Search

Considering the widespread use of cannabis and opioids, examining the use of cannabis, opioids and their combination with serious psychological distress (SPD) is important. A total of N = 12,358 adults participating in the Monitor surveillance study between 2014 and 2019 were included. Cannabis and opioid use reflected any use of the substances in the past 12 months. SPD was defined as having a score of 13 or more on the Kessler‐6 questionnaire, a 6‐item scale that includes feeling nervous, hopeless, restless or fidgety, sad or depressed. Odds ratios (ORs) were estimated from logistic regression models accounting for complex survey design and sociodemographic factors. Overall, 12.8% of the sample reported cannabis use only, 18% reported opioid use only, and 4.9% reported both cannabis and opioid use. Use of both cannabis and opioids was significantly associated with SPD in both women (OR = 4.24; 95% CI, 2.34 to 7.69), and in men (OR = 2.99; 95% CI, 1.56 to 5.73) compared to use of neither. The joint association of cannabis and opioids with SPD was additive. Addressing those who use both cannabis and opioids may help reduce the burden of SPD among adults in Ontario. [ABSTRACT FROM AUTHOR]

Introduction: Policy changes may contribute to increased alcohol‐related risks to populations. These include privatisation of alcohol retailing, which influences density of alcohol outlets, location of outlets, hours of sale and prevention of alcohol sales to minors or intoxicated customers. Meta‐analyses, reviews and original research indicate enhanced access to alcohol is associated with elevated risk of and actual harm. We assess the 10 Canadian provinces on two alcohol policy domains—type of alcohol control system and physical availability of alcohol—in order to track changes over time, and document shifting changes in alcohol policy. Methods: Our information was based on government documents and websites, archival statistics and key informant interviews. Policy domains were selected and weighted for their degree of effectiveness and population reach based on systematic reviews and epidemiological evidence. Government representatives were asked to validate all the information for their jurisdiction. Results: The province‐specific reports based on the 2012 results showed that 9 of 10 provinces had mixed retail systems—a combination of government‐run and privately owned alcohol outlets. Recommendations in each provincial report were to not increase privatisation. However, by 2017 the percentage of off‐premise private outlets had increased in four of these nine provinces, with new private outlet systems introduced in several. Discussion and Conclusions: Decision‐making protocols are oriented to commercial interests and perceived consumer convenience. If public health and safety considerations are not meaningfully included in decision‐making protocols on alcohol policy, then it will be challenging to curtail or reduce harms. [ABSTRACT FROM AUTHOR]

Aim: We conducted a responsibility analysis to determine whether drivers injured in motor vehicle collisions who test positive for Δ‐9‐tetrahydrocannabinol (THC) or other drugs are more likely to have contributed to the crash than those who test negative. Design Prospective case–control study. Setting: Trauma centres in British Columbia, Canada. Participants: Injured drivers who required blood tests for clinical purposes following a motor vehicle collision. Measurements Excess whole blood remaining after clinical use was obtained and broad‐spectrum toxicology testing performed. The analysis quantified alcohol and THC and gave semiquantitative levels of other impairing drugs and medications. Police crash reports were analysed to determine which drivers contributed to the crash (responsible) and which were 'innocently involved' (non‐responsible). We used unconditional logistic regression to determine the likelihood (odds ratio: OR) of crash responsibility in drivers with 0 < THC < 2 ng/ml, 2 ng/ml ≤ THC < 5 ng/ml and THC ≥ 5 ng/ml (all versus THC = 0 ng/ml). Risk estimates were adjusted for age, sex and presence of other impairing substances. Findings We obtained toxicology results on 3005 injured drivers and police reports on 2318. Alcohol was detected in 14.4% of drivers, THC in 8.3%, other drugs in 8.9% and sedating medications in 19.8%. There was no increased risk of crash responsibility in drivers with THC < 2 ng/ml or 2 ≤ THC < 5 ng/ml. In drivers with THC ≥ 5 ng/ml, the adjusted OR was 1.74 [95% confidence interval (CI) = 0.59–6.36; P = 0.35]. There was significantly increased risk of crash responsibility in drivers with blood alcohol concentration (BAC) ≥ 0.08% (OR = 6.00;95% CI = 3.87–9.75; P < 0.01), other recreational drugs detected (OR = 1.82;95% CI = 1.21–2.80; P < 0.01) or sedating medications detected (OR = 1.45; 95%CI = 1.11–1.91; P < 0.01). Conclusions: In this sample of non‐fatally injured motor vehicle drivers in British Columbia, Canada, there was no evidence of increased crash risk in drivers with Δ‐9‐tetrahydrocannabinol < 5 ng/ml and a statistically non‐significant increased risk of crash responsibility (odds ratio = 1.74) in drivers with Δ‐9‐tetrahydrocannabinol ≥ 5 ng/ml. [ABSTRACT FROM AUTHOR]

