Findings from the SIPS trial, the largest UK alcohol screening and brief intervention study, have been released.
The study took place across key settings of Primary Care, Emergency Departments and Probation and tested the effectiveness of a range of brief intervention approaches and screening tools. A conference event took place on the 5th of March to launch the findings, with presentations available to download. > > > > Read More
Excessive alcohol consumption is the third-leading cause of preventable death in the U.S. This systematic review is one in a series exploring effectiveness of interventions to reduce alcohol-related harms.
The focus of this review was on studies evaluating the effects of the privatization of alcohol retail sales on excessive alcohol consumption and related harms. Using Community Guide methods for conducting systematic reviews, a systematic search was conducted in multiple databases up to December 2010. Reference lists of acquired articles and review papers were also scanned for additional studies.
A total of 17 studies assessed the impact of privatizing retail alcohol sales on the per capita alcohol consumption, a well-established proxy for excessive alcohol consumption; 9 of these studies also examined the effects of privatization on the per capita consumption of alcoholic beverages that were not privatized. One cohort study in Finland assessed the impact of privatizing the sales of medium-strength beer (MSB) on self-reported alcohol consumption. One study in Sweden assessed the impact of re-monopolizing the sale of MSB on alcohol-related harms. Across the 17 studies, there was a 44.4% median increase in the per capita sales of privatized beverages in locations that privatized retail alcohol sales (interquartile interval: 4.5% to 122.5%). During the same time period, sales of nonprivatized alcoholic beverages decreased by a median of 2.2% (interquartile interval: −6.6% to −0.1%). Privatizing the sale of MSB in Finland was associated with a mean increase in alcohol consumption of 1.7 liters of pure alcohol per person per year. Re-monopolization of the sale of MSB in Sweden was associated with a general reduction in alcohol-related harms.
According to Community Guide rules of evidence, there is strong evidence that privatization of retail alcohol sales leads to increases in excessive alcohol consumption.
Excessive alcohol consumption causes 79,000 deaths annually in the U.S., shortening the lives of those who die from it by approximately 30 years. Although alcohol taxation is an effective measure to reduce excessive consumption and related harm, some argue that increasing alcohol taxes places an unfair economic burden on “responsible” drinkers and socially disadvantaged people.
To examine the impact of a hypothetic tax increase based on alcohol consumption and sociodemographic characteristics of current drinkers, individually and in aggregate.
Data from the 2008 Behavioral Risk Factor Surveillance System survey were analyzed from 2010 to 2011 to determine the net financial impact of a hypothetic 25-cent-per-drink tax increase on current drinkers in the U.S. Higher-risk drinkers were defined as those whose past-30-day consumption included binge drinking, heavy drinking, drinking in excess of the U.S. Dietary Guidelines, and alcohol-impaired driving.
Of U.S. adults who consumed alcohol in the past 30 days, 50.4% (or approximately 25% of the total U.S. population) were classified as higher-risk drinkers. The tax increase would result in a 9.2% reduction in alcohol consumption, including an 11.4% reduction in heavy drinking. Compared with lower-risk drinkers, higher-risk drinkers would pay 4.7 times more in net increased annual per capita taxes, and 82.7% of the net increased annual aggregate taxes. Lower-risk drinkers would pay less than $30 in net increased taxes annually. In aggregate, groups who paid the most in net tax increases included those who were white, male, aged 21–50 years, earning ≥$50,000 per year, employed, and had a college degree.
A 25-cent-per-drink alcohol tax increase would reduce excessive drinking, and higher-risk drinkers would pay the substantial majority of the net tax increase.
Nearly every combat outpost in Afghanistan is automatically part of a volatile mix: a hardened enemy, increasingly sophisticated and deadly land mines, nervous young soldiers, powerful weapons and machinery, suicide bombers, the stress of multiple deployments, searing heat, unfriendly locals, unfamiliar languages.
The U.S. Army has concluded that adding alcohol to that mix is unwise.
