Public health And Addiction

seekers at deaddiction centres in India reported opioid as the primary drug of abuse. [3] World over, there is a gradual paradigm shift in the management of opioid use disorder from symptomatic management and Naltrexone Maintenance Treatment (NMT) to opioid substitution therapy (OST) due to poor treatment retention with NMT. [4] Several studies have reported better outcome (retention in treatment, reduction of illicit drug use and reduction of craving) with Buprenorphine maintenance treatment (BMT). [4-9] But less than 2% of people who inject drugs in Southeast Asia have access to OST. [10] In view of the dearth of studies from south India on the usefulness of OST, we planned to study the effectiveness of BMT over NMT and Psychosocial Intervention alone as maintenance treatment. Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December 2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.

seekers at deaddiction centres in India reported opioid as the primary drug of abuse. [3] World over, there is a gradual paradigm shift in the management of opioid use disorder from symptomatic management and Naltrexone Maintenance Treatment (NMT) to opioid substitution therapy (OST) due to poor treatment retention with NMT. [4] Several studies have reported better outcome (retention in treatment, reduction of illicit drug use and reduction of craving) with Buprenorphine maintenance treatment (BMT). [4-9] But less than 2% of people who inject drugs in Southeast Asia have access to OST. [10] In view of the dearth of studies from south India on the usefulness of OST, we planned to study the effectiveness of BMT over NMT and Psychosocial Intervention alone as maintenance treatment. Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December 2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.

Background. Buprenorphine Maintenance therapy (BMT) is effective in improving follow-up rate in patients with Opioid Dependence Syndrome (ODS). However, there is very limited published literature regarding this from the Indian sub-continent. Aim. To compare follow-up rate in patients with opioid dependence syndrome who were on BMT with patients who were not on BMT. Method. Case files of patients (n = 248) registered at a tertiary care Psychiatric hospital from southern India with ODS, between 2005 to 2012, were reviewed. Basic demographic and management data of patients were noted. Details regarding follow up rate for a minimum of one-year after the initiation of the treatment was collected. R commander was used for analyzing the data. Result. 57 patients received BMT of which followup rate was 77% at 1month, 68% at 6months and 1year after initiation of treatment. 191 patients were not on BMT of which followup rate was 55% at 1month, 44% at 6months and 34% at 1year. There was significantly greater follow-up among patients of opioid dependence given BMT than patients who are not on BMT. Conclusion. BMT improves long term follow up rates in patients with ODS.

The underlying structure of problematic gambling behaviors, such as those assessed by the South Oaks Gambling Screen (SOGS), remain unknown: Can problem gambling be assessed unidimensionally or should multiple qualitatively different dimensions be taken into account, and if so, what do these qualitative dimensions indicate? How significant are the deviations from unidimensionality in practice? A cross-sectional random sample of Finns aged 15-74 (n = 4,484) was drawn from the Population Information Registry and surveyed in 2011-2012. Analyses were conducted using descriptive statistics, Confirmatory factor analysis (CFA) and multidimensional item response theory (MIRT) models. Altogether, 14.9% of the population endorsed at least one of the 20 SOGS items, but nine items had low endorsement rates (≤ 0.2%). CFA and MIRT techniques suggested that individuals differed from each other in two positively correlated (r = 0.70) underlying dimensions: "impact on self primarily" and "impact on others also". This two-factor correlated-factors model can be reinterpreted as a bifactor model with one general gambling-problem factor and two specific factors with similar interpretation as in the correlated-factors model but with non-overlapping items. The two specific factors may provide clinically useful information without extra costs of assessment.

seekers at deaddiction centres in India reported opioid as the primary drug of abuse. [3] World over, there is a gradual paradigm shift in the management of opioid use disorder from symptomatic management and Naltrexone Maintenance Treatment (NMT) to opioid substitution therapy (OST) due to poor treatment retention with NMT. [4] Several studies have reported better outcome (retention in treatment, reduction of illicit drug use and reduction of craving) with Buprenorphine maintenance treatment (BMT). [4-9] But less than 2% of people who inject drugs in Southeast Asia have access to OST. [10] In view of the dearth of studies from south India on the usefulness of OST, we planned to study the effectiveness of BMT over NMT and Psychosocial Intervention alone as maintenance treatment. Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December 2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.

