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, April 24, 2010

Alcohol use in Denmark: A descriptive study on drinking contexts

Using data from the National Health and Morbidity Survey from 2005, we examined the contexts of alcohol use in Denmark in relation to gender and age.

Among the 21,832 subjects invited to participate, 14,566 completed the survey. For the entire study population and restricted to heavy users (>21 standard drinks per week for males; >14 for females), we computed the prevalence of each age and gender group who indicated to drink alcohol in different drinking contexts. To compare the contexts for heavy use between age groups, we estimated prevalence ratios for each group compared to the 16–20-year-old age group, with adjustments for gender.

Results showed that more than 68% of the study population drank alcohol in social contexts, such as at home with/visiting family and friends, or in party contexts.

We found similar patterns among males and females; however, there was a predominance of males for drinking alcohol during work and leisure-times. The majority of heavy users also drank alcohol in social and party contexts.

Among heavy users, drinking at home alone was eight times more prevalent among those aged 45–64 compared with those aged 16–20 years.

We concluded that drinking contexts varied in relation to gender and age. Our findings provided useful insight into contexts for alcohol use in Denmark and will enable us to understand better some of the many aspects associated with alcohol use

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Familial drinking in Italy: Harmful or protective factors?

This study examined relations between cultural norms and drinking practices in Italian young people using qualitative interviewing techniques. We collected self-report drinking history information from young people including whether or not they were allowed alcohol with meals in a family setting when growing up.

We conducted ethnographic interviews of 80 adolescent (ages 16–18) and 80 young adult (ages 25–30) regular and heavy drinkers in two regions (Abruzzo and Umbria). All 20 Italian regions produce wine. Abruzzo has a high ratio of heavy drinkers while Umbria has a high ratio of regular drinkers. We used the AUDIT to determine eligibility. We queried age at first drink, first 5+, first drunk, context of drinking, drinking with family during meals, availability of alcohol at home, parent's relationship to, attitudes about and discussion about alcohol.

Half of regular and heavy drinkers were allowed alcohol in a family setting while growing up. Those allowed alcohol with meals when growing up consumed less on their first drink occasion and were more likely to never drink 5+ or get drunk than those not allowed. They also had reduced or delayed 5+ or drunk occasions.

In Italy the tradition of incorporating alcohol with meals in a family setting may protect against harmful drinking. Other qualitative research should explore family, other adult and peer relationships to clarify alcohol use and risk-related behaviors. Research in countries with similar and different early age introduction would increase knowledge about the protective aspect of drinking in a family setting.

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Friday, April 23, 2010

Dynamic Deconstructive Psychotherapy Versus Optimized Community Care for Borderline Personality Disorder Co-Occurring With Alcohol Use Disorders: A 30

Patients having co-occurring borderline personality disorder and alcohol use disorders represent a common, but particularly severe and refractory subgroup.

An individual, time-limited treatment, dynamic deconstructive psychotherapy (DDP), has been shown to be effective for this subgroup, but long-term outcomes are not known.

Participants were recruited from a sample of 30 patients enrolled in a 12-month randomized controlled trial of DDP versus optimized community care (OCC). Outcomes were assessed after an additional 18 months of naturalistic follow-up.

DDP participants received an equivalent amount of individual treatment and less group therapy than those receiving OCC, but demonstrated large, sustained treatment effects over a broad range of outcomes and achieved significantly greater improvement in core BPD symptoms, depression, parasuicide, and recreational drug use over the 30-month study.

These results suggest that DDP is a cost-effective treatment that can lead to broad and sustained improvement for the dually diagnosed subgroup.

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Does religious involvement protect against early drinking? A behavior genetic approach

Adolescent involvement in religious organizations has been hypothesized to protect against early age at first drink. However, the correlation between adolescent religiosity and later age at first drink may be confounded by environmental or genetic differences between families.

This study tests whether, after controlling for shared environmental and genetic confounds using a behavior genetic design, the association between individual levels of religiosity and earlier age at first drink is still evident.

Twin and sibling pairs were drawn from the National Longitudinal Study of Adolescent Health, a nationally-representative sample of US adolescents. Age at first drink was measured as how old adolescents were when they first had a drink of beer, wine, or liquor. Religiosity was measured using four items concerning frequency of religious activities and importance of religious beliefs. Using twins and siblings who were discordant for religiosity, analyses tested whether religious adolescents had a later age at first drink than their non-religious co-twins/co-siblings.

Religious adolescents did not differ from their non-religious siblings in their mean age at first drink. Results from survival models indicate that environmental differences between families completely account for the correlation between religiosity and later age at first drink.

Results suggest that individual religious involvement is a proxy variable for family or cultural environments that are salient for when adolescents initiate alcohol use.

Future research is needed to identify specific protective environments in religious families. These results have implications for both public policy and etiological theory.

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Evidence-based alcohol screening and brief intervention in Aboriginal Community Controlled Health Services: Experiences of health-care providers

Alcohol screening and brief intervention (SBI) is a cost-effective treatment for reducing alcohol misuse in non-Indigenous populations. To increase the likelihood of alcohol SBI proving cost-effective for Indigenous Australians in practice, strategies to increase its uptake in Aboriginal Community Controlled Health Services (ACCHSs) should be implemented.

The aim of this study is to describe the experiences of health-care providers supported to implement evidence-based alcohol SBI in two ACCHSs.

