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1、Update on Alcohol, Other Drugs, and HealthNovemberDecember 20091 1UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Studies on Interventions & Assessments2 2UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(
2、70)New Cocaine Vaccine Is Safe but Has Limited Efficacy Martell BA, et al. Martell BA, et al. Arch Gen Psychiatry.Arch Gen Psychiatry. 2009;66(10):11161123. 2009;66(10):11161123.Summary by Summary by Peter D. Friedmann, MD, MPHPeter D. Friedmann, MD, MPH3 3UpdateonAlcoholOtherDrugsandHUpdateonAlcoho
3、lOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nPreliminary studies suggest vaccination to produce Preliminary studies suggest vaccination to produce anticocaine antibodies attenuates cocaines anticocaine antibodies attenuates cocaines reinforcing effects.reinforcing effe
4、cts.n nResearchers conducted a randomized, double-blind, Researchers conducted a randomized, double-blind, placebo-controlled trial to evaluate the safety and placebo-controlled trial to evaluate the safety and efficacy of a cocaine vaccine among 115 volunteers efficacy of a cocaine vaccine among 11
5、5 volunteers enrolled in a US methadone maintenance program.enrolled in a US methadone maintenance program.n nOver the 12-week intervention period, 109 of 115 Over the 12-week intervention period, 109 of 115 subjects received 5 injections of vaccine or placebo.subjects received 5 injections of vacci
6、ne or placebo.n nFollow-up was at 24 weeks.Follow-up was at 24 weeks.4 4UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nThere were no treatment-related serious adverse There were no treatment-related serious adverse events, study withdrawal
7、s, or deaths.events, study withdrawals, or deaths.n nThe frequency of cocaine-free urine samples The frequency of cocaine-free urine samples during weeks 1during weeks 1 4 and weeks 524 did not differ 4 and weeks 524 did not differ between treatment conditions in intent-to-treat between treatment co
8、nditions in intent-to-treat analyses.analyses.n nThe 38% of vaccinated subjects who attained a The 38% of vaccinated subjects who attained a high serum IgG (antibody) level (43 g/mL) had high serum IgG (antibody) level (43 g/mL) had more cocaine-free urine samples (45%) than more cocaine-free urine
9、samples (45%) than those with a low IgG level or those who received those with a low IgG level or those who received placebo (35%).placebo (35%).5 5UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6 6Results (contd)n nThe proportion of subjects having
10、 a 50% The proportion of subjects having a 50% reduction in cocaine use was greater in subjects reduction in cocaine use was greater in subjects with a high IgG level (53%) than in those with a with a high IgG level (53%) than in those with a low IgG level (23%) during weeks 820, but low IgG level (
11、23%) during weeks 820, but there was no difference in complete abstinence.there was no difference in complete abstinence.6 6UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nThe vaccine in this study appears to have reduced The vaccine in th
12、is study appears to have reduced but not eliminated cocaine use for 2 months in the but not eliminated cocaine use for 2 months in the minority of cocaine-dependent persons who had a minority of cocaine-dependent persons who had a high antibody response.high antibody response.n nBefore this approach
13、 can be considered for routine Before this approach can be considered for routine clinical use, better vaccines that generate a clinical use, better vaccines that generate a sustained blocking antibody level in a larger sustained blocking antibody level in a larger percentage of individuals and with
14、 a less intensive percentage of individuals and with a less intensive vaccination schedule are needed.vaccination schedule are needed.7 7UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Efficacy of Brief Intervention for Heavy Drinking in Hospitalized
15、 Patients QuestionableMcQueen J, et al. McQueen J, et al. Cochrane Database Syst Rev.Cochrane Database Syst Rev. 2009;(3):CD005191. 2009;(3):CD005191.Summary by Richard Saitz MD, MPHSummary by Richard Saitz MD, MPH8 8UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物
16、与健康物与健康(70)(70)Objectives/Methodsn nTo determine whether BI improves outcomes for To determine whether BI improves outcomes for general hospital patients with heavy alcohol use, general hospital patients with heavy alcohol use, researchers performed a systematic review of researchers performed a sys
17、tematic review of controlled trials.controlled trials.n nEleven studies with 2441 participants were identified:Eleven studies with 2441 participants were identified:n n5 took place on general medical wards,5 took place on general medical wards,n n3 in trauma centers,3 in trauma centers,n n2 in a var
18、iety of settings, and2 in a variety of settings, andn n1 in an orthopedic/trauma center.1 in an orthopedic/trauma center.n nMost studies tested 1 intervention session, 2 involved Most studies tested 1 intervention session, 2 involved 2 sessions, and 1 involved 3 sessions.2 sessions, and 1 involved 3
19、 sessions.9 9UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nBrief intervention was associated with self-report Brief intervention was associated with self-report of less weekly consumption in the 3 studies of less weekly consumption in the
20、 3 studies examining 6-month outcomes.examining 6-month outcomes.n nThese results were heterogeneous and nonsignificant These results were heterogeneous and nonsignificant when 1 of the studies, which tested 3 sessions and when 1 of the studies, which tested 3 sessions and had nonblinded outcome ass
21、essments, was excluded.had nonblinded outcome assessments, was excluded.n nNo studies found differences in consumption No studies found differences in consumption between BI patients and controls at 1 year.between BI patients and controls at 1 year.1010UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOth
22、erDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)1111Results (contd)n nAmong the studies presenting change score data Among the studies presenting change score data on mean alcohol consumption per week, on mean alcohol consumption per week, decreases in weekly drinking were greater among decreases
23、 in weekly drinking were greater among BI patients than controls at 12 months (assessed BI patients than controls at 12 months (assessed in 2 studies) but not at 6 months (assessed in 2 in 2 studies) but not at 6 months (assessed in 2 studies).studies).n nNo studies found differences between BI pati
24、ents No studies found differences between BI patients and controls for laboratory markers, heavy and controls for laboratory markers, heavy drinking episodes, driving offenses, or death.drinking episodes, driving offenses, or death.1111UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthe
25、alth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nSeverity of heavy alcohol use seen in hospitals is Severity of heavy alcohol use seen in hospitals is greater than that seen in primary care settings, greater than that seen in primary care settings, and patient-provider relationships are not usually and
26、patient-provider relationships are not usually longitudinal. longitudinal. n nThis review suggests some promise for BI in This review suggests some promise for BI in hospital settings but raises serious questions hospital settings but raises serious questions about whether it has substantial long-te
27、rm about whether it has substantial long-term efficacy.efficacy.n nSuch evidence should be seriously considered Such evidence should be seriously considered when deciding whether additional treatment when deciding whether additional treatment services should be coupled with alcohol screening service
28、s should be coupled with alcohol screening and BI in general hospitals.and BI in general hospitals.1212UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Smith PC, et al. Smith PC, et al. J Gen Intern Med.J Gen Intern Med. 2009;24(7):783788. 2009;24(7):
29、783788.Summary by Summary by Peter D. Friedmann, MD, MPHPeter D. Friedmann, MD, MPHSingle Question Alcohol Screen Detects Unhealthy Alcohol Use in a Primary Care Setting 1313UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nA 2005
30、NIAAA* guideline recommended a single-A 2005 NIAAA* guideline recommended a single-question alcohol screening test that had yet to be question alcohol screening test that had yet to be validated in clinical settings:validated in clinical settings:n n“How many times in the past year have you had X or
31、 “How many times in the past year have you had X or more drinks in a day?”, where X was 4 drinks for more drinks in a day?”, where X was 4 drinks for women and 5 drinks for men.women and 5 drinks for men.n nResearchers conducted a validation study of the Researchers conducted a validation study of t
32、he screening test among 286 patients recruited from screening test among 286 patients recruited from an urban primary care setting.an urban primary care setting.*National Institute on Alcohol Abuse and Alcoholism.*National Institute on Alcohol Abuse and Alcoholism.1414UpdateonAlcoholOtherDrugsandHUp
33、dateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)1515Objectives/Methods (contd)n nThe sensitivity and specificity of the question was The sensitivity and specificity of the question was compared with:compared with:n na validated 30-day calendar method to assess risky a validated 30
34、-day calendar method to assess risky consumption, andconsumption, andn na structured questionnaire designed to establish DSM-a structured questionnaire designed to establish DSM-IV criteria for an alcohol use disorder.IV criteria for an alcohol use disorder.1515UpdateonAlcoholOtherDrugsandHUpdateonA
35、lcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nThe single-question screen was 84% sensitive and The single-question screen was 84% sensitive and 78% specific for risky consumption and 88% 78% specific for risky consumption and 88% sensitive and 67% specific for a current alcoh
36、ol sensitive and 67% specific for a current alcohol use disorder.use disorder.n nThe single-question screen was 82% sensitive and The single-question screen was 82% sensitive and 79% specific for any unhealthy use (risky con-79% specific for any unhealthy use (risky con-sumption or an alcohol use di
37、sorder). sumption or an alcohol use disorder). n nThe single-question screen performed comparably The single-question screen performed comparably to the 3-item AUDIT-C.*to the 3-item AUDIT-C.*n nTest characteristics did not vary by gender, Test characteristics did not vary by gender, ethnicity, or e
38、ducation.ethnicity, or education.*Alcohol Use Disorders Identification TestConsumption.*Alcohol Use Disorders Identification TestConsumption.1616UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nThe brevity and performance of this single-The
39、 brevity and performance of this single-question screen recommends its use to detect question screen recommends its use to detect both risky drinking and alcohol use disorders in both risky drinking and alcohol use disorders in the busy primary care setting.the busy primary care setting.n nThe phras
40、ing of the item should facilitate more The phrasing of the item should facilitate more discussion of heavy episodic (binge) drinking, a discussion of heavy episodic (binge) drinking, a major source of adverse consequences among major source of adverse consequences among nondependent drinkers.nondepe
41、ndent drinkers.n nThe vast majority of people who drink heavily at The vast majority of people who drink heavily at times are not dependent, and any success in times are not dependent, and any success in decreasing their drinking will greatly reduce decreasing their drinking will greatly reduce soci
42、etal and personal harms from alcohol use.societal and personal harms from alcohol use.1717UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Methadone Treatment Documentation in the Medical Record: Implications for Patient SafetyWalley AY, et al. Walley
