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, December 19, 2009
There are currently no consistent objective biochemical markers of alcohol abuse and alcoholism. Development of reliable diagnostic biomarkers that permit accurate assessment of alcohol intake and patterns of drinking is of prime importance to treatment and research fields. Diagnostic biomarker development in other diseases has demonstrated the utility of both open, systems biology, screening for biomarkers and more rational focused efforts on specific biomolecules or families of biomolecules.
Long-term alcohol consumption leads to altered inflammatory cell and adaptive immune responses with associated pathologies and increased incidence of infections. This has led researchers to focus attention on identifying cytokine biomarkers in models of alcohol abuse. Alcohol is known to alter cytokine levels in plasma and a variety of tissues including lung, liver, and very importantly brain.
A number of cytokine biomarker candidates have been identified, including: tumor necrosis factor-alpha, interleukin (IL)-1-alpha, IL-1-beta, IL-6, IL-8, IL-12, and monocyte chemoattractant protein-1.
This is an emerging and potentially exciting avenue of research in that circulating cytokines may contribute to diagnostic biomarker panels, and a combination of multiple biomarkers may significantly increase the sensitivity and specificity of the biochemical tests aiding reliable and accurate detection of excessive alcohol intake.
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Neuropeptide Y Signaling in the Central Nucleus of Amygdala Regulates Alcohol-Drinking and Anxiety-Like Behaviors of Alcohol-Prefering Rats
The neuropeptide Y (NPY) system of the central nucleus of amygdala (CeA) has been shown to be involved in anxiety and alcoholism. In this study, we investigated the molecular mechanisms by which NPY in the CeA regulates anxiety and alcohol drinking behaviors using alcohol-preferring (P) rats as an animal model.
We found that NPY infusion into the CeA produced anxiolytic effects, as measured by the LDB exploration test, and also decreased alcohol intake in P rats. NPY infusion into the CeA significantly increased levels of CaMK IV and phosphorylated cAMP responsive element-binding (pCREB) protein and increased mRNA and protein levels of NPY, but produced no changes in protein levels of CREB or the catalytic α-subunit of protein kinase A (PKA-Cα) in the CeA. We also observed that alcohol intake produced anxiolytic effects in P rats in the LDB test and also increased NPY expression and protein levels of pCREB and PKA-Cα without modulating protein levels of CREB or CaMK IV, in both the CeA and medial nucleus of amygdala. In addition, we found that CaMK IV-positive cells were co-localized with NPY in amygdaloid structures of P rats.
These results suggest that NPY infusion may increase the expression of endogenous NPY in the CeA, which is most likely attributable to an increase in CaMK IV-dependent CREB phosphorylation and this molecular mechanism may be involved in regulating anxiety and alcohol drinking behaviors of P rats.
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Four studies examined how impulse-control beliefs—beliefs regarding one's ability to regulate visceral impulses, such as hunger, drug craving, and sexual arousal—influence the self-control process.
The findings provide evidence for a restraint bias: a tendency for people to overestimate their capacity for impulse control. This biased perception of restraint had important consequences for people's self-control strategies. Inflated impulse-control beliefs led people to overexpose themselves to temptation, thereby promoting impulsive behavior.
-In Study 4, for example, the impulse-control beliefs of recovering smokers predicted their exposure to situations in which they would be tempted to smoke. Recovering smokers with more inflated impulse-control beliefs exposed themselves to more temptation, which led to higher rates of relapse 4 months later.
The restraint bias offers unique insight into how erroneous beliefs about self-restraint promote impulsive behavior.
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The public face of binge drinking: British and Danish young women, recent trends in alcohol consumption and the European binge drinking debate
International and national data sets are utilized to compare changes in young women’s alcohol consumption between the UK and Denmark, two European countries renowned for their alcohol-related problems.
Explanations for young women’s increased sessional drinking have previously focused on the public spectacle of the binge drinker and the notion of a ‘convergence’ between women’s and men’s consumption patterns, incomes and broader lifestyles.
An apparent decline in young women’s binge drinking and weekly drinking in both countries since 2000 is counterbalanced by more frequent drinking, home drinking and wine drinking into middle age, associated with professional occupations.
In the face of an enduring polarization of the public excesses of youth with supposedly civilized moderation within the home, the article argues for a more nuanced understanding of the relationship between alcohol, women’s changing lives and northern European drinking cultures.
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This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age-related patterns of alcohol outlet use.
Densities of off-premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults.
The distribution of alcohol-related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.
