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R Room

Publications and source records attributed to R Room.

At least 37 records · Page 2Linked to original sources
PubMed1997

WHO Study on the reliability and validity of the alcohol and drug use disorder instruments: overview of methods and results.

The WHO Study on the reliability and validity of the alcohol and drug use disorder instruments in an international study which has taken place in centres in ten countries, aiming to test the reliability and validity of three diagnostic instruments for alcohol and drug use disorders: the Composite International Diagnostic Interview (CIDI), the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and a special version of the Alcohol Use Disorder and Associated Disabilities Interview schedule-alcohol/drug-revised (AUDADIS-ADR). The purpose of the reliability and validity (R&V) study is to further develop the alcohol and drug sections of these instruments so that a range of substance-related diagnoses can be made in a systematic, consistent, and reliable way. The study focuses on new criteria proposed in the tenth revision of the International Classification of Diseases (ICD-10) and the fourth revision of the diagnostic and statistical manual of mental disorders (DSM-IV) for dependence, harmful use and abuse categories for alcohol and psychoactive substance use disorders. A systematic study including a scientifically rigorous measure of reliability (i.e. 1 week test-retest reliability) and validity (i.e. comparison between clinical and non-clinical measures) has been undertaken. Results have yielded useful information on reliability and validity of these instruments at diagnosis, criteria and question level. Overall the diagnostic concordance coefficients (kappa, kappa) were very good for dependence disorders (0.7-0.9), but were somewhat lower for the abuse and harmful use categories. The comparisons among instruments and independent clinical evaluations and debriefing interviews gave important information about possible sources of unreliability, and provided useful clues on the applicability and consistency of nosological concepts across cultures.

Adult↗
PubMed1997

Charting WHO--goals for licit and illicit drugs for the year 2000: are we 'on track'?

Both on a global and a regional basis, the World Health Organization (WHO) has set prominent goals for the turn of the millennium on the reduction of harms associated with licit and illicit drugs. Gauging what the world and its different regions are doing with respect to these specific public health goals is hindered by a conceptual problem: there is no clear concept and consistent way of defining or measuring 'harm' related to drugs, licit or illicit. In many instances, 'harm' is equated with substance use prevalence. Often, especially outside the developed world, basic harm data is not even available. Globally, a conceptually clear and consistently applied scheme of harm measurement related to licit and illicit drugs is needed, acknowledging the fact that drug-related harms occur at different individual and social levels as well as over different periods of time. Harms must also be recognized as an outcome of interactions between the substance user, the drug itself, and the physical and social environment. Looking at available macro-indicators of harm, it must be concluded with, we do not seem to be 'on track' globally in reducing harms related to drugs in accordance with the WHO goals. For alcohol and tobacco, trends for increased harm are just starting to show in the developing world, and will worsen over the next couple of decades. For illicit drugs, failing drug control policies have result in dramatically negative developments for public health, especially with respect to HIV infections and drug-related deaths, in the developed as well as developing world.

Alcohol Drinking↗
PubMed1997

Situational norms for drinking and drunkenness: trends in the US adult population, 1979-1990.

Drinking depends on time, place, situation and personal characteristics. Patterns and trends in situational drinking norms (subjective levels of acceptable consumption for various situations) for US adults are reported. Results are based on eight comparable normative questions from national household surveys conducted in 1979 (n = 1772), 1984 (n = 5221 including Hispanic and black oversamples) and 1990 (n = 2058). Across years and population subgroups, a correspondence in ordering of situations on acceptability of drinking and of drunkenness was found. There were contrasting secular trends in the acceptability of drunkenness in different situations: drinking "enough to feel the effects" became more acceptable when at home but less acceptable in several other situations, particularly for men at a bar. For a decreasing percentage of respondents of both genders, it remains more acceptable for men than women to drink in bars, but gender norms in such "wetter" situations were converging by 1990. Men remain more accepting of drinking (but not drunkenness) for "dryer" situations such as when driving, but the trend is towards reduced acceptance. Multiple regression models predicting "acceptance of drinking" and "acceptance of drunkenness" scores showed fair stability in explanatory variables over time, with drinking level and conservative Protestant affiliation (drinking) or age (drunkenness) the major contributors.

Adult↗
PubMed1997

Moderate drinking and health. Implications of recent evidence.

