Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and Implementation

While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder.

Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors.

The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care sett

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Request Reprint E-Mail: sgreenfield@mclean.harvard.edu

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Explaining change and stasis in alcohol consumption

The term 'saturation' has often been used when alcohol consumption in a region stays the same despite there having been reason to expect an increase, e.g. after a decrease of taxation. However, the term 'saturation' has been used only descriptively, and in different ways.

We therefore propose a wider-ranging framework for understanding and explaining trends in alcohol consumption, illustrating the operation of the factors with historical or contemporary examples.

In the framework, we include not only taxes and other alcohol controls, but also situational and other norms on drinking and intoxication, competing responsibilities and attractions that demand or favour sobriety, structural changes, external influences and the range of societal or cultural responses to alcohol problems.

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Request Reprint E-Mail: robin.roomsorad.u.se

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What neurobiology cannot tell us about addiction

Molecular neurobiological studies have yielded enormous amounts of valuable information about neuronal response mechanisms and their adaptive changes.

However, in relation to addiction this information is of limited value because almost every cell function appears to be involved. Thus it tells us only that neurons adapt to 'addictive drugs' as they do to all sorts of other functional disturbances. This information may be of limited help in the development of potential auxiliary agents for treatment of addiction.

However, a reductionist approach which attempts to analyse addiction at ever finer levels of structure and function, is inherently incapable of explaining what causes these mechanisms to be brought into play in some cases and not in others, or by self-administration of a drug but not by passive exposure.

There is abundant evidence that psychological, social, economic and specific situational factors play important roles in initiating addiction, in addition to genetic and other biological factors.

Therefore, if we hope to be able to make predictions at any but a statistical level, or to develop effective means of prevention, it is necessary to devise appropriate integrative approaches to the study of addiction, rather than pursue an ever-finer reductive approach which leads steadily farther away from the complex interaction of drug, user, environment and specific situations that characterizes the problem in humans.

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Request Reprint E-Mail: harold.kalant@utoronto.ca

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Health, United States, 2008

Health, United States presents national trends in health statistics on such topics (PDF, 14 MB) as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, and other health topics.

The report includes a chartbook (PDF, 14 MB) and trend tables (PDF, 14 MB) that may be viewed and printed using Adobe Acrobat. Trend tables are also available as downloadable spreadsheet files (PDF,) for data manipulation or graphical analysis. Data trends may be more complete in spreadsheet files than in pdf files.

The Preface (PDF, 14 MB) describes changes and additions to the current report.

Major findings are presented in the Highlights (PDF, 14 MB). Appendices (PDF, 14 MB) include Data Sources and Definitions and Methods.

The Index (PDF, 14 MB) is a topical index with cross references to such topics as child and adolescent health, elderly population, nutrition related, specific race and ethnic groups, State data, and women's health.

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United States Changes Its Mind on Addiction - It's Not a Chronic Brain Disease After All

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) looks at addiction and finds most people overcome alcoholism on their own - most without even quitting drinking! Thus one government agency - the NIAAA - contradicts another (the National Institute on Drug Abuse) by deciding that addiction is not a chronic relapsing brain disease.

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The Role of Attachment to Family, School, and Peers in Adolescents' Use of Alcohol: A Longitudinal Study of Within-Person and Between-Persons Effects

A great deal of time and money has been spent to understand why adolescents abuse alcohol. Some of the most fruitful work considers the social context navigated by adolescents, including family, school, and peer contexts. However, most of this work focuses on differences between adolescents in these contexts.

The present study adds to the literature by considering within-person changes in these contexts and examines the extent to which these changes are related to alcohol use.

Significant changes in all 3 contexts were observed, and these changes were significantly related to alcohol use.

The significant influence of intrapersonal variability highlights the importance of attending not only to chronic, between-individual issues facing at-risk youths but emergent and transient issues that may temporarily heighten alcohol use risk.

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Request Reprint E-Mail: kim.henry@colostate.edu

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Alcohol intake and the Risk of coronary heart disease in the Spanish EPIC cohort study

The association between alcohol consumption and Coronary Heart Disease (CHD) has been broadly studied. Most studies conclude that moderate alcohol intake reduces the risk of CHD. There are many discussions on whether the association is causal or biased.

The objective is to analyse the association between alcohol intake and risk of CHD in the Spanish cohort of the European Prospective Investigation into Cancer (EPIC).

In men aged 29-69 years, alcohol intake was associated with a more than 30% lower CHD incidence. Our study is based on a large prospective cohort study and is free of the abstainer error.

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Request Reprint E-Mail: l-arriola@ej-gv.es

Government vs science over drug and alcohol policy

David Nutt

My statement in October that alcohol was more dangerous than many illegal drugs, including cannabis, ecstasy, and LSD, referred back to a paper I published in The Lancet years ago. It would be an understatement, given the political, media, and academic interest, to say that I stirred up a hornets' nest in the UK Parliament and elsewhere. The Home Secretary, Alan Johnson, sacked me from my role as chair of the ACMD (the government's Advisory Council on the Misuse of Drugs, on which I had served with distinction for 10 years), and the Conservative shadow minister said it should have happened earlier this year when I published a paper comparing the harms of ecstasy and another addiction (which I had termed “equasy”—ie, horse riding).

