British Journal of Addiction (1989) 84, 1101-1104

News and Notes

BY MICHAEL FARRELL

Softly Softy on new HIV Funding InitiativeNow that the prime minister has become environ-mentally aware an eco-conscious fever has grippedthe cogs of the machinery of state in the U.K. Rainforests have been sacrificed in the cause of govern-ment department circulars. Just as the Departmentof Health allocated £14 million extra for the furtherdevelopment of drug services on a recurring basisfor 1989/1990 they decided to save on paper. Thedepartment announced this in the form of anexecutive letter which was circulated only toGeneral Managers and Chief Executives.

Funds totaling just under ;C15 million are nowallocated to Regions on a continuing basis inproportion to their population aged 15-34. Eachregion is asked to expand or develop community-based services and to strengthen hospital basedspecialist support for these community services. Tomake services known and accessible. To providetraining for staff. To meet the costs of prescribingsubstitute drugs and clean needles and syringesalong with facilities for their safe disposal.

The decision to announce this as an executiveletter meant that many of the people who mightapply for this money were unaware of its existenceand did not manage to influence the pattern of itsallocation. In some regional health authorities it mayeven have been carved up and allocated to districtswith no clear plan of what it was funding.

The expansion in secondary level services hasbeen slow in coming and is needed to support theremarkably expanded community-based servicesbut greater publicity about new funding initiativeswould go some way to help this.

Here is the total funding allocation per region for1989/90. Northern 940 (thousands); Yorkshire1,119; Trent 1,456; East Anglia 617; NW Thames1,126; NE Thames 1,195; SE Thames 1,125; SWThames 903; Wessex 917; Oxford 825; S Western

965; W Midlands 1,625; Mersey 750; N Western1,230. Totaling 14.793 million pounds.

Teenage Girls and SmokingDespite the decline in smoking among adults and theincreasingly negative image of smoking in the U.K.,the smoking prevalence among older teenagers andyoung women has remained high. By the last year ofcompulsory education, 30% of girls in England andWales were regular smokers in 1986 compared to 19%of boys. Smoking among teenage girls is related toeducational achievement. These and many otherfacts are presented in the Women and SmokingGroup, ASH (Action on Smoking Health) report onTeenage Girls and Smoking which recommends twoachievable goals for the next 5 years in the U.K.These should be to reverse the upward trend insmoking among girls over the age of 14 years and toreduce overall smoking prevalence among girls by

Copies of the report are available from: Womenand Smoking Group, Action on Smoking Health,5-11 Mortimer Street, London WIN 7RH.

Health WarningsIn some countries it is hard now to imagine a timewhen there were no warnings on cigarette packetsand no restrictions on advetisements. But we needonly look around the world to remind ourselves ofhow necessary it is to lose our timidity on healthpromotion. A report on 'Addictions: what's happen-

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ing in Japan' by Hiroshi Suwaki in the first issue ofthe International Review of Psychiatry describeshow modest restrictions are in Japan. Recently thehealth warnings on cigarette packs has become "Forour health, let us be careful not to smoke too much"!

Meanwhile in the U.K. new regulations imple-menting European Commission legislation makesalcohol strength markings compulsory for prepack-aged drinks containing more than 1.2% alcohol byvolume. Retailers must also display a guide orinformation on relative alcohol strengths. Thepresent licensing laws allow for the sale fromunlicensed premises of drinks whose alcoholstrength never exceeded 1.2% at any stage ofmanufacture. Moves are now afoot to alter this toallow the sale of low alcohol products that have hadtheir alcohol content reduced in the manufacturingprocess.

overloaded court system into treatment. In thefamily referral scheme parents and guardiansattending the charging or cautioning of a juvenilecaught in the possession of a small quantity of drugswill be given a referral sheet offering some simpleinformation and the phone number of an agencywhere they can seek help. The success of theseschemes depends on good working relationshipsbetween the police and the drug services. Initialfears were that the treatment agencies would bedeluged with police referrals but so far it hasresulted in a manageable number of referrals. Itaims to bring juveniles into contact with treatmentat an earlier stage of their drug using career.Further information: Dr Nick Dorn, ISDD, 1Hatton Place, London ECl 8ND.

Drug TheftsIn the United States a number of researchers areexpressing considerable interest in Buprenorphine forthe treatment of opiate and cocaine dependentindividuals. It is viewed as a substance of low abuseliability and thought to reduce cocaine consumption.They should think again. In Scotland there has beenconcern over the number of armed robberies ofcommunity pharmacies and pharmaceutical whole-salers. One firm was held up by four men, two of themarmed with sawn-off shotguns. They stole 18,000Temgesic (Buprenorphine) tablets and 200,000Temazepam capsules. As a result of repeatedrobberies a number of firms have stopped stockingTemgesic and Temazepam.

Situational Confidence QuestionnaireHelen Annis and Martin Graham of the AddictionResearch Foundation in Toronto have produced avery interesting instrument to monitor progress incognitive behavioural treatment approaches to theproblem drinker. They have devised a 42-itemquestionnaire using Bandura's concept of self efficacyand Marlatt and Gordons idea of high risk drinkingsituations. This is now available as the SCQ and as ashortened Alcohol Confidence Questionnaire. Bothhave been computerized and are available in sofi-ware form. It can be used clinically for clients tomeasure their confidence in resisting the urge to drinkheavily in eight different types of situations. Clientsare then able to define situations of lowest confidence,moderate confidence and highest confidence and tomonitor these over time. It is also a promisinginstrument for use in research in cognitive behav-ioural treatment. Specimen set $25.00.Further information: Marketing Services, Dept.SCF, Addiction Research Foundation, 33 Russell St,Toronto, Canada M5S 2SI.