43、 AY, et al. J Gen Intern Med. J Gen Intern Med. 2009;24(9):10071011.2009;24(9):10071011.Summary by Marc N. Gourevitch, MD, MPHSummary by Marc N. Gourevitch, MD, MPH1818UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nClinically im
44、portant interactions can occur between Clinically important interactions can occur between methadone and some other medications.methadone and some other medications.n nResearchers analyzed records of all patients Researchers analyzed records of all patients (N=84) in an MMT program who had provided
45、(N=84) in an MMT program who had provided consent for the release of their medical consent for the release of their medical information to an affiliated but separate medical information to an affiliated but separate medical center. center. n nThe most recent primary care note or hospital The most re
46、cent primary care note or hospital discharge summary of each patient was reviewed discharge summary of each patient was reviewed for mention of opioid use, abuse, or dependence, for mention of opioid use, abuse, or dependence, participation in MMT, and potential interactions participation in MMT, an
47、d potential interactions between methadone and other drugs.between methadone and other drugs.1919UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nIn 30% of patients, medical records lacked In 30% of patients, medical records lacked documenta
48、tion of opioid dependence.documentation of opioid dependence.n nIn 11% of patients, medical records lacked In 11% of patients, medical records lacked documentation of MMT.documentation of MMT.n nSixty-nine percent of patients were prescribed at Sixty-nine percent of patients were prescribed at least
49、 1 medication with the potential to interact least 1 medication with the potential to interact with methadone, while 19% were on 3 or more with methadone, while 19% were on 3 or more such medications.such medications.2020UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其
50、他药药物与健康物与健康(70)(70)Commentsn nTransfer of medical information between the 2 Transfer of medical information between the 2 treatment venues in this study was likely a best-case treatment venues in this study was likely a best-case scenario due to the close relationship between them scenario due to th
51、e close relationship between them and the fact that signed releases were in place.and the fact that signed releases were in place.n nMany medications can be safely prescribed to MMT Many medications can be safely prescribed to MMT patients as long as the clinician and patient are patients as long as
52、 the clinician and patient are monitoring the potential for interaction.monitoring the potential for interaction.n nClinicians can optimize exchange of clinical data Clinicians can optimize exchange of clinical data between treatment sites by routinely obtaining signed between treatment sites by rou
53、tinely obtaining signed consent for communication between providers, by co-consent for communication between providers, by co-locating MMT with other medical care, and by locating MMT with other medical care, and by promoting integrated delivery systems that allow promoting integrated delivery syste
54、ms that allow provider access to a single electronic health record.provider access to a single electronic health record.2121UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Otto C, et al. Otto C, et al. Drug Alcohol Depend.Drug Alcohol Depend. 2009;10
55、5(3):221226. 2009;105(3):221226.Summary by Hillary Kunins, MD, MPH, MSSummary by Hillary Kunins, MD, MPH, MSBrief Intervention for Hospitalized Patients with Problematic Prescription Drug Use: No Long-lasting Effects2222UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他
56、药药物与健康物与健康(70)(70)Objectives/Methodsn nThis randomized controlled trial assessed whether This randomized controlled trial assessed whether brief intervention (BI) involving 2 sessions of brief intervention (BI) involving 2 sessions of motivational interviewing could reduce problematic motivational i
57、nterviewing could reduce problematic PD use among 126 inpatients at a German PD use among 126 inpatients at a German university hospital.university hospital.n nProblematic use was defined as having a prior Problematic use was defined as having a prior diagnosis of prescription drug dependence or dia
58、gnosis of prescription drug dependence or abuse or as taking abuse or as taking nonprescribednonprescribed, potentially , potentially addictive medication for at least 60 of the 90 days addictive medication for at least 60 of the 90 days preceding baseline screening.preceding baseline screening.n nT
59、he first session of the intervention was conducted The first session of the intervention was conducted while the patients were hospitalized; the second while the patients were hospitalized; the second took place 4 weeks later.took place 4 weeks later.2323UpdateonAlcoholOtherDrugsandHUpdateonAlcoholO
60、therDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)2424Objectives/Methods (contd)n nA prior reportA prior report* * showed a reduction in PD use at 3 showed a reduction in PD use at 3 months following the intervention.months following the intervention.n nThis study examined 2 outcomes at 12 months
61、:This study examined 2 outcomes at 12 months:n ncessation of PD usecessation of PD usen n25% reduction in use25% reduction in usen nAnalyses controlled for baseline differences in PD Analyses controlled for baseline differences in PD dependence and duration of use. dependence and duration of use. *
62、*ZahradnikZahradnik A, et al. A, et al. Addiction.Addiction. 2009;104(1):109117. 2009;104(1):109117.2424UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nThere was no difference in PD cessation rates There was no difference in PD cessation ra
63、tes between the BI and control groups at 12 months between the BI and control groups at 12 months (25% versus 20%; odds ratio OR, 1.4).(25% versus 20%; odds ratio OR, 1.4).n nThere was no difference in proportion of patients There was no difference in proportion of patients who reduced their PD use
