Alcohol and drug use in UK university students

Twenty-year trends in illicit drug use among young Israelis completing military duty

AIM

This study examines patterns of illicit drug use in a national sample of young men and women in Israel over a 20-year period.

DESIGN

Annual cross-sectional data are analysed from an ongoing systematic sample of soldiers being discharged from active military service during the years 1982-2001.

SETTING

An anonymous questionnaire is self-administered to soldiers on the day of discharge in an unsupervised setting.

PARTICIPANTS

Between 1200 and 2800 individuals participated in the survey annually. A total of 40 518 people were included in the analysis. This sample frame is reflective of all Israel Defense Forces (IDF) releasees below the rank of Captain. Military recruits in Israel comprised about 80% of the country's 18-year-old Jewish male cohort in any given year, and about two-thirds of the female population of this age.

FINDINGS

Time-trends of drug use in Israel parallel those in the United States and European countries, although at much lower rates. Several indicators suggest a recent increase, particularly among women. Drug use is strongly inversely related to education level. Marijuana accounts for 65-75% of drug use in this young adult population.

CONCLUSION

Jewish cultural background and the military policy of zero tolerance are assumed contributors to the low drug use levels. Recent upward trends suggest that intensified prevention, surveillance and research efforts are in order.

Approaches to Brief Intervention for Hazardous Drinking in Young People

This article represents the proceedings of a symposium at the 2002 joint conference of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism in San Francisco. The chair was John B. Saunders. The focus of the symposium was on brief intervention approaches for hazardous drinking among young people. The presentations were (1) Evidence for the effectiveness of brief intervention as an approach to reducing hazardous alcohol use, by John B. Saunders; (2) College student hazardous drinking in New Zealand, the USA, UK, and Australia: implications for research, policy, and intervention, by Kypros Kypri; (3) Applications of motivational feedback on the college campus, by Scott T. Walters; (4) A population based individualized alcohol harm reduction feedback intervention: preliminary results from the college-based alcohol risk reduction (CBARR) trial, by Robert G. Laforge; and (5) Brief interventions: conclusions and future directions, by Mary E. Larimer.

Substance use in a sample of Turkish medical students

This study identifies the prevalence of smoking, alcohol, and illicit drug use in a sample of Turkish medical students. Information about substance use was obtained from 304 first-year, and 143 sixth-year medical students from three different medical schools in Turkey. Nearly half of the students (53.9%) were non-drinkers. Risky alcohol use was 7.4%. Lifetime smoking prevalence was 39.9 and 26.4% of the junior and 44.1% of the senior medical students (mean consumption of 13.9 and 15.5 cigarettes a day, respectively) reported regular smoking. Nicotine dependence was present in 3.1%. Only 4% of the students reported using illicit drugs (cannabis, ecstasy, cocaine) at least once in their lifetime. The mean ages of first use of cigarettes, alcohol and illicit drugs were earlier for junior medical students than senior students. Of the students, 25.5% had anxiety and 36.8% had depression scores in the clinically significant range. Our results suggest that although Turkish medical students are not at a high risk of substance abuse it should not be underestimated, and the risk factors as well as the protective factors must be identified in nation-wide studies.

Alcohol and drug use among vocational dental practitioners

OBJECTIVE

This study was designed to investigate the prevalence of alcohol and drug use in vocational dental practitioners (VDPs).

DESIGN

Anonymous self-report questionnaire.

SUBJECTS AND METHODS

All UK vocational dental practitioners (n = 719) who started practice in the summer of 1999 were questioned on their use of alcohol, tobacco, cannabis and other illicit drugs whilst a VDP and before graduation.

RESULTS

Eighty-nine per cent of males and 88% of females reported alcohol use. Of these, 35% of males and 36% of females drank above sensible levels (up to 21 units per week for males, 14 units for females), with 48% of males and 52% of females "binge drinking". Thirty-three per cent of respondents reported cannabis use whilst a VDP. Regular drug use (use at least once a month) other than cannabis whilst a VDP was found to be highest among males, with regular ecstasy use reported by 4% and regular cocaine use reported by 2%. Regular tobacco use (ten or more cigarettes per day) was reported by 9% of VDPs. Regular tobacco users were found to be six times more likely to use cannabis on a regular basis, three times more likely to use ecstasy on a regular basis and four times more likely to use cocaine on a regular basis than those VDPs who reported non regular tobacco use.

CONCLUSION

VDPs are drinking above sensible limits, binge drinking, using tobacco and indulging in illicit drug use to a degree that will cause health problems. However, use of all substances had reduced since qualification.

The pharmacology and clinical pharmacology of 3,4-methylenedioxymethamphetamine (MDMA, "ecstasy")

The amphetamine derivative (+/-)-3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is a popular recreational drug among young people, particularly those involved in the dance culture. MDMA produces an acute, rapid enhancement in the release of both serotonin (5-HT) and dopamine from nerve endings in the brains of experimental animals. It produces increased locomotor activity and the serotonin behavioral syndrome in rats. Crucially, it produces dose-dependent hyperthermia that is potentially fatal in rodents, primates, and humans. Some recovery of 5-HT stores can be seen within 24 h of MDMA administration. However, cerebral 5-HT concentrations then decline due to specific neurotoxic damage to 5-HT nerve endings in the forebrain. This neurodegeneration, which has been demonstrated both biochemically and histologically, lasts for months in rats and years in primates. In general, other neurotransmitters appear unaffected. In contrast, MDMA produces a selective long-term loss of dopamine nerve endings in mice. Studies on the mechanisms involved in the neurotoxicity in both rats and mice implicate the formation of tissue-damaging free radicals. Increased free radical formation may result from the further breakdown of MDMA metabolic products. Evidence for the occurrence of MDMA-induced neurotoxic damage in human users remains equivocal, although some biochemical and functional data suggest that damage may occur in the brains of heavy users. There is also some evidence for long-term physiological and psychological changes occurring in human recreational users. However, such evidence is complicated by the lack of knowledge of doses ingested and the fact that many subjects studied are or have been poly-drug users.

