Peer reviewed: Yes
Type of study: Longitudinal study
Subject of study: People
Funding: Government/research council and charity/NGO

When the Department of Health (England) introduced financial incentives to encourage general practitioners (GPs) to talk to patients about their drinking in April 2008, there was a small, gradual increase in screening and the provision of alcohol advice. However, when the incentives stopped in 2015, rates of screening and advice-giving decreased immediately, and have stayed low ever since.

Published today in the scientific journal Addiction, and funded by the National Institute for Health Research, this is first large-scale assessment of the impact of paying GPs in England to screen patients for higher-risk drinking, and provide advice to those needing to reduce their alcohol consumption. Under the incentive scheme, participating practices were paid £2.38 (approximately $3.04 or €2.71) for each newly registered adult patient they screened for higher-risk drinking. The scheme was withdrawn in April 2015. 

Using an electronic dataset of over 4 million newly registered patients, the study found:

• Before the introduction of the scheme, 92 out of every 1,000 eligible patients were screened for higher-risk drinking each month, and fewer than 15 in every 1,000 screen-positive patients received brief advice.
• Introducing financial incentives had little impact on screening rates but led to an immediate increase in advice provision, with just over 20 more higher-risk drinkers receiving support per month for every 1,000 patients that screened positive.
• Since the scheme was discontinued, the rate of screening has fallen by almost three patients per month, and as of December 2016, out of every 1000 screen positive patients, 31 fewer were receiving brief advice for their drinking compared with March 2015.

Lead author Dr Amy O’Donnell explains: “Scaling-up our findings to the English population, we estimate that by the end of 2016 alone, 27,000 fewer patients received brief advice as a result of terminating the alcohol incentive scheme. This is despite the fact that GPs are still legally obliged to identify and support higher-risk drinkers.” She continued: “As well as drawing attention to the disappointing rates of alcohol advice giving in England since GP payments were withdrawn, our findings also highlight the real risks of using short-term financial incentives to boost delivery of public health measures in healthcare.”

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For editors:

This paper is free to download for one month after publication from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.14778 (after the embargo has lifted) or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

To speak with lead author Dr. Amy O’Donnell: contact her through Newcastle University’s Institute of Health and Society by email (amy.odonnell@newcastle.ac.uk) or telephone (+44 (0)191 208 5696).

Full citation for article: O’Donnell A, Colin A, Hanratty B, Hamilton FL, Petersen I, and Kaner E (2019) Impact of the introduction and withdrawal of financial incentives on the delivery of alcohol screening and brief advice in English primary health care: an interrupted time series analysis.  Addiction 111: doi: 10.1111/add.14778.

Funders:  This research was funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR) and further supported by a research innovation grant from Alcohol Change UK (R2016/01).

The National Institute for Health Research (NIHR) is the nation's largest funder of health and care research. The NIHR:

• Funds, supports and delivers high quality research that benefits the NHS, public health and social care
• Engages and involves patients, carers and the public in order to improve the reach, quality and impact of research
• Attracts, trains and supports the best researchers to tackle the complex health and care challenges of the future
• Invests in world-class infrastructure and a skilled delivery workforce to translate discoveries into improved treatments and services
• Partners with other public funders, charities and industry to maximise the value of research to patients and the economy

The NIHR was established in 2006 to improve the health and wealth of the nation through research, and is funded by the Department of Health and Social Care. In addition to its national role, the NIHR commissions applied health research to benefit the poorest people in low- and middle-income countries, using Official Development Assistance funding.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2018 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

Peer reviewed: Yes
Type of study: Survey
Subject of study: People
Funding: Government/research council

A new study published today by the scientific journal Addiction found that raising the legal age of sale of cigarettes from 18 to 21 in the U.S. was associated with a 39% reduction in the odds of regular smoking in 18- to 20-year-olds who had experimented with cigarettes. The reduction was even greater (50%) in those who had close friends who smoked when they were 16.

The study compares smoking prevalence among 18-20 versus 21-22-year-olds, in regions that did versus did not raise the legal age of tobacco sales to 21. In areas with tobacco-21 laws, 18-20-year-olds were much less likely to smoke than their same-age peers in areas without these policies. That differential was not evident for 21-22-year-olds, who would not have been bound by the sales restriction but should have been affected by other local factors that might explain the younger age-group’s differential smoking rate (e.g., other local tobacco policies, regional attitudes towards smoking).

Lead author Abigail Friedman, assistant professor at the Yale School of Public Health, commented, “This research indicates that a ‘social multiplier’ effect may amplify the impact of tobacco-21 laws. While these policies were associated with a 39% drop in the odds of regular smoking overall, the reduction was larger among young people whose friends were likely to smoke before tobacco-21 laws were adopted. As peer smoking is a critical predictor of youth smoking, this study suggests that tobacco-21 laws may help reduce smoking among those most susceptible to tobacco use. This result supports raising the age of sale to 21 as a means to reduce young adult smoking and improve public health.”

As of June 2019, sixteen U.S. states and over 400 localities have adopted tobacco-21 laws.

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For editors:

Research reported in this press release was supported by grant number P50DA036151 from the National Institute on Drug Abuse, part of the National Institutes of Health (NIH), and FDA Center for Tobacco Products (CTP). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

This paper is free to download for one month after publication from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.14653 (after the embargo has lifted) or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

To speak with lead author Dr. Abigail Friedman: contact her through the Yale School of Public Health by email (abigail.friedman@yale.edu) or telephone (+1 203 785 5760).

Full citation for article: Friedman AS, Buckell J, and Sindelar JL (2019) Tobacco-21 laws and young adult smoking: quasi-experimental evidence.  Addiction 111: doi:10.1111/add.14653.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2018 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

31 July 2019 correction from lead author:  

The empirical analysis did not follow areas pre- and post- adoption of tobacco-21 policies. Thus, the following opening paragraph would be more accurate:

“A new study published today by the scientific journal Addiction suggests that raising the legal age of sale for cigarettes from 18 to 21 in the U.S. would reduce smoking among 18 to 20-year-olds. Specifically, living in a state or city with a minimum legal sales age of 21 was associated with a 39% reduction in the odds of regular smoking among 18- to 20-year-olds who had experimented with conventional or electronic cigarettes. The reduction was even greater (50%) among those who had close friends who smoked when they were 16.”

Peer reviewed: Yes
Type of study: Systematic Review
Subject of study: People
Funding: Government/research council

A new review of evidence from the UK has found high levels of alcohol dependence among hospital inpatients. The researchers estimate one in five patients in the UK hospital system uses alcohol harmfully, and one in ten is alcohol dependent.

