To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, January 26, 2008

Hypothalamic-pituitary-adrenal axis response to stress in male DUI recidivists.
Accid Anal Prev 2008 Jan; 40(1):246-53.

Cortisol is a stress hormone mediated by the hypothalamic-pituitary-adrenal (HPA) axis and a psychobiological marker of genetic risk for alcoholism and other high-risk behavioural characteristics.

In previous work with driving under the influence of alcohol (DUI) recidivists, we uncovered a significant inverse relationship between the frequency of past DUI convictions and salivary cortisol, whose strength surpassed those observed between DUI frequency and measures of alcohol abuse and other DUI-related characteristics. This finding emerged using a methodology not specifically contrived to test this relationship.

The goals of this follow-up study were to (a) examine if a standardized stress-induction protocol would produce a significant inverse relationship between cortisol response and number of DUI offences; and (b) clarify whether HPA axis dysregulation could be linked to particular DUI-related behavioural correlates, such as alcohol use severity, sensation seeking, and antisocial features.

Results indicated an inverse relationship between DUI frequency and cortisol response , as well as a lower cortisol response in DUI offenders than the comparison group. Finally, for recidivists, hierarchical regression analyses indicated that experience seeking , followed by number of cigarettes smoked daily , combined to explain 35% of the variance in cortisol.

These findings indicate that severe recidivism may have psychobiological underpinnings, and that HPA axis dysregulation appears to be a mechanism common to high-risk behaviours including DUI recidivism, sensation seeking, and cigarette smoking.

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A multi-level two-part random effects model, with application to an alcohol-dependence study
Statistics in Medicine, Early View 25 Jan 2008

Two-part random effects models have been applied to longitudinal studies for semi-continuous outcomes, characterized by a large portion of zero values and continuous non-zero (positive) values.

Examples include repeated measures of daily drinking records, monthly medical costs, and annual claims of car insurance. However, the question of how to apply such models to multi-level data settings remains.

In this paper, we propose a novel multi-level two-part random effects model. Distinct random effects are used to characterize heterogeneity at different levels. Maximum likelihood estimation and inference are carried out through Gaussian quadrature technique, which can be implemented conveniently in freely available software - aML.

The model is applied to the analysis of repeated measures of the daily drinking record in a randomized controlled trial of topiramate for alcohol-dependence treatment.

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WHO to recommend ways to reduce harm of alcohol

Fri Jan 25, 2008
By Laura MacInnis

GENEVA (Reuters) - World Health Organization (WHO) experts will recommend ways to fight dangers linked to alcohol, including heart and liver disease, road accidents, suicides and sexually-transmitted infections, a spokeswoman said on Friday.

The United Nations agency's executive board this week endorsed efforts to raise awareness about the risks of injury, violence and illness from the harmful use of alcohol, especially by young people and pregnant women, Fadela Chaib said.

The 34-member board agreed the WHO should draft a global strategy to reduce those threats. It may include guidance on the marketing, pricing and distribution of alcoholic drinks, as well as health worker training and public awareness campaigns.
. . . . . .

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Binge drinking in 20s takes its toll in later life

By Rebecca Smith, Medical Editor

Binge drinking by young adults is taking its toll years later, with twice as many middle-aged men and women dying from drink compared to 15 years ago, new figures show.

For the second year in a row the biggest rise in alcohol-related deaths was among men aged 35 to 54, closely followed by women in the same age group. Experts say this is largely due to damage done by heavy drinking during people's twenties and thirties.

In 2006, 2,539 men and 1,238 women in that age group died from alcohol-related causes, compared to 1,257 and 598 in 1994. The new figures come after warnings about alcohol consumption as stronger wine and larger measures mean people are drinking a third more alcohol than previously thought.
. . . . . . .

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Uses of Coercion in Addiction Treatment: Clinical Aspects
American Journal on Addictions, Volume 17, Issue 1 January 2008 , pages 36 - 47

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality.

An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports.

In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine.

The philosophical, historical, and societal aspects of coerced treatment are considered.

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Liquor prices could reflect alcohol content

By Michael Kane, Vancouver Sun
Published: Wednesday, January 23, 2008

VANCOUVER - Booze prices in British Columbia could soon reflect alcohol content - and potential for social harm - if proposals for the coming provincial budget are adopted.

The idea, proposed by the University of Victoria's Centre for Addictions Research, is to promote healthier choices by charging more for drinks that pack a heavier punch and less for weaker and mid-strength drinks.
. . . . . .

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Magnesium treatment in alcoholics: a randomized clinical trial
Substance Abuse Treatment, Prevention, and Policy
2008, 3:1

Magnesium (Mg) deficiency is common among alcoholics. Earlier research suggests that Mg treatment may help to normalize elevated enzyme activities and some other clinically relevant parameters among alcoholics but the evidence is weak.

The effect of Mg was studied in a randomized, parallel group, double blind trial. The patients were first treated for alcohol withdrawal symptoms and then received for 8 weeks either 500 mg of Mg divided into two tablets or matching placebo. Measurements were made at the beginning and in the end of the Mg treatment period. The primary outcome was serum gamma-glutamyltransferase (S-GGT) activity; secondary outcomes included aspartate-aminotransferase (S-AST) and alanine-aminotransferase (S-ALT) activity.

