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Saturday, February 9, 2008
Hypertension. 2008 Published online 7 Feb 2008
Heavy alcohol intake increases the risk of hypertension, but the relationship between light-to-moderate alcohol consumption and incident hypertension remains controversial.
During 10.9 and 21.8 years of follow-up, 8680 women and 6012 men developed hypertension (defined as new physician diagnosis, antihypertensive treatment, reported systolic blood pressure 140 mm Hg, or diastolic blood pressure 90 mm Hg).
In women, we found a J-shaped association between alcohol intake and hypertension in age- and lifestyle-adjusted models. Adding potential intermediates (body mass index, diabetes, and high cholesterol) attenuated the benefits of alcohol in the light-to-moderate range and strengthened the adverse effects of heavy alcohol intake. Beverage-specific relative risks paralleled those for total alcohol intake.
In men, alcohol intake was positively and significantly associated with the risk of hypertension and persisted after multivariate adjustment.
Models stratified by baseline systolic blood pressure or diastolic blood pressure did not alter the relative risks in women and men
In conclusion, light-to-moderate alcohol consumption decreased hypertension risk in women and increased risk in men. The threshold above which alcohol became deleterious for hypertension risk emerged at 4 drinks per day in women versus a moderate level of 1 drink per day in men.
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Alcohol and Alcoholism Advance Access published online on February 9, 2008
To analyse gender differences in the efficacy of stepped care brief interventions for general practice patients with alcohol problems.
Regression analysis revealed a significant effect size only in women (P = 0.039). After excluding alcohol dependents and binge drinkers, an effect size (R2) of 0.031 (P = 0.050) in women and an effect size (R2) of 0.069 (P = 0.057) in men was obtained. Among the patients in stepped care who, by the first assessment point, had reduced drinking to within safe-drinking limits, there was a tendency for females to have achieved this more often than males (40% vs. 24%; P = 0.089).
In a heterogeneous sample, the intervention was only effective for women. Women tended to profit more from the first, less intensive intervention than men. When analysis was limited to those reporting "at risk" average daily consumption and "alcohol abuse," the gender differences in efficacy appeared to be less, but the study was not sufficiently powered to affirm that.
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Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) o8 Feb 2008
Aripiprazole is an atypical antipsychotic with partial agonist activity at D2 receptors, which could reduce the reinforcing effects of alcohol.
The present study examined whether aripiprazole modifies the behavioral and physiological effects of a moderate dose of alcohol in a group of social drinkers.
Alcohol consumption produced physiological and subjective responses that were consistent with the literature on its effects. Pre-treatment with aripiprazole was generally well tolerated, with tiredness being the most commonly reported adverse event. The medication was associated with modest physiological effects. It also significantly and dose-dependently increased the sedative effects of alcohol and, to a lesser degree, decreased the euphoric effects of alcohol.
These findings require replication in a larger subject sample that includes heavy drinkers and in a study that employs a placebo session. Based on its capacity to increase the sedative effects and decrease the euphoric effects of alcohol, aripiprazole could be of value in the treatment of heavy drinking.
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In trying to dissociate the effect of alcohol and tobacco use on platelet monoamine oxidase-B (MAO-B) activity, we compared the enzyme kinetics in controls (n = 66) and alcohol-dependent patients (n = 81), subdivided according to the severity of both, alcohol and tobacco use. Platelet MAO-B kinetics was measured spectrophotofluorimetrically in chronic alcohol intoxication and after 3 weeks abstinence.
In alcoholic patients, an increased Michaelis-Menten constant (16%, p < 0.01) was shown, notwithstanding smoking status. Maximal velocity did not differ between patients and controls when adjusted for smoking. In cigarette smokers, a highly significant dose-dependent reduction of platelet MAO velocity (40%, p < 0.001) was demonstrated, with a similar degree of reduction in patients and controls. Tobacco use itself had no influence on MAO affinity.
No differences were shown between subtype 1 and 2 alcoholics, or between the day of admission and the 21st day of abstinence.
In conclusion, it seems that both, alcohol and tobacco consumption, may contribute to the lowering of overall platelet MAO-B activity. The effect of alcohol is small, due to interference with substrate binding, and not alteration of catalytic activity. In contrast, the effect of cigarette smoking is pronounced and relates to the dose-dependent reduction of platelet MAO velocity, with no influence on its affinity.
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According to the self-medication hypothesis, individuals with depression and anxiety disorders use alcohol to control their symptoms and subsequently become dependent. Conversely, alcohol dependence disorder (ADD) can cause or exacerbate psychiatric disorders.
This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder?
Baseline comparisons differentiated patients with a Hamilton Rating Scale for anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score >60: n = 20; 31.2%] were not distinguishable from those with an LSAS score 60 by depressive and anxiety disorder symptoms.
In postdetoxification assessment, patients who remitted from depression (HDRS score <7: n =" 35;" src="http://content.karger.com/ProdukteDB/..%5CProdukteDB%5Cimages%5Centity%5Cgteq.gif" alt="ge" border="0">7).
Patients who remitted from social phobia (LSAS score <30: n = 32; 50%) did not significantly differ from nonremitter subjects in depressive and anxiety disorder symptoms.