Currently little is being done to screen routinely for alcohol dependence in hospitals, and services for patients with alcohol dependence are limited. The researchers call for universal screening in hospitals for alcohol-related problems and improved training for hospital staff around alcohol-related conditions.

This new systematic review and meta-analysis, published in the scientific journal Addiction, provides the first robust estimates of alcohol-related conditions among UK hospital inpatients by pooling the results of 124 earlier studies covering a total of 1,657,614 participants.

The prevalence of alcohol-related conditions was already thought to be higher in hospital inpatients compared with the general population, but until now we have not had reliable estimates of the true overall prevalence of these conditions in the inpatient population.  The review suggests harmful alcohol use is ten times higher in hospital inpatients, and alcohol dependence is eight times higher, compared with the UK general population.

The review also found that harmful use of alcohol is most prevalent in mental health inpatient units and alcohol dependence is found most commonly in patients attending accident and emergency departments.

Alcohol-related conditions are estimated to cost the National Health Service (NHS) approximately 3.5 billion pounds per year. Alcohol can cause a large number of medical conditions and without in-hospital screening many alcohol-related conditions may be missed and not receive appropriate treatment. Accurate prevalence estimates are vital to inform policy makers of the scale of the problem and are particularly timely given the UK government’s development of a new alcohol strategy and the NHS 10-year plan, which includes funding allocations to combat alcohol-related conditions.  

Lead researcher Dr Emmert Roberts, from the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, says: ‘Many doctors are aware that alcohol-related conditions are common among hospital inpatients, but our results suggest the problem is much bigger than anecdotally assumed. Dedicated inpatient alcohol care teams are needed to ensure this widespread problem is being addressed, particularly in the context of diminishing numbers of specialist community alcohol services in the UK.’

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For editors:

This paper is free to download for one month after publication from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.14642 or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

To speak with lead author Dr Emmert Roberts, please contact: Robin Bisson, Senior Press Officer, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, robin.bisson@kcl.ac.uk / +44 20 7848 5377 / +44 7718 697176

Full citation for article: Roberts E, Morse R, Epstein S, Hotopf M, Leon D, and Drummond C (2019) The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: A systematic review, meta-analysis and meta-regression.  Addiction 111: doi:10.1111/add.14642.

The study was funded by the lead author’s Medical Research Council Addiction Research Clinical (MARC) Fellowship.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2018 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

About King’s College London and the Institute of Psychiatry, Psychology & Neuroscience
King's College London is one of the top 10 UK universities in the world (QS World University Rankings, 2018/19) and is among the oldest universities in England.  The Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London is the premier centre for mental health and related neurosciences research in Europe. It produces more highly cited publications in psychiatry and mental health than any other university in the world (Scopus, 2016), with 21 of the most highly cited scientists in this field. World-leading research from the IoPPN has made, and continues to make, an impact on how we understand, prevent and treat mental illness and other conditions that affect the brain. www.kcl.ac.uk/ioppn

Peer reviewed: Yes
Type of study: Review
Subject of study: People
Funding: Government/research council

A major new review of the world literature has found that Fetal Alcohol Spectrum Disorder (FASD) is 10 to 40 times higher in certain susceptible groups than the general population. These groups include children in care, people in correctional services or special education services, Aboriginal populations, and people using specialized clinical services.

FASD is a serious, lifelong, disabling condition that affects individuals from all racial, ethnic and socioeconomic backgrounds. It is caused by alcohol consumed during pregnancy. Alcohol is a toxic substance that can readily cross the placenta, resulting in permanent damage to the brain and other organs of the developing embryo and fetus. An estimated one in every 13 infants prenatally exposed to any level or type of alcohol will develop FASD; about 630,000 infants are born with FASD in the world each year.

This study used data from 69 studies representing 17 countries across North and South America, Europe, Asia, and Australasia. The studies included five sub-populations: children in care, people in correctional services, Aboriginal populations, people in special education services, and people using specialized clinical services (genetic clinics and clinics for developmental disabilities or psychiatric care).

The estimated prevalence of FASD in these groups ranged from 10 to 40 times higher than the 7.7 per 1,000 global FASD prevalence in the general population. For example, FASD prevalence among children in care was 32 times higher in the United States and 40 times higher in Chile; prevalence among adults in the Canadian correctional system was 19 times higher; and prevalence among special education populations in Chile was over 10 times higher.

Lead author Dr Svetlana Popova says, “Public policy and clinical care for people with FASD needs to recognise the severity of the problem globally. Routine screening protocols should be established to identify people with FASD in child welfare, special education, justice system and other settings to provide appropriate support and early interventions. Service staff should be trained in FASD awareness, identification, and interventions to provide better care. Women should completely abstain from any type of alcohol during their entire pregnancy and while trying to get pregnant.”

This review was restricted by the limited number of studies, some of which were dated and had methodological weaknesses. Countries need to conduct rigorous epidemiological studies to understand the size and severity of this serious but preventable alcohol-related neurodevelopmental disorder.

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For editors:

This paper is free to download for one month after publication from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/10.1111/add.14598 (after the embargo has lifted) or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

To speak with lead author Dr. Svetlana Popova: contact her through CAMH Public Affairs (Canada) by email (media@camh.ca) or telephone (+1 416-595-6015).

This study was funded by the Centre for Addiction and Mental Health (CAMH), Canada's largest mental health teaching hospital and one of the world's leading research centres in its field. CAMH is fully affiliated with the University of Toronto and is a Pan American Health Organization/World Health Organization Collaborating Centre.

Full citation for article: Popova S, Lange S, Shield K, Burd L, and Rehm, J. (2019) Prevalence of Fetal Alcohol Spectrum Disorder among Special Sub-populations: A Systematic Review and Meta-analysis. Addiction 111: doi:10.1111/add.14598.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2017 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

Peer reviewed: Yes
Type of study: Longitudinal Study
Subject of study: People
Funding: University

US doctors who receive direct payments from opioid manufacturers tend to prescribe more opioids than doctors who receive no such payments, according to new research published by Addiction. The report found that the association between payments and prescribing is strongest for hydrocodone and oxycodone, the most frequently prescribed opioids among Medicare patients (Americans of 65+ years and some younger people with disabilities). The Medicare population is estimated to have the highest and fastest growing prevalence of opioid use disorder in the US.(1)

Pharmaceutical companies can’t pay doctors to prescribe their drugs; that sort of incentive is illegal. But they can pay doctors to talk about their drugs in speaking engagements, and pay for consulting work and conference attendance. They can also send ‘detailers’ (salespeople) to doctors’ offices to promote their drugs, possibly paying for a meal or leaving drug samples behind. These types of incentives may make physicians consciously or unconsciously more inclined to prescribe a particular brand of drug, or prescribe it in greater quantities.