Pre- and post-surveys were administered to health staff (
n = 32) participating in training workshops, followed by group interviews with health-care providers delivering alcohol SBI. Patient group interviews were also conducted. Survey results were summarised using descriptive statistics and interviews were analysed using a phenomenological approach.

Thirty-two per cent (
n = 10) of workshop participants were confident or very confident at baseline to deliver alcohol SBI, increasing significantly to 81% (n = 25) post-training (McNemar Test, P < 0.05). Fifty-seven per cent (n = 16) of health-care providers attending workshops reported delivering alcohol SBI in the following 6 months.

Group interviews with health-care providers elicited five themes relating to their experiences of alcohol SBI delivery. Patients in group interviews expressed a preference to be screened for alcohol as part of health assessments. Discussion and Conclusions. Training workshops appear to be an acceptable initial strategy for disseminating alcohol SBI to ACCHSs. Outreach support is required to assist health-care providers to tailor guidelines and resources, and optimally integrate their clinical skills with evidence-based practice.

Patients' needs should inform the tailoring process. Tailored collaborative and supportive strategies are probably required to optimally disseminate alcohol SBI in ACCHSs.

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An exploratory study of the relationship between parental attitudes and behaviour and young people's consumption of alcohol

Concern is growing regarding frequent and excessive misuse of alcohol by young people. The average age at which young people in Europe start to drink is twelve and a half, and during the last decade, the quantity of alcohol consumed by younger adolescents in the UK has increased. Families are known to play an important role in shaping young people's alcohol misuse, although family risk and protective factors associated with misuse in a UK context are in need of further investigation.

The study used a cross-sectional design, involving secondary analyses of self-completion questionnaire responses from 6,628 secondary school children (i.e. aged 11-16 years), from 12 schools within an urban location in Wales. Items relating to family functioning and perceived parental attitudes were first subjected to factor analysis. Associations of family closeness and conflict, parental monitoring and attitudes and family history of substance misuse with children's self reported alcohol consumption were examined using logistic regression analyses.

Approximately three quarters of respondents reported having tried alcohol, most of whom had first tried alcohol aged 12 or under. Parental monitoring and family closeness were positively correlated with one another and were both associated with significantly lower levels of drinking behaviours. Family violence and conflict, more liberal parental attitudes towards substance use and towards alcohol and petty crime, and family history of substance misuse were positively correlated with one another and with higher levels of drinking behaviours. Parental monitoring was identified as the family functioning factor most consistently associated with drinking behaviour in multivariate analyses.

Significant relationships were found between young people's drinking behaviours and perceptions of risk and protective factors in the family environment. Parental monitoring was strongly associated with family closeness and appeared to form one part of a parenting style of more general communication and regulation of children's behaviour. Findings support the need for alcohol misuse prevention interventions which address risk and protective factors within the family setting. Timing of such prevention work should be related both to the development of family relationships and the age at which young people begin drinking alcohol.

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Model-Based Appraisal of Alcohol Minimum Pricing and Off-Licensed Trade Discount Bans in Scotland Using The Sheffield Alcohol Policy Model (V 2):- An

In 2009, ScHARR developed an adaptation of the Sheffield Alcohol Policy Model for the population of Scotland. The findings of this modelling work "Model-based appraisal of alcohol minimum pricing and off-licensed trade discount bans in Scotland - A Scottish adaptation of the Sheffield Alcohol Policy Model version 2. Report to the Scottish Government. September 2009." was published on 28 September 2009 (Purshouse et al, 2009b).

Since this time, a series of more up to date datasets have become available.

  • New consumption data from the Scottish Health Survey ( SHeS) and Scottish Schools Adolescent Lifestyle and Substance Use Survey ( SALSUS) has become available for 2008 (the data in the previous model relates to 2003 for SHeS and 2006 for SALSUS).
  • The Scottish Government has also procured market research data on the 2008/09 price distribution of off-trade alcohol (in terms of ethanol content) in Scotland from The Nielsen Company.
  • New mortality data is available for 2008.
  • Police recorded crime statistics and Scottish Crime and Justice Survey ( SCJS) data are now available for 2008/09.

The requirement of this research project was to update the previous Scotland model with the new data to provide revised estimates of the effects of current proposals for minimum pricing and prohibition of off-trade discounting. The technical details of the methodology have not been changed. Therefore the methods section (Chapter 2) of the previously published report was not reproduced.

The set of policies analysed remains the same as in the original research:

1. What are the likely effects of introducing a minimum unit price on alcohol consumption, sales, health, crime and workplace harms in Scotland?

2. What are the likely effects of introducing a ban on price-based promotions in the off-licensed trade in Scotland?

3. What are the likely effects of introducing a minimum unit price simultaneously with a ban on price-based promotions in the off-licensed trade in Scotland?

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Thursday, April 22, 2010

Call to return booze buying age to 20

Returning the alcohol buying age to 20 looks likely to be a hot topic when it comes before Parliament again, accompanied by strict recommendations for dealing with binge-drinking problems. . . . . .

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Development of an Acceptance-Based Coping Intervention for Alcohol Dependence Relapse Prevention

Both psychological and neurobiological findings lend support to the long-standing clinical observation that negative affect is involved in the development and maintenance of alcohol dependence, and difficulty coping with negative affect is a common precipitant of relapse after treatment.

Although many current approaches to relapse prevention emphasize change-based strategies for managing negative cognitions and affect, acceptance-based strategies for preventing relapse to alcohol use are intended to provide methods for coping with distress that are fundamentally different from, though in theory complementary to, approaches that emphasize control and change.

This paper describes the development of Acceptance-Based Coping for Relapse Prevention (ABCRP), a new intervention for alcohol-dependent individuals who are within 6 months of having quit drinking.

Results of preliminary testing indicate that the intervention is feasible with this population; and a small uncontrolled pilot study (N = 23) showed significant (P < .01) improvements in self-reported negative affect, emotional reactivity, perceived stress, positive affect, psychological well-being, and mindfulness level, as well as a trend (P = .06) toward reduction in craving severity between pre- and postintervention assessments.

The authors conclude that this acceptance-based intervention seems feasible and holds promise for improving affect and reducing relapse in alcohol-dependent individuals, warranting further research.

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The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis

The high rate of drug abuse among patients with psychosis represents a challenge to clinicians in their treatment of the patients. Powerful screening tools to detect problematic drug use in an early phase of psychotic illness are needed.

The aim of the present study was to investigate prevalence of drug use disorders and psychometric properties of the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) in 205 first-episode psychosis patients in Oslo, Norway.

Internal consistency of the instruments and criterion-based validity as compared to a current DSM-IV diagnosis of abuse or dependence of alcohol or other drugs were analyzed.

Fifteen percent of the men and 11% of the women had a DSM-IV diagnosis of alcohol use disorders while 33% of the men and 16% of the women had non-alcohol drug use disorders. The instruments were reliable (Cronbach's alpha above 0.90) and valid (Area under the curve above 0.83). Suitable cut-off scores (sensitivity >0.80 and specificity >0.70) were ten for men and eight for women on AUDIT and three for men and one for women on DUDIT.

The results of this study suggest that AUDIT and DUDIT are powerful screening instruments for detecting alcohol and other drug use disorders in patients with first-episode psychosis.

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Association of P3 amplitude to treatment completion in substance dependent individuals

Individuals with substance use disorders typically show reduced amplitudes of the P3 component of the evoked potential and high scores on impulsivity and aggression measures.

The present study investigated the usefulness of P3 amplitude, addiction severity and impulsivity as predictors of treatment completion in substance dependence.

Forty-four participants (8 women), between the ages of 19 and 61 years old, who met DSM-IV-TR Axis I substance/alcohol dependence criteria were recruited for the present study. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drug toxicity for a minimum of 21 days. The P3 was evoked using a standard rotated-heads oddball paradigm.

Significantly reduced P3 amplitude at Pz was found in patients who did not complete treatment compared to those who did.

P3 amplitude at Pz elicited by target stimuli correctly identified 76.2% of those who did complete the treatment and 46.7% of those who did not.

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The role of serotonin and possible interaction of serotonin-related genes with alcohol dehydrogenase and aldehyde dehydrogenase genes in alcohol depen

Alcohol dependence is believed to be a multifactorial, polygenic disorder involving complex gene-gene and gene-environment interactions and confounded by heterogeneity and sociocultural factors.

(5-Hydroxytryptamine, 5-HT) is thought to be involved in many aspects of alcohol consumption, abuse, and dependence.

There was some evidence that serotonin-related genes might interact with the alcohol
dehydrogenase (ADH) and the aldehyde dehydrogenase (ALDH) genes in the development of alcohol dependence.

In the current review, we discuss the role of serotonin and possible interaction of serotonin-related
genes with ADH and ALDH genes in alcohol dependence.

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Assessing recovery and functioning in former problem drinkers at different stages of their recovery journeys

Many studies which assess functioning in recovering problem drinkers are limited to early recovery within inpatient or detoxification settings, or focus on relapse rates and treatment outcomes. This study assesses how functioning varies according to recovery stage and abstinence duration.

Fifty-three recovering problem drinkers participated from mutual aid groups or snowball recruitment. Cross-sectional interviewer-administered structured questionnaires assessed quality of life (QoL), self-esteem, self-efficacy, psychological and physical health. Participants could also self-complete the questionnaire.

Those in 'stable recovery' (5 or more years into recovery, n
= 18) reported higher ratings of: three aspects of QoL—social relationships, psychological health, environment, as well as self-esteem (P < 0.05 for all variables) than those in 'early' (up to 5 years into recovery, n = 35). Depression was lower in 'stable recovery' (P = 0.027). Those in 'stable recovery' were more likely to live in their own home without professional support (P = 0.010) and have partners who had never been problem drinkers (P = 0.024). Overall, the continuous scores of many functioning variables correlated with abstinence duration indicating a continuous gain in functioning.

Although limited by sampling considerations, this paper shows a gradual growth in functioning over a prolonged recovery process, and provides positive findings that those in recovery may expect to experience improvements in many areas of life as abstinence duration increases. For two aspects of QoL—environment and social relationships—functioning reaches a level above population norms offering hope of moving to a functioning level beyond the pre-morbid state.

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Wednesday, April 21, 2010

Alcohol consumption in sport: The influence of sporting idols, friends and normative drinking practices

High-profile sportspeople are posited as role models for others. We examine whether university sportspeople and non-sportspeople's perceptions of high-profile sportspeople's (sports stars) and friends perceived drinking behaviours are related to their own drinking behaviours. Further, we examine the importance of drinking with competitors after sports events.

