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, June 12, 2010

Requiring suspended drunk drivers to install alcohol interlocks to reinstate their licenses: effective?

To evaluate a new method being used by some states for motivating interlock installation by requiring it as a prerequisite to reinstatement of the driver's license.

The driving records of Florida DWI offenders convicted between July 2002 and June 2008 were analyzed to determine the proportion of offenders subject to the interlock requirement who installed interlocks.

Due to long periods of complete suspension when no driving was permitted and the failure to complete all the requirements imposed by the court, only 21 377 of the 82 318 offenders studied qualified for reinstatement, but 93% of those who qualified did install interlocks to be reinstated.

Because of the lengthy license suspensions and other barriers that the offenders face in qualifying for reinstatement, it is not clear that requiring a period on the interlock as a prerequisite to reinstating will greatly increase the current installment rate.

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Anti-drink driving reform in Britain, c. 1920–80

The goal of this report is to provide a framework for understanding and interpreting political, scientific and cultural attitudes towards drink driving in 20th-century Britain. Exploring the inherent conservatism of successive governments, Members of Parliament (MPs) and the public towards the issue during the interwar years, the contribution seeks to explain the shift from legislative paralysis to the introduction of the breathalyser in 1967.

Based on governmental, parliamentary and administrative records, the report follows a mainly narrative route. It places particular emphasis on connections between post-war extra-parliamentary and parliamentary movements for reform.

The paper follows a linear path from the 1920s to the 1970s. Britain lies at the heart of the story but comparisons are made with nations—particularly the Scandinavian states—which took radical steps to prosecute drinking and dangerous drivers at an early date.

The report underlines the vital post-war role played by Graham Page, leading parliamentary spokesman for the Pedestrians' Association; the centrality of the Drew Report (1959) into an 'activity resembling driving'; the pioneering Conservative efforts of Ernest Marples; and Barbara Castle's consolidating rather than radically innovative activities between 1964 and 1967.

Both before and after the Second World War politicians from both major parties gave ground repeatedly to major motoring organizations. With the ever-escalating growth of mass motorization in the 1950s, both Conservative and Labour governments agonized over gridlock and 'murder on the roads'. Barbara Castle finally took decisive action against drink drivers, but the ground had been prepared by Graham Page and Ernest Marple.

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Prenatal Alcohol Exposure Induces Long-Term Changes in Dendritic Spines and Synapses in the Mouse Visual Cortex

To study the long-term changes of dendritic spine and synapse taking place in a mouse model of fetal alcohol spectrum disorders (FASDs).

Pregnant mice were intubated daily with ethanol (EtOH) from E5 to parturition. A DiI diolistic method was used to label dendritic spines of pyramidal cells in the visual cortex of EtOH-exposed and control pups over the period from postnatal (P) day P0 to P30; synaptic ultrastructure was also analyzed using transmission electron microscopy.

Prenatal alcohol exposure was associated with a significant decrease in the number of dendritic spines of pyramidal neurons in the visual cortex and an increase in their mean length. The changes were dose dependent and persisted to P30. Ultrastructural changes were also observed, with decreased numbers of synaptic vesicles, narrowing of the synaptic cleft and thickening of the postsynaptic density compared to controls; ultrastructural changes also persisted to P30.

Prenatal alcohol exposure is associated with long-term changes in dendritic spines and synaptic ultrastructure; these alterations probably reflect the developmental retardation of dendritic spines and synapses in visual cortex. These long-term changes are likely to contribute to lifelong mental retardation associated with childhood FASDs.

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Primary prevention among working age USA adults with and without disabilities

Health promotion and disease prevention among people with disabilities are often overlooked. The objective of this article is to determine if working age adults with disabilities differ in healthy behaviours from those without disabilities.

Behavioural Risk Factor Surveillance System data (2003) were used to assess healthy behaviours among 201,840 community dwelling working age adults.

People who reported activity limitation irrespective of assistive device use were more likely to be overweight and to smoke than people without a disability. The prevalence of heavy alcohol and insufficient fruit and vegetable consumption was significantly lower among those who used an assistive device irrespective of activity limitation compared to the No Disability Group. Adults in all disability groups were significantly more likely to report physical inactivity compared to the No Disability Group. Lower alcohol consumption and physical inactivity findings were accentuated when the disabled were not working.

There is evidence that people with a disability report poor lifestyle behaviours that increase disease risk and may need assistance with smoking cessation, weight loss and adoption of a physical activity routine. Screening for unhealthy behaviours and advice should be incorporated into routine health care visits for working age adults with disabilities.

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Neuropsychological performance of South African treatment-naïve adolescents with alcohol dependence

Alcohol dependence (AD) in developmentally vulnerable adolescents is ubiquitous and confers a risk for long-term neurocognitive sequelae, yet comorbid substance use disorders and psychopathology can complicate interpretations.

Here, we compare cognitive functioning in adolescents with and without AD, who are free from comorbid disorders.

English- and Afrikaans-speaking adolescents (13–15 years) of mixed ancestry and low socio-economic status were recruited from the Cape Town region of South Africa. Adolescents with psychiatric, developmental, or other substance use disorders (SUDs) were excluded.

AD (n = 26) and control (n = 26) groups were matched on age, gender, language, and level of education. Neuropsychological testing in participants’ home language followed detailed medical/psychiatric evaluation.

Although our sample included participants who smoked tobacco, lifetime dosage of other drugs was negligible. When tobacco and other drug use as well as demographic variables were controlled, adolescents with AD performed more poorly on measures of Verbal Story Memory, Self-Monitoring, and Psychomotor Speed and Coordination.

These preliminary results, although relatively subtle, suggest that adolescents with AD may be at increased risk for failure to reach optimal levels of neuromaturation, and may be susceptible to cognitive problems associated with protracted alcohol consumption.