Generalized anxiety (Hamilton Rating Scale for Anxiety) and hypochondriasis (Whiteley Index) were the significant predictors of global functioning (Global Assessment Scale).
Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.
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Friday, February 8, 2008
For Immediate Release:
Thursday, February 7, 2008
Patients with a certain gene variant drank less and experienced better overall clinical outcomes than patients without the variant while taking the medication naltrexone, according to an analysis of participants in the National Institutes of Health's 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) Study. About 87 percent of patients with the variant who received naltrexone. experienced good outcomes, compared with about 49 percent of those who received a placebo. About 55 percent of patients without the variant experienced a good outcome regardless of whether they received naltrexone or placebo. Good outcome was defined as abstinence or moderate drinking without related problems, according to an article in the Feb. 4 issue of the Archives of General Psychiatry
Drinking alcohol increases the release of endogenous opioids, compounds that originate in the body and promote a sense of pleasure or well-being. An opioid antagonist, naltrexone blocks brain receptors for endogenous opioids, making it easier for patients to remain abstinent or stop quickly in the event of a slip. In clinical studies, naltrexone has been shown to reduce relapse and craving for alcohol in some but not all treated patients. Earlier studies had suggested that a specific DNA variant of the opioid receptor gene (OPRM1) might have role in patients' response to naltrexone.
"Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone. This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development," said National Institute on Alcohol Abuse and Alcoholism (NIAAA) director Ting-Kai Li, M.D.
Depressed and bipolar alcoholics represent a significant affective subgroup that has a poorer prognosis than either diagnosis alone. To date few systematic treatment programs have been developed to treat dual diagnosis.
An inpatient treatment program was developed at St Patrick's Hospital Dublin to treat dual diagnosis clients with alcohol dependence and either unipolar or bipolar affective disorder. Clients (N = 232) were assessed for depression, anxiety, elation, cravings, drink and drug intake on admission, discharge, 3 and 6 months post-discharge from the program.
In the overall group there was a reduction in number of drinking days and units per drinking day over the study (p < .01). There was a 71.8% complete abstinent rate at 3 months and 55.8% at 6 months in the depression group, non-significantly greater than for the bipolar group at 64.7% and 54.1% respectively. Gamma GT, MCV and craving scores were significantly reduced over time (p < .01). Mania, depression and anxiety inventory scores fell over time in both groups (p < .01). 15–21-year olds were more severely anxious, had higher illicit drug use, and were more likely to relapse to drug use than older clients. Bipolar 1 clients were significantly more likely than bipolar 2 clients to be on mood stabilisers at all follow-up stages (p < .001).
There is evidence for efficacy of a specifically designed dual diagnosis inpatient treatment program as both depressed and bipolar alcoholics had significant reductions in all measurements of mood, craving, and alcohol/drug consumption by self report and biological markers, suggesting both diagnoses can be effectively treated together.
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February 9, 2008
BUFFALO, N.Y. -- Increases in young women's drinking during the transition from high school through the first year of college can have dangerous physical, sexual and psychological implications, according to a report out of the University at Buffalo's Research Institute on Addictions.
The good news is that during the first year of college, when many young women increase their drinking, the majority (78 percent) of the 870 incoming freshmen women who participated in the study did not experience any victimization. The bad news, however, is that among the 22 percent of women who were victimized, 13 percent experienced severe physical victimization and 38 percent experienced severe sexual victimization.
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J. Stud. Alcohol Drugs 69: 65-74, 2008
The current study assessed women's risk for victimization during the first year at college, based on changes in drinking during the transition from high school to college.
We were specifically interested in differential risk for victimization based on women's change in drinking status over the transition to college. We compared continued abstainers with women who began drinking (new drinkers) and women who continued drinking but either decreased, increased, or did not change their level of weekly drinking.
Abstainers were significantly less likely to experience physical or sexual victimization during the first year at college, compared with drinkers. Logistic regression indicated that there were differences in the predictors of physical and sexual victimization during the first year at college. These differences included history of victimization, psychological symptoms, and number of sexual partners, as well as the type of change in drinking over the transition.
In comparison with abstainers, having a history of physical victimization, greater psychological symptoms, and being a new drinker increased the odds of physical victimization, whereas having a greater number of current psychological symptoms, sexual partners, and increasing weekly drinking increased the odds of sexual victimization during the first year at college.
These findings have implications for prevention efforts targeting young women entering college.
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Genes, Brain and Behavior 7 (s1), 28–42.
This review addresses the role of adult hippocampal neurogenesis and stem cells in some of the most common neurodegenerative disorders and their related animal models.
We discuss recent literature in relation to Alzheimer’s disease and dementia, Parkinson’s disease, Huntington’s disease, amyotrophic lateral sclerosis, alcoholism, ischemia, epilepsy and major depression.
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Released: Fri 08-Feb-2008
The predictability of college students’ drinking could open a door to prevention, Scott Walters, Ph.D., a researcher at The University of Texas School of Public Health, recently told members of the American Public Health Association (APHA) at the group’s 135th annual meeting.
Walters, assistant professor of health promotion and behavioral sciences at the UT School of Public Health Dallas Regional Campus, based his symposium presentation on a paper he co-authored that was published in the November 2007 issue of Addictive Behaviors.