A convenience sample of 1028 participants (58% females,
n = 652 sportspeople) from two Australian universities were approached at sporting and university venues. Participants completed a survey booklet containing demographic questions, the Alcohol Use Disorders Identification Test (AUDIT, alcohol measure), perceived drinking of high-profile sportspeople and friends (social norms), and for sportspeople only, items assessing the importance of drinking with competitors. Bivariate and multivariate analyses were used to assess relationships.

Both sporting and non-sporting participants perceived high-profile sportspeople to drink less than themselves and their friends. Small significant bivariate relationships were found between high-profile sportspeople's perceived drinking and self-reported drinking for sportspeople
. However, in multivariate regression models the perceived drinking behaviours of high-profile sportspeople were not significant predictors of sportspeople's drinking, and were negatively related to non-sportspeople's drinking. The practice of drinking with competitors after sports and games accounted for an additional 6.1% of the unique variance in AUDIT-scores.

Sports stars are touted as negative role models when it comes to drinking. Contrary to expectations high-profile sportspeople were not perceived to be heavy drinkers and their perceived drinking was not predictive of others drinking. Friends' and normative drinking practices were predictors of drinking.

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Breastfeeding and Prolactin Levels in Lactating Women With a Family History of Alcoholism

Many motivated new mothers fail to reach public health goals for breastfeeding, highlighting the need to identify risk factors. Because having a family history of alcoholism is associated with blunted prolactin responses to an alcohol challenge in nonlactating individuals, this study aimed to identify associations in family history of alcoholism, prolactin, and breastfeeding behaviors in lactating women.

This was a 2-day experimental study that used within-subject alcohol or control beverage consumption and between-subject family history of alcoholism factors. The participants were non–alcohol-dependent lactating women; 7 were family history–positive (FHP) for alcohol dependence, and 21 were family history–negative (FHN). Consumption of 0.4 g/kg alcohol or nonalcoholic beverage occurred in separate randomized sessions, followed by use of a breast pump. Basal and suckling-induced prolactin, blood alcohol concentrations, milk yield, self-reported drug effects, neophobia, and breastfeeding patterning were measured.

Although no group differences in alcohol pharmacokinetics were detected, FHP women exhibited blunted prolactin to breast stimulation after drinking the control and alcohol beverage and felt more of the stimulant-like effects of alcohol than did FHN women. FHP women reported more frequent daily breastfeeding than did FHN women.

This is the first evidence that family history of alcoholism is associated with a blunted magnitude, rapidity, and duration of the prolactin response to breast stimulation and an alcohol challenge in lactating women. More frequent breastfeeding by FHP women suggests behavioral compensation for perceived and/or actual poor lactation. Alcohol did not enhance lactational performance, further disputing the lore that alcohol is a galactagogue.

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ASA clears anti-alcohol TV ads

A TV campaign featuring children as young as eight talking about being pressurised into sex and taking drugs has been cleared by the Advertising Standards Authority despite dozens of complaints that it was offensive and distressing.

The two TV ads form part of a Department for Children, Schools and Families (DCSF) campaign about the wider impacts of drinking alcohol on decisions that young people go on to make. . . . . .

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Resveratrol protects against experimental stroke: Putative neuroprotective role of heme oxygenase 1

Epidemiological and experimental reports have linked mild-to-moderate wine and/or grape consumption to a lowered incidence of cardiovascular, cerebrovascular, and peripheral vascular risk.

This study revealed that resveratrol, an enriched bioactive polyphenol in red wine, selectively induces heme oxygenase 1 (HO1) in a dose- and time-dependent manner in cultured mouse cortical neuronal cells and provides neuroprotection from free-radical or excitotoxicity damage.

This protection was lost when cells were treated with a protein synthesis or heme oxygenase inhibitor, suggesting that HO1 induction is at least partially required for resveratrol's prophylactic properties.

Furthermore, resveratrol pretreatment dose-dependently protected mice subjected to an optimized ischemic–reperfusion stroke model. Mice in which HO1 was selectively deleted lost most, if not all, of the beneficial effects.

Together, the data suggest a potential intracellular pathway by which resveratrol can provide cell/organ resistance against neuropathological conditions.

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An Exploratory Analysis of Factors Associated With Repeat Homicide in Canada

The current study presents the results of the first Canadian national study on the characteristics of repeat homicide offenders and the factors associated with homicide recidivism.

The research
involves an analysis of National Parole Board (NPB) files for all homicide offenders in Canada who committed more than one homicide ( n = 86) between 1975 and 2005 and a matched sample of homicide offenders who only committed one homicide (n = 84). Descriptive and bivariate analyses are used to examine and compare characteristics of single-time homicide offenders (SHOs) and repeat homicide offenders (RHOs).

Logistic regression analysis
reveals that RHOs lacked employment prior to their first homicide and became involved in alcohol and drug-influenced lifestyles.

Furthermore, RHOs experience reductions in family and community
support after release from custody for the first homicide. This reduction of support will likely reflect at-risk behavior and crime lifestyles associated with being unlawfully at large and alcohol and drug involvement.

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Modelling lifetime QALYs and health care costs from different drinking patterns over time: a Markov model

The negative health consequences of alcohol use and its treatment account for significant health care expenditure worldwide.

