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, February 13, 2010

Motivation in substance misuse treatment

This review summarises the different motivational frameworks that are commonly applied to the study of substance misuse and explores the potential of a comprehensive conceptualisation of motivation based on the self-determination theory (SDT).

The most prominent conceptualisations of motivation to change amongst substance misusing patients are identified. Defining and measuring the concept of motivation within a sound theoretical framework has been a challenge. The literature lends little support to the conceptualisation of motivation as internal and external types. Promising work employs a dynamic model of motivation, but empirical research based on such a framework is still in its infancy.

There is empirical support to the conceptual distinction between motivation and treatment readiness and it appears that such a distinction can be particularly useful to treatment services.

Clients’ motivation has significant implications for initiating and sustaining recovery, and future conceptual and methodological improvements are needed that can improve our understanding of how people change addictive behaviours and what can be done better to assist them in their attempts to recover from addiction.

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Wage penalty of abstinence and wage premium of drinking–A misclassification bias due to pooling of drinking groups?

Several studies have found protective effects of low/moderate (hereafter ‘light’) alcohol consumption compared with ‘abstinence’ on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption.

It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers.

The aim of this article is to study whether the pooling of consumption groups creates bias in the form of misclassification and confounding. The analysis focuses on: ‘former drinker error’ (pooling of lifelong abstainers and former drinkers); ‘former abstainer error’ (pooling of former abstainers and lifelong light drinkers) and ‘former heavy drinker error’ (pooling of light drinkers with and without a history of heavy drinking).

Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups.

The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers.

The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and therefore cannot explain the wage penalty of abstinence compared to light drinking.

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Confirmation and Generalization of an Alcohol-Dependence Locus on Chromosome 10q

Several genome scans on alcohol dependence (AD) and AD-related traits have been published.

In this article, we present the results of a genome-wide linkage scan on AD and several related traits in 322 European-American (EA) families, and results of additional analysis in 335 African-American (AA) families that were the subject of a previous report. All families were initially ascertained for cocaine and
/or opioid dependence.

Non-parametric linkage analysis in the EA sample revealed suggestive linkages on chromosomes 7 (LOD
=2.1 at 82.8cM, p=0.0009) and 10 (LOD=3.0 at 137.7cM, p=0.0001). The chromosome 10 linkage peak is 20cM distal from a genome-wide significant linkage peak we observed previously in the AA sample.

Parametric linkage analysis on chromosome 10 (assuming a recessive model, 80
% penetrance, disease allele frequency=0.3) resulted in LOD scores of 2.7 at 136.7cM and 1.9 at 121.7cM in the EA and AA samples, respectively, with a combined sample genome-wide significant LOD score of 4.1 at 131.7cM.

To reduce heterogeneity of the AD phenotype, we also assessed linkage of chromosome 10 markers with the presence of alcohol withdrawal symptoms, one of the seven components of the DSM-IV diagnosis of AD. Suggestive evidence for linkage was observed in both populations with only 5
cM separating the location of the peak LOD scores despite a loss of power due to a smaller number of families informative for this trait.

Results of our study confirm a chromosome 10 risk locus for AD in two genetically distinct populations and suggest that this locus may correspond more precisely to a specific component of the disorder.

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An evaluation of ‘Reach Out Central’: an online gaming program for supporting the mental health of young people

The objective of this study was to conduct an evaluation of Reach Out Central (ROC), an online gaming program designed to support the mental health of people aged 16–25. The evaluation sought to determine the benefit of playing ROC on alcohol use, use of coping strategies, psychological distress, resilience and satisfaction with life.

Changes in mental health literacy,
mental health stigma and willingness to seek help and program satisfaction were also investigated. A single group (N = 266) quasi-experimental repeated measures (pre-, post-program, 2-month follow-up) design was employed.

The results demonstrated positive
improvements across all outcome measures for females; however, a non-significant worsening effect was observed for males on seeking support, avoidance and resilience. Improvements for both genders were observed on mental health literacy and help-seeking.

However, literacy levels and help-seeking were significantly
higher, and stigma significantly lower for females. Program satisfaction ratings were high irrespective of gender.

some inconsistencies between genders were noted, ROC appears to enhance protective factors for the prevention or early intervention of mental health disorders.

The results of this study need to
be viewed with its limitations in mind, specifically, the use of an open trial methodology and the small number of male participants.

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Relation of Gamma-Glutamyltransferase and Alcohol Drinking with Incident Diabetes: the HIPOP-OHP Study

Gamma-glutamyltransferase (GGT) is known to correlate well with alcohol consumption; however, the relation between GGT and diabetes and that between alcohol consumption and diabetes mellitus (DM) is inconsistent. Thus, several questions, such as whether light to moderate drinkers can be considered as low risk for diabetes incidence irrespective of their GGT level, is unresolved.