There are several important aspects of what has happened, which some are calling the Nutt-gate affair. The first is the overwhelming public support I received, with tens of thousands sending emails, signing up to protest websites, and a petition to the government to reinstate me. Many academic groups have come out in support and there is an online petition in the academic world. A protest march was held on Nov 7, organised by a group called “Students for sensible drugs policy”, whose name represents exactly what I am saying—drugs policy should be based on evidence and common sense, the two factors that should drive interventions to reduce drug-related harm. . . . . .

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Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting

Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking.

The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States.

All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day.

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Request Reprint E-Mail: craig.field@austin.utexas.edu
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Continuities and changes in self-change research

A substantial literature demonstrates that natural recoveries from substance use disorders not only occur but are a common pathway to recovery.

This article reviews selectively and comments on the current state-of-the-art in natural recovery research.

Although considerable progress has occurred in natural recovery research, several topics deserving of further research are identified, and implications for policy practice are discussed.

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Rerquest Reprint E-Mail: harald.klingemann@dgsp.uzh.ch

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Failure to reduce drinking and driving in France: a 6-year prospective study in the GAZEL cohort

An unprecedented decline in alcohol consumption and road mortality has been observed recently in France, but it is still unclear whether or not these changes affected driving while alcohol-intoxicated (DWI).

The objective of the study was to estimate prospectively trends of excessive speed on the roads, alcohol consumption and DWI between 2001 and 2007 in a large cohort of experienced drivers.

A recent crackdown on road violations by the French government has failed to deter DWI. Given that DWI seems to be a sporadic and rarely punished behaviour, its prevention requires more coercive measures, such as using a breath alcohol ignition interlock device.

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Request Reprint E-Mail: aymery.constant@isped.u-bordeaux2.fr ______________________________________

PM under pressure to raise drinking age

A LEADING mental health advocate, Ian Hickie, has called for the Prime Minister to push for the drinking age to be lifted to 19 to break the connection between school leaving and drinking. . . . . .

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Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa

Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked.

Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use.

More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa.

Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence.

Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives.

Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.

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Variance-components methods for linkage and association analysis of ordinal traits in general pedigrees

Many complex human diseases such as alcoholism and cancer are rated on ordinal scales. Well-developed statistical methods for the genetic mapping of quantitative traits may not be appropriate for ordinal traits.

We propose a class of variance-component models for the joint linkage and association analysis of ordinal traits. The proposed models accommodate arbitrary pedigrees and allow covariates and gene-environment interactions.

We develop efficient likelihood-based inference procedures under the proposed models. The maximum likelihood estimators are approximately unbiased, normally distributed, and statistically efficient. Extensive simulation studies demonstrate that the proposed methods perform well in practical situations.

An application to data from the Collaborative Study on the Genetics of Alcoholism is provided.

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Request Reprint E-Mail: gdiao@gmu.edu
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IMPLICATIONS OF COMORBID ALCOHOL DEPENDENCE AMONG INDIVIDUALS WITH SOCIAL ANXIETY DISORDER

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUD) yet the nature of this comorbidity remains unclear. To better understand these associations, we first examined whether SAD was related to AUD above and beyond relevant covariates. Second, we examined the psychosocial impairment associated with the comorbidity of SAD and AUD versus SAD without AUD. Third, the temporal sequencing of SAD and AUD among comorbid individuals was examined.

Together, these data lend support for the contention that SAD may serve as a risk for alcohol dependence and indicate that the co-occurrence of these two conditions may result in greater personal and public health care costs.

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Dr. Nancy:Sober and drinking?

A new study challenges the core belief of Alcoholics Anonymous that total abstinence is the only way to control an alcohol problem.

Play Video
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A New View of Alcoholism

In her Personal Health column in Science Times, New York Times reporter Jane Brody touches on the issue of how much is too much when it comes to drinking alcohol. This week, Dr. Mark L. Willenbring, director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism and clinical professor of psychiatry at George Washington University School of Medicine, joins the Consults blog to answer readers’ questions about alcoholism. . . . . .

Read More
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How Much is Too Much

For our next report, a key question when it comes to alcohol abuse is How Much is Too Much. To learn more, we talked to Dr. Mark Willenbring, the Director of the Treatment and Recovery Research Division in the National Institute on Alcohol Abuse and Alcohol. His first point stresses the importance of understanding what a drink is…

Play Video
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Past conference presentations

Presentations:

• Preemption in Alcohol Control: Lessons Learned the Hard Way

• Failure of Self-Regulation of Alcohol Advertising

• Public Health and Alcohol Policy - Dispelling Myths, Forging Solutions

• Big Alcohol and Underage Drinking

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Psychological Distress in Non-Drinkers: Associations with Previous Heavy Drinking and Current Social Relationships

The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association.

The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers.

Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40–42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

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Request Reprint E-Mail: Nina.Lucas@mcri.edu.au
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Israel Cabinet communique

At the weekly Cabinet meeting on Sunday, 15 November 2009:

1. Prime Minister Benjamin Netanyahu said that today's meeting would be devoted to the national effort to reduce alcohol use, especially among young people. He made the following remarks:

"We face an epidemic. In the last three years there has been a 15% rise in alcohol use in Israel. One-third of all young people between the ages of 12-18 report that they became intoxicated in the past year, which is a terrible statistic. Here is another statistic: Approximately 20% of sixth grade boys claim that they consume an alcoholic drink once a week. Sixth grade. That is the second highest in Europe.

We must act against this. We will take three immediate steps: One, we are initiating a legislative change to restrict the sale of alcohol to minors, expand the ban on alcohol use, and seriously increase the penalty for those who break the law in this respect. Second, we will increase enforcement of the prohibition against alcohol sales in many places. Third, we intend to create a public atmosphere which is against alcohol use, especially amongst youth, by means of various public educational activities. To this end, we will today allocate NIS 27 million for their immediate start. . . . . .

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Alcohol price controls suggested by World Health Organisation

Minimum price controls should be imposed on alcohol and tougher drink-driving laws introduced, policy options circulated by the World Health Organisation (WHO) suggest.

Details in the global consultation process have emerged as the government is resisting demands from health professionals for alcohol to become more expensive.

The draft recommendations – so far not widely distributed – have been released in the run up to a formal decision by member states next year. . . . . .

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The Recovery Revolution: Will it include children, adolescents, and transition age youth?

Systems transformation efforts to shift addiction treatment from a model of acute stabilization to a model of sustained recovery management and to nest addiction treatment within a larger recovery-oriented system of care are underway at federal, state, and local levels, but these innovations to date have focused on the redesign of adult services.

This paper explores the potential and limitations of recovery as an organizing concept for services to children, adolescents, and transition age youth, and offers recommendations on how services for these populations can be integrated into recovery- and resiliency-focused, behavioral health care systems transformation efforts.

Read Full Text (PDF) ____________________________________________

Long-term strategies to reduce the stigma attached to addiction, treatment, and recovery within the City of Philadelphia

The purpose of this document is to:

1) review the historical and scientific research on the social/professional stigma related to addiction, with a particular focus on the stigma experienced by people in medication-assisted treatment and long-term medication-assisted recovery, and

2) outline strategies that could be used by the Philadelphia Department of Behavioral Health and Mental Retardation Services and its many community partners to reduce addiction/recovery-related stigma.

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Exploring productivity outcomes from a brief intervention for at-risk drinking in an employee assistance program.

Brief intervention (BI) research has traditionally examined alcohol and drug use outcomes; however it is unknown whether BIs can also impact on-the-job productivity.

This exploratory study examines changes in workplace productivity and related costs for clients receiving a BI for at-risk drinking in the employee assistance program (EAP).

Participants were 44 clients attending the EAP for behavioral health concerns, screened for at-risk drinking, assigned to BI + Usual Care (n = 25) or UC alone (n = 19), and who completed 3-month follow-up. Absenteeism, presenteeism, and productivity costs were derived as outcomes.

At follow-up, participants in the BI + UC group had improved productivity when at work (presenteeism) compared to the UC group. The estimated cost savings from improved productivity for the BI + UC group was $1200 per client over the UC group. Groups did not differ by absenteeism (missed days of work).

Preliminary evidence suggests the broad impact BIs may have. Implications for future BI research are discussed.

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Request Reprint E-Mail: karenc@rand.org
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News Release - Huge fall in alcohol consumption in first six months of 2009

UK alcohol consumption is falling at the fastest rate for more than 60 years according to new official figures released today by the British Beer & Pub Association (BBPA).

The amount we drink fell by over eight per cent to 3.81 litres per head in the first half of 2009 compared with 4.15 litres per head in the same period of 2008. The last time the nation’s alcohol consumption fell by more than this was during 1948 when it fell by 11 per cent over the course of the year. The numbers are from official HM Revenue & Customs data and have been compiled by the BBPA.

The amount we drink has now been on a strong downward trend for four and a half years, since a peak in 2004. On current trends, by the end of this year, the amount we drink could be down to the levels of ten years ago – 14 per cent down on 2004.

The numbers call into serious question alcohol policies designed to reduce drinking in the whole population, says the BBPA. Claims by some academics and medical lobby groups that a fall in total consumption would lead to significant social benefits, such as a fall in alcohol related hospital admissions, are not being borne out by the facts. . . . . . .

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Upcoming Event - The Social Cost of Alcohol: Passive drinking. 2 December 2009. Brussels

Place: European Parliament – Brussels (Room: tbc)

Date: Wednesday, 2 December 2009
Time: 12h30 – 14h30 (Lunch will be provided)

Drinking alcohol is a deeply ingrained part of the European society; each year, the average intake per adult is equivalent to 1,400 small beers (11 litres of pure alcohol).

The consequences of drinking go far beyond the individual drinker’s health and well-being. They include acts of drunken violence, vandalism, sexual assault, road accidents, harm to the unborn fetus, child abuse, and a huge health burden carried by both the National Health Systems and friends and family who care for those damaged by alcohol.