OBJECTIVE: To address three questions (Is moderate drinking good for health? Should people drink to prevent heart disease? What is moderate drinking?) and to examine and compare two recent Canadian guidelines on low-risk drinking in the context of counseling patients. DATA SOURCES: English-language data sources were searched, particularly peer-reviewed health and social science literature and recent expert reports. STUDY SELECTION: Studies and reports were selected for their scientific merit and direct relevance to the three questions addressed and to the formulation of guidelines on low-risk drinking. SYNTHESIS: While moderate drinking might protect some older people against coronary heart disease, it is associated with increased risk of hemorrhagic stroke, certain cancers, accidents and injuries, and a range of social problems. For most health outcomes, risk increases as consumption of alcohol increases. CONCLUSIONS: While the data have limitations, they provide a basis for formulating guidelines on low-risk drinking. The two Canadian guidelines, one developed from the perspective of health recovery, the other from the perspective of health promotion, complement each other in the context of counseling patients.

Accidents↗
PubMed1997

Alcohol, the individual and society: what history teaches us.

Drinkers derive both pleasure and pain from drinking, but harm may come also to others. Through religious or secular rules, societies have sought to limit these "externalities" of drinking. Societal reactions have primarily focused on social harms from drinking; policy attention to casualties and chronic health effects is fairly recent. Drinking behaviour varies greatly according to the cultural framing of alcohol; societal policies tend to vary accordingly. Ecological constraints and social norms on preparation and use meant that alcohol was often available only sporadically in tribal and village societies. Alcohol production has been increasingly industrialized and marketing increasingly globalized in the modern era. Now, free trade agreements and the doctrine of consumer sovereignty increasingly limit the scope of national alcohol control policies. On the other hand, modern society demands exacting standards of attention and care incompatible with intoxication, for instance when driving a car or minding children. Managing the conflict between these and alcohol's ready availability is seen as a wholly individual rather than a societal responsibility. Those who fail the task are defined as alcoholics, and modern states have increasingly provided treatment for them. While there is a renewed public health concern about the externalities of drinking, substantial availability reductions have historically often required the mobilization of strong popular movements of remoralization.

Alcohol Drinking↗
PubMed1996

Gender roles and interactions in drinking and drug use.

In gender-focused discussions of alcohol and other drug use and problems, the emphasis has usually been on the individual male or female or on the genders as aggregates of individuals. But most drinking and much drug use have strong social and interactional elements, where gender roles and often gendered interactions come into play. Drawing on the existing literature, opportunities for research on gender roles and interactions in drinking and drug use and problems are discussed under the following headings: courtship and affectional preference; sexuality; marriage and partnership; parenthood; friendship and peer relations; work roles; informal social control (spouse, relatives, friends); and domination, violence, and abuse.

Alcoholism↗
PubMed1996

WHO cross-cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results.

The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria--narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug--were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.

Alcoholism↗
PubMed1996

WHO working group on population levels of alcohol consumption: Oslo, 14-16 December 1994.

Target 17 of the Health Policy for Europe calls for the health-damaging consumption of dependence-producing substances such as alcohol, tobacco and psychoactive substances to be significantly reduced in all Member States between the year 1980 and the year 2000. With regard to alcohol, it is suggested that alcohol consumption be reduced by 25%, with particular attention to reducing harmful use. A question posed by a number of Member States is what is the level of per capita alcohol consumption of lowest risk to physical, psychological and social harm. A working group was convened to consider population levels of alcohol consumption with particular reference to the Member States of the European Region of WHO. A basis for understanding population problem experience can be established through the interaction between individual risk and distribution of consumption levels within the population. The working group concluded that public health policy within the European Region should continue to advise decreases of per capita consumption. Even when taking into account coronary heart disease, it can be concluded at the population level, across all ranges of alcohol consumption found in almost all countries of Europe, that a reduction in consumption is linked to better health. However, public health policy concerning alcohol should not be based solely on mortality. All outcomes of drinking, that is mortality, morbidity, social and criminal consequences, as well as quality of life, should be considered. The existing data relating alcohol consumption to health originates from countries primarily with a cultural experience of consuming alcohol. In those countries, where there is a cultural or religious tradition of not consuming alcohol, there can be no public health grounds for recommending alcohol consumption.

Adult↗
PubMed1996

Determinants of suggestions for alcohol treatment.

