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.