Drug problem
Shantanu Bagchi & James Feigenbaum
Review of Economic Dynamics, forthcoming
Abstract:
Even though smokers incur higher health expenditures than nonsmokers of the same age, smokers have significantly higher mortality rates, so the expected lifetime health expenditure for a smoker is actually lower than for a nonsmoker. Because of this fact, some politicians and policy-makers have argued that society might actually be better off promoting smoking rather than discouraging it. We consider this argument in a general-equilibrium model where health expenditures are paid for by a single-payer health-care system financed by taxes. Because the percentage increase in the tax base is larger than the percentage increase in health-care expenditures, the elimination of smoking actually decreases the budget-balancing health-care tax rate.
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Do time restrictions on alcohol advertising reduce youth exposure?
Craig Ross, Avalon de Bruijn & David Jernigan
Journal of Public Affairs, February 2013, Pages 123-129
Abstract:
Regulators may attempt to reduce youth exposure to alcohol advertising by restricting times during which alcohol ads may be aired on television or radio. The Netherlands introduced such a policy and found that teenage advertising exposure increased following the time restrictions. This study uses simulation analysis and a comprehensive database of television alcohol advertising to demonstrate that time restrictions are likely to reduce advertising exposure to the youngest viewers while increasing exposure for the high-risk teenage population.
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Cannabis use and suicidal ideation
Jan van Ours et al.
Journal of Health Economics, May 2013, Pages 524-537
Abstract:
Globally, suicide has emerged as the second leading cause of death among youth aged 10-24 years old. In order to better understand the causes of this phenomenon, we investigate the relationship between suicidal ideation and cannabis use. Our empirical analysis is based on a 30 year longitudinal study of a birth cohort. We find that intensive cannabis use - at least several times per week - leads to a higher transition rate into suicidal ideation for males. We find no evidence that suicidal ideation leads to cannabis use for either males or females.
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Cannabidiol reduces cigarette consumption in tobacco smokers: Preliminary findings
Celia Morgan et al.
Addictive Behaviors, forthcoming
Abstract:
The role of the endocannabinoid system in nicotine addiction is being increasingly acknowledged. We conducted a pilot, randomized double blind placebo controlled study set out to assess the impact of the ad-hoc use of cannabidiol (CBD) in smokers who wished to stop smoking. 24 smokers were randomized to receive an inhaler of CBD (n=12) or placebo (n=12) for one week, they were instructed to use the inhaler when they felt the urge to smoke. Over the treatment week, placebo treated smokers showed no differences in number of cigarettes smoked. In contrast, those treated with CBD significantly reduced the number of cigarettes smoked by ~ 40% during treatment. Results also indicated some maintenance of this effect at follow up. These preliminary data, combined with the strong preclinical rationale for use of this compound, suggest CBD to be a potential treatment for nicotine addiction that warrants further exploration.
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The price of a drink - too exactly? Flawed evidence for minimum unit pricing
John Duffy
Significance, April 2013, Pages 23-27
Abstract:
The UK government has been considering whether to introduce minimum unit pricing for alcohol. Extraordinarily precise benefits have been claimed for the measure, down to exactly how many lives a year will be saved. But are the statistics real or illusory? John Duffy says they are flawed to the point of uselessness.
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Christine Griffin et al.
Feminism & Psychology, May 2013, Pages 184-206
Abstract:
This paper contributes to debates on post-feminism and the constitution of contemporary femininity via an exploration of young women's alcohol consumption and their involvement in normative drinking cultures. We view femininity as a profoundly contradictory and dilemmatic space which appears almost impossible for girls or young women to inhabit. The juxtaposition of hyper-sexual femininity and the culture of intoxication produces a particularly difficult set of dilemmas for young women. They are exhorted to be sassy and independent - but not feminist; to be ‘up for it' and to drink and get drunk alongside young men - but not to ‘drink like men'. They are also called on to look and act as agentically sexy within a pornified night-time economy, but to distance themselves from the troubling figure of the ‘drunken slut'. Referring to recent research on young women's alcohol consumption and our own study on young adults' involvement in the culture of intoxication in the UK, we consider the ways in which young women manage to inhabit this terrain, and the implications for contemporary feminism and safer drinking initiatives.
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Lisa Berger, Michael Fendrich & Daniel Fuhrmann
Addictive Behaviors, forthcoming
Objective: The consumption of alcohol mixed with energy drinks (AmED) is prevalent among college students as is hazardous drinking, a drinking pattern that places one at risk for alcohol-related harm. The present study, therefore, examined associations between AmED use, hazardous drinking, and alcohol-related consequences in college students.