The number of randomized patients (completers) was 64 (27) in the treatment and 54 (31) in the control group. In intention-to-treat-analyses and in most analyses of study completers, there were no significant differences between the Mg-treated and placebo groups in the outcome variables.

When baseline serum Mg level, coffee intake, and the number of unused Mg tablets were controlled for in a multivariate regression model, after-treatment serum Mg levels were found to be higher among the Mg-treated group than in the placebo group .

After controlling for age, body weight, baseline alcohol intake, subsequent change in alcohol intake and baseline S-AST, the after-treatment S-AST levels were found to be lower among the Mg-treated group than in the placebo group .

Mg treatment may speed up the S-AST decrease in compliant patients. This might decrease the risk of death from alcoholic liver disease.

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Editorial - Why is it so difficult to legislate on alcohol in Spain?
Adicciones 2007; 19(4):325-31.

Wine belongs to the Mediterranean culture. Drinking alcohol is part of our social life, and its negative consequences have often been minimised, blame being apportioned rather to the individual, who doesn't know how to drink, than to the agent causing the harm.

In recent years, road accidents and binge-drinking among young people have put alcohol on the political agenda. Adolescents and young adults have increased their consumption, and a pattern of binge-drinking has developed based on the open-air 'fiesta' nightlife, where groups of young people drink large bottles in the streets and squares (botellón).

Educational campaigns and material have been mounted and produced, but two consecutive draft laws on measures for the prevention of alcohol-related harm have failed to be approved, coming up on both occasions against the same vested interests.

This editorial reviews the ambivalence of society towards regulations on alcohol and the current state of the art. The first draft law (2002) was about preventing alcohol problems in the general population; the second (2006) was limited to the question of prevention among minors. Nobody could oppose it, not even the industry. However, an interested bias put the accent on wine--which allegedly should be considered not as alcohol but rather as food, and consequently removed from the law--so that discussion of the draft law became a 'wine war', with predictable consequences.

Once again, a draft law on alcohol was shelved sine die and tossed into a corner to gather dust. WithIn this pessimistic scene, though, there are still some positive signs. No economic or political motives should constitute an obstacle to the protection of minors, at the very least.

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News release - WHO Executive Board opens on optimistic note


The Executive Board of the World Health Organization (WHO) began its twice-yearly session today on an optimistic note with a report highlighting progress in many areas of public health from the Director-General, Dr Margaret Chan.

. . . . . .

Other issues on the Board's agenda include: strategies to reduce the harmful use of alcohol; the international migration of health personnel; female genital mutilation, pandemic influenza preparedness, the implementation of the International Health Regulations and the health needs of people who migrate to new countries.

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Drinking expectancies and motives: a genetic study of young adult women
Addiction 103 (2), 194–204.

Constructs such as drinking expectancies (beliefs regarding the effects of alcohol) and motives (drinking alcohol to achieve a valued end) have been shown to be associated with various stages of alcohol use behaviors. However, little is known of the extent to which genetic and environmental influences contribute to individual differences in expectancies and motives.

Expectancies predicted initiation of alcohol use. Both motives and expectancies were associated with frequency and quantity of alcohol consumption and drinks-to-intoxication. There was no evidence for heritable influences on expectancies and enhancement motives, with familial similarity for these traits being due to shared environment. Heritable influences on social, coping and conformity motives ranged from 11% to 33%. When expectancies were stratified by alcohol use, significant heritable influences (31–39%) were found for cognitive–behavioral impairment and risk-taking/negative self-perception (RT/NSP) in abstainers only, while environmental influences contributed to familial variance for other measures of expectancies in alcohol users.

Environmental influences (both familial and individual-specific) shape alcohol expectancies, while heritable influences may predispose to motives for drinking. Individual differences in expectancies are moderated by alcohol use, suggesting that sources of individual differences in expectancies may vary in drinkers versus abstainers.

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Alcohol and drug use following traumatic brain injury: A prospective study
Brain Injury, Volume 21, Issue 13 & 14 December 2007 , pages 1385 - 1392

To establish pre-morbid alcohol and drug use in persons with TBI, relative to controls, investigate how patterns of substance use change over time following TBI and identify factors associated with heavy post-injury substance use.

Participants with TBI showed similar levels of drug and alcohol use to controls pre-injury, with 31.4% of the TBI group and 29.3% of controls drinking at hazardous levels. Alcohol and drug use declined in the first year post-injury, but increased by 2 years post-injury, with only 21.4% of participants with TBI reporting abstinence from alcohol and 25.4% drinking at hazardous levels. Only 9% showed a drug problem, but 24% had returned to some drug use.

Those showing heavy alcohol use post-injury were young, male and heavy drinkers pre-injury. Drug and alcohol use was similar at 3 years post-injury.

More active intervention is needed to reduce alcohol and drug use following TBI.

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Go out or stay in? The effects of zero tolerance laws on alcohol use and drinking and driving patterns among college students
HealthEconomics, Early View, 25 January 2008

Zero tolerance laws make it illegal per se for anyone under age 21 to drive with any measurable amount of blood alcohol. Although a link has been established between zero tolerance laws and lower motor vehicle fatalities, research has not produced strong evidence on how zero tolerance laws influence individual alcohol use and drinking and driving behaviors.