Background: Electronic gambling machines (EGMs) are considered a risky form of gambling. Internationally, studies have reported that the density of EGMs tends to be higher in socioeconomically disadvantaged areas than in more advantaged ones. We examined whether this holds true in the Finnish context where a decentralised system of EGMs guarantees wide accessibility to this form of gambling. More precisely, we investigated the association between the density of EGMs and area-level socioeconomic status (SES). Methods: The primary measure was the EGM density, referring to the number of EGMs per 1000 adults. The area-level SES was defined on the basis of the median income of inhabitants, the proportion of unemployment in the area and educational attainment (% of those beyond primary education). Three additional area characteristics were used as control variables in the analyses; the overall population density, economic activity (the number of jobs in the area per employed inhabitant), and the mean age of the inhabitants. Analyses were based on linear regression. Results: The EGM density was 3.68 per 1000 inhabitants (SD = 2.63). A lower area-level SES was correlated with a higher EGM density. In further analyses, this effect was mostly explained by the income of the inhabitants. Of the control variables, the population density had no detectable effect on the EGM density while areas with a higher mean age of the inhabitants, as well a higher density of jobs, had more EGMs. Conclusions: EGMs are unequally located in Finland, with more EGMs located in socioeconomically less advantaged areas. The higher machine density in areas of social disadvantage is not in line with the aim of the Finnish gambling policy, which is to prevent and reduce harm caused by gambling. Changes in policy are required, especially with regard to the decisions on the placement of EGMs. This should not be made solely by gaming operators and/or from fiscal perspectives.

Lotteries are one of the most prevalent forms of gambling and generate substantial state revenues. They are also argued to be one of the least harmful forms of gambling. This paper is one of the first to examine exclusive lottery gamblers and compares their gambling patterns and problems as well other associated risky behaviours to those who are not exclusive lottery gamblers. Data were derived from two large surveys conducted with representative adult samples in France (n = 15,635) and Québec (n = 23,896). Participants were separated into two groups: exclusive lottery gamblers (ELGs) and nonexclusive lottery gamblers. Using multivariate analysis, study results reveal that ELGs, who represent two thirds of gamblers, generally exhibit less intensive gambling patterns and are less likely to report other risky behaviours. However, harms associated with moderate risk and problem gambling are found to be concentrated in specific subpopulations for both groups, primarily males, older individuals, and those who report lower income and education level. Given widespread participation in lotteries and concentration of harm within specific subgroups, these findings point to the need for prevention efforts despite the lower levels of harm associated with lottery gambling.

seekers at deaddiction centres in India reported opioid as the primary drug of abuse. [3] World over, there is a gradual paradigm shift in the management of opioid use disorder from symptomatic management and Naltrexone Maintenance Treatment (NMT) to opioid substitution therapy (OST) due to poor treatment retention with NMT. [4] Several studies have reported better outcome (retention in treatment, reduction of illicit drug use and reduction of craving) with Buprenorphine maintenance treatment (BMT). [4-9] But less than 2% of people who inject drugs in Southeast Asia have access to OST. [10] In view of the dearth of studies from south India on the usefulness of OST, we planned to study the effectiveness of BMT over NMT and Psychosocial Intervention alone as maintenance treatment. Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December 2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.

The Finnish Gambling population study examines gambling and problem gambling among Finnish people aged from 15 to 74 in 2007, 2011, 2015 and 2019. The study was conducted by the Finnish Institute for Health and Welfare, and commissioned and financed by the Ministry of Social Affairs and Health (section 52 of the Lotteries Act). The data collection for the study was carried out by Statistics Finland as computer-assisted telephone interviews (CATI). In 2019, 3,994 Finnish people took part in the study (response rate 52%).

Objective: The purpose of this study was to provide an updated profile of gambling and problem gambling in Canada and to examine how the rates and pattern of participation compare to 2002. Method: An assessment of gambling and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 24,982 individuals aged 15 and older. The present analyses selected for adults (18þ). Results: A total of 66.2% of people reported engaging in some type of gambling in 2018, primarily lottery and/or raffle tickets, the only type in which the majority of Canadians participate. There are some significant interprovincial differences, with perhaps the most important one being the higher rate of electronic gambling machine (EGM) participation in Manitoba and Saskatchewan. The overall pattern of gambling in 2018 is very similar to 2002, although participation is generally much lower in 2018, particularly for EGMs and bingo. Only 0.6% of the population were identified as problem gamblers in 2018, with an additional 2.7% being at-risk gamblers. There is no significant interprovincial variation in problem gambling rates. The interprovincial pattern of problem gambling in 2018 is also very similar to what was found in 2002 with the main difference being a 45% decrease in the overall prevalence of problem gambling. Conclusions: Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods. Several mechanisms have likely collectively contributed to these declines. Decreases have also been reported in several other Western countries in recent years and have occurred despite the expansion of legal gambling opportunities, suggesting a degree of inoculation or adaptation in the population. Abrégé Objectif : La présenteétude a pour but d'offrir un profilà jour du jeu et du jeu problématique au Canada, et d'examiner comment les taux et le modèle de participation se comparentà ceux de 2002.

