Sawitri Assanangkornchai

Patterns of Alcohol Consumption in the Thai Population: Results of the National Household Survey of 2007

AIMS The National Household Survey for Substance and Alcohol Use is a periodic survey of the Thai population with the aim of estimating the number of people who use licit and illicit substances. This paper reports the findings regarding alcohol consumption from the 2007 survey. METHODS A multistage sampling scheme was used. Provinces, districts, sub-districts, villages and households were randomly selected in sequence. All residents aged 12-65 years who had lived in their current household for >3 months were included. Altogether, 11,348 households and 26,633 respondents from 29 provinces were selected. A structured interview questionnaire, including information on pattern of alcohol consumption, Alcohol Use Disorder Identification Test (AUDIT) and consequences of drinking, was used. RESULTS Of Thais aged 12-65 years, 63% were abstainers (men-40.9% and women-81.5%). The prevalence of current drinkers (defined as individuals who drank at least 10 g of alcohol in 12 months before the survey) was 28.6% (men-48.4% and women-12.7%). Based on the AUDIT score, 6.7% of the Thai population could be classified as hazardous drinkers, 0.9% as harmful drinkers and 0.6% as probable alcohol dependents. The median drinking intensity was 50.8 g in men and 25.4 g in women. After adjusting for other variables, predictors of being hazardous-harmful or probably dependent drinkers included male gender, age groups of 20-24 and 25-44 years, not married and living in Bangkok. CONCLUSION The present study highlights the gender and age differences in drinking patterns and drinking consequences in Thailand. These issues should be taken into consideration when planning preventive measures to reduce alcohol consumption and related problems.

The Use of Mitragynine speciosa (“Krathom”), an Addictive Plant, in Thailand

This study describes patterns and consequences of chewing leaves of krathom, Mitragynine speciosa, Kroth., traditionally used by rural people in Thailand as a mild narcotic. We surveyed 149 long-term regular users (daily for ≥ 5 years), 168 occasional users (used only in social situations or medicinally, less than once a week), and 116 nonusers from three rural villages where krathom use was traditional in southern Thailand. Users focused on the perceived advantages of krathom in relation to increased work endurance, medication, and as a substitute for other hard substances rather than its harmful effects. Limitations regarding self-report and generalizability of the study were noted, and further longitudinal study among other population groups is required for educating people and users about possible harmful impacts of krathom use.

Prevalence and Patterns of Alcohol Consumption and Health-Risk Behaviors Among High School Students in Thailand

BACKGROUND Underage drinking is a significant social and public health problem in Thailand. We report the prevalence and patterns of alcohol consumption and associated health-risk behaviors using data from a 2007-2008 national school survey. METHOD A cross-sectional survey using a self-administered questionnaire was conducted among 50,033 high school and vocational college students from 201 schools in 40 provinces between December 2007 and February 2008. RESULTS The prevalence rates of past-year drinking, past-30-day binge drinking, and drinking until intoxication were 25.5, 9.5, and 17.3% in boys and 14.5, 3.7, and 7.2% in girls, respectively. Higher school levels, lower grades, living with someone other than their own parents, and having family members with substance or alcohol problems were significantly associated with all kinds of drinking. Binge drinkers were significantly more likely to have drinking consequences, e.g., driving after drinking, nausea and vomiting, and having a hangover than were nonbinge drinkers. The rates of other behavior and emotional problems were 2.5 to 6.7 times as likely in drinkers as nondrinkers, including smoking (35.1% vs. 4.9%), prescription drug misuse (17.7% vs. 6.7%), illicit substance use (17.8% vs. 2.4%), carrying a weapon (6.5% vs. 1.8%), feeling depressed (23.2% vs. 10.9%), suicidal attempt (10.5% vs. 3.8%), and sexual intercourse (30.5% vs. 5.7%). CONCLUSION Alcohol consumption is a serious problem among adolescents in Thailand and is strongly associated with various health-risk behaviors. Effective age- and gender-specific interventions should be implemented to discourage underage drinking and associated adverse health and social consequences.

The treatment of alcohol dependence.

