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Robin Room

Publications and source records attributed to Robin Room.

At least 19 recordsLinked to original sources
PubMed2006

Global burden of disease from alcohol, illicit drugs and tobacco.

The use of alcohol, tobacco and illicit drugs entails considerable burden of disease: in 2000, about 4% of the global burden as measured in disability adjusted life years was attributable to each alcohol and tobacco, and 0.8% to illicit drugs. The burden of alcohol in the above statistic was calculated as net burden, i.e. incorporating the protective health effects. Tobacco use was found to be the most important of 25 risk factors for developed countries in the comparative risk assessment underlying the data. It had the highest mortality risk of all the substance use categories, especially for the elderly. Alcohol use was also important in developed countries, but constituted the most important of all risk factors in emerging economies. Alcohol use affected younger people than tobacco, both in terms of disability and mortality. The burden of disease attributable to the use of legal substances clearly outweighed the use of illegal drugs. A large part of the substance-attributable burden would be avoidable if known effective interventions were implemented.

Adolescent↗
PubMed2006

International control of alcohol: alternative paths forward.

Alcohol was the first psychoactive substance to be subject to international control, but these agreements between colonial powers have long since fallen away. In the wake of the entry into force of the Framework Convention on Tobacco Control (FCTC), paths forward for international control of alcohol are considered. The choices embedded in the FCTC are discussed, and the justifications for a parallel convention for alcohol considered. An alternative would be scheduling alcohol under one or more of the international drug conventions, most probably the 1971 convention, although the convention would have to be amended to allow use outside 'medical and scientific purposes' and without a prescription regime. In considering potential contents of an alcohol convention, it is noted that both the FCTC and the drug conventions are concerned at least as much with domestic markets as with international trade.

Alcohol Drinking↗
PubMed2006

Taking account of cultural and societal influences on substance use diagnoses and criteria.

AIMS: This article reviews the problems of cross-cultural applicability, which have been identified at the level of instrument items, at the level of criteria, and at the level of concepts and diagnoses. One near-universal appears to be that the diagnoses carry a weight of moral judgement and often of social stigma, whatever the clinician's intentions. METHODS: The findings of studies on variations between cultures in the meaningfulness and meaning of the main substance use diagnoses and criteria are described. RESULTS: Suggestions are made for directions of thinking and work to improve the cross-cultural applicability of five current diagnoses: intoxication, withdrawal, harmful use, abuse and dependence. CONCLUSIONS: It is argued that the possibility should be held open of bounded applicability of some diagnoses or criteria, in some societies but not in others.

Alcoholism↗
PubMed2005

Multi-level analysis of causal attribution of injury to alcohol and modifying effects: Data from two international emergency room projects.

Although alcohol consumption and injury has received a great deal of attention in the literature, less is known about patient's causal attribution of the injury event to their drinking or factors which modify attribution. Hierarchical linear modeling is used to analyze the relationships of the volume of alcohol consumed prior to injury and feeling drunk at the time of the event with causal attribution, as well as the association of aggregate individual-level and socio-cultural variables on these relationships. Data analyzed are from 1955 ER patients who reported drinking prior to injury included in 35 ERs from 24 studies covering 15 countries from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and the WHO Collaborative Study on Alcohol and Injuries. Half of those patients drinking prior to injury attributed a causal association of their injury with alcohol consumption, but the rate of causal attribution varied significantly across studies. When controlling for gender and age, the volume of alcohol consumed and feeling drunk (controlling for volume) were both significantly predictive of attribution and this did not vary across studies. Those who drink at least weekly were less likely to attribute causality at a low volume level, but more likely at high volume levels than less frequent drinkers. Attribution of causality was also less likely at low volume levels in those societies with low detrimental drinking patterns, but more likely at high volume levels or when feeling drunk compared to societies with high detrimental drinking patterns. These findings have important implications for brief intervention in the ER if motivation to change drinking behavior is greater among those attributing a causal association of their drinking with injury.

Adult↗
PubMed2005

Problematic drug use and drug use disorders in EU countries and Norway: an overview of the epidemiology.

OBJECTIVE: To estimate the prevalence of drug use disorders in the European Union and Norway. METHOD: Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of drug use disorders (DUD, defined as drug dependence and drug abuse or harmful use) in EU countries and Norway were reviewed. The search included both direct estimations based on general population surveys using the DSM-IIIR, DSM-IV, or ICD-10 definitions of DUD; and indirect estimates based on other epidemiological methods, such as multiplier procedures based on treatment or legal data and capture-recapture techniques. The indirect methods did not use diagnostic criteria, but criteria based on duration and pattern of use, labelled as problematic drug use as a meaningful approximation. RESULTS: The majority of DUD as estimated from direct methods using general population surveys were cannabis use disorders, usually not included in indirect estimates. The prevalence of thus defined disorders can be as high as 3%. For disorders other than cannabis use disorders (i.e. opioid, cocaine and amphetamine use disorders), indirect estimates of prevalence were consistently higher than those based on direct estimates, and ranged between 0.3% and 0.9% in European Union countries and Norway. Men have higher prevalence rates of DUD than women, but the difference was much less pronounced in general population surveys. Younger age (18-25 years) is the age group with the highest estimates. CONCLUSION: General population surveys typically result in a serious underestimation of the prevalence of DUD other than cannabis use disorders, because many people with DUD are not reached by these surveys (hidden populations). Based on the more valid indirect estimates, it is concluded that problem drug use constitutes a relatively high burden of disease and social problems in Europe.

Adolescent↗
PubMed2005

Alcohol use disorders in EU countries and Norway: an overview of the epidemiology.