Entry to treatment is often precipitated by suggestions or pressure from relatives or friends, but we know little of the circumstances in which suggestions to cut down on drinking include advice to seek professional help. In 1993, 1034 Ontario adults were asked in a random digit dialling telephone survey if they had said something to a friend or relative about their drinking, or suggested they cut down. About 35% had said something within the last year, and 15% had taken the further step of suggesting they seek professional help or helping them get assistance. Respondents were asked a series of questions about the circumstances of the most recent time they had said something to the person. Whether respondents who said something recommended seeking professional help is related to these circumstances, and to the respondent's demographics and relationship to the drinker.

Adolescent↗
PubMed1996

On the emerging paradigm of drinking patterns and their social and health consequences.

Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption. This paper presents recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995. In particular, the social dimension in pattern research, and the relationship between patterns of drinking and casualties as well as social harm, are stressed. The paper also argues for better theories, incorporating knowledge from related basic disciplines. In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns. Finally, implications of research on drinking patterns for policy and programme development are discussed.

Alcohol Drinking↗
PubMed1995

The risk of harm to oneself from drinking, Canada 1989.

In a national sample of 11,634 Canadians aged 15 years and above, risk curves for harm to six life-areas from one's own drinking and for assault by another drinker rose steadily with the respondent's volume of alcohol consumption. While drinking five or more drinks on an occasion at least once a month substantially raised the risk at a given volume of drinking, the risk rose with volume even among those not regularly drinking five or more drinks. These relationships remained in logistic regressions which controlled for gender, age and educational level. Younger respondents, those without higher education and men reported more harm for a given level of their own drinking although differences by gender disappeared above one-third of one drink per day. Three sets of guidelines for low-risk drinking--two from Canada, and one generally used in Britain--were compared in terms of the proportions of respondents reporting harm from their own drinking among those who had kept within the guideline in the previous 7 days' drinking. More restrictiveness in the guidelines was associated with substantial reductions in reported drinking-related harm.

Adolescent↗
PubMed1995

Trends in the treatment of alcohol problems in the US general population, 1979 through 1990.

OBJECTIVES: The purpose of this study was to conduct a comprehensive analysis of alcohol-treatment service utilization trends in the general population during the 1980s. METHODS: Three national surveys of the US household population (1979, 1984, and 1990) were used for trend analysis of treatment utilization. Trends in demographic characteristics of persons with lifetime treatment rates and particular types of treatment were examined by means of logistic regression analysis, controlling for alcohol problem severity and other variables. RESULTS: Substantial increases in the numbers reporting treatment were found. In all surveys, Alcoholics Anonymous was the treatment used most frequently and its use increased most, especially for women. Men were more likely than women (odds ratio [OR] = 2.01, 95% confidence interval [CI] = 1.20, 5.39) and unmarried persons were twice as likely as married persons to have been treated [corrected]. Social consequences carried more predictive power than dependence symptoms. CONCLUSIONS: From a general population perspective, while overall treatment capacity has increased, the structural changes in the public/private balance of services have not positively affected the representation of women or other characteristics of the treatment population.

Adolescent↗
PubMed1993

Alcoholics anonymous, other 12-step movements and psychotherapy in the US population, 1990.

Based on the 1990 US National Alcohol Survey, this note provides the first available comprehensive findings on self-reported utilization of a variety of sources of personal support and counselling for alcohol and other problems. Respondents were queried about lifetime attendance and number of times they went to identified sources of help in the prior year. Twelve-step groups included Alcoholics Anonymous, Al-Anon, Adult Children of Alcoholics, and other non-alcohol-oriented groups like Gamblers Anonymous, Narcotics Anonymous, and Overeaters Anonymous; additional questions inquired about support or therapy groups and individual counselling for non-alcohol problems. Of the US adult population, 9% have been to an AA meeting at some time, 3.6% in the prior year, only about one-third of these for problems of their own. About half these percentages, mostly women, have attended Al-Anon. Of the same population, 13.3% indicate ever attending a 12-step meeting (including non-alcohol-oriented groups), 5.3% in the last year. During the prior year a further 2.1% used other support/therapy groups and 5.5% sought individual counselling/therapy for personal problems other than alcohol. In contrast to this high reported utilization, only 4.9% (ever) and 2.3% (12-months) reported going to anyone including AA for a problem (of their own) related to drinking.

Adolescent↗