Using a unique data set and a difference-in-difference-in-difference-type research design, we are able to analyze a number of pathways through which zero tolerance laws can work among an important underage population, college students.

We find that zero tolerance laws reduce drinking and driving among college students. Further analysis of our detailed alcohol use measures suggests that zero tolerance laws are particularly effective at reducing the probability of driving after drinking for those who reported drinking away from home.

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Association of Lifetime Alcohol Drinking Trajectories with Cardiometabolic Risk
The Journal of Clinical Endocrinology & Metabolism Vol. 93, No. 1 154-161

Alcohol intakes may vary considerably over a drinker’s lifetime. This study was designed to examine whether lifetime drinking trajectories are associated with cardiovascular risk factors that are used to define the metabolic syndrome (MetS).

Trajectory analyses were based on estimates of total kilograms of ethanol for each age decade between 10 and 59 yr. Two groups of drinkers with distinct lifetime drinking trajectories were obtained, an early peak and a stable trajectory group. Compared with stable trajectory drinkers, early-peak drinkers were 10 yr younger on average, had earlier onset of regular drinking, drank heavily in late adolescence and early adulthood tapering off in middle age, averaged more drinks per drinking day in lifetime, and were more likely to abstain when interviewed.

After controlling for age, sex, and other potential confounders, early-peak trajectories were modestly associated with high odds of the MetS overall, low high-density lipoprotein cholesterol, abdominal obesity , and overweight.

Early initiation of alcohol drinking and heavy drinking in adolescence and early adulthood may be associated with an adverse cardiometabolic profile.

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Friday, January 25, 2008

Do Alcoholics Anonymous Groups Really Work? Factors of Adherence in a Brazilian Sample of Hospitalized Alcohol Dependents
American Journal on Addictions, Volume 17, Issue 1 January 2008 , pages 48 - 53

This study was designed to determine factors affecting adherence to Alcoholics Anonymous (AA) groups.

AA adherence was below 20%. The main factors reported by patients as reasons for non-adherence to AA were relapse, lack of identification with the method, lack of need, and lack of credibility. The factors reported by patients as reasons for adherence were identification with the method and a way to avoid relapse.

Although AA is considered an effective intervention for alcoholism, its adherence rate was excessively low. The identification of these nonadherence factors could help health professionals in referring certain alcoholic patients to therapeutic interventions other than AA.

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Alcohol Deaths
Rates in the UK continue to rise

Sources: Office for National Statistics, General Register Office for Scotland, Northern Ireland Statistics and Research Agency.

Published on 25 January 2008

Alcohol-related death rates by sex, United Kingdom, 1991-2006
Alcohol-related death rates by sex, United Kingdom, 1991-2006

The alcohol­-related death rate in the UK continued to increase in 2006, rising from 12.9 deaths per 100,000 population in 2005 to 13.4 in 2006. Rates almost doubled from 6.9 per 100,000 in 1991. The number of alcohol-related deaths more than doubled from 4,144 in 1991 to 8,758 in 2006.

In 2006 the male death rate (18.3 deaths per 100,000 population) was more than twice the rate for females (8.8 deaths per 100,000) and males accounted for two thirds of the total number of deaths.

For men, the death rates in all age groups increased between 1991 and 2006. The biggest increase was for men aged 35-54. Rates in this age group more than doubled, from 13.4 to 31.1 deaths per 100,000 over the period. However the highest rates in each year were for men aged 55-74.

Male alcohol-related death rates by age group, United Kingdom, 1991-2006

Male alcohol-related death rates by age group, United Kingdom, 1991-2006

Death rates by age group for females were consistently lower than rates for males, however trends showed a broadly similar pattern by age. The death rate for women aged 35­-54 doubled between 1991 and 2006, from 7.2 to 14.8 per 100,000 population, a larger increase than the rate for women in any other age group. As for men, the highest rates in each year were for the 55-74 age group.

Between 2005 and 2006, for both sexes, rates remained the same for those aged 15-34 and increased for those aged 35-54 and 55-74. There were small falls in the rates for those aged over 75, down 8 per cent for men and 6 per cent for women.

Alcoholic Beverages and Incidence of Dementia: 34-Year Follow-up of the Prospective Population Study of Women in Göteborg
American Journal of Epidemiology Advance Access published online on January 24, 2008

The objective of this study was to assess the association between different types of alcoholic beverages and 34-year incidence of dementia.

Wine was protective for dementia (hazard ratio (HR) = 0.6, 95% confidence interval (CI): 0.4, 0.8) in the updated model, and the association was strongest among women who consumed wine only (HR = 0.3, 95% CI: 0.1, 0.8). After stratification by smoking, the protective association of wine was stronger among smokers.

In contrast, consumption of spirits at baseline was associated with slightly increased risk of dementia (HR = 1.5, 95% CI: 1.0, 2.2). Results show that wine and spirits displayed opposing associations with dementia.

Because a protective effect was not seen for the other beverages, at least part of the association for wine may be explained by components other than ethanol.

