Alcohol use, alcohol disorders, and the use of health services: results from a population survey.

Data from a population survey were used to explore relationships among drinking levels/patterns, alcohol dependence or abuse, and the use of emergency services, hospital admissions, and frequent visits to general practitioners in the past year. For both males and females, self-reported hospital admissions were less common among daily moderate drinkers than among lifetime abstainers. Among males, drinkers with no history of alcohol dependence or abuse were less likely to report being in hospital in the last year than lifetime abstainers. For females, some groups defined by drinking patterns/levels and current drinkers without symptoms of alcohol abuse or dependence were more likely to report using emergency services than lifetime abstainers.

Public opinion on the health benefits of moderate drinking: results from a Canadian National Population Health Survey.

AIMS: To explore beliefs about the health benefits of drinking alcohol in the Canadian population. DESIGN: Secondary analysis of data from a national population health survey. PARTICIPANTS: Canadians age 12 or older (weighted n = 72375) in all provinces but Alberta excluding those living in remote regions, native reserves and armed forces bases. MEASURES: Responses to questions concerning the definition of moderate drinking and the belief that moderate drinking can be good for health. Self-reports of age, gender, province of residence, quantity and frequency of drinking, health problems and indicators of alcohol dependence. FINDINGS: Fifty-seven per cent of respondents believed that moderate drinking has health benefits. Forty-seven per cent defined moderate drinking as drinking less than one drink a day and believed this to be good for health. Twelve per cent defined moderate drinking as one or more drinks a day and believed this is good for health. Belief in the health benefits of moderate drinking was more common among men, those age 45 or older, residents of Ontario and Quebec, more frequent drinkers and those with ischaemic heart disease. Those who believed in the health benefits of at least one drink a day were more often males, older persons and frequent, heavy drinkers. CONCLUSIONS: Belief in the health benefits of moderate drinking is generally associated with a conservative definition of moderate drinking. However, some drinkers at risk for alcohol problems may be influenced to drink by the belief that this can have health benefits or use this belief as an excuse for drinking.

Who works in addictions treatment services? Some results from an Ontario survey.

This paper summarizes results from a survey of staff of specialized addiction treatment agencies in Ontario and includes information on demographic characteristics, education and related issues for those working in different types of agencies. Across all agencies 80% of staff had some sort of post secondary academic qualification and the majority reported taking professional development courses in the previous 12 months. However, only 20% of all respondents were "certified" as either an addictions counsellor or as another type of human service provider. There were differences within and between different agencies, and between respondents with and without administrative/supervisory responsibilities, with respect to education and certification status. Discussion concerns professionalization of the addiction treatment field, preparatory training for work in addictions treatment, and the generalizability of results.

The influence of early and frequent use of marijuana on the risk of desistance and of progression to marijuana-related harm.

BACKGROUND: A significant minority of lifetime marijuana users will eventually receive a diagnosis of abuse or dependence. Yet little is known regarding the effect of age at onset and frequency of lifetime marijuana use on desistance from use and on progression to marijuana disorders. METHODS: To address this issue, data were obtained from a community sample of 2,729 lifetime marijuana users participating in the Ontario Mental Health Supplement. RESULTS: Early and frequent lifetime marijuana use was associated with highly persistent use and rapid progression to marijuana-related harm. Multivariate analyses revealed a monotonic increase in the risk of desistance with less frequent categories of use and later ages of onset. Results also indicated a threshold of use (100-199 times) associated with an elevated risk of developing marijuana disorders. A lower threshold of risk for marijuana problems was observed for females (50-99 times). CONCLUSIONS: Early and frequent marijuana use are potent risk factors for prolonging desistance and hastening marijuana-related harm. Required are prevention programs aimed at delaying the onset of first use as well as harm reduction strategies that encourage cessation or reduced levels of consumption among those already using.

Drinking and heavy drinking by students in 18 countries.

This paper examines how levels of drinking, daily drinking and heavy drinking are related in 18 countries. There is wide national variation in consumption patterns. The proportions of students drinking and the proportion drinking at least six times in the past month correlated with per capita consumption in the total adult population. Some student drinking variables correlated with each other. Most countries (n=14) could be classified into one of two distinct groups based on the percentage of students who reported drinking at least six times per month, the percentage reporting drinking at least five drinks per day at any time in the last month and per capita alcohol consumption. Some countries in these groups were geographically close but others were not. Further research is needed to understand differences and similarities among countries with respect to student drinking.

Drug use and drinking among students in 36 countries.

This article summarizes data on alcohol and drug use from studies of high school students in 36 countries. Drug use levels varied greatly among countries, but alcohol and cannabis were used most often, followed by amphetamines, ecstasy, and cocaine. In countries having high levels of cannabis use, the use of other drugs was also more common but there were no consistent differences for alcohol. Use of various drugs was correlated except for alcohol use, which was related to cannabis use only when some countries with low alcohol use levels were removed. In general, the studies show that drug use priorities for studies are mainly the same in the countries studied.