Each year in Europe, alcohol causes:

• Some 50% of all violent crime to the person
• Some 40% of all domestic violence
• 2,000 homicides (4 in 10 of all murders)
• 10,000 deaths in drink-driving accidents for people other than the drink-driver
• 5 million people born with mental disorders and birth defects because of their mothers’ drinking
• 16% of all child abuse / neglect
• 5-9 million children living in families adversely affected by alcohol

DRAFT PROGRAMME
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Video - NIH Scientific Management Review Board Meeting

The Scientific Management Review Board was authorized by the NIH Reform Act of 2006 and signed into law by the President in January 2007. The NIH Reform Act provides certain organizational authorities to HHS and NIH officials regarding NIH institutes and centers and the Office of the Director. The purpose of the Scientific Management Review Board is to advise HHS and NIH officials on the use of those organizational authorities.

This Working Group of the SMRB is convened to recommend to the full Board whether organizational change within NIH could further optimize research into substance use, abuse, and addiction and maximize human health and/or patient well being. In addressing this issue, the SUAA Working Group will consider the scientific opportunities, public health needs, and research technologies in substance use, abuse, and addiction, in addition to research in these areas under the existing NIH structure.

November 13, 2009, 8:30:00 AM

Runtime:

322 minutes

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Drugs: Guidance for Schools

Drugs: Guidance for Schools provides guidance on all matters relating to drug education, the management of drugs within the school community, supporting the needs of pupils with regard to drugs and drug policy development. The document defines drugs as including alcohol, tobacco and illegal drugs, as well as medicines and volatile substances.

Read the consultation document on-line
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Fighting the ravages of alcoholism

Overconsumption of alcoholic beverages among Vietnamese, especially young ones, is posing a threat to society and the national economy. As much as 4.4 percent of the population is faced with health problems caused by drinking, according to statistics released by the Institute for Medical Policy Strategies. . .. . . .

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Government launches anti-alcohol campaign

The government approved Sunday the national program for the reduction of alcohol consumption at the cost of NIS 27 million (about $7.15 million) over a period of three years. Some NIS 8 million ($2.12 million) will be immediately invested in a public relations campaign to target both teens and adults.

As part of the program's first stage the government is planning to legislate laws for the reduction of alcohol consumption. The second stage will include creating alcohol rehabilitation centers for youths.

In addition, the State is also slated to track teens drinking alcohol in the streets. The second stage will also include the creation of an inter-ministerial committee which will draft recommendations to be submitted to the government within 45 days. . . . . .

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Alcohol is killing Israel

Alcohol consumption in Israel has been on the rise for two decades now. The especially worrisome trend is the fact that the age of people who consume alcohol is gradually declining – 75% percent of boys and 25% of girls in elementary school drink over the weekend at home, or during the week while celebrating outside the house. . . . . .

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Acute ethanol exposure elevates muscarinic tone in the septohippocampal system

The septohippocampal system has been implicated in the cognitive deficits associated with ethanol consumption, but the cellular basis of ethanol action awaits full elucidation. In the MS/DB, a muscarinic tone, reflective of firing activity of resident cholinergic neurons, regulates that of their non-cholinergic, putatively GABAergic, counterparts.

Here we tested the hypothesis that ethanol alters this muscarinic tone.

The spontaneous firing activity of cholinergic and non-cholinergic MS/DB neurons were monitored in acute MS/DB slices from C57Bl/6 mice.

Exposing the entire slice to ethanol increased firing in both cholinergic and non-cholinergic neurons. However, applying ethanol focally to individual MS/DB neurons increased firing only in cholinergic neurons. The differential outcome suggested different mechanisms of ethanol action on cholinergic and non-cholinergic neurons. Indeed, with bath-perfused ethanol, the muscarinic antagonist methyl scopolamine prevented the increase in firing in non-cholinergic, but not cholinergic, MS/DB neurons.

Thus, the effect on non-cholinergic neuronal firing was secondary to ethanol's direct action of acutely increasing muscarinic tone.

We propose that the acute ethanol-induced elevation of muscarinic tone in the MS/DB contributes to the altered net flow of neuronal activity in the septohippocampal system that underlies compromised cognitive function.

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Request Reprint E-Mail: hermes.yeh@dartmouth.edu

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Virtual Reality Cues for Binge Drinking in College Students

We investigated the ability of virtual reality (VR) cue exposure to trigger a desire for alcohol among binge-drinking students.

Fifteen binge-drinking college students and eight students who were nonbingers were immersed into a neutral-cue environment or room (underwater scenes), followed by four alcohol-cue rooms (bar, party, kitchen, argument), followed by a repeat of the neutral room. The virtual rooms were computer generated via head-mounted visual displays with associated auditory and olfactory stimuli. In each room, participants reported their subjective cravings for alcohol, the amount of attention given to the sight and smell of alcohol, and how much they were thinking of drinking. A 2×6 (type of drinker by VR room) repeated measures ANOVA was conducted on the responses to each question.

