CERGA Journal Title and Abstracts June 2015

Contents PAGE

LIST OF JOURNALS CHECKED 2

LIST OF REFERENCES

Addiction Theory 3

Alcohol – Epidemiology and Demography 3

Alcohol - Miscellaneous 3

Alcohol – Policy 3

Alcohol and Young People 4

Alcohol, Young People and Parenting 4

Blood Borne Viruses 4

Brief Intervention 4

Co-Morbidity 5

Community Pharmacy 5

Drug Related Death 5

Epidemiology and Demography 6

Hepatitis C 6

Homeless 6

Injecting Behaviour 7

Injecting Drug Use 7

Methadone Maintenance Treatment 7

Miscellaneous 8

New Psychoactive Substance 9

Opiate Recovery Treatment 9

Opiate Treatment 9

Primary Care 10

Psychosocial Therapy 10

Recovery 10

Recovery, Relapse and Prevention 10

Screening 11

Smoking Cessation 11

LIST OF ABSTRACTS 12-62

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Journal Title Volumes and Issues CheckedNumber of issues

per year

Addiction Volume 110, Issue 3[5], Issue 4[2], Issue 5[1]

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Addictive Behaviours Volume 44[3], Volume 45[5], Volume 46[2], Volume 47[1]

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Alcohol and Alcoholism Volume 50 Issue 3[2] 6Alcoholism Clinical & Experimental Research

Volume 39 Issue 4[3]12

Drug and Alcohol Dependence Volume 149[3], Volume 151[6] 12Drugs Education Prevention and Policy

Volume 22 Issue 2[2] 6

Drug and Alcohol Review Volume 34 Issue 2[1], Issue 3[2] 6European Addiction Research Volume 21 Issue 3[1], Issue 4[2] 4-5Harm Reduction Journal March 2015 Volume 12[3] 12International Journal of Drug Policy Volume 26 Issue 4[2], Issue 5[2] 6Journal of Substance Abuse Treatment

Volume 51[4], Volume 52[2], Volume 53[2],Volume 54[3] 8

The American Journal of Drug and Alcohol Abuse

Volume 41 Issue 3[2] 6

Substance Use and Misuse Early Online 2015[4], Volume 50 Issue 5[3] 12

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LIST OF REFERENCES

ADDICTION THEORY

1. The motivational basis of cognitive determinants of addictive behaviorsW. Miles Cox, Eric Klinger, Javad S. FadardiAddictive Behaviors 2015:44;16-22

ALCOHOL - EPIDEMIOLOGY AND DEMOGRAPHY

2. Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysisCharlotte Probst, Michael Roerecke, Silke Behrendt, Jürgen RehmDrug and Alcohol Review 2015:34(3);267-277

ALCOHOL MISCELLANEOUS

3. Alcohol-related morbidity and mortality within siblingsGrethe Søndergaard, Merete Osler, Anne-Marie Nybo Andersen, Per Kragh Andersen, Susanne Oksbjerg Dalton, Laust H. MortensenAddiction 2015:110(3);451-460

4. Psychosocial functioning in patients with alcohol-related liver disease post liver transplantationNell Pegum, Jason P. Connor, Ross McD. Young, Gerald F.X. FeeneyAddictive Behaviors 2015:45;70-73

5. Heavy Drinking Days and Mental Health: An Exploration of the Dynamic 10-

Year Longitudinal Relationship in a Prospective Cohort of Untreated Heavy DrinkersSteven Bell, Jim Orford, Annie BrittonAlcoholism: Clinical and Experimental Research 2015:39(4);688-696

6. The roles of outlet density and norms in alcohol use disorderJennifer Ahern, Laura Balzer, Sandro GaleaDrug and Alcohol Dependence 2015:151;144

ALCOHOL POLICY

7. The relationship between alcohol taxes and binge drinking: evaluating new tax measures incorporating multiple tax and beverage typesZiming Xuan, Frank J. Chaloupka, Jason G. Blanchette, Thien H. Nguyen, Timothy C. Heeren, Toben F. Nelson, Timothy S. NaimiAddiction 2015:110(3);441-450

8. How did policy actors use mass media to influence the Scottish alcohol minimum

unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviewsSrinivasa Vittal Katikireddi, Shona HiltonDrugs: education, prevention, and policy 2015:22(2);125–134

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9. What is the problem?: Evidence, politics and alcohol policy in England and Wales, 2010–2014James Nicholls, John GreenawayDrugs: education, prevention, and policy 2015:22(2);135–142

ALCOHOL AND YOUNG PEOPLE

10. Who Drinks Where: Youth Selection of Drinking ContextsSharon Lipperman-Kreda, Christina F. Mair, Melina Bersamin, Paul J. Gruenewald, Joel W. GrubeAlcoholism: Clinical and Experimental Research 2015:39(4);716-723

11. Using Contingency Management Procedures to Reduce At-Risk Drinking in Heavy DrinkersDonald M. Dougherty, Sarah L. Lake, Nathalie Hill-Kapturczak, Yuanyuan Liang, Tara E. Karns, Jillian Mullen, John D. RoacheAlcoholism: Clinical and Experimental Research 2015:39(4);743-751

12. Brand Preferences of Underage Drinkers Who Report Alcohol-Related Fights and InjuriesSarah P. Roberts, Michael B. Siegel, William DeJong, Timothy S. Naimi, David H. JerniganSubstance Use & Misuse 2015:50(5);619–929

ALCOHOL, YOUNG PEOPLE AND PARENTING

13. Alcohol expectancies in young children and how this relates to parental alcohol useSuzanne H.W. Mares, Lisanne L. Stone, Anna Lichtwarck-Aschoff, Rutger C.M.E. EngelsAddictive Behaviors 2015:45:93-98

BLOOD BORNE VIRUSES

14. Factors Associated with Hospitalization for Blood-Borne Viral Infections Among Treatment-Seeking Illicit Drug UsersIfeoma N. Onyeka, Olubunmi Olubamwo, Caryl M. Beynon, Kimmo Ronkainen, Jaana Föhr, Jari Tiihonen, Pekka Tuomola, Niko Tasa, Jussi KauhanenJournal of Substance Abuse Treatment 2015:53;71-77

BRIEF INTERVENTION

15. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview studyNiamh Fitzgerald, Heather Molloy, Fiona MacDonald, Jim McCambridgeDrug and Alcohol Review 2015:34(2);185-193

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CO-MORBIDITY

16. Substance Use and Response to Psychiatric Treatment in Methadone-Treated Outpatients with Comorbid Psychiatric DisorderMichael Kidorf, Van L. King, Jessica Peirce, Neeraj Gandotra, Sharon Ghazarian, Robert K. BroonerJournal of Substance Abuse Treatment 2015:51;64-69

17. Gender Differences in Treatment Retention Among Individuals with Co-

Occurring Substance Abuse and Mental Health DisordersSam Choi, Susie M. Adams, Siobhan A. Morse, Sam MacMasterSubstance Use & Misuse 2015:Early Online;Posted 14 Jan 2015

18. Prevalence and experience of chronic pain in suburban drug injectorsRobert Heimer, Weihai Zhan, Lauretta E. GrauDrug and Alcohol Dependence 2015:151;92-100

19. Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disordersTeresa López-Castro, Mei-Chen Hu, Santiago Papini, Lesia M. Ruglass, Denise A. HienDrug and Alcohol Review 2015:34(3);242-251

20. Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health DisordersSam Choi, Susie M. Adams, Siobhan A. Morse, Sam MacMasterSubstance Use & Misuse 2015:50(5);653–663

COMMUNITY PHARMACY

21. Factors Associated With Provision of Addiction Treatment Information by Community PharmacistsNicholas E. Hagemeier, Arsham Alamian, Matthew M. Murawski, Robert P. PackJournal of Substance Abuse Treatment 2015:52;67-72

DRUG RELATED DEATHS

22. Heavy alcohol use and suicidal behavior among people who use illicit drugs: A cohort studyMary Clare Kennedy, Brandon D.L. Marshall, Kanna Hayashi, Paul Nguyen, Evan Wood, Thomas KerrDrug and Alcohol Dependence 2015:151;272-277

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EPIDEMIOLOGY AND DEMOGRAPHY

23. Examining the role of common genetic variants on alcohol, tobacco, cannabis and illicit drug dependence: genetics of vulnerability to drug dependenceRohan H. C. Palmer, Leslie Brick, Nicole R. Nugent, L. Cinnamon Bidwell, John E. McGeary, Valerie S. Knopik, Matthew C. KellerAddiction 2015:110(3);530-537

24. Progression to regular heroin use: Examination of patterns, predictors, and consequencesEric A. Woodcock, Leslie H. Lundahl, Jonathan J.K. Stoltman, Mark K. GreenwaldAddictive Behaviors 2015:45;287-293

HEPATITIS C

25. A qualitative study trialling the acceptability of new hepatitis C prevention messages for people who inject drugs: symbiotic messages, pleasure and conditional interpretationsCarla Treloar, Jamee Newland, Louise MaherHarm Reduction Journal 2015:12;5 

HOMELESS

26. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependenceSusan E. Collins, Véronique S. Grazioli, Nicole I. Torres, Emily M. Taylor, Connor B. Jones, Gail E. Hoffman, Laura Haelsig, Mengdan D. Zhu, Alyssa S. Hatsukami, Molly J. Koker, Patrick Herndon, Shawna M. Greenleaf, Parker E. DeanAddictive Behaviors 2015:45;184-190

27. Social and recovery capital amongst homeless hostel residents who use drugs and alcoholJoanne Neale, Caral StevensonInternational Journal of Drug Policy 2015:26(5);475-483

28. A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use ProblemsCarole Upshur, Linda Weinreb, Monica Bharel, George Reedc, Christine FrisardJournal of Substance Abuse Treatment 2015:51;19-29

29. A Comparison of Three Interventions for Homeless Youth Evidencing Substance Use Disorders: Results of a Randomized Clinical TrialNatasha Slesnick, Xiamei Guo, Brittany Brakenhoff, Denitza BantchevskaJournal of Substance Abuse Treatment 2015:54;1-13

30. Safer-Drinking Strategies Used by Chronically Homeless Individuals with Alcohol DependenceVéronique S. Grazioli, Jennifer Hicks , Greta Kaese, , James Lenert , Susan E. CollinsJournal of Substance Abuse Treatment 2015:54;63-68

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INJECTING BEHAVIOUR

31. Gender differences in planning ability and hepatitis C virus among people who inject drugsJ.D. Scheidell , M.R. Khan, L.M. Clifford, E.M. Dunne, L.D. Keen II, W.W. LatimerAddictive Behaviors 2015:47;33-37

32. Factors associated with being asked to initiate someone into injection drug useRicky N. Bluthenthal, Lynn Wenger, Daniel Chu, Jennifer Lorvick, Brendan Quinn, James P. Thing, Alex H. KralDrug and Alcohol Dependence 2015:149;252-258

33. Peering into the literature: A systematic review of the roles of people who inject drugs in harm reduction initiativesZ. Marshall, M.K. Dechman, A. Minichiello, L. Alcock, G.E. HarrisDrug and Alcohol Dependence 2015:151;1-14

34. Factors affecting repeated cessations of injecting drug use and relapses during the entire injecting career among the Edinburgh Addiction CohortYang Xia, Shaun Seaman, Matthew Hickman , John Macleod, Roy Robertson, Lorraine Copeland, Jim McKenzie, Daniela De AngelisDrug and Alcohol Dependence 2015:151;76-83

INJECTING DRUG USE

35. Women’s injection drug practices in their own words: a qualitative studyEllen Tuchman Harm Reduction Journal 2015:12;6Abstract

36. How far will they go?: assessing the travel distance of current and former drug users to access harm reduction servicesSean Allen, Monica Ruiz and Allison O’Rourke Harm Reduction Journal 2015:12;3

METHADONE MAINTENANCE TREATMENT

37. Effectiveness of Rapid Intake into Methadone Treatment: A Natural Experiment in IsraelLawental MEuropean Addiction Research 2015:21(4);211-216

38. Increases in Body Mass Index Following Initiation of Methadone TreatmentJennifer M. Fenn, Jennifer S. Laurent, Stacey C. SigmonJournal of Substance Abuse Treatment 2015:51;59-63

39. A Satisfaction Survey of Opioid-Dependent Patients with Methadone Maintenance TreatmentZoriah Aziz , Nyuk Jet ChongJournal of Substance Abuse Treatment 2015:53;47-51

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40. Longitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenanceLara Dhingra, David C. Perlman, Carmen Masson, Jack Chen, Courtney McKnight, Ashly E. Jordan, Thomas Wasser, Russell K. Portenoy, Martin D. CheatleDrug and Alcohol Dependence 2015:149;285-289

MISCELLANEOUS

41. Drug analysis of residual content of used syringes: A new approach for improving knowledge of injected drugs and drug user practicesThomas Néfau , Eloïse Charpentier, Nora Elyasmino, Catherine Duplessy-Garson, Yves Levi, Sara KarolakInternational Journal of Drug Policy 2015:26(4);412-419

42. Sex work amongst people who inject drugs in England, Wales and Northern Ireland: Findings from a National Survey of Health Harms and BehavioursSara Croxford, Lucy Platt, Vivian D. Hope, Katelyn J. Cullen, John V. Parry, Fortune NcubeInternational Journal of Drug Policy 2015:26(4);429-433

43. Clinical Relevance of As-Needed Treatment with Nalmefene in Alcohol-Dependent PatientsAubin H. J, Reimer J, Nutt D.J, Bladström A, Torup L, François C, Chick JEuropean Addiction Research 2015:21(3);160-168

44. Questioning “Fluffy”: A Dog's Eye View of Animal-Assisted Interventions (AAI) in the Treatment of Substance MisuseAnne-Belle, Colleen Anne DellSubstance Use & Misuse March 2015:Early Online;1–5

45. The Role of Expectation in the Therapeutic Outcomes of Alcohol and Drug Addiction TreatmentsPrimavera A. Spagnolo , Luana Colloca , Markus Heilig Alcohol and Alcoholism 2015:50(3);282-285

46. Testosterone suppression in opioid users: A systematic review and meta-analysisMonica Bawor, Herman Bami, Brittany B. Dennis, Carolyn Plater, Andrew Worster, Michael Varenbut, Jeff Daiter, David C. Marsh, Meir Steiner, Rebecca Anglin, Margaret Coote, Guillaume Pare, Lehana Thabane, Zainab SamaanDrug and Alcohol Dependence 2015:149;1-9

47. Utilizing mHealth methods to identify patterns of high risk illicit drug useBeth S. Linas, Carl Latkin, Andrew Genz, Ryan P. Westergaard, Larry W. Chang, Robert C. Bollinger, Gregory D. KirkDrug and Alcohol Dependence 2015:151;250-257

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NEW PSYCHOACTIVE SUBSTANCES

48. Mortality related to novel psychoactive substances in Scotland, 2012: An exploratory studyAndrew McAuley, Garry Hecht, Lee Barnsdale, Catherine S. Thomson, Lesley Graham, Saket Priyadarshi, J. Roy RobertsonInternational Journal of Drug Policy 2015:26(5);461-467

OPIATE RECOVERY TREATMENT

49. Gender-Specific Predictors of Retention and Opioid Abstinence During Methadone Maintenance TreatmentAmanda R. Levine, Leslie H. Lundahl, David M. Ledgerwood, Michael Lisieski, Gary L. Rhodes, Mark K. GreenwaldJournal of Substance Abuse Treatment 2015:54;37-43

50. Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone TreatmentNina A. Cooperman, Kimber P. Richter, Steven L. Bernstein, Marc L. Steinberg, Jill M. WilliamsSubstance Use & Misuse 2015:50(5);566-581

51. Effects of methadone plus alcohol on cognitive performance in methadone-maintained volunteersBethea A. Kleykamp, Ryan G. Vandrey, George E. Bigelow, Eric C. Strain, Miriam Z. MintzerThe American Journal of Drug and Alcohol Abuse 2015:41(3);251–256

OPIATE TREATMENT

52. Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT)Nicola Metrebian, Teodora Groshkova, Jennifer Hellier, Vikki Charles, Anthea Martin, Luciana Forzisi, Nicholas Lintzeris, Deborah Zador, Hugh Williams, Tom Carnwath, Soraya Mayet, John StrangAddiction 2015:110(3);479-490

53. A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, AustraliaLucy Burns, Natasa Gisev, Sarah Larney, Timothy Dobbins, Amy Gibson, Jo Kimber, Briony Larance, Richard P. Mattick, Tony Butler, Louisa DegenhardtAddiction 2015:110(4);646-655

54. Randomized controlled trial of motivational interviewing for reducing injection risk behaviours among people who inject drugsKarine Bertrand, Élise Roy, Éric Vaillancourt, Jill Vandermeerschen, Djamal Berbiche, Jean-François BoivinAddiction 2015:110(5);832-841

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55. Attentional bias and treatment adherence in substitute-prescribed opiate usersM. Charles, C.E. Wellington, C. Mokrysz, T.P. Freeman, D. O'Ryan, H.V. CurranAddictive Behaviors 2015:46;100-105

56. Efficacy of Heroin-Assisted Treatment in Belgium: A Randomised Controlled TrialDemaret I, Quertemont E, Litran G, Magoga C, Deblire C, Dubois N, De Roubaix J, Charlier C, Lemaître A, Ansseau MEuropean Addiction Research 2015:21(4);179-187

57. Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes Brandon S. Bentzley, Kelly S. Barth , Sudie E. Back , Sarah W. BookJournal of Substance Abuse Treatment 2015:52;48-57

PRIMARY CARE

58. Comparing the Motivational Interviewing Integrity in Two Prevalent Models of Brief Intervention Service Delivery for Primary Care SettingsChris Dunn, Doyanne Darnell, Adam Carmel, David C. Atkins, Kristin Bumgardner, Peter Roy-ByrneJournal of Substance Abuse Treatment 2015:51;47-52

PSYCHOSOCIAL THERAPY

59. To suppress, or not to suppress? That is repression: Controlling intrusive thoughts in addictive behaviourAntony C. Moss , James A.K. Erskine, Ian P. Albery, James Richard Allen, George J. GeorgiouAddictive Behaviors 2015:44;65-70

RECOVERY

60. Implicit processing of heroin and emotional cues in abstinent heroin users: early and late event-related potential effectsLing Yang, Jianxun Zhang, Xin ZhaoThe American Journal of Drug and Alcohol Abuse 2015:41(3);237–245

RECOVERY, RELAPSE AND PREVENTION

61. The Social Identity Model of Cessation Maintenance: Formulation and initial evidenceDaniel Frings, Ian P. AlberyAddictive Behaviors 2015:44;35-42

62. Can exploring natural recovery from substance misuse in psychosis assist with treatment? A review of current researchShane Rebgetz, , David J. Kavanagh, Leanne HidesAddictive Behaviors 2015:46;106-112

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63. You Can't Be in Recovery If You Are on Medication: A Concept Worth RetiringGeorge E. WoodySubstance Use & Misuse 2015;Early Online:Posted 16 Mar 2015

64. Recovery Is A Reality: But What Is It?Carl LeukefeldSubstance Use & Misuse 2015:Early Online;Posted 20 Feb 2015

SCREENING

65. Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?Catherine L. Ward , Jennifer R. Mertens , Graham F. Bresick , Francesca Little , Constance M. Weisner Alcohol and Alcoholism 2015:50(3);302-309

SMOKING CESSATION

66. Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population studyStuart G. Ferguson, Jamie Brown, Mai Frandsen, Robert WestAddiction 2015:110(3);513-518

67. First- versus second-generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptomsLynne Dawkins, Catherine Kimber, Yasothani Puwanesarasa, Kirstie SoarAddiction 2015:110(4);669-677

68. Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacistsScott B. Cantor , Ashish A. Deshmukh, Nancy Stancic Luca, Graciela M. Nogueras-González, Tanya Rajan, Alexander V. ProkhorovAddictive Behaviors 2015:45;79-86

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LIST OF ABSTRACTS

ADDICTION THEORY

1. The motivational basis of cognitive determinants of addictive behaviorsW. Miles Cox, Eric Klinger, Javad S. FadardiAddictive Behaviors 2015:44;16-22

AbstractIf a person expects that (a) drinking alcohol or using another addictive substance will enhance positive affect or reduce negative affect, and (b) there is a strong likelihood that these desirable consequences will occur if the substance is used, that person is likely to form a goal of using the substance. The theoretical framework presented here predicts that when that happens, the person will have a current concern for using the substance, with the person thereby sensitized to environmental stimuli related to procuring and using the substance. One indication of the sensitization is selective attention to substance-related stimuli, which is correlated with urges to use and actual use of the substance. Accordingly, interventions have been developed for helping substance users to overcome substance-related attentional bias. The results are promising for reducing both the attentional bias and the substance use. Finally, we discuss other cognitive-modification and motivational techniques that have been evaluated with promising results.Keywords: Alcohol; Addiction; Attentional bias; Current concern; Goal theory; Motivation

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ALCOHOL - EPIDEMIOLOGY AND DEMOGRAPHY

2. Gender differences in socioeconomic inequality of alcohol-attributable mortality: A systematic review and meta-analysisCharlotte Probst, Michael Roerecke, Silke Behrendt, Jürgen RehmDrug and Alcohol Review 2015:34(3);267-277

AbstractIntroduction and Aims The present analysis contributes to understanding the societal distribution of alcohol-attributable harm by investigating socioeconomic inequality and related gender differences in alcohol-attributable mortality. Design and Methods A systematic literature search was performed on Web of Science, MEDLINE, PsycINFO and ETOH from their inception until February 2013. Articles were included when they reported data on alcohol-attributable mortality by socioeconomic status (SES), operationalised as education, occupation, employment status or income. Gender-specific relative risks (RR) comparing low with high SES were pooled using random effects meta-analyses. Gender differences were additionally investigated in random effects meta-regressions. Results Nineteen articles from 14 countries were included. For women, significant RRs across all measures of SES, except employment status, were found, ranging between 1.75 [95% confidence interval (CI) 1.21–2.54; occupation] and 4.78 (95% CI 2.57–8.87; income). For men, all measures of SES showed significant RRs ranging between 2.88 (95% CI 2.45–3.40; income) and 12.25 (95% CI 11.45–13.10; employment status). While RRs for men were in general slightly higher, only for occupation this gender difference was above chance (P = 0.01). Results refer to deaths 100% attributable to alcohol. Discussion and Conclusions The results are predominantly based on data from high-income countries, limiting generalisability. Alcohol-attributable mortality is strongly distributed to the disadvantage of persons with a low SES. Marked gender differences in this inequality were found for occupation. Possibly male-dominated occupations of low SES were more strongly related to risky drinking cultures compared with female-dominated occupations of the same SES.Keywords: socioeconomic status; gender; alcohol-related disorder; mortality; risk

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ALCOHOL MISCELLANEOUS

3. Alcohol-related morbidity and mortality within siblingsGrethe Søndergaard, Merete Osler, Anne-Marie Nybo Andersen, Per Kragh Andersen, Susanne Oksbjerg Dalton, Laust H. MortensenAddiction 2015:110(3);451-460

AbstractAims To estimate the association between educational status and alcohol-related somatic and non-somatic morbidity and mortality among full siblings in comparison with non-related individuals. Design Cohort study. Setting Denmark. Participants Approximately 1.4 million full siblings born in Denmark between 1950 and 1979 were followed from age 28–58 years or censoring due to alcohol-related hospitalization and mortality. Measurements Cox regression analyses were used to estimate associations of educational status with alcohol-related outcomes. Results from cohort analyses based on non-related individuals and inter-sibling analyses were compared. Findings A lower educational status was associated with a higher rate of alcohol-related outcomes, especially among the youngest (aged 28–37 years) and individuals born 1970–79. Compared with the cohort analyses, the associations attenuated slightly in the inter-sibling analysis. For example, in the cohort analysis, females with a basic school education born 1970–79 had an increased rate of alcohol-related non-somatic morbidity and mortality [hazard rate ratio (HR) = 4.05, 95% confidence interval (CI) = 3.27–5.02] compared to those with a vocational education. In the inter-sibling analysis, the HR attenuated (HR = 2.66, 95% CI = 1.95–3.63). For alcohol-related somatic outcomes the corresponding figures were HR = 3.47 (95% CI = 2.63–4.58) and HR = 3.36 (95% CI = 2.10–5.38), respectively. In general, the associations were stronger among females than males (aged 28–37) in the analyses of alcohol-related non-somatic outcomes. Health conditions earlier in life explained only a minor part of the associations. Conclusions The association between educational status and alcohol-related somatic and non-somatic morbidity and mortality is only driven by familial factors to a small degree.Keywords: Alcohol; education; family; hospitalization; morbidity; mortality; siblings; social inequality in health

4. Psychosocial functioning in patients with alcohol-related liver disease post liver transplantationNell Pegum, Jason P. Connor, Ross McD. Young, Gerald F.X. FeeneyAddictive Behaviors 2015:45;70-73 AbstractEmotional and role functioning difficulties are associated with chronic alcohol use and liver disease. Little is known about prospective changes in psychological and psychosocial functioning following orthotopic liver transplantation (OLT) amongst patients with alcoholic liver disease (ALD). We aimed to assess the functioning of this patient group post liver transplantation. Comprehensive psychosocial assessment of depression (Beck Depression Inventory [BDI]), anxiety (State-Trait Anxiety Inventory—Form X [STAI]) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale—Self-Report version [PAIS-SR]) was conducted with 42 ALD patients available for pre and post OLT testing. Dependence severity was assessed by the Brief Michigan Alcoholism Screening Test (bMAST). Significant reductions in average anxiety and depression symptoms were observed 12-months post-OLT. Significant improvements in psychosocial adjustment to illness were also reported. Patients

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with higher levels of alcohol dependence severity pre transplant assessment improved comparably to those with lower levels of dependence. In summary, the study found that OLT contributed to reducing overall levels of mood and anxiety symptoms in ALD patients, approximating general (non-clinical) population norms. Psychosocial adjustment also improved significantly post liver transplantation.Keywords: Psychosocial functioning; Alcoholic liver disease; Liver transplantation

5. Heavy Drinking Days and Mental Health: An Exploration of the Dynamic 10-Year Longitudinal Relationship in a Prospective Cohort of Untreated Heavy DrinkersSteven Bell, Jim Orford, Annie BrittonAlcoholism: Clinical and Experimental Research 2015:39(4);688-696

Abstract Background Identifying dominant processes that underlie the development of other processes is important when evaluating the temporal sequence between disorders. Such information not only improves our understanding of etiology but also allows for effective intervention strategies to be tailored. The temporal relationship between alcohol intake and mental health remains poorly understood, particularly in nonclinical samples. The purpose of this study was to disentangle the dominant temporal sequence between mental health and frequency of heavy drinking days. Methods We report a 10-year (1997 to 2007) prospective cohort study of 500 respondents (74% male) from the Birmingham Untreated Heavy Drinkers project. Participants were aged 25 to 55 years at baseline, drinking a minimum of 50/35 U.K. units of alcohol for men/women on a weekly basis, and were not seeking treatment for their alcohol use upon recruitment into the study. Heavy drinking days were defined as consuming 10/7+ U.K. units of alcohol in a single day for men/women. Mental health was assessed using the mental health component score of the SF-36 questionnaire. Dynamic longitudinal structural equation models were used to test competing theoretical models (frequency of heavy drinking days leading to changes in mental health scores and vice versa) and a reciprocal relationship (both mental health scores and the frequency of heavy drinking days influencing changes in each other). Results A model whereby mental health scores were predictors of change in the frequency of heavy drinking days was of best fit. In this model, mental health scores were negatively related to change in heavy drinking days (β −0.80, SE 0.28) indicating that those with higher mental health scores (i.e., better functioning) made larger reductions in the number of heavy drinking days over time. Conclusions Mental health appears to be the stronger underlying process in the relationship between mental health and frequency of heavy drinking days.Keywords: Alcohol; Mental Health; Longitudinal; Reciprocal; Self-Medication; Temporality

6. The roles of outlet density and norms in alcohol use disorderJennifer Ahern, Laura Balzer, Sandro GaleaDrug and Alcohol Dependence 2015:151;144

AbstractBackground Alcohol outlet density and norms shape alcohol consumption. However, due to analytic challenges we do not know: (a) if alcohol outlet density and norms also shape alcohol use disorder, and (b) whether they act in combination to shape disorder.