Methods: Based on a probability sample conducted in 2010, participants were 606 undergraduate students aged 18-25. AmED consumption included lifetime and past year use. Hazardous drinking and alcohol-related consequences were measured during the past year. Point prevalence was used to estimate rates of AmED use, and chi-square, ANOVA, and logistic regression were used to examine associations between AmED use, hazardous drinking, and alcohol-related consequences.
Results: Lifetime and past year AmED use prevalence rates were 75.2% and 64.7%, respectively. Hazardous drinkers who engaged in AmED use were significantly more likely than past year hazardous drinkers who did not engage in AmED use to have had unprotected sex (OR = 2.35, CI 1.27-4.32).
Conclusions: AmED use appears to be highly prevalent among college students, and AmED use may confer additional risk for unprotected sex beyond hazardous drinking. Unprotected sex has implications for public health, and students who drink hazardously and consume AmED may be at greater risk.
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Shanta Dube et al.
Journal of Adolescent Health, May 2013, Pages S45-S51
Purpose: Smoking is a leading cause of cancer, and most smokers begin during adolescence. We examined the proportion of adolescents exposed to pro-tobacco advertising and assessed the association between this exposure and susceptibility to smoking.
Methods: Data from the 2011 National Youth Tobacco Survey were used to calculate the proportion of susceptible middle school (MS) and high school (HS) students exposed to pro-tobacco advertisements through stores, magazines, and the Internet. Following previous work, susceptibility to smoking cigarettes was defined as "never smoked but open to trying cigarettes."
Results: In 2011, 81.5% of MS students and 86.9% of HS students were exposed to tobacco advertisements in stores; 48.2% of MS students and 54.0% of HS students were exposed to such advertising in magazines. Exposure to tobacco advertisements on the Internet was similar for MS (40.8%) and HS students (40.2%). Of those surveyed, 22.5% of MS students and 24.2% of HS students were susceptible to trying cigarettes. Exposure to magazine advertising declined from 71.8% in 2000 to 46.1% in 2009 among susceptible MS students; however, exposure increased to 55.4% in 2011. Tobacco advertising seen through the Internet among susceptible HS students increased from 25.9% in 2000 to 44.7% in 2011.
Conclusions: Adolescents continue to be exposed to pro-tobacco advertisements. Adolescents susceptible to smoking are more likely to report exposure to pro-tobacco advertisements. In addition to continued monitoring, more effective interventions to eliminate youth exposure to pro-tobacco marketing are needed.
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Health Consequences of Easier Access to Alcohol: New Zealand Evidence
Emily Conover & Dean Scrimgeour
Journal of Health Economics, May 2013, Pages 570-585
Abstract:
We evaluate the health effects of a reduction in New Zealand's minimum legal purchase age for alcohol. Difference-in-differences (DD) estimates show a substantial increase in alcohol-related hospitalizations among those newly eligible to purchase liquor, around 24.6% (s.e.=5.5%) for males and 22% (s.e.=8.1%) for females. There is less evidence of an effect among ineligible younger cohorts. There is little evidence of alcohol either complementing or substituting for drugs. We do not find evidence that earlier access to alcohol is associated with learning from experience. We also present regression discontinuity estimates, but emphasize DD estimates since in a simulation of a rational addiction model DD estimates are closer than regression discontinuity estimates to the policy's true effect.
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Pierre Maurage et al.
PLoS ONE, March 2013
Background: Emotional and interpersonal impairments associated with alcohol-dependence have been recently explored, but the distorted cognitive representations underlying these deficits remain poorly understood. The present study aims at exploring the presence of maladaptive social self-beliefs among alcohol-dependent individuals, as these biased self-beliefs have been recently shown to play a crucial role in the development and maintenance of other psychopathological states (social anxiety and depression).
Methodology/Principal findings: Twenty-five recently detoxified alcohol-dependent participants and 25 matched controls filled in self-report questionnaires evaluating maladaptive social self-beliefs, interpersonal problems and several comorbid states (anxiety, social anxiety, depression). As compared to controls, alcohol-dependent individuals showed higher scores than controls for the three subcategories of maladaptive social self-beliefs (high standards, conditional beliefs and unconditional beliefs). Our key finding was that when comorbidities were controlled for, alcohol-dependence was associated with a specific bias towards exaggerated high standards in social contexts. Moreover, these high standards beliefs were strongly correlated with interpersonal problems.