The data on direct payments to physicians came from the Open Payments website, which publishes data reported under the Physician Payments Sunshine Act (PPSA), the US healthcare law that requires medical product manufacturers to disclose payments and other transfers of value to physicians. The data on opioid prescriptions came from the Medicare Part D Prescriber Public Use File, which holds data on prescriptions provided to and filled by Medicare beneficiaries. Both datasets are available on data.cms.gov, a website maintained by the Centres for Medicare and Medicaid Services (CMS).

The study, led by Dr. Thuy Nguyen of Indiana University’s School of Public and Environmental Affairs, looked at the prescribing practices of 63,062 US physicians who directly received opioid-related promotional payments, compared with over 802,000 physicians who received no such payments. From 2014 to 2016, the doctors who received payments prescribed, on average, over 13,070 daily doses of opioids per year more than their unpaid colleagues.

Lead researcher Dr. Nguyen states, “Our work supports earlier research on the pharma-physician relationship with respect to opioid prescriptions and offers more comprehensive evidence on the role of opioid-related promotional activities, including how prescribing may be affected by the extent and intensity of payments. Put simply, drug-related payments to physicians seem to increase drug prescriptions, and higher payments seem to increase them more.”

As this is an observational study, the findings reveal associations between opioid manufacturer payments and the volume of opioid prescriptions by individual physicians that may not be causal. However, the associations remain after adjusting for a range of physician characteristics, local sociodemographic predictors, and state opioid control policies.

1. Lembke A, Chen JH. Use of opioid agonist therapy for Medicare patients in 2013. JAMA psychiatry. 2016; 73(9):990-992.

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For editors: This paper is free to download from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

To speak with lead author Dr. Thuy D. Nguyen: contact her at the School of Public and Environmental Affairs, Indiana University, by email (thdnguye@indiana.edu) or telephone (+1 314 817-6859).

Full citation for article: Nguyen TD, Bradford WD, and Simon K (2019) Pharmaceutical payments to physicians may increase prescribing for opioids. Addiction 111: doi: 10.1111/add.14509.

Funding for this research was provided by Indiana University’s Grand Challenges Initiative.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2017 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

Peer reviewed: Yes
Type of study: Randomised Controlled Trial (Secondary Analysis)
Subject of study: People
Funding: Government/research council

A housing subsidy treatment that enables low-income families in US cities to move from public to private housing appears to reduce adolescent girls’ binge drinking but increase adolescent boys’ binge drinking.  The reasons for these differential gender effects are not yet clear.

Affordable housing policies are common in democratic nations, and the Housing Choice Voucher (HCV) program represents the largest federal investment in affordable housing in the US. Such policies have the potential to address inequality for low-income households by defraying rental costs and promoting housing mobility to higher opportunity areas. 

The Moving to Opportunity (MTO) housing subsidy trial randomized volunteer low-income families in public housing to (1) receive rental subsidies redeemable in neighbourhoods with few residents living in poverty plus housing counselling, (2) receive unrestricted rental subsidies or (3) remain in public housing.  In this secondary study, results from groups 1 and 2 were pooled to represent the treatment group.

This secondary analysis, published today [6 Sep] by the scientific journal Addiction, examined 2829 adolescents (1950 in the treatment and 879 in the control group) for differences in binge drinking and other alcohol use outcomes 4 to 7 years after the study began, including following their family’s receipt and use of a rental subsidy to move to a private rental unit if they were assigned to the treatment condition, or their assignment to the public housing control condition.  The treatment-control risk difference (the excess risk than can be attributed to having moved with a subsidy vs. not) on binge drinking for girls was -0.022 (a beneficial effect of treatment) and for boys was 0.032 (a harmful effect of treatment).

Lead author Dr Theresa Osypuk, Associate Professor at the University of Minnesota School of Public Health, says “Our research addresses a key policy question in the popular US-based HCV programme:  whether or not to incorporate elements from non-housing sectors to improve outcomes for low-income children. Our findings suggest that although girls benefit from the HCV programme with respect to reducing underaged drinking, boys may need additional support to be successful.

“Although we don’t know exactly why there is a gender difference in adolescent binge drinking resulting from this housing subsidy program, we suspect the MTO treatment may have influenced binge drinking via social relationship mechanisms, which are different for girls and boys.  For example, girls and boys may cope with the stressors of moving differently, and/or parenting relationships affected by residential mobility may influence girls’ and boys’ drinking behaviours differently. Further research will uncover the exact mechanisms, but until then we need to respond to the fact that boys face increased risk of binge drinking under the current HCV programme.”

Binge drinking is a pattern of excessive alcohol consumption that results in elevated blood alcohol concentration, leads to cognitive, sensory and motor impairment, and causes tissue damage in both acute and chronic use.  Any alcohol use may cause some level of impairment, but binge drinking has a much higher risk for negative outcomes than measures such as life-time or past month alcohol use.

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For editors:

This paper is free to download from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0452.

Interviews with lead author Dr. Theresa Osypuk: contact her at the University of Minnesota School of Public Health by email (tosypuk@umn.edu).

Full citation for article: Osypuk TL, S Joshi, NM Schmidt, MM Glymour, and TF Nelson (2018) Effects of a federal housing voucher experiment on adolescent binge drinking: A secondary analysis of a randomized controlled trial.  Addiction 110: doi: 10.1111/add.14379.

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2017 ISI Journal Citation Reports ranking in the substance abuse category (science edition).

Peer reviewed: Yes
Type of study: Non-randomised comparative study
Subject of study: People
Funding: Government/research council

We already know that adolescents with conduct and/or substance use problems are at increased risk for premature death, mainly from substance-related deaths, traffic accidents, and violent deaths (related to suicide, assault, or legal intervention). This prospective study of more than 3700 US juveniles discovered that there is an independent association between conduct disorder and mortality hazard.   In other words, the connection between conduct disorder and risk of early death appears to exist even when other contributing factors such as sex, ethnicity, familial factors, and substance use are removed. 

This is important because conduct disorder can be treated and improved, potentially reducing the risk of early death. 

And the risk is substantial.  This study followed 1463 US youths with combined conduct disorder (CD) and substance use disorder (SUD), 1399 of their siblings, and 904 community controls.  It found that the relative risk of mortality among the first two groups was 4.99 times higher than the controls.  Over an average follow-up time of 16 years, 96 deaths were observed among adolescents with CD/SUD and their siblings versus 8 deaths among controls.

The study used the definition of conduct disorder provided by the APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV): “A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated,” which includes aggression toward people and animals, property destruction, deceitfulness or theft, and serious violation of rules.