Incentives to increase participation in an Internet survey of alcohol use: a controlled experiment

AIMS

To examine the use of the Internet in a survey of drinking among students, and the effectiveness of incentives to encourage participation.

METHODS

In a survey of drinking in university students, a random sample of 160 students were randomly assigned to one of four token incentive conditions. All received posted invitations, and reminders by e-mail and telephone.

RESULTS

Overall response was 85% and did not differ significantly by incentive condition.

CONCLUSION

Internet surveys are effective in obtaining alcohol use information from students. Minimal incentives may suffice if coupled with intensive follow-up.

Nutritional intake of hazardous drinkers and dependent alcoholics in the UK

There are no recent assessments of nutritional intake in alcohol misusers in the United Kingdom. The purpose of this study was to measure nutritional intake in alcoholics attending an Alcohol Misuse outpatient clinic in an inner city general hospital in the United Kingdom and relating this to various measures of alcohol dependence. All patients (n = 30; 27 male, 3 female) consumed at least 100 g ethanol per day (mean 162 g/day) for at least 5 years and completed questionnaires on socio-demographics, alcohol dependency and psychosocial problems and had assays of biochemical and haematological indices. The data were analysed first with respect to the entire patient population and then according to the degree of alcohol dependency (mild, moderate or severe). The results showed that with respect to the entire patient group, one-third were below normal body weights, but one-quarter was overweight. The total energy intake (kJ/day) including alcohol was apparently adequate with respect to recommended levels in most patients. On average, approx. 60% of energy intake came from alcohol. The whole patient population had a low intake of one or more macro- and micro-nutrient compared to the dietary reference requirements. All patients had intakes of vitamin E and folate below UK recommended standards, while 85 - 95% of patients had low intakes of selenium and Vitamin D. Between 50 and 85% of all patents had intakes below UK recommended standards in calcium and zinc and Vitamins A, B(1), B(2), B(6) and C. There were significant correlations between calorie intake (when alcohol was excluded) and vitamins B(1), B(2), B(6) and C, and Ca, Mg, Fe and Zn intake. There were no correlations between alcohol intake with any of the nutritional and anthropometric variables or between the three subgroups with respect to daily energy, micro- and macro-nutrient intakes. In conclusion, malnutrition was common in this patient group: all subjects had intakes below UK recommended standards in one or more micro- or macro-nutrient. However, there was no difference in the degree of malnutrition between the harmful drinkers (mild dependency) and heavily dependent subgroups.

Cannabis use and anxiety in daily life: a naturalistic investigation in a non-clinical population

The study's objective was to investigate in a non-clinical population the association between cannabis use and anxiety in daily life using the Experience Sampling Method (ESM). Seventy-nine subjects with high or low levels of cannabis use were selected among a sample of 685 undergraduate university students. ESM was used to collect information on cannabis use and state-anxiety in daily life. DSM-IV diagnoses were assessed using a structured clinical interview. Statistical analyses were performed using multilevel linear random regression models. There was no significant association between the level of state anxiety and cannabis use in daily life. However, a diagnosis of agoraphobia was significantly associated with increased likelihood of cannabis use, independent of state anxiety and other confounding factors. No evidence was found for an anxiolytic or anxiogenic effect of cannabis in daily life. This finding does not support the hypothesis that subjects with high levels of anxiety use cannabis as a means of self-medication. The association between agoraphobia and cannabis use in daily life may be explained by anticipatory anxiety secondary to previous cannabis-induced panic-like symptoms.

Socioeconomic status and drinking patterns in young adults

AIMS

To investigate the relationship between several indicators of socioeconomic status and drinking patterns in young adulthood.

DESIGN

Data collected in a longitudinal study of young adults was analysed using repeated-measures models to examine the relationship between income, occupational activity and educational achievement and patterns of drinking.

SETTING

These data were collected as part of a longitudinal study ofa birth cohort of New Zealanders. They were interviewed for the most part in a central location using a face-to-face method and a computer-assisted alcohol interview.

PARTICIPANTS

The participants were members of the Dunedin Multidisciplinary Health and Development study aged 18, 21 and 26 years. Nine hundred and sixty-nine study members contributed to the analysis. Study members have been found to be broadly representative of the New Zealand population and cross national studies suggest findings are generalizable to other similar market economies.

MEASUREMENTS

Three indicators of socioeconomic status were used; educational achievement, occupational activity and income. The educational achievement indicator at age 18 had three levels that ranged from no school qualifications to higher school qualifications. For age 21 two additional categories of tertiary educational achievement were included to make five categories and for age 26 higher tertiary degrees were included in the measure to make six categories. Five categories of occupational activity were used. Income data was also used. Two measures of alcohol consumption were used. These were the frequency of drinking and the typical quantity of alcohol consumed per drinking occasion in the past year.

FINDINGS

Frequency of drinking increased over these early adult years and the quantities consumed peaked at age 21 and decreased thereafter for both males and females. Frequency of drinking was influenced by income with the higher income respondents drinking more often and this was persistent overtime. Quantity of drinking was most influenced by educational achievement. The less well-educated young adult drank significantly more during a drinking occasion and at all ages. There was also a relationship between educational achievement and frequency of drinking for males at age 18 and a relationship between women's occupational activity and the quantities they consumed.

CONCLUSIONS

The finding that the dimensions of drinking operate differently explains the lack of consistency in previous research, which has investigated socioeconomic status and the volumes of alcohol consumed. The findings of higher quantities consumed among those of lower social status may explain some of the reduced life expectancy found among those with lower socioeconomic status.

Adolescent precursors of cannabis dependence: findings from the Victorian Adolescent Health Cohort Study

BACKGROUND

Dependence increases the likelihood of adverse consequences of cannabis use, but its aetiology is poorly understood.

AIMS

To examine adolescent precursors of young-adult cannabis dependence.

METHOD

Putative risk factors were measured in a representative sample (n=2032) of secondary students in the State of Victoria, Australia, six times between 1992 and 1995. Cannabis dependence was assessed in 1998, at age 20-21 years.