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Friday, June 11, 2010

The Impact of Parent-Child Discussions and Parent Restrictions on Adolescent Alcohol Consumption

The impact of parent influence on adolescent drinking behavior has been extensively researched, but remains unclear.

This assessment used data from a survey administered in after school programs in Maui County to further examine parents’ role in preventing underage drinking.

Two factors were explored for their impacts on drinking behavior: parent-child discussions and perceived parent sanctioning of alcohol use. Separate analysis was conducted for all respondents and for those who are drinkers. Youth ages 12-17 (n=572; 46.7% female; 25.2% alcohol drinkers; 16.4% binge drinkers) participated in the study.

No significant differences for the reported number of days of drinking (chi-square=1.38, p>0.05) and the number of days of binge drinking (chi-square=0.31, p>0.05) between those that did and did not have parent-child communications was found.

A significant difference was found, however, for the number of drinking days (chi-square=38.6, p<0.05) and the number of binge drinking days (chi-square=39.4, p<0.05), for “all respondents” between those who perceived parent restriction and those who did not.

These findings suggest that parent-child communication may be most influential when characterized in such a way as to include well-defined restrictions against alcohol use.

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State Estimates of Substance Use from the 2007–2008 National Surveys on Drug Use and Health

This report presents State estimates for 22 measures of substance use and mental health
problems based on the 2007 and 2008 National Surveys on Drug Use and Health (NSDUHs).

Sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA),
NSDUH is an ongoing survey of the civilian, noninstitutionalized population of the United States aged 12 years or older.

Interview data from 136,606 persons were collected in 2007-2008 (see
Table A.9 in Appendix A). Separate estimates have been produced for four age groups: 12 to 17, 18 to 25, 26 or older, and all persons 12 or older (estimates for past year major depressive episode [MDE] are available only for youths aged 12 to 17).

Also in this report are estimates for
persons aged 12 to 20 for two of the measures—past month alcohol use and binge alcohol use.

Although estimates for persons 18 or older are not a part of this report, they are available at

For each measure, States have been ranked and
categorized into quintiles, or fifths, in order to simplify the discussion. Estimates presented in this report are based on a hierarchical Bayes estimation method that combines survey data with a national model. Note that these estimates are benchmarked to the national design-based estimates (for details, see Section A.5 in Appendix A).

In addition to presenting State estimates for 2007-2008, Chapters 2 to 6 of this report
provide comparisons of the 2006-2007 estimates with the 2007-2008 estimates and indicate whether the differences between the two are statistically significant for all measures. Increases or decreases are discussed only if they are statistically significant at the 0.05 level. A separate chapter (Chapter 7) comparing estimates between 2002-2003 and 2007-2008 for a select set of outcomes also is included in this report.

Alcohol Use

• In 2007-2008, the national rate of past month alcohol use was 51.4 percent. Among persons aged 12 or older, the rate ranged from a low of 27.8 percent in Utah to a high of 63.1 percent in New Hampshire. (Table B.9)

• Nationally, almost a quarter (23.3 percent) of persons aged 12 or older participated in binge
use of alcohol in the past month in 2007-2008. Two States showed significant changes in binge alcohol use between 2006-2007 and 2007-2008: Oregon had a significant increase, whereas Wyoming had a decline. (Tables B.10 and C.10)

• In 2007-2008, the rate of past month alcohol use among persons aged 12 to 20 (underage use
of alcohol) ranged from a low of 13.6 percent in Utah to a high of 38.3 percent in Vermont. Utah (11.7 percent) also had the lowest rate for past month underage binge use of alcohol, and North Dakota (28.0 percent) had the highest rate for this measure. There was a decrease at the national level in underage alcohol use from 28.1 percent in 2006-2007 to 27.2 percent in 2007-2008; similarly, there was a decrease at the national level for underage binge alcohol use from 18.8 percent in 2006-2007 to 18.0 percent in 2007-2008. Twelve States showed decreases in underage binge alcohol use: Arizona, Arkansas, Idaho, Kansas, Kentucky, Missouri, Nebraska, New Jersey, Pennsylvania, Washington, West Virginia, and Wisconsin. (Tables B.12 and C.12)

• Underage binge alcohol use in the past month decreased nationwide from 19.2 percent in 2002-2003 to 18.0 percent in 2007-2008. Eighteen States showed declines during this time period; however, the District of Columbia showed an increase. (Table D.12)

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Treatment Episode Data Set -- Admissions (TEDS-A), 2008

The Treatment Episode Data Set -- Admissions (TEDS-A) is an administrative data system providing descriptive information about the national flow of admissions to providers of substance abuse treatment. TEDS-A is part of a reporting system that was originally designed to provide annual data on the number and characteristics of persons admitted to public and private substance abuse treatment programs receiving public funding.

The unit of analysis is treatment admissions. TEDS includes both Minimum Data Set (MDS) data (required reporting) and Supplemental Data Set (SuDS) data (optional reporting), as reported to state substance abuse agencies by the treatment programs.

Variables in the MDS include: information on service setting, number of prior treatments, primary source of referral, gender, race, ethnicity, education, employment status, substance(s) abused, route of administration, frequency of use, age at first use, and whether methadone was prescribed in treatment. Supplemental variables include: diagnosis codes, presence of psychiatric problems, living arrangements, source of income, health insurance, expected source of payment, pregnancy and veteran status, marital status, detailed not in labor force codes, detailed criminal justice referral codes, and days waiting to enter treatment.

Substances abused include alcohol, cocaine and crack, marijuana and hashish, heroin, nonprescription methadone, other opiates and synthetics, PCP, other hallucinogens, methamphetamine, other amphetamines, other stimulants, benzodiazepines, other non-benzodiazepine tranquilizers, barbiturates, other non-barbiturate sedatives or hypnotics, inhalants, over-the-counter medications, and other substances.