Lead author Richard Border (University of Colorado Boulder) adds this caveat: “Because this study focused on juveniles with severe CD and SUD, the extent to which the results might generalize to individuals with moderate CD and SUD is unclear.  But our results indicate that adolescents with severe CD are at marked risk for premature death beyond that which can be explained by substance use problems and sociodemographic factors, which should make them a prime target for future treatment research.”

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For editors:

This paper is free to download from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/full/10.1111/add.14366 or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Interviews with lead author Richard Border: contact him at the University of Colorado Boulder by email (richard.border@colorado.edu) or telephone (+1 303 492 7362).

Full citation for article: Border R, RP Corley, SA Brown, JK Hewitt, CJ Hopfer, SK McWilliams, SA Rhea, CL Shriver, MC Stallings, TL Wall, KE Woodward, and SH Rhee (2018) Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings, and community controls.  Addiction 110: doi: 10.1111/add.14366.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

Many popular online games include the option of paying small fees (microtransactions) to access additional features or content that enhance the player’s experience.  An editorial published today by Addiction argues that some online games use in-game purchasing systems that disguise or withhold the long-term cost of microtransactions until the player is already financially and psychologically committed.  Such purchasing systems push free-to-play online gaming closer to gambling and may present financial risks for vulnerable players.

The authors focus on a monetization scheme called the ‘loot box’, an in-game reward system in which players can repetitively buy a random selection of virtual items.  Players hoping to win a particular item may end up repeatedly buying loot boxes at significant personal expense.  The authors argue that because loot boxes require no player skill and have a randomly determined outcome or prize, they function similarly to gambling slot machines. 

The authors call loot boxes and similar schemes ‘predatory monetization’ because they encourage repeated spending using tactics that may involve limited disclosure of the product, unavoidable solicitations, and manipulation of reward outcomes to encourage purchasing behaviours over skilful play.  The authors point out that some of the top-earning game publishers have registered patents for microtransaction systems that incentivise the player to spend money (1,2) but there are few regulations or consumer protections associated with these systems.

The editorial appears in the wake of the World Health Organization’s announcement on 18 June that it plans for the first time to include ‘gaming disorder’ in its diagnostic manual, the International Classification of Diseases. 

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1. Marr M. D., Kaplan K. S., Lewis N. T. U.S. Patent No. 9,789,406 [internet]. 2017 October 17. Available at: https://www.google.com.au/patents/US9789406 (accessed 12 January 2018).
2. Xue S., Wu M., Kolen J., Aghdaie N., Zaman K. A. Dynamic difficulty adjustment for maximized engagement in digital games [internet]. 5 April 2017. Available at: http://papers.www2017.com.au.s3-website-apsoutheast-2.amazonaws.com/companion/p465.pdf (accessed 12 January 2018).

For editors:

This paper is free to download from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Interviews with lead author Dr Daniel King: contact him at the University of Adelaide (Australia) by email (daniel.king@adelaide.edu.au) or telephone (+61 883133740).

Full citation for editorial: King DL and PH Delfabbro (2018) Predatory monetization schemes in video games (e.g., ‘loot boxes’) and Internet gaming disorder. Addiction 110: doi: 10.1111/add.14286.

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A new review published online today in the journal Addiction has compiled the best, most up-to-date source of information on alcohol, tobacco, and illicit drug use and the burden of death and disease.  It shows that in 2015 alcohol and tobacco use between them cost the human population more than a quarter of a billion disability-adjusted life years, with illicit drugs costing a further tens of millions.

The largest health burden from substance use was attributable to tobacco smoking and the smallest was attributable to illicit drugs.  Global estimates suggest that nearly one in seven adults (15.2%) smoke tobacco and one in five adults report at least one occasion of heavy alcohol use in the past month. 

Compared with the rest of the world, Central, Eastern, and Western Europe recorded consistently higher alcohol consumption per capita (11.61, 11.98 and 11.09 litres, respectively) and a higher percentage of heavy consumption amongst drinkers (50.5%, 48.2%, and 40.2%, respectively).  The same European regions also recorded the highest prevalence of tobacco smoking (Eastern Europe 24.2%, Central Europe 23.7%, and Western Europe 20.9%).

In contrast, use of illicit drugs was far less common.  Fewer than one in twenty people were estimated to use cannabis in the past year, and much lower estimates were observed for amphetamines, opioids and cocaine.  Hotspots included the US, Canada, and Australasia.  The US and Canada had one of the highest rates of cannabis, opioid, and cocaine dependence (748.7 [694.8, 812.3], 650.0 [574.5, 727.3], and 301.2 [269.3, 333.7] per 100,000 people, respectively). Australasia (Australia and New Zealand) had the highest prevalence of amphetamine dependence (491.5 per 100,000 people [441.4, 545.5]), as well as high rates of cannabis, opioid and cocaine use dependence (693.7 [648.1, 744.4], 509.9 [453.7, 577.8], and 160.5 [136.4, 187.1] per 100,000 people, respectively).

Some countries and regions (e.g., Africa, Caribbean and Latin America, Asia regions) have little or no data on substance use and associated health burden. These are typically low or middle income countries that frequently have punitive drug policies, and may experience serious political and social unrest. These countries need enhanced monitoring because they are at risk of rapid escalation in substance use and related health burden.

The report, ‘Global Statistics on Alcohol, Tobacco, and Illicit Drug Use: 2017 Status Report’, uses data mainly obtained from the World Health Organization, United Nations Office on Drugs and Crime, and Institute for Health Metrics and Evaluation.  The authors note that there are important limitations to the data, especially for illicit drugs, but believe that putting all this information in one place will make it easier for governments and international agencies to develop policies to combat substance use.

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For editors:

This paper is free to download from the Wiley Online Library: https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14234 (after the embargo has lifted) or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Tables of particular note:

• Table 2: Modelled regional estimates of prevalence of alcohol use and tobacco smoking, 2015.
• Table 3: Past 12 month prevalence of any drug use among the population aged 15-64 years, by region and globally, 2015.
• Table 4: Modelled estimates of cases and age-standardised rates of past year substance dependence by GBD region, 2015.
• Table 5: Crude attributable DALYs and deaths (in 1000s) and age-standardised attributable DALYs and death rate (per 100,000) for alcohol, tobacco and illicit drugs as risk factors for disease burden by GBD region, 2015.
• Appendix B: Crude attributable DALYs and deaths (in thousands) and age-standardised attributable DALYs and death rate (per 100,000) for tobacco smoking and second-hand smoking by GBD region, 2015

Interviews with co-author and Addiction Editor-in-Chief Professor Robert West: contact him at UCL (University College London) by email (robert.west@ucl.ac.uk) or telephone (+44 (0)7813916681).