RESULTS

Of 1601 young adults, 115 met criteria for cannabis dependence. Male gender (OR=2.6, P < 0.01), regular cannabis use (weekly: OR=4.9; daily: OR=4.6, P=0.02), persistent antisocial behaviour (linear effect P=0.03) and persistent cigarette smoking (linear effect P=0.02) independently predicted cannabis dependence. Neither smoking severity (P=0.83) nor persistent psychiatric morbidity (linear effect P=0.26) independently predicted dependence. Regular cannabis use increased risk only in the absence of persistent problematic alcohol use.

CONCLUSIONS

Weekly cannabis use marks a threshold for increased risk of later dependence, with selection of cannabis in preference to alcohol possibly indicating an early addiction process.

Ecstasy (MDMA): effects and patterns of use reported by users in São Paulo

OBJECTIVE

As there are no studies about the use of ecstasy in Brazil, our aim was to identify the effects and patterns of use of this substance among users in the city of São Paulo.

METHODS

Subjects were recruited through the snowball technique. Fifty-two subjects of both genders who had been using ecstasy frequently and recently were interviewed. The instrument was a self-reported and anonymous questionnaire.

RESULTS

The sample's mean age was 24 years, mostly composed by single, college graduated middle-class subjects. Among the interviewed users, 61.6% used ecstasy at least once per week and 50% of them took one pill per episode of use and 46% more than one. Drug taking was usually performed in company of several people (63%) in contexts related to night leisure, such as rave parties (78.8%), dancing clubs (69.2%) and parties (53.8%). Ecstasy pills were mainly purchased from friends or acquaintances in order to favor a dancing mood in those places. Most subjects used ecstasy associated to other psychoactive drugs (93.3%), mainly Cannabis, followed by tobacco and LSD. The effects attributed to ecstasy were mainly positive.

DISCUSSION

The use of ecstasy in São Paulo has had a recreational pattern quite similar to those described in previous studies. The assessment of the use of ecstasy as positive also agrees with the findings of the literature.

Overweight and obesity in relation to cardiovascular disease risk factors among medical students in Crete, Greece

BACKGROUND

Recent data indicate increasing rates of adult obesity and mortality from cardiovascular disease (CVD) in Greece. No data, however, are available on prevalence of overweight and obesity in relation to CVD risk factors among young adults in Greece.

METHODS

A total of 989 third-year medical students (527 men, 462 women), aged 22 +/- 2 years, were recruited from the University of Crete during the period 1989-2001. Anthropometric measures and blood chemistries were obtained. The relationships between obesity indices (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHpR], waist-to-height ratio [WHtR]) and CVD risk factor variables (blood pressure, glucose, serum lipoproteins) were investigated.

RESULTS

Approximately 40% of men and 23% of women had BMI > or = 25.0 kg/m2. Central obesity was found in 33.4% (average percentage corresponding to WC > or = 90 cm, WHpR > or = 0.9 and WHtR > or = 50.0) of male and 21.7% (using WC > or = 80 cm, WHpR > or = 0.8, WHtR > or = 50.0) of female students. Subjects above the obesity indices cut-offs had significantly higher values of CVD risk factor variables. BMI was the strongest predictor of hypertension. WHtR in men and WC in women were the most important indicators of dyslipidaemia.

CONCLUSION

A substantial proportion of Greek medical students were overweight or obese, obesity status being related to the presence of hypertension and dyslipidaemia. Simple anthropometric indices can be used to identify these CVD risk factors. Our results underscore the need to implement health promotion programmes and perform large-scale epidemiological studies within the general Greek young adult population.

Correlates of ecstasy use among students surveyed through the 1997 College Alcohol Study

Anecdotal reports have suggested that the use of 3,4-methylenedioxymethamphetamine (MDMA or "ecstasy") is a growing problem across the United States, primarily among college students and rave attendees. To assess this contention, the drug-using behaviors of 14,520 college students were examined with data collected through the 1997 College Alcohol Study (CAS). Prevalence estimates of ecstasy use were generated and associations between ecstasy use, demographic characteristics, and alcohol and other drug (AOD) use were explored. Six percent of the sample reported lifetime ecstasy use, 3 percent reported use within the past 12 months, and 1 percent reported use within the past 30 days. Compared to non-users, 12-month ecstasy users were significantly more likely to be white, to be a member of a fraternity/sorority, and to have used all other drugs of abuse during the past 12 months. Implications for these findings are discussed.

Young adults, alcohol, crime and disorder

BACKGROUND

Alcohol-related crime is increasingly being recognized as a problem in cities and towns with popular entertainment districts. Crime and disorder linked to alcohol has been particularly connected with binge drinking or heavy sessional drinking. Research evidence indicates that it is the young adult age group who are most likely to be involved in crime and disorder and the most likely to binge drink. This paper examines the relationship between binge drinking and criminal and disorderly behaviour among 18- to 24-year-olds.

METHOD

Secondary analysis was undertaken of the 1998/1999 Youth Lifestyles Survey, a large-scale, representative, household survey of 12- to 30-year-olds living in England and Wales.

RESULTS

Binge drinking, and especially male binge drinking, among 18- to 24-year-olds is statistically related to offending behaviour. In the 12 months prior to interview 39% of binge drinkers admitted to committing an offence and 60% admitted criminal and/or disorderly behaviour during or after drinking alcohol. Multivariate analysis found that binge drinking remains strongly associated with criminal and disorderly behaviour even after taking other relevant factors into account. Individuals who got drunk at least once a week had more than five times the odds of being involved in fighting or violent crime. For offences or disorderly behaviour that took place during or after drinking alcohol an individual had a seven times greater chance of breaking or damaging something and a five times greater chance of being involved in a fight if he/she got drunk at least once a week.