Based on a systematic literature search and an expert survey, publications after 1990 on prevalence of alcohol use disorders (AUD) in EU countries and Norway were reviewed. The search was restricted to studies using the DSM-IIIR or DSM-IV, or ICD-10, plus validated instruments to assess AUD. Using only representative general population surveys, the weighted median estimates for 12-month prevalence rates for dependence alone are 6.1% for males (arithmetic mean 5.0%; interquartile range 0.4% to 7.5%) and 1.1% for females (arithmetic mean 1.4%; interquartile range 0.1% to 2.1%). Results thus showed, that AUD constitute a high burden of disease in Europe, but there was high variability of prevalence. Men have higher prevalence rates of AUD than women. No clear pictures emerged with respect to age and AUD prevalence, or with respect to urban vs. rural and AUD prevalence. The discussion highlights potential explanations for the high variability of prevalence between countries, and the fact, that AUD constitute only a small part of all alcohol-related harm.

Age Distribution↗
PubMed2005

Contributions of social science to the alcohol field in an era of biomedicalization.

In an era of biomedicalization where findings in genetic and neurobiological research are seen as "breakthroughs" by the media and hence by the general public, it is important for social scientists to acknowledge the effect of their contributions to the alcohol field not only to their own colleagues but also to the public at-large. Contributions of social science research to the development and evaluation of alcohol policies are illustrated in the following four areas: (1) alcohol epidemiological research focusing on the importance of examining drinking patterns and their relation to alcohol-related problems; (2) alcohol's contribution to the burden of disease; (3) alcohol control policies and their impact; and (4) brief interventions that provide strategies for at-risk drinkers as well as those who are alcohol dependent.

Alcohol Drinking↗
PubMed2005

Trends and issues in the international drug control system--Vienna 2003.

The April, 2003 meeting of the Commission on Narcotic Drugs, and the meetings and other efforts to influence it sponsored by interested parties before and around the Commission meeting, are described and analyzed. The 2003 meeting was seen as significant because it was the occasion for assessments of progress on the process goals set out in the United National General Assembly Special Session on drugs in 1998. Debate and discussion of the text of resolutions in the Commission meetings are analyzed in terms of the major points of conflict in 2003 between national delegations--cannabis policies, harm reduction, substitution therapy, and preferences for dramatizing or matter-of-fact language. Also discussed are the drift toward a crime rubric for the drug control system, and the increasing distance between the focus of the system on policing and the focus of most Western European governments on drugs as welfare or health issues. It is concluded that the system seems to be at a stalemate.

Drug and Narcotic Control↗
PubMed2005

Stigma, social inequality and alcohol and drug use.

A heavy load of symbolism surrounds psychoactive substance use, for reasons which are discussed. Psychoactive substances can be prestige commodities, but one or another aspect of their use seems to attract near--universal stigma and marginalization. Processes of stigmatization include intimate process of social control among family and friends; decisions by social and health agencies; and governmental policy decisions. What is negatively moralized commonly includes incurring health, casualty or social problems, derogated even by other heavy users; intoxication itself; addiction or dependence, and the loss of control such terms describe; and in some circumstances use per se. Two independent literatures on stigma operate on different premises: studies oriented to mental illness and disability consider the negative effects of stigma on the stigmatized, and how stigma may be neutralized, while studies of crime generally view stigma more benignly, as a form of social control. The alcohol and drug literature overlap both topical areas, and includes examples of both orientations. Whole poverty and heavy substance use are not necessary related, poverty often increases the harm for a given level of use. Marginalization and stigma commonly add to this effect. Those in treatment for alcohol or drug problems are frequently and disproportionately marginalized. Studies of social inequality and substance use problems need to pay attention also to processes of stigmatization and marginalization and their effect on adverse outcomes.

Alcoholism↗
PubMed2005

Alcoholics anonymous careers: patterns of AA involvement five years after treatment entry.

BACKGROUND: Most formal treatment programs recommend Alcoholics Anonymous (AA) attendance during treatment and as a form of aftercare, but we know very little about treatment seekers' patterns of AA involvement over time and how these relate to abstinence. METHOD: This paper applies latent class growth curve modeling to longitudinal data from 349 dependent drinkers recruited when they were entering treatment and were re-interviewed at one or more follow-up interviews one, three and five years later, and who reported having attended AA at least once. RESULTS: Four classes of AA "careers" of meeting attendance emerged: The low AA group mainly just attended AA during the 12 months following treatment entry. The medium and high AA groups were characterized by stable attendance at the second and third follow-ups-at about 60 meetings a year for the medium group and over 200 meetings per year for the high group, followed by slight increases for the medium group and slight decreases for the high group by year five. The declining AA group doubled its meeting attendance postbaseline, to almost 200 meetings during the year following treatment entry, but by year five they were only attending about six meetings on average. Decreases in AA meetings did not necessarily signal disengagement from AA; at the five-year follow-up, a third of the low AA group and over half of the declining AA group said they felt like a member of AA. Activities other than meeting attendance, such as having a sponsor, otherwise paralleled the meeting careers, but social networks were similar by year five. Rates of abstinence by year five (for the past 30 days) were 43% for the low AA group, 73% for the medium group, 79% for the high group and 61% for the declining group. Rates of dependence symptoms and social consequences of drinking did not differ between the groups at year five. CONCLUSIONS: The prototypical AA careers derived empirically are consistent with anecdotal data about AA meetings: some never connect; some connect but briefly; and others maintain stable (and sometimes quite high) rates of AA attendance. However, contrary to AA lore, many who connect only for a while do well afterwards.

Adult↗