In this study, we investigated the relation of GGT or alcohol drinking with DM incidence considering the body mass index (BMI) in healthy Japanese workers.

Participants with higher GGT (GGT ≥27 IU/L) showed an increased risk of diabetes incidence even when their BMI level was low. Although a U-shaped relation between alcohol drinking and incident diabetes was observed, the risk to light to moderate drinkers (alcohol <23>2) or had higher GGT (HR=2.60, p=0.08) or both overweight and higher GGT (HR=3.16, p=0.07) compared with never drinkers without higher GGT and overweight.

Higher GGT was associated with a higher incidence of DM irrespective of drinking status or obesity. Although a U-shaped relation between alcohol drinking and incident diabetes was observed, the risk to light to moderate drinkers was not low if they were either overweight or had higher GGT.

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Understanding the construct of impulsivity and its relationship to alcohol use disorders

There are well-established links between impulsivity and alcohol use in humans and other model organisms; however, the etiological nature of these associations remains unclear. This is likely due, in part, to the heterogeneous nature of the construct of impulsivity.

Many different measures of impulsivity have been employed in human studies, using both questionnaire and laboratory-based tasks. Animal studies also use multiple tasks to assess the construct of impulsivity. In both human and animal studies, different measures of impulsivity often show little correlation and are differentially related to outcome, suggesting that the impulsivity construct may actually consist of a number of more homogeneous (and potentially more meaningful) subfacets.

Here, we provide an overview of the different measures of impulsivity used across human and animal studies, evidence that the construct of impulsivity may be better studied in the context of more meaningful subfacets, and recommendations for how research in this direction may provide for better consilience between human and animal studies of the connection between impulsivity and alcohol use

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Consilient research approaches in studying gene × environment interactions in alcohol research

This review article discusses the importance of identifying gene-environment interactions for understanding the etiology and course of alcohol use disorders and related conditions.

A number of critical challenges are discussed, including the fact that there is no organizing typology for classifying different types of environmental exposures, many key human environmental risk factors for alcohol dependence have no clear equivalents in other species, much of the genetic variance of alcohol dependence in human is not 'alcohol specific', and the potential range of gene-environment interactions that could be considered is so vast that maintaining statistical control of Type 1 errors is a daunting task.

Despite these and other challenges, there appears to be a number of promising approaches that could be taken in order to achieve consilience and ecologically valid translation between human alcohol dependence and animal models.

Foremost among these is to distinguish environmental exposures that are thought to have enduring effects on alcohol use motivation (and self-regulation) from situational environmental exposures that facilitate the expression of such motivations but do not, by themselves, have enduring effects. In order to enhance consilience, various domains of human approach motivation should be considered so that relevant environmental exposures can be sampled, as well as the appropriate species to study them in (i.e. where such motivations are ecologically relevant).

Foremost among these are social environments, which are central to the initiation and escalation of human alcohol consumption.

The value of twin studies, human laboratory studies and pharmacogenetic studies is also highlighted.

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A comparison of selected quantitative trait loci associated with alcohol use phenotypes in humans and mouse models

Evidence for genetic linkage to alcohol and other substance dependence phenotypes in areas of the human and mouse genome have now been reported with some consistency across studies.

However, the question remains as to whether the genes that underlie the alcohol-related behaviors seen in mice are the same as those that underlie the behaviors observed in human alcoholics.

The aims of the current set of analyses were to identify a small set of alcohol-related phenotypes in human and in mouse by which to compare quantitative trait locus (QTL) data between the species using syntenic mapping.

These analyses identified that QTLs for alcohol consumption and acute and chronic alcohol withdrawal on distal mouse chromosome 1 are syntenic to a region on human chromosome 1q where a number of studies have identified QTLs for alcohol-related phenotypes.

Additionally, a QTL on human chromosome 15 for alcohol dependence severity/withdrawal identified in two human studies was found to be largely syntenic with a region on mouse chromosome 9, where two groups have found QTLs for alcohol preference.

In both of these cases, while the QTLs were found to be syntenic, the exact phenotypes between humans and mice did not necessarily overlap.

These studies demonstrate how this technique might be useful in the search for genes underlying alcohol-related phenotypes in multiple species.

However, these findings also suggest that trying to match exact phenotypes in humans and mice may not be necessary or even optimal for determining whether similar genes influence a range of alcohol-related behaviors between the two species.

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Acute withdrawal, protracted abstinence and negative affect in alcoholism: are they linked?

The role of withdrawal-related phenomena in the development and maintenance of alcohol addiction remains under debate. A 'self-medication' framework postulates that emotional changes are induced by a history of alcohol use, persist into abstinence, and are a major factor in maintaining alcoholism.