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Methods We applied a new targeted minimum loss-based estimator for rare outcomes (rTMLE) to a general population sample from New York City (N = 4000) to examine the separate and combined relations of neighborhood alcohol outlet density and norms around drunkenness with alcohol use disorder. Alcohol use disorder was assessed using the World Mental Health Comprehensive International Diagnostic Interview (WMH-CIDI) alcohol module. Confounders included demographic and socioeconomic characteristics, as well as history of drinking prior to residence in the current neighborhood. Results Alcohol use disorder prevalence was 1.78%. We found a marginal risk difference for alcohol outlet density of 0.88% (95% CI 0.00–1.77%), and for norms of 2.05% (95% CI 0.89–3.21%), adjusted for confounders. While each exposure had a substantial relation with alcohol use disorder, there was no evidence of additive interaction between the exposures. Conclusions Results indicate that the neighborhood environment shapes alcohol use disorder. Despite the lack of additive interaction, each exposure had a substantial relation with alcohol use disorder and our findings suggest that alteration of outlet density and norms together would likely be more effective than either one alone. Important next steps include development and testing of multi-component intervention approaches aiming to modify alcohol outlet density and norms toward reducing alcohol use disorder.Keywords: Alcohol-related disorders Residence characteristics Alcohol outlets Social norms Semi-parametric estimation

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ALCOHOL POLICY

7. The relationship between alcohol taxes and binge drinking: evaluating new tax measures incorporating multiple tax and beverage typesZiming Xuan, Frank J. Chaloupka, Jason G. Blanchette, Thien H. Nguyen, Timothy C. Heeren, Toben F. Nelson, Timothy S. NaimiAddiction 2015:110(3);441-450 AbstractAims U.S. studies contribute heavily to the literature about the tax elasticity of demand for alcohol, and most U.S. studies have relied upon specific excise (volume-based) taxes for beer as a proxy for alcohol taxes. The purpose of this paper was to compare this conventional alcohol tax measure with more comprehensive tax measures (incorporating multiple tax and beverage types) in analyses of the relationship between alcohol taxes and adult binge drinking prevalence in U.S. states. Design Data on U.S. state excise, ad valorem and sales taxes from 2001 to 2010 were obtained from the Alcohol Policy Information System and other sources. For 510 state-year strata, we developed a series of weighted tax-per-drink measures that incorporated various combinations of tax and beverage types, and related these measures to state-level adult binge drinking prevalence data from the Behavioral Risk Factor Surveillance System surveys. Findings In analyses pooled across all years, models using the combined tax measure explained approximately 20% of state binge drinking prevalence, and documented more negative tax elasticity (–0.09, P = 0.02 versus –0.005, P = 0.63) and price elasticity (–1.40, P < 0.01 versus −0.76, P = 0.15) compared with models using only the volume-based tax. In analyses stratified by year, the R-squares for models using the beer combined tax measure were stable across the study period (P = 0.11), while the R-squares for models rely only on volume-based tax declined (P < 0.01). Conclusions Compared with volume-based tax measures, combined tax measures (i.e. those incorporating volume-based tax and value-based taxes) yield substantial improvement in model fit and find more negative tax elasticity and price elasticity predicting adult binge drinking prevalence in U.S. states.Keywords: Ad valorem tax; alcohol control; alcohol tax; binge drinking; elasticity; excise tax; harm reduction; prevention; tax structure

8. How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviewsSrinivasa Vittal Katikireddi, Shona HiltonDrugs: education, prevention, and policy 2015:22(2);125–134

AbstractAims To explore how policy actors attempted to deliberately frame public debate around alcohol minimum unit pricing (MUP) in the UK by comparing and contrasting their constructions of the policy in public (newspapers), semi-public (evidence submissions) and private (interviews). Methods Content analysis was conducted on articles published in ten national newspapers between 1 January 2005 and 30 June 2012. Newsprint data were contrasted with alcohol policy documents, evidence submissions to the Scottish Parliament’s Health and Sport Committee and 36 confidential interviews with policy stakeholders (academics, advocates, industry representatives, politicians and civil servants). Findings A range of policy actors exerted influence both directly (through Parliamentary institutions and political representatives) and indirectly through the mass media. Policy actors were acutely

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aware of mass media’s importance in shaping public opinion and used it tactically to influence policy. They often framed messages in subtly different ways, depending on target audiences. In general, newspapers presented the policy debate in a “balanced” way, but this arguably over-represented hostile perspective and suggested greater disagreement around the evidence base than is the case. Conclusions The roles of policy actors vary between public and policy spheres, and how messages are communicated in policy debates depends on perceived strategic advantage.Keywords: Alcohol; evidence base; health; policy; public health; qualitative research

9. What is the problem?: Evidence, politics and alcohol policy in England and Wales, 2010–2014James Nicholls, John GreenawayDrugs: education, prevention, and policy 2015:22(2);135–142AbstractThis article considers alcohol policy development in England and Wales under the coalition government after 2010. With a particular focus on minimum unit pricing, it examines why policy departures based on supply-side controls drawn from public health models were abandoned in favour of a restoration of policy equilibrium. This article adopts a historically informed political science perspective, drawing upon insights from John Kingdon’s policy streams approach, with a focus on how the “alcohol problem” is defined and framed by policy actors. It argues that while the restoration of policy equilibrium was significantly attributable to industry lobbying, also important were the inconsistent framing of policy proposals, lack of departmental synergy, ideological tensions and a lack of coherence in the communication of evidence.Keywords: Alcohol; evidence base; policy

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ALCOHOL AND YOUNG PEOPLE

10. Who Drinks Where: Youth Selection of Drinking ContextsSharon Lipperman-Kreda, Christina F. Mair, Melina Bersamin, Paul J. Gruenewald, Joel W. GrubeAlcoholism: Clinical and Experimental Research 2015:39(4);716-723

Abstract Background Different drinkers may experience specific risks depending on where they consume alcohol. This longitudinal study examined drinking patterns, and demographic and psychosocial characteristics associated with youth drinking in different contexts. Methods We used survey data from 665 past-year alcohol-using youths (ages 13 to 16 at Wave 1) in 50 midsized California cities. Measures of drinking behaviors and drinking in 7 contexts were obtained at 3 annual time points. Other characteristics included gender, age, race, parental education, weekly disposable income, general deviance, and past-year cigarette smoking. Results Results of multilevel regression analyses show that more frequent past-year alcohol use was associated with an increased likelihood of drinking at parties and at someone else's home. Greater continued volumes of alcohol (i.e., heavier drinking) was associated with increased likelihood of drinking at parking lots or street corners. Deviance was positively associated with drinking in most contexts, and past-year cigarette smoking was positively associated with drinking at beaches or parks and someone else's home. Age and deviance were positively associated with drinking in a greater number of contexts. The likelihood of youth drinking at parties and someone else's home increased over time, whereas the likelihood of drinking at parking lots/street corners decreased. Also, deviant youths progress to drinking in their own home, beaches or parks, and restaurants/bars/nightclubs more rapidly. Conclusions The contexts in which youths consume alcohol change over time. These changes vary by individual characteristics. The redistribution of drinking contexts over the early life course may contribute to specific risks associated with different drinking contexts.Keywords: Youths; Drinking Contexts; Self-Selection; Longitudinal Study

11. Using Contingency Management Procedures to Reduce At-Risk Drinking in Heavy DrinkersDonald M. Dougherty, Sarah L. Lake, Nathalie Hill-Kapturczak, Yuanyuan Liang, Tara E. Karns, Jillian Mullen, John D. RoacheAlcoholism: Clinical and Experimental Research 2015:39(4);743-751

Abstract Background Treatments for alcohol use disorders typically have been abstinence based, but harm reduction approaches that encourage drinkers to alter their drinking behavior to reduce the probability of alcohol-related consequences, have gained in popularity. This study used a contingency management procedure to determine its effectiveness in reducing alcohol consumption among heavy drinkers. Methods Eighty-two nontreatment-seeking heavy drinkers (ages 21 to 54, M = 30.20) who did not meet diagnostic criteria for alcohol dependence participated in the study. The study had 3 phases: (i) an Observation phase (4 weeks) where participants drank normally; (ii) a Contingency Management phase (12 weeks) where participants were paid $50 weekly for not exceeding low levels of alcohol consumption as measured by transdermal alcohol concentrations, <0.03 g/dl; and (iii) a

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Follow-up phase (12 weeks) where participants (n = 66) returned monthly for 3 months to self-report drinking after the contingencies were removed. Transdermal alcohol monitors were used to verify meeting contingency requirements; all other analyses were conducted on self-reported alcohol use. Results On average 42.3% of participants met the contingency criteria and were paid an average of $222 during the Contingency Management phase, with an average $1,998 in total compensation throughout the study. Compared to the Observation phase, the percent of any self-reported drinking days significantly decreased from 59.9 to 40.0% in the Contingency Management and 32.0% in the Follow-up phases. The percent of self-reported heavy drinking days reported also significantly decreased from 42.4% in the Observation phase to 19.7% in the Contingency Management phase, which was accompanied by a significant increase in percent days of self-reported no (from 40.1 to 60.0%) and low-level drinking (from 9.9 to 15.4%). Self-reported reductions in drinking either persisted, or became more pronounced, during the Follow-up phase. Conclusions Contingency management was associated with a reduction in self-reported episodes of heavy drinking among nontreatment-seeking heavy drinkers. These effects persisted even after incentives were removed, indicating the potential utility of contingency management as a therapeutic intervention to reduce harmful patterns of drinking.Keywords: Contingency Management; Harm Reduction; Excessive Alcohol Use; Transdermal Monitors; Self-Report

12. Brand Preferences of Underage Drinkers Who Report Alcohol-Related Fights and InjuriesSarah P. Roberts, Michael B. Siegel, William DeJong, Timothy S. Naimi, David H. JerniganSubstance Use & Misuse 2015:50(5);619–929

Abstract Background A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. Objectives We aimed to: (1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and (2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. Methods We recruited 1,031 self-reported drinkers (ages 13–20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. Results Over one-quarter of the respondents (26.7%, N = 232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1–9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3–3.7; AOR: 1.8, 95% CI: 1.1–3.0 and 1.1–3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. 

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Conclusions/Importance Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes.Keywords: Alcohol, brands, underage drinkers, adolescents, fights, injuries

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ALCOHOL, YOUNG PEOPLE AND PARENTING

13. Alcohol expectancies in young children and how this relates to parental alcohol useSuzanne H.W. Mares, Lisanne L. Stone, Anna Lichtwarck-Aschoff, Rutger C.M.E. EngelsAddictive Behaviors 2015:45:93-98

AbstractAccording to the cognitive model of intergenerational transference, modeling of alcohol use is an indirect process in which parental drinking shapes alcohol expectancies of children, which in turn are associated with later alcohol use in adolescents. The present study examined whether parental alcohol use was related to alcohol expectancies and experimentation with alcohol use in young children. A community sample of 240 children aged 8.02 (SD = 1.13) participated. Alcohol expectancies were assessed by means of the Berkeley Puppet Interview. Children reported consistently and reliably on the positive and negative consequences of alcohol use among adults. Their positive and negative expectancies were equally strong. Compared to younger children, older children had more negative and less positive expectancies. For girls, more paternal alcohol use was associated with less negative alcohol expectancies. For older children, more alcohol use of the mother was related to less positive expectancies, while more alcohol use of the father was related to more positive expectancies. The present study showed that young children already have clear ideas about the positive and negative consequences alcohol can have among adults, which can be captured with the Berkeley Puppet Interview. These expectancies are partly associated with alcohol use of their parents.Keywords: Alcohol-related cognitions; Childhood; Parental drinking; Berkeley Puppet Interview

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BLOOD BORNE VIRUSES

14. Factors Associated with Hospitalization for Blood-Borne Viral Infections Among Treatment-Seeking Illicit Drug UsersIfeoma N. Onyeka, Olubunmi Olubamwo, Caryl M. Beynon, Kimmo Ronkainen, Jaana Föhr, Jari Tiihonen, Pekka Tuomola, Niko Tasa, Jussi KauhanenJournal of Substance Abuse Treatment 2015:53;71-77 AbstractBlood-borne viral infections (BBVIs) are important health consequences of illicit drug use. This study assessed predictors of inpatient hospital admissions for BBVIs in a cohort of 4817 clients seeking treatment for drug use in Finland. We examined clients’ data on hospital admissions registered in the Finnish National Hospital Discharge Register from 1997 to 2010 with diagnoses of BBVIs. Cox proportional hazards regression analyses were separately conducted for each of the three BBVI groups to test for association between baseline variables and hospitalizations. Findings were reported as adjusted hazard ratios (aHRs). Based upon primary discharge diagnoses, 81 clients were hospitalized for HIV, 116 for hepatitis C, and 45 for other types of hepatitis. Compared to those admitted for hepatitis C and other hepatitis, drug users with HIV had higher total number of hospital admissions (294 versus 141 and 50 respectively), higher crude hospitalization rate (7.1 versus 3.4.and 1.2 per 1000 person-years respectively), and higher total length of hospital stay (2857 days versus 279 and 308 respectively). Trends in hospitalization for all BBVI groups declined at the end of follow-up. HIV positive status at baseline (aHR: 6.58) and longer duration of drug use (aHR: 1.11) were independently associated with increased risk for HIV hospitalization. Female gender (aHR: 3.05) and intravenous use of primary drug (aHR: 2.78) were significantly associated with HCV hospitalization. Having hepatitis B negative status at baseline (aHR: 0.25) reduced the risk of other hepatitis hospitalizations. Illicit drug use coexists with blood-borne viral infections. To address this problem, clinicians treating infectious diseases need to also identify drug use in their patients and provide drug treatment information and/or referral.Keywords: Blood-borne pathogen; HIV; Hepatitis C; Substance abuse; Hospitalization; Risk factor

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BRIEF INTERVENTION

15. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: A qualitative interview studyNiamh Fitzgerald, Heather Molloy, Fiona MacDonald, Jim McCambridgeDrug and Alcohol Review 2015:34(2);185-193 AbstractIntroduction and Aims Few studies of the implementation of alcohol brief interventions (ABI) have been conducted in community settings such as mental health, social work and criminal justice teams. This qualitative interview study sought to explore the impact of training on ABI delivery by staff from a variety of such teams. Design and Methods Fifteen semi-structured telephone interviews were carried out with trained practitioners and with managers to explore the use of, perceived need for and approaches to ABI delivery and recording with clients, and compatibility of ABIs with current practice. Interviews were analysed thematically using an inductive approach. Results Very few practitioners reported delivery of any ABIs following training primarily because they felt ABIs to be inappropriate for their clients. According to practitioners, this was either because they drank too much or too little to benefit. Practitioners reported a range of current activities relating to alcohol, and some felt that their knowledge and confidence were improved following training. One practitioner reported ABI delivery and was considered a training success, while expectations of ABIs did not fit with current practice including assessment procedures for the remainder.Discussion and Conclusions Identified barriers to ABI delivery included issues relating to individual practitioners, their teams, current practice and the ABI model. They are likely to be best addressed by strategic team- and setting-specific approaches to implementation, of which training is only one part.Keywords: alcohol consumption; brief intervention; training; qualitative; social work

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CO-MORBIDITY

16. Substance Use and Response to Psychiatric Treatment in Methadone-Treated Outpatients with Comorbid Psychiatric DisorderMichael Kidorf, Van L. King, Jessica Peirce, Neeraj Gandotra, Sharon Ghazarian, Robert K. BroonerJournal of Substance Abuse Treatment 2015:51;64-69 AbstractThe psychiatric care of opioid users receiving agonist therapies is often complicated by high rates of illicit drug use (Brooner et al., 2013). The present study evaluates if illicit drug use (i.e., opioids, cocaine, sedatives) detected at the start of psychiatric care affects treatment response. Methadone maintenance patients (n = 125) with at least one current psychiatric disorder completed a 3-month randomized clinical trial evaluating the efficacy of financial incentives on attendance to on-site integrated substance abuse and psychiatric services (Kidorf et al., 2013). The present study re-analyzes the data set by grouping participants into one of two conditions based on the 4-week baseline observation: (1) no illicit drug use (baseline negative; n = 50), or (2) any illicit drug use (baseline positive; n = 75). All participants received a similar schedule of psychiatric services, and had good access to prescribed psychiatric medications. The Global Severity Index (GSI) of the Hopkins Symptom Checklist-Revised was administered monthly to evaluate changes in psychiatric distress. Results showed that while both conditions evidenced similar utilization of on-site psychiatric services, baseline negative participants remained in treatment somewhat longer (80.7 vs. 74.8 days, p = .04) and demonstrated greater reductions in GSI scores than baseline positive participants at month 3 (p = .004). These results have implications for interpreting previous studies that have shown inconsistent efficacy of pharmacotherapy and other psychiatric treatments, and for providing clinical care for patients with co-occurring substance use and psychiatric disorders.Keywords: Opioid dependence; Methadone maintenance; Psychiatric treatment; Poly-drug use

17. Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health DisordersSam Choi, Susie M. Adams, Siobhan A. Morse, Sam MacMasterSubstance Use & Misuse 2015:Early Online;Posted 14 Jan 2015

Abstract Background  A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. Although prior research indicates that women and men differ in their substance abuse treatment experiences, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited. Objectives The purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment. Methods  The participants were 1,317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analyses) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women. Results