Identifying and treating patients with alcohol-related problems.

Problem drinking is a serious health issue, but often patients whose alcohol consumption places them at risk are not diagnosed by physicians. Case finding is an essential component of "best practice." In many cases if given the appropriate advice, counselling and behavioural interventions, problem drinkers can be helped to reduce their use of alcohol and improve functioning in other areas of their lives. Some patients may benefit from more comprehensive therapy including the prescription of disulfiram, calcium carbimide or naltrexone. For those with serious problems with alcohol, referral to specialized addiction treatment programs and other community resource centres may also be appropriate.

Age at first alcohol use: a risk factor for the development of alcohol disorders.

OBJECTIVE: This study aimed to describe the natural course of DSM-III-R alcohol disorders as a function of age at first alcohol use and to investigate the influence of early use as a risk factor for progression to the development of alcohol disorders, exclusive of the effect of confounding influences. METHOD: Data were obtained from a community sample (N=5,856) of lifetime drinkers participating in the 1990-1991 Mental Health Supplement of the Ontario Health Survey. RESULTS: Survival analyses revealed a rapid progression to alcohol-related harm among those who reported having their first drink at ages 11-14. After 10 years, 13.5% of the subjects who began to drink at ages 11 and 12 met the criteria for a diagnosis of alcohol abuse, and 15.9% had a diagnosis of dependence. Rates for subjects who began to drink at ages 13 and 14 were 13.7% and 9.0%, respectively. In contrast, rates for those who started drinking at ages 19 and older were 2.0% and 1.0%. Unexpectedly, a delay in progression to harm was observed for the youngest drinkers (ages 10 and under). Hazard regression analyses revealed a nonlinear effect of age at first alcohol use, marked by an elevated risk of developing disorders among subjects first using alcohol at ages 11-14. CONCLUSIONS: First use of alcohol at ages 11-14 greatly heightens the risk of progression to the development of alcohol disorders and therefore is a reasonable target for intervention strategies that seek to delay first use as a means of averting problems later in life.

Cannabis users in the general Canadian population.

In a national survey conducted in 1994, 29.3% of all respondents reported that they had used cannabis at least once, 7.3% reported using at least once during the year of the survey, and 2.0% reported using cannabis at least once a week during the year of survey. Nonusers and those with different patterns of cannabis use could be distinguished by age; gender; the use of alcohol, tobacco, and other drugs; and involvement with drug users. Frequent cannabis use at the time of the survey was associated with "heavy" drinking and drinking problems, drinking and driving, driving within 2 hours of using cannabis, and the use of other drugs, especially among young males. The association between regular cannabis use, "heavy" drinking, and other risk behaviors poses challenges to prevention and harm-reduction initiatives.

Who is using cannabis as a medicine and why: an exploratory study.

This article reports on an exploratory study of medical cannabis users. Interviews were completed with 50 self-identified medical cannabis users recruited through notices in newspapers and on bulletin boards. They reported using cannabis for a variety of conditions including HIV-AIDS-related problems, chronic pain, depression, anxiety, menstrual cramps, migraine, narcotic addiction as well as everyday aches, pains, stresses and sleeping difficulties. A majority also used cannabis for recreational purposes, and many were longer-term cannabis users. However, there were some notable exceptions. Almost all smoked cannabis and many did so two to three times a day. Few admitted negative experiences with cannabis, although some problems evident to the researchers were not clearly admitted. Those who told their doctors about their medical cannabis use found doctors noncommittal or supportive. The results raise questions about the definition of medical cannabis use and about policies that might be developed to accommodate such use. Limitations of the study are noted and further research suggested. Research priorities include population surveys, studies involving larger, more representative samples of medical cannabis users and studies of medical cannabis use among people with HIV-AIDS.

Lifetime use of professional and community services for help with drinking: results from a Canadian population survey.

OBJECTIVE: To determine the lifetime prevalence of help seeking for alcohol problems among Canadian drinkers; to explore the influence on help seeking of age, gender, education, marital status and the number of life areas where alcohol was felt to have caused harm; and to consider any similarities and differences in the rate of help seeking in Canada and in the U.S. METHOD: Analyses of data from a survey of 12,155 Canadian adults (response rate 75.6%) conducted in 1994. Use of logistic regression to examine the influence on help seeking of demographic characteristics and perceptions of alcohol-related harm. RESULTS: Two percent (2%) of lifetime drinkers reported seeking help at some time. Help from AA or from addictions agencies was reported by 1.3% and 0.3%, respectively. Logistic regression showed that help seeking was more common among those aged 40-49 years than those in other age groups, and less common among those with no post-secondary education and those who were married. The best predictor of help seeking was the number of life areas where alcohol was felt to have caused harm. Controlling for this variable, the influence of gender on help seeking was negligible. The rate of help seeking was similar to that in the U.S. 15 years earlier but lower than the U.S. rate in 1990. CONCLUSIONS: More effort may be required to encourage Canadians with alcohol problems to seek help. Gender does not appear to influence the chances of seeking some form of help when perceptions of harm are controlled. More research is needed to determine why proportionally fewer Canadian than American drinkers report seeking help for alcohol problems.