But now, with the massacre of 16 Afghan civilians, alcohol has been suggested as a possible causal factor in the killings, along with other stressors. Inquiries into the tragedy are ongoing; the facts remain unclear.
The banning of alcohol in war zones became an issue when the United States military entered combat situations in Muslim countries that frown on drinking, first in Afghanistan and later in Iraq. (Still, alcohol was easy to get in the Green Zone in Baghdad, for example, or in the more tolerant Kurdish areas of northern Iraq.) > > > > Read More
Excessive consumption of alcohol is a major public health issue in university students. The dangers of heavy drinking are well known, with both acute and long-term consequences; however, there is limited information on patterns of extreme drinking (twice over the recommended threshold for low-risk drinking), and the differential effects of heavy versus extreme drinking on immediate consequent functioning in daily life. The current study investigated drinking patterns in a sample of university students and the association of different levels of alcohol consumption with self-reported physical, cognitive and emotional function the day after the drinking episode.
Data for this study were collected from a sample of 281 University of Otago students using a 21 day Internet-based daily diary. Participants reported on their drinking the previous night and their physical, cognitive and emotional functioning on that day.
Participants reported drinking on 26.8% days overall and consuming an average of 7.2 standard drinks per occasion. Only heavy drinking (7+standard drinks for men, 5+standard drinks for women) and particularly extreme drinking (14+for men, 10+for women) predicted significant decreases in physical and cognitive functioning the next day. However, low-risk drinking (≤ 6 drinks for men,≤ 4 for women) was not associated with next-day impairment.
Findings suggest that there are adverse, intermediate consequences of excessive drinking on dimensions relevant to students' lives. Drinking within low-risk guidelines is recommended.
Excessive alcohol consumption amongst university students has received increasing attention. A social norms approach to reducing drinking behaviours has met with some success in the USA. Such an approach is based on the assumption that student's perceptions of the norms of their peers are highly influential, but that these perceptions are often incorrect. Social norms interventions therefore aim to correct these inaccurate perceptions, and in turn, to change behaviours. However, UK studies are scarce and it is increasingly recognised that social norm interventions need to be supported by socio ecological approaches that address the wider determinants of behaviour.
To describe the research design for an exploratory trial examining the acceptability, hypothesised process of change and implementation of a social norm marketing campaign designed to correct misperceptions of normative alcohol use and reduce levels of misuse, implemented alongside a university wide alcohol harm reduction toolkit. It also assesses the feasibility of a potential large scale effectiveness trial by providing key trial design parameters including randomisation, recruitment and retention, contamination, data collection methods, outcome measures and intracluster correlations.
The study adopts an exploratory cluster randomised controlled trial design with halls of residence as the unit of allocation, and a nested mixed methods process evaluation. Four Welsh (UK) universities participated in the study, with residence hall managers consenting to implementation of the trial in 50 university owned campus based halls of residence. Consenting halls were randomised to either a phased multi channel social norm marketing campaign addressing normative discrepancies (n = 25 intervention) or normal practice (n = 25 control). The primary outcome is alcohol consumption (units per week) measured using the Daily Drinking Questionnaire. Secondary outcomes assess frequency of alcohol consumption, higher risk drinking, alcohol related problems and change in perceptions of alcohol-related descriptive and injunctive norms. Data will be collected for all 50 halls at 4 months follow up through a cross-sectional on line and postal survey of approximately 4000 first year students. The process evaluation will explore the acceptability and implementation of the social norms intervention and toolkit and hypothesised process of change including awareness, receptivity and normative changes.
Exploratory trials such as this are essential to inform future definitive trials by providing crucial methodological parameters and guidance on designing and implementing optimum interventions.
The dental care setting is an appropriate place to deliver dietary assessment and advice as part of patient management. However, we do not know whether this is effective in changing dietary behaviour.
To assess the effectiveness of one-to-one dietary interventions for all ages carried out in a dental care setting in changing dietary behaviour. The effectiveness of these interventions in the subsequent changing of oral and general health is also assessed.