Purpose of review The present review summarizes current research on the management of alcohol dependence, including pharmacotherapy, psychosocial interventions and treatment of alcohol dependence with comorbid psychiatric disorders. Recent findings Among recent studies, naltrexone has demonstrated the most consistent effect in reducing alcohol consumption in the context of behavioral therapy. In contrast to most previous studies, acamprosate did not show significant benefits on treatment outcomes relative to placebo. The combined use of naltrexone and acamprosate appeared to be safe and well tolerated but there was no additional therapeutic benefit. With the exception of topiramate, there are currently no new, effective medications for alcohol dependence. Of the psychosocial interventions, such as social behavior and network therapy, cognitive behavioral therapy, and motivational enhancement therapy, no one appears to be superior to another. Psychiatric comorbidity is common in alcohol-dependent patients; however, there are too few studies to effectively guide treatment practice. Summary Progress has been made with pharmacotherapy and psychosocial interventions for alcohol-dependent individuals. More research is needed, however, in developing newer medications and psychosocial interventions in alcohol-dependent populations and in those with comorbid psychiatric conditions, and to improve the strategies to engage patients in continuing care.

Drug and alcohol services in middle-income countries

Purpose of review The present review summarizes current research in middle-income countries on drug and alcohol services for prevention, screening, treatment, care and rehabilitation between June 2006 and December 2007. Recent findings There is a dearth of scientific literature on prevention, treatment and rehabilitation in middle-income countries and no novel effective approaches reported during the review period. The Lancet Series on Global Mental Health showed only 0.7% of all papers reviewed were on low-income and middle-income countries. Several studies in these countries confirmed the effectiveness of brief interventions in treating alcohol use disorders at a primary care level. One study on alcohol screening in Brazil produced a promising screening tool. Other studies reported the availability of pharmacological and nonpharmacological treatments for alcohol and drug use disorders. Overall, poor accessibility to services and delayed onset of treatment persist. Political and cultural environments play a crucial role in providing services to fulfill treatment needs. Summary During the review period, reports from middle-income countries on alcohol and drug services were very limited. A few studies in some countries confirm the effectiveness of brief interventions in primary care settings. There is an obvious need for more research on alcohol and drug treatment services in middle-income countries.

Risk Behaviors, Prevalence of HIV and Hepatitis C Virus Infection and Population Size of Current Injection Drug Users in a China-Myanmar Border City: Results from a Respondent-Driven Sampling Survey in 2012

Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed.

Cross-border activities and association with current methamphetamine use among Chinese injection drug users (IDUs) in a China-Myanmar border region

BACKGROUND Methamphetamine has become one of the most widely used illicit substances in the world. We measured the prevalence and identified the correlates of methamphetamine use amongst current injection drug users (IDUs) in a China-Myanmar border region. METHODS A cross-sectional survey including interviews and serological testing was conducted in 2012. Chinese IDUs who had injected within the past six months and aged ≥ 18 years were recruited using respondent-driven sampling (RDS). Logistic regression indentified factors associated with current methamphetamine use. RESULTS Among 370 IDUs recruited, prevalence of lifetime and current methamphetamine use was 84.2% and 75.2% respectively. Amongst 293 current users, 18.1% ever purchased methamphetamine from Myanmar while 8.9% ever used it there during the past 6 months. IDUs who had cross-border activities, including purchasing drugs (AOR: 1.20; 95% CI: 1.10, 1.31) and visiting family/friends, doing business or odd jobs in Myanmar (AOR: 1.13; 95% CI: 1.02, 1.24) were more likely to use methamphetamine in the past six months. Other factors independently associated with current methamphetamine use included being younger (aged  ≤ 25 years, AOR: 1.24; 95% CI: 1.09, 1.41), being syphilis positive (AOR: 1.17; 95% CI: 1.03, 1.33), having used previously self-used needle/syringe (AOR: 1.20; 95% CI: 1.08, 1.34) and recently received prevention services (AOR: 1.15; 95% CI: 1.04, 1.28). CONCLUSION Methamphetamine has become another major drug of use and poses the serious concern among injecting drug users living in the China/Myanmar border region. The bi-national cooperation is urgently needed to develop targeted effective intervention strategies.