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This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. Conclusions/Importance  These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.Keywords: gender differences; co-occurring disorders; dual diagnosis; substance abuse and mental health disorder; retention; predictors; residential treatment

18. Prevalence and experience of chronic pain in suburban drug injectorsRobert Heimer, Weihai Zhan, Lauretta E. GrauDrug and Alcohol Dependence 2015:151;92-100

AbstractAims To explore the relationship between chronic pain and characteristics, behaviors, and psychological status of suburban Connecticut injection drug users. Methods Cross-sectional study with quantitative interview and serological testing for HIV and hepatitis B and C in 456 individuals who injected drugs in the past month. Participants were dichotomized into those reporting current chronic pain of at least six months duration and all others. The interview covered (i) sociodemographics, (ii) injection drug use, (iii) interactions with drug treatment, criminal justice, and harm reduction, (iv) screening for alcohol use, chronic pain, anxiety, and depression, and (v) knowledge regarding HIV, hepatitis B (HBV) and C (HCV), and opioid overdose. Serological testing for HIV, HBV, and HCV was conducted. Results One-third (n = 143) reported chronic pain. These individuals differed significantly from those not reporting chronic pain on characteristics that included older age, lower educational achievement, and injection of pharmaceutical opioids. They also reported experiencing more psychological and family problems on the ASI and higher levels of depression and anxiety. Four of five individuals with chronic pain (n = 117) reported non-medical opioid use prior to the onset of chronic pain. Conclusions Chronic pain is common among drug injectors in our study population although it was unusual for chronic pain to have preceded non-medical opioid use. Psychological problems in injectors with co-occurring chronic pain are likely pose significant complications to successful treatment for substance abuse, pain, or infectious disease treatment.Keywords: Injection drug use; Chronic pain; Suburbs; Opioids; Depression; Anxiety

19. Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disordersTeresa López-Castro, Mei-Chen Hu, Santiago Papini, Lesia M. Ruglass, Denise A. HienDrug and Alcohol Review 2015:34(3);242-251 AbstractIntroduction and Aims Despite advances towards integration of care for women with co-occurring substance use disorder (SUD) and post-traumatic stress disorder (PTSD), low abstinence rates following SUD/PTSD treatment remain the norm. The utility of investigating distinct substance use trajectories is a critical innovation in the detection and refining of effective interventions for this clinical population. Design and Methods The present study

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reanalysed data from the largest randomised clinical trial to date for co-occurring SUD and PTSD in women (National Drug Abuse Treatment Clinical Trials Network; Women and Trauma Study). Randomised participants (n = 353) received one of two interventions in addition to treatment as usual for SUD: (i) trauma-informed integrative treatment for PTSD/SUD; or (ii) an active control psychoeducation course on women's health. The present study utilised latent growth mixture models (LGMM) with multiple groups to estimate women's substance use patterns during the 12-month follow-up period. Results Findings provided support for three different trajectories of substance use in the post-treatment year: (i) consistently low likelihood and use frequency; (ii) consistently high likelihood and use frequency; and (iii) high likelihood and moderate use frequency. Covariate analyses revealed improvement in PTSD severity was associated with membership in a specific substance use trajectory, although receiving trauma-informed treatment was not. Additionally, SUD severity, age and after-care efforts were shown to be related to trajectory membership.Discussion and Conclusions Findings highlight the necessity of accounting for heterogeneity in post-treatment substance use, relevance of trauma-informed care in SUD recovery and benefits of incorporating methodologies like LGMM when evaluating SUD treatment outcomes. [López-Castro T, Hu M-C, Papini S, Ruglass LM, Hien DA. Pathways to change: Use trajectories following trauma-informed treatment of women with co-occurring post-traumatic stress disorder and substance use disorders. Drug Alcohol Rev 2015]Keywords: substance abuse; post-traumatic stress disorder; substance use trajectory; latent growth mixture modelling; relapse

20. Gender Differences in Treatment Retention Among Individuals with Co-Occurring Substance Abuse and Mental Health DisordersSam Choi, Susie M. Adams, Siobhan A. Morse, Sam MacMasterSubstance Use & Misuse 2015:50(5);653–663

Abstract Background  A significant number of individuals with co-occurring substance abuse and mental health disorders do not engage, stay, and/or complete residential treatment. Although prior research indicates that women and men differ in their substance abuse treatment experiences, our knowledge of individuals with co-occurring substance abuse and mental health disorders as well as those attending private residential treatment is limited. Objectives The purpose of this study is to examine gender differences on treatment retention for individuals with co-occurring substance abuse and mental health disorders who participate in private residential treatment. Methods  The participants were 1,317 individuals (539 women and 778 men) with co-occurring substance abuse and mental health disorders receiving treatment at three private residential treatment centers. Bivariate analyses, life tables, and Cox regression (survival analyses) were utilized to examine gender effects on treatment retention, and identify factors that predict treatment retention for men and women. Results This study found that women with co-occurring disorders were more likely to stay longer in treatment when compared to men. The findings indicate the factors influencing length of stay differ for each gender, and include: type of substance used prior to admission; Addiction Severity Index Composite scores; and Readiness to Change/URICA scores. Age at admission was a factor for men only. Conclusions/Importance  These findings can be incorporated to develop and initiate program interventions to minimize early attrition and increase overall retention in private residential treatment for individuals with co-occurring substance use and mental health disorders.

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Keywords: gender differences, co-occurring disorders, dual diagnosis, substance abuse and mental health disorder, retention, predictors, residential treatment

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COMMUNITY PHARMACY

21. Factors Associated With Provision of Addiction Treatment Information by Community PharmacistsNicholas E. Hagemeier, Arsham Alamian, Matthew M. Murawski, Robert P. PackJournal of Substance Abuse Treatment 2015:52;67-72 AbstractCommunity pharmacists in the United States have significant opportunity to engage in community-level prescription substance abuse prevention and treatment efforts, including dissemination of information specific to available addiction treatment options. Our cross-sectional study of Tennessee community pharmacists noted that 26% had previously provided addiction treatment facility information to one or more patients in the past. The purpose of this study was to employ multivariate modeling techniques to investigate associations between community pharmacist and community pharmacy factors and past provision of addiction treatment information to pharmacy patients. Multivariate logistic regression indicated having addiction treatment facility information in a pharmacy setting (aOR = 8.19; 95% CI = 4.36–15.37), having high confidence in ability to discuss treatment facility options (aOR = 4.16; 95% CI = 2.65–6.52), having participated in prescription opioid abuse-specific continuing education (aOR = 2.90; 95% CI = 1.70–4.97), being male (aOR = 2.23; 95% CI = 1.38–3.59), and increased hours per week in the practice setting (aOR = 1.02; 95% CI = 1.004–1.05) were all significantly associated with provision of information about addiction treatment. Dissemination of addiction treatment information, improvements in communicative self-efficacy beliefs, and dissemination of prescription opioid abuse-specific continuing education are modifiable factors significantly associated with increased provision of addiction treatment information by community pharmacists.Keywords: Addiction treatment; Community pharmacist; Communication

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DRUG RELATED DEATHS

22. Heavy alcohol use and suicidal behavior among people who use illicit drugs: A cohort studyMary Clare Kennedy, Brandon D.L. Marshall, Kanna Hayashi, Paul Nguyen, Evan Wood, Thomas KerrDrug and Alcohol Dependence 2015:151;272-277 AbstractBackground People who use illicit drugs (PWUD) are known to experience high rates of suicidal behavior. While heavy alcohol use has been associated with suicide risk, its impact on the suicidal behavior of PWUD has not been well characterized. Therefore, we examined the relationship between heavy alcohol use and suicidal behavior among PWUD in Vancouver, Canada. Methods Data are derived from two prospective cohort studies of PWUD in Vancouver, Canada, from 2005 to 2013. Participants completed questionnaires that elicited information regarding sociodemographics, drug use patterns, and mental health problems, including suicidal behavior. We used recurrent event survival analyses to estimate the independent association between at-risk/heavy drinking (based on National Institute of Alcohol Abuse and Alcoholism [NIAAA] criteria) and risk of incident, self-reported suicide attempts. Results Of 1757 participants, 162 participants (9.2%) reported 227 suicide attempts over the 8-year study period, resulting in an incidence rate of 2.5 cases per 100 person-years. After adjusting for potential confounders, including intensive illicit drug use patterns, heavy alcohol use (adjusted hazard ratio [AHR] = 1.97; 95% confidence interval [CI] = 1.39, 2.78) was positively associated with an increased risk of suicidal behavior.Conclusions We observed a high burden of suicidal behavior among a community-recruited sample of PWUD. Heavy alcohol use predicted a higher risk of suicide attempt, independent of other drug use patterns. These findings demonstrate the need for evidence-based interventions to address suicide risk among PWUD, particularly those who are heavy consumers of alcohol.Keywords: Alcohol; Suicide; Illicit drug use; Survival analysis; Canada

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EPIDEMIOLOGY AND DEMOGRAPHY

23. Examining the role of common genetic variants on alcohol, tobacco, cannabis and illicit drug dependence: genetics of vulnerability to drug dependenceRohan H. C. Palmer, Leslie Brick, Nicole R. Nugent, L. Cinnamon Bidwell, John E. McGeary, Valerie S. Knopik, Matthew C. KellerAddiction 2015:110(3);530-537 AbstractBackground and Aims Twin and family studies suggest that genetic influences are shared across substances of abuse. However, despite evidence of heritability, genome-wide association and candidate gene studies have indicated numerous markers of limited effects, suggesting that much of the heritability remains missing. We estimated (1) the aggregate effect of common single nucleotide polymorphisms (SNPs) on multiple indicators of comorbid drug problems that are typically employed across community and population-based samples, and (2) the genetic covariance across these measures. Participants A total of 2596 unrelated subjects from the Study of Addiction: Genetics and Environment provided information on alcohol, tobacco, cocaine, cannabis and other illicit substance dependence. Phenotypic measures included: (1) a factor score based on DSM-IV drug dependence diagnoses (DD), (2) a factor score based on problem use (PU; i.e. 1+ DSM-IV symptoms) and (3) dependence vulnerability (DV; a ratio of DSM-IV symptoms to the number of substances used). Findings Univariate and bivariate genome-wide complex trait analyses of this selected sample indicated that common SNPs explained 25–36% of the variance across measures, with DD and DV having the largest effects [h2

SNP (standard error) = 0.36 (0.13) and 0.33 (0.13), respectively; PU = 0.25 (0.13)]. Genetic effects were shared across the three phenotypic measures of comorbid drug problems [rDD-PU = 0.92 (0.08), rDD-DV = 0.97 (0.08) and rPU-DV = 0.96 (0.07)]. Conclusion At least 20% of the variance in the generalized vulnerability to substance dependence is attributable to common single nucleotide polymorphisms. The additive effect of common single nucleotide polymorphisms is shared across important indicators of comorbid drug problems.Keywords: Addiction; dependence vulnerability; drug dependence; genetics; genome-wide association studies (GWAS); genome-wide complex trait analysis

24. Progression to regular heroin use: Examination of patterns, predictors, and consequencesEric A. Woodcock, Leslie H. Lundahl, Jonathan J.K. Stoltman, Mark K. GreenwaldAddictive Behaviors 2015:45;287-293 AbstractBackground The present study retrospectively evaluated the chronology and predictors of substance use progression in current heroin-using individuals. Methods Out-of-treatment heroin users (urinalysis-verified; N = 562) were screened for laboratory-based research studies using questionnaires and urinalysis. Comprehensive substance use histories were collected. Between- and within-substance use progression was analyzed using stepwise linear regression models. Results The strongest predictor of onset of regular heroin use was age at initial heroin use, accounting for 71.8% of variance. The strongest between-substance predictors of regular heroin use were ages at regular alcohol and tobacco use, accounting for 8.1% of variance. Earlier onset of regular heroin use (≤ 20 years) vs. older onset (≥ 30 years) was associated with a more rapid progression from initial to regular use, longer duration of

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heroin use, more lifetime use-related negative consequences, and greater likelihood of injecting heroin. The majority of participants (79.7%) reported substance use progression consistent with the gateway hypothesis. Gateway-inconsistent individuals were more likely to be African-American and to report younger age at initial use, longer duration of heroin use, and more frequent past-month heroin use. Conclusions Our findings demonstrate the predictive validity and clinical relevance of evaluating substance use chronology and the gateway hypothesis pattern of progression.Keywords: Substance use progression; Gateway hypothesis; Opioid; Heroin use disorder

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HEPATITIS C

25. A qualitative study trialling the acceptability of new hepatitis C prevention messages for people who inject drugs: symbiotic messages, pleasure and conditional interpretationsCarla Treloar, Jamee Newland, Louise MaherHarm Reduction Journal 2015:12;5 

AbstractAim Prevention of hepatitis C (HCV) remains a public health challenge. A new body of work is emerging seeking to explore and exploit “symbiotic goals” of people who inject drugs (PWID). That is, strategies used by PWID to achieve other goals may be doubly useful in facilitating the same behaviours (use of sterile injecting equipment) required to prevent HCV. This project developed and trialled new HCV prevention messages based on the notion of symbiotic messages. Method New HCV prevention messages were developed in a series of 12 posters after consultation with staff from needle and syringe programs (NSPs) and a drug user organisation. Two posters were displayed each week for a 6-week period within one NSP. NSP staff and clients were invited to focus groups to discuss their responses to the posters. Results A total of four focus groups were conducted; one group of seven staff members and three groups of clients with a total of 21 participants. Responses to each of the posters were mixed. Staff and clients interpreted messages in literal ways rather than as dependent on context, with staff concerned that not all HCV prevention information was included in any one message; while clients felt that some messages were misleading in relation to the expectations of pleasure. Clients appreciated the efforts to use bright imagery and messages that included acknowledgement of pleasure. Clients were not aware of some harm reduction information contained in the messages (such as “shoot to the heart”), and this generated potential for misunderstanding of the intended message. Clients felt that any message provided by the NSP could be trusted and did not require visible endorsement by health departments. Conclusions While the logic of symbiotic messages is appealing, it is challenging to produce eye-catching, brief messages that provide sufficient information to cover the breadth of HCV prevention. Incorporation of symbiotic messages in conversations or activities between staff and clients may provide opportunities for these messages to be related to the clients’ needs and priorities and for staff to provide HCV prevention information in accord with their professional ethos. Keywords: Hepatitis C; Prevention; Education; People who inject drugs; Needle and syringe programs