Conclusions/Significance: These results provide the first insights into the influence of cognitive biases on interpersonal problems in addictive states, and suggest that maladaptive self-beliefs could have a central influence on the development and maintenance of alcohol-dependence.
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Trenette Clark, Otima Doyle & Amanda Clincy
Addictive Behaviors, forthcoming
Abstract:
This study examines age of first cigarette, alcohol, and marijuana use among self-identified biracial youth, using data from the National Longitudinal Study of Adolescent Health (Add Health). We found an intermediate biracial phenomenon in which some biracial youth initiate substance use at ages that fall between the initiation ages of their 2 corresponding monoracial groups. When controlling for the covariates, our findings show White-Asian biracial youth begin smoking marijuana and drinking alcohol at earlier ages than Whites and engaging in all forms of substance use at earlier ages than Asian youth. Results indicate White-American Indian youth start smoking cigarettes at earlier ages than all biracial and monoracial groups. Our findings underscore the need for future research to examine substance-use initiation and progression among biracial/ethnic youth.
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Stephen Magura, Charles Cleland & Scott Tonigan
Journal of Studies on Alcohol and Drugs, May 2013, Pages 378-385
Objective: The objective of the study is to determine whether Alcoholics Anonymous (AA) participation leads to reduced drinking and problems related to drinking within Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), an existing national alcoholism treatment data set.
Method: The method used is structural equation modeling of panel data with cross-lagged partial regression coefficients. The main advantage of this technique for the analysis of AA outcomes is that potential reciprocal causation between AA participation and drinking behavior can be explicitly modeled through the specification of finite causal lags.
Results: For the outpatient subsample (n = 952), the results strongly support the hypothesis that AA attendance leads to increases in alcohol abstinence and reduces drinking/ problems, whereas a causal effect in the reverse direction is unsupported. For the aftercare subsample (n = 774), the results are not as clear but also suggest that AA attendance leads to better outcomes.
Conclusions: Although randomized controlled trials are the surest means of establishing causal relations between interventions and outcomes, such trials are rare in AA research for practical reasons. The current study successfully exploited the multiple data waves in Project MATCH to examine evidence of causality between AA participation and drinking outcomes. The study obtained unique statistical results supporting the effectiveness of AA primarily in the context of primary outpatient treatment for alcoholism
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Spatial Panel Analyses of Alcohol Outlets and Motor Vehicle Crashes in California: 1999-2008
William Ponicki, Paul Gruenewald & Lillian Remer
Accident Analysis & Prevention, June 2013, Pages 135-143
Abstract:
Although past research has linked alcohol outlet density to higher rates of drinking and many related social problems, there is conflicting evidence of density's association with traffic crashes. An abundance of local alcohol outlets simultaneously encourages drinking and reduces driving distances required to obtain alcohol, leading to an indeterminate expected impact on alcohol-involved crash risk. This study separately investigates the effects of outlet density on (1) the risk of injury crashes relative to population and (2) the likelihood that any given crash is alcohol-involved, as indicated by police reports and single-vehicle nighttime status of crashes. Alcohol outlet density effects are estimated using Bayesian misalignment Poisson analyses of all California ZIP codes over the years 1999 to 2008. These misalignment models allow panel analysis of ZIP-code data despite frequent redefinition of postal-code boundaries, while also controlling for overdispersion and the effects of spatial autocorrelation. Because models control for overall retail density, estimated alcohol-outlet associations represent the extra effect of retail establishments selling alcohol. The results indicate a number of statistically well-supported associations between retail density and crash behavior, but the implied effects on crash risks are relatively small. Alcohol-serving restaurants have a greater impact on overall crash risks than on the likelihood that those crashes involve alcohol, whereas bars primarily affect the odds that crashes are alcohol-involved. Off-premise outlet density is negatively associated with risks of both crashes and alcohol involvement, while the presence of a tribal casino in a ZIP code is linked to higher odds of police-reported drinking involvement. Alcohol outlets in a given area are found to influence crash risks both locally and in adjacent ZIP codes, and significant spatial autocorrelation also suggests important relationships across geographical units. These results suggest that each type of alcohol outlet can have differing impacts on risks of crashing as well as the alcohol involvement of those crashes.
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Enforcement following 0.08% BAC law change: Sex-specific consequences of changing arrest practices?