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Friday, December 18, 2009
Mechanisms of Postural Control in Alcoholic Men and Women: Biomechanical Analysis of Musculoskeletal Coordination During Quiet Standing
Excessive sway during quiet standing is a common sequela of chronic alcoholism even with prolonged sobriety. Whether alcoholic men and women who have remained abstinent from alcohol for weeks to months differ from each other in the degree of residual postural instability and biomechanical control mechanisms has not been directly tested.
Reduction in sway and closed-loop activity during quiet standing with stabilizing factors shows some differential expression in men and women with histories of alcohol dependence. Nonetheless, enduring deficits in postural instability of both alcoholic men and alcoholic women suggest persisting liability for falling.
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Subjective response to alcohol (SR), which reflects individual differences in sensitivity to the pharmacological effects of alcohol, may be an important endophenotype in understanding genetic influences on drinking behavior and alcohol use disorders (AUDs). SR predicts alcohol use and problems and has been found to differ by a range of established risk factors for the development of AUDs (e.g., family history of alcoholism). The exact pattern of SR associated with increased risk for alcohol problems, however, remains unclear. The Low Level of Response Model (LLR) suggests that high-risk individuals experience decreased sensitivity to the full range of alcohol effects, while the Differentiator Model (DM) asserts that high risks status is associated with increased sensitivity to alcohol's positive effects but decreased sensitivity to negative effects.
Despite commendable advances in SR research, important questions remain unanswered. Inconsistent results across studies may be attributable to a combination of an inadequate understanding of the underlying construct and methodological differences across studies (e.g., number and timing of assessments across the BAC, inclusion of a placebo condition). With respect to the underlying construct, existing measures fail to adequately distinguish between cognitive/behavioral impairment and sedation, aspects of which may be perceived positively (e.g., anxiolysis) due to their ability to act as negative reinforcers.
Addressing the concerns raised by the current review will be integral to making meaningful scientific progress in the field of subjective response.
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The Effect of Moderate to Heavy Alcohol Consumption on Neuropsychological Performance as Measured by the Repeatable Battery for the Assessment of Neur
Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the indiividual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined.
The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance.
Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.
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Multiple episodes of ethanol intoxication and withdrawal result in progressive, irreversible intensification of the withdrawal reaction, a process termed "ethanol withdrawal kindling." Previous studies show that a single episode of chronic ethanol intoxication and withdrawal causes prominent changes in neuropeptide Y (NPY) and its receptors that have been implicated in regulating withdrawal hyperexcitability.
This study for the first time examined the NPY system during ethanol withdrawal kindling.
Multiple withdrawal episodes reversibly decreased NPY and NPY receptor mRNA levels at peak withdrawal, with smaller decreases in NPY mRNA levels and augmented decreases in Y1/Y5 mRNA levels compared with a SW episode. Multiple withdrawal-induced seizures increased the Y2 mRNA levels in PirCx. These complex changes in NPY system gene expression could play a role in the ethanol withdrawal kindling process.
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Driving while under the influence of alcohol is a major public health problem whose neural basis is not well understood. In a recently published functional magnetic resonance imaging (fMRI) study (Meda et al., 2009), our group identified 5, independent critical driving-associated brain circuits whose inter-regional connectivity was disrupted by alcohol intoxication. However, the functional connectivity between these circuits has not yet been explored in order to determine how these networks communicate with each other during sober and alcohol-intoxicated states.
Connections between frontal-temporal-basal ganglia and cerebellum have recently been explored; these may be responsible in part for maintaining normal motor behavior by integrating their overlapping motor control functions. These connections appear to be disrupted by alcohol intoxication, in turn associated with an explicit type of impaired driving behavior.
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Fetal alcohol disorders are preventable, but self-reported alcohol consumption can be misleading and impede effective treatment. Biomarkers represent an alternative method for assessing alcohol use, and this study evaluated the relationship between blood phosphatidylethanol (PEth) and alcohol use in a sample of reproductive age women.
PEth is a highly sensitive indicator of moderate and heavy alcohol consumption in reproductive age women and may complement the use of self-report alcohol screens when additional objective markers of alcohol use are desirable.
However, choosing a highly valid cutoff concentration for PEth to differentiate various levels of alcohol consumption may not be feasible.
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Phosphodiesterase Type 4 Inhibition Does Not Restore Ocular Dominance Plasticity in a Ferret Model of Fetal Alcohol Spectrum Disorders
There is growing evidence that deficits in neuronal plasticity account for some of the neurological problems observed in fetal alcohol spectrum disorders (FASD). Recently, we showed that early alcohol exposure results in a permanent impairment in visual cortex ocular dominance (OD) plasticity in a ferret model of FASD. This disruption can be reversed, however, by treating animals with a Phosphodiesterase (PDE) type 1 inhibitor long after the period of alcohol exposure.
Using in vivo electrophysiology we show that inhibition of PDE4 by rolipram does not restore OD plasticity in alcohol-treated ferrets.
This result suggests that contrary to PDE1, PDE4 inhibition does not play a role in the restoration of OD plasticity in the ferret model of FASD.
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Feasibility of Using Interactive Voice Response to Monitor Daily Drinking, Moods, and Relationship Processes on a Daily Basis in Alcoholic Couples
Daily process research on alcohol involvement has used paper-and-pencil and electronic data collection methods, but no studies have yet tested the feasibility of using Interactive Voice Response (IVR) technology to monitor drinking, affective, and social interactional processes among alcoholic (ALC) couples. This study tested the feasibility of using IVR with n = 54 ALC couples.
Findings supported that IVR is a useful method for collecting daily drinking, mood, and relationship process data from alcoholic couples. Probands' compliance is strongly associated with their partners' compliance, and autFmated IVR calls may facilitate compliance on high anxiety, high conflict days.
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Revisiting Intragastric Ethanol Intubation as a Dependence Induction Method for Studies of Ethanol Reward and Motivation in Rats
The purpose of this study was to re-examine intragastric ethanol intubation as a dependence induction method that effectively induces physical dependence upon ethanol over a short time period, is devoid of intrinsic stress artifacts, inexpensive, and easy to implement.
These findings suggest that intragastric ethanol administration produces a behavioral profile consistent with ethanol dependence (i.e., significant withdrawal signs after termination of ethanol exposure and elevated anxiety-like behavior persisting beyond completion of physical withdrawal), and that the intubation procedure itself does not produce lasting nonspecific anxiety-like effects. Thus, under the conditions employed here, this procedure provides an effective tool for inducing and evaluating the consequences of ethanol dependence in animal models of ethanol reward and motivation.
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Differential Central NOS-NO Signaling Underlies Clonidine Exacerbation of Ethanol-Evoked Behavioral Impairment
Alterations in NOS-derived NO in the LC underlie clonidine–ethanol induced behavioral impairment. A decrease in nNOS activity, due at least partly to a reduction in nNOS phosphorylation, mediates rotorod impairment, while enhanced eNOS activity contributes to LORR, elicited by clonidine–ethanol combination.
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Nonalcoholic steatohepatitis (NASH) develops in the absence of chronic and excessive alcohol consumption. However, it remains unknown whether moderate alcohol consumption aggravates liver inflammation in pre-existing NASH condition.
Exploring the Relationship Between Depressive and Anxiety Symptoms and Neuronal Response to Alcohol Cues
Depressive and anxiety symptoms tend to co-occur with heavy drinking. Specifically, their presence may exacerbate the severity and intractability of heavy drinking. Similarly, heavy drinking may increase the risk for and experience of depressive and anxiety symptoms. Although depressive and anxiety symptoms have been significantly correlated with alcohol craving in cue-exposure paradigms, physiological responses have not always mapped onto emotional responses. Therefore, this study sought to examine the role of depressive and anxiety symptoms using a more basic science approach, through examining functional brain changes.
Significant correlations were found between depressive symptoms, anxiety symptoms, and differential brain activation in response to an alcohol versus an appetitive control cue in an fMRI paradigm. Moreover, the pattern of activation mapped onto expected regions. This study strongly supports the posited relationships between depressive symptoms, anxiety symptoms, and differential brain activation in an alcohol cue-exposure paradigm with a sample of heavy drinking adults.
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Excessive alcohol intake produces structural and functional deficits in corticolimbic pathways that are thought to underlie cognitive deficits in the alcohol use disorders (AUDs). Animal models of binge alcohol administration support the direct link of high levels of alcohol consumption and neurotoxicity in the hippocampus and surrounding cortex. In contrast, voluntary wheel running enhances hippocampal neurogenesis and generally promotes the health of neurons
Rats that exercised prior to binge exposure were significantly less behaviorally intoxicated, which was not a result of enhanced hepatic metabolism. Rats that exercised prior to binge alcohol consumption had reduced loss of dentate gyrus granule cells and fewer FluoroJade B positive cells in the dentate gyrus and associated entorhinal-perirhinal cortex compared to nonexercisers. However, exercise did not protect against cell death in the piriform cortex nor protect against alcohol-induced decreases in cell proliferation, evidenced by a similar alcohol-induced reduction in Ki67 labeled cells between exercise and sedentary rats.