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HOMELESS

26. Qualitatively and quantitatively evaluating harm-reduction goal setting among chronically homeless individuals with alcohol dependenceSusan E. Collins, Véronique S. Grazioli, Nicole I. Torres, Emily M. Taylor, Connor B. Jones, Gail E. Hoffman, Laura Haelsig, Mengdan D. Zhu, Alyssa S. Hatsukami, Molly J. Koker, Patrick Herndon, Shawna M. Greenleaf, Parker E. DeanAddictive Behaviors 2015:45;184-190 AbstractIntroduction Most treatment programs for alcohol dependence have prioritized alcohol abstinence as the primary treatment goal. However, abstinence-based goals are not always considered desirable or attainable by more severely affected populations, such as chronically homeless people with alcohol dependence. Because these individuals comprise a multimorbid and high-utilizing population, they are in need of more focused research attention that elucidates their preferred treatment goals. The aim of this secondary study was therefore to qualitatively and quantitatively document participant-generated treatment goals Methods Participants were currently or formerly chronically homeless individuals (N = 31) with alcohol dependence who participated in a pilot of extended-release naltrexone and harm-reduction counseling. Throughout the treatment period, study interventionists elicited participants' goals and recorded them on an open-ended grid. In subsequent weeks, progress towards and achievement of goals was obtained via self-report and recorded by study interventionists. Conventional content analysis was performed to classify participant-generated treatment goals Results Representation of the three top categories remained stable over the course of treatment. In the order of their frequency, they included drinking-related goals, quality-of-life goals and health-related goals. Within the category of drinking-related goals, participants consistently endorsed reducing drinking and alcohol-related consequences ahead of abstinence-based goals. Quantitative analyses indicated participants generated an increasing number of goals over the course of treatment. Proportions of goals achieved and progressed towards kept pace with this increase Conclusions Findings confirmed hypotheses that chronically homeless people with alcohol dependence can independently generate and achieve treatment goals towards alcohol harm reduction and quality-of-life improvement.Keywords: Harm reduction; Goals; Alcohol dependence; Homelessness; Qualitative analysis

27. Social and recovery capital amongst homeless hostel residents who use drugs and alcoholJoanne Neale, Caral StevensonInternational Journal of Drug Policy 2015:26(5);475-483 AbstractBackground Homeless people who use drugs and alcohol have been described as one of the most marginalised groups in society. In this paper, we explore the relationships of homeless drug and alcohol users who live in hostels in order to ascertain the nature and extent of their social and recovery capital. Methods Data were collected during 2013 and 2014 from three hostels. Each hostel was in a different English city and varied in size and organisational structure. Semi-structured interviews were conducted with 30 residents (21 men; 9 women) who self-reported current drink and/or drug problems. Follow-up interviews were completed

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after 4–6 weeks with 22 residents (16 men; 6 women). Audio recordings of all interviews were transcribed verbatim, systematically coded and analysed using Framework. Results Participants’ main relationships involved family members, professionals, other hostel residents, friends outside of hostels, current and former partners, and enemies. Social networks were relatively small, but based on diverse forms of, often reciprocal, practical and emotional support, encompassing protection, companionship, and love. The extent to which participants’ contacts provided a stable source of social capital over time was, nonetheless, uncertain. Hostel residents who used drugs and alcohol welcomed and valued interaction with, and assistance from, hostel staff; women appeared to have larger social networks than men; and hostels varied in the level of enmity between residents and antipathy towards staff.Conclusion Homeless hostel residents who use drugs and alcohol have various opportunities for building social capital that can in turn foster recovery capital. Therapies that focus on promoting positive social networks amongst people experiencing addiction seem to offer a valuable way of working with homeless hostel residents who use drugs and alcohol. Gains are, however, likely to be maximised where hostel management and staff are supportive of, and actively engage with, therapy delivery.Keywords: Homelessness; Drug and alcohol; Qualitative research; Social capital; Recovery capital; Social networks; England

28. A Randomized Control Trial of a Chronic Care Intervention for Homeless Women With Alcohol Use ProblemsCarole Upshur, Linda Weinreb, Monica Bharel, George Reedc, Christine FrisardJournal of Substance Abuse Treatment 2015:51;19-29 AbstractA clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n = 82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a primary care provider (PCP) brief intervention, referral to addiction services, and on-going support from a care manager (CM) for 6 months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3 months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest that screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems.Keywords: Alcohol abuse; Homeless women; Chronic care model; Primary care; Randomized trial

29. A Comparison of Three Interventions for Homeless Youth Evidencing Substance Use Disorders: Results of a Randomized Clinical TrialNatasha Slesnick, Xiamei Guo, Brittany Brakenhoff, Denitza BantchevskaJournal of Substance Abuse Treatment 2015:54;1-13 AbstractWhile research on homeless adolescents and young adults evidencing substance use disorder is increasing, there is a dearth of information regarding effective interventions, and more research is needed to guide those who serve this population. The current study builds upon

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prior research showing promising findings of the community reinforcement approach (CRA) (Slesnick, Prestopnik, Meyers, & Glassman, 2007). Homeless adolescents and young adults between the ages of 14 to 20 years were randomized to one of three theoretically distinct interventions: (1) CRA (n = 93), (2) motivational enhancement therapy (MET, n = 86), or (3) case management (CM, n = 91). The relative effectiveness of these interventions was evaluated at 3, 6, and 12 months post-baseline. Findings indicated that substance use and associated problems were significantly reduced in all three interventions across time. Several moderating effects were found, especially for sex and history of childhood abuse. Findings show little evidence of superiority or inferiority of the three interventions and suggest that drop-in centers have choices for addressing the range of problems that these adolescents and young adults face.Keywords: Homeless adolescents and young adults; Substance use disorders; Treatment outcomes

30. Safer-Drinking Strategies Used by Chronically Homeless Individuals with Alcohol DependenceVéronique S. Grazioli, Jennifer Hicks , Greta Kaese, , James Lenert , Susan E. CollinsJournal of Substance Abuse Treatment 2015:54;63-68 AbstractChronically homeless individuals with alcohol dependence experience severe alcohol-related consequences. It is therefore important to identify factors that might be associated with reduced alcohol-related harm, such as the use of safer-drinking strategies. Whereas effectiveness of safer-drinking strategies has been well-documented among young adults, no studies have explored this topic among more severely affected populations, such as chronically homeless individuals with alcohol dependence. The aims of this study were thus to qualitatively and quantitatively document safer-drinking strategies used in this population. Participants (N = 31) were currently or formerly chronically homeless individuals with alcohol dependence participating in a pilot study of extended-release naltrexone and harm-reduction counseling. At weeks 0 and 8, research staff provided a list of safer-drinking strategies for participants to endorse. Implementation of endorsed safer-drinking strategies was recorded at the next appointment. At both time points, strategies to buffer the effects of alcohol on the body (e.g., eating prior to and during drinking) were most highly endorsed, followed by changing the manner in which one drinks (e.g., spacing drinks), and reducing alcohol consumption. Quantitative analyses indicated that all participants endorsed safer-drinking strategies, and nearly all strategies were implemented (80–90% at weeks 0 and 8, respectively). These preliminary findings indicate that chronically homeless people with alcohol dependence use strategies to reduce harm associated with their drinking. Larger randomized controlled trials are needed to test whether interventions that teach safer-drinking strategies may reduce overall alcohol-related harm in this population.Keywords: Safer-drinking strategies; Alcohol dependence; Homelessness; Harm reduction

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INJECTING BEHAVIOUR

31. Gender differences in planning ability and hepatitis C virus among people who inject drugsJ.D. Scheidell , M.R. Khan, L.M. Clifford, E.M. Dunne, L.D. Keen II, W.W. LatimerAddictive Behaviors 2015:47;33-37 AbstractHepatitis C virus (HCV) is primarily spread through risky injection practices, including sharing needles, cookers, cottons, rinse water, and the practice of backloading. An important aspect of harm reduction for people who inject drugs (PWID) is to identify factors that contribute to safer injection. Planning ability may influence risky injection practices and gender differences in factors that drive injection practices indicate a need to examine associations between planning and injection behaviors in men versus women. Data from the NEURO-HIV Epidemiologic Study was restricted to those who had ever injected in their lifetime (n = 456). Impaired planning ability was assessed with the Tower of London and defined as a standardized total excess move score below the 10th percentile. We used logistic regression to estimate the gender-specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between impaired planning, each injection practice, and biologically-confirmed HCV. Impaired planning ability was associated with sharing needles (AOR = 2.93, 95% CI: 1.33, 6.47), cookers (AOR = 3.13, 95% CI: 1.22, 8.02), cottons (AOR = 2.89, 95% CI: 1.23, 6.78), rinse water (AOR = 2.43, 95% CI: 1.15, 5.14), and backloading (AOR = 2.68, 95% CI: 1.26, 5.70) and HCV (AOR = 3.42, 95% CI: 1.03, 11.38) among men. Planning ability was not significantly associated with the injection behaviors or HCV among women, suggesting that other factors likely contribute to risky injection practices. Interventions to promote harm reduction among PWID should ascertain and strengthen planning ability. Women may have additional barriers to practicing safe injection beyond impaired planning abilities, which should also be addressed.Keywords: Injection drug use; Hepatitis C virus; Gender differences

32. Factors associated with being asked to initiate someone into injection drug useRicky N. Bluthenthal, Lynn Wenger, Daniel Chu, Jennifer Lorvick, Brendan Quinn, James P. Thing, Alex H. KralDrug and Alcohol Dependence 2015:149;252-258 AbstractAims Injection drug use initiation typically involves an established person who injects drugs (PWID) helping the injection-naïve person to inject. Prior to initiation, PWID may be involved in behaviors that elevate injection initiation risk for non-injectors such as describing how to inject and injecting in front of injection-naïve people. In this analysis, we examine whether PWID who engage in either of these behaviors are more likely to be asked to initiate someone into drug injection. Methods Interviews with PWID (N = 602) were conducted in California between 2011 and 2013. Multivariate analysis was conducted to determine factors associated with being asked to initiate someone. Results The sample was diverse in terms of age, race/ethnicity, and drug use patterns. Seventy-one percent of the sample had ever been asked to initiate someone. Being asked to initiate someone was associated with having injected in front of non-injectors (Adjusted Odds Ratio [AOR] = 1.80, 95% Confidence Interval [CI] = 1.12, 2.91), having described injection to non-injectors (AOR = 3.63; 95% CI = 2.07, 6.36), and doing both (AOR = 9.56; 95% CI = 4.43, 20.65) as compared to doing

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neither behavior (referent). Being female (AOR = 1.73; 95% CI = 1.10, 2.73) and non-injection prescription drug misuse in the last 30 days (AOR = 1.69; 95% CI = 1.12, 2.53) were also associated with having been asked to initiate someone. Conclusion Reducing initiation into injection drug use is an important public health goal. Intervention development to prevent injection initiation should include established PWID and focus on reducing behaviors associated with requests to initiate injection and reinforcing refusal skills and intentions among established PWID.Keywords: Injection initiation; Request to initiate; PWID; Social learning theory; Observational epidemiology

33. Peering into the literature: A systematic review of the roles of people who inject drugs in harm reduction initiativesZ. Marshall, M.K. Dechman, A. Minichiello, L. Alcock, G.E. HarrisDrug and Alcohol Dependence 2015:151;1-14

AbstractBackground People who inject drugs have been central to the development of harm reduction initiatives. Referred to as peer workers, peer helpers, or natural helpers, people with lived experience of drug use leverage their personal knowledge and skills to deliver harm reduction services. Addressing a gap in the literature, this systematic review focuses on the roles of people who inject drugs in harm reduction initiatives, how programs are organized, and obstacles and facilitators to engaging people with lived experience in harm reduction programs, in order to inform practice and future research. Methods This systematic review included searches for both peer reviewed and gray literature. All titles and abstracts were screened by two reviewers. A structured data extraction tool was developed and utilized to systematically code information concerning peer roles and participation, program characteristics, obstacles, and facilitators. Results On the basis of specific inclusion criteria 164 documents were selected, with 127 peer-reviewed and 37 gray literature references. Data extraction identified key harm reduction program characteristics and forms of participation including 36 peer roles grouped into five categories, as well as obstacles and facilitators at systemic, organizational, and individual levels. Conclusions Research on harm reduction programs that involve people with lived experience can help us better understand these approaches and demonstrate their value. Current evidence provides good descriptive content but the field lacks agreed-upon approaches to documenting the ways peer workers contribute to harm reduction initiatives. Implications and ten strategies to better support peer involvement in harm reduction programs are identified.Keywords: Systematic review; Injection drug use; Peer worker; Participation; Harm reduction; HIV

34. Factors affecting repeated cessations of injecting drug use and relapses during the entire injecting career among the Edinburgh Addiction CohortYang Xia, Shaun Seaman, Matthew Hickman , John Macleod, Roy Robertson, Lorraine Copeland, Jim McKenzie, Daniela De AngelisDrug and Alcohol Dependence 2015:151;76-83 AbstractBackground and aims Injecting drug use is a chronic condition, with people who inject drugs (PWID) typically experiencing repeated cessations and relapses during their injection

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careers. We characterize patterns of ceasing and relapsing and the impact of opiate substitution treatment (OST) during the entire injecting careers of PWID in the Edinburgh Addiction Cohort (EAC). Methods During 2005–2007, 432 surviving participants of the EAC were interviewed about their injecting histories. Adjusted associations between covariates and hazards of cessation and relapse were estimated using random-effects models.Results OST was strongly associated with a higher hazard of cessation (HR = 1.71, P < 0.001), but there was no significant evidence of association with hazard of relapse (HR = 0.81, P = 0.14). Women and older PWID were less likely to relapse (HR = 0.73, P = 0.02 and HR = 0.55, P < 0.001, respectively). Hazards of both cessation and relapse decreased monotonically with time since last relapse/cessation (both P < 0.001). An individual's hazard of cessation increased with his/her number of previous cessations (HR = 3.58 for 10+ previous cessations, P < 0.001), but there was no evidence that an individual's hazard of relapse changed with number of previous relapses (P = 0.37). There was heterogeneity in the individual hazards of both cessation and relapse.Conclusions OST was associated with reduced time to cessation, and there was some suggestion of increased time to relapse too. The likelihood of prolonged cessation is greater for women, increases with age, and decreases with time since last relapse.Keywords: Heroin addiction; Opiate substitution treatment; Random effects model; Recurrent events; Cessation; Relapse

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INJECTING DRUG USE

35. Women’s injection drug practices in their own words: a qualitative studyEllen Tuchman Harm Reduction Journal 2015:12;6 AbstractBackground There are significant gender differences in injection drug practices and relative risks involved for women who inject drug compared with men. This qualitative study aims to explore the social, contextual, and behavioral dimensions of injecting practices among women who inject drugs. Methods Participants were selected by purposive venue-based sampling from a syringe exchange program in 2012–2013. In-depth interviews were conducted with 26 women to elicit detailed perspectives regarding injection drug use practices and women-focused decision-making. All interviews were transcribed verbatim and analyzed with Atlas.ti. Results Participant’s mean age was 43.2 years, 48% Caucasian, 36% African American, and 16% Latina, poorly educated, mostly single, and heroin self-injectors. Three themes emerged; a) transitioning from non-injection to injection drug use; b) patterns and variations of initiation to injecting; and c) shifting toward autonomy or reliance on others. Women were predominantly influenced to transition to injection drug use by other women with their claims that injecting was a way to curtail their daily drug expenditure. More than half the women received their first injection from another woman in their social network rather than a male sexual partner. Self-injecting women exhibited agency around the circumstances of injection safety and potential risks. Other women revealed that their inability to inject themselves could and did make them dependent on others for unsafe injection practices. Conclusions The finding that many women were influenced to transition to injection drug use and receive the first injection from a woman is contrary to literature claims that male sexual partners introduce and initiate women to injection drug use. Self-injecting women possessed capacity to act in a way that produced the results they wanted, not sharing prepared drugs or injecting equipment. In stark contrast, women assisted with injections could and did make them vulnerable to unsafe injecting. Findings support early prevention strategies that discourage women’s transition from non-injection to injection and development of female peer-driven experiential interventions to dispel myths for non-injection women and to increase personal capability to self-inject for women who require assistance with injecting, to reduce injection-related harm. Keywords: Injection drug practices; Initiation; Self-injection; Women; Harm reduction; Syringe exchange; Gender differences; Qualitative