Building on earlier studies that have shown college students tend to binge drink around specific events, the paper, “Event-specific prevention: Addressing college student drinking during known windows of risk,” reviewed existing literature about prevention efforts.
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Addictive Behaviors Volume 32, Issue 11, November 2007, Pages 2667-2680
Reducing Alcohol Consumption in University Students
The unique drinking patterns of college students call for Event-Specific Prevention (ESP) strategies that address college student drinking associated with peak times and events. Despite limited research evaluating ESP, many college campuses are currently implementing programming for specific events.
The present paper provides a review of existing literature related to ESP and offers practical guidance for research and practice.
The prevention typology proposed by DeJong and Langford [DeJong, W. & Langford, L. M. (2002). A typology for campus-based alcohol prevention: Moving toward environmental management strategies. Journal of Studies on Alcohol, 140–147.] provides a framework for strategic planning, suggesting that programs and policies should address problems at the individual, group, institution, community, state, and society level, and that these interventions should focus on knowledge change, environmental change, health protection, and intervention and treatment services. From this typology, specific examples are provided for comprehensive program planning related to orientation/beginning of school year, homecoming, 21st birthday celebrations, spring break, and graduation.
In addition, the University of Connecticut's efforts to address problems resulting from its annual Spring Weekend are described as an illustration of how advance planning by campus and community partners can produce a successful ESP effort.
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Journal of Substance Use, First Published 08 February 2008
This study aimed to (i) test the hypothesis that stable housing, older age, gate-kept admission route and female gender are predictive of completion of in-patient detoxification treatment, and (ii) compare two care pathways into treatment.
Factors predictive of treatment completion were found to be older age, female gender, employment and undergoing a process of gate-keeping for admission. A comparison of treatment completers between gate-kept and non-gate-kept admissions indicated that while gate-keeping is sensitive to potential completers by favouring people with stable housing it may also be excluding a proportion of clients among younger males with unstable housing who would otherwise benefit from admission.
In developing care pathways that ensure effective and appropriate use of services careful consideration must be given to the impacts upon some client groups who may be disadvantaged by the process.
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, , Pages 101-107
Alcohol consumption has been shown to contribute to a favorable lipid profile, and most studies have reported a reduction in coronary heart disease risk with low-to-moderate consumption of alcohol that is generally attributed to the beneficial effects of alcohol on lipids. The influence of different types of alcoholic beverages on plasma lipid levels has been investigated to a lesser extent and in limited populations.
We investigated the effect of overall alcohol consumption, as well as the type of alcoholic beverage consumed, on multiple lipid measures in the large bi-ethnic population of the Atherosclerosis Risk in Communities study.
We found both low-to-moderate and heavy alcohol consumption, regardless of the type of alcoholic beverage consumed, to result in significantly greater levels of high-density lipoprotein (HDL) cholesterol, HDL3 cholesterol, and apolipoprotein A-I in both white and African-American males and females.
Associations with other lipid measures contrasted between whites and African Americans, with greater levels of alcohol consumption resulting in significantly greater triglyceride levels in African Americans.
Our results confirm previous studies associating alcohol consumption, regardless of beverage type, with greater HDL cholesterol levels, with additional consistent associations detected for the major HDL cholesterol density subfraction, HDL3 cholesterol, and the major HDL cholesterol structural apolipoprotein, apolipoprotein A-I.
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The Annals recently published the proceedings of a symposium on the health effects of moderate alcohol. A summary of the symposium was written by the organizers and sent to the readership of several other journals. Others at the symposium had a differing view of the conclusions. In particular, there is disagreement over interpretation of the epidemiologic data that support or refute the contention that moderate alcohol consumption has health benefit, and over whether that issue was resolved at the Symposium. Also available is a response from guest editors to the commentary. Readers of The Annals will find the arguments of considerable interest, since they invoke fundamental epidemiologic issues of bias and misclassification that are at the center of so much epidemiologic work, and we would welcome any further commentary from the readership on these issues. – The Editor
Drug and Alcohol Review, Volume 27, Issue 2 March 2008 , pages 204 - 211
It is of no coincidence that a number of recent Harm Reduction Digests have addressed the issue of the reduction of alcohol-related harm. Despite the dominant focus on illicit drug use in the popular discourse, alcohol remains Australia's number one drug problem, as it is in many other developed countries.
In this Digest Munro and de Wever use the 'four Ps' of marketing: product, price, place and promotion, to critique the two decades industry self-regulation of alcohol marketing.
They conclude that if we are going to develop policies which effectively change Australian drinking culture to reduce alcohol-related harm, we need first to accept that the alcohol industry and the health field have separate and conflicting interests.
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Thursday, February 7, 2008
Cochrane Database Syst Rev 2008; (1):CD001088.
BACKGROUND: Even low levels of substance misuse by people with a severe mental illness can have detrimental effects.
OBJECTIVES: To assess the effects of psychosocial interventions for substance reduction in people with a serious mental illness.
SEARCH STRATEGY: For this update (2007) we searched the Cochrane Schizophrenia Group Trials Register (May 2006) which is based on regular searches of major databases.
SELECTION CRITERIA: We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness.