Created variables include total number of substances reported, intravenous drug use (IDU), and flags for any mention of specific substances.

The public-use files were created using the data that were current as of August 2009 (the August 31, 2009, extract).

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National Survey of Substance Abuse Treatment Services (N-SSATS), 2008 [United States]

The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect information from all facilities in the United States, both public and private, that provide substance abuse treatment. N-SSATS provides the mechanism for quantifying the dynamic character and composition of the United States substance abuse treatment delivery system.

The objectives of N-SSATS are to collect multipurpose data that can be used to assist the Substance Abuse and Mental Health Services Administration (SAMHSA) and state and local governments in assessing the nature and extent of services provided and in forecasting treatment resource requirements, to update SAMHSA's Inventory of Substance Abuse Treatment Services (I-SATS), to analyze general treatment services trends, and to generate the National Directory of Drug and Alcohol Abuse Treatment Programs and its online equivalent, the Substance Abuse Treatment Facility Locator (

Data are collected on topics including ownership, services offered (assessment and pre-treatment, pharmacotherapies, testing, transitional, ancillary), detoxification, primary focus (substance abuse, mental health, both, general health, and other), hotline operation, methadone/buprenorphine dispensing, counseling and therapeutic approaches, languages in which treatment is provided, type of treatment provided, number of clients (total and under age 18), number of beds, types of payment accepted, sliding fee scale, special programs offered, facility accreditation and licensure/certification, and managed care agreements.

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Appeals to social norms as policy instruments to address consumption externalities

We consider appeals to social norms as a policy instrument to address consumption externalities. We explore whether appeals to social norms can be an efficient policy instrument and compare the efficiency of such appeals to the efficiency of taxation in addressing consumption externalities.

We find that when the existing norm helps to shift consumption towards the socially optimal level of consumption, taxation welfare dominates appeals to social norms as a policy tool.

While previous studies have found that economic instruments are superior to information in other contexts, we arrive at a different conclusion for situations where the norm shifts behavior away from what is socially optimal. In such cases appeals to social norms can be a better policy instrument than taxation.

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Depression, Craving, and Substance Use Following a Randomized Trial of Mindfulness-Based Relapse Prevention

A strong relation between negative affect and craving has been demonstrated in laboratory and clinical studies, with depressive symptomatology showing particularly strong links to craving and substance abuse relapse. Mindfulness-based relapse prevention (MBRP), shown to be efficacious for reduction of substance use, uses mindfulness-based practices to teach alternative responses to emotional discomfort and lessen the conditioned response of craving in the presence of depressive symptoms.

The goal in the current study was to examine the relation between measures of depressive symptoms, craving, and substance use following MBRP.

Individuals with substance use disorders (N = 168; mean age 40.45 years, SD = 10.28; 36.3% female; 46.4% non-White) were recruited after intensive stabilization, then randomly assigned to either 8 weekly sessions of MBRP or a treatment-as-usual control group. Approximately 73% of the sample was retained at the final 4-month follow-up assessment.

Results confirmed a moderated-mediation effect, whereby craving mediated the relation between depressive symptoms (Beck Depression Inventory) and substance use (Timeline Follow-Back) among the treatment-as-usual group but not among MBRP participants. MBRP attenuated the relation between postintervention depressive symptoms and craving (Penn Alcohol Craving Scale) 2 months following the intervention (f2 = .21). This moderation effect predicted substance use 4 months following the intervention (f2 = .18).

MBRP appears to influence cognitive and behavioral responses to depressive symptoms, partially explaining reductions in postintervention substance use among the MBRP group. Although results are preliminary, the current study provides evidence for the value of incorporating mindfulness practice into substance abuse treatment and identifies a potential mechanism of change following MBRP.

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Examining the Differential Effectiveness of a Life Skills Program (IPSY) on Alcohol Use Trajectories in Early Adolescence

This study investigated whether a universal school-based life skills program—IPSY (Information + Psychosocial Competence = Protection)—against substance misuse exerted the same effectiveness for young adolescents (10.5–13 years) from distinct alcohol use trajectories characterized by late childhood risk factors (temperament, self-worth, social problems with peers).

Analyses were based on a German sample of school students (N = 1,484). A longitudinal quasi-experimental design (intervention/control) with schoolwise assignment to the respective groups was used. Data were gathered via self-report questionnaire. Two-part growth mixture modeling was applied.

Two prototypical trajectory classes of early alcohol use were found: a problematic group with a sharp increase in prevalence and quantity of consumed alcohol (19.7%) and a normative group with a moderate increase in both outcomes (80.3%). The problematic trajectory class was associated with several risk factors. IPSY decreased the likelihood of membership in the problematic group. Furthermore, IPSY buffered the increase in prevalence and quantity for the normative group, whereas it had no effects on these indicators for the problematic group. Concerning quantity of alcohol use, the effect size in terms of a difference in estimated means between intervention and control group at the last measurement point in the normative group was d = 0.33 (95% CI [0.21, 0.44]).

Study findings indicate the usefulness of IPSY for reducing alcohol use especially in normative developing adolescents. However, the minority of adolescents consistently pursuing a problematic developmental pathway of alcohol use seem to be in need of earlier, more tailored treatments.

