Brief intervention is effective for alcohol misuse, but not adequately tested in the clinical setting with drug using patients. This study tested the impact of a single, structured encounter ...targeting cessation of drug use, conducted between peer educators and out-of-treatment cocaine and heroin users screened in the context of a routine medical visit.
A randomized, controlled trial was conducted in inner-city teaching hospital outpatient clinics with 3 and 6 months follow-up by blinded observers. Drug abstinence was documented by RIA hair testing. Analysis was limited to enrollees with drug-positive hair at baseline.
Among 23,669 patients screened 5/98–11/00, 1232 (5%) were eligible, and 1175 enrolled. Enrollees (mean age 38 years) were 29% female, 62% non-hispanic black, 23% hispanic, 46% homeless. Among those with positive hair at entry, the follow-up rate was 82%. The intervention group was more likely to be abstinent than the control group for cocaine alone (22.3% versus 16.9%), heroin alone (40.2% versus 30.6%), and both drugs (17.4% versus 12.8%), with adjusted OR of 1.51–1.57. Cocaine levels in hair were reduced by 29% for the intervention group and only 4% for the control group. Reductions in opiate levels were similar (29% versus 25%).
Brief motivational intervention may help patients achieve abstinence from heroin and cocaine.
This study was undertaken to determine whether reductions in alcohol-related fatal crashes following adoption of 0.08% legal blood alcohol limits were independent of general regional trends.
The ...first five states that lowered legal blood alcohol limits to 0.08% were paired with five nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre- and postlaw years.
States adopting 0.08% laws experienced 16% and 18% relative postlaw declines in the proportions of fatal crashes involving fatally injured drivers whose blood alcohol levels were 0.08% or higher and 0.15% or higher.
It all states adopted 0.08% legal blood alcohol limits, at least 500 to 600 fewer fatal crashes would occur annually.
•Limitations of FARS data prevent unbiased estimation of drugged driving.•Drug testing rates varied across states and differed by driver types.•Drug testing rates were lowest for surviving drivers ...not transported to a hospital.•States testing higher percentages of drivers for BAC had higher drug testing rates.•States with vs. without arrest laws had higher testing rates for surviving drivers.
Driving under the influence of drugs, including marijuana, has become more prevalent in recent years despite local, state, and federal efforts to prevent such increases. The Fatality Analysis Reporting System (FARS) is the primary source of drugged driving data for fatal crashes in the United States but lacks the completeness required to calculate unbiased estimates of drug use among drivers involved in fatal crashes.
This article uses the 2013 FARS dataset to present differences in state drug testing rates by driver type, driver fault type, and state-level factors; discusses limitations related to analysis and interpretation of drugged driving data; and offers suggestions for improvements that may enable appropriate use of FARS drug testing data in the future.
Results showed that state drug testing rates were highest among drivers who died at the scene of the crash (median=70.8%) and drivers who died and were at fault in the crash (median=64.4%). The lowest testing rates were seen among surviving drivers who were not transported to a hospital (median=14.0%) and surviving drivers who were not at fault in the crash (median=10.0%). Drug testing rates differed by state blood alcohol content (BAC) testing rate across all driver types and driver fault types, and in general, states that tested a higher percentage of drivers for BAC had higher drug testing rates.
Testing rates might be increased through standardization and mandatory testing policies. FARS data users should continue to be cautious about the limitations of using currently available data to quantify drugged driving. More efforts are needed to improve drug testing and reporting practices, and more research is warranted to establish drug concentration levels at which driving skills become impaired.
Objectives—This study assessed whether states that lowered legal blood alcohol limits from 0.10% to 0.08% in 1993 and 1994 experienced post-law reductions in alcohol related fatal crashes. ...Methods—Six states that adopted 0.08% as the legal blood alcohol limit in 1993 and 1994 were paired with six nearby states that retained a 0.10% legal standard. Within each pair, comparisons were made for the maximum equal available number of pre-law and post-law years. Results—States adopting 0.08% laws experienced a 6% greater post-law decline in the proportion of drivers in fatal crashes with blood alcohol levels at 0.10% or higher and a 5% greater decline in the proportion of fatal crashes that were alcohol related at 0.10% or higher. Conclusions—If all states adopted the 0.08% legal blood alcohol level, 400–500 fewer traffic fatalities would occur annually.
We explored among people who ever consumed alcohol whether early age at drinking onset and alcohol dependence predicted drug use and dependence. We also examined among drinkers who have used drugs ...whether they also predict driving under the influence of drugs and motor-vehicle crash involvement because of drugs.
A U.S. national sample of 42,867 persons age 18 and older was surveyed in 1991-1992 (response rate = 90%). Logistic regression examined these potential associations among 27,616 respondents who ever drank alcohol, controlling for numerous demographic and personal characteristics.