This view initially focused on negative emotional states during early withdrawal: these are pronounced, occur in the vast majority of alcohol-dependent patients, and are characterized by depressed mood and elevated anxiety.

This concept lost popularity with the realization that in most patients, these symptoms abate over 3–6 weeks of abstinence, while relapse risk persists long beyond this period. More recently, animal data have established that a prolonged history of alcohol dependence induces more subtle neuroadaptations. These confer altered emotional processing that persists long into protracted abstinence. The resulting behavioral phenotype is characterized by excessive voluntary alcohol intake and increased behavioral sensitivity to stress.

Emerging human data support the clinical relevance of negative emotionality for protracted abstinence and relapse. These developments prompt a series of research questions: (1) are processes observed during acute withdrawal, while transient in nature, mechanistically related to those that remain during protracted abstinence?; (2) is susceptibility to negative emotionality in acute withdrawal in part due to heritable factors, similar to what animal models have indicated for susceptibility to physical aspects of withdrawal?; and (3) to what extent is susceptibility to negative affect that persists into protracted abstinence heritable?

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Reward sensitivity: issues of measurement, and achieving consilience between human and animal phenotypes

Reward is a concept fundamental to discussions of drug abuse and addiction.

The idea that altered sensitivity to either drug–reward, or to rewards in general, contributes to, or results from, drug-taking is a common theme in several theories of addiction. However, the concept of reward is problematic in that it is used to refer to apparently different behavioural phenomena, and even to diverse neurobiological processes (reward pathways).

Whether these different phenomena are different behavioural expressions of a common underlying process is not established, and much research suggests that there may be only loose relationships among different aspects of reward.

Measures of rewarding effects of drugs in humans often depend upon subjective reports. In animal studies, such insights are not available, and behavioural measures must be relied upon to infer rewarding effects of drugs or other events. In such animal studies, but also in many human methods established to objectify measures of reward, many other factors contribute to the behaviour being studied. For that reason, studying the biological (including genetic) bases of performance of tasks that ostensibly measure reward cannot provide unequivocal answers.

The current overview outlines the strengths and weaknesses of current approaches that hinder the conciliation of cross-species studies of the genetics of reward sensitivity and the dysregulation of reward processes by drugs of abuse.

Some suggestions are made as to how human and animal studies may be made to address more closely homologous behaviours, even if those processes are only partly able to isolate 'reward' from other factors contributing to behavioural output.

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Human and laboratory rodent low response to alcohol: is better consilience possible?

If people are brought into the laboratory and given alcohol, there are pronounced differences among individuals in many responses to the drug.

Some participants in alcohol challenge protocols show a cluster of 'low level of responses to alcohol' determined by observing post-drinking-related changes in subjective, motor and physiological effects at a given dose level. Those individuals characterized as having low level of response (LR) to alcohol have been shown to be at increased risk for a lifetime diagnosis of alcohol dependence (AD), and this relationship between low LR and AD appears to be in part genetic.

LR to alcohol is an area where achieving greater consilience between the human and the rodent phenotypes would seem to be highly likely.

However, despite extensive data from both human and rodent studies, few attempts have been made to evaluate the human and animal data systematically in order to understand which aspects of LR appear to be most directly comparable across species and thus the most promising for further study.

We review four general aspects of LR that could be compared between humans and laboratory animals: (1) behavioral measures of subjective intoxication; (2) body sway; (3) endocrine responses; and (4) stimulant, autonomic and electrophysiological responses.

None of these aspects of LR provide completely face-valid direct comparisons across species. Nevertheless, one of the most replicated findings in humans is the low subjective response, but, as it may reflect either aversively valenced and/or positively valenced responses to alcohol as usually assessed, it is unclear which rodent responses are analogous. Stimulated heart rate appears to be consistent in animal and human studies, although at-risk subjects appear to be more rather than less sensitive to alcohol using this measure. The hormone and electrophysiological data offer strong possibilities of understanding the neurobiological mechanisms, but the rodent data in particular are rather sparse and unsystematic.

Therefore, we suggest that more effort is still needed to collect data using refined measures designed to be more directly comparable in humans and animals. Additionally, the genetically mediated mechanisms underlying this endophenotype need to be characterized further across species

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Friday, February 12, 2010

Ethanol consumption: how should we measure it? Achieving consilience between human and animal phenotypes

There is only modest overlap in the most common alcohol consumption phenotypes measured in animal studies and those typically studied in humans.

To address this issue, we identified a number of alcohol consumption phenotypes of importance to the field that have potential for consilience between human and animal models.

These phenotypes can be broken down into three categories: (1) abstinence/the decision to drink or abstain; (2) the actual amount of alcohol consumed; and (3) heavy drinking.

A number of suggestions for human and animal researchers are made in order to address these phenotypes and enhance consilience. Laboratory studies of the decision to drink or to abstain are needed in both human and animal research. In human laboratory studies, heavy or binge drinking that meets cut-offs used in epidemiological and clinical studies should be reported. Greater attention to patterns of drinking over time is needed in both animal and human studies. Individual differences pertaining to all consumption phenotypes should be addressed in animal research.

Lastly, improved biomarkers need to be developed in future research for use with both humans and animals. Greater precision in estimating blood alcohol levels in the field, together with consistent measurement of breath/blood alcohol levels in human laboratory and animal studies, provides one means of achieving greater consilience of alcohol consumption phenotypes.

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Thursday, February 11, 2010

Dopamine D2 receptor polymorphisms and susceptibility to alcohol dependence in Indian males: a preliminary study

Dopamine is an important neurotransmitter involved in reward mechanism in brain and thereby influences development and relapse of alcohol dependence. The dopamine D2 receptor (DRD2) gene on chromosome 11 (q22-q23) has been found to be associated with increased alcohol consumption through mechanisms involving incentive salience attributions and craving in alcoholic patients.

Therefore, we investigated the association of three single nucleotide polymorphisms (SNP) in DRD2 gene with alcohol dependence in north Indian subjects.

The study showed a significant association of -141C Ins allele and a trend of association of TaqI A1 allele of DRD2 with alcohol dependence. Haplotype with the predisposing -141C Ins and TaqI A1 alleles (-141C Ins-A-A1) seems to confer [almost equal to] 2.5 times more risk to develop alcohol dependence.

The study provides preliminary insight into genetic risk to alcohol dependence in Indian males. Two polymorphisms namely, -141C Ins/Del and TaqI A in DRD2 gene may have clinical implications among Indian alcoholic subjects.

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Preventing Fetal Alcohol Spectrum Disorders: The Role of Protection Motivation Theory

This article examines health communication campaigns aimed at preventing alcohol consumption among women who are pregnant or attempting to become pregnant.

A majority of the campaigns followed the tenets of protection motivation theory by focusing on the threat variables of severity and vulnerability, as well as emphasizing response efficacy. Few campaigns focused on costs or self-efficacy.

Future fetal alcohol spectrum disorders prevention initiatives should attempt to reduce perceived costs, as well as include self-efficacy messages in order to increase women's confidence that they can carry out the recommended actions.

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Genetics of Addictions

Addictions include a group of common, heritable psychiatric illnesses that have multiple psychiatric and medical comorbidities.

Robust genetic associations have been found for alcohol dependence, nicotine dependence, and cocaine dependence.

Common genetic associations have been found between alcohol dependence and aerodigestive cancers and between nicotine dependence and lung disease.

These associations highlight the importance of understanding the genetics of substance dependence in the context of its multiple medical and psychiatric comorbidities.

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Acute psychomotor effects of MDMA and ethanol (co-) administration over time in healthy volunteers

In Western societies, a considerable percentage of young people use 3,4-methylenedioxymethamphetamine (MDMA or ‘ecstasy’). The use of alcohol (ethanol) in combination with ecstasy is common.

The aim of the present study was to assess the acute psychomotor and subjective effects of (co-) administration of MDMA and ethanol over time and in relation to the pharmacokinetics.

MDMA significantly increased psychomotor speed but did not affect psychomotor accuracy and induced subjective arousal. Ethanol impaired both psychomotor speed and accuracy and induced sedation. Coadministration of ethanol and MDMA improved psychomotor speed but impaired psychomotor accuracy compared with placebo and reversed ethanol-induced sedation.

Pharmacokinetics and pharmacodynamics showed maximal effects at 90—150 min after MDMA administration after which drug effects declined in spite of persisting MDMA plasma concentration, with the exception of ethanol-induced sedation, which manifested itself fully only after the infusion was stopped.

In conclusion, results show that subjects were more aroused when intoxicated with both substances combined compared with placebo, but psychomotor accuracy was significantly impaired.

These findings may have implications for general neuropsychological functioning as this may provide a sense of adequate performance that does not agree with a significant reduction in psychomotor accuracy.

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Ethanol co-administration moderates 3,4-methylenedioxymethamphetamine effects on human physiology

Alcohol is frequently used in combination with 3,4-methylenedioxymethamphetamine
(MDMA). Both drugs affect cardiovascular function, hydration and temperature regulation, but may have partly opposing effects.

The present study aims to assess the acute physiologic effects of (co-) administration of MDMA and ethanol over time.

Ethanol did not significantly affect physiologic function, with the exception of a short lasting increase in heart rate. MDMA potently increased heart rate and blood pressure and induced fluid retention as well as an increase in temperature.