After alcohol exposure, binge drinkers reported significantly higher cravings for and thoughts of alcohol than nonbinge drinkers, whereas differences between the groups following the neutral rooms were not significant.

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Request Reprint E-Mail: ryan@ucmo.edu
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Changes in Alcohol-Related Mortality and its Socioeconomic Differences After a Large Reduction in Alcohol Prices: A Natural Experiment Based on Regist

The authors examined the effect of a large reduction in the price of alcohol in Finland in 2004 on alcohol-related mortality by age and socioeconomic group.

Alcohol-related mortality increased by 16% among men and by 31% among women; 82% of the increase was due to chronic causes, particularly liver diseases. The increase in absolute terms was largest among men aged 55–59 years and women aged 50–54 years. Among persons aged 30–59 years, it was biggest among the unemployed or early-age pensioners and those with low education, social class, or income. The relative differences in change between the education and social class subgroups were small. The employed and persons aged <35 years did not suffer from increased alcohol-related mortality during the 2 years after the change.

These results imply that a large reduction in the price of alcohol led to substantial increases in alcohol-related mortality, particularly among the less privileged, and in chronic diseases associated with heavy drinking.

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'Make minimum alcohol price 45p per unit'

A GOVERNMENT adviser has called for the minimum price for alcohol to be set at 45p per unit to cover the social, policing and health costs of binge drinking in Scotland.

Professor Anne Ludbrook, the head of Aberdeen University’s health and economics research unit, said the charge was the minimum required to cover the £2.25 billion annual cost of problem drinking. . . . . . .

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Services that manage the care needs of drunk and incapable people: a review of the literature

The Scottish Government have released a review of the literture on 'Services that Manage the Care Needs of Drunk and Incapable People'. From the summary page:

'The main focus of this report is on "sobering-up services" - services which provide an overnight place of safety for people who are identified as intoxicated (either with alcohol or drugs) in a public place, and who are incapable of looking after themselves because of their intoxication. . . . . . .

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New report says Indiana binge drinking rate up

Indiana college students are binge drinking at a rate higher the national average, according to a new report.

A report released Friday by the Indiana Collegiate Action Network found that 48 percent of Hoosier students surveyed reported binge drinking in a two-week period, compared to 40 percent nationally. . . . . . .

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Indiana College Substance Use Survey

Key Findings

Eight in ten Indiana college students reported drinking alcohol in the past year, including three‐fourths of the students under 21 years of age. . . . . .

Three‐fourths (74.6%) of the Indiana students reported using alcohol in the past month, compared to 69% nationally (Johnston et al., 2009). . . . . .

In Indiana, almost half of the students surveyed reported binge drinking in the past two weeks, with male students reporting statistically higher rates than female students. . . . . .

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24-hour drinking 'leaves police dangerously stretched,' warns assistant chief constable

The introduction of 24-hour drinking has backfired as alcohol-fuelled disorder in cities now persists throughout the night leaving police dangerously stretched, an assistant chief constable has warned.

Garry Shewan, of Greater Manchester Police (GMP), called for the legislation to be reversed.

He also warned of the "real risks" associated with recession-busting all-you-can drink "Carnage" nights and cheap alcohol in supermarkets that people buy to get drunk before going out. . . . . . . .

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Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agenc

An evaluation of a two-year project that aimed to move the practice of two specialist substance misuse treatment teams towards greater involvement of family members.

The conclusion is drawn that the project was successful in changing team practice in the desired direction: by the end of the project both teams were capable of acting as demonstration sites for family-oriented alcohol and drug problems treatment.

The paper includes details of the family work conducted and its perceived benefits. Also discussed are the initial barriers to family involvement, a number of issues that remained unresolved, and the question of whether such changes are sustainable.

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Request Reprint E-Mail: j.f.orford@bham.ac.uk
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Fancy a pint?: Alcohol use and smoking in soap operas

This study examined the frequency and portrayal of alcohol use and smoking in soap operas aired on British nonsatellite television.

Fifty-four hours of programing were analyzed, monitoring the type of alcohol act, who was carrying it out, and why, where, and what consequences of the acts were depicted.

Results supported previous findings that illustrate the prominent use of alcohol in popular soaps. More than 90% of the episodes viewed included some alcohol-related acts, with an average of 7.65 acts per episode, most of which were shown without any consequences. Female characters were drinking alcohol more often than expected and were also more likely to drink at home as a short-term means of coping. Alternatively, male characters were more often depicted as social drinkers, with more drinking inside pubs than expected.

The frequency of smoking was also investigated. This was rarely shown in the episodes viewed, with 82.41% of the episodes containing no smoking acts. Eastenders accounted for 78.57% of all smoking acts but even this soap only had, on average, 32 s per episode of smoking in the foreground.

Implications of the findings are discussed with regards to the possible influence on the socialization of younger viewers.

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Request Reprint E-Mail: smcoyne@byu.edu

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The latent structure of alcohol dependence in female federal prisoners

Results obtained from a structured interview of substance abuse diagnoses were subjected to taxometric analysis in a group of 459 low and minimum security female federal prisoners applying for admission to a comprehensive drug treatment program.