The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 24 January 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 1), MEDLINE via OVID (1950 to 24 January 2012), EMBASE via OVID (1980 to 24 January 2012), CINAHL via EBSCO (1982 to 24 January 2012), PsycINFO via OVID (1967 to 24 January 2012), and Web of Science (1945 to 12 April 2011). We also undertook an electronic search of key conference proceedings (IADR and ORCA between 2000 and 13 July 2011). Reference lists of relevant articles, thesis publications (Dissertations Abstracts Online 1861 to 2011) were searched. The authors of eligible trials were contacted to identify any unpublished work.
Randomised controlled trials assessing the effectiveness of one-to-one dietary interventions delivered in a dental care setting.
Abstract screening, eligibility screening and data extraction decisions were all carried out independently and in duplicate by two review authors. Consensus between the two opinions was achieved by discussion, or involvement of a third review author.
Five studies met the criteria for inclusion in the review. Two of these were multi-intervention studies where the dietary intervention was one component of a wider programme of prevention, but where data on dietary behaviour change were reported. One of the single intervention studies was concerned with dental caries prevention. The other two concerned general health outcomes. There were no studies concerned with dietary change aimed at preventing tooth erosion. In four out of the five included studies a significant change in dietary behaviour was found for at least one of the primary outcome variables.
There is some evidence that one-to-one dietary interventions in the dental setting can change behaviour, although the evidence is greater for interventions aiming to change fruit/vegetable and alcohol consumption than for those aiming to change dietary sugar consumption. There is a need for more studies, particularly in the dental practice setting, as well as greater methodological rigour in the design, statistical analysis and reporting of such studies.
To investigate whether the predominant finding of generalized positive associations between self-rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by a) using raw scores of motives that may weight inter-individual response behaviours too strongly, and b) predictor-criterion contamination by using consequence items where respondents attribute alcohol use as the cause.
Cross-sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD)
School classes
Students, ages 13 to 16 (n= 5633)
Raw, rank, and mean-variance standardized scores of the Drinking Motives Questionnaire-Revised (DMQ-R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights, and troubles with the police, each itemized with attribution ("because of your alcohol use") and without.
As previously found in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative, and internal reinforcing motives (enhancement, coping) had non-significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non-attributed ones.
Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified whereas use of rank or z scores does permit this. Use of attributed consequences overestimates the association with drinking motives.
Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are associated with suicide risk and alcohol use, and sleep problems may be associated with suicide risk in those with alcohol use disorders. For the present study, we hypothesized that self-reported sleep problems are associated with suicidal thoughts in a sample of adults seeking treatment for alcohol dependence in Poland.
The sample included 304 patients in addiction treatment programs in Warsaw, Poland who met criteria for alcohol dependence. Measures included demographic characteristics, frequency of alcohol use, psychiatric symptoms, suicidal ideation and two measures of insomnia, which differed by time frame: the Athens Insomnia Scale (AIS, past 1 month) and the Sleep Disorders Questionnaire (SDQ-7, past 6 months). Multivariable logistic regression models tested the association between insomnia and suicidal thoughts.
In models that controlled for age, gender, and days of recent drinking, both measures of sleep problems were associated with suicidal ideation: AOR = 2.01 (95% CI: 1.50–2.70) [AIS] and 1.73 (95% CI: 1.29–2.31) [SDQ-7]. The association of sleep problems, as measured by the AIS, with suicide remained significant after adjusting for psychiatric symptoms, although the estimated effect size was smaller (AOR = 1.47; 95% CI: 1.05–2.06).
Among Polish adults with alcohol dependence, insomnia severity was associated with suicidal ideation. This finding highlights the need to assess for sleep problems, in addition to suicidal thoughts, in alcohol treatment settings and to further examine the potential consequences of poor sleep in this population.
The results suggest a causal association between alcohol misuse and violent offending/victimization and IPV perpetration, with estimates suggesting that alcohol use disorder accounted for approximately 4.6–9.3% of the reported violent offending/victimization and IPV perpetration in the cohort.