Introduction and Aims: While the perceived risks of driving under the influence of cannabis (DUIC) have been a focus of recent drug-driving research, relevant concepts from the social cognition literature have rarely been applied to inform understanding of DUIC. This study aims to expand knowledge of perceived collision risk and social influences associated with DUIC and driving after other substance use.Design and Methods: Semi-structured interviews were conducted with 20 participants of a remedial program for impaired drivers. Thematic analysis began with two independent coders. Early discussion of emergent themes resulted in the identification of applicable social cognition concepts, resulting in selective coding and interpretation.Results: Many participants identified DUIC as less risky than driving under the influence of alcohol or other drugs. Mixed perceptions regarding the dangerousness of DUIC were expressed, with some participants denying increased collision risk except among novice cannabis users. Comparative optimism bias was also expressed by participants who perceived themselves as less likely than others to be involved in a collision when DUIC. In view of normative influence, friends were generally seen as more accepting of DUIC than family, and there were indications that the opinions of others who use cannabis were regarded as more credible than the opinions of those who do not use the drug.Discussion and Conclusions: Comparative optimism bias and normative influence may contribute to perceived risks associated with DUIC and may, therefore, be useful concepts to employ to increase the effectiveness of public health and road safety initiatives. [ABSTRACT FROM AUTHOR]