Drawing indicators from a DSM-IV diagnosis of alcohol dependence (tolerance/withdrawal, loss of control, negative social/psychological consequences) the authors conducted a taxometric analysis using the following procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIG), and latent mode factor analysis (L-Mode).

Results were generally consistent with taxonic (categorical) latent structure for a DSM-IV diagnosis of alcohol dependence.

The implications and limitations of this study are examined and recommendations for future research are offered.

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Request Reprint E-Mail: gwalters@bop.gov



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Who receives confrontation in recovery houses and when is it experienced as supportive?

The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that measures a construct of confrontation defined as warnings about potential harm associated with alcohol and drug use.

This analysis describes the characteristics of individuals entering residential recovery homes (N = 323) who received confrontation and when it was experienced as supportive.

A large proportion reported receiving at least one confrontational statement (80%), most commonly from family/friends (71%). Individuals who did and did not receive confrontation did not differ by demographics, but those receiving confrontation had more recent substance use, higher perceived costs of sobriety and more severe family and psychiatric problems. Differences were noted in confrontation from the criminal justice system versus family/friends.

Overall, residents experienced confrontation as supportive regardless of who confronted them. Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.

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Request Reprint E-Mail: dpolcin@arg.org
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Denial in alcohol and other drug use disorders: A critique of theory

Despite the centrality of the construct in the field of alcohol and other drug (AOD) addiction, denial remains poorly conceptualized. One reason for this narrow conceptualization is the recent unilateral devotion to the Transtheoretical Model (TTM).

In an effort to demonstrate denial's theoretical complexity, the TTM and five additional intuitively appealing theories of denial will be summarized. The strengths and weaknesses of each theory and possible treatment implications based on each theory will also be presented.

The article concludes with a recommendation for future research to evaluate multiple theories of denial using consistent and rigorous research methodology in order to develop a comprehensive theory of denial. This will promote evolution of the deductive research process, and eventually lead to the development of empirically generated interventions which address the complex nature and etiology of denial.

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Request Reprint E-Mail: P.STODDARDDARE@csuohio.edu

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Industry Drug and Alcohol Testing Program

The Omnibus Transportation Employee Testing Act of 1991 requires drug and alcohol testing of safety-sensitive transportation employees in aviation.

The Drug Abatement Division develops and implements regulations for DOT/FAA drug and alcohol testing. These regulations cover employers, safety-sensitive employees and service agents. These rules are encompassed in 49 Code of Federal Regulations (CFR) Part 40 and 14 CFR Part 120.

The division also oversees the aviation industry’s compliance with drug and alcohol testing regulations. This oversight is accomplished with on-site inspections, guidance documents, and policies.

A Message from the Secretary: Why this Program is so
Important (PDF)
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News Release - FDA To Look Into Safety of Caffeinated Alcoholic Beverages Agency Sends Letters to Nearly 30 Manufacturers

The Food and Drug Administration today notified nearly 30 manufacturers of caffeinated alcoholic beverages that it intends to look into the safety and legality of their products.

“The increasing popularity of consumption of caffeinated alcoholic beverages by college students and reports of potential health and safety issues necessitates that we look seriously at the scientific evidence as soon as possible,” said Dr. Joshua Sharfstein, principal deputy commissioner of food and drugs.

Of the combined use of caffeine and alcohol among U.S. college students in the few studies on this topic, the prevalence was as high as 26 percent.

Under the Federal Food, Drug, and Cosmetic Act, a substance added intentionally to food (such as caffeine in alcoholic beverages) is deemed “unsafe” and is unlawful unless its particular use has been approved by FDA regulation, the substance is subject to a prior sanction, or the substance is Generally Recognized As Safe (GRAS). FDA has not approved the use of caffeine in alcoholic beverages and thus such beverages can be lawfully marketed only if their use is subject to a prior sanction or is GRAS. For a substance to be GRAS, there must be evidence of its safety at the levels used and a basis to conclude that this evidence is generally known and accepted by qualified experts. . . . . .

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You can cut back on alcohol

Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol in a book by the same name. The failed businessman contended that, as an alcoholic, he had to "hit bottom" before changing his life and that sobriety could only be achieved through complete abstention.

For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.

They now say that many drinkers can evaluate their habits and -- using new knowledge about genetic and behavioral risks of addiction -- change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts education, ruins careers and damages health.

In short, say some of the nation's leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol -- and most never reach that point.

"We're on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation's leading authority on alcoholism and the major provider of funds for alcohol research. "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence." . . . . . .

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The Content of Substance Abuse and Mental Health Counseling Reported by Patients in a National Survey

This study examined counseling content reported by a national sample of persons receiving care for alcohol, drug or mental health (ADM) problems in a year.

The sample included 2,722 individuals over 18 who reported past year mental health or substance abuse care or assessments in a nationally representative survey conducted in 2000–2001.

Counseling domains approximating commonly practiced or evidence-based approaches for depression, anxiety, or substance abuse were assessed.

Patient self-report may be one useful way of tracking whether components of standard therapies are implemented in practice.