Full citation for article: Peacock A, J Leung, S Larney, S Colledge, M Hickman, J Rehm, GA Giovino, R West, W Hall, P Griffiths, R Ali, L Gowing, J Marsden, AJ Ferrari, J Grebely, M Farrell, and L Degenhardt  (2018) Global statistics on alcohol, tobacco, and illicit drug use: 2017 status report.  Addiction 110: doi: 10.1111/add.14234

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

Debunking Two Claims about US Medical Marijuana: Increased Recreational Use among Teens and Decreased Opioid Deaths

In 1996, California became the first US state to legalise marijuana use for medical purposes.  Medical marijuana is now legal in 29 states.  Opponents of medical marijuana argue that such laws increase recreational marijuana use among adolescents, while advocates contend that medical marijuana helps to address the US opioid crisis by reducing overdose deaths.

Two papers published today in the scientific journal Addiction look at the current evidence of the effects of medical marijuana laws and conclude that there is little support for either claim.

The first claim, that legalizing medical marijuana increases recreational use among adolescents, is addressed by a new meta-analysis that pooled the results of eleven separate studies of data from four large-scale US surveys dating back as far as 1991.  Results of the meta-analysis indicate that no significant changes (increases or decreases) occurred in adolescent recreational use following enactment of medical marijuana laws.  Far fewer studies examined the effects of medical marijuana laws among adults, although existing evidence suggests that adult recreational use may increase after medical marijuana laws are passed    

Senior author Professor Deborah Hasin says, “Although we found no significant effect on adolescent marijuana use, we may find that the situation changes as commercialized markets for medical marijuana develop and expand, and as states legalize recreational marijuana use.  However, for now, there appears to be no basis for the argument that legalising medical marijuana increases teens’ use of the drug.”

The second claim, that legalising medical marijuana reduces opioid overdose deaths by offering a less risky method of pain management, is addressed in an editorial co-authored by several members of Addiction’s editorial board.  Here, the evidence is clear but weak, being rooted in ecological studies whose results have not been confirmed through more rigorous methods.  Although those studies show a correlation over time between the passage of medical marijuana laws and opioid overdose death rates, they do not provide any evidence that the laws caused the reduction in deaths.  In fact, several recent studies have shown that chronic pain patients who use cannabis do not use lower doses of opioids.  There are more plausible reasons for the reduction in opioid deaths that ought to be investigated.

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For editors:

Sarvet AL, Wall MM, Fink DS, Greene E, Le A, Boustead AE, Pacula RL, Keyes KM, Cerda M, Galea S, and Hasin DS (2018) Medical marijuana laws and adolescent marijuana use in the United States: A systematic review and meta-analysis. Addiction, doi: 10.1111/add.14136.

Hall W, West R, Marsden J, Humphreys K, Neale J, and Petry N (2018) It is premature to expand access to medicinal cannabis in hopes of solving the US opioid crisis. Addiction, doi: 10.1111/add.14139.

These papers are free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Journalists seeking interviews with Professor Deborah Hasin can contact her via Columbia University by email (dsh2@cumc.columbia.edu) or at deborah.hasin@gmail.com.

Journalists seeking interviews with Professor Wayne Hall can contact him via the University of Queensland by email (w.hall@uq.edu.au) or telephone (+61 7 336 55246).

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A new study published by the scientific journal Addiction has found that a concentrated 2mg intranasal naloxone spray delivers naloxone as effectively, over the critical first 15 minutes, as the standard 0.4mg intramuscular (IM) naloxone injection.  The 2mg spray also maintains blood levels of naloxone more than twice as high as the 0.4mg IM levels for two hours after administration.  It should therefore be highly effective in reversing opioid overdose.

These results support the recent announcement on 14 September 2017 that the European Medicines Agency (EMA) has issued a positive opinion for a 1.8mg naloxone nasal spray formulation (equivalent to 2mg naloxone hydrochloride), under the brand name Nyxoid.

Take-home naloxone (naloxone kits provided to drug users and other non-medical persons for use in emergency situations) helps to prevent death from heroin/opioid overdose.  Naloxone is usually given by injection, but more user-friendly non-injectable alternatives are being developed, including nasal sprays. To be effective, the intranasal spray must be highly concentrated to achieve good absorption, the dose must be adequate but not excessive, and early absorption should be comparable to IM injection.

This study tested nasal naloxone at 1mg, 2mg, and 4mg doses on 38 healthy volunteers, compared with 0.4mg IM and 0.4mg intravenous doses.  Each volunteer received all five study treatments, with one naloxone dose per session and each session separated by a washout period.  Blood plasma concentrations of naloxone were measured nineteen times for each volunteer during each treatment session, with intense sampling in the first 15 minutes after dosing. 

All three doses of naloxone nasal spray were well absorbed, with the 2mg spray most closely replicating the performance of the 0.4mg IM naloxone injection over the critical first 15 minutes.  The volunteers experienced no severe adverse effects; the main mild adverse effect was headache, in six volunteers.

Professor Sir John Strang, who co-authored the report, is cautiously optimistic: “Our findings demonstrate good early absorption and overall bioavailability of naloxone in healthy subjects, but concentrated naloxone nasal spray has yet to be formally tested in the target population of opioid users.  Nasal naloxone might be absorbed differently by opioid users due to damaged nasal mucosa, rhinitis, or nasal obstruction from mucus or vomit during overdose.  Nevertheless we are very pleased that concentrated nasal naloxone formulations are now receiving regulatory approval and believe that they will help widen the provision of take-home naloxone and thereby save lives.”

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For editors:

McDonald R, Lorch U, Woodward J, Bosse B, Dooner H, Mundin G, Smith K, and Strang J. (2017) Pharmacokinetics of concentrated naloxone nasal spray for opioid overdose reversal: Phase-I healthy volunteer study. Addiction, doi: 10.1111/add.14033.

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with author Professor Sir John Strang can contact him at the National Addiction Centre, King’s College London by email (john.strang@kcl.ac.uk) or telephone (+44 020 7848 0438).

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

The study pooled the results from 32 double-blind randomised controlled trials representing 6,036 patients, published between 1994 and 2015.  The studies compared the effects of oral nalmefene (n=9), naltrexone (n=14), acamprosate (n=1), baclofen (n=4) and topimarate (n=4) against placebo.

Many of the studies provided unreliable results due to risk of bias (potential exaggeration of the effects of the drug).  Twenty-six studies (81%) showed an unclear or high risk of incomplete outcome data due to the large number of withdrawals.  Seventeen studies (53%) showed an unclear or a high risk of selective outcome reporting, as they did not include a protocol registration number, which would allow another researcher to check whether all outcomes were reported.

