Addiction (1999) 94(8), 1253± 1255

News and Notes

COMPILED BY SARAH WELCH

New UK guidelines for managers of drug

misuse and dependence

The UK Department of Health publication for

doctors, entitled Drug M isuse and Dependence:

Guideline s on Clinical M anagement, was last re-

vised in 1991. Since then, there have been devel-

opments in UK policy, new trends in drug

misuse, and new options for treatment, rehabili-

tation and prevention. A new revised version has

now been launched, as a result of the thorough

review carried out by a multidisciplinary Work-

ing Group set up by the Department of Health

and chaired by Professor John Strang. UK doc-

tors accustomed to the small booklet sometimes

referred to as the ª orange guidelinesº will ® nd

that the new publication is still orange, but quite

a lot larger. However, it is not a long-winded

text, but a clearly produced and detailed

guide presented in a well-structured, easy to use

format. The guidelines stress the need for well-

organized partnerships in the clinical manage-

ment of drug misusers, and the undesirability of

practitioners working in isolation. Models of

shared care between primary care practitioners

and specialist services are discussed in detail. An

emphasis on safe prescribing is at the core of the

guidelines, with a move towards greater use of

supervised consumption of methadone in the

early stages of methadone treatment than is

current practice in the UK.

Copies are available by mail from: The

Stationery Of® ce, PO Box 276, London SW8 5DT,

UK. For general telephone enquiries, call 0171

873 0011; for telephone orders call 0171 873

9090; and for fax orders call 0171 873 8200.

The guidelines are also available on the

Department of Health’ s web site at www.doh.

gov.uk/drugdep.htm

Forests fall for tobacco production

A paper in the journal Tobacco Control points to

another area of damage following in the wake of

cigarette productionÐ the cutting down of

forests to provide fuel used in tobacco curing.

The authors calculate that around 114 million

tonnes of solid wood per year was used be-

tween 1990 and 1995 to produce an annual 3.8

tonnes of cured tobacco (about half the world

production). Another paper in the journal

points to cigarette remnants as signi® cant causes

of environmental pollution: for example, the

depositing of cigarette butts and the poorly

biodegradable cellulose acetate ® lters on

beaches.

Reducing alcohol consumption prior to

surgery may reduce complications

A recent study from Denmark has addressed the

problem of increased post-operative morbidity in

alcohol misusers undergoing surgery. The study,

carried out in three gastrointestinal surgical cen-

tres, involved randomization of patients who

regularly drank ® ve or more alcoholic drinks per

day to either the routine procedure, or to a

pre-operative intervention aimed at stopping

drinking prior to surgery. The intervention in-

volved withdrawal from alcohol and treatment

with disul® ram (with twice weekly supervision)

for a month prior to colorectal surgery. The

patients who were abstinent from alcohol for a

month prior to surgery had signi® cantly lower

rates of speci® c complications of surgery. Active

encouragement and help to reduce or stop al-

cohol consumption could become a more rou-

tine part of preparation of patients for elective

surgery.

ISSN 0965± 2140 print/ISSN 1360-0443 online/99/081253± 03 Ó Society for the Study of Addiction to Alcohol and Other Drugs

Carfax Publishing, Taylor & Francis Ltd

1254 News and Notes

T é NNESON , H., ROSENBERG, J., N IELSEN , H.J. et al.(1999) Effect of preoperative abstinence on poorpostoperative outcome in alcohol misusers: ran-domised controlled trial, British Medical Journal,318, 1311 ± 1316.

Breast-feeding and alcoholism Ð a 200-year-

old hypothesis tested

Thomas Trotter, the author of a thesis prepared

for the University of Edinburgh which was sub-

sequently published in 1804 as An Essay,

Medical, Philosophical, and Chemical, on Drunken-

ness and its Effects on the Human Body, believed

that alcoholism was caused in part by inherited

factors and in part by environmental factors. In

his view, a crucial environmental factor was early

weaning. A study published this year in the

American Journal of Psychiatry makes use of data

collected on 9182 babies delivered consecutively

in a Danish Hospital in the late 1950’ s and

1960’ s. A group of 200 of these babies partici-

pated in a 30-year high-risk follow-up study of

the antecedents of alcoholism. When examined

together with other perinatal variables in a mul-

tiple regression analysis, early weaning con-

tributed signi® cantly to the prediction of the

severity of alcoholism at age 30. The authors

discuss this ® nding in the context of related

animal studies, and raise the question of whether

early weaning in¯ uences the development of do-

paminergic mechanisms that play an important

role in neurobiological theories of addiction.

