Are Americans ‘Nutty’ About Drinking?
By Mark Willenbring, M.D.

Dr. Mark L. Willenbring, director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism, took readers’ questions in the Consults blog, “A New View of Alcoholism.”

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VideoCast - Brain Stress Systems and Addiction

Presented by: George Koob, Ph.D., Committee of the Neurobiology of Addictive Disorders, The Scripps Research Institute

Previous studies of alcohol dependent, opiate dependent and cocaine dependent animals during acute withdrawal have shown enhanced stress-like responses that are reversed by selective competitive corticotropin-releasing factor (CRF) antagonists. Studies with animals exposed to chronic administration of cocaine, alcohol and cannabinoids have shown increases in CRF activity in the amygdala as measured by in vivo microdialysis. Even more exciting are results showing that CRF antagonists gain the ability to reduce alcohol drinking in animals with a history of dependence, but are inactive in animals with no history of dependence. These results suggest that the increased drug intake associated with drug dependence may involve not only decreases in the function of transmitter systems that are associated with the acute reinforcing (rewarding) effects of drugs of abuse (previous work from our group), but also with the recruitment of the brain neuropeptide systems associated with behavioral and neurobiological responses.

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Apparent Consumption of Alcohol, Australia, 2007-08

The total quantity of pure alcohol available for consumption in alcoholic beverages produced in Australia continues to increase. Between 2006–07 and 2007–08, the total quantity of pure alcohol available for consumption increased by 1.4% from 168.1 million to 170.5 million litres of alcohol. Of the total litres of alcohol available for consumption in 2007-08, beer contributed 46%, wine 31%, spirits 12% and ready to drink pre-mixed products 11.0%.

The apparent per capita consumption of pure alcohol by persons aged 15 years and over decreased slightly by 0.5% between 2006-07 and 2007–08, after an increase of 1.7% between 2005-06 and 2006-07.

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Problem gamblers share deficits in impulsive decision-making with alcohol-dependent individuals

Addiction Volume 104 Issue 6, Pages 1006 - 1015

Gambling and alcohol-dependent groups shared deficits in tasks linked to ventral prefrontal cortical dysfunction. Tasks loading on dorsolateral prefrontal cortex were selectively impaired in the alcohol-dependent group, presumably as a consequence of long-term alcohol use.

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Request Reprint E-Mail: lc260@cam.ac.uk

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Progressive stage transition does mean getting better: a further test of the Transtheoretical Model in recovery from alcohol problems

Addiction Volume 104 Issue 6, Pages 949 - 958

In contrast to a previous study by Callaghan and colleagues, our findings largely support the TTM account of recovery from alcohol problems in treatment. The discrepancy can be explained by the use in our study of a more reliable and valid method for assigning stage of change.

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Request Reprint E-Mail: nick.heather@unn.ac.uk

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Lifetime alcohol use, abuse and dependence among university students in Lebanon: exploring the role of religiosity in different religious faiths
Addiction Volume 104 Issue 6, Pages 940 - 948

Students belonging to conservative religious groups may be shielded from the opportunity to try alcohol. Once an ever drinker, however, religion is not related to the odds of an alcohol use disorder. Religiosity (i.e. belief in God and religious practice) is, nevertheless, related inversely to alcohol-related problems, even among drinkers. Findings from this culturally and religiously diverse Arab country corroborate the international literature on religion, religiosity and alcohol use, highlighting potential differences between Christians and Muslims.

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Request Reprint E-Mail: lilian@ghandours.com
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Twelve-Step affiliation and 3-year substance use outcomes among adolescents: social support and religious service attendance as potential mediators

Addiction Volume 104 Issue 6, Pages 927 - 939

The findings suggest the importance of 12-Step affiliation in maintaining long-term recovery, and help to understand the mechanism through which it works among adolescents.

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Request Reprint E-Mail: felicia.w.chi@kp.org

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Urinary ethyl glucuronide (EtG) and ethyl sulphate (EtS) assessment: valuable tools to improve verification of abstention in alcohol-dependent patients during in-patient treatment and at follow-ups
Addiction Volume 104 Issue 6, Pages 921 - 926

Urinary EtG and EtS improve verification of abstinence in studies of alcohol-dependent patients.