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Liquor advice too severe: industry

Jill Stark
January 22, 2008

MAJOR alcohol industry players have condemned new drinking guidelines as scientifically flawed, confusing and destined to fail.

The draft guidelines — warning adults to have no more than two drinks a day and pregnant women not to drink at all — are too extreme and lack credibility, the consortium of liquor sellers and manufacturers has claimed.

They warn the changes to the existing recommendations will not prevent harmful drinking as many Australians will find the advice "culturally irrelevant" and ignore them.

There is also anger that physiological differences such as age, gender and weight, were not considered. Health benefits of moderate alcohol consumption were also overlooked.

. . . . . .

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Thursday, January 24, 2008

Effects of Topiramate on Urge to Drink and the Subjective Effects of Alcohol: A Preliminary Laboratory Study
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 22 Jan 2008

Topiramate was recently reported to be efficacious in reducing drinking rates and craving among individuals with alcohol dependence in a randomized controlled trial, but dose effects could not be determined.

This laboratory study systematically examined the dose-dependent effects of topiramate on cue-elicited craving and other putative mechanisms of its pharmacotherapeutic effects on drinking.

The results of this study support previous findings that topiramate reduces drinking, but the behavioral mechanism underlying this effect does not appear to be attenuation of craving for alcohol as measured using the approaches employed in this study. Rather, the results tentatively suggest that topiramate may exert its beneficial effects by altering the subjective experiences of alcohol consumption.

Limitations of the current study are discussed and complementary methods are recommended for future studies, such as the use of behavioral economic paradigms and ecological momentary assessment.

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In Vivo Time-Course Changes in Ethanol Levels Sampled With Subcutaneous Microdialysis
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 22 Jan 2008

The objective of this study was to determine time-course changes in in vivo ethanol (EtOH) concentrations using a novel subcutaneous (s.c.) microdialysis sampling technique. The hypothesis to be tested was that EtOH concentrations in the s.c. fluid would reflect blood EtOH concentrations. If this is the case, then s.c. microdialysis could allow a more detailed analysis of changes in in vivo levels of EtOH under different drinking paradigms.

In vivo probe recovery (extraction fraction) obtained using the alcohol clamp method was 69 ± 3%, and was comparable to the in vitro recovery of 73 ± 2%. For the EtOH dose–response experiment, rats injected i.p. with 0.5, 1.0, or 2.0 g/kg EtOH showed a clear dose–response effect in the s.c. dialysate samples. Peak concentrations (70, 123, and 203 mg%, respectively) were reached by 15 minutes after injection. In an experiment comparing levels of EtOH in s.c. dialysis and arterial blood samples in rats administered 1.0 g/kg EtOH, similar time-course changes in in vivo EtOH concentrations were observed with both i.g. and i.p. EtOH administration. In P rats drinking 15% EtOH during a 1-hour scheduled access period, EtOH levels in s.c. microdialysates rose rapidly over the session and peaked at approximately 50 mg% at 60 to 80 minutes.

Overall, these experiments indicate that s.c. EtOH and blood EtOH concentrations follow a similar time course. Moreover, s.c. microdialysis can be useful as an experimental approach for determining detailed time-course changes in in vivo EtOH concentrations associated with alcohol drinking episodes.

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Prospective Study of Alcohol Consumption in the United States: Quantity, Frequency, and Cause-Specific Mortality
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 22 Jan 2008

Alcohol average volume (quantity multiplied by frequency) has been associated with mortality in drinkers. However, average volume may mask associations due to quantity or frequency alone.

We prospectively assessed relationships between alcohol quantity and frequency, and mortality from all-causes, cardiovascular disease, cancer, and other-causes in a cohort created by linking the 1988 National Health Interview Survey (response rate 87%) to the National Death Index through 2002. Participants were 20,765 current drinkers age ≥ 18 years. At 14-year follow-up 2,547 had died.

For quantity, among men who consumed ≥5 drinks (compared to 1 drink) on drinking days, adjusted relative risks (RR) of mortality were: for cardiovascular disease, 1.30 , for cancer, 1.53 , and for other-causes, 1.42; among women for other-causes, 2.88.

For frequency, among men in the highest frequency quartile (compared to the lowest), RR were: for cardiovascular disease, 0.79 , for cancer, 1.23 , and for other-causes, 1.30 among women, for cancer, 1.65.

Average volume obscured effects of quantity alone and frequency alone, particularly for cardiovascular disease in men where quantity and frequency trended in opposite directions.

Alcohol quantity and frequency were independently associated with cause-specific mortality. Accumulating evidence of their differential effects may, in the future, be useful for clinical and public health recommendations.

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Action on Alcohol & Drugs in Edinburgh
Annual Report 2006/2007

Action on Alcohol and Drugs in Edinburgh is a strategic partnership of Edinburgh’s key bodies working together to ensure the best, most effective responses to alcohol and drug issues in the city.

Alcohol is our number one problem substance.The statistics paint a stark picture of a growing number of men and women, drinking excessively, creating problems for themselves both now and in the future. The numbers of chronic alcohol-related illnesses and deaths are rising.

. . . . .