Jennifer Schwartz & Ardavan Davaran
Addictive Behaviors, forthcoming
Abstract:
This research evaluated effects of stricter 0.08% BAC drunken driving law on changes in sex-specific DUI arrest rates, controlling for increased law enforcement resources and shifts in DUI-related behaviors. Another main purpose, the study assessed female/male differences in arrest increases due to broader enforcement standards and efforts. Panel data was assembled for 24 states over 1990-2007 on DUI arrests, alcohol policy, law enforcement resources, drinking and drunken driving prevalence. Two-way fixed-effects seemingly unrelated regression models predicted female versus male changes in DUI arrests following implementation of lower legal limits of intoxication, net controls. Findings suggest, first, a broader legal definition of drunken driving intending to officially sanction less serious offenders (0.08% vs. 0.10% BAC) was associated with increased DUI arrests for both sexes. Second, growth in specialized DUI-enforcement units also was related to increased arrests. Whereas male and female arrest trends were equally affected by the direct net-widening effects of 0.08% BAC alcohol-policy, specialized DUI-enforcement efforts to dig deeper into the offender-pool had stronger arrest-producing effects on females, particularly prior to law change. Specifying how changes in law and enforcement resources affect arrest outcomes is an important pre-cursor to alcohol-policy analyses of effectiveness. A potential unintended consequence, effects of law and enforcement may differ across population segments.
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Demand for Smokeless Tobacco: Role of Advertising
Dhaval Dave & Henry Saffer
Journal of Health Economics, forthcoming
Abstract:
While the prevalence of smokeless tobacco (ST) is low relative to smoking, the distribution of ST use is highly skewed with consumption concentrated among certain segments of the population (rural residents, males, whites, low-educated individuals). Furthermore, there is suggestive evidence that use has trended upwards recently for groups that have traditionally been at low risk of using ST, and thus started to diffuse across demographics. This study provides the first estimates, at the national level, of the effects of magazine advertising on ST use. The focus on magazine advertising is significant given that ST manufacturers have been banned from using other conventional media since the 1986 Comprehensive ST Act and the 1998 ST Master Settlement Agreement. This study is based on the 2003-2009 waves of the National Consumer Survey (NCS), a unique data source that contains extensive information on the reading habits of individuals, matched with magazine-specific advertising information over the sample period. This allows detailed and salient measures of advertising exposure at the individual level and addresses potential bias due to endogeneity and selective targeting. We find consistent and robust evidence that exposure to ST ads in magazines raises ST use, especially among males, with an estimated elasticity of 0.06. There is suggestive evidence that both ST taxes and cigarette taxes reduce ST use, indicating contemporaneous complementarity between these tobacco products. Sub-analyses point to some differences in the advertising and tax response across segments of the population. The effects from this study inform the debate on the cost and benefits of ST use and its potential to be a tool in overall tobacco harm reduction.
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Daniel Belsky et al.
JAMA Psychiatry, forthcoming
Objective: To test how genetic risks discovered in genome-wide association studies of adult smoking influence the developmental progression of smoking behavior from initiation through conversion to daily smoking, progression to heavy smoking, nicotine dependence, and struggles with cessation.
Design: A 38-year, prospective, longitudinal study of a representative birth cohort.
Setting: The Dunedin Multidisciplinary Health and Development Study of New Zealand.
Participants: The study included 1037 male and female participants.
Exposure: We assessed genetic risk with a multilocus genetic risk score. The genetic risk score was composed of single-nucleotide polymorphisms identified in 3 meta-analyses of genome-wide association studies of smoking quantity phenotypes.
Main Outcomes and Measures: Smoking initiation, conversion to daily smoking, progression to heavy smoking, nicotine dependence (Fagerström Test of Nicotine Dependence), and cessation difficulties were evaluated at 8 assessments spanning the ages of 11 to 38 years.
Results: Genetic risk score was unrelated to smoking initiation. However, individuals at higher genetic risk were more likely to convert to daily smoking as teenagers, progressed more rapidly from smoking initiation to heavy smoking, persisted longer in smoking heavily, developed nicotine dependence more frequently, were more reliant on smoking to cope with stress, and were more likely to fail in their cessation attempts. Further analysis revealed that 2 adolescent developmental phenotypes-early conversion to daily smoking and rapid progression to heavy smoking-mediated associations between the genetic risk score and mature phenotypes of persistent heavy smoking, nicotine dependence, and cessation failure. The genetic risk score predicted smoking risk over and above family history.
Conclusions and Relevance: Initiatives that disrupt the developmental progression of smoking behavior among adolescents may mitigate genetic risks for developing adult smoking problems. Future genetic research may maximize discovery potential by focusing on smoking behavior soon after smoking initiation and by studying young smokers.
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Brandon Oberlin et al.