DATA COLLECTION AND ANALYSIS: We extracted data independently. For dichotomous data we calculated relative risks (RR) and their 95% confidence intervals (CI) on an intention-to-treat basis, based on a random effects model. We calculated numbers needed to treat/harm (NNT/NNH) where data were homogeneous. For continuous data, we calculated weighted mean differences (WMD) again based on a random effects model.
MAIN RESULTS: Evaluation of long-term integrated care included 4 RCTs (total n=735). We found no significant difference on measures of substance use (n=85, 1 RCT, RR 0.89 CI 0.6 to 1.3) or loss to treatment (n=603, 3 RCTs, RR 1.09 CI 0.8 to 1.5). For the non-integrated intensive case management trials (4 RCTs, total n=151) we also found no significant difference for loss (n=134, 3 RCTs, RR 1.35 CI 0.8 to 2.2). Motivational interviewing plus cognitive behavioural therapy (3 RCTs, total n=276) did not reveal any advantage for retaining participants (n=36, 1 RCT, RR lost to treatment 0.50 CI 0.1 to 5.0) or for relapse (n=36, 1 RCT, RR 0.58 CI 0.3 to 1.1), and no benefit for reducing substance use (n=119, 1 RCT, RR 0.19 CI -0.2 to 0.6). Cognitive behavioural therapy alone (4 trials, total n=260) showed fewer participants lost from treatment (n=260, 4 RCTs, p=0.02, RR 0.61 CI 0.4 to 0.9). No benefits were observed on measures of lessening cannabis use (n=47, 1 RCT, RR 1.30 CI 0.8 to 2.2) or on the number of participants using substances (alcohol; n=46, 1 RCT, RR 5.88 CI 0.8 to 44.0, drugs; n=46, 1 RCT, RR 2.02 CI 0.9 to 4.8) and no differences were observed on measures of mental state (n=105, 1 RCT, RR 0.52 CI -0.8 to 1.8). We found no advantage for motivational interviewing alone (5 trials, total n=338) in reducing 'lost to evaluation' (n=338, 5 RCTs, RR 0.96 CI 0.6 to 1.5) compared with treatment as usual, although significantly more participants in the motivational interviewing group reported for their first aftercare appointment (n=93, 1 RCT, RR 0.69 CI 0.5 to 0.9, NNT 4 CI 3 to 12). Some differences were observed in abstaining from alcohol favouring treatment (n=28, 1 RCT, RR 0.36 CI 0.2 to 0.8, NNT 2 CI 2 to 5), but not other substances (n=89, 1 RCT, RR -0.07 CI -0.6 to 0.4) and no differences were observed in mental state (n=30, 1 RCT, WMD -4.20 CI -18.7 to 10.3). Finally, we found no significant differences for skills training in the numbers lost to treatment by 12 months (n=94, 2 RCTs, RR 0.70 CI 0.4 to 1.1). AUTHORS'
CONCLUSIONS: We included 25 RCTs and found no compelling evidence to support any one psychosocial treatment over another to reduce substance use (or improve mental state) by people with serious mental illnesses. Furthermore, methodological difficulties exist which hinder pooling and interpreting results; high drop out rates, varying fidelity of interventions, varying outcome measures, settings and samples and comparison groups may have received higher levels of treatment than standard care. Further studies are required which address these concerns and improve the evidence in this important area.
Alcohol and Alcoholism Advance Access published online on February 7, 2008
Archival data from structured interviews of 1193 male prison inmates were subjected to taxometric analysis to determine the latent structure of the alcohol use disorder construct.
Analyses were performed using three taxometric procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIG), and latent mode factor analysis (L-Mode).
The outcomes were based on three indicators: (1) DSM-IV alcohol dependence criteria 1 and 2 (tolerance/withdrawal), (2) DSM-IV alcohol dependence criteria 3, 4, and 5 and DSM-IV alcohol abuse criterion 3 (loss of control), and (3) DSM-IV alcohol dependence criteria 6 and 7 and DSM-IV alcohol abuse criteria 1, 2, and 4 (negative social/psychological consequences). The outcomes revealed consistent support for a taxonic (categorical) interpretation of alcohol use disorders.
There may be a taxonic boundary separating those who do and do not qualify for a diagnosis of alcohol dependence or abuse with important implications for diagnosis and treatment.
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Psychology of Addictive Behaviors. 2007 Dec Vol 21(4) 441-452
Analysis of alcohol use data and other low base rate risk behaviors using ordinary least squares regression models can be problematic.
This article presents 2 alternative statistical approaches, generalized linear models and bootstrapping, that may be more appropriate for such data. First, the basic theory behind the approaches is presented. Then, using a data set of alcohol use behaviors and consequences, results based on these approaches are contrasted with the results from ordinary least squares regression.
The less traditional approaches consistently demonstrated better fit with model assumptions, as demonstrated by graphical analysis of residuals, and identified more significant variables potentially resulting in theoretically different interpretations of the models of alcohol use.
In conclusion, these models show significant promise for furthering the understanding of alcohol-related behaviors.
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Journal of Substance Abuse Treatment , Article in Press, 14 January 2008
To date, the only published norms for the Drinker Inventory of Consequences (DrInC) have come from a sample of heavy drinkers in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) who were enrolling in a treatment program.