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Request Reprint E-Mail: klaus.junghanns@psychiatrie.uk-sh.de
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Ethyl glucuronide in hair. A sensitive and specific marker of chronic heavy drinking
Addiction Volume 104 Issue 6, Pages 915 - 920

Our results confirm further that HEtG is a sensitive and specific marker of chronic heavy drinking.

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Request Reprint E-Mail: luca.morini@unipv.it
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Gene–environment interactions and alcohol use and dependence: current status and future challenges
Addiction Volume 104 Issue 6, Pages 907 - 914

Challenges for future gene–environment studies are abundant, and consist of, for example, the development of clear theoretical assumptions about neurobiological mechanisms and the recruitment of large longitudinal samples that already start in childhood. Replication is essential to prevent an overload of false-positive results. Despite the difficulties, it is crucial to include gene–environment interactions in future studies in order to unravel the aetiological factors of human alcohol outcomes.

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Request Reprint E-Mail: c.vanderzwaluw@bsi.ru.nl
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Alcohol Intoxication in Pediatric Age: Ten-year Retrospective Study

Croat Med J. 2009; 50: 151-6

The alarming increase in the number of hospitalizations due to alcohol intoxication in children, especially among girls and in the adolescent age group, represents a serious problem, which requires further attention and research.

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Gender, acculturation, and other barriers to alcohol treatment utilization among Latinos in three National Alcohol Surveys

Journal of Substance Abuse Treatment Volume 36, Issue 4, Pages 446-456 (June 2009)

Whereas men and women differed little on perceived barriers, analyses showed greater barriers among Spanish (vs. English) interviewees. Latina women's underutilization of alcohol treatment requires further research but may be partially explained by stigma. Associations between language of interview and treatment utilization imply a need for outreach and culturally sensitive programming.

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Request Reprint E-Mail: szemore@arg.org

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Outcomes from primary care management of alcohol dependence in France

Journal of Substance Abuse Treatment Volume 36, Issue 4, Pages 457-462 (June 2009)

In this French sample, management by the general practitioners appears to be a positive predictor of outcome in alcohol dependence. Future research could (a) enlighten the relationship between detoxification and frequency or circumstances of the visits and (b) tell whether formal planned follow-up by general practice physicians could improve outcome in alcohol dependence.

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Request Reprint E-Mail: lmalet@chu-clermontferrand.fr

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Children Living with Substance-Dependent or Substance-Abusing Parents: 2002 to 2007



Combined data from SAMHSA's 2002 to 2007 National Surveys on Drug Use and Health were used to provide average annualized estimates of the number of children under age 18 living with a substance abusing parent, that is, a parent who was dependent on or abused alcohol or an illicit drug.

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Drinking in the UK: An exploration of trends

6 May 2009

This study is a systematic review of research relevant to trends in alcohol consumption over the last 20 to 30 years in the UK.

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The effect of alcohol advertising, marketing and portrayal on drinking behaviour in young people: systematic review of prospective cohort studies

BMC Public Health 2009, 9:51

The effect of alcohol portrayals and advertising on the drinking behaviour of young people is a matter of much debate. We evaluated the relationship between exposure to alcohol advertising, marketing and portrayal on subsequent drinking behaviour in young people by systematic review of cohort (longitudinal) studies.

Data from prospective cohort studies suggest there is an association between exposure to alcohol advertising or promotional activity and subsequent alcohol consumption in young people. Inferences about the modest effect sizes found are limited by the potential influence of residual or unmeasured confounding

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Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults

JAMA. 2009;301(17):1771-1778.

After adjustment, offering housing and case management to a population of homeless adults with chronic medical illnesses resulted in fewer hospital days and emergency department visits, compared with usual care.

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Is “maturing out” of problematic alcohol involvement related to personality change?.