64、by at least 25% at 12 who reduced their PD use by at least 25% at 12 months (50% versus 49%; OR, 0.9). months (50% versus 49%; OR, 0.9). 2525UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nAlthough application of the BI model for Although
65、application of the BI model for problematic PD use among hospitalized patients is problematic PD use among hospitalized patients is appealing, BI had no effect on use of potentially appealing, BI had no effect on use of potentially addictive medications at 12 months in this study.addictive medicatio
66、ns at 12 months in this study.n nWhether a more intensive or long-standing Whether a more intensive or long-standing intervention would be effective for hospitalized intervention would be effective for hospitalized patients with PD use, who are generally sicker than patients with PD use, who are gen
67、erally sicker than patients with risky alcohol use in ambulatory patients with risky alcohol use in ambulatory settings (the group for which BI was originally settings (the group for which BI was originally developed), remains an important area for developed), remains an important area for investiga
68、tion.investigation.2626UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Kinlock TW, et al. Kinlock TW, et al. J Subst Abuse Treat.J Subst Abuse Treat. 2009;37(3):277285. 2009;37(3):277285.Summary by Jeanette M. Tetrault, MDSummary by Jeanette M. Tetra
69、ult, MDPrison-initiated Methadone Maintenance Improves Postrelease Treatment Outcomes 2727UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nThe risk of postrelease relapse to opioid use is The risk of postrelease relapse to opioid
70、use is high among inmates who were dependent prior to high among inmates who were dependent prior to incarceration. incarceration. n nIn this randomized clinical trial, male inmates In this randomized clinical trial, male inmates (N=204) with preincarceration heroin dependence (N=204) with preincarc
71、eration heroin dependence were assigned to either:were assigned to either:n ncounseling (advice to seek methadone maintenance counseling (advice to seek methadone maintenance therapy MMT upon release),therapy MMT upon release),n ncounseling plus transfer (directive to report to an MMT counseling plu
72、s transfer (directive to report to an MMT facility within 10 days of release), orfacility within 10 days of release), orn ncounseling plus methadone (gradual initiation of MMT counseling plus methadone (gradual initiation of MMT in prison and directive to report to an MMT facility in prison and dire
73、ctive to report to an MMT facility within 10 days of release).within 10 days of release).2828UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)2929Objectives/Methods (contd)n nMean age of participants was 40 years, 70% Mean age of participants was 40 y
74、ears, 70% were African American, and 71% had received were African American, and 71% had received prior substance abuse treatment.prior substance abuse treatment.n nMean duration of incarceration was 605 days. Mean duration of incarceration was 605 days. 2929UpdateonAlcoholOtherDrugsandHUpdateonAlco
75、holOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nPrimary outcomes at 12 months postrelease:Primary outcomes at 12 months postrelease:Treatment and Urine Toxicology Results Treatment and Urine Toxicology Results Outcome measureOutcome measureTreatment conditionTreatment conditionp p
76、Counseling Counseling onlyonlyCounseling + Counseling + transfertransferCounseling + Counseling + methadonemethadoneMean days of methadone Mean days of methadone treatmenttreatment232391911661660.010.01In methadone treatment In methadone treatment for 12 monthsfor 12 months0%0%17%17%37%37%- -Opioid-
77、positive urine test Opioid-positive urine test 66%66%49%49%25%25%0.010.01Cocaine-positive urine testCocaine-positive urine test72%72%67%67%43%43%0.050.053030UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nIn this trial, counseling plus pre
78、release MMT was In this trial, counseling plus prerelease MMT was superior to counseling alone or counseling plus superior to counseling alone or counseling plus transfer to MMT at engaging patients in treatment transfer to MMT at engaging patients in treatment and decreasing illicit drug use follow
79、ing release and decreasing illicit drug use following release among inmates with prior heroin dependence.among inmates with prior heroin dependence.n nAlthough urine toxicology data were not available Although urine toxicology data were not available in 44% of the sample due to reincarceration, in 4
80、4% of the sample due to reincarceration, hospitalization, or relocation, these results provide hospitalization, or relocation, these results provide further support for public-health initiatives that further support for public-health initiatives that improve the transition of substance-use care from
81、 improve the transition of substance-use care from the institutional to the community setting.the institutional to the community setting.3131UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)3232Abstinence Rates with Office-based Buprenorphine Treatmen
82、t Differ by Retention and Insurance StatusParran TV, et al. Parran TV, et al. Drug Alcohol Depend.Drug Alcohol Depend. 2009;106(1):5660. 2009;106(1):5660.Summary by Hillary Kunins, MD, MPH, MSSummary by Hillary Kunins, MD, MPH, MS3232UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealtheal
83、th更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)3333Objectives/Methodsn nAn increasing number of reports describe practices An increasing number of reports describe practices and outcomes of office-based buprenorphine and outcomes of office-based buprenorphine treatment for opioid dependence in real-world treatment
84、 for opioid dependence in real-world settings.settings.n nThis report describes a highly structured office-This report describes a highly structured office-based program including:based program including:n n12 day inpatient induction;12 day inpatient induction;n n5 weeks of 3-hour counseling session