Lead author Dr Palpacuer states: “Although our report is based on all available data in the public domain, we did not find clear evidence of benefit of using these drugs to control drinking.  That doesn’t mean the drugs aren’t effective; it means we don’t yet know if they are effective.  To know that, we need better studies.  Researchers urgently need to provide policymakers with evidence as to which of these drugs can be effectively translated into a real harm reduction strategy.”

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For editors:

Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, and Naudet F (2017) Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: A systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen, and topiramate. Addiction, doi:10.1111/add.13974.

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with lead author Dr Clément Palpacuer should contact him at INSERM Centre d’Investigation Clinique 1414 by email (clement.palpacuer@gmail.com).

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

The international drug control treaties are endorsed by most member states of the United Nations (UN).  The treaties prohibit the non-medical use of amphetamines, cannabis, cocaine and heroin.  They aim to reduce the harmful use of prohibited drugs and facilitate access to these drugs for medical and scientific purposes.  Critics claim that the treaties have failed to tackle non-medical use of prohibited drugs and have justified policies that conflict with UN human rights treaties by incarcerating large numbers of drug users. 

Hall’s paper outlines types of policies that nations could adopt to address the different types of harm that different illicit drugs cause to users and others.  Some would require treaty change, while others could be accomplished by more ‘flexible interpretations’ of treaty provisions by member states and UN agencies.  His suggestions are:

• Cannabis: This is the strongest candidate for national policy experiments on different ways of regulating its sale and use. This is happening in the USA, Uruguay and Canada. Rigorous evaluations of these experiments will be useful for other countries considering legalizing cannabis for adult recreational use.
• Party drugs, such as ecstasy, LSD, and novel psychoactive substances:  The most important regulatory challenge for those who advocate more liberal policies is ensuring that drug manufacture and sale meet reasonable standards of consumer safety and consumers are well informed about the risks of using these drugs.
• Opioids:  The best way forward may be a mitigated form of prohibition.  Mitigated prohibition differs from a ‘war on drugs’ by expanding treatment for opioid dependence, reducing some of its serious medical complications, and reducing the number of opioid users who are imprisoned.
• Cocaine and amphetamines:  There are no easy answers here.  Proposed regulation via a modified prescription system seems unlikely to reduce harmful use. Prohibition may minimize use but it is not sufficient, because stimulants are very easy to produce illicitly. Stimulant policy needs better ways of reducing the demand for stimulants and more effective treatments for problem stimulant users.

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For editors:

Hall W (2017) The future of the international drug control system and national drug prohibitions. Addiction 112. doi: 10.1111/add.13941

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Professor Wayne Hall has made large contributions in the field of public health in the area of drug use, addiction, treatment, ethics, and research as World Health Organization's expert adviser. As a "Highly Cited Author" identified by the Institute for Scientific Analysis, he is dedicated to public health research. His research interests include alcohol and drug research and education, cancer prevention, epidemiology, health policy, mental health, pharmacoeconomics and policy, and tobacco control. 

Media seeking interviews with Professor Wayne Hall should contact him via the University of Queensland by email (w.hall@uq.edu.au) or telephone (+61 7 336 55246).

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

This nationwide study followed five large smoking cessation clinical trials in the US that enrolled smokers at hospitalization.  At 6-month follow-up, 822 participants (out of 4,206 who completed the follow-up survey) reported they had not smoked in the past 7 days and provided a usable saliva sample for verification by testing for a chemical called ‘cotinine’. The liver converts nicotine in the body to cotinine and so this chemical is a very accurate measure of whether someone has smoked in the past few days. More than 40% of those 822 self-reported quitters failed the saliva test.

The misreporting rate may be even higher because, despite the offer of $50 to $100 for providing a sample 18.6% of people who had said they had quit smoking did not reply, even after multiple attempts. These participants were excluded from the study. The study also excluded anyone who said they were using another nicotine product such as smokeless tobacco, nicotine patches or e-cigarettes. Even very heavy exposure to other people smoking would not have raised cotinine levels to those found in this study.

Lead author Dr. Taneisha Scheuerman says “Our study shows that in studies where participants may feel pressure to say they have quit when they have not, it is essential to verify claims of quitting using an objective test such as cotinine to know true quit rates. For clinical researchers, another important finding is that misreporting rates were similar across intervention and control conditions, suggesting that the relative effectiveness of interventions tested was the same using self-report and cotinine levels.”

Professor Robert West, Editor-in-Chief of the journal, Addiction, that published the article comments, “Other research has shown very low misreporting rates in population surveys of smoking. Hospital patients and pregnant women would be likely to feel strong pressure to have stopped smoking.”

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For editors:

Scheuermann TS, Richter KP, Rigotti NA, Cummins SE, Harrington KF, Sherman SE, Zhu S-H, Tindle HA, Preacher KJ, and the Consortium of Hospitals Advancing Research on Tobacco (CHART) (2017) Accuracy of self-reported smoking abstinence in clinical trials of hospital-initiated smoking interventions. Addiction 112. doi:10.1111/add.13913

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with lead author Dr Taneisha Scheuermann should contact her via the University of Kansas Medical Center by telephone (+1 913-588-2641) or email (tscheuermann@kumc.edu)

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A new study published today by the scientific journal Addiction reveals that the incidence of neonatal abstinence syndrome – often caused by mothers using opioids during pregnancy – is increasing in the United States, and carries an enormous burden in terms of hospital days and costs. The number of US hospital admissions involving neonatal abstinence syndrome increased more than fourfold between the years 2003 and 2012. In 2012, neonatal abstinence syndrome cost nearly $316 million in the United States.

Neonatal abstinence syndrome (NAS) is a constellation of symptoms that occur in newborn infants exposed to addictive illegal or prescription drugs in utero.  Infants affected by NAS typically show a number of neurological symptoms and behaviors (e.g., tremors, seizures) as well as poor feeding and gastrointestinal dysfunction. Standard management of NAS involves the administration of opioids for opioid withdrawal, with additional medications for stubborn cases or instances of multi-drug exposure. This drug administration has been performed traditionally in the hospital setting, consuming valuable and finite hospital resources.

In this study, researchers measured the inflation-adjusted health care provider costs and length of hospital stay for almost 28,000 infants with NAS, compared with over 3 million infants without NAS.  They found that between 2003 and 2012, NAS admissions increased more than fourfold, resulting in a surge in annual costs from $61 million and 67,869 hospital days in 2003 to nearly $316 million and 291,168 hospital days in 2012. For an infant affected by NAS, the hospital stay was nearly 3.5 times as long (16.57 hospital days compared with 4.98 days for a non-NAS patient) and the costs more than three times greater ($16,893 compared with $5,610 for a non-affected infant).