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Request Reprint E-Mail: cmlandry@ucla.edu
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Correlates of Past Homelessness in the National Epidemiological Survey on Alcohol and Related Conditions

This study sought to investigate correlates of past homelessness, especially mental illness and substance abuse, using data from the National epidemiological survey on alcohol and related conditions (NESARC), a large nationally representative survey conducted in 2001–2002.

Multivariate analyses showed that the factors most strongly related to past homelessness were diagnoses of behavioral health conditions which showed consistently stronger association than sociodemographic characteristics, measures of economic well being, or general health indicators.

The results presented here confirm in a nationally representative sample a number of single site studies that have also demonstrated the over representation of both mental illness and substance abuse disorders in homeless populations.

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Request Reprint E-Mail: greg.greenberg@yale.edu
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Establishment of a Low Birth Weight Registry and Initial Outcomes

The study was conducted to evaluate a regional, prospective database of information on mothers of low birth weight (LBW) infants.

The database informs on unidentified or under-reported modifiable risk factors from which evidence-based, targeted community intervention strategies could be designed to lower the rate of low birth weight in the region. The LBW Registry is based on informed consent, a semi-structured face-to-face (FTF) interview with the mother of the newborn LBW infant, medical record review, and birth certificate worksheet data collection.

High rates of modifiable risk factors among mothers of low birth weight infants (October 2007–October 2008) include smoking (44%), alcohol consumption (16%), and drug abuse (14%). Preconception vitamin use was low (34%). The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers (5.4 vs. 1.5%), as was alcohol use during pregnancy (16 vs. 1.3%).

More than half (52%) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy. Additionally there were higher than average rates of unmarried mothers (62%), unintended pregnancies (67%), and Medicaid beneficiaries (57%). Mothers repeatedly expressed excessive demands in their lives, straining their coping abilities and resources.

The LBW Registry provides expanded local data on potentially modifiable risk factors to aid in designing targeted prevention and intervention strategies.

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Request Reprint E-Mail: e.eisenhauer@att.net
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Empirically supported religious and spiritual therapies

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues.

Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality. Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort. Read Full Abstract Rerquest Reprint E-Mail: eworth@vcu.edu _____________________________________________

New Reports Highlight Important Gender Differences in Substance Use and Mental Health for Adolescents in Each State and the District of Columbia

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed 52 new short reports providing key information about the level of substance use and mental health problems and treatment among adolescents (age 12 to 17 years) in each state, the District of Columbia and for the country as a whole. The reports provide first-of-a-kind, state–by–state breakdowns by gender on substance abuse and mental health problems experienced by adolescents. In addition, the reports provide data on adolescent treatment facilities and admission factors for each state, the District of Columbia and for the country as a whole.

“These reports provide state and local authorities vital information about substance using behaviors and service needs of adolescents in their communities,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “The public health community can use these data to develop programs targeted to the specific needs of adolescent boys and girls.”

Entitled Adolescent Behavioral Health: States in Brief, the reports provide the following information for each individual state, the District of Columbia and the country as a whole through a variety of charts, graphs and accompanying text:

• Adolescents’ risk perceptions associated with substance use
• Prevalence of illicit substance and alcohol use
• Number and type of substance abuse treatment facilities
• Numbers and trends on those seeking treatment for substance abuse
• Levels of those needing, but not receiving substance abuse treatment
• Levels of underage smoking
• Mental health indicators

The data included in these States in Brief reports are drawn from three large national surveys sponsored by SAMHSA - the National Survey on Drug Use and Health, the Treatment Episode Data Set and the National Survey on Substance Abuse Treatment Services.

These reports are available on the web at http://samhsa.gov/statesinbrief/

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Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for al

The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined.

Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence , lifetime history of injection drug use , lifetime history of needle sharing. As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT and a downward shift in baseline CDT . When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT , and with decreases in CDT .

These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.

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Request Reperint E-Mail: plebani_j@mail.trc.upenn.edu

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Drinking motives, drinking restraint and drinking behaviour among young adults

Motives to drink alcohol are widely thought to be the proximal cognitive factors involved in the decision to consume alcohol beverages. However it has also been argued that the ability to restrain drinking may be a more proximal predictor of drinking behaviour.

The current study aimed to examine the relationships between drinking motives, drinking restraint and both alcohol consumption and alcohol-related problems in a sample of young adults. A sample of 221 young adults (aged 17–34 years) completed self-report measures assessing drinking behaviour, motives for drinking and drinking restraint.

Multiple regression analyses revealed that coping, enhancement and social motives were related to alcohol consumption and alcohol-related problems, while Cognitive and Emotional Preoccupation with drinking was related to all criterion variables. Further, the relationship between coping motives and drinking behaviour was mediated by preoccupation with drinking.

The results are discussed in light of the roles of drinking motives and drinking restraint in risky drinking among young people, and implications for prevention and early intervention are presented.

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Request Reprint E-Mail: mlyvers@bond.edu.au

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Alcohol cue reactivity task development

The physiological and cognitive reactions provoked by alcohol cues, as compared to non-alcohol cues, can predict future drinking. Alcohol cue reactivity tasks have been developed; however, most were created for use with alcohol use disordered individuals and utilize limited or only partially standardized stimuli.