Co-administration of ethanol with MDMA did not affect cardiovascular function compared to the MDMA alone condition, but attenuated the effects of MDMA on fluid retention and showed a trend for attenuation of MDMA-induced temperature increase.

In conclusion, co-administration of ethanol and MDMA did not exacerbate physiologic effects compared to all other drug conditions, and moderated some effects of MDMA alone.

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Polymorphisms of the µ-opioid receptor and dopamine D4 receptor genes and subjective responses to alcohol in the natural environment.

Polymorphisms of the µ-opioid receptor (OPRM1) and dopamine D4 receptor (DRD4) genes are associated with subjective responses to alcohol and urge to drink under laboratory conditions.

This study examined these associations in the natural environment using ecological momentary assessment.

Participants were non-treatment-seeking heavy drinkers (n = 112, 52% female, 61% alcohol dependent) who enrolled in a study of naltrexone effects on craving and drinking in the natural environment. Data were culled from 5 consecutive days of drinking reports prior to medication randomization.

Analyses revealed that, after drinking, carriers of the Asp40 allele of the OPRM1 gene reported higher overall levels of vigor and lower levels negative mood, as compared to homozygotes for the Asn40 variant.

Carriers of the long allele (i.e., =7 tandem repeats) of the DRD4 endorsed greater urge to drink than homozygotes for the short allele.

Effects of OPRM1 and DRD4 variable-number-of-tandem-repeats genotypes appear to be alcohol dose-dependent. Specifically, carriers of the DRD4-L allele reported slight decreases in urge to drink at higher levels of estimated blood alcohol concentration (eBAC), and Asp40 carriers reported decreases in vigor and increases in negative mood as eBAC rose, as compared to carriers of the major allele for each gene.

Self-reported vigor and urge to drink were positively associated with alcohol consumption within the same drinking episode.

This study extends findings on subjective intoxication, urge to drink, and their genetic bases from controlled laboratory to naturalistic settings.

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Do changes in drinking motives mediate the relation between personality change and “maturing out” of problem drinking?.

Recent research has indicated that developmental changes in the personality traits of neuroticism and impulsivity correlate with changes in problem drinking during emerging and young adulthood.

However, it remains unclear what potential mechanisms, or mediators, could account for these associations. Drinking motives, particularly drinking to regulate negative affect (drinking to cope) and to get “high” or “drunk” (drinking for enhancement), have been posited to mediate the relationship between personality and drinking problems.

Recent work indicates that changes in drinking motives parallel changes in alcohol involvement from adolescence to young adulthood.

The present study examined changes in drinking motives (i.e., coping and enhancement) as potential mediators of the relation between changes in personality (impulsivity and neuroticism) with changes in alcohol problems in emerging and young adulthood.

Analyses were based on data collected from a cohort of college students (N = 489) at varying risk for alcohol use disorders from ages 18 to 35.

Parallel process latent growth modeling indicated that change in coping (but not enhancement) motives specifically mediated the relation between changes in neuroticism and alcohol problems as well as the relation between changes in impulsivity and alcohol problems.

Findings suggest that change in coping motives is an important mechanism in the relation between personality change and the “maturing out” of problematic alcohol involvement

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Alcohol demand, delayed reward discounting, and craving in relation to drinking and alcohol use disorders.

A behavioral economic approach to alcohol use disorders (AUDs) emphasizes both individual and environmental determinants of alcohol use.

The current study examined individual differences in alcohol demand (i.e., motivation for alcohol under escalating conditions of price) and delayed reward discounting (i.e., preference for immediate small rewards compared to delayed larger rewards) in 61 heavy drinkers (62% with an AUD).

In addition, based on theoretical accounts that emphasize the role of craving in reward valuation and preferences for immediate rewards, craving for alcohol was also examined in relation to these behavioral economic variables and the alcohol-related variables.

Intensity of alcohol demand and delayed reward discounting were significantly associated with AUD symptoms, but not with quantitative measures of alcohol use, and were also moderately correlated with each other.

Likewise, craving was significantly associated with AUD symptoms, but not with alcohol use, and was also significantly correlated with both intensity of demand and delayed reward discounting.

These findings further emphasize the relevance of behavioral economic indices of motivation to AUDs and the potential importance of craving for alcohol in this relationship.

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New doubt on drink prices crackdown – by expert used to justify policy

ONE of the scientists whose research has underpinned the Scottish Government's push to introduce minimum pricing for alcohol admitted yesterday there is no evidence to show the controversial policy would work.

Sheffield University senior lecturer Dr Petra Meier told Holyrood's health committee the effects of the SNP's minimum pricing policy were "like the weather forecast" because her work was just "a model" of what might happen.