Guided by the prediction of response-outcome theory of cognitive control (Alexander and Brown, 2010a), the present study examined reward-seeking medial prefrontal cortex (mPFC) activity as a common neuro-functional marker of excessive alcohol consumption, trait disinhibition, and reduced cognitive capacity; all of which have shown consistent patterns of covariation in previous psychometric research (e.g., Bogg and Finn, 2010).
A sample of 18–23-year-old university students with a heterogeneous prevalence of alcohol dependence was assessed with functional magnetic resonance imaging (fMRI) while completing a version of the Balloon Analogue Risk Task (Lejuez et al., 2002). A follow-back typical weekly alcohol consumption interview, self-report measures of trait disinhibition and IQ, and a complex span working memory task also were administered.
Correlational region-of-interest analyses showed greater typical weekly alcohol consumption, greater trait disinhibition, and lower IQ were associated with greater reductions in mPFC activity during reward-seeking behaviors (successive inflation choices). The results also showed greater typical weekly alcohol consumption, greater trait disinhibition, and lower IQ were associated with greater increases in mPFC activity during reward-seeking outcomes (successive successful inflation outcomes). No significant relations with the measure of working memory were found.
Naltrexone is one of the few drugs approved by the Federal Drug Administration for the treatment of alcoholism. However, naltrexone is only effective in a subpopulation of treatment-seeking alcohol abusers, and suffers from compliance issues. The non-selective nature of this opioid antagonist likely contributes to its side effects and poor therapeutic efficacy. Drugs selectively targeting delta opioid receptor subtypes offer a potential way to treat alcohol abuse disorders. We have recently shown that delta subtype-selective agonists TAN-67 and SNC80 can have opposing effects on alcohol consumption, while having similar effects on alcohol withdrawal-induced anxiety.
We studied the ability of TAN-67 and SNC80 to induce place preference in naïve and ethanol exposed C57BL/6 mice and determined the effect of these agonists on the expression of ethanol place preference.
We show that TAN-67 and SNC80 have opposing actions on ethanol place preference. However, neither of the drugs induces place preference by themselves at doses that are therapeutically effective in mice. Interestingly, SNC80, like naltrexone reduces ethanol place preference, however we have previously shown that SNC80 increases ethanol consumption at the tested dose. Similar to naltrexone, TAN-67 reduces alcohol consumption, but we show here that it may be due to an increase in ethanol place preference. Importantly, we found that chronic ethanol exposure does not increase the rewarding properties of the DOR subtype selective agonists.
Our results provide a better understanding of how DOR subtype selective drugs could potentially be used for treatment of alcohol abuse disorders.
Animal and human studies have suggested that the serotonergic system plays an important role in alcohol consumption and abuse, mainly due to the serotonin receptor 1B (5-HT1B) function in the mesolimbic reward pathway. Association studies between the HTR1B gene variants and alcoholism have found significant results. There is also evidence for a complex balancing regulation of the gene by two functional variants in the promoter region (rs11568817 and rs130058), which are in linkage disequilibrium.
The aim of this study is to investigate the role of the most relevant variants (rs11568817, rs130058, rs6296 and rs13212041) of the HTR1B gene in the susceptibility to alcohol dependence. The sample comprised 136 Brazilian alcoholics of European descendent and 237 controls.
The results suggest an association between a functional variant of the gene (rs11568817) and alcohol dependence (p = 0.001). In addition, this association could also be confirmed in an independent sample using imputed data from a GWAS, where marginal significant association (p = 0.03, one-tailed) with the same allele was obtained. The pattern of distribution of haplotypes was significantly different between patients and controls (p < 0.0001), which is consistent with the role of the two functional variants of the promoter region.
In conclusion, our findings point to an association between functional variants in the promoter region of the HTR1B gene and alcohol dependence, supporting previous neurobiological evidences of the involvement of HTR1B variations in alcohol-related phenotypes.