This project systematically created an alcohol cue reactivity task for studies with non-drinkers, using well-characterized stimuli.

The long-term objectives of this project are to utilize this task with non-drinking youth to investigate how reactivity to alcohol stimuli may predict alcohol use initiation and escalation, to help identify the role of exposure to alcohol stimuli on the subsequent development of alcohol-related problems.

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Request Reprint E-Mail: cpulido@ucsd.edu

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A cognitive model for the intergenerational transference of alcohol use behavior

A family history of alcoholism has shown to be one of the greatest consistent risk factors in the intergenerational transference of alcohol problems. Whereas a large number of studies have attempted to identify the processes responsible for this interfamilial transfer, the mechanisms remain unclear.

Family, twin and adoption studies, and environmental theories have resulted in a number of unanswered questions regarding the extent that these factors influence the transmission of alcohol behavior. Recently, cognitive theories have suggested that the observation of parental drinking habits contributes to the child's beliefs and expectations of alcohol's effects.

A hypothesised cognitive model will be proposed suggesting that the mechanism for the transference of particular drinking styles from parent to offspring may be further explained by the transference of alcohol cognitions, in particular, alcohol expectancies and drinking refusal self-efficacy.

This review focuses on research of bio/psycho/social factors that perpetuate alcohol misuse across generations, and will delineate the proposed cognitive mechanisms for the interfamilial transference of alcohol problems and discuss the implications of the proposed model.

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Request Reprint E-Mail: oei@psy.uq.edu.au

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Deficits in amygdaloid cAMP-responsive element–binding protein signaling play a role in genetic predisposition to anxiety and alcoholism

We investigated the role of cAMP-responsive element–binding protein (CREB) in genetic predisposition to anxiety and alcohol-drinking behaviors using alcohol-preferring (P) and -nonpreferring (NP) rats.

The levels of CREB, phosphorylated CREB, and neuropeptide Y (NPY) were innately lower in the central amygdala (CeA) and medial amygdala (MeA), but not in the basolateral amygdala (BLA), of P rats compared with NP rats. P rats displayed higher baseline anxiety-like behaviors and consumed higher amounts of alcohol compared with NP rats.

Ethanol injection or voluntary intake reduced the higher anxiety levels in P rats. Ethanol also increased CREB function in the CeA and MeA, but not in the BLA, of P rats.

Infusion of the PKA activator Sp-cAMP or NPY into the CeA decreased the alcohol intake and anxiety-like behaviors of P rats. PKA activator infusion also increased CREB function in the CeA of P rats.

On the other hand, ethanol injection or voluntary intake did not produce any changes either in anxiety levels or on CREB function in the amygdaloid structures of NP rats. Interestingly, infusion of the PKA inhibitor Rp-cAMP into the CeA provoked anxiety-like behaviors and increased alcohol intake in NP rats. PKA inhibitor decreased CREB function in the CeA of NP rats.

These novel results provide the first evidence to our knowledge that decreased CREB function in the CeA may be operative in maintaining the high anxiety and excessive alcohol-drinking behaviors of P rats.

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Minimum pricing needed now, argues Lib Dem MP

Blaming pubs for the problems of “Binge Britain” is often wrong and minimum pricing is now the best way to tackle “pocket money” off-trade prices, according to a senior Liberal Democrat.

Don Foster, Lib Dem shadow culture secretary, slammed the supermarkets’ policy on alcohol and pledged his support for pubs, during the Business In Sport and Leisure conference today in London.

“There is no doubt that Booze Britain is causing real problems… but far too often the problems are laid at the door of hard pushed pub landlords and club owners,” he said. . . . . . .

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Alcohol use and related harms in school students in the USA and Australia

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA.

Sampling methods were matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002.

Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls).

Relative to Washington, the students in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use.

These findings reveal considerable variation in international rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study.

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Request Reperint E-Mail: john.toumbourou@deakin.edu.au

Cluster-randomized Controlled Trial of Dissemination Strategies of an Online Quality Improvement Programme for Alcohol-related Disorders

This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany.

Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034)

No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable.

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Request Reprint E-Mail: daniela.ruf@uniklinik-freiburg.de
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Planned and Unplanned Discharge from Alcohol Services in Scotland, 2004–2008

Available data suggests that the rate of unplanned discharge from alcohol treatment services is an international problem reflective, perhaps, of ambivalence surrounding treatment in general. Given Scotland's escalating prevalence of alcohol misuse, a preliminary study of Scottish dropout rates would make a useful contribution to the international scene.

Of 48,299 cases, 52.23% (n = 25,231) were unplanned discharges. Data showed a general increasing trend in the rate of planned discharges across the examined 4-year period, from 41.66% in 2004–2005 to 51.94% in 2007–2008. Inspection of the data revealed marked regional variations in ratios of planned to unplanned discharge, with only four of the 10 regions examined reporting a planned discharge rate >50%.

More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.

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Request Reprint E-Mail: rosemary.e.newham@strath.ac.uk
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