Long-term modelling techniques are developed in this paper to establish a link between drinking patterns, health consequences and alcohol treatment effectiveness and cost-effectiveness.

The overall change in health related quality and quantity of life which results from changes in health-related behaviour is estimated.

Specifically, a probabilistic lifetime Markov model is presented where alcohol consumption in grams of alcohol per day and drinking history are used for the categorization of patients into four Markov states.

Utility weights are assigned to each drinking state using EQ-5D scores. Mortality and morbidity estimates are state, gender and age specific, and are alcohol-related and non-alcohol-related. The methodology is tested in a case study.

This represents a major development in the techniques traditionally used in alcohol economic models, in which short-term costs and outcomes are assessed, omitting potential longer term cost savings and improvements in health related quality of life.

Assumptions and implications of the approach are discussed.

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Stop Underage Drinking Portal of Federal Resources

StopAlcoholAbuse.Gov is a comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue.

Community members interested in underage drinking prevention—including but not limited to parents, educators, youth, concerned citizens, prevention specialists, business leaders, law enforcement and public health officials—will find a wealth of valuable information here.

The resources featured to the right are among the many useful materials available on this site to aid your underage drinking prevention efforts.


Regional Differences in Alcohol Consumption in Croatia

This study aims to estimate regional and gender differences in the prevalence of alcohol consumption in Croatia. It is based on the data obtained from the Croatian Adult Health Survey 2003.

The highest prevalence of alcohol consumption
in men was reported in Eastern Croatia (14.1%). Men living in the Mountainous region had the lowest prevalence of reported alcohol consumption (8.8%).

In contrast to men in the Eastern region, women in the same region reported drinking
alcoholic beverages with the lowest prevalence (0.3%). The highest proportion of women who reported drinking alcoholic beverages was recorded the Northern Croatian region (1.5%). Results support the expected gender gap in alcohol consumption and point out strong regional pattern of alcohol consumption.

The observed pattern shows that primary
prevention and health promotion should be implemented with special concern to regional differences and traditions.

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The Drinker’s Effect on the Social Environment: A Conceptual Framework for Studying Alcohol’s Harm to Others

The paper considers conceptual and methodological issues in studying the scope of alcohol’s harm to others. Reasons are suggested for the relative neglect of the topic.

The approaches in two relevant research traditions are considered: population surveys on alcohol problems, and economic cost of alcohol studies.

Ways of conceptualizing and measuring aspects of the drinker’s effects on others are considered, in terms of main types of relationship with the other, and in terms of major societal response institutions.

The main types of data tend to measure different levels of severity, with population survey data dominated by less severe problems, and response institution data by more severe problems; so both are needed for a three-dimensional view.

Research questions for the field and its policy significance are noted.

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Press Release - Excessive Alcohol Consumption May Lead to Increased Cancer Risk

Researchers have detected a link between alcohol consumption, cancer and aging that starts at the cellular level with telomere shortening.

Results of this cross-sectional study were presented at the American Association for Cancer Research 101st Annual Meeting 2010, held here, April 17-21, at the Walter E. Washington Convention Center.

Telomeres are found at the region of DNA sequences at the end of a chromosome, and are important for the genetic stability of cells. As people age, telomere length shortens progressively.

Excessive use of alcohol has been linked to oxidative stress and inflammation, two mechanisms that accelerate telomere shortening. Since telomere shortening is thought to increase cancer risk, the researchers speculated that those with shorter telomeres due to heavy alcohol consumption would have an increased risk of cancer. . . . . .

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Dual Tasking and Working Memory in Alcoholism: Relation to Frontocerebellar Circuitry

Controversy exists regarding the role of cerebellar systems in cognition and whether working memory compromise commonly marking alcoholism can be explained by compromise of nodes of corticocerebellar circuitry.

We tested 17 alcoholics and 31 age-matched controls with dual-task, working memory paradigms. Interference tasks competed with verbal and spatial working memory tasks using low (three item) or high (six item) memory loads. Participants also underwent structural MRI to obtain volumes of nodes of the frontocerebellar system.

On the verbal working memory task, both groups performed equally. On the spatial working memory with the high-load task, the alcoholic group was disproportionately more affected by the arithmetic distractor than were controls

In alcoholics, volumes of the left thalamus and left cerebellar Crus I volumes were more robust predictors of performance in the spatial working memory task with the arithmetic distractor than the left frontal superior cortex. In controls, volumes of the right middle frontal gyrus and right cerebellar Crus I were independent predictors over the left cerebellar Crus I, left thalamus, right superior parietal cortex, or left middle frontal gyrus of spatial working memory performance with tracking interference.

The brain–behavior correlations suggest that alcoholics and controls relied on the integrity of certain nodes of corticocerebellar systems to perform these verbal and spatial working memory tasks, but that the specific pattern of relationships differed by group. The resulting brain structure–function patterns provide correlational support that components of this corticocerebellar system not typically related to normal performance in dual-task conditions may be available to augment otherwise dampened performance by alcoholics.

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Cross-sectional measures and modelled estimates of blood alcohol levels in UK nightlife and their relationships with drinking behaviours and observed

Management of nightlife in UK cities focuses on creating safe places for individuals to drink. Little is known about intoxication levels as measuring total alcohol consumption on nights out is complicated by early evening interviews missing subsequent consumption and later interviews risking individuals being too drunk to recall consumption or participate at all. Here we assess mixed survey and modelling techniques as a methodological approach to examining these issues.