Background: Several studies have found a connection between attentional deficit hyperactivity disorder (ADHD) and criminal behaviour in clinical and prison samples of adults, but there is a lack of representative general population data on this.Aim: To test relationships between histories of ADHD and arrest. Our main research question was whether any such relationship is direct or best explained by co-occurring variables, especially indicators of social bonds.Method: Data were from a sample of 5,376 adults (18+) representative of the general population of Ontario, Canada. Logistic regression analysis was used to explore the relationship between self-reported arrest on criminal charges and ADHD as measured by the Adult Self Report Scale (ASRS-v1.1). Indicators of strong social bonds (post secondary education, household size) and weak bonds (drug use, antisocial behaviours, alcohol dependence) were also obtained at interview and included in the statistical models.Results: In a main effects model, screening positive for ADHD was twice as likely (OR 2.05 CI 1.30, 3.14) and past use of medications for ADHD three times as likely (OR 3.94 CI 2.46, 6.22) to be associated with ever having been arrested. These associations were no longer significant after controls for weak and strong social bonds were added to the models. In the best fitting statistical model, ever having been arrested was not associated with ADHD, but it was significantly associated with indicators of strong and weak social bonds.Conclusions: The observed connection between ADHD and criminality may be better understood through their shared relationships with indicators of poor social bonds. These include antisocial behaviour more generally, but also drug use and failure to progress to any form of tertiary education, including vocational training. Copyright © 2017 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and aims Little research has examined the relationship between incentives used by gambling venues to attract customers and the experience of gambling-related harm. Organized and subsidized bus tours are a common example of such incentives. The aim of this study was to examine whether bus-tour patronage was associated with increased odds of problem gambling among older adults. This study also compared rates of bus-tour use by socio-demographic characteristics and gambling behaviours. Design Pearson's χ2 tests and Mann-Whitney U-tests were applied for bivariate analyses. Multivariate generalized mixed-effects regression modelling was used to examine the relationship between bus-tour patronage and problem gambling while controlling for possible confounding factors. Setting Seven gambling venues located in Central and Southwestern Ontario, Canada. Participants A total of 1978 gambling venue patrons over the age of 55 years. Measurements Problem gambling as indicated by the Problem Gambling Severity Index, bus-tour patronage in the 12 months prior to the survey, spending per gambling visit and past-month slot machine participation. Findings Regression analyses showed that bus-tour patronage was associated with higher odds of problem gambling [odds ratio (OR) = 1.71, confidence interval (CI) = 1.06, 2.76] after controlling for several demographic characteristics, type of gambling and gambling expenditures. Bivariate analyses showed past-year bus-tour patronage was associated with more frequent slot machine play (χ2 = 48.16, P < 0.001), more past-year gambling venue visits ( P < 0.001) and lower spending on gambling per casino visit ( P < 0.001). Compared with non-patrons, bus tour patrons were more likely to be female (χ2 = 21.92, P < 0.001), born outside Canada (χ2 = 113.18, P < 0.001), above the age of 75 (χ2 = 24.02, P < 0.001) and retired (χ2 = 16.60, P < 0.001). Conclusions When adjusting for potential confounders among older adults, using bus tours to access Canadian gambling venues is associated with increased risk of problem gambling. Bus-tour patrons are more likely to be female, born outside Canada and above the age of 75 years. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study examined prevalence of alcohol consumption among immigrants and the Canadian-born populations of Ontario by ethnic origin, and the association between ethnicity, country of birth, age at arrival, length of residence in Canada and drinking measures.Design and Methods: Data were derived from the Centre for Addiction and Mental Health (CAMH) Monitor, a cross-sectional survey of Ontario adults, conducted between January 2005 and December 2010 (n = 13,557).Results: The prevalence of alcohol consumption and risk drinking was generally lower among foreign-born than Canadian-born respondents, but significant variations across ethnic groups were found. In general, foreign-born respondents of European descent reported higher rates of alcohol use and risk drinking than foreign-born respondents from other ethnic groups. We also observed that ethnicity effects varied by whether or not respondents were born in Canada, and by the age at which they arrived in Canada.Discussion and Conclusions: While previous studies generally found an increase in immigrants' alcohol consumption with years in Canada, our data suggest that longer duration of residence may have either positive or negative effects on immigrants' alcohol use, depending on the country of origin/traditional drinking pattern. More research is needed to explore determinants of alcohol use and risk drinking among immigrants and to identify those groups at highest risk. [ABSTRACT FROM AUTHOR]

Background. Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that can persist in adolescence and adulthood. Aim. To examine prevalence of ADHD symptoms and correlates in a representative sample of adults 18 years and older living in Ontario, Canada. Method. We used the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, to examine the relationships between ADHD positive symptoms and comorbidities, substance use, medication use, social outcomes, and sociodemographics. Results. Of 4014 residents sampled in 2011-2012, 3.30% (2.75%–3.85%) screened positively for ADHD symptoms (women = 3.6%; men = 3.0%). For men, distress, antisocial symptoms, cocaine use, antianxiety medication use, antidepressant medication use, and criminal offence arrest were associated with positive ADHD screen. For women, distress, cocaine use, antianxiety medication use, antidepressant medication use, pain medication use, and motor vehicle collision in the past year were associated with positive ADHD screen. Conclusions. ADHD symptoms are associated with adverse medical and social outcomes that are in some cases gender specific. [ABSTRACT FROM AUTHOR]

Introduction and Aims To assess the prevalence and key covariates of non-medical prescription opioid use ( NMPOU) in two representative surveys of adults ( Centre for Addiction and Mental Health Monitor, CM) and secondary-school students ( Ontario Student Drug Use and Health Survey, OSDUHS). Design and Methods Data from the 2010 and 2011 cycles ( n = 4023) of CM-a stratified, multi-stage, random-digit-dialling telephone survey of adults (18 years and older)-and the 2011 cycle of OSDUHS ( n = 3266)-a self-administered written questionnaire-based survey of grade 7-12 public system students-were used. Besides NMPOU prevalence, associations were assessed by univariate and multi-step multivariate (logistic regression) analyses. NMPOU and key socioeconomic (i.e. sex, age, Aboriginal ethnicity, household location, income, subjective social status), health indicators (physical health status, psychological distress, suicidal ideation), drug use (cigarette smoking, binge drinking, cannabis use, other drug use) were measured. Results NMPOU (past year) prevalence was 15.5% in students and 5.9% in adults. Various univariate associations with social, health and drug use factors were found in both populations, with differences by sex. Based on multivariate analyses, other drug use (male students) and rural residence, subjective social status, other drug use and suicidal ideation (female students); marital status and cannabis use (male adults) and binge drinking (female adults) were independently associated with NMPOU in the respective study populations. Discussion and Conclusions NMPOU was high in adults and especially students. Independent predictors of NMPOU were largely inconsistent by sex. Notably, NMPOU is widely distributed across socio-demographic and -economic strata, and thus requires broad-based interventions. [ABSTRACT FROM AUTHOR]