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NIAAA Spectrum Volume 2, Issue 2, June 2010

In This Issue


1 The Stars of Alcohol
Research Shine in
Honorary Lectures

3 Two Meds Are Better
Than One for
Depressive Alcoholics

Photo Essay

2 Three-Dimensional
Environments for
Drug Development


4 Unmet Treatment Need

News From The Field

5 Diet Quality Worsens With
Increased Alcohol Intake

5 Light to Moderate
Drinking Linked to
Lower Risk for
Cardiovascular Death

6 Older But Not Wiser:
At-Risk Drinking in
Older Adults

7 Scientists Find Genes
That Influence
Brain Wave Patterns

5 Questions With...

7 Robert Huebner, Ph.D.

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NIAAA Newsletter Summer 2010 • Issue 20

  • NIAAA Mourns the Loss of Brenda G. Hewitt
  • NIAAA Celebrates 40 Years of Research, Outreach
  • Popularity of NIAAA Seasonal Outreach Series Soars
  • APIS Announces New Web Site Design
  • SUAA Work Group of the SMRB Reports on Optimizing Addictions Research
  • Alcohol Researcher Marisa Roberto Receives PECASE Award
  • Kovacs and Szabo complete ELAM Program
  • New Publications
  • Personnel

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NIAAA Director's Report on Institute Activities to the 124th Meeting of the National Advisory Council on Alcohol Abuse and Alcoholism - June 10, 2010


A. Legislation, Budget and Policy

F. New Media Interactions

B. Director's Activities

G. What's Ahead

C. NIAAA Staff and Organization

H. NIAAA Program Announcement and Request for Applications Information

D. Multi-Media Products from NIAAA

I. NIAAA Research Programs

E. Outreach

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Housing and drinking in the home: 3rd London practitioners forum

The Third London Alcohol Practitioners’ Forum was held on Thursday 20th May at City Hall with the theme of alcohol related housing problems and drinking in the home.

The Alcohol Practitioners' Forum is an information sharing and networking group that provides a pool of knowledge, skills and expertise to support the Joint Action Group (JAG) on Alcohol - established to deliver the Regional Statement of
Priorities on Alcohol.

Presentations from the day: . . . . . .

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Can the alcohol industry represent genuine social responsibilty?

A paper exploring how substantial are 'unhealthy' drinkers to alcohol sales volume asks whether this means the industry can have genuine corporate social responsibilty in promoting sensible drinking.

Conflict of interest in the alcoholic drinks industry: how important are ‘unhealthy drinkers’ in total UK consumption? is available to download here [pdf]

Critics suggest that the industry's commercial interests are such that it cannot feasibly have a genuine interest in reducing consumption given the volume of alcohol consumed by those drinking above reccommended guidelines. Largely the drinks industry has invested in an awareness raising approach, such as through, as part of its corporate social responsibilty agenda. . . . . .

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Delay discounting predicts increase in blood alcohol level in social drinkers

Variations in delay discounting correspond with variations in alcohol consumption; however, this relationship has not been generalized to social drinkers using objective measures of intoxication.

The objective was to assess the generalizability of the delay discounting paradigm to a social setting measuring alcohol use with an alcometer.

Forty-six male social drinkers were breathalyzed as they entered a bar to consume alcohol and again as they left. At the first interview, estimates of their hyperbolic delay discount function were taken.

Participants who discounted future rewards more heavily also demonstrated a greater increase in alcohol intoxication up to the end of their drinking session. The success for delay discounting to explain variations in alcohol use is extended to social settings.

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Press Release - Scripps Research Study Overturns Decade-Old Findings in Neurobiology

In findings that should finally put to rest a decade of controversy in the field of neurobiology, a team at The Scripps Research Institute has found decisive evidence that a specific neurotransmitter system—the endocannabinoid system—is active in a brain region known to play a key role in the processing of memory, emotional reactions, and addiction formation.

The new study also shows that this system can dampen the effects of alcohol, suggesting an avenue for the development of drugs to combat alcohol addiction.

The research was published in the journal Neuropsychopharmacology on May 12. . . . . . .

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Prenatal alcohol exposure triggers ceramide-induced apoptosis in neural crest-derived tissues concurrent with defective cranial development

Fetal alcohol syndrome (FAS) is caused by maternal alcohol consumption during pregnancy. The reason why specific embryonic tissues are sensitive toward ethanol is not understood. We found that in neural crest-derived cell (NCC) cultures from the first branchial arch of E10 mouse embryos, incubation with ethanol increases the number of apoptotic cells by fivefold. Apoptotic cells stain intensely for ceramide, suggesting that ceramide-induced apoptosis mediates ethanol damage to NCCs.

Apoptosis is reduced by incubation with CDP-choline (citicoline), a precursor for the conversion of ceramide to sphingomyelin. Consistent with NCC cultures, ethanol intubation of pregnant mice results in ceramide elevation and increased apoptosis of NCCs
in vivo.

Ethanol also increases the protein level of prostate apoptosis response 4 (PAR-4), a sensitizer to ceramide-induced apoptosis. Prenatal ethanol exposure is concurrent with malformation of parietal bones in 20
% of embryos at day E18. Meninges, a tissue complex derived from NCCs, is disrupted and generates reduced levels of TGF-β1, a growth factor critical for bone and brain development.

Ethanol-induced apoptosis of NCCs leading to defects in the meninges may explain the simultaneous presence of cranial bone malformation and cognitive retardation in FAS.
In addition, our data suggest that treatment with CDP-choline may alleviate the tissue damage caused by alcohol.

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Thursday, June 10, 2010

Genetic origins of the association between verbal ability and alcohol dependence symptoms in young adulthood

Cognitive deficits in alcohol dependence (AD) have been observed, poorer verbal ability being among the most consistent findings. Genetic factors influence both cognitive ability and AD, but whether these influences overlap is not known.

A subset of 602 monozygotic (MZ) and dizygotic (DZ) twins from FinnTwin16, a population-based study of Finnish twins, was used to study the associations of verbal ability with DSM-III-R diagnosis and symptoms of AD, the maximum number of drinks consumed in a 24-h period, and the Rutgers Alcohol Problem Index (RAPI) scores. These twins, most of them selected for within-pair discordance or concordance for their RAPI scores at age 18.5 years, were studied with neuropsychological tests and interviewed with the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) in young adulthood (mean age 26.2 years, range 23–30 years).