Among "ever" drinkers, 22% used drugs, 10% had driven under the influence of drugs, and nearly 1% was in a motor-vehicle crash because of drug use, the equivalent of 1 million people. The younger the age of respondents when they first began drinking and whether they ever experienced alcohol dependence were independently associated with greater odds of ever using drugs and experiencing drug dependence. Among persons who consumed alcohol and drugs, having ever experienced drug dependence was the strongest predictor of driving under the influence of drugs and motor-vehicle crash involvement because of drug use. After controlling for drug dependence and age at first drug use, having experienced alcohol dependence was also independently associated with both outcomes.
Efforts to prevent drug-related crashes should include drug use prevention and treatment, as well as prevention of early alcohol use and treatment of alcohol dependence.
Men have higher drowning rates than women for most age groups. Data from a 1991 national household survey (n = 3042) on aquatic activities were used to examine hypotheses about differential drowning ...rates by sex. Men and women were compared by (1) exposure to aquatic environments; (2) frequency of aquatic activities involving or potentially involving, submersion; (3) swimming training and ability; (4) aquatic risk-taking behaviors; and (5) alcohol use on or near the water. Men had elevated risks for exposure, risk taking, and alcohol use. It was concluded that several factors contribute to their relatively high drowning rates, including a possible interaction between overestimation of abilities and heavy alcohol use.
Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of ...inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options.
We randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous (AA) meetings, and a choice of options. Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period.
All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often (P less than 0.0001) by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment.
Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.
This study assessed current levels of sunbathing and sunscreen use in the United States.
From a general-population telephone survey of aquatic activities among adults in 3042 US households, we ...examined responses by the 2459 Whites.
Most adults (59%) reported sunbathing during the past year, and 25% reported frequent sunbathing. Of the subsample who reported sunbathing during the month before the interview, 47% routinely used sunscreen. Of these individuals, almost half did not use sunscreens with a solar protection factor of 15 or higher.
About a quarter of US White adults report frequent sunbathing, and only about a quarter of sunbathers use sunscreens at recommended levels. These results should help focus future sun protection educational efforts.
To reduce the involvement of young drivers in alcohol-related crashes, 29 States and the District of Columbia have established lower legal blood alcohol limits for drivers younger than age 21 than ...for adult drivers. Of these, 12 lowered the legal limit for young people prior to 1991. To assess the impact, these 12 States were paired for comparison with 12 nearby States matched for legal drinking age and timing of changes in that law. Among drivers ages 15-20, fatal crashes involving a single vehicle at night are three times more likely than other fatal crashes to be alcohol-related. Whether the proportion of fatal crashes that involved single vehicles at night declined more among young drivers targeted by lower blood alcohol limits than among young drivers of the same age in comparison States was examined. The maximum available equal number of pre- and post-law years were compared in each pair of States. During the post-law period, the proportion of fatal crashes that involved single vehicles at night declined 16 percent among young drivers targeted by lower blood alcohol laws, whereas it rose 1 percent among drivers of the same age in comparison States where blood alcohol limits were not changed (P <.001). Among adults, the proportion of fatal nocturnal crashes that involved single vehicles declined 5 percent in the group of States with the lowered levels for yound people during the period after the law was enacted and 6 percent in the group of neighboring comparison States. The proportion of fatal crashes that involved single vehicles at night declined 22 percent among drivers in States with .00 percent limits, whereas it declined only 2 percent among drivers of the same age in comparison States (P <.003). Among those targeted by .02 percent BAL limits, the proportion of fatal crashes that involved single vehicles at night declined 17 percent. It rose 4 percent in comparison States (P = .005). No significant difference appeared between States that lowered blood alcohol levels to the range of .04-.06 percent relative to comparison States. If all States adopted .00 or .02 percent limits for drivers ages 15-20, at least 375 fatal single vehicle crashes at night would be prevented each year.
Adolescents are a group at high risk for exposure to acquired immunodeficiency syndrome (AIDS). Results of a random-sample survey of 860 adolescents 16 to 19 years of age, in Massachusetts indicate ...that many adolescents are still misinformed or confused about AIDS and AIDS transmission. Of the adolescent respondents, 70% said they were sexually active (having sexual intercourse or other sexual contact) but only 15% of them reported changing their sexual behavior because of concern about contracting AIDS, and only 20% of those who changed their behavior used effective methods. Of both sexually active and nonactive adolescents, 8% did not know that AIDS is transmitted by heterosexual sexual intercourse. Psychoactive drugs other than alcohol and marijuana had been used by 13% of those responding, and 1% reported injecting drugs. Of those psychoactive drug users, 8% did not know that AIDS can be transmitted by injecting drugs. There was no significant difference in knowledge between the sexually active and nonactive adolescents concerning sexual behavior and AIDS transmission or between the drug users and nonusers concerning drug use and AIDS transmission. The majority of respondents knew a relationship exists between AIDS and blood, and other body fluids, but knowledge of the mode of transmission was limited. Hence, many adolescents, including those in the highest risk subgroups of sexually active or psychoactive drug users, did not know what sexual and drug precautions are needed to prevent transmission of the virus. School systems and health care providers should systematically educate this population about AIDS to counter the current misinformation and confusion.
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