Foreword 02

Introduction 03

Tackling Edinburgh’s alcohol problems 05

Action Team Partners 04

Licensing in Edinburgh 06

Edinburgh Licensing Standards Initiative 06

Future of licensing 07

Alcohol treatment and rehabilitation 07

Young people, alcohol and drugs 08

Working with families where there is 09
parental drug and alcohol use

Engaging with pregnant alcohol and 10
drug users

Disengaged and vulnerable groups 11

Improving the delivery of treatment 12
and support services

Drugs: looking after communities 14

Discarded needles and drugs paraphernalia 14

Other important areas of work 15

Priorities for 2007/08 16

Financial Spend 16

Contact details and postholders 17

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Association of Drinking Pattern and Alcohol Beverage Type With the Prevalence of Metabolic Syndrome, Diabetes, Coronary Heart Disease, Stroke, and Peripheral Arterial Disease in a Mediterranean Cohort
Angiology, Vol. 58, No. 6, 689-697 (2008)

The purpose of this study was to investigate the relationship between alcohol consumption and the prevalence of the metabolic syndrome (MetS), type 2 diabetes mellitus (DM), coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and overall cardiovascular disease (CVD) in a Mediterranean cohort.

Moderate alcohol consumption is associated with a lower prevalence of the MetS, DM, PAD, CHD, and overall CVD but not stroke compared with no alcohol use in a Mediterranean population. Heavy drinking was associated with an increase in the prevalence of all of these disease states.

Advice on alcohol consumption should probably mainly aim at reducing heavy drinking.

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The effect of acamprosate on alcohol and food craving in patients with alcohol dependence
Drug and Alcohol Dependence, Volume 93, Issue 3, 1 March 2008, Pages 279-283

The balance between inhibitory (gamma aminobutyric acid; GABAergic) and excitatory (glutamatergic) neurotransmission is thought to be associated with craving for alcohol and food. The anticraving effect of acamprosate is thought to be mediated through modifying the balance of GABA and glutamate. Recent studies in animals have suggested that acamprosate may have non-selective effects on craving for both alcohol and food.

The influence of acamprosate for reducing craving for alcohol and food was assessed in 204 in-patients with alcohol dependence (96 patients treated with acamprosate, PWA; 108 patients were not treated PNA) was assessed at baseline and following 1, 2, and 4 weeks of treatment.

There was a significant reduction in craving for alcohol over 4 weeks of treatment in both PWA and PNA groups, but without significant group differences. In contrast, a reduction in food craving was observed only in the PWA group. In addition, there was a significant increase of body mass index (BMI) in the PNA group but not the PWA group over the 4-week period.

These results demonstrate acamprosate nonselective effects on craving for drinking and eating in alcoholic patients.

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Evaluation of a telephone-based stepped care intervention for alcohol-related disorders: A randomized controlled trial
Drug and Alcohol Dependence, Volume 93, Issue 3, 1 March 2008, Pages 244-251

Brief interventions for problem drinking in medical settings are effective but rarely conducted, mainly due to insufficient time. A stepped care approach (starting with a very brief intervention and intensifying efforts in case of no success) could save resources and enlarge effectiveness; however, research is lacking.

The present study compares a full care brief intervention for patients with at-risk drinking, alcohol abuse or dependence with a stepped care approach in a randomized controlled trial.

Participants were proactively recruited from general practices in two northern German cities. In total, 10,803 screenings were conducted (refusal rate: 5%). Alcohol use disorders according to DSM-IV were assessed with the Munich-Composite International Diagnostic Interview (M-CIDI). Eligible participants were randomly assigned to one of three conditions: (1) stepped care (SC): a computerized intervention plus up to three 40-min telephone-based interventions depending on the success of the previous intervention; (2) full-care (FC): a computerized intervention plus a fixed number of four 30-min telephone-based interventions that equals the maximum of the stepped care intervention; (3) an untreated control group (CG). Counseling effort in the intervention conditions and quantity/frequency of drinking were assessed at 12-month follow-up.

SC participants received roughly half of the amount of intervention in minutes compared to FC participants. Both groups did not differ in drinking outcomes. Compared to CG, intervention showed small to medium effect size for at-risk drinkers.

Study results reveal that a stepped care approach can be expected to increase cost-effectiveness of brief interventions for individuals with at-risk drinking.

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Brief alcohol intervention for general hospital inpatients: A randomized controlled trial
Drug and Alcohol Dependence, Volume 93, Issue 3, 1 March 2008, Pages 233-243

To test the effectiveness of a brief alcohol intervention among non-dependent general hospital inpatients with alcohol problems, delivered by either a specialized liaison service or hospital physicians.

All inpatients of 29 wards from four general hospitals of one region in Germany were screened for alcohol problems (n = 14,332). Of those screening positive, 595 patients were included in a randomized controlled group design using a time-frame. Patients with alcohol dependence were not considered in this study. Patients received Motivational Interviewing based counselling either by a specialized liaison service, by hospital physicians trained under routine conditions or received hospital treatment as usual without additional counselling. One year later, alcohol consumption, motivation and well-being were assessed. Sample survey analyses and generalized estimating equations were conducted.

