摘要:

AbstractThis paper presents a review of health promotion strategies to help people to stop using benzodiazepines. Four strategies are described and evaluated: health persuasion, personal counselling, state action and community development. It is argued that the first two strategies have been the most popular to date, especially among doctors, and have an important part to play in changing individual behaviour. Less consideration has been given to the other two strategies, but these are equally important if a comprehensive policy is to be developed concerned with social as well as individual change.

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03749.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe key components of a strategy to prevent tobacco–related disease are outlined. These measures aim to increase the cessation of tobacco use and reduce its uptake. Components are wide–ranging, including a taxation policy, a ban on advertising and promotion, a comprehensive health promotion programme including advice from primary health care professionals and the development of campaigning skills, particularly by the medical profession. The prevention of tobacco–related disease has moved into the domain of campaigners and lobbyists at political, economic and international levels. The key target is countering the activities, especially the unethical trade practices, of the wealthy and powerful tobacco ind

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03750.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper explores the varied and potentially conflicting goals of preventive measures as applied to opiate use. These goals relate both to the overall extent of opiate use and the amount of harm arising from this drug use. Prevention involves the control both of the supply side and the demand for opiates. Particular targets may include sharing equipment, injecting, progression to more harmful routes of administration, prevention of development of dependence, harmful sequelae of opiate use and co‐morbidity. There may be a place for manipulating the black market for opiates to channel users in directions that achieve particular prevention goals, and being more selective about targeting particular groups of users at particular times. It is the role of scientists to quantify the dimensions of harm and the likely impact on these dimensions of particular interventions. It is then up to elected representatives to determine the prioritie

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03751.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThe term ‘stimulant’ refers to a class of drugs that increase psychophysiological arousal. From the viewpoint of prevention, it is more useful to look primarily at the social consequences and functions of stimulants. Every society has a documented use of stimulants. When planning interventions the dynamics of use must be placed in the foreground. Stimulant epidemics, like problematic stimulant users, have a natural tendency to burn themselves out. Different types of stimulants may differ in their origins, but their epidemiological consequences and use functions tend to be similar. Implications for prevention can be drawn from the characteristics of stimulant use epidemics. Users at risk for socially unacceptable patterns should be targeted for prevention efforts. Mass media campaigns that single out stimulants should be avoided. Much of the harm associated with stimulants is a consequence of life‐styles characterized by polydrug use and unhealthy practices. Prevention should be timed to the appropriate period of the epidemic. Interventions useful at period I will not work at period 2. The recommendations of the WHO Advisory Group on the Adverse Effects of Cocaine and Coca provide a good model for primary, secondary and tertiary prevention for all forms of stimulant misuse. Stimulant prevention must be creative in finding ways of encouraging the movements of the drug to the periphery of users

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03752.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractAll of the dependence‐producing substances are capable of causing harm but in most cases the harm is preventable. This paper seeks to develop some of the themes raised by the five substance‐based prevention papers by presenting an outline of the Ottawa Charter for Health Promotion. The Ottawa Charter provides a strategic framework for prevention and covers public health policy, trade issues, availability, price, advertising and types of supportive environments and responses. It is suggested that an effective approach to the prevention of harm from dependence‐producing substances would involve a planned response which included alcohol, tobacco and drugs. Such a response would also emphasize financial and economic consequences of drug use, and would seek to strengthen or develop links with partners outside the immediate health care

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03753.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractThis paper gives an overview of the variety of approaches that have been used in the treatment of alcohol problems. There is good evidence that approaches directed at improving social and marital relationships, self‐control and stress management are effective. There is at present little to suggest that aversion therapies, confrontational interventions, educational lectures or films and group psychodynamic therapy are effective, nor is there good evidence yet that use of psychotropic medications is effective. However, it may be that therapies that have not proved effective with the broad range of individuals with alcohol problems might prove effective with selected cases. Future research should place more emphasis on determining the kinds of alcohol problems that are likely to respond to different kinds of treatments directed at different kinds of goals and by different kinds of practitioners. The base of treatment should be broadened to include the large numbers of individuals with alcohol problems but who could not be considered as alcohol‐dependent. This would have to involve a wide range of primary care and generic workers and include use of brief interventi

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03754.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractWithdrawal of benzodiazepines is currently advised for long‐term benzodiazepine users because of doubts about continued efficacy, risks of adverse effects, including dependence and neuropsychological impairment and socio‐economic costs. About half a million people in the UK may need advice on withdrawal. Successful withdrawal strategies should combine gradual dosage reduction and psychological support. The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. The whole process may take weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepines. Adjuvant medication may occasionally be required (antidepressants, propranolol) but no drugs have been proved to be of general utility in alleviating withdrawal‐related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non‐pharmacological ways of coping with stress. For many patients the degree of support required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to withdraw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, rate of withdrawal, symptom severity, psychiatric history or personality disorder. Longer‐term outcome is less clear; a considerable proportion of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post‐withdr

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03755.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractResearch in treatments for smokers benefits from the feasibility of relatively large samples and well developed evaluative methodology. The field is currently dominated by nicotine replacement methods, for which some degree of efficacy has been clearly demonstrated, A number of psychological methods are widely used as well, although there is little consistent evidence that one specific method is better than any other. Two approaches 10 treating smokers can be distinguished, i.e. intensive clinic‐based treatments and brief community‐orientated interventions, e.g. in primary health care. The latter are applicable on a large scale, and aim to affect overall smoking prevalence. Among intensive treatments, the current state of the an would include nicotine replacement and group support of several weeks’ duration. In primary health care, simple routine interventions are the preferred o

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03756.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractOne of the greatest of challenges facing medicine is to devise effective and appropriate treatments for opiate problems. Such treatments are based on principles derived from the disciplines of pharmacology and psychology, but are also shaped by social issues and even by the views of practitioners. There are many misconceptions about opiate problems. In this review it is suggested that there are good reasons for stating that opiate users do change over time, treatment can also lead to change and psychological interventions are of great importance. However, current methods of opiate detoxification are of low efficacy and methadone maintenance, although of benefit for some, is not a panacea for opiate problems.

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03757.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

AbstractRehabilitation efforts offered to individuals with stimulant dependence incorporate a series of maneuvers to accomplish three major goals. Following active detoxification, most clinicians attempt to: (1) increase motivation for abstinence and maintain a high level of commitment to this goal; (2) help individuals to rebuild a stable life–style without substances; and (3) actively work toward ways of decreasing the probability of relapse (relapse prevention). While these activities incorporate education, counseling, outreach to families and exposure to self–help groups (e.g. Cocaine Anonymous), numerous pharmacological approaches have been tested. Each mode of drug therapy is based on a reasonable hypothesis, but appropriately controlled and structured clinical trials have not yet revealed any pharmacological approach for rehabilitation of stimulant–dependent individuals for which the risks have been shown to outweigh the a

ISSN:0965-2140    

DOI:10.1111/j.1360-0443.1994.tb03758.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY