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, November 21, 2009

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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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.


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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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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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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Wednesday, November 18, 2009

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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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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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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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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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.

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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. . . . . .

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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…

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Past conference presentations


Monday, November 16, 2009

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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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.

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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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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

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


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

Sunday, November 15, 2009

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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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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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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