We conclude that exercise can reduce behavioral sensitivity to ethanol intoxication and protect vulnerable brain areas from alcohol-induced cell death. Exercise neuroprotection of alcohol-induced brain damage has important implications in understanding the neurobiology of the AUDs as well as in developing novel treatment strategies.
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Intoxication With Bourbon Versus Vodka: Effects on Hangover, Sleep, and Next-Day Neurocognitive Performance in Young Adults
This study assessed the effects of heavy drinking with high or low congener beverages on next-day neurocognitive performance, and the extent to which these effects were mediated by alcohol-related sleep disturbance or alcoholic beverage congeners, and correlated with the intensity of hangover.
After alcohol, people had more hangover and more decrements in tests requiring both sustained attention and speed. Hangover correlated with poorer performance on these measures. Alcohol decreased sleep efficiency and rapid eye movement sleep, and increased wake time and next-day sleepiness. Alcohol effects on sleep correlated with hangover but did not mediate the effects on performance. No effect of beverage congeners was found except on hangover severity, with people feeling worse after bourbon. Virtually no sex differences appeared.
As drinking to this level affects complex cognitive abilities, safety could be affected, with implications for driving and for safety-sensitive occupations. Congener content affects only how people feel the next day so does not increase risk. The sleep disrupting effects of alcohol did not account for the impaired performance so other mechanisms of effect need to be sought. As hangover symptoms correlate with impaired performance, these might be contributing to the impairment.
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Despite mounting evidence that use of and dependence on alcohol and cannabis are influenced by heritable factors, the extent to which heritable influences on these phenotypes overlap across the 2 substances has only rarely been explored. In the current study, we quantified cross-substance overlap in sources of variance and estimated the degree to which within-substance associations between use and dependence measures are attributable to common genetic and environmental factors for alcohol and cannabis.
Over 60% of variance in alcohol consumption, cannabis use, and cannabis dependence symptoms, and just under 50% of variance in alcohol dependence (AD) symptoms were attributable to genetic sources. Shared environmental factors did not contribute significantly to the 4 phenotypes. Nearly complete overlap in heritable influences was observed for within-substance measures of use and dependence symptoms. Genetic correlations across substances were 0.68 and 0.62 for use and dependence symptoms, respectively.
Common heritable influences were evident for alcohol and cannabis use and for AD and cannabis dependence symptomatology, but findings indicate that substance-specific influences account for the majority of the genetic variance in the cannabis use and dependence phenotypes. By contrast, the substantial correlations between alcohol use and AD symptoms and between cannabis use and cannabis dependence symptoms suggest that measures of heaviness of use capture much of the same genetic liability to alcohol- and cannabis-related problems as dependence symptomatology.
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This paper builds upon the work of previous authors who have explored the evolution of ideas in the alcohol arena. With revisions in the relevant sections of ICD and DSM forthcoming, such matters are of considerable contemporary importance.
The focus here will be upon the history of the last 200 years. The main themes to be explored include the flux of ideas on what, over time, has counted as the trouble with drink, ideas on the cause of the problem and the impact of this thinking on public action.
Medical authorities of the late Enlightenment period made the revolutionary suggestion that habitual drunkenness constituted a disease, rather than a vice. The thread of that idea can be traced to the present day, but with an alternative perception of drink itself or alcohol-related problems generally, as cause for concern, also having a lineage.
There are several inferences to be drawn from this history: the need for vigilance lest disease formulations become stalking-horses for moralism and social control, the need to integrate awareness of alcohol dependence as a dimensional individual-level problem, with a public health understanding of the vastly amorphous and at least equally important universe of alcohol-related problems; the dangers lurking in scientific reductionism when the problems at issue truly require a multi-disciplinary analysis; and the need for global consensus rather than cultural imposition of ideas on what counts as the problem with drink.
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The National Survey on Drug Use and Health (NSDUH) series (formerly titled National Household Survey on Drug Abuse) primarily measures the prevalence and correlates of drug use in the United States. The surveys are designed to provide quarterly, as well as annual, estimates. Information is provided on the use of illicit drugs, alcohol, and tobacco among members of United States households aged 12 and older.
The 2008 NSDUH data and documentation files are now available for download and online analysis from the Substance Abuse and Mental Health Data Archive (SAMHDA). SAMHDA provides ready access to the most current and comprehensive national data on substance abuse and mental health. All SAMHDA data and services are free of charge and may be downloaded from the SAMHDA Web site. Most studies are available for online analysis. Annual reports for the NSDUH series are provided by SAMHSA's Office of Applied Studies.
With tools such as Quick Tables, users can easily produce custom analytic tables with the NSDUH data. Just choose from preselected variables on drop-down menus by pointing and clicking. Then, copy and paste the results into documents or slides.
Download Data | Use Quick Tables | Analyze Data Online
Morphometric analysis and classification of the facial phenotype associated with fetal alcohol syndrome in 5- and 12-year-old children
Landmark-based morphometric analysis holds promise for quantitative assessment of craniofacial dysmorphology.
We describe an application of facial shape analysis to characterize the facial anomalies associated with fetal alcohol syndrome (FAS) in a mixed ancestry population.
Generalized Procrustes analysis, regression and discriminant function analysis were applied to stereo-photogrammetrically derived 3D coordinates of landmarks taken from 34 subjects (n = 17 FAS and n = 17 normal controls).
Four shape analyses were carried out, namely a comparison of the FAS and control facial shapes at age 5, and one at age 12; a comparison of the FAS facial shapes at ages 5 and 12; and a comparison of control facial shapes at ages 5 and 12.
The first two analyses showed that the FAS face is characterized by small palpebral fissures, a thin upper lip, and midfacial hypoplasia. Classification of subjects as having FAS using leave-one-out cross-validation showed that the 5-year-old group could be classified with 95.46% accuracy and the 12-year-olds with 80.13% accuracy.
The third and fourth analyses revealed that the differences in facial shape between FAS individuals in different age groups were more pronounced than for control individuals, supporting the notion that FAS facial anomalies diminish with age.
Geometric morphometric analysis of stereo-photogrammetrically derived 3D facial landmarks allows visualization of the facial anomalies associated with FAS, as well as classification of facial shapes.
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Thursday, December 17, 2009
We sought to identify a level of alcohol consumption representing the boundary between health protective and hazardous drinking.
The Winnipeg Health and Drinking Survey began in 1990–91 (n = 1257). Seven years later, a third wave of interviews (n = 785) expanded questions on heavy episodic drinking (HED) and assessed the consumption of ≥ 3, ≥ 5, ≥ 8, and ≥ 12 drinks at a sitting for each of wine, beer and liquor (equivalent to about 40 g, 65 g, 105 g and 155 g of ethanol). Cox proportional hazards models were based on seven years of illness and mortality data following the Wave 3 interview, and were stratified by gender and HED definition.
For HED of ≥ 40 g, ≥ 65 g, ≥ 105 g, or ≥ 155 g per occasion, the hazard ratios for morbidity and mortality from all causes were 1.06, 1.09, 1.17, and 1.16 respectively in women, and 1.00, 0.98, 1.02, and 1.02 in men. Most of these hazard ratios were significant in women, whereas none was significant in men.
This study did not provide support for a definition of HED that could divide protective from hazardous alcohol consumption.
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Binge drinking is a major problem at North American universities. Disinhibited traits have provided insight on other patterns of alcohol involvement, but less is known about how they relate to bingeing.
Thrill and Adventure Seeking and Boredom Susceptibility predicted bingeing. As about 15% of the variability in bingeing was due to disinhibition facets, they should be considered in future models of student vulnerability to bingeing.
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A Systematic Review of Continuous Performance Task Research in Children Prenatally Exposed to Alcohol
The aim of this study was to review systematically, research investigating an association between the continuous performance task (CPT) in children and exposure to alcohol in utero, in order to identify any evidence of a specific deficit in performance.
A total of 14 papers were identified for inclusion. There was no consistent evidence of any association between prenatal alcohol exposure and correct responses, reaction time, commission or omission errors during CPT testing. Apparent trends in the reported results, however, suggest that a potential effect might have been missed.
Identifying a specific profile of CPT performance may assist in the detection and management of attention deficits amongst children with prenatal alcohol exposure. Future research with more consistent measures of exposure and outcome is, however, required before any valid generalizations about CPT performance can be made.
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Healthcare and Medical Graduates of 2009: Their Reactions to Four Key Proposals in the Scottish Government’s Strategy for Tackling Alcohol Misuse
This study compares the views of final year medical, and nursing and allied health professional (NAHP) students in relation to four governmental proposals impacting on the sale and purchase of alcohol.
Over three quarters of all students agreed with the proposed change to reduce the drink driving limit to 50 mg/100 ml blood. Less support was evident for the raising of the minimum legal purchase age for off-sales (37%), the banning of below cost price promotions of alcohol (47%) and minimum retail pricing (37%). However, there were differences between the NAHP and medical students in the case of the final two proposals; over 60% of the medical students agreed they would have a positive impact. For NAHPs, figures were 41% and 31%, respectively.