In an era of increasingly constrained health-care resources, the rising incidence of NAS has significant implications for policymakers, hospital administrators and health care providers nation-wide. Increased public health initiatives are needed to target, educate and provide resources for women of reproductive age to decrease in utero drug exposure. Additionally, given the large variation in screening and treatment of NAS, further study is needed to determine the most effective assessment and management strategies, with a focus on developing therapeutic plans that offer more cost-efficient management of NAS.

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For editors:

Corr TE and Hollenbeak CS (2017) The economic burden of neonatal abstinence syndrome in the United States. Addiction 112. doi: 10.1111/add.13842

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with lead author Dr Tammy Corr should contact her via the Penn State College of Medicine Office of Marketing and Communications by telephone (+1 717 531 8606).

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A new review published online today in the scientific journal Addiction has found that dental patients with substance use disorders have more tooth decay and periodontal disease than the general population, but are less likely to receive dental care. With drug use increasing by approximately three million new users each year, this is a problem that won’t disappear anytime soon.

Drug use affects oral health through direct physiological routes such as dry mouth, an increased urge for snacking, clenching and grinding of teeth, and chemical erosion from applying cocaine to teeth and gums.  The lifestyle that often accompanies problematic drug use also affects oral health through high sugar diets, malnutrition, poor oral hygiene, and lack of regular professional dental care.  Dental care can be further compromised by tolerance to painkillers and anaesthetics.

Oral health has significant consequences on quality of life and general health. In addition to functional and self-esteem issues that accompany bad teeth, the chronic inflammation and bacteraemia (bacteria in the blood) characteristic of poor oral health increase the incidence of coronary heart disease, stroke, diabetes and respiratory disease.

There are simple steps that both dentists and doctors can take to improve this population’s oral health. Dentists should screen their patients for substance use, notice any advanced dental or periodontal disease inconsistent with patient age and consider referral to medical doctors for management. In patients with suspected substance use disorders, dentists should be aware of issues concerning treatment and consent when the patient is intoxicated and be alert to the possibility of resistance to painkillers. 

Doctors and clinicians who care for people with substance use disorders should screen for oral diseases and arrange for dental care as needed, consider using sugar-free preparations when prescribing methadone, and warn patients of the oral health risks associated with dry mouth and cravings for sweet foods.

These findings mirror those of increased dental decay and periodontal disease in people with severe mental illness, eating disorders and alcohol use disorders, compared with the general population. 

The review combined the results of 28 studies from around the world, which collectively provided data on 4,086 dental patients with substance use disorder and 28,031 controls.

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For editors:

Baghaie H, Kisely S, Forbes M, Sawyer E, and Siskind DJ (2017) A systematic review and meta-analysis of the association between poor oral health and substance abuse. Addiction 112: doi:10.1111/add.13754

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with lead author Dr Hooman Baghaie should contact him via email (h.baghaie@uq.net.au).

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

Leading public health experts warn that youth around the world are exposed to extensive alcohol marketing, and that current controls on that marketing appear ineffective in blocking the association between youth exposure and subsequent drinking.  Alcohol is the leading cause of death and disability for young males aged 15-24 in nearly every region of the world, and young females of the same age in the wealthy countries and the Americas.

The experts call for governments around the world to renew their efforts to address the problem by strengthening the rules governing alcohol marketing with more effective independent statutory regulations. Their call coincides with the publication of a series of reports in a supplement to the scientific journal Addiction that presents the latest evidence on alcohol marketing and its impact on children. Key findings from the collection of peer-reviewed manuscripts include:

• Exposure to alcohol marketing is associated with youth alcohol consumption
• Analysis of alcohol promotion during the 2014 FIFA World Cup indicates alcohol marketing practices frequently appeared to breach industry voluntary codes of practice’ 
• Alcohol industry self-regulatory codes do not sufficiently protect children and adolescents from exposure to alcohol promotions, especially through social media

The Addiction supplement comprises 14 papers, with research presented from around the world. Lead editor Professor Thomas Babor, of the University of Connecticut, says:

“Governments are responsible for the health of their citizens.  No other legal product with such potential for harm is as widely promoted and advertised in the world as alcohol. These papers provide a wealth of information to support governments in their efforts to protect children and other vulnerable populations from exposure to alcohol marketing.” 

Chris Brookes of the UK Health Forum noted that “Governments have previously approved self-regulatory measures on alcohol advertising; however, we can no longer say that they might work to protect our young people – they don’t. In a literature review of more than 100 studies, none was identified that supported the effectiveness of industry self-regulation programmes.”

The papers offer guidelines to developing more effective alcohol marketing regulations:

• The most effective response to alcohol marketing is likely to be a comprehensive ban on alcohol advertising, promotion and sponsorship, in accordance with each country’s constitution or constitutional principles. 
• Regulations should be statutory, and enforced by an appropriate public health agency of the local or national government, not by the alcohol industry. 
• Regulations should be independent of the alcohol industry, whose primary interest lies in growing its markets and maximizing profits. 
• A global agreement on the marketing of alcoholic beverages would support country efforts to move towards a comprehensive ban on alcohol advertising, promotion and sponsorship. 
• Collaboration with other population-level efforts to restrict marketing of potentially harmful products, such as ultra-processed food, sugary beverages, tobacco, and breast-milk substitutes, should be encouraged and supported. 

The journal supplement is funded by Alcohol Research UK and the Institute of Alcohol Studies, with the authors and editors of the supplement giving their time to produce these papers pro bono. The papers originated in work undertaken by the UK Health Forum to bring EU and US alcohol policy leads together, with funding from the EU. The specific papers were developed for a meeting on alcohol marketing convened by the Pan American Health Organization (PAHO).  This collection of papers represents the highest level of scholarly attention devoted to this issue that has been brought together in the pages of one scientific journal. 

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For editors:

The Addiction supplement, Alcohol marketing regulation: From research to public policy, is free to download from the Wiley Online Library: http://onlinelibrary.wiley.com/doi/10.1111/add.v112.S1/issuetoc

Media seeking interviews with lead author Prof. Thomas Babor, Chair, Department of Community Medicine and Health Care, University of Connecticut, can contact him by telephone (+1 860 679 5459) or email (babor@nso.uchc.edu). 

The UK Health Forum is a registered charity whose mission is to operate as a centre of expertise, working with and through their members to contribute to the prevention of the avoidable non-communicable diseases - coronary heart disease, stroke, type 2 diabetes, obesity, cancer, respiratory diseases and vascular dementia.

Alcohol Research UK is an independent charity that tackles alcohol-related harm by funding high quality, impartial research.

The Institute of Alcohol Studies is a registered charity (number 1112671) aiming to educate, preserve and protect the good health of the public by promoting the scientific understanding of beverage alcohol and the individual, societal and health consequences of its consumption and promoting measures for the prevention of alcohol-related problems and to promote, for the public benefit, research into beverage alcohol and to publish the useful results. 

Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

In December 2006, the USA regulated sodium permanganate, a chemical essential to the manufacture of cocaine. In March 2007, Mexico, the USA’s primary source for methamphetamine, closed a chemical company accused of illicitly importing more than 60 tons of pseudoephedrine, a methamphetamine precursor chemical. A study published today by the scientific journal Addiction found that those two events were associated with large, extended reductions in cocaine users and methamphetamine users in the USA — impacts that have lasted approximately eight years so far.

After changing little during the early 2000s, cocaine use in the USA began a downward shift at the time of the sodium permanganate regulation. In association with that regulation, there was an estimated decrease of approximately 1.9 million past-year cocaine users (a drop of 32%) and 0.7 million past-month cocaine users (-29%). During the period examined following the sodium permanganate regulation (December 2006 to December 2014), there was little or no recovery in the number of cocaine users.

Methamphetamine use in the USA also began a downward shift at the time of the chemical company closure.  In association with Mexico’s 03/2007 chemical company closure, there was an estimated decrease of approximately half a million past-year methamphetamine users (-35%), and a decrease of a little more than a quarter million past-month methamphetamine users (-45%). During the period examined following closure of the chemical company (March 2007 to December 2014), methamphetamine user numbers generally remained below pre-closure levels, though a partial recovery in the numbers may have occurred in 2013.

Lead author James Cunningham, PhD, says, “Cocaine and methamphetamine production for international markets requires access to massive amounts of legally manufactured chemicals. Disrupting that access should disrupt the drugs’ availability and use.”  He also says, “Strategies directed towards individual users, for example, information campaigns and direct medical care, have not yet fully addressed the public health problem of cocaine and methamphetamine abuse, indicating the need for additional approaches. To this end, and given our study’s findings, control of essential and precursor chemicals warrants a closer look.”

Dr Cunningham is a social epidemiologist with the Department of Family and Community Medicine at the University of Arizona College of Medicine – Tucson.  

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For editors:

Cunningham JK, Lui L-M, Callaghan RC (2016) Essential/precursor chemicals and drug consumption:  Impacts of US sodium permanganate and Mexico pseudoephedrine controls on the numbers of US cocaine and methamphetamine users. Addiction 111: doi: 10.1111/add.13480

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with lead author Dr James Cunningham can contact him via Jane Erikson, tel +1-520-334-9464, email jerikson@email.arizona.edu, or Jean Spinelli, tel +1-520-626-2531, email jspinell@email.arizona.edu.

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A study published today in the scientific journal Addiction finds that exposure to several different types of alcohol marketing is positively associated with the amount and frequency of drinking among adolescents across Europe.

These findings support the demand for legal restrictions of the amount of alcohol marketing in the European Union, where the Audio Visual Media Services Directive (AVMSD) is the only EU regulation currently in place.  The AVMSD regulates the content of alcohol marketing in audiovisual media but does not restrict the amount of alcohol marketing on TV or elsewhere.

The study included more than 9,000 adolescents in Germany, Italy, the Netherlands, and Poland.  The average age was 14 years.  The students reported their drinking frequency and binge drinking as well as their exposure to a wide range of alcohol marketing, including television ads; online marketing; sponsorship of sports, music events, or festivals; ownership of alcohol branded promotional items; receipt of free samples; and exposure to price offers. 

The data showed that exposure to alcohol marketing of all kinds was positively associated with adolescents’ alcohol use over time.  This link was found in four countries of varying cultural, regulatory and drinking contexts. A causal connection cannot be proved with this kind of study but the findings are clearly a cause for concern.

Lead author Avalon de Bruijn, of the European Centre for Monitoring Alcohol Marketing (EUCAM), says “Europe is the world’s heaviest drinking region, and youth drinking is particularly problematic.  Our study highlights the need to restrict the volume of alcohol marketing to which young people are exposed in everyday life.  It’s no longer just a matter of restricting television ads; policymakers need to examine the alcohol industry’s total marketing scheme and develop regulations that will reduce all types of alcohol marketing.”

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For editors:

De Bruijn A, Tanghe J, de Leeuw R, Engels R, Anderson P, Beccaria F, Bujalski M, Celata C, Gosselt J, Schreckenberg D, Słodownik L, Wothge J, and van Dalen W (2016) European longitudinal study on the relationship between adolescents’ alcohol marketing exposure and alcohol use. Addiction 111: doi: 10.1111/add.13455

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with co-author Wim van Dalen, Director of the Dutch Institute for Alcohol Policy, should contact him by telephone (+31 653295544) or email (wvandalen@stap.nl).

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.

A new review of epidemiological evidence supports a causal association between alcohol consumption and cancers at seven sites in the body: oropharynx, larynx, oesophagus, liver, colon, rectum and female breast.  This is a stronger statement than the long-recognised association between alcohol and cancer. An association means there is a relationship of some kind between the two variables.  A causal association means there is evidence that alcohol consumption directly causes cancer.

The causal link was supported by evidence for a dose-response relationship, at least partial reversal of risk when alcohol consumption is reduced, statistical adjustment for other factors that might explain the association, and specificity of the association with some cancers and not others.

The epidemiological evidence for these conclusions comes from comprehensive reviews undertaken in the last 10 years by the World Cancer Research Fund and American Institute for Cancer Research, the International Agency for Research on Cancer, the Global Burden of Disease Alcohol Group, and the most recent comprehensive meta-analysis undertaken by Bagnardi and colleagues*, building on meta-analyses of the effect of alcohol on single cancers.

The review cites evidence that alcohol caused approximately half a million deaths from cancer in 2012, 5.8% of cancer deaths worldwide. The highest risks are associated with the heaviest drinking, but a considerable burden is experienced by drinkers with low to moderate consumption. 

The review also finds the current evidence that moderate drinking provides protection against cardiovascular disease is not strong.

The review is published online today by the scientific journal Addiction.

*Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015;112(3):580-93.

-- Ends –

For editors:

Connor J (2016) Alcohol consumption as a cause of cancer. Addiction 111: doi: 10.1111/add.13477

This paper is free to download for one month after publication from the Wiley Online Library or by contacting Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org, tel +44 (0)20 7848 0853.

Media seeking interviews with Prof Jennie Connor may contact her at the University of Otago, New Zealand, by telephone (+64 34797243) or email (jennie.connor@otago.ac.nz)

Addiction (www.addictionjournal.org) is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, illicit drugs, tobacco, and gambling as well as editorials and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884. Addiction is the number one journal in the 2016 ISI Journal Citation Reports ranking in the substance abuse category for both science and social science editions.