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Addiction (1998) 93(9), 1435± 1437
News and Notes
COMPILED BY SARAH WELCH
World Health Organization Expert Com-
mittee on Drug Dependence: Thirtieth Re-
port
The WHO’ s thirtieth report stresses the need for
treatment and service planning to move to
greater attention to the requirements of evi-
dence-based medicine. Examples of studies with
important implications are given. These include
studies leading to the general acceptance of ben-
zodiazepines as the drugs of choice in treating
the alcohol withdrawal syndrome; the evaluation
of acamprosate for preventing relapse in alcohol-
dependence, and the conclusion that lithium has
little speci® c bene® t for alcohol-dependent peo-
ple who do not also suffer from manic-depressive
disorder. The need for more and better-designed
studies of both pharmacotherapies and psycho-
social therapies is stressed. The recent emphasis
on health services research in many countries is
noted, together with the hope that this may help
improve links between research and practice,
leading to a shorter time-lag between the emerg-
ence of research ® ndings and their use in day-to-
day treatment. The report points to heroin
maintenance prescribing as a controversial area,
and calls for rigorous design in studies of its
comparative effectiveness and cost-effectiveness.
The report is disapproving of the prescribing of
injectable methadone and of amphetamines in
the absence of evidence of effectiveness, and
suggests that whether such interventions reduce
rather than increase harm remains unknown.
WORLD HEALTH ORGANIZAT ION (1998) WHO Expert
Committee on Drug Dependence; Thirtieth Report.WHO Technical Report Series 873. Geneva, WorldHealth Organization.
Alcohol in South-East Asia
Alcohol-related problems are often perceived as
predominantly a concern of Western countries.
However, there is some evidence that alcohol-
related problems are signi® cant, and have been
increasing rapidly, in South-East Asia. Professor
Shekhar Saxena has produced a report for the
WHO on the state of knowledge regarding al-
cohol consumption and related problems in the
South-East Asia Region. The main categories of
information are sociodemographic data, avail-
ability of alcoholic beverages, drinking habits
and patterns, alcohol-related harm, economic
and employment prospects, prevention and
treatment policies and programmes, and national
data collection agencies. Multiple sources were
used to try to make the best of available infor-
mation in an area in which it was expected to be
sparse. The outcome of this task is a clear and
informative report about this large region, in
which the component countries vary enormously
in terms of the role played by alcohol in society.
For example, in Bangladesh the production, sale
and consumption of alcoholic beverages is pro-
hibited by law, while in Bhutan alcohol is an
integral part of the culture and is used in almost
all religious ceremonies. In the Maldives, alcohol
is available only for foreign tourists and perhaps
those working in the tourist industry, and the
majority of the population is abstinent. Few
countries currently have accessible estimates of
alcohol-related harm, and in others such as the
Democratic People’ s Republic of Korea, virtually
no information could be collated in any of the
categories of interest. The most detailed infor-
mation available is that from India and Sri
Lanka. Concerns about alcohol vary; for exam-
ple in Bhutan, one concern is the diversion of
food grains into brewing, thereby affecting the
availability and price of certain foods. While
there are wide variations, all the countries have
low income and have a majority of their popu-
lation living in rural areas. Most are multi-eth-
nic, multi-religion mixed societies. Most have no
clear policy on alcohol except those pursuing
complete prohibition as policy based on religion.
0965 ± 2140/98/091435 ± 03 $9.50 Ó Society for the Study of Addiction to Alcohol and Other Drugs
Carfax Publishing Limited
1436 News and Notes
In general, the evidence points towards a rapid
increase in alcohol consumption in the area over
the past few decades, though with a highly skewed
population of drinkers (a high percentage abstain-
ing from alcohol, but a high per capita consump-
tion among those who do consume alcohol). The
report closes with a series of recommendations for
data collection and policy development.
WHO (March 1998) Alcohol in South-East Asia: A
Status Report. Prepared by Shekhar Saxena, Depart-ment of Psychiatry, All India Institute of MedicalSciences, New Delhi, India, for the World HealthOrganization South East Asia Regional Of® ce.
Sm oking in the hom e
A study carried out in Ontario and reported in the
American Journal of Public Health reports on trends
in attitudes and practices concerning smoking in
the home. Based on telephone surveys carried out
between 1992 and 1996, the authors found that
there had been changes in attitudes of both
smokers and non-smokers. The percentage of
non-smokers who agreed that parents spending
time with young children should not smoke at all
inside the house increased steadily from 62.6% in
1992 to 78%. The corresponding change among
smokers was more marked, increasing from
16.7% in 1992 to 42.6% in 1996. The proportion
of smokers unopposed to parental smoking in
front of children decreased from 22.4% in 1992 to
13.8% in 1996. However, among those house-
holds with children under 18 and at least one
daily smoker, only 19.8% kept the home smoke-
free. The authors conclude that attitudes towards
smoke-free homes for children are much more
positive than only 4 years ago, but that parents
who smoke may still need further help in keeping
smoking out of the home.