At baseline, the three groups differed regarding motivation, with higher motivation among the controls. At follow-up, the groups did not differ regarding alcohol consumption, alcohol-related problems and well-being. All groups decreased their alcohol consumption significantly. Regarding motivation, longitudinal analyses revealed significant interaction effects of time and intervention (p <>

The intervention was not effective in reducing alcohol consumption or in increasing well-being 12 months after hospitalization. It had a positive effect on readiness to change drinking and on readiness to seek formal help for alcohol problems. The intervention groups compensated their lag of motivation.

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Cumulative lifetime adversities and alcohol dependence in adolescence and young adulthood
Drug and Alcohol Dependence, Volume 93, Issue 3, 1 March 2008, Pages 217-226

Negative life events have been implicated in the development of alcohol dependence. This paper tests whether cumulative exposure to such stressors significantly predicts risk of DSM-IV alcohol dependence disorder in young adults. We also provide descriptive data that characterizes the patterns of cumulative exposure to such events and rates of alcohol dependence across gender, race/ethnic, and socioeconomic group.

Event history analysis suggested that lifetime stress exposure exhibits a pattern of association with alcohol dependence that is consistent with a cumulative impact interpretation. Both recent events and events more distant in time were significantly and independently associated with such risk. Although these results contribute toward an understanding of variations in alcohol dependence across individuals, they do not assist in the understanding of observed ethnic group differences in such dependence.

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Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients
Journal of Consulting and Clinical Psychology
, Volume 75, Issue 6, December 2007, Pages 947-959

Male and female managed care clients randomized to day hospital (n = 154) or community residential treatment (n = 139) were compared on substance use outcomes at 6 and 12 months.

To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n = 321) and for clients excluded from randomization and directed to residential treatment because of high environmental risk (n = 82). American Society of Addiction Medicine criteria defined study and randomization eligibility.

More than 50% of followed clients reported past-30-day abstinence at follow-ups (unadjusted rates, not significant between groups). Despite differing baseline severities, randomized, self-selecting, and directed clients displayed similar abstinence outcomes in multivariate longitudinal models.

Index treatment days and 12-step attendance were associated with abstinence (p < .001). Other prognostic effects (including gender and ethnicity) were not significant predictors of differences in outcomes for clients in the treatment modalities.

Although 12-step attendance continued to be important for the full 12 months, treatment beyond the index stay was not, suggesting an advantage for engaging clients in treatment initially and promoting 12-step attendance for at least a year.

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Wednesday, January 23, 2008

Health Characteristics of the Asian Adult Population: United States, 2004–2006
Advance Data Report Number 394 January 22, 2008

This report compares national estimates for selected health status indicators, health behaviors, health care utilization, health conditions, immunizations, and human immunodeficiency virus (HIV) testing status among selected non-Hispanic Asian adult subgroups (Chinese, Filipino, Asian Indian, Japanese, Vietnamese, and Korean). Comparison estimates for the non-Hispanic white, non-Hispanic black, non-Hispanic American Indian or Alaska Native (AIAN), and Hispanic adult populations are also presented
  • Japanese adults (14%) were more likely to be current moderate or heavier drinkers compared with Filipino (9%), Chinese (7%), Asian Indian (6%), or Vietnamese adults (6%).
  • Vietnamese adults (68%) had the highest percentage of lifetime abstinence from alcohol use; rates for adults in other Asian subgroups ranged from 32% for Japanese to 57% for Asian Indian.
  • White adults (22%) were more likely to be current moderate or heavier drinkers compared with AIAN (15%), Hispanic (13%), black (12%), or Asian adults (9%).
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Tuesday, January 22, 2008

Longitudinal Associations Between Problem Alcohol Use and Violent Victimization in a National Sample of Adolescents
Journal of Adolescent Health Volume 42, Issue 1, January 2008, Pages 21-27

Research indicates that alcohol use is both a risk factor for and a consequence of violent victimization. This study investigated the longitudinal associations between problem alcohol use and victimization, and whether these associations varied by gender.

Data from the National Longitudinal Study on Adolescent Health (Add Health) were used to investigate the prospective associations between alcohol use and victimization over three time points spanning 7 years. Because adolescence is a time of rapid growth, we used latent growth modeling (LGM) in addition to traditional cross-lagged structural equation modeling (SEM).

For boys, both SEM and LGM indicated that problem alcohol use was a risk factor for subsequent violent victimization. For girls, the SEM suggested a bi-directional association, although the LGM provided stronger support for problem alcohol use as a risk factor for, rather than a consequence of, violent victimization.

Findings across the two statistical approaches suggest that interventions that reduce the likelihood of problem alcohol use among adolescents can minimize the short-term risk of victimization and the long-term risk of problem alcohol use in young adulthood.

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Alcohol, cannabis, and methamphetamine use and other risk behaviours among Black and Coloured South African women: A small randomized trial in the Western Cape
International Journal of Drug Policy, published online 21 January 2008.

The primary aim of this pilot, randomized trial was to examine whether an adapted evidence-based intervention would be equally, more, or less effective at reducing HIV risk behaviours when delivered using an individual or group format.

The secondary aim was to examine differences between Black and Coloured South African women across pre- and post-intervention measures of alcohol and illicit drug use and sex risk behaviours.