We have generated an additional set of norms for the DrInC based on a large sample (N = 1,564) of heavy drinkers who have completed the DrInC as part of a Web-based brief motivational intervention, the Drinker's Checkup (DCU; www.drinkerscheckup.com). Although these drinkers were not seeking formal treatment, they were concerned enough about their drinking to pay $25 to use the DCU.
Comparing the means and decile scores for lifetime and recent total scores and subscale scores between the DCU and MATCH samples revealed that DrInC scores for the DCU sample were significantly lower than the MATCH sample.
These findings have implications for giving normative feedback using the DrInC with non-treatment-seeking populations. The use and limitations of these findings are discussed.
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Journal of Substance Abuse Treatment Article in Press, Corrected Proof - 14 January 2008
First-week Dimensions of Change Instrument (DCI) assessments from a cohort of 519 adults entering six therapeutic communities (TCs) were used to predict treatment retention and outcomes.
A more positive first-week response to TC social processes (Community Responsibility; Resident Sharing, Support, and Enthusiasm; Group Process; and Clarity and Safety) and to one TC personal-development process (Positive Self-Attitude and Commitment to Abstinence) predicted retention for the first month.
Improvement in Clarity and Safety and Resident Sharing, Support, and Enthusiasm scores at 30 days predicted retention in treatment for 3, 6, and 9 months.
In multivariate analyses available to a subset of the entry cohort, a longer tenure in treatment was a robust predictor of posttreatment outcomes.
First-week DCI scores on the community process scales predicted posttreatment alcohol-and-other-drug abstinence and functioning.
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This report presents the results of the adaptation process and exploratory pilot study of the Strengthening Families Programme SFP10-14 materials for use in the United Kingdom.
The Strengthening Families Programme 10-14 (SFP10-14) is a seven session video based family skills training programme designed to increase resilience and reduce risk factors for alcohol and substance misuse, depression, violence and aggression, delinquency and school failure in The SFP10-14 has been evaluated for primary prevention effectiveness with young people and their parents living in mainly rural areas in Iowa, U.S.A. (Spoth et al 2001a; Spoth et al 2001b).
Whilst initial reports of implementation of the SFP10-14 in the UK are valuable it has been recognised that the US SFP10-14 programme materials and approach might need to be adapted to meet the needs of a UK audience and that a more systematic approach to evaluation of SFP10-14 in the UK was needed (Coombes et al 2006). This report presents the results of the adaptation process and exploratory pilot study of the adapted SFP10-14 materials and approach in the UK.
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6th February 2008
Today’s speech by Home Secretary Jacqui Smith simply re-states existing powers of the police which have limited impact on reducing under-age drinking, says Addaction, Britain’s biggest specialist drug and alcohol charity. It welcomes the ‘stepping up’ of efforts to tackle under-age drinking, but says this approach must be backed up with support for young people and parents to tackle problems with alcohol.
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Alan Travis, home affairs editor
Thursday February 7, 2008
The majority of Britain's 13-year-olds have drunk alcohol, marking a worrying "tipping point" for underage drinking, the home secretary, Jacqui Smith, warned yesterday as she promised to step up enforcement action.
The home secretary also gave a clear hint that the 24-hour drinking laws are now likely to remain in place.
Smith indicated that Home Office research to be published later this month is expected to show that the change in the licensing laws has not had the dramatic impact on crime and disorder that some have claimed.
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The Wine and Spirit Trade Association
4 February 2008
While anti-alcohol lobbyists have argued that a tax increase on alcohol is the magic bullet to address problem-drinking, new economic research shows this is not the case. The Wine and Spirit Trade Association (WSTA) warned today that any potential tax increase on wine and spirits threatens to significantly increase the prices consumers will pay while doing nothing to reduce problem-drinking. Highlighted in its budget submission to the Treasury, the WSTA warned that not only would increases in tax punish the majority of responsible drinkers, but such increases would actually reduce revenue for the Treasury and threaten over 50,000 jobs.
Commenting on the release of the report, Jeremy Beadles, Chief Executive of the WSTA said: “Raising the price of alcohol by raising taxes will unfairly punish the majority of responsible drinkers for the misdeeds of a small minority. Our research shows that any such increases will do little to address problem-drinking while hurting the economy and the Treasury. It simply does not make any sense.”
. . . . . . .
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Addiction 103 (3), 368–376.
To critique the methodological adequacy of evaluations of emergency department (ED)-based interventions for alcohol problems and to conduct a meta-analysis to examine the extent to which interventions in this setting are effective in reducing alcohol consumption and related harm.
Thirteen studies were identified for inclusion in the review. Methodological quality was found to be reasonable, with the exception of poor reporting of effect-size information and inconsistent selection of outcome measures. Meta-analyses revealed that interventions did not significantly reduce subsequent alcohol consumption, but were associated with approximately half the odds of experiencing an alcohol-related injury (odds ratio = 0.59, 95% confidence interval 0.42–0.84).
There are few evaluations of emergency department-based interventions for alcohol problems. Future evaluations should use consistent outcome measures and report effect sizes.
The existing evidence suggests that interventions are effective in reducing subsequent alcohol-related injuries.Read Full Abstract
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Wednesday, February 6, 2008
Addiction 103 (3), 424–432.