All alcohol problem measures were associated with lower scores on the Vocabulary subtest of the Wechsler Adult Intelligence Scale – Revised (WAIS-R), a measure of verbal ability. In bivariate genetic models, Vocabulary and the alcohol problem measures had moderate heritabilities (0.54–0.72), and their covariation could be explained by correlated genetic influences (genetic correlations −0.20 to −0.31).

Poorer verbal ability and AD have partly overlapping biological etiology. The genetic and environmental influences on the development of cognitive abilities, alcohol problems and risk factors for AD should be studied further with prospective longitudinal designs.

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Russia considers doubling minimum vodka price

President Dmitry Medvedev last year ordered tough measures to curb alcohol abuse in a country where the average Russian drinks 18 litres (38 pints) of pure alcohol each year.

In January, Russia raised taxes on beer and introduced a minimum vodka price of 89 roubles per half litre, effectively doubling the cost of the cheapest bottle.

Now the Finance Ministry has proposed increasing the minimum price to 120 roubles in 2011, 160 roubles in 2012 and 200 roubles in 2013, local news agencies quoted deputy minister Sergei Shatalov as saying Wednesday.

"Vodka should not be cheap, it is not a product of first necessity," Shatalov said, according to Itar-Tass. . . . . .

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Wednesday, June 9, 2010

The economic costs of alcohol consumption in Thailand, 2006

There is evidence that the adverse consequences of alcohol impose a substantial economic burden on societies worldwide. Given the lack of generalizability of study results across different settings, many attempts have been made to estimate the economic costs of alcohol for various settings; however, these have mostly been confined to industrialized countries. To our knowledge, there are a very limited number of well-designed studies which estimate the economic costs of alcohol consumption in developing countries, including Thailand. Therefore, this study aims to estimate these economic costs, in Thailand, 2006.

This is a prevalence-based, cost-of-illness study. The estimated costs in this study included both direct and indirect costs. Direct costs included health care costs, costs of law enforcement, and costs of property damage due to road-traffic accidents. Indirect costs included costs of productivity loss due to premature mortality, and costs of reduced productivity due to absenteeism and presenteeism (reduced on-the-job productivity).

The total economic cost of alcohol consumption in Thailand in 2006 was estimated at 156,105.4 million baht (9,627 million US$ PPP) or about 1.99% of the total Gross Domestic Product (GDP). Indirect costs outweigh direct costs, representing 96 % of the total cost. The largest cost attributable to alcohol consumption is that of productivity loss due to premature mortality (104,128 million baht/ 6,422 million US$ PPP), followed by cost of productivity loss due to reduced productivity (45,464.6 million baht/ 2,804 million US$ PPP), health care cost (5,491.2 million baht/ 339 million US$ PPP), cost of property damage as a result of road traffic accidents (779.4 million baht/ 48 million US$ PPP), and cost of law enforcement (242.4 million baht/ 15 million US$ PPP), respectively. The results from the sensitivity analysis revealed that the cost ranges from 115,160.4 million baht to 214,053.0 million baht (7,102.1 - 13,201 million US$ PPP) depending on the methods and assumptions employed.

Alcohol imposes a substantial economic burden on Thai society, and according to these findings, the Thai government needs to pay significantly more attention to implementing more effective alcohol policies/ interventions in order to reduce the negative consequences associated with alcohol

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Tuesday, June 8, 2010

Alcohol-Attributable Mortality in Ireland

The study aim was to calculate Irish alcohol-attributable fractions (AAFs) and to apply these measurements to existing data in order to quantify the impact of alcohol on mortality.

Exposure of the Irish population to alcohol was derived from a national survey and combined with estimates of the alcohol–disease/injury risk association from meta-analyses in the international literature to calculate Irish AAFs. In diseases for which relative risk estimates were not available, such as injury, AAFs were taken directly from Ridolfo and Stevenson [(2001) The quantification of drug-caused mortality and morbidity in Australia, 1998. In Drug Statistics Series no. 7. AIHW cat. no. PHE 29. Australian Institute of Health and Welfare, Canberra]. AAFs were applied to national datasets to calculate alcohol-attributed mortality caused or prevented and potential years of life lost (PYLL) or saved.

In Ireland, over the 5-year period from January 1, 2000 to December 31, 2004, alcohol was estimated to have caused 4.4% (6584) of deaths and 10.8% (131,245) of all-cause PYLL. Alcohol was estimated to have prevented 2.7% (3967) of deaths and 1.5% (18,285) of all-cause PYLL. This resulted in an estimated net effect of 1.8% (2616) of deaths and 9.3% (112,959) of all-cause PYLL. Chronic conditions were responsible for 69% of alcohol-attributable deaths and acute conditions for 31%. Conditions not wholly attributable to alcohol accounted for 83% of deaths as opposed to 17% for conditions wholly caused by alcohol.

This study showed for the first time the full magnitude of deaths from alcohol in Ireland and revealed that while young people and those dependent on alcohol are at high risk of negative outcomes due to alcohol, particularly acute injuries, at an individual level, at a population level it is in fact moderate drinkers and chronic diseases, not wholly attributable to alcohol, that are associated with most alcohol-attributed deaths. The findings of this study suggest that policies focusing on the whole population attitude to alcohol, and chronic conditions and conditions partially attributable to alcohol, would yield considerable public health benefits.

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Athletes and Energy Drinks: Reported Risk-Taking and Consequences from the Combined Use of Alcohol and Energy Drinks

This study measured athletes' alcohol, energy drink, and combined-use. It also compared athletes' reported risk-taking and consequences while using alcohol-only and in combination with energy drinks.

From the total sample of 401 intercollegiate student-athletes, 315 (78%) used alcohol, 150 (37%) combined alcohol with energy drinks, and 194 (48%) used energy drinks (EDs) without alcohol. Ninety-two percent of drinkers participated in binge drinking. Sixty-one percent of combined users participated in high risk “energy binge” drinking episodes (using 3+ EDs on one occasion). Results indicated combined users (n = 150) consumed significantly more alcohol and had riskier drinking habits (e.g., heavy binge drinking) than athletes who used alcohol only (n = 165).

The combined use of alcohol and energy drinks could potentially contribute to increased risk-taking and negative consequences.

Results suggest a possible need to include information about energy drinks in existing athlete alcohol education and prevention programs.

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Associations of Diet and Lifestyle With Headache in High-School Students: Results From a Cross-Sectional Study

Diet and lifestyle are seen as factors which influence headache in adults. However, population-based studies on this issue in adolescents are rare.

Aim of the present study was to investigate associations between diet and lifestyle factors and different types of headache, ie, migraine and tension-type headache (TTH) in adolescents.

A total of 1260 adolescents from the 10th and 11th grades of high schools filled in questionnaires on intake of meals, coffee, nonalcoholic and alcoholic drinks, smoking, and physical activity. Type of headache was classified according to the International Classification of Headache Disorders – 2nd edition. Multiple logistic regression models, adjusted for sex and grade, were calculated.

High consumption of cocktails (odds ratio = 3.4; 95% confidence interval 1.9-6.0) and coffee (2.4; 1.3-4.7), smoking (2.7; 1.4-5.1), and lack of physical activity (2.2; 1.3-3.7) were significantly associated with migraine plus TTH episodes, consumption of coffee and physical inactivity particularly with migraine (3.4; 1.6-7.0 and 4.2; 2.2-7.9, respectively) and physical inactivity with TTH (1.7; 1.1-2.7). Skipping of meals or insufficient fluid intake were not associated with any type of headache.

Adolescents with any type of headache might benefit from regular physical activity and low consumption of alcoholic drinks, while for migraine patients a low consumption of coffee should additionally be recommended. Intervention studies are warranted to assess whether psycho-educational programs conferring knowledge of these associations will influence headache-triggering behavior and headache in adolescents.

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Monday, June 7, 2010

SAMHSA's 10 Strategic Initiatives

10 Strategic Initiatives

Through continued improvement in the delivery and financing of prevention, treatment, and recovery support services SAMHSA with its partners can advance and protect the Nation’s health. In order to achieve this goal SAMHSA has identified 10 Strategic Initiatives to focus the Agency’s work on improving lives and capitalizing on emerging opportunities. The 10 Initiatives are briefly described below with the Agency lead identified along with some background on the issue.

1. Abuse and Mental Illness

Goal—Create prevention prepared communities where individuals, families, schools, workplaces, and communities take action to promote emotional health and prevent and reduce mental illness, substance abuse including tobacco, and suicide across the lifespan

2. Trauma and Justice

Goal—Reduce the pervasive, harmful, and costly health impact of violence and trauma by integrating trauma-informed approaches throughout health and behavioral healthcare systems and to divert people with substance use and mental disorders from criminal and juvenile justice systems into trauma-informed treatment and recovery.

3 . Military Families—Active, Guard, Reserve, and Veteran

Goal—Support of our service men and women and their families and communities by leading efforts to ensure needed behavioral health services are accessible and outcomes are successful.

4. Health Reform

Goal—Broaden health coverage and the use of evidence based practices to increase access to appropriate and high quality care, and to reduce disparities that currently exist between the availability of services for substance use and mental disorders and other medical conditions.

5. Housing and Homelessness

Goal—Provide housing and reduce the barriers that homeless persons with mental and substance use disorders and their families experience to accessing effective programs that sustain recovery.

6. Jobs and Economy

Goal—Promote the behavioral health of individuals, families, and communities affected by the economic downturn; the employment of people with mental and substance use disorders, and policies for employers that support behavioral health in the workplace.

7. Health Information Technology for Behavioral Health Providers

Goal—Ensure the behavioral health provider network, including prevention specialists and consumer providers, fully participates with the general health care delivery system in the adoption of health information technology.

8. Behavioral Health Workforce—In Primary and Specialty Care Settings

Goal—Provide a coordinated approach to address workforce development issues affecting the behavioral health and general health service delivery community to promote the integration of services and the training and use of behavioral health screening, brief intervention and referral for treatment in primary care settings.

9. Data, Outcomes, and Quality—Demonstrating Results

Goal— Realize an integrated data strategy that informs policy, measures program impact, and results in improved quality of services and outcomes for individuals, families, and communities.

10. Public Awareness and Support

Goal—Increase understanding of mental and substance use disorder prevention and treatment services to achieve the full potential of prevention and help people recognize and seek assistance for these health conditions with the same urgency as any other health condition.

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Naltrexone Selectively Elevates GABAergic Neuroactive Steroid Levels in Heavy Drinkers With the ASP40 Allele of the OPRM1 Gene: A Pilot Investigation

Preclinical studies have implicated GABAergic neurosteroids in behavioral responses to alcohol. Naltrexone is thought to blunt the reinforcing effects of alcohol, and a few studies have found that the effects of naltrexone are moderated by the Asn40Asp polymorphisms of the OPRM1 gene.

The present study seeks to integrate these lines of research by testing (i) the moderating role of the functional Asn40Asp polymorphism of the OPRM1 gene on naltrexone-induced alternations in GABAergic neurosteroid levels, namely (3α,5α)-3-hydroxypregnan-20-one (allopregnanolone, ALLO); and (ii) the combined effects of naltrexone or genotype with alcohol administration on neurosteroid levels in a sample of at-risk drinkers.

Participants were 32 (9 females) nontreatment-seeking heavy drinkers who completed a placebo-controlled laboratory study of naltrexone (50 mg/d for 3 days) and provided complete sets of serum samples for ALLO assays before and after alcohol administration under both naltrexone and placebo conditions.