DISCUSSION

These findings suggest that frequency of drunkenness is a better predictor of offending behaviour than frequency of drinking per se. Using frequency of drunkenness as the basis for defining binge drinking reveals that a large minority of young adults who binge drink also become involved in offending or disorderly behaviour. Binge drinking is particularly associated with crimes of violence. The relationship between binge drinking and crime and disorder is stronger among young males than females.

A little nightclub medicine: the healthcare implications of clubbing

OBJECTIVE

To describe the scale and range of acute medical problems among patients who present to an inner city accident and emergency (A&E) department after attending nightclubs in Liverpool.

METHODS

From April 1997 to April 1998, all patients identified as having attended a nightclub before their arrival at the department were included in the study. Information regarding their attendance was gathered retrospectively using a standard proforma.

SETTING

A large, city centre, teaching hospital A&E department with an annual new patient attendance rate of over 95,000.

RESULT

777 such patients were enrolled in the study (0.81% of all new attendances during the same period). This was probably an underestimate, as some eligible patients were not identified during the study. Predictably, most presentations were at the weekend between midnight and 08.00. Surprisingly, the commonest mode of transport to the hospital was an ambulance (38%, 298 of the total). Assault accounted for most presentations (57%, 443 of the total) and lacerations were the commonest injury (the face being most frequently affected). Alcohol was the commonest intoxicant overtly associated with the A&E department attendance.

CONCLUSIONS

Injury after assault is the commonest precipitant of hospital care among clubbers in Liverpool. Alcohol is the most important contributory factor, although illegal drug misuse is a considerable challenge in the clubs themselves. A number of measures such as (a) the introduction of unbreakable glass or plastic containers; (b) the elimination of glass from outside clubs; (c) the provision of high quality immediate medical care at larger venues; (d) the curbing of over crowding and cheap drinks promotions; (e) registration of doormen, and (f) targeted policing of the areas around nightclubs are urgently required to reduce the healthcare (and civic) burden of clubbing. The cost for these should be borne by the highly profitable clubbing and brewing industries. A national code of practice for clubs-already in existence voluntarily-should be made mandatory.

The relation between alcohol abuse or dependence and academic performance in first-year college students

A large-scale study (N = 3,518) was designed to assess the academic performance of college freshmen in relationship to alcohol abuse or dependence. Alcohol abuse or dependence was identified in 501 (14%) students; of these, 128 (3.6%) were alcohol-dependent. Of the students who met criteria of alcohol dependence, 62.5% failed in their first year, compared to 50% among students who did not report these drinking problems.

The changing patterns of drinking, illicit drug use, stress, anxiety and depression in dental students in a UK dental school: a longitudinal study

OBJECTIVE

To investigate alcohol and illicit drug use in a cohort of dental undergraduates through to VT year.

SETTING

A UK dental school (with a medical school comparison group).

SUBJECTS AND METHODS

A cohort of dental students anonymously completed a lifestyle questionnaire about drinking and smoking, illicit drug use, stress, anxiety and depression in the spring of 1995 and 1998 as second and final year undergraduate students respectively, and in the summer of 1999 after one year working as qualified dentists. A parallel cohort of medical students also anonymously completed the questionnaire at the same time points in their undergraduate course as for the dental students, and at the end of a year working as Pre-Registration House Officers (PRHOs).

RESULTS

The proportion of dental students in Newcastle drinking above the recommended low risk limits of alcohol declined from 47% as second year students to 25% as final year students and then it increased to 41% as qualified dentists, whilst in medical students it steadily increased over the three time points of the survey (33% to 43% to 54%). A greater proportion of dental students were drinking at hazardous levels at all three time-points, compared with medical students. Experimentation with illicit drugs ranged from 47% as second year students to 54% as final year students and to 51% as dentists. The prevalence of illicit drug use in medical students was similar to that in dental students. Forty seven per cent of the dental student cohort as second year students, 67% as final year students and 16% as dentists suffered from possible pathological anxiety, compared with 47%, 26% and 30% in the medical student cohort. The proportion of dentists suffering from stress decreased from 72% as final year students to 19% as dentists. In the medical student group, the proportion increased from 32% as final year students to 39% as PRHOs.

CONCLUSION

This longitudinal study revealed that a high proportion of dental students from Newcastle continue to drink excessively and experiment with illicit drugs both as undergraduates and as practising dentists. A significant proportion also suffer from anxiety and stress. Further measures are needed in order to reduce alcohol and substance misuse and stress and anxiety among dental students and dentists.

Recreational Ecstasy/MDMA, the serotonin syndrome, and serotonergic neurotoxicity

The ring-substituted amphetamine derivative 3,4-methylenedioxymethamphetamine (MDMA) or "Ecstasy" is widely used a recreational drug. It stimulates the release and inhibits the reuptake of serotonin (5-HT) and other neurotransmitters such as dopamine to a lesser extent. The acute boost in monoamine activity can generate feelings of elation, emotional closeness, and sensory pleasure. In the hot and crowded conditions of raves/dances, mild versions of the serotonin syndrome often develop, when hyperthermia, mental confusion, and hyperkinesia predominate. Rest in a cooler environment generally reverses these problems, although they can develop into medical emergencies, which occasionally prove fatal. This acute serotonergic overactivity is exacerbated by the high ambient temperatures, overcrowding (aggregate toxicity), and use of other stimulant drugs. The on-drug experience is generally followed by negative moods, with 80--90% of weekend Ecstasy users reporting 'midweek blues', due probably to monoaminergic depletion. Single doses of MDMA can cause serotonergic nerve damage in laboratory animals, with repeated doses causing extensive loss of distal axon terminals. Huether's explanatory model for this 5-HT neurotoxicity will be briefly described. There is an increasing body of evidence for equivalent neuropsychobiological damage in humans. Abstinent regular Ecstasy users often show: reduced cerebrospinal 5-HIAA, reduced density of 5-HT transporters, blunted response to a fenfluramine challenge, memory problems, higher cognitive deficits, various psychiatric disorders, altered appetite, and loss of sexual interest. Functional deficits may remain long after drug use has ceased and are consistent with serotonergic axonal loss in higher brain regions.