Exposure to child maltreatment is associated with elevated risk for behavioral disorders in adulthood. One explanation for this life-course association is that child maltreatment increases vulnerability to the effects of subsequent stressors; however, the extent to which maltreatment increases sensitivity to social context has never been examined. We evaluated whether the association between neighborhood physical disorder and binge drinking was modified by child maltreatment exposure.
Data were drawn from the Detroit Neighborhood Health Study, a prospective representative sample of predominately African Americans in the Detroit population. Neighborhood physical disorder was measured via systematic neighborhood assessment. Child maltreatment indicators included self-reported physical, sexual, and emotional abuse. Incident binge drinking was defined as at least one episode of ≥5 drinks (men) or ≥4 drinks (women) in the past 30-day period among those with no binge drinking at baseline (N = 1013).
Child maltreatment and neighborhood physical disorder interacted to predict incident binge drinking (B = 0.16, p = 0.02) and maximum number of past 30-day drinks (B = 0.15, p = 0.04), such that neighborhood physical disorder predicted problematic alcohol use only among individuals with high exposure to child maltreatment.
The results add to the growing literature that African Americans in the US are exposed to an array of stressors that have pernicious consequences for problematic alcohol use. Our results document the need for increased attention to the potential for at-risk alcohol use among populations with a high degree of stress exposure.
The abused volatile solvent toluene shares many behavioral effects with classic central nervous system depressants such as ethanol. Similarities between toluene and ethanol have also been demonstrated using in vitro electrophysiology. Together, these studies suggest that toluene and ethanol may be acting, at least in part, via common mechanisms.
We used the genetic model, Caenorhabditis elegans, to examine the behavioral effects of toluene in a simple system, and used mutant strains known to have altered responses to other CNS depressants to examine the involvement of those genes in the motor effects induced by toluene.
Toluene vapor brings about an altered pattern of locomotion in wild-type worms that is visibly distinct from that generated by ethanol. Mutants of the slo-1, rab-3 and unc-64 genes that are resistant to ethanol or the volatile anesthetic halothane show no resistance to toluene. A mutation in the unc-79 gene results in hypersensitivity to ethanol, halothane and toluene indicating a possible convergence of mechanisms of the three compounds. We screened for, and isolated, two mutations that generate resistance to the locomotor depressing effects of toluene and do not alter sensitivity to ethanol.
In C. elegans, ethanol and toluene have distinct behavioral effects and minimal overlap in terms of the genes responsible for these effects. These findings demonstrate that the C. elegans model system provides a unique and sensitive means of delineating both the commonalities as well as the differences in the neurochemical effects of classical CNS depressants and abused volatile inhalants.
A number of changes have been proposed and investigated in the criteria for substance use disorders in DSM-5. However, although clinical utility of DSM-5 is a high priority, relatively little of the empirical evidence supporting the changes was obtained from samples of substance abuse patients.
Proposed changes were examined in 663 patients in treatment for substance use disorders, evaluated by experienced clinicians using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Factor and item response theory analysis was used to investigate the dimensionality and psychometric properties of alcohol, cannabis, cocaine and heroin abuse and dependence criteria, and craving.
The seven dependence criteria, three of the abuse criteria (hazardous use; social/interpersonal problems related to use; neglect of roles to use), and craving form a unidimensional latent trait for alcohol, cannabis, cocaine and heroin. Craving did not add significantly to the total information offered by the dependence criteria, but adding the three abuse criteria and craving together did significantly increase total information for the criteria sets associated with alcohol, cannabis and heroin.
Among adult patients in treatment for substance disorders, the alcohol, cannabis, cocaine and heroin criteria for dependence, abuse (with the exception of legal problems), and craving measure a single underlying dimension. Results support the proposal to combine abuse and dependence into a single diagnosis in the DSM-5, omitting legal problems. Mixed support was provided for the addition of craving as a new criterion, warranting future studies of this important construct in substance use disorders.
U.S. Department of Health and Human Services Secretary Kathleen Sebelius recently appointed four new members to the National Advisory Council on Alcohol Abuse and Alcoholism of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The council advises the Secretary, the Director of the National Institutes of Health and the director of NIAAA on program and policy matters, offers recommendations on research conducted at NIAAA, and reviews applications for grants and cooperative agreements.