Brief interventions effectively reduce alcohol problems; however, it is controversial whether longer interventions result in greater improvement. This study aims to determine whether an increase in treatment for people with more severe problems resulted in better outcome. We employed regression-discontinuity analyses to determine if drinking driver clients ( n = 22,277) in Ontario benefited when they were assigned to a longer treatment program (8-hour versus 16-hour) based on assessed addiction severity criteria. Assignment to the longer16-hour program was based on two addiction severity measures derived from the Research Institute on Addictions Self-inventory (RIASI) (meeting criteria for assignment based on either the total RIASI score or the score on the recidivism subscale). The main outcome measure was self-reported number of days of alcohol use during the 90 days preceding the six month follow-up interview. We found significant reductions of one or two self-reported drinking days at the point of assignment, depending on the severity criterion used. These data suggest that more intensive treatment for alcohol problems may improve results for individuals with more severe problems. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Centre for Addiction and Mental Health is one of the premier centres for research related to substance use and addiction. This research began more than 50 years ago with the Addiction Research Foundation (ARF), an organization that contributed significantly to knowledge about the aetiology, treatment and prevention of substance use, addiction and related harm. After the merger of the ARF with three other institutions in 1998, research on substance use continued, with an additional focus on comorbid substance use and other mental health disorders. In the present paper, we describe the structure of funding and organization and selected current foci of research. We argue for the continuation of this successful model of integrating basic, epidemiological, clinical, health service and prevention research under the roof of a health centre. [ABSTRACT FROM AUTHOR]

The current study examines the impact of psychological distress on the likelihood of reporting collision involvement in the preceding year. Two measures of psychological distress were obtained from the 12-item General Health Questionnaire (GHQ-12): depression–anxiety and social functioning. Data are based on the 2002–2004 Centre for Addiction and Mental Health Monitor (36 months), a repeated cross-sectional telephone survey of Ontario adults aged 18 and older (n = 4935). Logistic regression analyses were performed on collision involvement within the past 12 months with the measures of depression–anxiety, social functioning and demographic factors as independent variables. The analyses revealed that the odds of involvement in a collision in the last 12 months were significantly related to the demographic factors of age, location of residence, income, educational level and marital status. After controlling for demographic factors, the odds of collision involvement increased significantly as the depression–anxiety score increased (odds ratio = 1.05 for each unit increase). These results suggest that higher levels of psychological distress, as indicated by scores on the depression–anxiety scale of the GHQ-12, are associated with higher likelihood of collision involvement in the previous year. Research to understand the link observed here between distress and collision risk in the general population is needed. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Research has shown a strong link between alcohol use and a variety of problems, including violence. Parker and colleagues have presented a selective disinhibition theory for the link between alcohol use and homicide (and other violence) that posits a causal relationship that is also influenced by other situational and contextual factors. This model is particularly well suited for aggregate-level investigations. In this study, we examine the impact of alcohol factors, including consumption measures and Alcoholics Anonymous (AA) membership rates, on homicide mortality rates in Ontario, and test predictions derived from the selective disinhibition model. Methods: Time series analyses with ARIMA modeling were applied to total, male, and female homicide rates in Ontario between 1968 and 1991. The analyses performed included total alcohol consumption, spirits consumption, beer consumption, and wine consumption. Missing AA membership data were interpolated with cubic splines. Results: For the total population and males, homicide rates were significantly and positively related to total alcohol consumption and to the consumption of beer and spirits. They were also negatively related to AA membership rates in the analyses involving spirits and wine and positively related to unemployment rates in the analyses involving beer, wine, and total alcohol. Among females, none of the measures were significant predictors of homicide mortality rates. Conclusions: These data provide important support for the selective disinhibition model and confirm important relationships between per capita consumption measures and homicide mortality rates, especially among males, seen in other studies. Additionally, the results for AA membership rates are consistent with the hypothesis that AA membership and treatment for misuse of alcohol can exert beneficial effects observable at the population level. [ABSTRACT FROM AUTHOR]