Naltrexone treatment raised ALLO levels among carriers of the Asp40 allele, but not homozygotes for the Asn40 allele. The Asn40Asp polymorphism did not moderate effects of naltrexone on cortisol levels. Ethanol infusion modestly reduced ALLO levels in all subjects, independent of genotype or naltrexone exposure.

Naltrexone increased ALLO levels among individuals with the Asn40Asp allele suggesting a potential neurosteroid contribution to the neuropharmacological effects of naltrexone among Asp40 carriers.

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An fMRI Study of Number Processing in Children With Fetal Alcohol Syndrome

Number processing deficits are frequently seen in children exposed to alcohol in utero.

Functional magnetic resonance imaging was used to examine the neural correlates of number processing in 15 right-handed, 8- to 12-year-old children diagnosed with fetal alcohol syndrome (FAS) or partial FAS (PFAS) and 18 right-handed, age- and gender-matched controls from the Cape Coloured (mixed ancestry) community in Cape Town, South Africa, using Proximity Judgment and Exact Addition tasks.

Control children activated the expected fronto-parietal network during both tasks, including the anterior horizontal intraparietal sulcus (HIPS), left posterior HIPS, left precentral sulcus, and posterior medial frontal cortex. By contrast, on the Proximity Judgment task, the exposed children recruited additional parietal pathways involving the right and left angular gyrus and posterior cingulate/precuneus, which may entail verbally mediated recitation of numbers and/or subtraction to assess relative numerical distances. During Exact Addition, the exposed children exhibited more diffuse and widespread activations, including the cerebellar vermis and cortex, which have been found to be activated in adults engaged in particularly challenging number processing problems.

The data suggest that, whereas control children rely primarily on the fronto-parietal network identified in previous studies to mediate number processing, children with FAS/PFAS recruit a broader range of brain regions to perform these relatively simple number processing tasks. Our results are consistent with structural neuroimaging findings indicating that the parietal lobe is relatively more affected by prenatal alcohol exposure and provide the first evidence for brain activation abnormalities during number processing in children with FAS/PFAS, effects that persist even after controlling statistically for group differences in total intracranial volume and IQ.

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Recent Research on Impulsivity in Individuals With Drug Use and Mental Health Disorders: Implications for Alcoholism

Alcohol misuse and dependence, and many of its accompanying psychological problems, are associated with heightened levels of impulsivity that both accelerate the development of clinically significant illness and complicate clinical outcome.

This article reviews recent developments in our understanding of impulsivity as they relate to brain circuitry that might underlie these comorbid factors, focusing upon the clinical features of substance use (and dependence), bipolar disorder, and pathological gambling.

Individuals who are affected by these disorders exhibit problems in several domains of impulsive behavior including deficient response or "motor" control, and the tolerance of prolonged delays prior to larger rewards at the expense of smaller rewards ("delay-discounting"). These populations, like alcoholic dependents, also exhibit impairments in risky decision-making that may reflect dysfunction of monoamine and catecholamine pathways.

However, several areas of uncertainty exist including the specificity of impairments across disorders and the relationship between impulse control problems and altered evaluation of reward outcomes underlying observed impairments in action selection.

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Alcohol self-administration in rats: Modulation by temporal parameters related to repeated mild social defeat stress

Clinical evidence often points to stress as a cause or an antecedent to the development of drinking problems. Yet, animal models of alcohol drinking have yielded inconsistent evidence for a direct contribution of stress, and many studies have shown that stress suppresses alcohol consumption.

The aim of the present study was to examine alcohol reward in animals exposed to repeated, mild social stress, and to determine whether alcohol drinking changes as a function of the temporal parameters of alcohol access relative to the stressor.

Male Long-Evans rats, trained to self-administer a 6% (wt/vol) alcohol solution using a sucrose-fading procedure, were exposed to five brief (5min) episodes of contact with an aggressive male. Full contact with the resident was limited to a single episode of defeat, whereas the following four encounters occurred with the subjects behind a protective wire mesh cage. Alcohol self-administration was measured 1 week prior to stress (baseline), on each day of stress exposure, and 1 week following stress. Separate groups of animals were randomly assigned to self-administer alcohol immediately prior, immediately following, or 2h following defeat stress.

Stress preferentially increased alcohol drinking on stress-exposure days, and further elevated the amount consumed 1 week following stress. Temporal parameters of alcohol access relative to the stressor were found to be important. Average alcohol consumption was greatest for animals drinking 2h postdefeat, whereas animals drinking immediately prior to or following the stressor did not show a significant increase in alcohol consumption.

Results suggest that mild social defeat stress is sufficient to elicit increases in alcohol consumption in nonpreferring strains of rodents, provided alcohol access occurs at an optimal time interval after the social defeat experience.

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Limited access to ethanol increases the number of spontaneously active dopamine neurons in the posterior ventral tegmental area of nondependent P rats

Microdialysis experiments in alcohol-preferring (P) rats have shown that chronic ethanol exposure increases extracellular levels of dopamine (DA) in the nucleus accumbens.

Because DA neuronal activity contributes to the regulation of DA overflow in terminal regions, we hypothesized that posterior ventral tegmental area (VTA) DA neuronal activity (firing frequency, burst activity, and/or the number of spontaneously active DA neurons) would be increased in P rats consuming ethanol compared with P rats consuming only water. I

n vivo electrophysiological techniques were used to evaluate the activity of single DA neurons in the posterior VTA.

Our findings show that voluntary ethanol intake by nondependent P rats significantly increased the number of spontaneously active DA neurons in the posterior VTA compared with P rats that consumed only water. Firing frequency and burst activity did not differ between the two groups.