Neuropsychopharmacology, forthcoming
Abstract:
Striatal dopamine (DA) is increased by virtually all drugs of abuse, including alcohol. However, drug-associated cues are also known to provoke striatal DA transmission- a phenomenon linked to the motivated behaviors associated with addiction. To our knowledge, no one has tested if alcohol's classically-conditioned flavor cues, in the absence of a significant pharmacologic effect, are capable of eliciting striatal dopamine release in humans. Employing positron emission tomography (PET), we hypothesized that beer's flavor alone can reduce the binding potential of [11C]raclopride (a reflection of striatal DA release) in the ventral striatum, relative to an appetitive flavor control. Forty-nine men, ranging from social to heavy drinking, mean age 25, with a varied family history of alcoholism underwent two [11C]raclopride PET scans: one while tasting beer, and one while tasting Gatorade®. Relative to the control flavor of Gatorade, beer flavor significantly increased self-reported desire to drink, and reduced [11C]raclopride binding potential, indicating that the alcohol-associated flavor cues induced dopamine release. Binding potential reductions were strongest in subjects with first-degree alcoholic relatives. These results demonstrate that alcohol-conditioned flavor cues can provoke ventral striatal dopamine release absent significant pharmacologic effects, and that the response is strongest in subjects with a greater genetic risk for alcoholism. Striatal DA responses to salient alcohol cues may thus be an inherited risk factor for alcoholism.
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Association of PER2 Genotype and Stressful Life Events with Alcohol Drinking in Young Adults
Dorothea Blomeyer et al.
PLoS ONE, March 2013
Background: Clock genes govern circadian rhythms and shape the effect of alcohol use on the physiological system. Exposure to severe negative life events is related to both heavy drinking and disturbed circadian rhythmicity. The aim of this study was 1) to extend previous findings suggesting an association of a haplotype tagging single nucleotide polymorphism of PER2 gene with drinking patterns, and 2) to examine a possible role for an interaction of this gene with life stress in hazardous drinking.
Methods: Data were collected as part of an epidemiological cohort study on the outcome of early risk factors followed since birth. At age 19 years, 268 young adults (126 males, 142 females) were genotyped for PER2 rs56013859 and were administered a 45-day alcohol timeline follow-back interview and the Alcohol Use Disorders Identification Test (AUDIT). Life stress was assessed as the number of severe negative life events during the past four years reported in a questionnaire and validated by interview.
Results: Individuals with the minor G allele of rs56013859 were found to be less engaged in alcohol use, drinking at only 72% of the days compared to homozygotes for the major A allele. Moreover, among regular drinkers, a gene x environment interaction emerged (p = .020). While no effects of genotype appeared under conditions of low stress, carriers of the G allele exhibited less hazardous drinking than those homozygous for the A allele when exposed to high stress.
Conclusions: These findings may suggest a role of the circadian rhythm gene PER2 in both the drinking patterns of young adults and in moderating the impact of severe life stress on hazardous drinking in experienced alcohol users. However, in light of the likely burden of multiple tests, the nature of the measures used and the nominal evidence of interaction, replication is needed before drawing firm conclusions.
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Adolescents' Attitudes Toward Antimarijuana Ads, Usage Intentions, and Actual Marijuana Usage
Eusebio Alvaro et al.
Psychology of Addictive Behaviors, forthcoming
Abstract:
The association of adolescents' appraisals of the antimarijuana TV ads used in the National Youth Antidrug Media Campaign with future marijuana use was investigated. The 12- to 18-year-old respondents (N = 2,993) were first classified as users, resolute nonusers, or vulnerable nonusers (Crano, Siegel, Alvaro, Lac, & Hemovich, 2008). Usage status and the covariates of gender, age, and attitudes toward marijuana were used to predict attitudes toward the ads (Aad) in the first phase of a multilevel linear analysis. All covariates were significantly associated with Aad, as was usage status: Resolute nonusers evaluated the ads significantly more positively than vulnerable nonusers and users (all ps < .001), who did not differ. In the second phase, the covariates along with Aad and respondents' usage status predicted intentions and actual usage 1 year after initial measurement. The lagged analysis disclosed negative associations between Aad and usage intentions and between Aad and actual marijuana use (both ps < .05); however, this association held only for users (p < .01), not vulnerable or resolute nonusers. Users who reported more positive attitudes toward the ads were less likely to report intention to use marijuana and to continue marijuana use at 1-year follow-up. These findings may inform designers of persuasion-based prevention campaigns, guiding preimplementation efforts in the design of ads that targeted groups find appealing and thus, influential.