85、s 4 times per week;5 weeks of 3-hour counseling sessions 4 times per week;n nweekly counseling sessions for an additional 12 weeks.weekly counseling sessions for an additional 12 weeks.n nParticipants attended subsequent monthly follow-up Participants attended subsequent monthly follow-up visits and
86、 were required to attend thrice weekly 12-visits and were required to attend thrice weekly 12-step meetings. Full adherence was required to step meetings. Full adherence was required to remain in the program. remain in the program. 3333UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthe
87、alth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)3434Results n nAmong the 110 of 176 (63%) consecutively Among the 110 of 176 (63%) consecutively admitted patients available for follow-up at a admitted patients available for follow-up at a minimum of 18 months, minimum of 18 months, n n85 patients (77%) reported c
88、ontinuous buprenorphine 85 patients (77%) reported continuous buprenorphine treatment.treatment.n nretained patients were more likely to report abstinence retained patients were more likely to report abstinence (p=0.01) and to be employed (p=0.03) than (p=0.01) and to be employed (p=0.03) than nonre
89、tained patients.nonretained patients.n nretained patients with insurance were more likely to retained patients with insurance were more likely to report abstinence than those without insurance (97% report abstinence than those without insurance (97% versus 86%, respectively) (p=0.04).versus 86%, res
90、pectively) (p=0.04).3434UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)3535Commentsn nThe high retention rate in this office-based The high retention rate in this office-based buprenorphine treatment program may reflect the buprenorphine treatment p
91、rogram may reflect the selection of motivated patients. selection of motivated patients. n nPatients not available for follow-up were likely not Patients not available for follow-up were likely not in treatment, resulting in a retention rate of 48% in treatment, resulting in a retention rate of 48%
92、(similar to previous reports).(similar to previous reports).n nThe association between insurance status and The association between insurance status and abstinence is not surprising given that treatment abstinence is not surprising given that treatment costs are often a barrier for patients. Insuran
93、ce costs are often a barrier for patients. Insurance coverage for ongoing treatment of substance use coverage for ongoing treatment of substance use disorders might improve long-term outcomes. disorders might improve long-term outcomes. 3535UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHe
94、althealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Studies of Health Outcomes3636UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Mitchell SG, et al.Mitchell SG, et al. Am J Addict.Am J Addict. 2009;18(5):346355. 2009;18(5):346355.Summary by Summary by Darius A.
95、Rastegar, MDDarius A. Rastegar, MDDiverted Methadone and Buprenorphine Primarily Used to Prevent Withdrawal or to Stop Using Heroin3737UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nOpioid agonist treatment (OAT) with methadone
96、Opioid agonist treatment (OAT) with methadone or buprenorphine is effective for reducing illicit or buprenorphine is effective for reducing illicit drug use among opioid-dependent patients. drug use among opioid-dependent patients. However, the diversion of these agents may be However, the diversion
97、 of these agents may be harmful.harmful.n nA subsample of a larger 3-year longitudinal study A subsample of a larger 3-year longitudinal study involving 515 opioid-dependent subjects in involving 515 opioid-dependent subjects in Baltimore, MD, most of whom were seeking Baltimore, MD, most of whom we
98、re seeking methadone treatment, was recruited to undergo methadone treatment, was recruited to undergo in-depth interviews regarding their use of diverted in-depth interviews regarding their use of diverted methadone or buprenorphine.methadone or buprenorphine.3838UpdateonAlcoholOtherDrugsandHUpdate
99、onAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nTwenty-two people (24% of the subjects Twenty-two people (24% of the subjects interviewed) reported using diverted methadone or interviewed) reported using diverted methadone or buprenorphine. Of these, 17 used methadone only,
100、buprenorphine. Of these, 17 used methadone only, 4 used methadone and buprenorphine, and 1 used 4 used methadone and buprenorphine, and 1 used buprenorphine only.buprenorphine only.n nThose who used diverted methadone were more Those who used diverted methadone were more likely to have been enrolled
101、 in OAT in the past and likely to have been enrolled in OAT in the past and were less likely to have used heroin or cocaine in were less likely to have used heroin or cocaine in the past month.the past month.3939UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与
102、健康(70)(70)4040Results (contd)n nMost of the diverted methadone used was in Most of the diverted methadone used was in liquid form. Only 2 people had taken the pill liquid form. Only 2 people had taken the pill form.form.n nAll but 1 subject used the diverted medication All but 1 subject used the div
103、erted medication to prevent withdrawal symptoms or to stop to prevent withdrawal symptoms or to stop using heroin, and all generally took modest using heroin, and all generally took modest doses (about 30doses (about 30 40 mg per day of methadone 40 mg per day of methadone and 4 mg per day of bupren
104、orphine).and 4 mg per day of buprenorphine).4040UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nAlthough this was a small sample of an opioid-Although this was a small sample of an opioid-dependent population in one locale, it is reassurin
105、g dependent population in one locale, it is reassuring that diverted methadone and buprenorphine was that diverted methadone and buprenorphine was not used to produce euphoria and that modest not used to produce euphoria and that modest doses were used.doses were used.n nHowever, this study does not
