus reasons for dying: examining the internal debate of suicide.

The Reasons for Living vs. Reasons for Dying (RFL/RFD) Assessment was used to obtain suicidal outpatients' top five reasons for living and for dying, respectively. Forty-nine suicidal university counseling center patients provided 173 RFL and 145 RFD responses. These responses were organized into eight RFL coding categories and nine RFD coding categories. Two coders trained in the RFL/RFD coding system showed high levels of interrater reliability (KRFL = .81; KRFD = .80). Chi-square results for RFL and RFD coding categories showed that the coding categories were not equally salient to these suicidal patients.

Adolescents, bush parties and drinking-driving.

OBJECTIVE: We describe the prevalence of bush party (an outdoor gathering of youth) attendance and examine predictors of attendance and of driving after drinking at bush parties. METHOD: The 1995 Ontario Student Drug Use Survey (OSDUS) data on students (n = 1,853) in schools across the province in grades 7, 9, 11 and 13 are employed to estimate prevalence of bush party attendance within the previous 12 months. The 1994 Graduated Licensing Study (GLS), a multi-community survey of drivers (n = 1,157, 53.6% male) in grades 11 and 12 in Ontario, data are employed to study predictors of attendance and of drinking-driving. RESULTS: Based on the OSDUS, the prevalence of bush party attendance is 37.6%. Based on the GLS, 38.4% attended bush parties, and among attenders 71.5% drank at bush parties, 63.5% observed drinking-driving, 16.1% rode with a drinking-driver and 16.6% drove after drinking at bush parties. Logistic regression reveals that attendance at bush parties is positively associated with number of other places alcohol was consumed, tobacco use, number of alcohol-related problems, number of kilometers ever driven, sensation seeking and northern residents. Among attenders who drank at bush parties, males were three and a half times more likely to drive after drinking at a bush party, and the probability of drinking and driving increased with the number of other drugs used. CONCLUSIONS: Despite important differences in the design and purpose of the two surveys, both indicate that bush party attendance is prevalent among adolescents. Driving after drinking at these events is common and warrants community action.

Treatment, Alcoholics Anonymous and alcohol controls during the decrease in alcohol problems in Alberta: 1975-1993.

In this study, the trends in alcohol consumption, alcohol-related problems, alcohol availability and treatment efforts were examined for the province of Alberta, for the period 1975-1993. Most of the trends previously observed in Ontario were also observed in Alberta. We found: (1) stabilization followed by important declines in per capita consumption of alcohol; (2) large decreases in most measures of problems such as cirrhosis mortality and traffic fatalities related to drinking; (3) increases in treatment and Alcoholics Anonymous membership rates; (4) increases in measures of physical availability of alcohol. One problem, impaired driving arrest rate, increased substantially during the years examined.

Changes in liver cirrhosis death rates in different countries in relation to per capita alcohol consumption and Alcoholics Anonymous membership.

OBJECTIVE: This study examines how trends in liver cirrhosis relate to per capita alcohol consumption and Alcoholics Anonymous (AA) membership in 33 countries between 1965 and 1991. It was expected that reductions in liver cirrhosis deaths seen in many countries would be related to both decreased consumption and increased AA membership. METHOD: Data on liver cirrhosis death rates, alcohol consumption and AA membership were gathered from a variety of international sources. The data were analyzed with regression analyses (Ordinary Least Squares). RESULTS: Cirrhosis deaths and alcohol consumption levels were positively related in all analyses. In two of the four analyses, the negative relationship between cirrhosis deaths and AA group rates was marginally significant. CONCLUSIONS: Liver cirrhosis rates were strongly related to alcohol consumption and showed some relationship to AA group rates. The modest impact of AA may be due to the weakness of the true relationship but also to incompleteness in the cirrhosis and AA data in some countries.

Introduction of high-alcohol beer in Ontario: preliminary observations on its use by underage drinkers.

Preliminary data are reported on the use of high-alcohol beer by underage drinkers in Ontario. Students in grades 11 and 12 with a valid driver's licence completed a questionnaire between January and May, 1994 (i.e., between three and seven months after the introduction of high-alcohol beer). About one-half of students who had drunk alcohol within the previous four weeks reported consuming high-alcohol beer within that period. In this group, males were much more likely to report high-alcohol beer consumption in the previous month. Both male and female high-alcohol beer consumers drank alcohol more frequently, got drunk more frequently, and drank five or more drinks on the same occasion more frequently than non-consumers. One reason for trying high-alcohol beer, "wanted a higher alcohol content", was endorsed by more than one-third of high-alcohol beer consumers. Our data suggest that the users of high-alcohol beer among this underage drinking sample tend to be heavier drinkers and more likely to experience alcohol-related problems.

Drugs and violence among Ontario students.

In this research the links among violence and nonviolent delinquency and the use of alcohol and other drugs were investigated. The data were derived from the 1995 Ontario Student Drug Use Survey, a cross-sectional probability survey of Ontario students in grades seven, nine, 11 and 13 (n = 3,870). Students were classified into four groups: those who reported engaging in no delinquency, those who reported violent delinquency only, those who reported nonviolent delinquency only, and those who reported both violent and nonviolent delinquency. As expected, individuals who reported violent delinquency also reported the most frequent use of cocaine and amphetamine. The association of violent delinquency with alcohol use was not as strong as expected; nonviolent delinquents reported the most frequent use.