Support for four key proposals outlined by the Scottish Government to address alcohol misuse varied. Only the suggestion to lower the drink driving limit received backing overall and within students in these professions. Effectiveness of proposed restrictions on the price of alcohol was less well regarded except by medical students. Evident gaps in knowledge around health guidelines, and the finding that almost half of NAHPs disagreed that they had the appropriate knowledge to advise patients about responsible drinking advice and alcohol misuse problems, suggest a need for improved undergraduate education and continued professional development with respect to public health aspects of alcohol use.
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What are your priorities right now? Identifying service needs across recovery stages to inform service development
Substance use disorders (SUD) are, for many, chronic conditions that are typically associated with severe impairments in multiple areas of functioning. “Recovery” from SUD is, for most, a lengthy process; improvements in other areas of functioning do not necessarily follow the attainment of abstinence.
The current SUD service model providing intense, short-term, symptom-focused services is ill-suited to address these issues. A recovery-oriented model of care is emerging, which provides coordinated recovery-support services using a chronic-care model of sustained recovery management.
Information is needed about substance users' priorities, particularly persons in recovery who are not currently enrolled in treatment, to guide the development of recovery-oriented systems.
As a first step in filling this gap, we present qualitative data on current life priorities among a sample of individuals that collectively represent successive recovery stages (N = 356).
Findings suggest that many areas of functioning remain challenging long after abstinence is attained, most notably employment and education, family/social relations, and housing. Although the ranking of priorities changes somewhat across recovery stages, employment is consistently the second most important priority, behind working on one's recovery.
Study limitations are noted, and the implications of findings for the development and evaluation of recovery-oriented services are discussed.
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Xie Feiyong, leader of a traffic police detachment in Shenzhen, really knew how to care for his subordinates. He recently invited his officers to dinner and after one died of drinking, his detachment reported the officer as dying in the line of duty and named him as a candidate for the honor of a martyr.
When questioned by the press, Xie said: "There was nothing unusual about it."
"Martyr" is a noble and sacred word. However, because of Xie, it has become a tool of corruption. Any educated Chinese knows what "martyr" means. It would be difficult for anybody to associate it with a police officer who died of binge drinking.
Xie believed that drinking is part of an officer's job. As he said: "For our work, we must maintain good relations with village heads, we often went for a drink with them. There is nothing wrong about it." . . . . .
Wednesday, December 16, 2009
The Road to Recovery Update keeps you informed about activities leading up to National Alcohol and Drug Addiction Recovery Month (Recovery Month) in September as well as throughout the year.
We encourage you to forward this information to friends and colleagues, include it in newsletters or listservs, or link to it from your Web site by going to Road to Recovery Updates.
Early Release of Selected Estimates Based on Data From the January-June 2009 National Health Interview Survey
9. Alcohol consumption
- Figure 9.1. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year: United States, 1997-June 2009
- Figure 9.2. Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by age group and sex: United States, January-June 2009
- Figure 9.3. Age-sex-adjusted percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by race/ethnicity: United States, January-June 2009
- Data tables for Figures 9.1-9.3
Cross-Cultural Gateway to Recovery: A Qualitative Study of Recovery Experiences in International AA Online Groups
This ethnographic case-study explored people's use of online Alcoholics Anonymous (AA) groups with a global membership. The main objective was to explore AA members' preferences for using online AA groups, or not.
Main queries were: Do participants use only online AA groups or both face-to-face and online groups? If they use only online groups, how do they explain their preference? If they use both, how do they view the online alternative? Finally, how do the AA members experience the global membership in the online groups? Can they identify with each other?
The empirical basis for the discussion comprises data from participant observation in two international online AA groups for 1 year, involving content analysis of discussion threads, and a limited number of e-mail interviews.
The result of the analysis is presented as a summary of what is gained from participation in online vs. F2F AA groups. The discussion of emerging themes suggests that online AA members can easily identify with each other despite their cultural differences. The majority of AA members in this study seem to prefer a combination of face-to-face and online AA groups.
The plethora of AA resources on the Internet also seems to have provided AA members the opportunity to "customise" their recovery program and support network in a way that suits their particular needs and life situations, and in ways that transcend their native culture.
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Parents who give their children watered-down wine in the hope of introducing them to sensible drinking habits are misguided, according to the chief medical officer, who today recommends that no young person under the age of 15 should drink at all. . .
Guidance on the consumption of alcohol by children and young people. A report by the Chief Medical Officer
In April 2008 the Chief Medical Officer was asked by the Secretaries of State for Health and for Children, Schools and Families to prepare guidance on the consumption of alcohol by children and young people.
Over the last decade, public concern about the impact of alcohol on health and society has steadily mounted.
Particular concern has centred on the level and pattern of drinking among children and young people and its consequences on health, crime, violence and antisocial behaviour.
The key role of the Chief Medical Officer is to provide, for the Government and the public, advice without fear or favour. The best scientific evidence has been sought and used as the basis not just for presenting the facts, but also for making well-founded policy recommendations.
The work to support the Department of Health in producing this report has been carried out by Professor Mark Bellis and his team at the Centre for Public Health, Liverpool John Moores University. . . . .
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This study seeks to address analytical issues regarding the joint usage of alcohol, tobacco, and drugs, focusing on incomes, taxes, and gender-related differences.
Many studies analyze a single addictive substance, with the maintained assumption (often due to data inadequacies) that the use of other addictive substances does not matter. Using a database that is uniquely suited to the task, this study examines economic determinants of addiction probabilities and decomposes the differences between men and women into risk factors and probabilities.
Women, Blacks, and Hispanics are less likely to engage in addictive behaviors. Increased cigarette and beer taxes negatively affect probabilities of smoking and drinking. Increasing both cigarette and beer taxes is related both to more abstinence (none of the three types of substances), and to more use of drugs (which are untaxed).
The measured impacts of current income and current taxes on addictive goods are strong even though addictive decisions are almost certainly longer term decisions, reflecting both current and past prices. However, the impacts of current incomes and taxes in the multinomial logit formulations are highly significant and the results are plausible.
To the extent that taxes can reduce harmful addictive behaviors, the utilization and cost of health care attributable to addiction may be reduced.
Higher taxes have strong potential negative impacts on addictive behaviors. The effects differ, however, by gender, race, and age, and ethnicity.
The analysis could be extended to two part models, in which quantities and/or expenditures on alcohol, tobacco, or drugs may be examined, conditional on the individuals' specific categories of addictive substance used. With panel data, decisions on starting and/or stopping drinking, smoking, or ingesting drugs may also be considered.
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A recent comparison of proposed national alcohol policies in Lesotho, Malawi, Uganda, and Botswana shows that the drinks industry has assumed a significant and detrimental role in designing national alcohol policies in Sub-Saharan Africa. The policy drafts point to the alcohol industry's preferred version of a national alcohol policy, which includes letting the industry regulate its own marketing activities.
In a study published in the January issue of the journal Addiction, researchers Øystein Bakke and Dag Endal found that that alcohol policy documents from the four African countries were almost identical, and were likely based on a single source document that reflects alcohol industry interests. That source document originates from a series of alcohol policy initiatives in Sub-Saharan countries sponsored by multinational brewer SABMiller and the International Center on Alcohol Policies (ICAP), an alcohol industry-funded organisation. . . . . .
Tuesday, December 15, 2009
Commentary on Mishra et al. (2010): Transcranial magnetic stimulation effects on craving: impressive therapy or therapeutic impressions?
With their clinical trial of repetitive transcranial magnetic stimulation (TMS) of the dorsolateral prefrontal cortex, Mishra and colleagues unveil an exciting, novel, high-tech approach to the treatment of alcohol dependence Ten daily sessions of TMS reduced alcohol craving during the month following treatment in patients who received active versus sham TMS. The exact mechanisms of this treatment (i.e. its impact on circuits, neural firing patterns and plasticity, and addiction processes) are unclear, but biologically plausible. Promising to validate undeniably Alan Leshner's credo that 'addiction is a brain disease' to the world, this early clinical trial will rightfully generate interest and excitement.
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Efficacy of repetitive transcranial magnetic stimulation in alcohol dependence: a sham-controlled study
To study the anticraving efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) of the right dorsolateral pre-frontal cortex (DLPFC) in patients with alcohol dependence.
Right dorsolateral pre-frontal high-frequency rTMS was found to have significant anticraving effects in alcohol dependence.
The results highlight the potential of rTMS which, combined with other anticraving drugs, can act as an effective strategy in reducing craving and subsequent relapse in alcohol dependence.
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Vested Interests in Addiction Research and Policy Alcohol policies out of context: drinks industry supplanting government role in alcohol policies in
In this paper, we describe an analysis of alcohol policy initiatives sponsored by alcohol producer SABMiller and the International Center on Alcohol Policies, an alcohol industry-funded organization. In a number of sub-Saharan countries these bodies have promoted a 'partnership' role with governments to design national alcohol policies.
The comparison indicated that the four drafts are almost identical in wording and structure and that they are likely to originate from the same source.
