Erika Bácskai

Cocaine Use in Europe – A Multi-Centre Study: Patterns of Use in Different Groups

Aim: The study investigates patterns of cocaine powder and crack cocaine use of different groups in nine European cities. Design, Setting, Participants: Multi-centre cross-sectional study conducted in Barcelona, Budapest, Dublin, Hamburg, London, Paris, Rome, Vienna, and Zurich. Data were collected by structured face-to-face interviews. The sample comprises 1,855 cocaine users out of three subgroups: 632 cocaine users in addiction treatment, mainly maintenance treatment; 615 socially marginalized cocaine users not in treatment, and 608 socially integrated cocaine users not in treatment. Measurements: Use of cocaine powder, crack cocaine and other substances in the last 30 days, routes of administration, and lifetime use of cocaine powder and crack cocaine. Findings: The marginalized group showed the highest intensity of cocaine use, the highest intensity of heroin use and of multiple substance use. 95% of the integrated group snorted cocaine powder, while in the two other groups, injecting was quite prevalent, but with huge differences between the cities. 96% of all participants had used at least one other substance in addition to cocaine in the last 30 days. Conclusions: The use of cocaine powder and crack cocaine varies widely between different groups and between cities. Nonetheless, multiple substance use is the predominating pattern of cocaine use, and the different routes of administration have to be taken into account.

Cocaine Use in Europe – A Multi-Centre Study

An increase in the use of cocaine and crack in several parts of Europe has raised the question whether this trend is similar to that of the USA in the 1980s. However, research in the field of cocaine use in Europe has been only sporadic. Therefore, a European multi-centre and multi-modal project was designed to study specific aspects of cocaine and crack use in Europe, in order to develop guidelines for public health strategies. Data on prevalence rates were analysed for the general population and for specific subgroups. Despite large differences between countries in the prevalence of cocaine use in the general population, most countries show an increase in the last few years. The highest rate with a lifetime prevalence of 5.2% was found for the United Kingdom, although with a plateau effect around the year 2000. With regard to specific subgroups, three groups seem to show a higher prevalence than the general population: (1) youth, especially in the party scene; (2) socially marginalized groups, such as homeless and prostitutes or those found in open drug scenes; (3) opiate-dependent patients in maintenance treatment who additionally use cocaine. Specific strategies need to be developed to address problematic cocaine use in these subgroups.

Reliability and Validity of the Hungarian Version of the European Addiction Severity Index

We attempted a Hungarian adaptation of the European version (EuropASI) of the widely used Addiction Severity Index (ASI) within the frame of a multi-stage quality development programme. The ASI is characterised by good reliability and validity indicators. The empirical background for our research was the data obtained from ASI ratings for 266 alcohol- and drug-using patients presenting for treatment in addiction medicine clinics in different regions of the country. The reliability indicators for measurement tool rating (interrater) and time (test-retest) were high, with the exception of the correlation value for employment and support. The internal consistency of the test was good. The degree of correlation between the individual items did not exceed that found internationally. The psychometric results corresponded to the results obtained in foreign investigations. The Hungarian version of the ASI can be regarded as a useful and reliable measuring tool that can be used to identify the problems of addiction patients and to assess treatment efficacy.

Substance use in Roma and non-Roma adolescents.

Little data have been published on specific health indicators for Roma, especially on substance use and related problems, and to our knowledge no data are available for Roma adolescents. The objective was to assess substance use of Roma as compared with non-Roma adolescents. Prevalence of tobacco and illicit drug use, and alcohol intoxication were examined in 225 Roma and 182 non-Roma adolescents. Relationship between substance use and potential risk factors, and ethnicity, was investigated by logistic regression analyses. A matched sample of Roma and non-Roma subjects was also used for additional confirmatory conditional regression analyses. Results indicated a significant association between Roma ethnicity and higher lifetime prevalence of tobacco use, alcohol intoxication, and illicit drugs use. Roma girls as compared with non-Roma girls evidenced a disproportionately higher prevalence of smoking as compared with the difference between Roma and non-Roma boys. Chi square analyses showed for both Roma parents a higher level of tolerant attitude to smoking. The inequalities of the health status in substance use behaviors of the Roma versus non-Roma population, expressed in a more pronounced way in the female Roma population, emerge at an early age, based on our data; they are observable already in the early adolescent and adolescent age groups.

Aggression levels in treatment seeking inpatients with alcohol-related problems compared to levels in the general population in Hungary

Association between aggression and heavy alcohol use is documented in the literature in various disparate samples and settings. Comparison of trait aggression levels using a uniform methodology across different samples is almost entirely lacking. This study compared trait aggression levels of treated inpatients with severe alcohol-related problems with those of a nationally representative sample of the general adult population using the same methodology. Results indicated that in the patient population the trait aggression levels were substantially higher than in the general population. Because several studies have demonstrated that aggressive personality traits are closely linked with violence after drinking alcohol, our results further highlight the importance of treatment programs in this at-risk population. From a methodological perspective, the higher trait aggression level of inpatients with alcohol-related problems compared with the general population supports the assumption that the underrepresentation of alcoholics in the population surveys may restrict the range in the severity of alcohol use and dependence, and may therefore produce severely biased results in such studies.