106、 allay concern about However, this study does not allay concern about the availablility of doses for diversion or about the availablility of doses for diversion or about potential dangers of these drugs in less potential dangers of these drugs in less experienced and opioid naive individuals.experie
107、nced and opioid naive individuals.4141UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Does alcohol use affect driving performance in patients with obstructive sleep apnea?Vakulin A, et al. Vakulin A, et al. Ann Intern Med.Ann Intern Med. 2009;151(7):
108、447455. 2009;151(7):447455.Summary by Kevin L. Kraemer, MD, MSc Summary by Kevin L. Kraemer, MD, MSc 4242UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Objectives/Methodsn nAlcohol use and sleep deprivation may affect the Alcohol use and sleep depri
109、vation may affect the driving performance of patients with obstructive driving performance of patients with obstructive sleep apnea (OSA) more than it affects healthy sleep apnea (OSA) more than it affects healthy people.people.n nResearchers compared the simulated 90-minute Researchers compared the
110、 simulated 90-minute driving performance of 38 patients with untreated driving performance of 38 patients with untreated OSA and 20 healthy ageOSA and 20 healthy age - and gender-matched - and gender-matched controls randomized to 1 of 3 experimental controls randomized to 1 of 3 experimental condit
111、ions:conditions:n nblood alcohol concentration of 0.05 g/dL.blood alcohol concentration of 0.05 g/dL.n nsleep restricted to a maximum of 4 hours.sleep restricted to a maximum of 4 hours.n nunrestricted sleep.unrestricted sleep.4343UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更
112、新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Results n nParticipants with OSA were more likely than Participants with OSA were more likely than controls to have at least 1 crash (odds ratio OR, controls to have at least 1 crash (odds ratio OR, 25.425.4* *). They were also more likely to crash after ). They were als
113、o more likely to crash after alcohol use (OR, 2.3) or restricted sleep (OR, 4.0).alcohol use (OR, 2.3) or restricted sleep (OR, 4.0).n nParticipants with OSA had greater steering Participants with OSA had greater steering deviation than controls at baseline. Alcohol use and deviation than controls a
114、t baseline. Alcohol use and restricted sleep were each associated with a 40% restricted sleep were each associated with a 40% greater increase in steering deviation in participants greater increase in steering deviation in participants with OSA compared with controls. with OSA compared with controls
115、. n nAlcohol use did not affect braking reaction time in Alcohol use did not affect braking reaction time in either group.either group.*The high OR probably reflects the fact that only 1 crash occurred in the control *The high OR probably reflects the fact that only 1 crash occurred in the control g
116、roup.group.4444UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nIn this well-designed study, blood alcohol In this well-designed study, blood alcohol concentrations less than the typical legal limits concentrations less than the typical leg
117、al limits for driving were associated with significantly for driving were associated with significantly poorer driving performance in participants with poorer driving performance in participants with untreated OSA than in controls.untreated OSA than in controls.n nPatients with untreated OSA should
118、be urged to Patients with untreated OSA should be urged to seek treatment and to avoid alcohol use.seek treatment and to avoid alcohol use.n nThis study does not address the question of This study does not address the question of whether the same level of alcohol use would whether the same level of
119、alcohol use would have a similar effect on driving performance have a similar effect on driving performance among patients with treated OSA. among patients with treated OSA. 4545UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Kim TW, et al. Kim TW, e
120、t al. J Addiction Med.J Addiction Med. 2009;3(3):134138. 2009;3(3):134138.Summary by Jeanette M. Tetrault, MDSummary by Jeanette M. Tetrault, MDMethadone Contributes toBone and Dental Disease:Fact or Fiction?4646UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与
121、健康(70)(70)Objectives/Methodsn nPatients receiving methadone maintenance Patients receiving methadone maintenance treatment (MMT) for opioid dependence often treatment (MMT) for opioid dependence often express concern that methadone causes bone express concern that methadone causes bone disease and d
122、ental decay. disease and dental decay. n nLow bone density has been noted in some MMT Low bone density has been noted in some MMT patients.patients.n nThis cross-sectional study sought to determine the This cross-sectional study sought to determine the prevalence and risk factors associated with vit
123、amin-prevalence and risk factors associated with vitamin-D deficiency in patients receiving MMT. Deficiency D deficiency in patients receiving MMT. Deficiency was defined as a 25-hydroxyvitamin D level less was defined as a 25-hydroxyvitamin D level less than 20 ng/mL, while insufficiency was define
124、d as than 20 ng/mL, while insufficiency was defined as a level between 2030 ng/mL. a level between 2030 ng/mL. 4747UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nOf the 93 patients enrolled in the study, 36% Of the 93 patients enrolled in
125、the study, 36% had evidence of vitamin-D deficiency and an had evidence of vitamin-D deficiency and an additional 16% had evidence of insufficiency.additional 16% had evidence of insufficiency.n nVitamin-D deficiency was associated with age Vitamin-D deficiency was associated with age over 40 (odds
126、ratio OR, 3.47) and black or over 40 (odds ratio OR, 3.47) and black or Hispanic race/ethnicity (OR, 3.34).Hispanic race/ethnicity (OR, 3.34).n nLonger enrollment in MMT was not associated Longer enrollment in MMT was not associated with vitamin-D deficiency.with vitamin-D deficiency.4848UpdateonAlc