Journal of Abnormal Psychology. Vol 118(2), May 2009, 360-374

Latent growth models indicated that both normative and individual changes in alcohol involvement occur between ages 18 and 35 and that these changes are associated with changes in neuroticism and impulsivity. Moreover, marital and parental role statuses did not appear to be third-variable explanations of the associated changes in alcohol involvement and personality. Findings suggest that personality change may be an important mechanism in the maturing-out effect.

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Request Reprint E-Mail: littlefielda@missouri.edu

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Association of Markers in the 3' Region of the GluR5 Kainate Receptor Subunit Gene to Alcohol Dependence

Alcoholism: Clinical and Experimental Research Volume 33 Issue 5, Pages 925 - 930

These findings provide support for the hypothesis that variation in the 3' portion of the gene encoding the GluR5 kainate receptor subunit contributes to the risk for AD. Further research is needed to ascertain whether this SNP is itself functional or whether the association reflects linkage disequilibrium with functional variation elsewhere in the gene and whether this SNP moderates topiramate's effects in the treatment of AD.

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Request Reprint E-Mail: kranzler@psychiatry.uchc.edu

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Ethanol-Sensitive Brain Regions in Rat and Mouse: A Cartographic Review, Using Immediate Early Gene Expression

Alcoholism: Clinical and Experimental Research Published Online: 19 Mar 2009

The review sheds light on the specific patterns of response in regions of the brain to different types of ethanol exposure and shows that activation of specific brain regions may occur in particular phases of the development of ethanol addiction. Some brain regions respond consistently following acute or chronic treatments or withdrawal: the prefrontal cortex; nucleus accumbens; lateral septum; hippocampus; perioculomotor urocortin-containing cells population (pIIIu), also known as Edinger-Westphal nucleus; central nucleus of the amygdale; and the paraventricular nucleus of hypothalamus. The two last brain areas are particularly activated by relapse-inducing stressors. It is of interest that the amygdala, hippocampus, and prefrontal cortex, which belong to the reward system, are activated by cue-induced relapse to ethanol self-administration in rodents and humans, while activation of these regions is reversed with anticraving compounds. Following chronic exposure, IEG induction desensitizes while withdrawal reactivates these regions.

Some responding regions are implicated in reward related processes (VTA, extended amygdala, hypothalamus, hippocampus, prelimbic cortex, ventral part of lateral septum) and some others in aversive-related processes (area postrema, nucleus of solitary tract).

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Request Reprint E-Mail: catherine.vilpoux@u-picardie.fr

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Alcohol Consumption, Social Support, and Risk of Stroke and Coronary Heart Disease Among Japanese Men: The JPHC Study
Alcoholism: Clinical and Experimental Research Published Online: 19 Mar 2009

During an average follow-up of 9.9 years, 629 total strokes and 207 coronary heart diseases were documented. Light-to-moderate alcohol consumption was associated with reduced risks of coronary heart disease and total cardiovascular disease, while heavy alcohol consumption was associated with increased risk of total stroke, in particular hemorrhagic stroke. When stratified by social support score, the multivariable hazard ratios of total cardiovascular disease associated with light-to-moderate alcohol consumption (1 to 299 g/wk) were 0.99 (0.72 to 1.37) in the low social support group and 0.56 (0.44 to 0.70) in the high social support group (p for interaction = 0.002), while the multivariable hazard ratios of hemorrhagic stroke associated with heavy alcohol consumption (≥300 g/wk) were 2.09 (1.03 to 4.27) in the low social support group and 1.25 (0.72 to 2.15) in the high social support group (p for interaction = 0.44). There was no interaction between alcohol consumption and social support in relation to risk of coronary heart disease.

Social support may enhance the beneficial effect of light-to-moderate alcohol consumption on risk of cardiovascular disease.