Aims We test the hypotheses that cirrhosis mortality rates are positively associated with per capita alcohol consumption and negatively associated with Alcoholics Anonymous (AA) membership rates. Design The impact of alcohol consumption levels and AA membership rates on cirrhosis mortality rates in Ontario from 1968 to 1989 were examined. Time-series analyses with ARIMA modelling were applied to male and female cirrhosis mortality rates in three age groups: 15–44, 45–64 and 65 + years. Missing AA membership data were interpolated using two methods: linear splines and cubic splines. Findings In general, cirrhosis mortality rates were positively associated with alcohol consumption and negatively associated with AA membership. For some age and gender combinations, these effects were not statistically significant. Conclusions The limits of this study include restrictions in the length of series available and in the ability to infer causality. Despite these limitations, these findings are consistent with previous research demonstrating that per capita consumption is a strong determinant of cirrhosis mortality rates, and also that higher levels of AA membership can reduce cirrhosis mortality rates. [ABSTRACT FROM AUTHOR]

This article discusses the role of the social and physical environment in substance addiction. It is noted that the immediate environment in which substance use occurs has been shown to have a strong relationship with harmful outcomes, such as violence. For instance, the wider socio-cultural context in which alcohol is consumed has been shown to be a critical factor in the strength of the association between alcohol use and violence. Likewise, in the illicit drug use field, strong evidence has emerged concerning the crucial role of socio-environmental determinants for drug-related morbidity and mortality. Thus, its is pointed out that the characteristics of the social and physical environment of the user and the immediate environment in which substance use occurs contribute directly to harmful use patterns as well as modifying the level of harm associated with substance abuse.

Ontario introduced an Administrative Driver's Licence Suspension (ADLS) law in 1996, whereby a person with a blood alcohol level over the legal limit of 80 mg%, or who refused to provide a breath sample, would have his or her driver's licence suspended immediately for a period of 90 days. We test the differential deterrence hypothesis which would predict that social or lighter drinkers would be more affected by the Administrative Driver's License Suspension law than heavier drinkers. Data from the 1996 and 1997 cycles of the Ontario Drug Monitor, a general population survey of Ontario adults (monthly cross-sectional surveys), were employed (response rate 64–67%). Analyses were restricted to drivers who reported at least some drinking during the last year ( n = 3827). The total number of drinks consumed during the past 12 months was analysed with analysis of variance. We found that the mean alcohol consumption of those who reported drinking-driving increased significantly after the ADLS was introduced, whereas the alcohol consumption of those who did not drive after drinking remained the same. The limits of this study include a lack of comparison data from regions without ADLS, a reliance on self-report measures, possible age restrictions of the findings and the fact that only an inferential test of the differential deterrence hypothesis is permitted by the data. Despite these limitations, these findings are consistent with the prediction that lighter or more moderate drinkers will tend to stop driving after drinking completely, and thus drop out of the drinking-driving population when the ADLS law was introduced, leaving heavier drinkers in this population. It will be important to continue to examine the dynamics of differential deterrence over a longer interval. [ABSTRACT FROM AUTHOR]

Discusses the efforts to understand the factors affecting levels of alcohol problems. Reasons for ruling out alternative hypotheses; Ecological validity and the analysis of complex systems; Information on a public health approach to treatment.