Objectives The purpose of this study is to provide an updated profile of gamblers and problem gamblers in Canada and to identify characteristics most strongly associated with problem gambling. Methods An assessment of gambling participation and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 23,952 individuals 18 years and older. Descriptive statistics provided a demographic profile for each type of gambling involvement as well as category of gambler (non-gambler, non-problem gambler, at-risk gambler, problem gambler). A logistic regression identified characteristics that best distinguished problem from non-problem gamblers. Results Gambling participation and problem gambling both varied as a function of gender, income, educational attainment, and race/ethnicity. However, multivariate analysis identified electronic gambling machine (EGM) participation to be the primary predictor of problem gambling status, with race/ethnicity, presence of a mood disorder, male gender, casino table game participation, older age, a greater level of smoking, participation in speculative financial activity, instant lottery participation, lower household income, and lottery or raffle ticket participation providing additional predictive power. Provincial EGM density and EGM participation rates are also very strong predictors of provincial rates of at-risk and problem gambling. Conclusion Problem gambling has a biopsychosocial etiology, determined by personal vulnerability factors combined with the presence of riskier types of gambling such as EGMs. Effective prevention requires a multifaceted approach, but constraints on the availability and operation of EGMs would likely have the greatest single public health benefit.

Aim: The total consumption model (TCM) originates from studies of the distribution of alcohol consumption and posits that there is a strong association between the total consumption and the prevalence of excessive/harmful consumption in a population. The policy implication of the TCM is that policy measures which effectively lead to a reduction of the total consumption, will most likely also reduce the extent of harmful consumption and related harms. Problem gambling constitutes a public health issue and more insight into problem gambling at the societal level and a better understanding of how public policies may impact on the harm level, are strongly needed. The aim of this study was to review the literature pertaining to empirical validity of the TCM with regard to gambling behaviour and problem gambling and, on the basis of the literature review, to discuss the policy implications of the TCM. Methods: The study is based on a literature mapping through systematic searches in liter...

The present study provides a profile of Canadian Indigenous gambling and problem gambling using the 2018 Canadian Community Health Survey (CCHS) (n = 23,952 adults; 1,324 Indigenous) and an online panel survey of 10,199 gamblers (n = 589 Indigenous). The relative popularity of different types of gambling was similar between Indigenous and non-Indigenous samples. However, there was higher Indigenous participation in electronic gambling machines (EGMs), bingo, instant lotteries, overall gambling and a higher rate of problem gambling (2.0% versus 0.5%). Variables predictive of Indigenous problem gambling were EGM participation, gambling fallacies, having a mental or substance use disorder, sports betting, and male gender. Compared to non-Indigenous problem gamblers, Indigenous problem gamblers had higher substance use and lower impulsivity. In general, variables predictive of Indigenous problem gambling were the same ones predictive of problem gambling in all populations, with elevated Indigenous problem gambling rates primarily being due to elevated rates of these generic risk factors. Many of these risk factors are modifiable. Particular consideration should be given to reducing the disproportionate
concentration of EGMs in geographic areas having the highest concentration of Indigenous people and ameliorating the disadvantageous social conditions in this population that are conducive to mental health and substance use problems.

Objectives
The purpose of this study is to provide an updated profile of gamblers and problem gamblers in Canada and to identify characteristics most strongly associated with problem gambling.

Methods
An assessment of gambling participation and problem gambling was included in the 2018 Canadian Community Health Survey and administered to 23,952 individuals 18 years and older. Descriptive statistics provided a demographic profile for each type of gambling involvement as well as category of gambler (non-gambler, non-problem gambler, at-risk gambler, problem gambler). A logistic regression identified characteristics that best distinguished problem from non-problem gamblers.

Results
Gambling participation and problem gambling both varied as a function of gender, income, educational attainment, and race/ethnicity. However, multivariate analysis identified electronic gambling machine (EGM) participation to be the primary predictor of problem gambling status, with race/ethnicity, presence of a mood disorder, male gender, casino table game participation, older age, a greater level of smoking, participation in speculative financial activity, instant lottery participation, lower household income, and lottery or raffle ticket participation providing additional predictive power. Provincial EGM density and EGM participation rates are also very strong predictors of provincial rates of at-risk and problem gambling.

Conclusion
Problem gambling has a biopsychosocial etiology, determined by personal vulnerability factors combined with the presence of riskier types of gambling such as EGMs. Effective prevention requires a multifaceted approach, but constraints on the availability and operation of EGMs would likely have the greatest single public health benefit.