Interviews with a cross sectional sample of nightlife patrons (n=214) recruited at different locations in three cities established alcohol consumption patterns up to the point of interview, self-assessed drunkenness and intended drinking patterns throughout the remaining night out. Researchers observed individuals' behaviours to independently assess drunkenness. Breath alcohol tests and general linear modelling were used to model blood alcohol levels at participants' expected time of leaving nightlife settings.

At interview 49.53% of individuals regarded themselves as drunk and 79.43% intended to consume more alcohol before returning home, with around one in ten individuals (15.38% males; 4.35% females) intending to consume >40 units (equal to 400mls of pure alcohol). Self-assessed drunkenness, researcher observed measures of sobriety and blood alcohol levels all correlated well. Modelled estimates for blood alcohol at time of going home suggested that 71.68% of males would be over 0.15%BAC (gms alcohol/100mls blood). Higher blood alcohol levels were related to drinking later into the night.

UK nightlife has used substantive health and judicial resources with the aim of creating safer and later drinking environments. Survey and modelling techniques together can help characterise the condition of drinkers when using and leaving these settings. Here such methods identified patrons as routinely getting drunk, with risks of drunkenness increasing over later nights. Without preventing drunkenness and sales to intoxicated individuals, extended drinking hours can simply act as havens for drunks. A public health approach to nightlife is needed to better understand and take into account the chronic effects of drunkenness, the damages arising after drunk individuals leave city centres and the costs of people avoiding drunken city centres at night.

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Tuesday, April 20, 2010

An Alcoholic’s Savior: God, Belladonna or Both?

In October 1909, Dr. Alexander Lambert boldly announced to a New York Times reporter that he had found a surefire cure for alcoholism and drug addiction. Even more astounding, he stated that the treatment required “less than five days.” The therapy consisted of an odd mixture of belladonna (deadly nightshade), along with the fluid extracts of xanthoxylum (prickly ash) and hyoscyamus (henbane). “The result is often so dramatic,” Lambert said, “that one hesitates to believe it possible.”

Dr. Lambert was hardly a quack looking for headlines. He was widely known as Theodore Roosevelt’s personal physician, a professor of medicine at Cornell Medical College and an expert on alcoholism. Dr. Lambert had years of experience taking care of thousands of alcoholics at Bellevue Hospital’s infamous “drunk ward.” In fact, it was on this storied hospital ward where he experimented with the belladonna cure. . . . . .

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Sports Participation and Problem Alcohol Use: A Multi-Wave National Sample of Adolescents

Sports participation, though offering numerous developmental benefits for youths, has been associated with adolescent alcohol use. Differences also exist between men/boys and women/girls in both sports participation and patterns of alcohol-related behaviors, but there are few longitudinal investigations of this relationship.

This study investigated the relationship between school-based sports participation and alcohol-related behaviors using data from a multiwave national study of adolescent men/boys and women/girls.

Nationally representative data from the National Longitudinal Study of Adolescent Health, collected between 1994 and 2001, were analyzed in 2009 (n=8271). Latent growth modeling, accommodating the complex sampling design, was applied to examine whether participation in school-based sports was associated with initial levels and change in problem alcohol use over three waves of data collection.

After taking into account time-invariant covariates including demographics and other predictors of alcohol use, greater involvement in sports during adolescence was associated with faster average acceleration in problem alcohol use over time among youths who took part in only sports. The findings suggest, however, that the relationship between sports participation and problem alcohol use depends on participation in sports in combination with other activities, but it does not differ between men/boys and women/girls.

Sports may represent an important and efficient context for selective interventions to prevent problem alcohol use and negative consequences of alcohol use among adolescents.

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Integrated Treatment for Co-Occurring Disorders

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Integrated Dual Diagnosis Treatment is for people who have co-occurring disorders, mental illness and a substance abuse addiction. This treatment approach helps people recover by offering both mental health and substance abuse services at the same time and in one setting.

Integrated Treatment for Co-Occurring Disorders-CD/DVD Version EPB KIT


Persistent High Alcohol Consumption in Alcohol-Preferring (P) Rats Results from a Lack of Normal Aversion to Alcohol

In this study, we tested the impact of pretreatment with alcohol on subsequent alcohol drinking in outbred Sprague–Dawley and selectively bred alcohol-preferring (P) rats.

As a pretreatment, male Sprague–Dawley and P rats were given a passive oral administration of either alcohol (1.0 g/kg) or tap water. Then, they were given free choice of drinking alcohol (5% v/v) or water in their home cages, which was measured over 4 weeks.

Without alcohol pretreatment, there was no significant strain difference in alcohol preference; both strains preferred 5% (v/v) alcohol solution. The strain difference was only apparent in the groups given alcohol pretreatment. This arose from the fact that alcohol pretreatment significantly reduced alcohol preference in the Sprague–Dawley rats to a level well below 50%, while it did not alter drinking behavior in P rats. The same effects were seen with total alcohol consumption (g/kg/day). These effects persisted throughout the 4 weeks of the study.

The principal difference between the Sprague–Dawley and P rats was that the P rats did not show the normal aversion to alcohol after forced exposure to alcohol that the Sprague–Dawley rats showed. One of the potential contributors to high alcohol intake and preference in P rats may be lack of sensitivity to aversive effects of alcohol.