To assess the prospective association between alcohol consumption and self-rated health: in particular whether there is a relationship between stable alcohol intake and health; whether health is affected by changes in alcohol consumption; whether having a chronic condition alters the relationships between stable and changing alcohol intake and health; and whether the health of longer-term abstainers is different from more recent and intermittent abstainers.
Longitudinal models of consistent alcohol intake showed mean scores for general health of moderate drinkers were significantly better than that of non-drinkers [mean difference = 4.3, standard error (SE) = 0.61], occasional drinkers (mean difference = 3.1, SE = 0.52) and heavy drinkers (mean difference = 2.1, SE = 1.00). Among moderate drinkers, a decrease or variation in alcohol consumption was associated with a significant decline of three to four points in general health. Similar results were obtained when women with an existing chronic condition were excluded from these models. The health of recent abstainers and intermittent drinkers was the same as longer-term abstainers.
Consistent moderate drinkers had the best health even after adjustment for having a chronic condition, depression and life-style factors. Poorer health was associated with decreased alcohol intake among occasional and moderate drinkers.
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Addiction 103 (3), 347–348.
Substance misuse is generally thought of as a problem of young people, but such problems have no age limits.
Prescription and over-the-counter drugs are used widely by older adults. About one-third of all prescribed drugs, often including benzodiazepines and opioid analgesics, are used by people aged over 65 years. Problematic use of prescribed drugs may involve inappropriate use such as ‘borrowing’ a medication from a friend or relative, occasional recreational use or persistent use and dependence. The misuse of prescribed or over-the-counter drugs may involve deliberately using higher than recommended doses, using for extended periods, hoarding medications and using medications together with alcohol.
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Addiction 103 (3), 387–396.
This paper provides an overview of some of the probable active ingredients of self-help groups in light of four related theories that identify common social processes that appear to underlie effective psychosocial treatments for and continuing remission from these disorders.
Social control theory specifies active ingredients such as bonding, goal direction and structure; social learning theory specifies the importance of norms and role models, behavioral economics and behavioral choice theory emphasizes involvement in rewarding activities other than substance use, and stress and coping theory highlights building self-efficacy and effective coping skills. A review of existing studies suggests that the emphasis on these active ingredients probably underlies some aspects of the effectiveness of self-help groups.
Several issues that need to be addressed to enhance understanding of the active ingredients of action of self-help groups are discussed, including consideration of indices of Alcoholics Anonymous (AA) affiliation as active ingredients, identification of personal characteristics that may moderate the influence of active ingredients on substance use outcomes, examination of whether active ingredients of self-help groups, can amplify or compensate for treatment, identification of potential detrimental effects of involvement in self-help groups and focusing on the link between active ingredients of self-help groups and other aspects of the overall recovery milieu, such as the family and social networks
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Addiction Biology 13 (1), 88–94.
OPRL1 encodes the nociceptin receptor, which has been shown to be involved in alcohol dependence in previous studies.
In the present study, we investigated the association between genetic polymorphisms of OPRL1 and alcohol dependence in a Scandinavian population.
We genotyped 15 single nucleotide polymorphisms (SNPs) spanning the OPRL1 locus and found that SNP rs6010718 was significantly associated with both Type I and Type II alcoholics (P < 0.05). Linkage disequilibrium and haplotype analysis identified two haplotype blocks in this region. Furthermore, two haplotypes composed of five tag SNPs showed significant association with alcohol dependence.
These findings suggest that genetic variants of the OPRL1 gene play a role in alcohol dependence in the Scandinavian population, warranting further investigation at the OPRL1 locus.
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Alcohol Volume 42, Issue 1, February 2008, Pages 1-11
Many studies have used voluntary ethanol consumption by animals to assess the influence of genetic and environmental manipulations on ethanol drinking. However, the relationship between home cage ethanol consumption and more formal assessments of ethanol-reinforced behavior using operant and instrumental conditioning procedures is not always clear.
The present review attempted to evaluate whether there are consistent correlations between mouse and rat home cage ethanol drinking on the one hand, and either operant oral self-administration (OSA), conditioned taste aversion (CTA), or conditioned place preference (CPP) with ethanol on the other. We also review literature on intravenous ethanol self-administration (IVSA).
To collect data, we evaluated a range of genetic manipulations that can change both genes and ethanol drinking behavior including selective breeding, transgenic and knockout models, and inbred and recombinant inbred strain panels. For a genetic model to be included in the analysis, there had to be published data resulting in differences on home cage drinking and data for at least one of the other behavioral measures.
A consistent, positive correlation was observed between ethanol drinking and OSA, suggesting that instrumental behavior is closely genetically related to consummatory and ingestive behavior directed at ethanol.
A negative correlation was observed between CTA and drinking, suggesting that ethanol's aversive actions may limit oral consumption of ethanol.
A more modest, positive relationship was observed between drinking and CPP, and there were not enough studies available to determine a relationship with IVSA.
That some consistent outcomes were observed between widely disparate behavioral procedures and genetic populations may increase confidence in the validity of findings from these assays.
These findings may also have important implications when researchers decide which phenotypes to use in measuring alcohol-reward relevant behaviors in novel animal models.