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36. How far will they go?: assessing the travel distance of current and former drug users to access harm reduction servicesSean Allen, Monica Ruiz and Allison O’Rourke Harm Reduction Journal 2015:12;3

AbstractBackground Prior research has explored spatial access to syringe exchange programs (SEPs) among people who inject drugs (PWID), but little is known about service utilization by former PWID who continue to access services (e.g., HIV screenings and referrals for social services) at harm reduction providers. The purpose of this research is to examine differences in access to SEPs between current and former PWID seeking services at a mobile SEP in Washington, DC. Findings A geometric point distance estimation technique was applied to data collected as part of a PWID population estimation study that took place in Washington, DC, in March and April 2014. We calculated the walking distance from the centroid point of home residence zip code to the mobile exchange site where PWID presented for services. An independent samples t-test was used to examine differences in walking distance measures between current and former PWID. Differences in mean walking distance were statistically significant with current and former PWID having mean walking distances of 2.75 and 1.80 miles, respectively. Conclusions The results of this study suggest that former PWID who are engaging with SEPs primarily for non-needle exchange services (e.g., medical or social services) may have decreased access to SEPs than their counterparts who are active injectors. This research provides support for expanding SEP operations such that both active and former PWID have increased access to harm reduction providers and associated health and social services. Increasing service accessibility may help resolve unmet needs among current and former PWID. Keywords: Syringe exchange programs; Access; People who inject drugs; Harm reduction

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METHADONE MAINTENANCE TREATMENT

37. Effectiveness of Rapid Intake into Methadone Treatment: A Natural Experiment in IsraelLawental MEuropean Addiction Research 2015:21(4);211-216

AbstractThe effect of intake procedures on treatment entry and retention was examined in a natural experiment, in which a methadone maintenance clinic in Israel admitted 127 clients by employing a rapid intake procedure (maximum of 3 days before the initiation of treatment was offered). Using information gathered from patient files, these clients were retrospectively compared to a control group (n = 121) who underwent the clinic's regular intake procedure (between 3 weeks and 3 months). Outcome measures included entry into treatment and subsequent retention in treatment (at 3, 6 and 12 months). Results show that 81% of clients from the rapid intake group entered treatment compared to only 57% from the regular intake group. Treatment retention was similar for both groups. In addition, Jewish clients were more likely to enter treatment via the rapid intake procedure than clients from other religions, and women were retained in treatment longer than men, regardless of the type of intake procedure. Results of this single-site study lend support to the effectiveness of rapid intake procedures as a way to engage clients in treatment and carry significant implications for improving access into treatment.Keywords: Methadone maintenance treatment; Rapid intake; Retention rates

38. Increases in Body Mass Index Following Initiation of Methadone TreatmentJennifer M. Fenn, Jennifer S. Laurent, Stacey C. SigmonJournal of Substance Abuse Treatment 2015:51;59-63 AbstractDespite the clear efficacy of methadone for opioid dependence, one less desirable phenomenon associated with methadone may be weight gain. We examined changes in body mass index (BMI) among patients entering methadone treatment. A retrospective chart review was conducted for 96 patients enrolled in an outpatient methadone clinic for ≥ 6 months. The primary outcome of BMI was assessed at intake and a subsequent physical examination approximately 1.8 ± 0.95 years later. Demographic, drug use and treatment characteristics were also examined. There was a significant increase in BMI following intake (p < 0.001). Mean BMIs increased from 27.2 ± 6.8 to 30.1 ± 7.7 kg/m2, translating to a 17.8-pound increase (10% increase in body weight) in the overall patient sample. Gender was the strongest predictor of BMI changes (p < 0.001), with significantly greater BMI increases in females than males (5.2 vs. 1.7 kg/m2, respectively). This translates to a 28-pound (17.5%) increase in females vs. a 12-pound (6.4%) increase in males. In summary, methadone treatment enrollment was associated with clinically significant weight gain, particularly among female patients. This study highlights the importance of efforts to help patients mitigate weight gain during treatment, particularly considering the significant health and economic consequences of obesity for individuals and society more generally.Keywords: Methadone; BMI; Weight gain; Opioid addiction; Opioid treatment

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39. A Satisfaction Survey of Opioid-Dependent Patients with Methadone Maintenance TreatmentZoriah Aziz , Nyuk Jet ChongJournal of Substance Abuse Treatment 2015:53;47-51 AbstractThe aim of this study was to examine opioid-dependent patients' satisfaction with the methadone maintenance treatment (MMT) program in Malaysia and identify predictors of satisfaction. We used an interviewer-administered questionnaire developed and validated by Rankin Court, New South Wales, Australia. Of 502 patients approached in 11 MMT centers in Malaysia, 425 agreed to participate giving a response rate of 85%. In terms of overall satisfaction, a high percentage of respondents (85%) were satisfied with the MMT services. A logistic regression analysis showed that only “centres” and marital status were associated with overall satisfaction and that being single (OR 3.31; 95% CI 1.52 to 7.20) or married (OR 4.06; 95% CI 1.76 to 9.38) was associated with higher odds of overall satisfaction compared to being divorced or separated. An analysis of the responses pertaining to the most desired changes required at the center found dosing hours, waiting area and staff shortages to be common. The findings acquired from this survey will be useful to attain a clearer perspective on what aspects of the MMT service need to be reviewed for the improvement of service delivery.Abbreviations: CSQ-8, Client Satisfaction Questionnaire; MMT, Methadone Maintenance Treatment; SSS-30, Service Satisfaction Scale; VSSS-32, Verona Service Satisfaction Scale; VSSS-MT, Verona Service Satisfaction Scale for methadone-treated opioid-dependent patientsKeywords: Opioid dependency; Methadone maintenance treatment services; Satisfaction; Predictors

40. Longitudinal analysis of pain and illicit drug use behaviors in outpatients on methadone maintenanceLara Dhingra, David C. Perlman, Carmen Masson, Jack Chen, Courtney McKnight, Ashly E. Jordan, Thomas Wasser, Russell K. Portenoy, Martin D. CheatleDrug and Alcohol Dependence 2015:149;285-289

AbstractBackground Little is known about the experience of chronic pain and the occurrence of illicit drug use behaviors in the population enrolled in methadone maintenance treatment (MMT) programs. Methods This is a secondary analysis of longitudinal data from two MMT samples enrolled in a randomized controlled trial of hepatitis care coordination. Patients completed pain, illicit drug use, and other questionnaires at baseline and 3, 9, and 12 months later. Associations were sought over time between the presence or absence of clinically significant pain (average daily pain ≥4 or mean pain interference ≥4 during the past week) and current illicit drug use (i.e., non-therapeutic opioid, cocaine or amphetamine use identified from self-report or urine drug screening). Results Of 404 patients providing complete data, within-patient variability in pain and illicit drug use was high across the four assessment periods. While 263 denied pain at baseline, 118 (44.9%) later experienced clinically significant pain during ≥1 follow-up assessments. Of 180 patients (44.6%) without evidence of illicit drug use at baseline, only 109 (27.0%) had similar negative drug use at all follow-up assessments. Across four assessment periods, there was no significant association between pain group status and current illicit drug use. Conclusions This one-year

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longitudinal analysis did not identify a significant association between pain and illicit drug use in MMT populations. This finding conflicts with some earlier investigations and underscores the need for additional studies to clarify the complex association between pain and substance use disorders in patients in MMT program settings.Keywords: Pain; Methadone maintenance; Addiction; Illicit drug use; Pain management

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MISCELLANEOUS

41. Drug analysis of residual content of used syringes: A new approach for improving knowledge of injected drugs and drug user practicesThomas Néfau , Eloïse Charpentier, Nora Elyasmino, Catherine Duplessy-Garson, Yves Levi, Sara KarolakInternational Journal of Drug Policy 2015:26(4);412-419 AbstractBackground Since their inception, harm reduction services, including needle exchange programs, have aimed to improve and update knowledge about illicit drug consumption and injection practices in order to assess and regularly revise the effectiveness of preventive strategies. Methods In this paper we describe the development of a scientific approach to obtaining this type of information through analysis of the residual content of used syringes. This was done using a validated liquid chromatography method with mass spectrometry detection to identify different molecules. Used syringes were collected from automatic injection kit dispensers at 17 sites in Paris and the surrounding suburbs each month for one year. Results In total, 3489 syringes were collected. No compounds were detected in 245 syringes. Heroin was the most commonly observed compound (42%), followed by cocaine (41%), buprenorphine (29%) and 4-methylethylcathinone (23%). These analyses also showed the increased appearance of 4-methylethylcathinone between the summer and winter of 2012. Conclusions Despite the bias involved in this approach, the method can provide rapid data on patterns of drug consumption for specific time periods and for well-defined locations. This kind of analysis enables the detection of new substances being injected and thus enables harm reduction services to revise and adapt prevention strategies.Keywords: Injection drug users; Used syringes analysis; HPLC; Mass spectrometry; Drug consumption

42. Sex work amongst people who inject drugs in England, Wales and Northern Ireland: Findings from a National Survey of Health Harms and BehavioursSara Croxford, Lucy Platt, Vivian D. Hope, Katelyn J. Cullen, John V. Parry, Fortune NcubeInternational Journal of Drug Policy 2015:26(4);429-433 No abstract available

43. Clinical Relevance of As-Needed Treatment with Nalmefene in Alcohol-Dependent PatientsAubin H. J, Reimer J, Nutt D.J, Bladström A, Torup L, François C, Chick JEuropean Addiction Research 2015:21(3);160-168

AbstractNalmefene is the first drug approved for reduction of alcohol consumption. The aim of this study was to evaluate the clinical relevance of treatment with nalmefene in alcohol-dependent patients with a high drinking risk level from two randomised placebo-controlled 6-month studies (NCT00811720 and NCT00812461). Response criteria were based on alcohol consumption, Clinical Global Impression, and Short Form Health Survey mental component summary scores at month 6, analysed using logistic regression. The proportion of responders was higher in the nalmefene group than in the

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placebo group with odds ratios significantly in favour of nalmefene for all responder criteria; numbers-needed-to-treat ranged from 6 to 10. Significant differences from placebo in clinician-rated and patient-reported outcomes, and liver enzymes further supported the clinical relevance of the treatment effect. In conclusion, this study supports the clinical relevance of nalmefene treatment in patients with alcohol dependence. Nalmefene may help to reduce the alcohol-related burden and the large treatment gap, with currently less than 10% of alcohol-dependent patients in Europe receiving treatment.Keywords: Alcohol dependence; Harm reduction; Nalmefene; Opioid antagonist; Clinical relevance

44. Questioning “Fluffy”: A Dog's Eye View of Animal-Assisted Interventions (AAI) in the Treatment of Substance MisuseAnne-Belle, Colleen Anne DellSubstance Use & Misuse March 2015:Early Online;1–5

No abstract available

45. The Role of Expectation in the Therapeutic Outcomes of Alcohol and Drug Addiction TreatmentsPrimavera A. Spagnolo , Luana Colloca , Markus Heilig Alcohol and Alcoholism 2015:50(3);282-285

AbstractThroughout history, patient–physician relationships have been acknowledged as an important component of the therapeutic effects of any pharmacological treatment. Here, we discuss the role of physicians’ expectations in influencing the therapeutic outcomes of alcohol and drug addiction pharmacological treatments. As largely demonstrated, such expectations and attitudes may contribute to produce placebo and nocebo effects that in turn affect the course of the disease and the response to the therapy. This article is aimed at discussing the current insights into expectations, placebo and nocebo mechanisms and their impact on the therapeutic outcomes of alcohol and drug addiction treatments; with the goal of informing physicians and other health care providers about the potentially widespread implications for clinical practice and for a successful treatment regimen.

46. Testosterone suppression in opioid users: A systematic review and meta-analysisMonica Bawor, Herman Bami, Brittany B. Dennis, Carolyn Plater, Andrew Worster, Michael Varenbut, Jeff Daiter, David C. Marsh, Meir Steiner, Rebecca Anglin, Margaret Coote, Guillaume Pare, Lehana Thabane, Zainab SamaanDrug and Alcohol Dependence 2015:149;1-9

AbstractBackground Whether used for pain management or recreation, opioids have a number of adverse effects including hormonal imbalances. These imbalances have been reported to primarily involve testosterone and affect both males and females to the point of interfering with successful treatment and recovery. We conducted a systematic review and meta-analysis to determine the extent that opioids affect testosterone levels in both men and women, which

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may be relevant to improved treatment outcomes for opioid dependence and for pain management. Methods We searched PubMed, EMBASE, PsycINFO, and CINAHL for relevant articles and included studies that examined testosterone levels in men and women while on opioids. Data collection was completed in duplicate. Results Seventeen studies with 2769 participants (800 opioid users and 1969 controls) fulfilled the review inclusion criteria; 10 studies were cross-sectional and seven were cohort studies. Results showed a significant difference in mean testosterone level in men with opioid use compared to controls (MD = −164.78; 95% CI: −245.47, −84.08; p < 0.0001). Methadone did not affect testosterone differently than other opioids. Testosterone levels in women were not affected by opioids. Generalizability of results was limited due to high heterogeneity among studies and overall low quality of evidence. Conclusions Our findings demonstrated that testosterone level is suppressed in men with regular opioid use regardless of opioid type. We found that opioids affect testosterone levels differently in men than women. This suggests that opioids, including methadone, may have different endocrine disruption mechanisms in men and women, which should be considered when treating opioid dependence.Keywords: Testosterone; Sex hormones; Opiates; Prescription opioids; Methadone

47. Utilizing mHealth methods to identify patterns of high risk illicit drug useBeth S. Linas, Carl Latkin, Andrew Genz, Ryan P. Westergaard, Larry W. Chang, Robert C. Bollinger, Gregory D. KirkDrug and Alcohol Dependence 2015:151;250-257

AbstractIntroduction We assessed patterns of illicit drug use using mobile health (mHealth) methods and subsequent health care indicators among drug users in Baltimore, MD.Methods Participants of the EXposure Assessment in Current Time (EXACT) study were provided a mobile device for assessment of their daily drug use (heroin, cocaine or both), mood and social context for 30 days from November 2008 through May 2013. Real-time, self-reported drug use events were summed for individuals by day. Drug use risk was assessed through growth mixture modeling. Latent class regression examined the association of mHealth-defined risk groups with indicators of healthcare access and utilization.Results 109 participants were a median of 48.5 years old, 90% African American, 52% male and 59% HIV-infected. Growth mixture modeling identified three distinct classes: low intensity drug use (25%), moderate intensity drug use (65%) and high intensity drug use (10%). Compared to low intensity drug users, high intensity users were younger, injected greater than once per day, and shared needles. At the subsequent study visit, high intensity drug users were nine times less likely to be medically insured (adjusted OR: 0.10, 95%CI: 0.01–0.88) and at greater risk for failing to attend any outpatient appointments (aOR: 0.13, 95%CI: 0.02–0.85) relative to low intensity drug users. Conclusions Real-time assessment of drug use and novel methods of describing sub-classes of drug users uncovered individuals with higher-risk behavior who were poorly utilizing healthcare services. mHealth holds promise for identifying individuals engaging in high-risk behaviors and delivering real-time interventions to improve care outcomes.Keywords: mHealth; Ecological Momentary Assessment; Illicit drug use; HIV; Growth mixture models