The 15-member council includes outstanding representatives from health and science fields relevant to NIAAA activities, as well as leaders from among the general public in fields including health policy, law, economics, and management.
“We are delighted to welcome this distinguished group of leaders to our advisory council,” said NIAAA Acting Director Kenneth R. Warren, Ph.D. “NIAAA will benefit greatly from their insight and experience.”
The recently appointed council members are:
The Honorable Linda Chezem J.D., who is a professor in the Department of Youth Development and Agriculture Education in the College of Agriculture at Purdue University, West Lafayette, Ind. The first woman to serve as a department head in the College of Agriculture, Chezem teaches at both the undergraduate and graduate levels, as well as in the law school, where her courses include Alcohol Science and Law. She also holds an adjunct appointment in the Department of Medicine at the Indiana University School of Medicine, Indianapolis. Chezem was the first woman to serve as a circuit court judge in Indiana and the second woman to be appointed as presiding judge on the Indiana Court of Appeals. In September 2007, Governor Mitch Daniels appointed her to serve on the Indiana Health Informatics Corporation Board. Among her many awards, Chezem received the Richard M. Fairbanks Circle of Hope Award from the Fairbanks Addiction Treatment Center, the oldest independent drug and treatment center in the United States, for her outstanding contributions to research, education, and treatment of drug and alcohol abuse and addiction.
Fulton Crews, Ph.D., who is the director of the Bowles Center for Alcohol Studies, and the John R. Andrews Professor of Pharmacology and Psychiatry at the School of Medicine at the University of North Carolina at Chapel Hill. Dr. Crews is also director of the NIAAA-supported Comprehensive Alcohol Research Center at the Bowles Center. Respected internationally for his research on addiction, neurodegeneration, depression and alcohol-related neuropathology, Crews is a longtime NIH grantee, and the author of more than 200 scientific articles published in peer reviewed journals and books. Crews serves on many editorial boards, as well as on the board of directors of several agencies. He has served on numerous NIH peer review committees and is the chair of the NIAAA Advisory Council’s Extramural Advisory Working Group. Crews has received numerous awards, including the Norbert Kelly Distinguished Award on Addiction from the Addiction Professionals of North Carolina, an NIAAA Method to Extend Research in Time Award, and the NIAAA Mark Keller Memorial Lecture Award.
Mimi Fleury, a parent who is founder and president of the Community of Concern, North Bethesda, Md., a non-profit organization that focuses on disseminating information to help keep youth free from alcohol and drug use. Her efforts to raise awareness about drinking and drug use among young people have been widely effective, and she has successfully established Community of Concern organizations in 24 states. Fleury’s organization published A Parent’s Guide for the Prevention of Alcohol, Tobacco and Other Drug Use. This booklet received critical acclaim from scientific experts and community organizations, as well as the Caron Foundation Award for Educational Excellence. Fleury received the Parents’ Council of Washington Volunteer of the Year Award for her work on this book.
Craig J. McClain, M.D., who is professor of medicine at the School of Medicine, University of Louisville and the chief of gastroenterology at the Louisville Veterans Administration Medical Center in Kentucky. McClain also serves as chief of research affairs, Division of Gastroenterology, Hepatology, and Nutrition, associate vice president for translational research, and distinguished university scholar. McClain is an internationally distinguished clinician-scientist in the fields of gastroenterology, alcoholic liver disease, nutrition, and infectious diseases including HIV/AIDS. Since 1977, McClain has earned funding from the Veterans Administration, and multiple institutes of the NIH including NIAAA, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Institute of Neurological Diseases and Strokes. He has published 300 peer-reviewed articles and 100 manuscripts in books and proceedings. He has been a member of many editorial boards, NIH peer review committees, and was a member of the Center for Scientific Review/NIH Advisory Council. His numerous awards include the Jewish Hospital Distinguished Chair in Hepatology and the NIAAA Method to Extend Research in Time Award. > > > > Read More