Her comments came as the committee considers the first stage of the Scottish Government's Alcohol Bill and they have raised further doubts about the value of the Sheffield University study into drinking in Scotland, which SNP ministers have claimed proves the case for introducing minimum pricing. . . . . .

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Irregular Heavy Drinking Occasions and Risk of Ischemic Heart Disease: A Systematic Review and Meta-Analysis

Contrary to a cardioprotective effect of moderate regular alcohol consumption, accumulating evidence points to a detrimental effect of irregular heavy drinking occasions (>60 g of pure alcohol or ≥5 drinks per occasion at least monthly) on ischemic heart disease risk, even for drinkers whose average consumption is moderate.

In a random-effects model, the pooled relative
risk of irregular heavy drinking occasions compared with regular moderate drinking was 1.45 (95% confidence interval: 1.24, 1.70), with significant between-study heterogeneity (I2 = 53.9%). Results were robust in several sensitivity analyses.

The authors concluded
that the cardioprotective effect of moderate alcohol consumption disappears when, on average, light to moderate drinking is mixed with irregular heavy drinking occasions.

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Witnessed community and parental violence in relation to substance use and delinquency in a national sample of adolescents

This study examined whether witnessed community and parental violence represented risk factors for substance use and delinquency among adolescents, beyond the contribution of direct violence and other risk factors. We also examined the role of violence characteristics.

While accounting for trauma history and other risk factors, witnessed community and parental violence were associated with delinquency. Community violence was associated with substance use. Chronic violence, knowing the perpetrator, and violence outside of school were correlated with substance use and delinquency among adolescents who witnessed community violence.

These findings highlight the importance of targeting witnessed violence in prevention and intervention efforts

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Recidivist drink drivers’ self-reported reasons for driving whilst unlicensed—A qualitative analysis

This paper presents qualitative data from an in-depth interview study of 40 repeat drink drivers in Perth Western Australia to inform countermeasures for these high risk offenders.

Most respondents who had had their licence suspended admitted to driving whilst under suspension. Employment and social factors were key themes emerging in respondents’ accounts of driving whilst under licence suspension.

Whilst a range of enforcement countermeasures are needed to deter drunk and unlicensed driving, this study suggests that where possible we aim to keep offenders within the system that consists of formal laws and informal social controls, rather than apply penalties in ways that undermine adherence to the law by increasing unlicensed driving. Allowing for interlock installation early in the driving suspension period, and allowing fines to offset cost of interlock installation and monitoring, may maximise community benefit and reduce unlicensed driving.

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The role of substance use and psychosocial characteristics in explaining unintentional injuries

The objective of this study was to examine the relationship between the use of various substances and selected psychosocial characteristics with unintentional injury.

For the univariate analyses, both frequency of cocaine and cannabis use, risk-taking/impulsivity, stress, and coping were significantly related to injuries.

For the multivariate analyses, only risk-taking/impulsivity, stress, age, and sex were significantly related to injuries.

The results provide important information regarding factors associated with reported injuries among individuals in addiction treatment.

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Sweet preferences and analgesia during childhood: effects of family history of alcoholism and depression

To determine whether depression and family history of alcoholism are associated with heightened sweet preferences in children, before they have experienced alcohol or tobacco and at a time during the life-span when sweets are particularly salient.

The co-occurrence of having a family history of alcoholism and self-reports of depressive symptomatology was associated significantly with a preference for a more concentrated sucrose solution, while depressive symptomatology alone was associated with greater liking for sweet-tasting foods and candies and increased pain sensitivity. Depression antagonized the analgesic properties of sucrose.

While children as a group innately like sweets and feel better after eating them, the present study reveals significant contributions of family history of alcoholism and depression to this effect. Whether the heightened sweet preference and the use of sweets to alleviate depression are markers for developing alcohol-related problems or responses that are protective are important areas for future research.

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Internet-based prevention for alcohol and cannabis use: final results of the Climate Schools course

To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools.

This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools.

Internet-based prevention programs for school-age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.

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Wednesday, February 10, 2010

How much alcohol do you buy? A comparison of self-reported alcohol purchases with actual sales

Unrecorded alcohol has increased in the Nordic countries during recent years, above all in terms of cross-border trade. This implies that trends and levels of per capita consumption would look different without estimates of this source of alcohol, estimates that in Sweden and other countries are made through surveys.

Of the recorded amount of purchases at Systembolaget, 87% was reported in the survey, compared with the 40–60% usually found for self-reported consumption. Significant differences across beverages were revealed, showing a lower coverage rate for beer and spirits and a higher coverage rate for wine and cider. Changes in purchases of all beverages were captured fairly well, at least changes taking place from one month to another.