Aims. Historically, treatment programs and related activities for alcoholics or high-risk drinkers have been viewed as not relevant to efforts to prevent alcohol problems, and in particular population-based prevention efforts. In this review we consider evidence that high-risk programs may have an impact on population or aggregate levels of these problems. Design. We first summarize recent reviews of the clinical impact of programs for high-risk drinkers, since some level of effectiveness at the individual level is necessary for these programs to have an aggregate level impact. Following that, correlational evidence on the impact of high-risk programs on aggregate problem levels is examined. Estimates of the potential impact of high-risk programs on aggregate problem levels, based on available information on the impact of these programs and the numbers of individuals affected, are then considered, as are estimations of the comparative aggregate level impact of high-risk and consumption reduction strategies. Findings. There is increasing evidence that high-risk programs have beneficial effects for individuals. Available correlational evidence supports the proposal that increases in treatment and AA have contributed to the declines in alcohol-related morbidity and mortality observed in some countries in recent years. Studies estimating the recent impact of increases in levels of treatment and AA membership support that interpretation, and studies comparing estimated effects of high-risk and population strategies find similar potential for aggregate effects. Conclusions. Programs for high-risk drinkers can have beneficial aggregate-level effects and are thus a valuable component of population-based efforts to reduce alcohol problems. [ABSTRACT FROM AUTHOR]

In Canada, deaths from liver cirrhosis have declined by about 25% since 1974. To gain further insight into the nature of this decline, mortality rates for the years 1974-1984 and morbidity (hospital separation) rates for the years 1974-1980 were examined by age and sex and by province and sex. As well, survey data on drinking practices in Ontario were analyzed. Both mortality and morbidity declined over the time period involved, although variations over provinces, age groups, and sex were observed. The pattern of variations (largest declines in provinces with highest per capita alcohol consumption and in young to middle-aged males) strongly suggests decreased incidence of alcoholic liver cirrhosis. Among the factors which may be contributing to these declines are: the stabilization and small decreases in per capita consumption of alcohol; consumption pattern changes consistent with observed mortality and morbidity changes; expanded health promotion activities; and increases in the numbers of alcoholics receiving treatment. [ABSTRACT FROM AUTHOR]

Recent reductions in liver cirrhosis morbidity and mortality rates have been noted in many Western countries. We have previously observed that these declines are associated with increases in treatment for alcohol abuse over regions of Ontario, and increases in Alcoholics Anonymous (AA) membership over American states. One important question is whether the potential impact of treatment and AA membership increases could be large enough to have an impact on population cirrhosis rates. We explore this issue using estimates of the effects of treatment and AA membership, and of the likelihood of alcohol abusers developing cirrhosis, derived from the research literature. The results suggest that increases in treatment and AA membership could indeed have made important contributions to declines in cirrhosis mortality and morbidity in Ontario (1975-82) and the USA (1979-82). [ABSTRACT FROM AUTHOR]

In this paper the relationships among suicide rates in Ontario for males, females and the total population, alcohol consumption, and other alcohol-related problems are examined for the period 1963-1983. Suicide rates, like other alcohol-related problems, were strongly correlated with per capita consumption over the total period. However, during the recent period of stabilization in consumption (1975-83), the correlations were markedly reduced and substantial differences in trends for males and females were observed. The contribution to these diverging trends of such factors as increased treatment of alcohol abuse, rising unemployment, and reduced use of tranquillizing drugs is discussed. [ABSTRACT FROM AUTHOR]

In this study, the impact of change in rates of Alcoholics Anonymous (AA) membership and per capita consumption of alcohol on changes in rates of cirrhosis, drinking-driving charges and liquor act charges are examined for the 10 provinces of Canada over the period 1974-1983. Neither measure was significantly related to changes in cirrhosis rates However, AA membership and consumption changes were associated, in an interactive manner, with changes in drinking-driving and liquor act charges. [ABSTRACT FROM AUTHOR]

In Ontario, liver cirrhosis mortality and morbidity have decreased substantially in recent years. Over the corresponding period, substantial increases have occurred in the number of people receiving treatment for an alcohol problem. The potential contributions of both changes in alcoholism treatment and changes in per capita consumption of alcohol to declines in hospital discharges for liver cirrhosis were examined with regression analyses. The results indicate that, with the exception of one area of the province, increases in treatment were linearly related to decreases in cirrhosis discharges. [ABSTRACT FROM AUTHOR]