Prevalence of hazardous—harmful drinking in a southern Thai community

The objective of this study was to identify the prevalence and characteristics of hazardous-harmful drinkers in a Thai community population using a cross-sectional survey in two urban and five rural areas in Southern Thailand. Face-to-face interviews were conducted with 1,005 subjects, aged > or = 35, at the community centres to collect data on demographic characteristics and smoking and drinking patterns. The Alcohol Use Identification Test (AUDIT) was used to classify the subjects into three groups: hazardous-harmful drinkers (AUDIT > or = 8), non-problem drinkers (AUDIT=1 - 7) and non-drinkers (AUDIT=0). Blood samples were drawn from 200 randomly selected subjects to determine the gamma glutamyltransferease (GGT) level. The analysis was performed on 898 respondents, 325 males and 573 females. Age-adjusted prevalence of hazardous-harmful drinkers was 10% (27% in males and 1% in females). Adjusted for other variables, men were seven times (95% CI=4.2 - 11.5) more likely to be non-problem drinkers and 42 times (95% CI=18.1 - 99.0) more likely to be hazardous-harmful drinkers than women. Median intensity of drinking was 43 g and 25 g per drinking day in the hazardous-harmful and non-problem drinkers, respectively. Of all the subjects, 48%, 25% and 15% of the hazardous-harmful, non-problem and non-drinkers had abnormal GGT. Hazardous-harmful drinking is a prevalent problem in male general population in Thailand.

Validation of Krathom (Mitragyna speciosa Korth.) Dependence Scale (KDS): A Dependence Screen for Internationally Emerging Psychoactive Substance

BACKGROUND Krathom (Mitragyna speciosa Korth.) is the most commonly used illicit substance in Thailand, and its use has become widespread internationally. Studies on krathom dependence and its health impact are scarce, as there has been no instrument to measure its dependence syndrome and classify krathom users. This study aimed to develop and explore the factor structure, reliability, and validity of a Krathom Dependence Scale (KDS). METHODS This study comprised 2 phases. First, cross-sectional surveys were conducted with 523 (Phase I) and 595 (Phase II) male villagers aged >25 years who were regular, occasional, ex-, or nonusers of krathom. Scale construction was based on the qualitative results from users and previous literature. Exploratory factor analysis (EFA) using maximum likelihood extraction with oblimin rotation was conducted in Phase I and confirmatory factor analysis (CFA) in Phase II to confirm the construct of the scale. Internal consistency of the KDS was assessed using Cronbachs alpha coefficient. Discriminative validity was examined by checking its ability to differentiate between regular and occasional users and patterns of krathom use and its concurrent validity by comparing its levels of score with the Fagerstrom Test for Nicotine Dependence (FTND). The KDS contains 16 items on a 0-3 (never-always) rating scale, making a total score of 0-48. RESULTS Phase I EFA revealed a single-factor solution for the scale, which was confirmed by the CFA in Phase II, with an alpha coefficient of .98. The KDS discriminates regular from occasional users reasonably well and is highly correlated with the FTND score. Two cutoffs were suggested: 34/35 for distinguishing moderate from high dependence and 13/14 for low from moderate. CONCLUSIONS The KDS appears to capture key theoretical constructs and correlates with indices of drug dependence by standard criteria. It should be useful in early intervention for those with krathom use disorders in community and primary care settings.

Anxiolytic and hypnotic drug misuse in Thailand: findings from a national household survey.

INTRODUCTION AND AIMS The non-medical use of prescription drugs, such as anxiolytics and hypnotics, has become a growing public health problem in Thailand. The objective of this study was to examine the patterns of non-medical use of these drugs, using data from a nationally representative sample of Thais interviewed in 2007. DESIGN AND METHODS A nationwide, multi-stage, household survey of 26 633 respondents aged 12-65 years living in 11 348 households throughout Thailand using a face-to-face structured interview questionnaire was carried out. RESULTS In 2007, 1.58% (734 288) and 1.58% (733 318) of Thais indicated that they had misused anxiolytics or hypnotics, respectively, at some time during their lives. Less than 1% had misused these drugs during the 12 months preceding the interview (426 170 or 0.92% for anxiolytics, 372 920 or 0.80% for hypnotics), fewer during the preceding 30 days (234 871 or 0.50% for anxiolytics, 225 638 or 0.48% for hypnotics).The highest prevalence of past 30 day use was in Bangkok, the lowest in Southern Thailand. More women than men, older than younger respondents, and subjects who considered they were in poor physical health or had emotional problems than those who thought otherwise used the drugs during the 30 days before the interviews. DISCUSSION AND CONCLUSIONS The prevalence of anxiolytic/hypnotic misuse/abuse appears to be lower than that reported from more developed countries, but a small increase in problems resulting from the use of these substances has a disproportionately large effect on the overstretched resources of a developing country.