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NEW PSYCHOACTIVE SUBSTANCES

48. Mortality related to novel psychoactive substances in Scotland, 2012: An exploratory studyAndrew McAuley, Garry Hecht, Lee Barnsdale, Catherine S. Thomson, Lesley Graham, Saket Priyadarshi, J. Roy RobertsonInternational Journal of Drug Policy 2015:26(5);461-467 AbstractBackground The growth of novel psychoactive substances (NPS) over the last decade, both in terms of availability and consumption, is of increasing public health concern. Despite recent increases in related mortality, the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level remain relatively unknown. Methods The Scottish National Drug Related Death Database (NDRDD) collects a wide-range of data relating to the nature and circumstances of individuals who have died a drug-related death (DRD). We conducted exploratory descriptive analysis of DRDs involving NPS recorded by the NDRDD in 2012. Statistical testing of differences between sub-groups was also conducted where appropriate. Results In 2012, we found 36 DRDs in Scotland to have NPS recorded within post-mortem toxicology. However, in only 23 of these cases were NPS deemed by the reporting pathologist to be implicated in the actual cause of death. The majority of NPS-implicated DRDs involved Benzodiazepine-type drugs (13), mainly Phenazepam (12). The remaining 10 NPS-implicated deaths featured a range of different Stimulant-type drugs. The majority of these NPS-implicated deaths involved males and consumption of more than one drug was recorded by toxicology in all except one case.NPS-implicated deaths involving Benzodiazepine-type NPS drugs appeared to involve older individuals known to be using drugs for a considerable period of time, many of whom had been in prison at some point in their lives. They also typically involved combinations of opioids and benzodiazepines; no stimulant drugs were co-implicated. Deaths where stimulant-type NPS drugs were implicated appeared to be a younger group in comparison, all consuming two or more Stimulant-type drugs in combination. Conclusion This exploratory study provides an important insight into the circumstances surrounding and characteristics of individuals involved in NPS deaths at a population level. It identifies important issues for policy and practice, not least the prominent role of unlicensed benzodiazepines in drug-related mortality, but also the need for a range of harm reduction strategies to prevent future deaths.Keywords: Novel psychoactive substances; Drugs; Mortality; Overdose

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OPIATE RECOVERY TREATMENT

49. Gender-Specific Predictors of Retention and Opioid Abstinence During Methadone Maintenance TreatmentAmanda R. Levine, Leslie H. Lundahl, David M. Ledgerwood, Michael Lisieski, Gary L. Rhodes, Mark K. GreenwaldJournal of Substance Abuse Treatment 2015:54;37-43 AbstractAims Retention in methadone maintenance treatment (MMT) for 1 year is associated with positive outcomes including opioid abstinence, however, most studies have not investigated gender differences. We hypothesized that predictors of retention and opioid abstinence would differ between men and women, and aimed to determine which factors best predict retention and abstinence for each gender. Methods Data were available for 290 patients (173 M, 117 F) admitted to outpatient MMT. Regression analyses, stratified by gender, were conducted to identify unique predictors of MMT retention (< 1 vs. > 1 year) and opioid abstinence rate (proportion of opioid-free urine samples up to 1 year retention).Results Gender did not significantly predict treatment retention (mean = 231 days, 39% retained > 1 year) or opioid abstinence (49% overall). For males, significant predictors of > 1-year retention were urine samples negative for opioids (odds ratio [OR] = 6.67) and cannabinoids (OR = 5.00) during the first month, and not cocaine dependent (OR = 2.70). Significant predictors of higher long-term opioid abstinence were first-month urine samples negative for opioids and cocaine metabolites. For females, significant predictors of > 1-year retention were first-month urine samples negative for cocaine metabolites (OR = 4.00) and cannabinoids (OR = 9.26), and no history of sexual victimization (OR = 3.03). The only significant predictor of higher opioid abstinence rate was first-month opioid-free urine samples. Conclusions These findings indicate gender-specific predictors of MMT retention and opioid abstinence. Future studies on MMT outcomes should examine each gender separately, and consider unique pathways by which females and males adhere to, and benefit from MMT.Keywords: Gender; Methadone maintenance; Treatment; Retention; Abstinence; Predictors

50. Determining Smoking Cessation Related Information, Motivation, and Behavioral Skills among Opiate Dependent Smokers in Methadone TreatmentNina A. Cooperman, Kimber P. Richter, Steven L. Bernstein, Marc L. Steinberg, Jill M. WilliamsSubstance Use & Misuse 2015:50(5);566-581

Abstract Background  Over 80% of people in methadone treatment smoke cigarettes, and existing smoking cessation interventions have been minimally effective. Objective: To develop an Information-Motivation-Behavioral Skills (IMB) Model of behavior change based smoking cessation intervention for methadone maintained smokers, we examined smoking cessation related IMB factors in this population. Methods  Current or former smokers in methadone treatment (n = 35) participated in focus groups. Ten methadone clinic counselors participated in an individual interview. A content analysis was conducted using deductive and inductive approaches. Results  Commonly known IMB factors related to smoking cessation were described. These factors included: the health effects of smoking and treatment options for quitting (information); pregnancy and cost of cigarettes (motivators); and coping with

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emotions, finding social support, and pharmacotherapy adherence (behavioral skills). IMB factors specific to methadone maintained smokers were also described. These factors included: the relationship between quitting smoking and drug relapse (information), the belief that smoking is the same as using drugs (motivator); and coping with methadone clinic culture and applying skills used to quit drugs to quitting smoking (behavioral skills). IMB strengths and deficits varied by individual. Conclusions  Methadone maintained smokers could benefit from research on an IMB Model based smoking cessation intervention that is individualized, addresses IMB factors common among all smokers, and also addresses IMB factors unique to this population.Keywords: methadone, smoking cessation, opiate, cigarette, Information-Motivation-Behavioral Skills Model

51. Effects of methadone plus alcohol on cognitive performance in methadone-maintained volunteersBethea A. Kleykamp, Ryan G. Vandrey, George E. Bigelow, Eric C. Strain, Miriam Z. MintzerThe American Journal of Drug and Alcohol Abuse 2015:41(3);251–256

AbstractBackground Methadone maintenance patients (MMP) often abuse other drugs, including alcohol. The combined use of methadone and alcohol could impair performance and daily functioning. Objective: To examine the effects of methadone in combination with alcohol, as well as acute increases in methadone, on performance outcomes. Methods This double-blind, double-dummy, crossover study included eight opioid-dependent participants stabilized on methadone. Participants completed six inpatient sessions corresponding to methadone (100% or 150% of daily dose) and beverage (placebo, 0.25 or 0.50 g/kg alcohol). Performance tasks were completed before and after drug administration. Area under the time-course values were analyzed by a 2 (methadone dose) by 3 (alcohol dose) repeated measures analysis of variance. Results Main effects of methadone were observed for two attention outcomes, suggesting reduced accuracy and slowed responding at an elevated methadone dose. In addition, main effects of alcohol were observed for episodic memory (false alarms and response bias) suggesting more impulsive responding as alcohol dose increased. No robust interactions of methadone and alcohol were observed for any outcome. Conclusions Study findings indicate that an acute increase in methadone (150%) and a moderate dose of alcohol (2–3 drinks) can impair distinct aspects of performance, although no significant interactive effect between methadone and alcohol was found. Future studies with larger sample sizes, larger doses, and more clinically informative tasks could expand on the present findings and further explore the cognitive consequences of concurrent opioid and alcohol use.Keywords: Alcohol, attention, cognition, methadone, performance

51

OPIATE TREATMENT

52. Drug use, health and social outcomes of hard-to-treat heroin addicts receiving supervised injectable opiate treatment: secondary outcomes from the Randomized Injectable Opioid Treatment Trial (RIOTT)Nicola Metrebian, Teodora Groshkova, Jennifer Hellier, Vikki Charles, Anthea Martin, Luciana Forzisi, Nicholas Lintzeris, Deborah Zador, Hugh Williams, Tom Carnwath, Soraya Mayet, John StrangAddiction 2015:110(3);479-490

AbstractAims The Randomized Injectable Opioid Treatment Trial (RIOTT) compared supervised injectable heroin (SIH) and supervised injectable methadone (SIM) with optimized oral methadone (OOM) (ISRCTN0133807). Heroin addicts (previously unresponsive to treatment) made significant reductions in street heroin use at 6 months when treated with SIH. We now examine secondary outcomes. Design Multi-site randomized controlled trial (RCT) comparing SIH versus OOM and SIM versus OOM. Setting Three supervised injectable opiate clinics in England. Participants Chronic refractory heroin addicts continuing to inject street heroin virtually daily despite oral substitution treatment (n = 127), randomized to either SIH(n = 43), SIM(n = 42) or OOM(n = 42). All received high levels of medical and psychosocial support. Measurements Secondary outcomes: wider drug use, crime, health and social functioning at 6 months. Findings At 6 months, no significant differences were found between treatment groups in wider drug use (crack/cocaine, benzodiazepines, alcohol), physical and mental health (SF-36) or social functioning. Within each treatment group, significant reductions were observed in crime [SIH = odds ratio (OR) 0.05; P < 0.001; SIM = OR 0.11; P = 0.002; OOM = OR 0.11; P = 0.003] and money spent per week on illicit drugs (SIH = mean change £–289.43; P < 0.001; SIM = mean change £–183.41; P < 0.001; OOM = mean change £–162.80; P < 0.001), with SIH significantly more likely to have reduced money spent on illicit drugs versus OOM (mean difference £–92.04; P < 0.001). Significant improvements were seen in physical health for SIH and SIM (SIH = mean change 3.97; P = 0.008; SIM = mean change 4.73; P = 0.002) and mental health for OOM (mean change 6.04; P = 0.013). Conclusions Supervised injectable heroin treatment and supervised injectable methadone treatment showed no clearly identified benefit over optimized oral methadone in terms of wider drug use, crime, physical and mental health within a 6-month period, despite reducing street heroin use to a greater extent. However, all interventions were associated with improvements in these outcomes.Keywords: Addiction; diamorphine; heroin; injectable opiate treatment; methadone; opiates; substance misuse

53. A longitudinal comparison of retention in buprenorphine and methadone treatment for opioid dependence in New South Wales, AustraliaLucy Burns, Natasa Gisev, Sarah Larney, Timothy Dobbins, Amy Gibson, Jo Kimber, Briony Larance, Richard P. Mattick, Tony Butler, Louisa DegenhardtAddiction 2015:110(4);646-655

AbstractBackground and Aim To examine characteristics of first-time methadone and buprenorphine clients and factors associated with risk of leaving first treatment in New South Wales (NSW), Australia. Design Retrospective linkage study of opioid substitution therapy

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(OST) treatment, court, custody and mortality data. Setting NSW, Australia. Participants First-time OST entrants (August 2001–December 2010). Measurements Characteristics of clients were examined. Time-dependent Cox models examined factors associated with the risk of leaving first treatment, with demographic, criminographic and treatment variables jointly considered. Interactions between medication and other variables upon risk of leaving treatment were examined. Findings There were 15 600 treatment entrants: 7183 (46%) commenced buprenorphine, 8417 (54%) commenced methadone; the proportion entering buprenorphine increased over time. Those starting buprenorphine switched medications more frequently and had more subsequent treatment episodes. Buprenorphine retention was also poorer. On average, 44% spent 3+ months in treatment compared with 70% of those commencing methadone; however, buprenorphine retention for first-time entrants improved over time, whereas methadone retention did not. Multivariable Cox models indicated that in addition to sex, age, treatment setting and criminographic variables, the risk of leaving a first treatment episode was greater on any given day for those receiving buprenorphine, and was dependent on the year treatment was initiated. There was no interaction between any demographic variables and medication received, suggesting no clear evidence of any particular groups for whom each medication might be better suited in terms of improving retention. Conclusions Although retention rates for buprenorphine treatment have improved in New South Wales, Australia, individuals starting methadone treatment still show higher retention rates.Keywords: Buprenorphine; methadone; opioid dependence; opioid substitution treatment; treatment retention

54. Randomized controlled trial of motivational interviewing for reducing injection risk behaviours among people who inject drugsKarine Bertrand, Élise Roy, Éric Vaillancourt, Jill Vandermeerschen, Djamal Berbiche, Jean-François BoivinAddiction 2015:110(5);832-841

AbstractAim We tested the efficacy of a brief intervention based on motivational interviewing (MI) to reduce high-risk injection behaviours over a 6-month period among people who inject drugs (PWID). Design A single-site two-group parallel randomized controlled trial comparing MI with a brief educational intervention (EI). Setting A study office located in downtown Montréal, Canada, close to the community-based harm reduction programmes where PWID were recruited. Participants PWID who had shared drug injection equipment or shared drugs by backloading or frontloading in the month prior to recruitment were randomized to either the MI (112) or EI (109) groups. Intervention The MI aimed to (1) encourage PWID to voice their desires, needs and reasons to change behaviours; (2) boost motivation to change behaviours; and (3) when the person was ready, support the plan he or she chose to reduce injection risk behaviours. The EI consisted of an individual session about safe injection behaviours. Measurements The primary outcome was defined as having any of these risk behaviours at 6 months: having shared syringes, containers, filters or water to inject drugs in the previous month and backloading/frontloading; each behaviour was examined separately, as secondary outcomes. Findings The probability of reporting a risk injection behaviour decreased in both the MI and the EI groups. At 6-month follow-up, participants who reported any risk behaviours were 50% [odds ratio (OR) = 0.50; confidence interval (CI) = 0.13–0.87] less likely to be in the MI group than in the EI group as well as those who reported sharing containers (OR = 0.50; CI = 0.09–0.90). PWID who reported

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sharing equipment excluding syringes were 53% less likely to be in the MI group (OR = 0.47; CI = 0.11–0.84). Conclusions A brief motivational interviewing intervention was more effective than a brief educational intervention in reducing some high risk injecting behaviours up in the subsequent 6 months.Keywords: Drug injection; educational intervention; HIV prevention; injection risk behaviours; motivational interviewing; randomized controlled trial

55. Attentional bias and treatment adherence in substitute-prescribed opiate usersM. Charles, C.E. Wellington, C. Mokrysz, T.P. Freeman, D. O'Ryan, H.V. CurranAddictive Behaviors 2015:46;100-105 AbstractBackground Attentional bias (AB) is implicated in the development and maintenance of substance dependence and in treatment outcome. We assessed the effects of attentional bias modification (ABM), and the relationship between AB and treatment adherence in opiate dependent patients. Method An independent groups design was used to compare 23 opiate dependent patients with 21 healthy controls. Participants completed an AB task before either a control or an ABM task designed to train attention away from substance-related stimuli. Pre- and post-ABM AB and craving were assessed to determine any changes. Relationships between treatment adherence (‘using on top’ of prescribed opiates or not) and AB, craving and psychopathology were also examined. Results There was no baseline difference in AB between patients and controls, and no significant effect of ABM on AB or substance craving. However, treatment adherent patients who did not use illicit opiates on top of their prescribed opiates had statistically significantly greater AB away from substance-related stimuli than both participants using on top and controls, and reported significantly lower levels of craving than non-treatment adherent patients. Conclusion Whilst we did not find any significant effects of ABM on AB or craving, patients who were treatment adherent differed from both those who were not and from controls in their attentional functioning and substance craving. These findings are the first to suggest that AB may be a within-treatment factor predictive of adherence to pharmacological treatment and potentially of recovery in opiate users.Keywords: Attentional bias; Opiates; Prescribed; Illicit; Dependence