In Ontario, per capita consumption of alcohol rose steadily from 1963 to 1975. Beginning in 1975, consumption stabilized and declined slightly (2.6%) to 1983. Correlational analyses of the data during the period of consumption increase demonstrated significant associations between consumption and all problem indices. During the period of consumption stabilization the linear relationships between consumption and problem indices appeared to break down; most of the problem indices declined more than would be expected. The possible contributions of changes in demographic factors, consumption patterns, and prevention/treatment efforts to these declines are discussed. [ABSTRACT FROM AUTHOR]

Comments on an article on the role of individual interventions in reducing alcoholism. Explanations on how employee assistance programs prevent alcoholism; Impact of health promotion on alcohol and drug education; Association between treatment and prevention activities and reduction in alcohol consumption and related problems.

Mortality rates for 639 drinking drivers were calculated. The sample consisted of ail individuals convicted of ia second offence in two Ontario cities (Oshawa and North Bay) between 1973 and late 1978. There were 53 deaths (51 males, 2 females) in the sample prior to the end of 1986. Among males, significant excess total mortality was observed (Standardized Mortality Ratio = 1.7); similar trends were observed among females. Age-related excess mortality and excess mortality by cause were strikingly similar to mortality patterns observed among alcoholics. [ABSTRACT FROM AUTHOR]

This paper examines the proposition that increased treatment for alcohol abuse and Alcoholics Anonymous (AA) membership can account for a large part of the recent declines in cirrhosis mortality and morbidity. Data on treatment and AA membership in the USA between 1979 and 1987 and in Ontario between 1975 and 1986 are used, together with estimates of cirrhosis risk and the likely impact of treatment and AA membership. The results show that increased treatment levels and AA membership could account for all of the reductions in cirrhosis deaths and hospital admissions in Ontario. In the USA all of the deaths and about 40% of the admissions could be accounted for by these factors. [ABSTRACT FROM AUTHOR]

The authors discuss the need for newer data regarding the use of cannabis by youth. They mention the increased levels of tetrahydrocannabinol and its impact, the greater risk factors for mental illness, and the increased use of marijuana with its legalization as contributing to this need.

Presents the final results from a meta-analysis of remedial interventions with drink and drive offenders, by Wells-Parker et al.'s papers. Publication in Addition 90 magazine; achievement of the paper; Focus of the research; Methodological problems in the report; Evaluation on drink and drive offenders.

The authors comment "Why don't northern American solutions to drinking and driving work in southern America?" by F. Pechansky and A. Chandran on the perils of drunk driving in South America can affect international progress on alcohol and traffic safety. They mention the proposed three-pronged strategy to address the problem, which if implemented can have a major impact on drink driving deaths, injuries and collisions. They also discuss the importance enacting effective legislation.

Editorial. Discusses the selection of a rational threshold for the definition of drunk driving. Question on the appropriate level at which to set the legal limit; Lines of research that have direct implications for setting the legal limit; Effects of the varying amounts of alcohol on driving ability; Risk of collision involvement; Effects of introducing legal limits.

Drinking-driving is a leading cause of preventable morbidity and mortality in Canada. The purpose of this paper was to examine factors that influenced drinking driver deaths in Ontario. We examined the impact of per capita consumption of total alcohol, and of beer, wine and spirits separately, on drinking-driving deaths in Ontario from 1962 to 1996, as well as the impact of the introduction of Canada's per se law and the founding of People to Reduce Impaired Driving Everywhere - Mothers Against Drunk Driving (PRIDE - MADD) Canada. We utilised time-series analyses with autoregressive integrated moving average (ARIMA) modelling. As total alcohol consumption increased, drinking driving fatalities increased. The introduction of Canada's per se law, and of PRIDE-MADD Canada, acted to reduce drinking driving death rates. Among the specific beverage types, only consumption of beer had a significant impact on drinking driver deaths. Several factors were identified that acted to increase and decrease drinking driver death rates. Of particular interest was the observation of the impact of beer consumption on these death rates. In North America, beer is taxed at a lower rate than other alcoholic beverages. The role of taxation policies as determinants of drinking-driving deaths is discussed.