Use, abuse and dependence of ecstasy and related drugs in adolescents and young adults-a transient phenomenon? Results from a longitudinal community study

OBJECTIVE

To determine incidence and patterns of natural course of ecstasy/stimulant/hallucinogen (ESH) use and disorders as well as cohort effects in a community sample of adolescents and young adults.

METHOD

Cumulative incidence and patterns of ecstasy use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14-24 years at the outset of the study. Patterns of DSM-IV defined ESH use, abuse and dependence were assessed with the Munich Composite International Diagnostic Interview (M-CIDI).

RESULTS

(1) Cumulative lifetime incidence for use of ESH at second follow-up: 9.1%, 1.0% for abuse, 0.6% for dependence; (2) men used and abused ESH more often than women; (3) the younger birth cohort (1977-81) tended to start earlier with substance (ab)use compared to the older birth cohort (1970-77); (4) use of ESH was associated with increasing rates of concomitant use of other licit and illicit drugs; (5) the majority of the lifetime ESH users without disorder had stopped to use these substances and not consumed them during the 12 months preceding the second follow-up; (6) those who had stopped to take ecstasy and related drugs at follow-up also took other illicit drugs less often than those who continued to consume ESH.

CONCLUSIONS

Use of designer drugs is widespread in our sample, but the probability of developing use disorders is fairly low (1.6%). The majority of the ESH users stopped their use spontaneously in their twenties (80% of the prior users without disorder, 67% of the prior abusers), but 50% of those that once had fulfilled DSM-IV criteria of dependence continued to use these substances.

The interactive effects of low self-control and commitment to school on substance abuse among college students

This study examined the combined influence of two predicting factors-low self-control and commitment to schooling-that research has shown have independent effects on substance abuse. In a sample of 598 college students, this study tested the interactive effects of these factors while controlling for other established predictors of binge drinking and drug use. Analysis showed that participants who had both low self-control and low schooling commitment had significantly higher scores on substance abuse than would be expected from the independent influences of the component factors, which suggests that the combined effects of these predictors on substance abuse have a greater influence than their direct influences.

Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research

MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' was scheduled as an illegal drug in 1986, but since then its recreational use has increased dramatically. This review covers 15 years of research into patterns of use, its acute psychological and physiological effects, and the long-term consequences of repeated use. MDMA is an indirect monoaminergic agonist, stimulating the release and inhibiting the reuptake of serotonin (5-HT) and, to a lesser extent, other neurotransmitters. Single doses of MDMA have been administered to human volunteers in double-blind placebo-controlled trials, although most findings are based upon recreational MDMA users. The 'massive' boost in neurotransmitter activity can generate intense feelings of elation and pleasure, also hyperactivity and hyperthermia. This psychophysiological arousal may be exacerbated by high ambient temperatures, overcrowding, prolonged dancing and other stimulant drugs. Occasionally the 'serotonin syndrome' reactions may prove fatal. In the days after Ecstasy use, around 80% of users report rebound depression and lethargy, due probably to monoaminergic depletion. Dosage escalation and chronic pharmacodynamic tolerance typically occur in regular users. Repeated doses of MDMA cause serotonergic neurotoxicity in laboratory animals, and there is extensive evidence for long-term neuropsychopharmacological damage in humans. Abstinent regular Ecstasy users often display reduced levels of 5-HT, 5-HIAA, tryptophan hydroxylase and serotonin transporter density; functional deficits in learning/memory, higher cognitive processing, sleep, appetite and psychiatric well-being, and, most paradoxically, 'loss of sexual interest/pleasure'. These psychobiological deficits are greatest in heavy Ecstasy users and may reflect serotonergic axonal loss in the higher brain regions, especially the frontal lobes, temporal lobes and hippocampus. These problems seem to remain long after the recreational use of Ecstasy has ceased, suggesting that the neuropharmacological damage may be permament. Copyright 2001 John Wiley & Sons, Ltd.

Patterns of drug use among young men in Piedmont (Italy)

Increasing alarm is shown regarding patterns of polydrug use among young people, particularly regarding recreational drugs. Prevalence of recreational drug usage in Europe is not clearly defined, varying for ecstasy, from 0.2% (Finland, 1995) to 9.2% (UK, 1995) and suggesting a tendency to increase in the last years. The aim of this study is to present patterns of polydrug use among a sample of the general population of young males in Piedmont (Northern Italy), focusing particularly on ecstasy consumption. A cross sectional study was carried out between September and November 1998 on a continuous sample of 3274 18-year-old conscripts. A self-administered anonymous questionnaire on socio-demographic characteristics and substances use was submitted during routine tests. Results showed that the overall lifetime prevalence of drug use is 36.6%; prevalence of polydrug use is 30% and the more frequently associated drugs are LSD, cocaine, inhalants and ecstasy. One hundred and forty five (4.6%) subjects reported having taken ecstasy at least once in their life; 20 of the 145 (13.8%) suffered from negative effects and three (2%) presented to a hospital or to a physician. The risk of ever taking ecstasy is inversely related to father's education, with a trend that is quite similar to that of heroin consumption but that is different from the trend for cannabis. In conclusion the four major results of this study are: (i) a prevalence of drug consumption similar to other European estimates, with a clear tendency to polydrug use; (ii) for ecstasy, a very high association rate with other substances; (iii) the moderately high prevalence of self-reported symptoms, and (iv) a social distribution of use similar to the one observed for heroin. This last consideration suggests that a high level of attention and further research should be addressed to the natural history of ecstasy use.

Drink and drugs: from medical students to doctors

Drinking and illicit drug use were assessed longitudinally in a cohort of medical students who were surveyed in the second and fifth year of their undergraduate studies and after 1 year as PRHOs. Mean alcohol consumption had increased significantly (P<0.015) over the three time points; 15.2-16.0-18.8 units/week. Experimentation with illicit drugs had increased from 50 to 63 to 65%. Although education on alcohol and illicit drugs should be part of core curriculum in medical schools, support and intervention in the workplace is also needed for individuals with alcohol and/or drug problems.