Gender differences in trait aggression in young adults with drug and alcohol dependence compared to the general population

OBJECTIVE Data in gender differences in aggression among alcohol and drug dependent subjects are lacking, and no published data are available about gender differences among various subtypes of substance using populations. The goal of this cross-sectional study was to investigate gender differences with regard to types of trait aggression in substance dependent young populations (age: 20-35 years) compared to the general population. METHODS Subjects were selected from two clinical samples with a diagnosis of alcohol and drug dependence as well as from a representative sample of the general population. Trait aggression was measured by the four individual subscales of the Buss Perry Aggression Questionnaire (physical-PA, verbal aggression-VA, hostility-H and anger AN) whereas alcohol and drug use were characterized by the AUDIT and EuroADAD scales, respectively. RESULTS Alcohol and drug dependent subjects showed higher severity on all four subscales of trait aggression compared to the general population. The male-female difference was the highest in the cannabis group. General Linear Model analysis for PA indicated a significant main effect of gender (higher PA for males, p=0.034) with no interaction between substance dependence and gender. For VA, no main effect or interaction for gender was found. Effect sizes for gender difference indicated that while males and females were similar in the control group in the severity in H and A, the level of H and AN was substantially higher in females than in males in the clinical group. These differences between the two genders reached statistical significance in the marijuana group, where female subjects showed a significantly higher severity in these two domains. CONCLUSIONS Compared to the normal sample chronic substance use is associated with higher scores on certain factors of trait aggression, including hostility and anger, in females than in males. Our data suggest that aggression in substance dependent females is more provocable by chronic use of alcohol and drugs than in males.

Suicidality and trait aggression related to childhood victimization in patients with alcoholism

The relationship between physical abuse in childhood and suicide attempts in adulthood has long been known. However, the phenomenon has not been examined in patients who are undergoing treatment for alcoholism. In this study we seek an answer to the questions of whether exposure to physical abuse in childhood predisposes to violence, which in turn increases the likelihood of suicidal behavior in adulthood. The sample studied comprised 172 patients with alcohol dependence and with data for childhood physical abuse, trait aggression and lifetime suicide attempts. The measuring instruments used for the investigation were the European Addiction Severity Index, the Buss and Perry Aggression Questionnaire and the Janus Questionnaire. Generalized Linear Model analysis revealed a significant gender-dependent association between physical abuse by the parents suffered in childhood and later suicide attempts. In females, childhood victimization by parents increased the likelihood of suicide attempts by approximately 15 times; in males, the increase was about twofold. Association of suicide attempts with the overall level of trait aggression also significantly interacted with gender. In females, the increase in the level of total scores of the trait aggression from 0 to 50 points (approximately the mean level in the study population) elevated the likelihood of the suicide attempts by almost ninefold, whereas the analogous increase in males was about threefold. The results draw attention to the importance of preventing suicide in clinical populations of alcohol-dependent patients.

Heavy drinking as a differential predictor of physical aggression in clinical and general populations

OBJECTIVE Whereas the association between heavy alcohol use and physical aggression (PA) is documented in alcohol dependent patients and the general population, comparison studies between populations treated for alcohol dependence and general population are lacking. In this study the nature of association between heavy drinking and PA was explored both in alcohol dependent inpatients and the general population. METHOD Three hundred thirty inpatients with alcohol dependence and 1199 adult subjects representing the general population were examined with PA score of Buss-Perry Aggression Questionnaire and the AUDIT scores. Relationship between PA and AUDIT total score was investigated with ANCOVA analysis. RESULTS Significant association was found between alcohol use and PA in the ANCOVA analyses in both the inpatient and the control (general population) samples. At lower severity of alcohol use (total AUDIT score<8) the clinical sample showed a substantially higher severity of PA than the control sample, but at higher severity of alcohol use the control sample displayed a higher score of PA compared to the clinical sample. CONCLUSIONS Clinical and general populations may need different risk management strategies in order to address their needs in rationalistic way.

Protective and Risk Predictors in the Development of Drug Use

The authors examined the relationship of two dimensions of the theory of social development—vulnerability (predictors, risk factors) and protectivity—in two samples, schoolchildren aged ten to fifteen years and addictive drug users. On the basis of the Hirschi model of protective factors, they found that the most important protective factors (attachment, commitment, involvement, belief) act against substance use. A surprising finding was that among the predictors of the addicts some forms of escape from the family act against the development of drug use, that is, they can be regarded as a protective predictor. The findings of the study draw attention to the complexity of the vulnerability-protectivity relationship and to the need for further research.

Trait aggression, depression and suicidal behavior in drug dependent patients with and without ADHD symptoms

The objective of this study was to investigate trait-aggression, depression and suicidal behavior of drug dependent patients with and without ADHD symptoms. The cross sectional survey was conducted in outpatient drug centers in Hungary. The Adult Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (AQ), the European Version of the ADolescent Assessment Dialogue (EuroADAD), and the Beck Depression Inventory (BDI) were used for measures. GLM analyses, adjusting for age and gender, indicated that patients who screened positive for ADHD (ADHD+ group) had significantly higher severity of overall trait aggression, as well as physical and verbal aggression than patients who did not (ADHD negative group). The highest severity of aggression was observed when the ADHD+ status co-occurred with heroin use, while the lowest severity of aggression was detected when ADHD- status co-occurred with the use of marijuana. ADHD+ patients showed a marked increase in depression symptoms, suicidal ideation, suicidal attempts as well as self-injuries associated with suicidal attempts. Considering the substantial costs of aggression and suicide from a societal perspective and from the point of view of the individual sufferer, our results highlight the importance of the diagnostic investigation of ADHD in the treatment of drug dependent patients.