127、oholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Commentsn nThis cross-sectional study demonstrated a high This cross-sectional study demonstrated a high prevalence of vitamin-D deficiency among patients prevalence of vitamin-D deficiency among patients receivin
128、g MMT.receiving MMT.n nA model adjusting for all independent variables A model adjusting for all independent variables could not be constructed due to limited outcome could not be constructed due to limited outcome cases. cases. n nFurther investigation is needed to better Further investigation is n
129、eeded to better understand the association between MMT, other understand the association between MMT, other risk factors (e.g., smoking), and vitamin-D risk factors (e.g., smoking), and vitamin-D deficiency.deficiency.4949UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精
130、其他药药物与健康物与健康(70)(70)5050Meade CS, Meade CS, et al. et al. Am J Addict.Am J Addict. 2009;18(4):289293. 2009;18(4):289293.Summary by Summary by R. Curtis Ellison, MDR. Curtis Ellison, MDAdults with Prescription-Opioid Dependence Engage in High Rates of HIV Risk Behaviors5050UpdateonAlcoholOtherDrugsan
131、dHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)5151Objectives/Methodsn nLittle is known about the HIV risk behaviors of Little is known about the HIV risk behaviors of people who abuse prescription opioids. people who abuse prescription opioids. n nResearchers compared data o
132、n HIV risk Researchers compared data on HIV risk behaviors obtained via interview from persons behaviors obtained via interview from persons seeking detoxification treatment for heroin seeking detoxification treatment for heroin (n=27) or oxycodone (n=23) dependence at an (n=27) or oxycodone (n=23)
133、dependence at an inpatient psychiatric hospital.inpatient psychiatric hospital.n nDemographic characteristics were similar Demographic characteristics were similar between groups.between groups.5151UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)5252
134、Resultsn nPatients who used Patients who used oxycodoneoxycodone reported more past reported more past 30-day use than patients who used heroin and 30-day use than patients who used heroin and were more likely to report marijuana use (13% were more likely to report marijuana use (13% versus 2%).vers
135、us 2%).n nNone of the patients using None of the patients using oxycodoneoxycodone engaged in engaged in IDU, while 89% of the patients using heroin did.IDU, while 89% of the patients using heroin did.5252UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(
136、70)5353Results (contd)n nPast-month rates of sexual activity (68%), Past-month rates of sexual activity (68%), unprotected intercourse (47%), sex while unprotected intercourse (47%), sex while intoxicated (51%), and sex with strangers (18%) intoxicated (51%), and sex with strangers (18%) were simila
137、r between groups; however, patients were similar between groups; however, patients who used who used oxycodoneoxycodone were more likely to report were more likely to report having multiple partners (30% versus 4%).having multiple partners (30% versus 4%).n nPatients who used Patients who used oxyco
138、doneoxycodone were also less likely were also less likely to report having an HIV test in the past year (33% to report having an HIV test in the past year (33% versus 71%).versus 71%).5353UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)5454Commentsn
139、nThis study reflects a small number of subjects at This study reflects a small number of subjects at a single institution.a single institution.n nHowever, it does suggest that adults with However, it does suggest that adults with prescription opioid dependence engage in risky prescription opioid dep
140、endence engage in risky sexual behaviors at rates comparable to, if not sexual behaviors at rates comparable to, if not higher than, their heroin-dependent counterparts.higher than, their heroin-dependent counterparts.n nScreening opioid-dependent individuals for HIV Screening opioid-dependent indiv
141、iduals for HIV infection and counseling them regarding their risk infection and counseling them regarding their risk is warranted. is warranted. 5454UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Inverse Association between Alcohol Consumption and M
142、ortality May Differ by EthnicityFreiberg MS, et al. Freiberg MS, et al. Am J Hypertens.Am J Hypertens. 2009;22(11):12121218. 2009;22(11):12121218.Summary by R. Curtis Ellison, MDSummary by R. Curtis Ellison, MD5555UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康
143、物与健康(70)(70)Objectives/Methodsn nModerate alcohol consumption is associated with a Moderate alcohol consumption is associated with a reduced risk of mortality among Caucasian women, reduced risk of mortality among Caucasian women, but whether it has the same protective effect for but whether it has
144、the same protective effect for African-American women or all women with African-American women or all women with hypertension is unclear.hypertension is unclear.n nThis prospective study assessed the relationship This prospective study assessed the relationship between alcohol intake and mortality a
145、mong 10,576 between alcohol intake and mortality among 10,576 black and 105,610 white postmenopausal women black and 105,610 white postmenopausal women participating in the Womens Health Initiative.participating in the Womens Health Initiative.n nWomen with a history of cancer or cardiovascular Wome
146、n with a history of cancer or cardiovascular disease at baseline were excluded. Mean follow-up disease at baseline were excluded. Mean follow-up was 8 years.was 8 years.5656UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)Resultsn nA total of 5608 wom
147、en died over the follow-up A total of 5608 women died over the follow-up period. period. n nAfter adjusting for potential confounders, After adjusting for potential confounders, moderate drinking (1 to 7 drinks per week) was moderate drinking (1 to 7 drinks per week) was associated with a lower risk
148、 of mortality among associated with a lower risk of mortality among Caucasian women hazard ratio (HR), 0.81 and Caucasian women hazard ratio (HR), 0.81 and all hypertensive women (HR, 0.76) compared all hypertensive women (HR, 0.76) compared with lifetime abstainers, but it had no significant with l