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Request Reprint E-Mail: fvgh5640@mb.infoweb.ne.jp
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Ethanol Promotes Thiamine Deficiency-Induced Neuronal Death: Involvement of Double-Stranded RNA-activated Protein Kinase

Alcoholism: Clinical and Experimental Research Published Online: 23 Mar 2009

Thiamine deficiency caused death of CGNs but ethanol did not. However, TD plus ethanol induced a much greater cell loss than TD alone. TD-induced PKR phosphorylation and ethanol exposure significantly promoted TD-induced PKR phosphorylation as well as its nuclear translocation. A selective PKR inhibitor not only protected CGNs against TD toxicity, but also abolished ethanol potentiation of TD-induced loss of CGNs.

Ethanol promoted TD-induced PKR activation and neuronal death. PKR may be a convergent protein that mediates the interaction between TD and ethanol.

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Request Reprint E-Mail: jialuo888@uky.edu

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Acupuncture for Alcohol Dependence: A Systematic Review

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

The results of the included studies were equivocal, and the poor methodological quality and the limited number of the trials do not allow any conclusion about the efficacy of acupuncture for treatment of alcohol dependence. More research and well-designed, rigorous, and large clinical trials are necessary to address these issues.

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The Impact of Chronic Cigarette Smoking on Recovery From Cortical Gray Matter Perfusion Deficits in Alcohol Dependence: Longitudinal Arterial Spin Labeling MRI

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Although cerebral perfusion in alcohol dependent individuals shows improvement with abstinence from alcohol, cigarette smoking appears to hinder perfusion improvement.

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Request Reprint E-Mail: Anderson.Mon@ucsf.edu

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Ethanol Attenuates Spatial Memory Deficits and Increases mGlu1a Receptor Expression in the Hippocampus of Rats Exposed to Prenatal Stress
Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Our findings support the idea that stress-related events occurring before birth have long-lasting effects on brain function and behavior, and suggest that the impact of ethanol on cognition is not only dose- and duration-dependent, but also critically influenced by early life experiences.

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Request Reprint E-Mail: stefania.maccari@univ-lille1.fr
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The Dopamine Response in the Nucleus Accumbens Core–Shell Border Differs From That in the Core and Shell During Operant Ethanol Self-Administration
Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

We conclude that dopamine responses to operant ethanol self-administration are subregion specific. After operant training, accumbal dopamine responses in the core and shell occur when cues that predict ethanol availability are presented and not when the reinforcer is consumed. However, core–shell border dopamine responses occur at the time of the cue and consumption of the reinforcer.

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Request Reprint E-Mail: rgonzales@mail.utexas.edu
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Characterizing and Reaching High-Risk Drinkers Using Audience Segmentation

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Audience segmentation can assist in identifying and describing target audience segments, as well as identifying places where segments congregate on- or offline. This information can be helpful for recruiting subjects for alcohol prevention research as well as planning health promotion campaigns. Through commercial data about high-risk drinkers as "consumers," planners can develop interventions that have heightened salience in terms of opportunities, perceptions, and motivations, and have better media channel identification.

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Request Reprint E-Mail: mossh@mail.nih.gov
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Ethanol-Responsive Genes (Crtam, Zbtb16, and Mobp) Located in the Alcohol-QTL Region of Chromosome 9 Are Associated With Alcohol Preference in Mice
Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Our results are consistent with the hypothesis that Crtam, Zbtb16, and Mobp may be involved in AP in mice. The nature of this association remains to be established and may reflect a direct effect of these genes or an indirect effect caused by linked genes on mouse chromosome 9.

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Carisbamate, a Novel Antiepileptic Candidate Compound, Attenuates Alcohol Intake in Alcohol-Preferring Rats

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Our results showed that there was a selective dose-dependent reduction in alcohol intake and preference in the alcohol-preferring P rat after an acute oral administration of carisbamate. There were no significant effects on food or water intake. Chronic administration of carisbamate significantly reduced alcohol intake and preference initially, but partial tolerance developed after the 10th treatment. The degree of tolerance development was less than that observed for naltrexone. Acute administration of carisbamate was more effective than naltrexone in reducing enhanced alcohol intake after a period of alcohol deprivation. Compared with control vehicle neither carisbamate nor naltrexone had a significant effect on saccharin intake and preference.

The novel neuromodulator compound carisbamate has a favorable profile of effects on alcohol intake and related measures and should be considered for testing on human alcoholics.