Family Referral and Arrest Referral SchemesNew and exciting projects aimed to bring drug usersinto contact with treatment agencies for help andadvice are now well underway as national pilotprojects in the U.K. and should soon be reporting ontheir first year of work. Both the family referralscheme and the arrest referral scheme aim toprovide information to individual drug users andtheir families and to divert them away from the

AUDIT: The Alcohol Use DisordersIdentification TestThis screening instrument has been developed byThomas Babor, Juan Ramon de la Fuente, JohnSaunders & Marcus Grant as a guideline for use inprimary health care and other non-specialist set-

News and Notes 1103

tings. It is composed of two parts an AUDITquestionnaire and AUDIT clinical questions andprocedure. It is devised to distinguish betweenhazardous use, harmful use, alcohol-related disabili-ties and alcohol dependence. It has attempted tosynthesize a variety of national approaches toscreening. Field studies on this instrument havebeen carried out in Norway, Kenya, Bulgaria,Mexico and the United States of America.

It is an attractive ten-item questionnaire with a0-4 score on each question with a score of 5 or moreindicating a positive case. Those who are disen-chanted with the MAST or CAGE may find this awelcome development. You can brace yourself for abinge of publications comparing the MAST and theAUDIT. These guidelines explain in a clear andunambiguous manner how to use this screeninginstrument and also explain the theoretical model ofdependence underlying it.Further information: Marcus Grant, World HealthOrganization, Division of Mental Health, 1211Geneva 27, Switzerland.

Mandatory HIV TestingPremarital syphillis testing has been mandatory inthe U.S.A. for a long time. Hie poor clean livingneedle phobic just could not bring himself to marry. Ithas never been clear to me how public health officialsthought that premarital screening would reduce thespread of syphillis. But the same logic has beenapplied now to HIV testing. In 1987 33 statesconsidered legislation on mandatory premaritalscreening. Louisiana and Illinois adopted legislationmandating premarital screening but Louisiana re-pealed its law 6 months after enactment. A report inthe Journal of the American Medical Associationpoints out that in the first 6 months of testing 70,846people were tested and 8 were found to be seropositive.The total cost of the programme for 6 months wasestimated at $2.5 million. It cost $312,000 to identifya single seropositive individual. Marriage licenses inIllinois went down by 22.5% but there was acorresponding increase in marriages in surroundingstates. The report concludes that mandatory testing isnot cost effective.CJAMA, 1989; 261: 3415-3418).

New JournalsAt least two new journals relevant to BJA readershave appeared in 1989. You will probably havenoticed both advertised in this journal as they haveerupted from the same publishing stable. The fistAIDS Care is edited by Loraine Sher at St Mary'sHospital, London and Robert Bor of Royal FreeHospital & School of Medicine, London. It aims tocover issues in HIV and AIDS from a multidiscipli-nary perspective: Psychology, Sociology, Epidemi-ology, Social Work, Anthropology, Social Aspects ofMedicine, Nursing Education, Health Education,Law, Administration and Counselling. The firstissue has a range of international contributors. It isunfortunate that the article 'HIV Counselling inPrisons' is remarkably similar to an article by thesame authors in Counselling Psychology Quarterly.Even in the age of the word processor suchsimilarity is unjustifiable.

The second journal International Review inPsychiatry is edited by Dr Paul Bebbington of theInstitute of Psychiatry. Each issue will be guestedited by a specialist on the topic of the issue. Itplans to provide a state of the art view of each topic.This is very successfully achieved in the first issuewhich covers the Addictions and is edited byGriffith Edwards. It has a distinguished rangeof international contributors including HerbertKleber, Jerome Jaffe, John Saunders, DonaldGoodwin and Robin Room. It has a particularlyineresting book section where a range of interna-tional experts write on what they think are the threemost infiuential books in the field of addictions.Further details: Carfax Publishing Company, POBox 25, Abingdon, Oxfordshire 0X14 3UE, U.K.

Teaching VideosTwo videos on interviewing and approaches to theproblem drinker have been produced. These twovideos contain a wealth of clinical information andhave many of the experts in the alcohol fieldexplaining their own clinical approach. The informa-tion and clinical content of these videos is first class. Itis unfortunate that the technical production qualitiesof these videos do not match. The producers were

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clearly constrained by a low budget but if teachingvideos are to make an impact they must be producedto the highest professional standards. Despite thisthese videos provide a wealth of material to constructteaching session around.Further information: Turnip Video Services, 193Queens Rd, Wimbledon, London SW19 8NX, U.K.Tel: 01-543 0213.

Drugs, Alcohol and Crime 16-17 November1989The two-day annual sympsoium on the Society forthe Study of Addictions to Alcohol and other Drugswill be devoted to the association between drugs,alcohol and crime and the second day will coverissues of law enforcement. The Dent MemorialLecture will be given by Professor David Pittman.This will take place in Leicester Polytechnic.Further information: Noreen Rooney, Departmentof Addiction Behaviour, St Georges Hospital,Blackshaw Rd, London SW17 OQT.