It is common for jurisdictions tasked with minimising gambling-related harm to conduct problem gambling prevalence studies for the purpose of monitoring the impact of gambling to the community. However, given that both public health theory and empirical findings suggest that harms can occur without individuals satisfying clinical criteria of addiction, there is a recognized conceptual disconnect between the prevalence of clinical problem gamblers, and aggregate harm to the community. Starting with an initial item pool of 72 specific harms caused by problematic gambling, our aim was to develop a short gambling harms scale (SGHS) to screen for the presence and degree of harm caused by gambling. An Internet panel of 1524 individuals who had gambled in the last year completed a 72-item checklist, along with the Personal Wellbeing Index, the PGSI, and other measures. We selected 10 items for the SGHS, with the goals of maximising sensitivity and construct coverage. Psychometric analysis suggests very strong reliability, homogeneity and unidimensionality. Non-zero responses on the SGHS were associated with a large decrease in personal wellbeing, with wellbeing decreasing linearly with the number of harms indicated. We conclude that weighted SGHS scores can be aggregated at the population level to yield a sensitive and valid measure of gambling harm.

This article examines gambling harms from both gamblers and affected others’ perspectives. Participants (3076 gamblers and 2129 affected others) completed a retrospective survey that elicited information on harms they experienced from gambling across their lifetime. Their responses were analyzed through testing measurement invariance, estimating item-response theoretic parameters, calculating percentages, confidence intervals, and correlations, as well as regressions. The results indicated large commonalities in the experience of harms reported by gamblers and affected others. Further, gamblers appeared to ‘export’ about half of the harms they experienced to those around them. The findings also provided detailed profiles of evolving harms as problem gambling severity varies.

Markham, Young & Doran provide further evidence that there is a significant, robust positive relationship between gambling availability and gambling-related harm . Importantly, they show this relationship using a different level of analysis than previous researchers have used-they model the association between prevalence of electronic gambling machine (EGM) per capita expenditure at the venue level and gambling-related harm population estimates. These sophisticated statistical models, including the Huff modeling of the consumer population, suggest that about 25% of the variance in gambling-related harm is associated with monthly expenditure per adult, venue type and number of EGMS per venue.

The dual-frame survey conducted by Dowling and colleagues should cause gambling researchers to re-evaluate the scientific value of routinely conducting problem gambling prevalence studies. A better use of resources would support research designed to reduce the incidence of gambling-related harm rather than perpetuate its ongoing mismeasurement.

Background and Aims Flaws in previous studies mean that findings of J-shaped risk curves for gambling should be disregarded. The current study aims to estimate the shape of risk curves for gambling losses and risk of gambling-related harm (a) for total gambling losses and (b) disaggregated by gambling activity.  Design Four cross-sectional surveys. Setting Nationally representative surveys of adults in Australia (1999), Canada (2000), Finland (2011) and Norway (2002).  Participants A total of 10 632 Australian adults, 3120 Canadian adults, 4484 people aged 15–74 years in Finland and 5235 people aged 15–74 years in Norway. Measurements Problem gambling risk was measured using the modified South Oaks Gambling Screen, the NORC DSM Screen for Gambling Problems and the Problem Gambling Severity Index. Findings Risk curves for total gambling losses were estimated to be r-shaped in Australia {β losses = 4.7 [95% confidence interval (CI) = 3.8, 6.5], β losses2 = –7.6 (95% CI = –17.5, –4.5)}, Canada [β losses = 2.0 (95% CI = 1.3, 3.9), β losses2 = –3.9 (95% CI = –15.4, –2.2)] and Finland [β losses = 3.6 (95% CI = 2.5, 7.5), β losses2 = –4.4 (95% CI = –34.9, –2.4)] and linear in Norway [β losses = 1.6 (95% CI = 0.6, 3.1), β losses2 =  –2.6 (95% CI = –12.6, 1.4)]. Risk curves for different gambling activities showed either linear, r-shaped or non-significant relationships. Conclusions Player loss–risk curves for total gambling losses and for different gambling activities are likely to be linear or r-shaped. For total losses and electronic gaming machines, there is no evidence of a threshold below which increasing losses does not increase the risk of harm.

Background: Opioid Use disorders are emerging as a serious public health concern in India. Opioid substitution treatment
is one of the emerging forms of treatment in this population which needs more evidence to increase its availability and
address prejudices towards the same. Materials and Methods: This is a case control study with retrospective design
reviewing the charts of patients with opioid dependence syndrome registered between January 2005 to December
2012. Adherence to treatment was the outcome variable assessed in this study. Results: The odds of the Buprenorphine
Maintenance Treatment (BMT) group remaining in treatment is 4.5 (P < 0.005) times more than Naltrexone Maintenance
Treatment (NMT) group and 7 times (P < 0.001) more than Psychosocial intervention (PST) alone group. Discussion: We
believe that these study findings will help in reducing the prejudice towards BMT and encourage further research in this
field. Conclusion: BMT has a better adherence rate than other treatments in opioid use disorders.