Coloured women reported greater methamphetamine use (13 days in the past 30 days) and Black women reported mostly cannabis use (27 days in the past 30 days). Although both groups reported having unprotected sex under the influence of alcohol and/or other drugs, Black women reported greater condom use and having one partner; Coloured women reported having more than one sex partner.

One-month post-intervention assessments indicated significant reductions in substance use and sex risk behaviours. After controlling for baseline measures, there were no significant differences between the two intervention conditions.

Significant differences in risk behaviours were observed between Black and Coloured South African women. However, both ethnic groups were responsive to the adapted intervention and no differences were found by intervention assignment.

These findings support the assertion that group interventions may be more cost-effective in reaching at-risk women in resource-scarce environments. Larger studies are needed to show efficacy and effectiveness of woman-focused group prevention interventions.

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Frequency, course and correlates of alcohol use from adolescence to young adulthood in a Swiss community survey
BMC Psychiatry 2008, 8:5

Few studies have analyzed the frequency of alcohol use across time from adolescence to young adulthood and its outcome in young adulthood. A Swiss longitudinal multilevel assessment project using various measures of psychopathology and psychosocial variables allowed for the study of the frequency and correlates of alcohol use so that this developmental trajectory may be better understood.

The increase of alcohol use from early adolescence to young adulthood showed only a few sex-specific differences in terms of the amount of alcohol consumption and the motives to drink.

In late adolescence and young adulthood, males had a higher amount of alcohol consumption and were more frequently looking for drunkenness and feeling high. Males also experienced more negative consequences of alcohol use.

A subgroup of heavy or problem drinkers showed a large range of emotional and behavioural problems and further indicators of impaired psychosocial functioning both in late adolescence and young adulthood.

This Swiss community survey documents that alcohol use is problematic in a sizeable proportion of youth and goes hand in hand with a large number of psychosocial problems.

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Depression and Social Phobia Secondary to Alcohol Dependence
Neuropsychobiology 2007;56:111-118

This study analyzed the characteristics of depression and social phobia secondary to ADD. (1) What is their functional impact? (2) Are they independent or associated conditions? (3) Do they completely remit in abstinent individuals? (4) Is the remission of one disorder associated with the remission of the other disorder?

Baseline comparisons differentiated patients with a Hamilton Rating Scale for Depression (HDRS) score >35 (n = 50; 78%) from those with an HDRS score le35 by higher levels of generalized anxiety and lower global functioning. Patients with generalized social phobia [Leibowitz Social Anxiety Scale (LSAS) score >60: n = 20; 31.2%] were not distinguishable from those with an LSAS score le60 by depressive and anxiety disorder symptoms.

In postdetoxification assessment, patients who remitted from depression (HDRS score <7: n =" 35;" alt="ge" src="" border="0">7). Patients who remitted from social phobia (LSAS score <30: n =" 32;">

Depression and social phobia secondary to ADD are independent conditions that do not completely remit after cessation of drinking. Specific treatments are needed to reduce residual depressive and anxiety symptoms in abstinent alcoholics.

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Health behaviours as explanations for educational level differences in cardiovascular and all-cause mortality: a follow-up of 60 000 men and women over 23 years
The European Journal of Public Health 2008 18(1):38-43;

Health behaviours are potential explanatory factors for socioeconomic differences in mortality. We examined the extent to which seven health behaviours covering dietary habits, smoking and physical avtivity, can account for relative differences in cardiovascular and all-cause mortality by educational level.

Health behaviour data derived from nationwide Finnish health behaviour surveys from the years 1979 to 2001. These annually repeated cross-sectional surveys were linked to register-based information on educational level and subsequent mortality from the year of the survey until the end of 2001 (average follow-up time 11.9 years). The analyses included 29 065 men and 31 543 women of whom 4263 died. Cardiovascular disease (CVD), coronary heart disease (CHD), stroke and all-cause mortality was studied.

Educational level showed a graded association with all mortality outcomes. Health behaviours explained 54% of the relative difference between primary and higher educational level in CVD mortality among in men and 22% among in women. For all-cause mortality the corresponding figures were 45 and 38%. Smoking, vegetable use and physical activity were the most important health behaviours explaining educational level differences in all mortality outcomes, while the effects of type of fat used on bread, coffee drinking, relative weight and alcohol use were small.

Smoking, low vegetable use and physical inactivity explained a substantial part of educational level differences in cardiovascular and all-cause mortality among men and women. Socioeconomic trends in these behaviours are of crucial importance in determining whether socioeconomic mortality differences will widen or narrow in the future.

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Individual, group and community risk and protective factors for alcohol and drug use among Swedish adolescents
The European Journal of Public Health 2008 18(1):12-18

The aim of the present study was to examine the associations between risk and protective factors and adolescents’ use of alcohol and drugs.

About 44% of the adolescents in grade 9 (15–16 years of age) had been drunk on at least one occasion and nearly 80% of those in grade 11 (17–18 years of age). Almost 15% in grade 9 and 40% in grade 11 had been drinking heavily during the previous month, and 4% in grade 9 and 12% in grade 11 had used cannabis. Strong associations were found between elevated individual, family, school and community risk factors and use of alcohol and drugs. Conversely, protective factors were negatively related to the use of alcohol and drugs.