These results suggest that adaptive changes occur in the mesolimbic DA system of nondependent P rats to increase the excitability of posterior VTA DA neurons and enhance DA release from nerve terminals in the nucleus accumbens

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Serotonin-3 receptors in the posterior ventral tegmental area regulate ethanol self-administration of alcohol-preferring (P) rats

Several studies indicated the involvement of serotonin-3 ([5-hydroxy tryptamine] 5-HT3) receptors in regulating alcohol-drinking behavior.

The objective of this study was to determine the involvement of 5-HT
3 receptors within the ventral tegmental area (VTA) in regulating ethanol self-administration by alcohol-preferring (P) rats.

Standard two-lever operant chambers (Coulbourn Instruments, Allentown, PA) were used to examine the effects of seven consecutive bilateral microinfusions of ICS 205-930 (ICS), a 5-HT
3 receptor antagonist, directly into the posterior VTA on the acquisition and maintenance of 15% (vol/vol) ethanol self-administration.

P rats readily acquired ethanol self-administration by the fourth session. The three highest doses (0.125, 0.25, and 1.25μg) of ICS prevented acquisition of ethanol self-administration.

During the acquisition postinjection period, all rats treated with ICS demonstrated higher responding on the ethanol lever, with the highest dose producing the greatest effect. In contrast, during the maintenance phase, the three highest doses (0.75, 1.0, and 1.25
μg) of ICS significantly increased responding on the ethanol lever; after the 7-day dosing regimen, responding on the ethanol lever returned to control levels.

Microinfusion of ICS into the posterior VTA did not alter the low responding on the water lever and did not alter saccharin (0.0125% wt/v) self-administration. Microinfusion of ICS into the anterior VTA did not alter ethanol self-administration.

Overall, the results of this study suggest that 5-HT
3 receptors in the posterior VTA of the P rat may be involved in regulating ethanol self-administration. In addition, chronic operant ethanol self-administration and/or repeated treatments with a 5-HT3 receptor antagonist may alter neuronal circuitry within the posterior VTA.

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RAYPRO, a Resource on Alcohol and Youth Projects

The on-line database RAYPRO, a Resource on Alcohol and Youth Projects, enables to share information on projects and activities to reduce alcohol-related harm among children and young people, and promotes good practice based on sound evaluation of effectiveness.

Projects and activities are grouped according to themes:

  • Curbing under-age drinking
  • Curbing drink-driving by young people
  • Educating and empowering young people on alcohol issues
  • Promoting responsible selling and serving of alcohol to young people
  • Protecting young people from the consequences of alcohol abuse by others.

The age range extends from children – for example reducing harm from alcohol use disorders in the family - to young adults, as late teenage and early adulthood affect drinking habits for life.

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Pattern of alcohol consumption and its effect on gastrointestinal symptoms in inflammatory bowel disease

Alcohol consumption is a potential trigger for flare in inflammatory bowel disease (IBD) flare because of alcohol's pro-oxidant effects and its deleterious effects on gut barrier function. The association with alcohol consumption and IBD flare is unclear.

To test this hypothesis, we evaluated the pattern of alcohol consumption and its self-reported effect on gastrointestinal (GI) symptoms in patients with IBD.

We recruited 129 consecutive patients: 52 patients with Crohn's disease, 38 patients with ulcerative colitis, and 39 patients with irritable bowel syndrome (IBS). All the participants completed a validated questionnaire on disease activity (the Crohn's disease activity index or ulcerative colitis clinical activity index, respectively) validated questionnaires to quantify alcohol consumption by National Institute of Alcohol Abuse and Alcoholism criteria, and two structured questionnaires we designed to access patients' perception of the effect of alcohol on their GI symptoms and on overall GI symptom severity.

The pattern of current, light, moderate, and heavy alcohol consumption in inactive IBD was similar to the general U.S. population. Specifically, of the 90 inactive IBD patients, 56 (62%) were current drinkers, compared with 61% in the general U.S. population. Of current drinkers, 75% of IBD (N=42) and 43% of IBS (N=9) reported a worsening of GI symptoms with alcohol consumption (P=.01); however, overall GI symptom severity did not differ when compared with quantity of alcohol consumed. Patients with inactive IBD drink alcohol in quantities similar to the general population.

Current drinkers with inactive IBD are more likely to report worsening of GI symptoms with alcohol than current drinkers with IBS.

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Cortical perfusion in alcohol-dependent individuals during short-term abstinence: relationships to resumption of hazardous drinking after treatment

Relapse to hazardous levels of alcohol consumption after treatment for alcohol use disorders is common. Investigation of the neurobiological correlates of resumption of hazardous drinking is necessary to clarify the mechanisms contributing to relapse

. Fifty-seven treatment-seeking alcohol-dependent participants (ALC) completed arterial spin labeling perfusion MRI of the frontal and parietal gray matter (GM) at 7
±3 days of abstinence (baseline). ALC participants were restudied after 35±11 days of abstinence (assessment point 2: AP2). Twenty-eight nonsmoking, light-drinking control participants (nsLD) from the community were studied with perfusion MRI. ALC participants were followed over 12 months after baseline study and were classified as abstainers (no alcohol consumption; n=19) and resumers (any alcohol consumption; n=38) at follow-up. Cross-sectional and longitudinal perfusion was compared in abstainers, resumers, and nsLD.

At baseline, resumers demonstrated significantly lower frontal and parietal GM perfusion than nsLD and abstainers. Abstainers and nsLD were not different on frontal or parietal GM perfusion. No significant longitudinal perfusion changes were observed in abstainers and resumers. At AP2, resumers showed significantly lower frontal GM perfusion than nsLD and abstainers, whereas no group differences were observed for parietal GM. Abstainers and nsLD were not different on frontal GM perfusion.

The significantly decreased frontal GM perfusion in resumers compared with both abstainers and nsLD across the assessment interval suggests premorbid and/or acquired neurobiolog
ical abnormalities of the frontal GM in resumers.

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