The processes and the draft policy documents reviewed provide insights into the methods, as well as the strategic and political objectives of the multi-national drinks industry. This initiative reflects the industry's preferred version of a national alcohol policy. The industry policy vision ignores, or chooses selectively from, the international evidence base on alcohol prevention developed by independent alcohol researchers and disregards or minimizes a public health approach to alcohol problems. The policies reviewed maintain a narrow focus on the economic benefits from the trade in alcohol. In terms of alcohol problems (and their remediation) the documents focus upon individual drinkers, ignoring effective environmental interventions. The proposed policies serve the industry's interests at the expense of public health by attempting to enshrine 'active participation of all levels of the beverage alcohol industry as a key partner in the policy formulation and implementation process'.
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- Among young adults approaching their 21st birthdays (i.e., persons surveyed in the 30 days prior to their 21st birthdays), 86.1 percent had used alcohol in their lifetime, including 62.8 percent who had initiated use before their 18th birthdays
- Rates of past month and binge alcohol use were higher among young adults who had recently turned 21 than among those who were still 20 years old
- Rates of past month and binge alcohol use among 21 year olds declined and then stabilized in the months following their 21st birthdays, but their rates still remained higher than those for 20 year olds
Enthusiastic young colleagues new to the addiction treatment field not infrequently ask a question something like this: 'What are the most important things I need to know about addiction and how to treat it that I can read about over the next month or two?'. This paper documents a list of 10 things about addiction that have emerged over the last three or four decades that form an overview of the most important things known about addiction that I think would be useful for new colleagues to get to grips with quickly as they embark on their career in addiction treatment. It may also be useful for established colleagues to compare with their own list in the ongoing process of freshening up clinical practice and as a prelude to considering the most fruitful areas to research that will bring about the greatest treatment improvements for addicted people. This summary is not intended to be an exhaustive catalogue of addiction treatment knowledge. It focuses upon addiction treatment in dedicated addiction treatment settings and is naturally biased towards the work of key figures in the international field who have had a significant influence on the thinking of our group at the National Addiction Centre (NAC) Aotearoa, New Zealand. If you were limited to listing the 10 most important things known about addiction, would your list be similar to what follows? . . . .
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truly enjoyed reading Doug Sellman's paper . These types of paper, which summarize the literature briefly and, even more importantly, review it critically, are needed, especially right now, as there are increasing numbers of scientific outlets for papers and it becomes increasingly difficult to gain an overview of the field—not only for young scholars, who have just entered the field, but also for 'old and wise' researchers who have been in the field for a long time. The paper is an eye-opener, not so much because of the discussed empirical evidence for the 10 important insights, but through the combination and order of the 10 things. It makes one think about where we stand and what the next endeavours should be.
However, the question is not whether or not I agree with Sellman on the selection of 10 most important 'things'. Such a list is driven by personal experience, expertise and motivations. In fact, I fully agree with many of his statements; for instance, the neuropsychological processes related to addictive behaviours such as cue-signalling and reactivity, that go outside conscious awareness, the recent trends in thinking about addiction as complex gene–environment interactions and the statement that addictive behaviours occur mainly with other psychiatric disorders—which has huge complications for studying treatment effects. I also agree with the relevance of scrutinizing treatment alliances, and the dynamic developmental interactions between therapist and patient, rather than testing differences exclusively between treatments.
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In his paper, Sellman divides the scientific evidence that impacts treatment for addictions into 10 principles. It is easy to follow and is a most welcome guide for those interested in treatment and a useful translation of scientific evidence for both the specialist and the non-specialist responsible for making decisions related to the funding of services and training of specialists and so on.
The paper marshals evidence against mistaken conceptions about the nature of addiction and the effectiveness of treatment. It is often thought that one episode of treatment is enough and that relapse constitutes failure, conceptions that must be corrected if we want to reduce the treatment gap. This issue is reflected in the statement: 'Addiction is a chronic relapsing disorder in the majority of people who present for help'. To this very interesting review of the issue I would add that treatment should be readily available because, as Sellman correctly states, 'Change takes time'.
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There is a fault line beneath addiction treatment, between the 'moral–spiritual' and the 'empirical, social sciences' traditions. The dominant paradigm is moral–spiritual, in which conversion (the 'epiphany') is the basis of recovery. In so far as therapists can promote change it is slow, fluctuating, and lacks the black-and-white clarity that fits the dominant paradigm. Worse, we are in a bind—we must engender 'hope', while avoiding 'unrealistic expectations'. Unrealistic expectations of cure contribute to frustration in the lives of addicts and their families, and corrupt the practitioners who seek to meet those expectations. Young practitioners, you must avoid the lure of being a charismatic healer; the 'first step' towards helping people is to admit that we are powerless to cure our patients.
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