This study confirms the importance of risk and protective factors within different domains in explaining alcohol and drug use among adolescents. The results support efforts targeting multiple risk and protective factors in alcohol and drug preventive interventions for adolescents.

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News Release - Men drink twice as much alcohol as women
22 January 2008

Smoking and drinking among adults 2006 and Drinking: adults’ behaviour and knowledge in 2007

Men are drinking twice as much alcohol as women according to new figures from the Office for National Statistics - 18.7 units a week, on average, compared with 9.0 units.

A report on smoking and drinking among adults, which uses data from the 2006 General Household Survey (GHS), found that men were more likely than women to have drunk alcohol on at least one day in the previous week: 71 per cent of men and 56 per cent of women had done so. Men also drank on more days of the week than women. More than one in five men (21 per cent) compared with just over one in ten women (11 per cent) had drunk on at least five of the previous seven days.
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Press Release - Labels on Alcoholic Drinks Should Include Calories, Ingredients & Alcohol Content, Says CSPI

For Immediate Release January 22, 2008

Not Protein, Fat and Carbs as Bush Administration Proposes

WASHINGTON—Consumers would benefit from information about calories, serving size, ingredients, and alcohol content on labels for beer, wine, and hard liquor, according to the nonprofit Center for Science in the Public Interest. But a rule proposed by federal alcohol regulators at the Treasury Department would let manufacturers omit alcohol content from the proposed information panel, and instead include line items for fat and protein, nutrients not in the vast majority of alcoholic drinks. In comments filed with the Treasury Department’s Tax and Trade Bureau today, CSPI urged the agency to go back to the drawing board and conduct real-world consumer research about how a new uniform alcohol label would help consumers measure and moderate their drinking.

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Multiple OPR genes influence personality traits in substance dependent and healthy subjects in two American populations
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Published Online 22 January 2008

Personality traits are among the most complex quantitative traits. Certain personality traits are associated with substance dependence (SD); genetic factors may influence both. Associations between opioid receptor (OPR) genes and SD have been reported.

This study investigated the relationship between OPR genes and personality traits in a case-control sample. We assessed dimensions of the five-factor model of personality in 556 subjects: 250 with SD [181 European-Americans (EAs) and 69 African-Americans (AAs)] and 306 healthy subjects (266 EAs and 40 AAs).

We found that personality traits were associated as main or interaction effects with the haplotypes, diplotypes, alleles and genotypes at the three OPR genes (0.002 < P <>P <>OPRM1 had main effects on Extraversion (P = 0.008), and diplotypes OPRM1TTCAGA/TTCAGA and OPRD1CAC/TAC had interaction effects on Openness (P = 0.010) after conservative correction for multiple testing.

The present study demonstrates that the genes encoding the mu-, delta-, and kappa-opioid receptors may contribute to variation in personality traits. Further, the three OPR genes have significant interaction effects on personality traits.

This work provides additional evidence that personality traits and SD have a partially overlapping genetic basis

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Marriage, cohabitation and alcohol consumption in young adults: An international exploration
Journal of Substance Use, Published Online 18 January 2008

This paper examines the drinking behaviour of young adults aged 24-32 who were married or were cohabiting.

In general married people were similar to those cohabiting on annual frequencies of alcohol consumption, but lower on amounts consumed on each occasion and, therefore, on annual volumes. However, the extent of these differences varied in different countries.

On the usual consumption per occasion measure, there were larger differences between married and cohabiting in Sweden, Spain, the United Kingdom, the Czech Republic and Norway than in Germany, Finland, Denmark, Iceland and Hungary. The differences between married and cohabiting people were, however, not associated with gender or with the presence of children.

At the aggregate country level no associations could be shown with women's empowerment, age of first marriage or per capita alcohol consumption.

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The two worlds of alcohol problems: Who is in treatment and who is not?
Addiction Research & Theory, Volume 16, Issue 1 February 2008 , pages 67 - 84

The aim of this article is to study the relative strength of factors in predicting entering and the clinical population.

The studied factors are demographics and marginalization; volume and frequency of drinking; alcohol dependence; social response to drinking (suggestions to cut down or seek treatment by informal actors, e.g. family and friends, and formal actors such as employer, the social services or judicial system); and treatment history.

As expected, clients were older, more marginalized and reported more severe alcohol problems, and many reported previous treatment experiences and social responses. Logistic regression analyses show that previous treatment, unemployment/institutionalization and having an unstable living situation are the strongest predictors of who is in treatment, followed by age, alcohol dependence and frequency of drinking. Formal pressures to cut down or seek treatment are also important and males are more likely to be in treatment.

The results support a notion of the treatment system as a place for handling marginalized people, beyond and beside their extent of drinking.

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Alcohol Labeling Proposal Sets Off a Brawl

Tuesday, January 22, 2008; Page D01

After more than 30 years of deliberation, federal regulators have proposed requiring the alcoholic-beverage industry to put nutrition and alcohol-content labels on their containers, setting off the equivalent of a barroom brawl among makers of beer, wine and liquor.

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