149、ifetime abstainers, but it had no significant protective effect for African-American women protective effect for African-American women (HR, 0.94).(HR, 0.94).5757UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)5858Results (contd)n nOverall, in compar
150、ison with lifetime abstainers, Overall, in comparison with lifetime abstainers, current drinking of 1 drink per month to 14 current drinking of 1 drink per month to 515 g per day, HR, 1.14.515 g per day, HR, 1.14.n nNo significant interaction between alcohol and No significant interaction between al
151、cohol and folatefolate was seen in adjusted models. was seen in adjusted models.6363UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6464Commentsn nThis analysis found no evidence that folate intake This analysis found no evidence that folate intake r
152、educes breast cancer risk in postmenopausal reduces breast cancer risk in postmenopausal women who consume alcohol.women who consume alcohol.n nMost of the potential confounding variables showed Most of the potential confounding variables showed the expected positive association with breast cancer t
153、he expected positive association with breast cancer risk, and the association with alcohol intake was risk, and the association with alcohol intake was similar to that shown in other studies.similar to that shown in other studies.n nRecruitment occurred after the fortification of Recruitment occurre
154、d after the fortification of cereals and grains with folate in the US, which could cereals and grains with folate in the US, which could have resulted in fewer women with inadequate have resulted in fewer women with inadequate intake. Further, the relatively brief follow-up period intake. Further, t
155、he relatively brief follow-up period may not have been adequate to demonstrate a may not have been adequate to demonstrate a protective effect.protective effect.6464UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6565The Impact of Neighborhood Alcoho
156、l Outlet Density on Alcohol-related Health OutcomesTheall KP, et al. Theall KP, et al. Alcohol Alcohol.Alcohol Alcohol. 2009;44(5):491499. 2009;44(5):491499. Summary by Summary by Nicolas Bertholet, MD, MScNicolas Bertholet, MD, MSc6565UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthe
157、alth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6666Objectives/Methodsn nResearchers at 2 US sites conducted a cross-Researchers at 2 US sites conducted a cross-sectional study to assess the association sectional study to assess the association between alcohol outlet density and self-reported between alcohol outl
158、et density and self-reported alcohol-related health outcomes.alcohol-related health outcomes.n nThey also sought to determine whether these They also sought to determine whether these associations were mediated by individual alcohol associations were mediated by individual alcohol use.use.6666Update
159、onAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6767Objectives/Methods (contd)n nThree measures of alcohol outlet density were Three measures of alcohol outlet density were used:used:n nneighborhood density (number of outlets per square neighborhood densit
160、y (number of outlets per square mile of census tract).mile of census tract).n nindividual density (number of outlets within 1 mile of individual density (number of outlets within 1 mile of each subjects home).each subjects home).n ndistance to the nearest outlet from each subjects distance to the ne
161、arest outlet from each subjects home.home.6767UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6868Resultsn nThe average distance to the nearest outlet was The average distance to the nearest outlet was 0.5 miles. The average outlet density within 1 m
162、ile 0.5 miles. The average outlet density within 1 mile was 1.1.was 1.1.n nIn analyses adjusted for age, sex, race, ethnicity, In analyses adjusted for age, sex, race, ethnicity, education, location, and income, individual outlet education, location, and income, individual outlet density was associa
163、ted with sexually transmitted density was associated with sexually transmitted infection (adjusted odds ratio AOR,infection (adjusted odds ratio AOR,* * 1.80), liver 1.80), liver problems (AOR, 1.33), and violence (AOR, 1.31). problems (AOR, 1.33), and violence (AOR, 1.31). n nDistance to the neares
164、t outlet was not associated Distance to the nearest outlet was not associated with STI, liver problems, or violence.with STI, liver problems, or violence.*Indicates the change in likelihood when outlet density increased by 1 unit.*Indicates the change in likelihood when outlet density increased by 1
165、 unit.6868UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)6969Results (contd)n nIndividual alcohol use partially mediated the Individual alcohol use partially mediated the relationship between outlet density, STI, and relationship between outlet dens
166、ity, STI, and violence and fully mediated the association violence and fully mediated the association between outlet density and liver problems.between outlet density and liver problems.6969UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)7070Comments
167、n nIn this study, the association between outlet In this study, the association between outlet density and some alcohol-related health outcomes density and some alcohol-related health outcomes is only partially explained by individual alcohol is only partially explained by individual alcohol use.use
168、.n nClinicians and policymakers should consider the Clinicians and policymakers should consider the potential impact of alcohol outlet density in a potential impact of alcohol outlet density in a patients neighborhood as a factor in his or her patients neighborhood as a factor in his or her health, even in the absence of unhealthy alcohol health, even in the absence of unhealthy alcohol use.use.7070UpdateonAlcoholOtherDrugsandHUpdateonAlcoholOtherDrugsandHealthealth更新酒精其他更新酒精其他药药物与健康物与健康(70)(70)