Trends in alcohol consumption in undergraduate third level students: 1992-1999

BACKGROUND

Alcohol consumption has increased in the Irish population in recent years. It is not known to what extent the student population has been affected by this increase.

AIM

To determine levels of alcohol consumption among undergraduates in one Irish university and identify changes in drinking patterns in the years 1992-1999.

METHODS

Information on alcohol use was obtained by anonymous self-completed questionnaire in a stratified random cross-faculty sample of undergraduates in 1992 and 1999. The CAGE questionnaire to determine problem drinking was included in both surveys.

RESULTS

A statistically significant (p=0.01) drop in weekly alcohol consumption by males was found, although the proportion of male problem drinkers increased. Consumption for females remained the same.

CONCLUSIONS

Findings are contrary to recent figures for drinking patterns in young Irish people in general. The fall in alcohol consumption in male students may be linked to improved male insight into the negative effects of alcohol or to the substitution of cheaper available substances.

Drugs and the dance music scene: a survey of current drug use patterns among a sample of dance music enthusiasts in the UK

This study explores the utility of a self-completion survey method to quickly and cheaply generate information on patterns and trends among regular "recreational" drug consumers. Data is reported here from 1151 subjects accessed through a dance music publication. In keeping with previous studies of drug use within the dance scene polysubstance use was the norm. Many of those reporting use of "ecstasy" were regularly using multiple tablets often consumed in combination with other substances thus exposing themselves to serious health risks, in particular the risk of dose related neurotoxic effects. Seventy percent were drinking alcohol at hazardous levels. Subjects' patterns of drug purchasing also put them at risk of severe criminal sanction. Data supported evidence that cocaine use had become increasing popular in the UK, but contrasted with some commentators' views that ecstasy use was in decline. The utility of this method and how the results should be interpreted is discussed, as are the data's implications for harm and risk reduction activities.

[Drug use prevalence and school performance among adolescents]

OBJECTIVE

To assess the prevalence of drug use among teenagers.

METHODS

A cross-sectional study was carried out in Pelotas, Southern Brazil, in 1998. An anonymous, self-administered questionnaire was answered by a sample of 2,410 students with ages ranging from 10 to 19 years old, registered in all public and private high schools of the area. The schools were visited up to three times to reach absent students.

RESULTS

The attrition rate was 8%. The substances mostly used by the students were alcohol (86.8%), tobacco (41.0%), marijuana (13.9%), inhalants (11.6%), anxiolytic drugs (8.0%), amphetamines (4.3%), and cocaine (3.2%). Marijuana, inhalants and cocaine were used mainly by male students, while anxiolytics and amphetamines were used mainly by female students. Alcohol consumption in the last 30 days, frequent drug use, heavy drinking and alcohol intoxication were more prevalent among males. After controlling for confounding factors, there was still an association between drug use (except for alcohol and tobacco) and evening courses, higher degree of nonattendance in the previous month and higher rate of school failure.

CONCLUSIONS

The prevalence of drug experimentation among high school teenagers is high, indicating the importance of early detection of risk groups and development of programs to prevent drug abuse and addiction.

The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in healthy volunteers

MDMA (3,4-methylenedioxymethamphetamine) or 'Ecstasy' is a widely used recreational drug that produces a state of heightened mood but also cardiovascular and vegetative side-effects. In animals, MDMA releases serotonin and, to a lesser extent, dopamine and norepinephrine. The release of serotonin can be blocked by serotonin uptake inhibitors such as citalopram. It is unknown to what extent this mechanism is also responsible for the physiological side-effects of MDMA seen in humans. We investigated the effect of citalopram pretreatment (40 mg i.v.) on vegetative and cardiovascular effects of MDMA (1.5 mg/kg p.o.) in a double-blind placebo-controlled study in 16 healthy volunteers. MDMA moderately increased blood pressure and heart rate, slightly elevated body temperature and produced a broad range of acute and short-term side-effects. Citalopram reduced all these MDMA-induced physiological changes except for body temperature. These findings suggest that physiological effects of MDMA in humans are partially due to an interaction of MDMA with the serotonin carrier and a subsequent release of serotonin.

The effect of (R)-HA966 or ACEA 1021 on dexfenfluramine or (S)-MDMA-induced changes in temperature, activity, and neurotoxicity

The glycine site-specific N-methyl-D-aspartate (NMDA) antagonist 5-nitro-6,7-dichloro-2,3-quinoxalinedione (ACEA 1021, 4x30 mg/kg, i.p.) given 30 min before dexfenfluramine (4x15 mg/kg, i.p., every 2 h) was unable to prevent dexfenfluramine-induced depletion of 5-hydroxytryptamine (5-HT), 5-hydroxyindoleacetic acid (5-HIAA) content, and 5-HT transporter (5-HTT) density. Another glycine site-specific NMDA antagonist, R(+)-3-aminohydroxypyrrolidin-2-one [(R)-HA 966] (2x30 mg/kg, ip), given 30 min before dexfenfluramine (2x10 mg/kg, ip, 2 hourly) was also unable to prevent regional depletion of 5-HT, 5-HIAA, and 5-HTT density. However, ACEA 1021 (4x30 mg/kg, i.p.) given 30 min before (S)-3,4-methylenedioxymethamphetamine (MDMA, 4x10 mg/kg, 2 hourly, ip) attenuated the regional depletion of dopamine (DA), dihydroxyphenylacetic acid (DOPAC), 5-HT, 5-HIAA content, and 5-HTT density. ACEA 1021 combined with (S)-MDMA also prevented (S)-MDMA-induced hyperthermia without causing hypothermia or preventing an (S)-MDMA-induced increase in locomotor activity.

Pharmacology and effects of cannabis: a brief review

BACKGROUND

Increasing prevalence of recreational cannabis use among the young population has stimulated debate on the possible effects of acute and longterm use.

AIMS

To highlight recent knowledge of mechanisms of action, effects on psychomotor and cognitive performance, and health risks associated with cannabis consumption.