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Alcohol Volume 42, Issue 1, February 2008, Pages 47-53
Biochemical changes in plasma and red cell membrane in moderate and heavy alcoholics were investigated to compare them with teetotalers in the present study.
Significant changes in lipid, lipoprotein profile, and lipid peroxidation were evident from the study suggesting the cardioprotective effect in moderate alcoholics, and adverse changes leading to cardiovascular risk in heavy alcoholics. Both nitrite and nitrate levels in plasma of moderate alcoholics increased significantly when compared with teetotalers and the increase is more pronounced in heavy alcoholics.
The results of the present study showed no significant difference in osmotic hemolysis in red cells from moderate and heavy alcoholics incubated with NaCl at concentrations ranging from 0.1% to 0.9%. Further, the study showed a possible relationship of nitric oxide (NO) with changes in plasma lipid profile.
To sum up, these changes in both moderate and heavy alcoholics clearly indicated the involvement of NO in rendering tolerance to alcohol-induced effects and also in modulation of alcohol effects.
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Alcohol Volume 42, Issue 1, February 2008, Pages 37-45
Numerous reports have described gastric mucosal injury in rats treated with high ethanol concentrations. However, to the best of our knowledge, ultrastructural characteristics of G cells and antral gastrin levels have not been previously reported, either in rats that chronically consumed alcohol or in human alcoholics.
The goal of this study was to examine the effect of ethanol consumption (8.5 g/kg) over a 4-month period, under controlled nutritional conditions, on antral and plasma levels of gastrin, ultrastructure of G cells, morphometric characteristics of G cells by stereological methods, and analysis of endocrine cells in the gastric mucosa by immunohistochemistry.
The chronic alcohol consumption resulted in a nonsignificant decrease in gastrin plasma levels and unchanged antral gastrin concentrations. A slightly damaged glandular portion of the gastric mucosa and dilatation of small blood vessels detected by histological analysis, suggests that ethanol has a toxic effect on the mucosal surface.
Chronic alcohol treatment significantly decreased the number of antral G cells per unit area, and increased their cellular, nuclear, and cytoplasmatic profile areas. In addition, the volume density and diameter of G-cell granules, predominantly the pale and lucent types, were increased, indicating inhibition of gastrin release.
Ethanol treatment also decreased the number of gastric somatostatin-, serotonin-, and histamine-immunoreactive cells, except the somatostatin cells in the pyloric mucosa, as well as both G: D: enterochromaffin cells (EC) cell ratios in the antrum and D: ECL cell ratios in the fundus.
These results indicate that the change of morphometric parameters in G cells may be related to cellular dysfunction.
Our findings also suggest that regulation of G-cell secretion was not mediated by locally produced somatostatin in ethanol-consuming rats, but may involve gastric luminal content and/or neurotransmitters of gastric nerve fibers.
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Alcohol Volume 42, Issue 1, February 2008, Pages 29-36
Oxidative stress is a candidate mechanism for ethanol neuropathology in fetal alcohol spectrum disorders. Oxidative stress often involves production of reactive oxygen species (ROS), deterioration of the mitochondrial membrane potential (MMP), and cell death. Previous studies have produced conflicting results regarding the role of oxidative stress and the benefit of antioxidants in ethanol neuropathology in the developing brain.
This study investigated the hypothesis that ethanol neurotoxicity involves production of ROS with negative downstream consequences for MMP and neuron survival. This was modeled in neonatal rats at postnatal day 4 (P4) and P14. It is well established that granule neurons in the rat cerebellar cortex are more vulnerable to ethanol neurotoxicity on P4 than at later ages. Thus, it was hypothesized that ethanol produces more oxidative stress and its negative consequences on P4 than on P14.
A novel experimental approach was used in which ethanol was administered to animals in vivo (gavage 6 g/kg), granule neurons were isolated 2–24 h post-treatment, and ROS production and relative MMP were immediately assessed in the viable cells. Cells were also placed in culture and survival was measured 24 h later.
The results revealed that ethanol did not induce granule cells to produce ROS, cause deterioration of neuronal MMP, or cause neuron death when compared to vehicle controls. Further, granule neurons from neither P4 nor P14 animals mounted an oxidative response to ethanol.
These findings do not support the hypothesis that oxidative stress is obligate to granule neuron death after ethanol exposure in the neonatal rat brain. Other investigators have reached a similar conclusion using either brain homogenates or cell cultures.
In this context, it is likely that oxidative stress is not the sole and perhaps not the principal mechanism of ethanol neurotoxicity for cerebellar granule neurons during this stage of brain development.
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Alcohol Volume 42, Issue 1, February 2008, Pages 21-27
Ethanol is a known teratogen and has been implicated in the etiology of human fetal alcohol syndrome (FAS), which is characterized by distinct craniofacial abnormalities such as microcephaly, agnathia, and ocular aberrations.
Attempts at quantifying the craniofacial anomalies arising from ethanol exposure have largely been limited to radiographic evaluation in postnatal rats. Such studies discount the role of the cranial soft tissue in the morphology of FAS.
We present a study whose aim was to conduct measurements of the entire head including soft and hard tissue in full-term fetuses of mice by means of a digital analyzer, while at the same time comparing stained skeletal tissues in treated and untreated animals.