They call for replication and further investiga-

tion.

GO ODW IN, D.W., GABRIELLI, W.F., PENIC K, E.C. et al.(1999) Breast-feeding and alcoholism: the Trotterhypothesis, American Journal of Psychiatry, 156, 650±652.

Substance abuse and gun violence

Thank you to an organization in the USA called

Join Together, for sending me a copy of their

quarterly publication. Join Together is a project

of the Boston University School of Public

Health, and aims to be a national resource for

communities tackling problems of substance

abuse and gun violence. The purpose of

the publication is to communicate effective

community-based strategies. The issue sent to

me focussed on the links between substance

abuse and violence involving ® rearms in the

USA, and particularly on the shared risk factors

which may lead young people into substance

abuse, and also into situations in which guns are

involved. Collaborative local community-based

strategies are discussed, such as the Boston

Strategy to Prevent Youth Violence. Another

article discusses the recent lawsuits ® led against

gun manufacturers, taking a lead from the to-

bacco settlements by arguing that the manufac-

turers should take some responsibility for the

public health consequences of the use of their

product. Contact: Join Together, 4412 Stuart

Street, Seventh Floor, Boston, MA 02116, USA.

Website www.jointogether.org

Club culture, drug culture and advertising

The other ª Addictionº , a fragrance for which a

recent advertisement showed an eye with a very

dilated pupil, has featured in this column before.

More advertisements with drug references have

been picked up by Alix Sharkey, writing in the

UK newspaper The Guardian (Saturday 22 May,

1999). Products which use bizarre hallucinatory

experiences to make their product appealing in-

clude a car, a chocolate bar and a cough sweet.

Change of News and Notes com piler

After an enjoyable couple of years, I am passing

on my role in compiling News and Notes to

someone new. Many thanks to people who have

sent me material and comments. Other members

of Addiction staff remain more constant. ¼

Iguana colum n

Iggy writes: I have had passed to me a copy of a

brie® ng paper on alcohol misuse prepared by the

Church of England Board for Social Responsi-

bility. Speaking as a lay lizard I found this paper

extremely well-informed, readable, and well, re-

sponsible. Among other things it mentioned the

connection between drinking level and rates of

drinking problems. Guess what! Subsequent

conversation over tea and cucumber sandwiches

with an ecclesiastical source, reveals that this

document has attracted critical comments from

that well-known guardian of righteousness, the

Portman Group. I’ m told that there was also

criticism from one individual with a Temperance

background, thus con® rming your Iguana’ s view

that the Church of England got their balance

eminently right.

Copies of the brie® ng paper may be obtained

from: Revd Dr Peter Sedgwick, Assistant Secretary

(Home Affairs), The Church of England Board for

Social Responsibility, Church House, Great Smith

Street, London SW1P 3NZ, UK.

News and Notes 1255

Conferences and events

Substance Use: Policy and Practice Ð Past, Present

and Future, an international conference on 9± 10

September 1999, at the Centre for Alcohol and

Drug Studies, Paisley, Scotland. Further details

from: Alison Munro, Centre for Alcohol and Drug

Studies , University of Paisley, High Street, Paisley

PA1 2BE, UK. Tel: 0141 848 3899. Email:

conf@ jmcm-paisley.demon.co.uk

SUCHT ’ 99 Ð Fachkonferenz der Deutschen

Hauptstelle gegen die Suchtgefahren (DHS), 8± 10

November 1999, in Weimar. Thema: Individu-

elle Hilfen fuÈ r SuchtkrankeÐ FruÈ h erkennen,

professionell handeln, effektiv integrieren.

Deutsche Hauptstelle gegen die Suchtgefahren

(DHS), Postfach 1369, 59003 Hamm. Tel: 02381/

90 15 0, Fax: 90 15 30.