Self-reported alcohol purchases achieve a higher coverage rate than found typically in studies based on self-reported use of alcohol. If adjustments are to be made to correct for underreporting in self-reported data on alcohol purchases, different weights should be applied to different beverages. Furthermore, at least major changes in how much alcohol is purchased in the population can be monitored using well-designed population surveys.

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How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?

To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up.

We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07–2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range.

Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.

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Consequences of eliminating federal disability benefits for substance abusers

Using annual, repeated cross-sections from national household surveys, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation.

We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity-score methods to address differences in observed characteristics between likely substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias.

In the short-run (1997–1998), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes.

In the later period after the policy change (1999–2002), the rate of SSI receipt rose, and short-run gains in labor market outcomes diminished.

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Monday, February 8, 2010

Readiness to Change in Brief Motivational Interventions: A Requisite Condition for Drinking Reductions?

Brief motivational interventions (BMIs) have been found to be efficacious for reducing alcohol use and consequences among college student drinkers. Despite the putative emphasis on motivation, surprisingly little is known about the role of motivation in BMI-facilitated changes.

Using data from three published randomized trials implementing BMIs, we examined motivation or readiness to change (RTC) as a potential mechanism of behavior change. Two of the three studies indicated that BMI were associated with increases in motivation to change alcohol use that are apparent immediately after BMI sessions and persist up to 6-months post-intervention.

However, RTC does not appear to be a mechanism of behavior change, as it did not mediate reductions in alcohol use or problems in any of the studies.

Issues regarding the conceptualization and measurement of RTC are discussed, as well as promising directions for future research.

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Cerebral white matter recovery in abstinent alcoholics—a multimodality magnetic resonance study

Most previous neuroimaging studies of alcohol-induced brain injury and recovery thereof during abstinence from alcohol used a single imaging modality. They have demonstrated widespread microstructural, macrostructural or metabolite abnormalities that were partially reversible with abstinence, with the cigarette smoking potentially modulating these processes.

The goals of
this study were to evaluate white matter injury and recovery thereof, simultaneously with diffusion tensor imaging, magnetic resonance imaging and spectroscopy in the same cohort; and to evaluate the relationships between outcome measures of similar regions.

We scanned 16 non-smoking and 20 smoking alcohol-dependent
individuals at 1 week of abstinence from alcohol and 22 non-smoking light drinkers using a 1.5 T magnetic resonance scanner. Ten non-smoking alcohol-dependent individuals and 11 smoking alcohol-dependent individuals were re-scanned at 1 month of abstinence.

All regional
diffusion tensor imaging, magnetic resonance imaging and spectroscopic outcome measures were calculated over comparable volumes of frontal, temporal, parietal and occipital white matter.

At 1
week of abstinence and relative to non-smoking light drinkers, non-smoking alcohol-dependent individuals had higher mean diffusivity in frontal, temporal and parietal white matter (all P <> whereas smoking alcohol-dependent individuals had elevated mean diffusivity only in frontal white matter (P = 0.03).

alcohol-dependent individuals demonstrated lower concentrations of N-acetyl-aspartate (a marker of neuronal viability) in frontal white matter (P = 0.03), whereas non-smoking alcohol-dependent individuals had lower N-acetyl-aspartate in parietal white matter (P = 0.05).

These abnormalities were not accompanied by detectable white matter atrophy. However, the patterns of white matter recovery were different between non-smoking alcohol-dependent individuals and smoking alcohol-dependent individuals. In non-smoking alcohol-dependent individuals, the increase in fractional anisotropy of temporal white matter (P = 0.003) was accompanied by a pattern of decreases mean diffusivity in all regions over 1 month of abstinence; no corresponding changes were observed in smoking alcohol-dependent individuals.

In contrast, a pattern of white
matter volume increase in frontal and temporal lobes was apparent in smoking alcohol-dependent individuals but not in non-smoking alcohol-dependent individuals. These results were not accompanied by significant changes in metabolite concentrations.

there were no consistent patterns of association between measures obtained with different imaging modalities, either cross-sectionally or longitudinally.

These data demonstrate significant white
matter improvements with abstinence from alcohol, reflected either as microstructural recovery or volumetric increases that depend on the smoking status of the participants.

We believe
our results to be important, as they demonstrate that use of a single imaging modality provides an incomplete picture of neurobiological processes associated with alcohol-induced brain injury and recovery thereof that may even lead to improper interpretation of results.

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Silicon in beer and brewing

It has been claimed that beer is one of the richest sources of silicon in the diet; however, little is known of the relationship between silicon content and beer style and the manner in which beer is produced.

The purpose of this study was to measure silicon in a diversity of beers and ascertain the grist selection and brewing factors that impact the level of silicon obtained in beer.