Antecedents of the risk of recovery from DSM-III-R social phobia.

BACKGROUND: This study reports antecedents of recovery from DSM-III-R social phobia. METHODS: Retrospective data were obtained from 1116 individuals age 15 to 64 participating in a large population health survey in the province of Ontario, Canada RESULTS: Approximately 50% of the sample recovered from their illness. Survival analysis revealed a median length of illness of 25 years with peak periods of risk of recovery occurring between 30 and 45 years duration. Using discrete time multivariate hazard regression analysis, statistically significant predictors of recovery from social phobia included: childhood social contextual factors (one or no childhood siblings, a small town childhood place of residence), characteristics of the disorder (onset past the age of 7, less than three disorder symptoms), an absence of co-morbid health-related conditions and psychiatric disorders (chronic health problems and major depression), and the occurrence of co-morbid chronic health problems and major depression prior to the onset of the disorder. CONCLUSIONS: Our data indicate that social phobia in the general population is a chronic and unremittent disorder. Determinants of recovery are rooted in distal childhood circumstances, disorder attributes, and the physical and mental health status of individuals over the life course.

A framework for the evaluation of activities and programs with harm-reduction objectives.

This paper presents a framework for the evaluation of activities and programs with harm-reduction objectives that draws attention to the logic, implementation, outcomes, costs, and cost-effectiveness of these initiatives and encompasses stakeholder concerns and theoretical models. Evaluations of harm-reduction initiatives are essential if their proponents wish to establish them as viable alternatives to abstinence-oriented approaches. [Translations are provided in the International Abstracts Section of this issue.]

Working in addictions treatment services: some views of a sample of service providers in Ontario.

Respondents in a survey of specialized addiction treatment providers indicated a strong commitment to the addictions field. In a multivariate analysis, intention to stay in the addictions field was positively related to a measure of attitudes toward staying or leaving, to age, involvement in an addictions studies program, working in a residential service, and job satisfaction. Intention to stay was negatively related to education and working in a nonresidential setting. Attention to factors that create positive attitudes to the addictions field, especially among younger, more educated people and those working in nonresidential services, is necessary to ensure a healthy future for addictions treatment.

Measuring treatment process beliefs among staff of specialized addiction treatment services.

In a survey conducted in Ontario, front-line staff of specialized addiction treatment services were asked to indicate the extent to which they believed 53 different treatment processes to be necessary for the effective treatment of people with alcohol and drug problems. Cognitive-behavioural processes were generally rated as almost essential for treatment to be effective. Other processes received mixed ratings, while confrontation and pharmacological treatment were, on average, rated as detrimental. Factor analysis identified three interpretable dimensions of beliefs (a) cognitive-behavioural, (b) disease, and (c) medication. A fourth dimension involved both psychodynamic and conditioning processes and did not clearly correspond with any known therapeutic approach. Scores on scales developed using items from these four dimensions were variously influenced by respondents age, education, place of work, and certification status. Two groups identified using cluster analysis differed primarily with respect to scores on the disease scale. Logistic regression analysis showed that age, certification status, and place of work were associated with membership in these groups. Implications for treatment system development and research are discussed.

Developing an integrated information system for specialized addiction treatment agencies.

This article outlines the development of an integrated information system for specialized alcohol and drug treatment agencies in Ontario, Canada. The system is being developed following a strategic planning process involving provincial funding ministries and coalitions of service providers. An overview of the system's development is provided and the implementation of one subcomponent, a client-tracking system, is described. Some challenges to the implementation of this component are identified.

Support for harm-reduction among staff of specialized addiction treatment services in Ontario, Canada.

In a mail survey of staff of specialized addiction treatment services in Ontario, respondents from different types of services varied in their level of support for a variety of harm reduction initiatives. Across all types of services support was common for needle exchange services (82-95% in favour) and for short-term non-abstinence goals for clients with alcohol or drug problems (51-98% in favour). However, mean ratings for the effectiveness of methadone maintenance were negative or near zero, and only in assessment/referral and out-patient samples did the majority (61% in each case) have a positive view of methadone maintenance programmes. Only a minority of respondents (15% to 35%) indicated support for the prescription of heroin to heroin addicts. In multivariate analyses, support for harm-reduction strategies was found to be positively related to belief in the effectiveness of pharmacological and cognitive-behavioural interventions and working in an out-patient treatment service, and negatively related to belief in interventions based on the disease model.