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The Effects of Gender and a Co-occurring Depressive Disorder on Neurocognitive Functioning in Patients with Alcohol Dependence

The present study aims to examine neuropsychological impairments by comorbidity and gender among patients with alcohol dependence.

The study sample is comprised of 123 subjects who fulfilled a Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) diagnosis of alcohol dependence from January 2006 to December 2007. Subjects were asked to complete the following psychological tests: the Barratt Impulsivity Scale (BIS), Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Color Trails Test. We compared the results of neuropsychological assessments based on two types of classifications: people with comorbid depression and people without comorbidity; females and males.

The immediate visual memory and the BIS scores in patients with comorbid depression were significantly different from the scores in patients without comorbidity. In addition, females performed significantly poorer on the Working Memory Index than males and had a later age of regular drinking.

Further investigation of the mechanism associated with the gender difference on cognition and exploration of the temporal relationship between alcohol dependence and depressive disorder on the cognitive aspect is

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Non-right-handedness and Free Serum Testosterone Levels in Detoxified Patients with Alcohol Dependence

The influence of testosterone on the extent of hemispheric dominance has been discussed not just during the first two trimesters of pregnancy but also later in life. An increase in free serum testosterone levels has been found during and after the detoxification phase of patients with alcohol dependence.

In 250 participants (125 men and 125 women) with alcohol dependence immediately after the direct withdrawal phase (Day 21) and in 250 healthy age- and gender-matched participants, free testosterone in the serum was determined and handedness was assessed as a peripheral marker of central hemispheric dominance.

Patients with alcohol dependence were 2.7-fold (odds ratio, OR: 2.66; 95% confidence interval, CI: 1.62–4.38) and men 4.1-fold (OR: 4.12; 95% CI: 2.44–6.98) more likely to be non-right-handed (NRH). In addition to male gender, non-right-handedness and alcohol dependence contributed statistically significantly to higher serum testosterone levels.

Testosterone values of patients
with alcohol dependence differed significantly between the four different Lesch subtypes; in particular, participants with alcohol dependence classified according to Lesch subtype IV were found to have significantly higher serum testosterone levels (F = 20.5; P <> according to Lesch subtypes I–III.

An alteration of hemispheric dominance and thus an exogenously modifiable neuronal plasticity may be demonstrated directly on a population at risk.

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Screening and Brief Intervention for Risky Alcohol Consumption in the Workplace: Results of a 1-Year Randomized Controlled Study

To assess the effectiveness of brief alcohol intervention on hazardous and harmful drinking in the 12-month period after a voluntary alcohol screening.

At a large transport company, employees presenting to the occupational health services for a routine health and lifestyle check-up were offered to undertake an alcohol screening by means of self-report (the Alcohol Use Disorders Identification Test—AUDIT) and a biomarker (carbohydrate-deficient transferrin in serum—CDT). Those screening positive for the AUDIT and/or CDT were randomized to a brief or comprehensive intervention group or to a control group. An identical follow-up session was performed 12 months later.

Of 990 employees (68% men) that volunteered for the alcohol screening, 194 (20%) tested positive for the AUDIT and/or CDT. Among the 158 (81%) subjects who also attended the follow-up session, the frequency of positive screening results at baseline/follow-up were 51%/23% for the AUDIT (P <> and 58%/34% (P <> significant differences between the brief and comprehensive intervention groups or between the intervention groups and the control group.

The results suggested that alcohol screening and brief intervention performed in connection with routine health and lifestyle examinations in the workplace may be effective in reducing alcohol consumption. Given the lack of difference in outcome between the intervention groups and the control group, alcohol screening may in itself cause reduction in drinking. In addition, at least some of the positive effect may be explained by regression towards the mean.

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Twelve-Month Follow-up Results from a Randomized Controlled Trial of a Brief Personalized Feedback Intervention for Problem Drinkers

To examine the impact of a web-based personalized feedback intervention, the Check Your Drinking (CYD; screener at 12-month follow-up.

Respondents (N = 185) were recruited from a general population telephone survey of Ontario, Canadian adults (≥18 years) by asking risky drinkers if they were willing to help develop and evaluate Internet-based interventions for drinkers. Those randomly assigned to the intervention condition were provided with the web address and a unique password to a study-specific copy of the CYD. Respondents assigned to the control condition were sent a written description of the different components of the CYD and asked how useful they thought each of the components might be. Respondents were followed up at 3, 6 and 12 months.

By the 12-month follow-up, the impact of the intervention previously reported at 3 and 6 months of CYD on problem drinkers’ alcohol consumption was no longer apparent (P > 0.05).

Recognizing that many people with alcohol concerns will never seek treatment, recent years have seen an increase in efforts to find ways to take treatment to problem drinkers. The CYD is one such intervention that has a demonstrated effect on reducing alcohol consumption in the short term (i.e. 6 months). Other more intensive Internet-based interventions or interventions via other modalities may enhance this positive outcome over the short and long term among problem drinkers who would be otherwise unlikely to access treatment for their alcohol concerns.

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Monday, April 19, 2010

Alcohol intake and its correlates in a transitional predominantly Muslim population in southeastern Europe

Our aim was to assess alcohol consumption and its correlates in Albania, a predominantly Muslim though largely secular Southeast European republic in transition from rigidly structured socialism to a market-oriented system.