METHOD

A brief review of recent literature on the prevalence of recreational cannabis use, the potency of modern cannabis preparations and the pharmacological actions of cannabis.

RESULTS

Cannabinoids derived from herbal cannabis interact with endogenous cannabinoid systems in the body. Actions on specific brain receptors cause dose-related impairments of psychomotor performance with implications for car and train driving, aeroplane piloting and academic performance. Other constituents of cannabis smoke carry respiratory and cardiovascular health risks similar to those of tobacco smoke.

CONCLUSIONS

Cannabis is not, as widely perceived, a harmless drug but poses risks to the individual and to society.

An "accidental" acute psychosis with ecstasy use

Over the last 10 years, Europe has witnessed the development of the ecstasy phenomenon; this term is used to describe several products sharing more or less the same effects. The most widely used and hence the most well known is 3,4 MDMA, but MDA, MDEA, MBDB and even 2CB or nexus are available. The psychopathological consequences of MDMA use in man are relatively poorly understood. The case reported here involves an acute psychotic episode with residual symptoms after six months, with a sudden onset at least 12 hours after taking alcohol and ecstasy without realising it, in an individual with no previous psychopathology other than a moderate anxiety disorder. Twelve cases of acute psychotic episodes after taking ecstasy have been reported in the literature; two after taking the drug on two occasions and one after a single use. No authors have examined the previous mental state or possible previous psychopathology with any precision. The present subject had not displayed any previous psychotic behavior when tested with a proven standardized interview technique; this was confirmed by his peers and his family. He did, however, show signs of social phobia. Although the personality of an individual is a factor in taking a drug, and probably in the quality of the psychotropic effects experienced, a host of arguments favor the appearance of psychotic symptoms de novo, which were probably related to direct toxicity by MDMA and/or its metabolites on the serotoninergic neurons.

Use and abuse of licit and illicit substances: prevalence and risk factors among students in Lebanon

OBJECTIVE

This study aims at examining the patterns of 'substance' use in Lebanon among an 'at risk' population, the university students.

METHOD

A stratified cluster sample of 1,851 students from two major universities was included in the study and the Diagnostic Interview Schedule (version 3) was administered.

RESULTS

The prevalence of nicotine users in the sample was 18.3% and of ever consuming alcohol 49.4%. 2.1% of the sample were alcohol abusers and 2.4% alcohol dependents according to DSM-III criteria. For the remaining substances, tranquilizers were found to have the highest rate of ever use (10.2%), whereas heroin had the lowest rate (0.4%); the rates of abuse and dependence in these categories (other than alcohol and nicotine) following DSM-III criteria ranged from 0.1 to 0.8%.

CONCLUSION

University students in Lebanon in this study have relatively low rates of use and abuse of substances but this might be changing.

Issues in measurement

Measurement lies at the heart of all quantitative methods in clinical, epidemiological and health services research. If the measures employed lack the essential features of validity and reliability then the conclusions drawn from empirical findings may mislead. This short article explains and explores the desirable features of measurement instruments used in health-care research.

A survey of alcohol and drug use among UK based dental undergraduates

OBJECTIVE

This study was designed to investigate the prevalence of alcohol and drug use.

DESIGN

Anonymous self-report questionnaire.

SETTING

A UK dental school in May 1998.

SUBJECTS AND METHODS

1st-5th year dental undergraduates (n = 264) were questioned on their use of alcohol and tobacco, cannabis and other illicit drugs whilst at dental school, and before entry.

RESULTS

Eighty two per cent of male and 90% of female undergraduates reported drinking alcohol. Of those drinking, 63% of males and 42% of females drank in excess of sensible weekly limits (14 units for females, 21 units for males), with 56% of males and 58.5% of females 'binge drinking'. Regular tobacco smoking (10 or more cigarettes a day) was found to have a statistically significant association with year of study, 4th-5th year undergraduates being eight times more likely to regularly smoke than their junior colleagues. Fifty five per cent of undergraduates reported cannabis use at least once or twice since starting dental school, with 8% of males and 6% of females reporting current regular use at least once a week.

CONCLUSION

Dental undergraduates are drinking above sensible weekly limits of alcohol, binge drinking and indulging in illicit drug use. Dental Schools should designate a teacher responsible for education of undergraduates regarding alcohol and substance abuse.

Human research on MDMA (3,4-methylene- dioxymethamphetamine) neurotoxicity: cognitive and behavioural indices of change

Laboratory animals can develop serotonergic neurotoxicity after repeated doses of 3,4-methylenedioxymethamphetamine (MDMA) or 'Ecstasy'. If similar neural damage occurs in humans, this may be evident in cognitive or behavioural impairments. In a review of the behavioural skills shown by drug-free recreational Ecstasy users, three aspects of cognitive performance are often affected: reduced memory for new information (Rivermead Behavioral Memory, supraspan word recall), impaired higher executive processing (Wisconsin Card Sort, Tower of London), and heightened impulsivity (Impulsiveness, Venturesomeness and Empathy Questionnaire, Matching Familiar Figures test). Performance on other more basic cognitive functions is generally unimpaired (simple reaction time, choice reaction time, number vigilance, Stroop, trail making). Some Ecstasy users also complain of poor memories and/or concentration difficulties, which they attribute to MDMA use. There are many methodological problems and uncertainties with research in this field: non-random allocation of subjects to drug conditions, the deleterious effects of other psychoactive drugs, and the possibility that these adverse profiles reflect pre-existing personality characteristics in Ecstasy users. However, this particular pattern of cognitive decrements in humans, is consistent with the animal data on those brain areas showing serotonergic damage following MDMA: the frontal cortex (impulsivity and higher cognitive impairments), and hippocampus (memory deficits). Finally, this profile of cognitive deficits is also consistent with a hypothetical integrative construct: namely reduced cortical inhibition.