ASH LEY, M.-J., COH EN, J., FERRENC E, R. et al. (1998)Smoking in the home: changing attitudes and cur-rent practices. American Journal of Public Health, 88,797± 799.
Fetal alcohol syndrom e in Alaska
Another paper in the same volume of the Ameri-
can Journal of Public Health reports on the preva-
lence and characteristics of fetal alcohol
syndrome cases in Alaska from 1977 ± 1992, and
the usefulness of various data sources for surveil-
lance. The authors found a high prevalence of
the syndrome in Alaska, and found that use of
multiple data sources for identi® cation of the
syndrome yielded a higher prevalence than re-
liance on any single data source. However, they
point out that such exhaustive methods as theirs
would be too expensive for routine surveillance,
and recommend the use of the most reliable data
source to provide a minimum estimate of trends
in prevalence of the syndrome.
EGELAND , G. M., PERHAM -HESTER , K. A., GESSNER , B.D. et al. (1998) Fetal alcohol syndrome in Alaska,1977 through 1992 : an administrative prevalencederived from multiple data sources. American Journal
of Public Health, 88, 781± 786.
Risk factors for lung cancer
A recent study from Germany takes another look
at the relationship between smoking and lung
cancer, in particular to examine the risk factors
for developing lung cancer under the age of 45.
Earlier work has suggested that samples of
younger people with lung cancer include a higher
proportion of women; a predominance of adeno-
carcinomas; and more and heavier smokers com-
pared with older subjects. There is also thought
to be a heritable component to early onset of
lung cancer. Their own study included four
groups: people aged 45 or younger with lung
cancer; people aged 55± 69 with lung cancer, and
two appropriately aged control groups without
lung cancer. Smoking was the main risk factor
for lung cancer in both age groups. A familial
aggregation of lung cancer, increasing the risk by
a factor of three, was found only in the younger
age group. Smokers who have a family history of
smoking-related cancer may be at particular risk
of developing lung cancer at an early age.
KREUZER, M., KREIENBROC K, L., GERKEN , M. et al.(1998 ) Risk factors for lung cancer in young adults,American Journal of Epidemiology, 147, 1028 ± 1036 .
Doctors’ advice on smoking: what do pa-
tients think?
A qualitative study carried out in Wales, UK,
was designed to seek the views of smokers and
ex-smokers on the advice they had been given by
doctors. Many patients were sceptical about the
power of doctors’ advice to in¯ uence smoking, as
they felt that most smokers are already aware of
the dangers. Patients thought that opportunistic
News and Notes 1437
interventions should be sympathetic and centred
on the individual, for example by asking ª Would
you like to give up smokingº rather than by
ª preachingº . Some vivid examples are given of
patients being deterred from seeking medical
help when they needed it, because they expected
to be blamed for smoking. The authors catego-
rize their subjects as ª contraryº , ª matter-of-factº
and ª self-blamingº in their reaction to anti-
smoking advice, with the risks of damaging the
doctor-patient relationship through anti-smoking
advice being greatest for patients in the
ª contraryº and ª self-blamingº categories. They
suggest that doctors can tailor their interventions
by taking into consideration how the patient
considers himself or herself as a smoker.
BUTLER, C. C., PILL, R. & STOTT , N. C. H. (1998 )Qualitative study of patients’ perceptions of doctors’advice to quit smoking: implications for opportunis-tic health promotion, British Medical Journal, 316,1878± 1881.
The inevitable Viagra com m ent
Will Viagra, the new drug for erectile impotence,
become a drug of misuse available on the illicit
market? Users of drugs from ª non-of® cialº
sources need to know what the drugs they are
seeking look like, in order to have some
con® dence that they are buying the right thing.
Recent reports that Viagra may cause blue/green
colour-blindness, or blue vision, suggest that
confusion may ensue, since the tablets them-
selves are blue. New myths about the relation-
ships between sex and eyesight could be on the
way.
Conferences and events
Alcoologie et Francophonie/Alcohology and French
Speaking Communities. Meeting of the Societe
Francaise d’Alcoologie, 11± 12 December 1998,
Paris, France. This meeting will celebrate the
20th anniversary of the society, and will have
speakers from French-speaking communities
around the world, as well as other international
experts in the ® eld. Information from: Jean-
Dominique Favre, Societe Francaise d’ Alcoologie,
101 Avenue Henri Barbusse, F-92141 Clamart,
Cedex France. Tel/fax: 1 33(0) 14146 6951.
10e Conference Internationale sur la Reduction des
Risques Lies aux Drogues/10th International Confer-
ence on the Reduction of Drug-Related Harm , 21±
25 March 1999, Geneva, Switzerland. This
conference is organized by the International
Harm Reduction Association and co-sponsored
by the Swiss Federal Of® ce of Public Health.
Abstracts will be invited. Information from: Con-
ference Secretariat, Harm Reduction Conference, Hit
Conferences, Cavern Court, 8 Mathew Street, Liver-
pool L2 6RE, UK. Tel: 1 44 (0) 151 227 4423.
Fax: 1 44 (0) 151 236 4829.