A population-based sample of Tirana residents aged 35–74 years was interviewed and examined in 2003–2006 (450 men and 235 women with data on alcohol intake, 65.5% response). Multivariable-adjusted logistic regression was used to assess the association of drinking frequency, quantity and type of drink with socioeconomic, psychosocial and coronary risk characteristics.

30.6% (95%CI = 26.3%–34.9%) of men, age-standardized to the 2005 census, and 5.6% (95%CI = 2.6%–8.6%) of women reported almost daily intake of alcohol, whereas 17.0% (95%CI = 13.4%–20.5%) of men and 46.6% (95%CI = 40.2%–53.1%) of women abstained. In men, frequent drinking was positively associated with age and not receiving financial support from close family emigrants, and was strongly inversely related to religious observance in both Muslims and Christians. In women it was associated with smoking and upward social mobility. Alcohol intake was not associated with religious affiliation in either sex. In men, intake of spirits (predominantly raki) and beer were associated with lower socioeconomic indices, smoking and obesity (beer only), whereas wine intake was associated with financial security, being secular, and not smoking. Among men, 11.3% (95%CI = 8.3%–14.3%) reported high intakes (≥ 210 g of pure alcohol/week) and 6.0% (95%CI = 3.8%–8.3%) very high intakes (≥ 420 g/week). High intakes were associated with frequent, rather than episodic, drinking.

Our study may be the first to provide information on alcohol intake and its characteristics in an Albanian population sample, one of the few predominantly Muslim countries in Europe. Alcohol consumption in women was extremely low. However, consistent very heavy intake of alcohol appears to be more frequent among Albanian men than in many former communist countries in Europe, and is cause for concern.

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This guidance takes the local community as the starting point of its approach to dealing with drug and alcohol problems. Its focus is not only on meeting national priorities, but about making a difference at a local level. Communities will perceive change and will feel more confident when they see that a difference is being made in their area and that this change responds to their concerns. Taking an approach that makes the community the starting point empowers the community to bring about changes and to take a stand about the issues that affect them.

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Why do we need to control alcohol use through legislative measures? A south east asia perspective?

Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control in several countries, contrary to other controlled substances like opium, cocaine, cannabis, and so on.

To demonstrate the similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence for both substances.

Consecutively admitted patients during the period August 2005 to May 2006, in the Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, with ICD-10 (DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome were recruited for the study and administered the alcohol or other drug (opioid) section of SSAGA-II, respectively, and the data was entered in the corresponding tally sheet.

The total sample size was 150, of which 112 consented to participate. Eighty-one (72%) were alcohol-dependent and 31 (28%) were opioid-dependent. Mean ages of the patients of alcohol dependence for opioid dependence was 35.16 ± 10.2 compared to 26.09 ± 5.65. Mean age of onset of alcohol and opioid use were similar (18.72 ± 6.84 and 20.73 ± 3.93 years, respectively). Patterns of dependence were also similar for both substances, from the first criteria to dependence (0.49 years for alcohol versus 0.64 years for opioids), and from the appearance of the second criteria to dependence (0.24 years versus 0.28 years).

This study recommends alcohol to be treated on par with opioids and calls for legislations for the control of alcohol, uniformly, across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

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Cocaethylene: responding to combined alcohol and cocaine use

A briefing paper 'Cocaethylene: responding to combined alcohol and cocaine use' has been produced by the AERC Alcohol Academy. The paper assesses the current understanding, data, trends and implications for public health and alcohol policy.

The briefing identifies that combined alcohol and cocaine use appears to be increasingly popular despite indications of significantly increased health and social risks. Combining alcohol and powder cocaine can form cocaethylene in the liver, a unique metabolite that can enhance the user's experience but significantly increase the risk of heart attack or sudden death. Its use has also been linked to other health conditions and an increased risk of violence. . . . . .

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Sunday, April 18, 2010

Cost-effectiveness of volumetric alcohol taxation in Australia

To estimate the potential health benefits and cost savings of an alcohol tax rate that applies equally to all alcoholic beverages based on their alcohol content (volumetric tax) and to compare the cost savings with the cost of implementation.

Mathematical modelling of three scenarios of volumetric alcohol taxation for the population of Australia: (i) no change in deadweight loss, (ii) no change in tax revenue, and (iii) all alcoholic beverages taxed at the same rate as spirits.

The estimated cost of changing to a volumetric tax rate is $18 million. A volumetric tax that is deadweight loss-neutral would increase the cost of beer and wine and reduce the cost of spirits, resulting in an estimated annual increase in taxation revenue of $492 million and a 2.77% reduction in annual consumption of pure alcohol.

The estimated net health gain would be 21 000 disability-adjusted life-years (DALYs), with potential cost offsets of $110 million per annum.

A tax revenue-neutral scenario would result in an 0.05% decrease in consumption, and a tax on all alcohol at a spirits rate would reduce consumption by 23.85% and increase revenue by $309 million.

All volumetric tax scenarios would provide greater health benefits and cost savings to the health sector than the existing taxation system, based on current understandings of alcohol-related health effects.

An equalised volumetric tax that would reduce beer and wine consumption while increasing the consumption of spirits would need to be approached with caution.

Further research is required to examine whether alcohol-related health effects vary by type of alcoholic beverage independent of the amount of alcohol consumed to provide a strong evidence platform for alcohol taxation policies.

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