Aortic dissection after ingestion of "ecstasy" (MDMA)

The authors report a case of aortic dissection and cardiac tamponade in a 29-year-old man after ingestion of ecstasy (methylenedioxymethamphetamine, MDMA) at a "rave" party. There was no history of hypertension, myxoid heart disease, or other risk factors for aortic dissection in the deceased, although a minor degree of cystic medial necrosis was noted on histologic examination of the aorta. Autopsy toxicology revealed low residual levels of MDMA in the blood about 48 hours after ingestion of the drug. This case report describes a probable association between MDMA ingestion and aortic dissection in a previously well young adult. The likely mechanisms are discussed, and the difficulties in diagnosing this complication are highlighted.

Factors influencing alcohol and illicit drug use amongst medical students

Alcohol, illicit drug use, and other lifestyle variables, as well as stress, anxiety and personality were evaluated in 194 first year medical students. 45% of the students reported drinking above the recommended UK limits for alcohol consumption. The age at which the first full drink of alcohol was taken was predictive of the current level of alcohol use. Cannabis was the most frequently used illicit drug (45%). There were significant positive associations between alcohol consumption and experiences such as missing study, becoming more sexually involved and getting into a physical fight or argument. There were also significant positive associations between the personality characteristic of psychoticism and alcohol and illicit drug consumption. The effectiveness of current health education on alcohol and illicit drugs is questioned.

Amphetamine designer drugs - an overview and epidemiology

The methylenedioxy-derivatives of amphetamine and methamphetamine represent the largest group of designer drugs. The most frequently used compounds are 3,4-methylenedioxy-methamphetamine (MDMA-ecstasy) and 3,4-methylenedioxy-amphetamine (MDA), first synthesised in 1910 (MDA) and 1914 (MDMA), respectively, to be used as an appetite suppressant. At the end of the 1960s, non-medical (recreational) use appeared in the USA, and in the middle of the 1980s in Europe. In Norway, MDMA and related compounds have been detected in forensic samples since the early 1990s. In order to bypass the legal regulations and to produce more potent substances, a number of related compounds have been synthesised, including derivatives with one or more substituents (methoxy, methyl, halogen or sulphur), attached at different positions to the phenylring of amphetamine or methamphetamine. A report from 1998 shows that 0.5-3% of the adult European population, mainly young people, has used ecstasy.

Analysis of illicit ecstasy tablets: implications for clinical management in the accident and emergency department

OBJECTIVE

To examine the composition of illicitly manufactured "ecstasy" tablets sold on the UK drugs market.

METHODS

Analysis by gas chromatography of 25 illicit ecstasy tablets handed in under amnesty to Leeds Addiction Unit.

RESULTS

Illicitly manufactured ecstasy tablets contain a range of ingredients, of widely differing concentrations, and even tablets with the same brand name have variable concentrations of active ingredients. Concentrations of 3,4-methylenedioxymethamphetamine (MDMA) more popularly known as ecstasy, varied 70-fold between tablets. Nine tablets contained neither MDMA nor related analogues.

CONCLUSIONS

These results have implications for emergency workers attending to those who have become casualties of the drug ecstasy. Those claiming to have ingested ecstasy may actually have taken other agents that require different clinical management.

The biosciences in the pre-registration nursing curriculum: staff and students' perceptions of difficulties and relevance

This paper considers the problematic position of the biological sciences in pre-registration nurse education--'The Bioscience Question'. There is no consensus and little research on the appropriate content and depth of bioscience knowledge required by nurses. Attempts to apportion curriculum time for the biosciences are confounded by the difficulty experienced by nursing students with this area. Within one university department, a survey was undertaken to investigate the perceptions of pre-registration students, and their teachers, of the teaching and learning of biological science, in comparison with other areas of the curriculum. Our findings concur with others that the biosciences are a source of disproportionate difficulty and anxiety to nursing students. Among the students, but not the lecturers, there was some, by no means universal, support for the suggestion that these problems could be reduced by a reallocation of curriculum time in favour of the biosciences. Although it was agreed that bioscience theory should be related more closely to nursing practice, there was no evidence that this lessened the students' difficulties with the subject. In contrast to lecturers, students felt the biosciences to be one of the areas of the pre-registration curriculum most relevant to clinical practice.

An update on British medical students' lifestyles

Information about medical students' lifestyles was obtained from 785 second-year students from seven medical schools in Great Britain by a personally administered questionnaire. Fifteen per cent of the students were non-drinkers. Among those who drank, 48% of the men and 38% of the women exceeded sensible weekly limits of alcohol consumption, and high-risk levels of consumption were reported by 12% of men and 7% of women. Cannabis had been used at least once or twice by more than half the men and 40% of the women, and 10% reported regular use (weekly or more often). Experience with other illicit drugs was also reported: amphetamines (8% of students), LSD (7%), ecstasy (4%), amyl/butyl nitrate (10%) and magic mushrooms (7%). Nineteen per cent of the students had used two or more different drugs. Experience with illicit drugs started before entering university in more than a third of those who used them. Comparison of the results with other student surveys suggests that the lifestyles of medical students differ little from those of other student groups, but that alcohol and illicit drug consumption is increasing in university students generally. Prospective studies are under way to establish whether medical students change their lifestyles at later stages of their course and after qualification.

Patterns of alcohol consumption, smoking and illicit drug use in British university students: interfaculty comparisons

The use of tobacco, alcohol and illicit drugs was investigated by questionnaire in 3699 second year students in ten UK universities. Patterns of use varied considerably between different faculty groups. Tobacco use was most prevalent in arts, social science and biological science students, among whom 36-39% of men and nearly one third of women were regular smokers, and least in female veterinary students (5%). Alcohol consumption was greatest in biological science students: 23% of those who drank exceeded 'hazardous' levels compared with 10-16% in all other faculties. Prevalence of cannabis use was highest in arts and social science students of whom 27% reported regular weekly use compared with 9-22% in other faculties. Experience with other illicit drugs was greatest among arts, social science and physical science students, of whom 64-71% reported experience at least once or twice, and least among veterinary students (42%). Identification of different lifestyles may help to direct appropriate health information to particular student groups.