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Request Reprint E-Mail: Azadi@duke.edu

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Translating Effective Web-Based Self-Help for Problem Drinking Into the Real World

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

Drinking Less (DL) is a 24/7 free-access anonymous interactive web-based self-help intervention without therapeutic guidance for adult problem drinkers in the community. In a randomized controlled trial (referred to here as DL-RCT), DL has been shown effective in reducing risky alcohol consumption.

The results from DL-RCT and DL-RW were similar, and they demonstrate that web-based self-help without therapeutic guidance is feasible, well accepted, and effective for curbing adult problem drinking in the community.

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Request Reprint E-Mail: hriper@trimbos.nl

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Three-Year Chemical Dependency and Mental Health Treatment Outcomes Among Adolescents: The Role of Continuing Care

Alcoholism: Clinical and Experimental Research Published Online: 30 Apr 2009

A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents.

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Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions

Journal of Affective Disorders Volume 115, Issue 3, Pages 367-375 (June 2009)

Almost one-quarter of individuals with mood disorders (24.1%) used alcohol or drugs to relieve symptoms. The highest prevalence of self-medication was seen in bipolar I disorder (41.0%). Men were more than twice as likely as women to engage in self-medication (Adjusted Odds Ratio=2.18; 95% Confidence Interval 1.90–2.49).

After controlling for the effects of substance use disorders, self-medication was associated with higher odds of comorbid anxiety and personality disorders when compared to individuals who did not self-medicate.

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Sibling Agreement on Retrospective Reports of Parental Alcoholism and Other Childhood Events

Substance Use & Misuse Published Online 30 April 2009

Descriptive statistics showed that agreement was strong for measures of parental alcoholism and psychiatric problems, weaker for family environment, and varied little by subject characteristics. Study limitations and implications are noted, and future research suggested.

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Request Repreint E-Mail: mamodeo@bu.edu

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Self-Control in Decision-Making Involves Modulation of the vmPFC Valuation System

Science 1 May 2009:Vol. 324. no. 5927, pp. 646 - 648

Every day, individuals make dozens of choices between an alternative with higher overall value and a more tempting but ultimately inferior option. Optimal decision-making requires self-control.

We propose two hypotheses about the neurobiology of self-control: (i) Goal-directed decisions have their basis in a common value signal encoded in ventromedial prefrontal cortex (vmPFC), and (ii) exercising self-control involves the modulation of this value signal by dorsolateral prefrontal cortex (DLPFC).

We used functional magnetic resonance imaging to monitor brain activity while dieters engaged in real decisions about food consumption.

Activity in vmPFC was correlated with goal values regardless of the amount of self-control. It incorporated both taste and health in self-controllers but only taste in non–self-controllers. Activity in DLPFC increased when subjects exercised self-control and correlated with activity in vmPFC.

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Request Reprint E-Mail: thare@hss.caltech.edu

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An historical perspective on recovery

Griffith Edwards, Assistant Commissioning Editor, Addiction

Download or stream the presentation by connecting to the Pathways Internet Radio or click on "Play Now" or click on the Powerpoint Presentation to download copies of the presentation slides:

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Amygdala protein kinase C epsilon controls alcohol consumption

Genes, Brain and Behavior Published Online: 19 Feb 2009

Alcoholism is a progressive disorder that involves the amygdala. Mice lacking protein kinase C epsilon (PKCɛ) show reduced ethanol consumption, sensitivity and reward. We therefore investigated whether PKCɛ signaling in the amygdala is involved in ethanol consumption.

Local knockdown of PKCɛ in the amygdala reduced ethanol consumption and preference in a limited-access paradigm. Further, mice that are heterozygous for the PKCɛ allele consume less ethanol compared with wild-type mice in this paradigm. These mice have a >50% reduction in the abundance of PKCɛ in the amygdala compared with wild-type mice.

We conclude that amygdala PKCɛ is important for ethanol consumption in mice.

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Request Reprint E-Mail: H.M.B.Lesscher@umcutrecht.nl

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