Ethanol-exposed mice showed a number of abnormalities such as anophthalmia and agnathia, but these were not significantly increased over those from nontreated fetuses (P = .5). Birth weight (P = .5), crown-rump length (P = .8), and mandibular length (P = .9) were also not significantly reduced compared to control fetuses. However, defects in some cranial bones and degrees of ossification that trailed same-stage controls were observed in treated animals, at a nonstatistically significant level (P = .14).
Acute maternal ingestion of alcohol in mice during pregnancy may not cause a significant increase in craniofacial or skeletal defects when evaluated at term. However, these effects may be latent, manifesting postnatally.
The postnatal ability of mice for recovery from alcohol-induced birth defects deserves further investigation.
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Alcohol Volume 42, Issue 1, February 2008, Pages 13-20
The Group I family of metabotropic glutamate receptors includes subtype 1 (mGlu1) and subtype 5 (mGlu5) receptors. This family of receptors has generated interest as potential targets for different areas of therapeutic development, including intervention for alcohol and drug abuse. Most of this interest is driven by findings showing involvement of mGlu5 receptors in the regulation of drug self-administration; however, studies examining the role of mGlu1 receptors in drug self-administration are limited.
The purpose of this work was to examine the role of mGlu1-receptor antagonism in the maintenance of ethanol self-administration and the self-administration of an alternate nondrug reward, sucrose.
Ethanol self-administration was dose dependently reduced by JNJ16259685. This reduction was likely due to a motor impairment as the lowest effective dose (0.1 mg/kg) significantly reduced locomotor behavior. Sucrose self-administration was reduced by the highest JNJ16259685 dose (1.0 mg/kg), and this reduction was also likely due to a motor impairment. Interestingly, ethanol self-administration was more sensitive to mGlu1-receptor antagonism than sucrose self-administration as lower JNJ16259685 doses reduced ethanol-reinforced responding and motor behavior.
Together, these results suggest that mGlu1 receptors do not play a specific role in modulating ethanol self-administration or the self-administration of an alternate nondrug reward (i.e., sucrose).
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6 February 2008
The Home Secretary has announced tough police powers to prevent underage drinking, and called for more involvement by parents and the alcohol industry to deal with the problem of teenage alcohol abuse.
Speaking to an audience of police, local authority licencing officers and representatives from the alcohol and retail industries, she described a package of new measures designed to address alcohol-related crime and anti-social behaviour among young people.
Among the actions to be taken are:
- a crackdown by police on underage drinkers consuming alcohol in public places
- extra powers for police to confiscate alcohol
- wider use of parenting contracts to get parents involved in helping their children deal with drinking addictions
- a new public information campaign directed at binge drinkers
- an independent review of how well industry standards are being met when it comes to responsible sales of alcohol
Good work already underway
Home Secretary Jacqui Smith emphasised that a lot of good work is already being done to address the problem of binge drinking, but there's more still to do.
'Police must have all the powers they need to make groups of young people drinking in public a thing of the past,' she said. 'A new campaign to confiscate alcohol from underage drinkers begins this month, and lessons will be learned from it.
'At the same time, we will continue to punish those few irresponsible retailers who flout the law by persistently selling to children.'
Parents will also play their part, and those whose children are consistently found drinking illegally will be given support to help their children stop drinking.
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Injury Prevention 2008;14:19-23
To estimate the effect of a new road traffic law against alcohol-impaired driving in Japan.
Japan passed a new road traffic law in June 2002 intended to reduce alcohol-impaired driving by decreasing the permissible blood alcohol level and by increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries were analyzed by time series.
Simple comparisons of the average of all severe traffic injuries, traffic fatalities, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven showed reductions after enactment of the new road traffic law in June 2002. The rate of alcohol-related traffic fatalities per billion kilometers driven decreased by 38% in the post-law period.
In segmented regression analyses with adjustment for baseline trends, seasonality, and autocorrelation, all traffic injuries, severe traffic injuries, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven declined significantly from baseline after the new traffic law.
Large, immediate public health benefits resulted from the new road traffic law in Japan
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Tuesday, February 5, 2008
Alcohol and Alcoholism Advance Access published online on February 3, 2008
Hazardous consumption of large quantities of alcohol is a major cause of ill-health in the former Soviet Union (fSU). The objective of this study was to describe episodic heavy drinking and other hazardous drinking behaviors in eight countries of the fSU.
Data from national surveys of adults conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2001 were used (overall sample size 18,428; response rates 71–88%). Heavy episodic drinking, high alcohol intake, drinking alcohol during the working day, and using illegally produced strong spirits were examined.
On average, 23% of men and 2% of women were defined as heavy episodic drinkers (2 l of beer or 750 g bottle of wine or 200 g strong spirits at least once every 2–3 weeks). This was more common in young males, women who are single or who are divorced/separated/widowed, in smokers, and in frequent alcohol drinkers. About half the respondents who drank strong spirits obtained at least some alcohol from private sources. Among drinkers, 11% of males and 7% of women usually took their first drink before the end of working day.
Heavy episodic alcohol drinking is frequent in males throughout the region—although prevalence rates may have been affected by underreporting—but is still relatively rare in women.
Alcohol policies in the region should address hazardous drinking patterns and the common use of illegally produced alcohol.
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