56. Efficacy of Heroin-Assisted Treatment in Belgium: A Randomised Controlled TrialDemaret I, Quertemont E, Litran G, Magoga C, Deblire C, Dubois N, De Roubaix J, Charlier C, Lemaître A, Ansseau MEuropean Addiction Research 2015:21(4);179-187

AbstractBackground/Aims Heroin-assisted treatment (HAT) can improve the condition of heroin addicts still using street heroin after a methadone treatment. In Belgium, a new trial compared the efficacy of a HAT to existing methadone maintenance treatment. Methods In this randomised controlled trial, HAT was limited to 12 months. Participants were assessed every 3 months. They were responders if they showed improvement on the level of street heroin use, health or criminal involvement. Results 74 participants were randomised in the trial. The experimental group (n = 36) counted 30% of responders more than the control group (n = 38) at each assessment point (p < 0.05), except at 12 months where the difference (11%) was no longer significant (p = 0.35). Still, after 12 months, participants in the experimental group reported significantly

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greater improvements (p < 0.05) than the control group on the level of street heroin use and on the level of physical and mental health. Both groups reported significantly less criminal acts after 12 months (p < 0.001), but with no significant difference between the groups. Conclusions This trial confirms the short-term efficacy of HAT for severe heroin addicts, who already failed methadone treatment.Keywords: Diacetylmorphine; Heroin-assisted treatment; Methadone maintenance treatment

57. Discontinuation of Buprenorphine Maintenance Therapy: Perspectives and Outcomes Brandon S. Bentzley, Kelly S. Barth , Sudie E. Back , Sarah W. BookJournal of Substance Abuse Treatment 2015:52;48-57

AbstractBuprenorphine maintenance therapy (BMT) is increasingly the preferred opioid maintenance agent due to its reduced toxicity and availability in an office-based setting in the United States. Although BMT has been shown to be highly efficacious, it is often discontinued soon after initiation. No current systematic review has yet investigated providers' or patients' reasons for BMT discontinuation or the outcomes that follow. Hence, provider and patient perspectives associated with BMT discontinuation after a period of stable buprenorphine maintenance and the resultant outcomes were systematically reviewed with specific emphasis on pre-buprenorphine-taper parameters predictive of relapse following BMT discontinuation. Few identified studies address provider or patient perspectives associated with buprenorphine discontinuation. Within the studies reviewed providers with residency training in BMT were more likely to favor long term BMT instead of detoxification, and providers were likely to consider BMT discontinuation in the face of medication misuse. Patients often desired to remain on BMT because of fear of relapse to illicit opioid use if they were to discontinue BMT. The majority of patients who discontinued BMT did so involuntarily, often due to failure to follow strict program requirements, and 1 month following discontinuation, rates of relapse to illicit opioid use exceeded 50% in every study reviewed. Only lower buprenorphine maintenance dose, which may be a marker for attenuated addiction severity, predicted better outcomes across studies. Relaxed BMT program requirements and frequent counsel on the high probability of relapse if BMT is discontinued may improve retention in treatment and prevent the relapse to illicit opioid use that is likely to follow BMT discontinuation.Keywords: Buprenorphine; Opioid dependence; Treatment cessation; Provider perspectives, patient perspectives

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PRIMARY CARE

58. Comparing the Motivational Interviewing Integrity in Two Prevalent Models of Brief Intervention Service Delivery for Primary Care SettingsChris Dunn, Doyanne Darnell, Adam Carmel, David C. Atkins, Kristin Bumgardner, Peter Roy-ByrneJournal of Substance Abuse Treatment 2015:51;47-52 AbstractThis quasi experimental study compared the motivational interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 audiorecorded BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40 months post MI training.Both groups met the lower standard (beginning proficiency in MI) on 4 of 5 MI integrity scores, but NRCPs met more of the higher standards (competency in MI) than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity.Keywords: Motivational interviewing integrity; Screening Brief Intervention and Referral for Treatment (SBIRT); Substance use; Primary care

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PSYCHOSOCIAL THERAPY

59. To suppress, or not to suppress? That is repression: Controlling intrusive thoughts in addictive behaviourAntony C. Moss , James A.K. Erskine, Ian P. Albery, James Richard Allen, George J. GeorgiouAddictive Behaviors 2015:44;65-70

AbstractResearch to understand how individuals cope with intrusive negative or threatening thoughts suggests a variety of different cognitive strategies aimed at thought control. In this review, two of these strategies – thought suppression and repressive coping – are discussed in the context of addictive behaviour. Thought suppression involves conscious, volitional attempts to expel a thought from awareness, whereas repressive coping, which involves the avoidance of thoughts without the corresponding conscious intention, appears to be a far more automated process. Whilst there has been an emerging body of research exploring the role of thought suppression in addictive behaviour, there remains a dearth of research which has considered the role of repressive coping in the development of, and recovery from, addiction. Based on a review of the literature, and a discussion of the supposed mechanisms which underpin these strategies for exercising mental control, a conceptual model is proposed which posits a potential common mechanism. This model makes a number of predictions which require exploration in future research to fully understand the cognitive strategies utilised by individuals to control intrusive thoughts related to their addictive behaviour.Keywords: Alcohol; Mindfulness; Repressive coping; Smoking; Thought suppression

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RECOVERY

60. Implicit processing of heroin and emotional cues in abstinent heroin users: early and late event-related potential effectsLing Yang, Jianxun Zhang, Xin ZhaoThe American Journal of Drug and Alcohol Abuse 2015:41(3);237–245

AbstractBackground The abnormal cognitive processing of drug cues is a core characteristic of drug dependence. Previous research has suggested that the late positive potential (LPP) of heroin users is increased by heroin-related stimuli because of the attention-grabbing nature of such stimuli. Objectives The present research used a modified emotional Stroop (eStroop) task to examine whether there was an early posterior negativity (EPN) modulation to heroin cues compared with emotional or neutral stimuli in heroin dependent subjects. Methods Fifteen former heroin users and 15 matched controls performed the eStroop task, which was composed of positive, negative, heroin-related, and neutral pictures with superimposed color squares. Participants responded to the color of the square and not to the picture while behavioral data and event-related potentials were recorded. Results There were no significant differences of EPN amplitudes to emotional and neutral stimuli between heroin users and controls. However, heroin users displayed increased EPN modulation for heroin cues, whereas this modulation was absent in controls. Conclusions Drug-related cues acquire motivational salience and automatically capture the attention of heroin users at early processing stages, even when engaged in a non-drug-related task. The EPN to heroin cues could represent a novel electrophysiological index with clinical implications for selecting abstinent drug users who are at increased risk of relapse or to evaluate treatment interventions.Keywords: Attentional bias, early posterior negativity (EPN), event-related potentials (ERP), heroin dependence, late positive potential (LPP)

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RECOVERY, RELAPSE AND PREVENTION

61. The Social Identity Model of Cessation Maintenance: Formulation and initial evidenceDaniel Frings, Ian P. AlberyAddictive Behaviors 2015:44;35-42 AbstractIntroduction Group therapy can be highly influential in helping addicts (individuals presenting with problematic addictive behaviors) achieve and maintain cessation. The efficacy of such groups can be understood by the effects they have on members' social identity and also through associated group processes. The current paper introduces the Social Identity Model of Cessation Maintenance (SIMCM). Methods The SIMCM outlines how a number of processes (including self/collective efficacy and esteem, normative structure and social support and control) may affect cessation maintenance. It also provides a framework to make predictions about how automatic and/or implicit processes influence the activation of addiction relevant identities through cognitive accessibility and complexity in particular. Results A review of initial empirical evidence supporting some of the key specified relationships is provided, along with potential applications in therapy settings. Conclusions Insights into how SIMCM could be generalized beyond treatment contexts and avenues for future research are outlined.Keywords: Addiction; Identity; Social; Automaticity; Implicit; Recovery

62. Can exploring natural recovery from substance misuse in psychosis assist with treatment? A review of current researchShane Rebgetz, , David J. Kavanagh, Leanne HidesAddictive Behaviors 2015:46;106-112

AbstractSubstance misuse in people with psychosis presents significant problems, but trials of treatments to address it show little sustained advantage over control conditions. An examination of mechanisms underpinning unassisted improvements may assist in the refinement of comorbidity treatments. This study reviewed existing research on natural recovery from substance misuse in people with psychosis. To address this issue, a systematic search identified only 7 articles that fulfilled the criteria. Their results suggest that people with psychosis report similar reasons to change as do non-psychotic groups, although they did not clarify whether the relative frequencies or priority orders were the same. Differences involved issues relating to the disorder and the functional problems faced by this group: receipt of treatment for mental health difficulties, worsening of mental health difficulties, and homelessness. The current research on reasons for change in people with psychosis is sparse and has significant limitations, and as yet it offers little inspiration for new treatments. A more fertile source may prove to be a detailed investigation of successful substance control strategies that are used in self-management by this group.Keywords: Natural recovery; Psychosis; Substance use; Comorbidity

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63. You Can't Be in Recovery If You Are on Medication: A Concept Worth RetiringGeorge E. WoodySubstance Use & Misuse 2015;Early Online:Posted 16 Mar 2015

No abstract available

64. Recovery Is A Reality: But What Is It?Carl LeukefeldSubstance Use & Misuse 2015:Early Online;Posted 20 Feb 2015

No abstract available

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SCREENING

65. Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?Catherine L. Ward , Jennifer R. Mertens , Graham F. Bresick , Francesca Little , Constance M. Weisner Alcohol and Alcoholism 2015:50(3);302-309

AbstractPurpose To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. Methods Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up. Results Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours. Conclusions Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.

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SMOKING CESSATION

66. Associations between use of pharmacological aids in a smoking cessation attempt and subsequent quitting activity: a population studyStuart G. Ferguson, Jamie Brown, Mai Frandsen, Robert WestAddiction 2015:110(3);513-518 AbstractBackground and Aims Modelling the population impact and cost-effectiveness of smoking cessation aids is limited by lack of knowledge about how the use of aids changes across quit attempts. Here we test whether the quit method used in a previous attempt influences (i) future decisions to quit and/or (ii) treatment/s used during subsequent attempts. Design and Setting Data came from the Smoking Toolkit Study, a United Kingdom national household survey. Participants and Measures Smokers (n = 5489) who completed a baseline and 6-month follow-up questionnaire. Respondents were asked what treatment/s, grouped as: prescription medication/s [bupropion, varenicline or nicotine replacement therapy (NRT)], over-the-counter NRT or unaided that they had used in their most recent quit attempt (at baseline), and any use of treatment/s for a quit attempt in the last 3 months at follow-up. Results Smokers who had tried to quit at baseline were more likely to report having tried to quit again prior to follow-up [all odds ratios ≥ 2.19 relative to no attempt at baseline, P < 0.001]. Smokers who tried to quit using pharmacological aids were more likely to try to quit again at follow-up (all ORs ≥ 2.19 relative to no attempt at baseline, P < 0.001). Smokers tended to re-try aids used in baseline attempts in future attempts (all ORs ≥ 1.48 relative to no attempt at baseline, P < 0.01). Conclusions Smokers who have tried to quit in the past year are more likely to try to quit again within 6 months regardless of whether they used a pharmacological aid, and they are more likely to re-try aids they had used previously.Keywords: Behavioural support; bupropion; cessation medication; modelling; nicotine replacement therapy; quitting behaviour; smoking cessation; varenicline

67. First- versus second-generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptomsLynne Dawkins, Catherine Kimber, Yasothani Puwanesarasa, Kirstie SoarAddiction 2015:110(4);669-677 AbstractAims To (1) estimate predictors of first- versus second-generation electronic cigarette (e-cigarette) choice; and (2) determine whether a second-generation device was (i) superior for reducing urge to smoke and withdrawal symptoms (WS) and (ii) associated with enhanced positive subjective effects. Design Mixed-effects experimental design. Phase 1: reason for e-cigarette choice was assessed via questionnaire. Phase 2: participants were allocated randomly to first- or second-generation e-cigarette condition. Urge to smoke and WS were measured before and 10 minutes after taking 10 e-cigarette puffs. Setting University of East London, UK. Participants A total of 97 smokers (mean age 26; standard deviation 8.7; 54% female). Measurements Single-item urge to smoke scale to assess craving and the Mood and Physical Symptoms Scale (MPSS) to assess WS. Subjective effects included: satisfaction, hit, ‘felt like smoking’ and ‘would use to stop smoking’ (yes versus no response). Findings Equal numbers chose each device, but none of the predictor variables (gender, age, tobacco dependence, previous e-cigarette use) accounted for choice. Only baseline urge to smoke/WS predicted urge to smoke/WS 10 minutes after use (B =0.38; P

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<0.001 and B =0.53; P <0.001). E-cigarette device was not a significant predictor. Those using the second-generation device were more likely to report satisfaction and use in a quit attempt (χ2 = 12.10, P =0.001 and χ2 = 5.53, P =0.02). Conclusions First- and second-generation electronic cigarettes appear to be similarly effective in reducing urges to smoke during abstinence, but second-generation devices appear to be more satisfying to users.Keywords: Electronic cigarette; ENDS; urge to smoke; withdrawal symptoms

68. Cost-effectiveness analysis of smoking-cessation counseling training for physicians and pharmacistsScott B. Cantor , Ashish A. Deshmukh, Nancy Stancic Luca, Graciela M. Nogueras-González, Tanya Rajan, Alexander V. ProkhorovAddictive Behaviors 2015:45;79-86 AbstractBackground Although smoking-cessation interventions typically focus directly on patients, this paper conducts an economic evaluation of a novel smoking-cessation intervention focused on training physicians and/or pharmacists to use counseling techniques that would decrease smoking rates at a reasonable cost. Purpose To evaluate the cost-effectiveness of interventions that train physicians and/or pharmacists to counsel their patients on smoking-cessation techniques. Methods Using decision-analytic modeling, we compared four strategies for smoking-cessation counseling education: training only physicians, training only pharmacists, training both physicians and pharmacists (synergy strategy), and training neither physicians nor pharmacists (i.e., no specialized training, which is the usual practice). Short-term outcomes were based on results from a clinical trial conducted in 16 communities across the Houston area; long-term outcomes were calculated from epidemiological data. Short-term outcomes were measured using the cost per quit, and long-term outcomes were measured using the cost per quality-adjusted life-year (QALY). Cost data were taken from institutional sources; both costs and QALYs were discounted at 3%. Results Training both physicians and pharmacists added 0.09 QALY for 45-year-old men. However, for 45-year-old women, the discounted quality-adjusted life expectancy only increased by 0.01 QALY when comparing the synergy strategy to no intervention. The incremental cost-effectiveness ratio (ICER) of the synergy strategy with respect to the non-intervention strategy was US$868/QALY for 45-year-old men and US$8953/QALY for 45-year-old women. The results were highly sensitive to the quit rates and community size. Conclusion Synergistic educational training for physicians and pharmacists could be a cost-effective method for smoking cessation in the community.Keywords: Medical decision making; Costs and cost analysis; Nicotine; Smoking cessation

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