Commercial beers ranged from 6.4 to 56.5 mg L
-1 in silicon. Products derived from a grist of barley tended to contain more silicon than did those from a wheat-based grist, likely because of the high levels of silica in the retained husk layer of barley. Hops contain substantially more silicon than does grain, but quantitatively hops make a much smaller contribution than malt to the production of beer and therefore relatively less silicon in beer derives from them. During brewing the vast majority of the silicon remains with the spent grains; however, aggressive treatment during wort production in the brewhouse leads to increased extraction of silicon into wort and much of this survives into beer.

It is confirmed that beer is a very rich source of silicon.

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Alcohol levels in killed drivers and pedestrians on Irish roads 2003-2005: a national study.

No official data are provided in Ireland to indicate what proportion of the deaths on Irish roads have alcohol as a contributory factor.

The aim of this study was to identify the blood alcohol concentration (BAC) in fatally injured drivers and pedestrians in Ireland.

An Garda Síochána (The Irish police) gather data on all fatal road crashes and individual paper files are kept on each crash. The authors examined all such files for deaths in 2003-2005.

Of the 611 drivers fatally injured, 184 (30.1%) were over the BAC legal limit (80 mg/100 ml). BACs were available for only 397 (64.9%) of drivers. Of the 397 drivers who had their BACs recorded, 184 (46.3%) had a BAC over the legal limit of 80 mg/100 ml and 220 (55.4%) had BACs 20 mg/100 ml or higher. Fatally injured drivers with BACs 20 mg/100 ml or greater were more likely to be male (88.6%/o, p<0.01).

Alcohol-related crashes were more likely to occur on week end nights. Pedestrian alcohol consumption was considered to be a contributory factor in 50 (24.4%) of the pedestrian deaths with 22 (10.7%) of the pedestrians having alcohol levels exceeding 240 mgl/100 ml.

This study confirms that alcohol is a significant factor in road deaths. Further targeted action including a reduction in the legal limit is required.

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Sunday, February 7, 2010

The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing

Mental and substance use disorders are often associated with an elevated risk for suicidal behaviors. The role of the co-occurrence of multiple disorders in this association is still unclear.

Persons with lifetime suicide attempt were more likely than those without attempt to have experienced lifetime DSM-IV disorders. Lifetime attempters were also more likely to have comorbid conditions. Compared with only 0.4% of persons with no history of lifetime attempts, over 11% of persons with lifetime attempt had three or more co-occurring disorders.

Multivariate analysis controlling for the effects of comorbid conditions suggests that while mood disorder is independently associated with suicidal outcomes, comorbidity partly explains the association of anxiety disorders and almost fully accounts for the association of substance use disorders with suicidal outcomes.

Comorbidity is an important factor in the association of mental and substance use disorders with suicidal behavior.

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Ethanol alters endosomal recycling of human dopamine transporters

Dynamic membrane trafficking of the monoamine dopamine transporter (DAT) regulates dopaminergic signaling. Various intrinsic and pharmacological modulators can alter this trafficking. Previously we have shown ethanol potentiates in vitro DAT function and increases surface expression. However, the mechanism underlying these changes is unclear.

In the present study, we found ethanol directly regulates DAT function by altering endosomal recycling of the transporter.

We defined ethanol's action on transporter regulation by [3H]DA uptake functional analysis combined with biochemical and immunological assays in stably expressing DAT HEK-293 cells.

Short-term ethanol exposure potentiated DAT function in a concentration-, but not time-dependent manner. This potentiation was accompanied by a parallel increase in DAT surface expression.

Ethanol had no effect on function or surface localization of the ethanol-insensitive mutant (G130T DAT), suggesting a trafficking-dependent mechanism in mediating the ethanol sensitivity of the transporter.

The ethanol-induced increase in DAT surface expression occurred without altering the overall size of DAT endosomal recycling pools.

We found ethanol increased the DAT membrane insertion rate while having no effect on internalization of the transporter.

Ethanol had no effect on the surface expression or trafficking of the endogenously expressing transferrin receptor, suggesting ethanol does not have a non-specific effect on endosomal recycling.

These results define a novel trafficking mechanism by which ethanol regulates DAT function.

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Prevention of cardiovascular risk by moderate alcohol consumption: epidemiologic evidence and plausible mechanisms

An inverse association between moderate alcohol intake and cardiovascular risk, in particular coronary disease and ischemic stroke, has been shown in many epidemiologic studies.

In addition, several other diseases are also known to occur less frequently in moderate drinkers than in non-drinkers, whereas excess of drinking is invariably harmful.

However, some concern has been recently raised about the possibility that at all dosages the harm of alcohol could overcome its beneficial effects.

We present here the epidemiologic and mechanistic evidence to support the protective effect of moderate alcohol intake against cardiovascular disease and all-cause mortality.

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