EUCAM will organize its third conference on alcohol marketing in Europe on November 25th and 26th 2010 in Amsterdam.
 

U.S. Senators Tell FDA Alcoholic Energy Drinks Unsafe and Possibily Illegal 

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Stigma and Treatment for Alcohol Disorders in the United States

Among a nationally representative sample of adults with an alcohol use disorder, the authors tested whether perceived stigmatization of alcoholism was associated with a lower likelihood of receiving alcohol-related services. 

Data were drawn from a face-to-face epidemiologic survey of 34,653 adults interviewed in 2004–2005 who were aged 20 years or older and residing in households and group quarters in the United States. Alcohol abuse/dependence was diagnosed by using the Alcohol Use Disorder and Associated Disabilities Interview Schedule–Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version (AUDADIS-IV). The stigma measure used was the Perceived Devaluation-Discrimination Scale. The main outcome was lifetime intervention including professional services and 12-step groups for alcohol disorders.

Individuals with a lifetime diagnosis of an alcohol use disorder were less likely to utilize alcohol services if they perceived higher stigma toward individuals with alcohol disorders (odds ratio = 0.37, 95% confidence interval: 0.18, 0.76). 

Higher perceived stigma was associated with male gender (β = −0.75; P < 0.01), nonwhite compared with non-Hispanic white race/ethnicity, lower income (β = 1.0; P < 0.01), education (β = 1.48; P < 0.01), and being previously married (β = 0.47; P = 0.02). 

Individuals reporting close contact with an alcohol-disordered individual (e.g., relative with an alcohol problem) reported lower perceived stigma (β = −1.70; P < 0.01). 

A link between highly stigmatized views of alcoholism and lack of services suggests that stigma reduction should be integrated into public health efforts to promote alcohol treatment. 

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Request Reprint E-Mail:  kmk2104@columbia.edu

Excessive drinking and history of unemployment and cohabitation in Danish men born in 1953

Few studies exist on social inequality of excessive drinking in Denmark and differences seem to be less pronounced than in other European countries.

The aims of this study were to investigate how history of employment and cohabitation is associated with excessive drinking and to study interaction between both.  

Birth-cohort study of 6112 Danish men born in 1953 with follow-up in 2004 on excessive drinking at age 51 years.  

Excessive drinking (between 22 and 35 units of alcohol per week) differed little depending on history of unemployment and cohabitation. Risk of very excessive drinking (drinking >35 units of alcohol per week) increased with number of job losses—ranging from one job-loss [odds ratio (OR) 1.72, 95% confidence interval (CI) 1.39–2.14] to three or more job-losses (OR 2.48, 95% CI 1.75–3.52)—and duration of unemployment—ranging from 1 to 5 years (OR 1.34, 95% CI 1.11–1.63) to ≥10 years (OR 4.16, CI 3.13–5-53). Very excessive drinking was also associated with number of broken partnerships—ranging from one broken partnership (OR 1.43, 95% CI 1.16–1.77) to three or more broken partnerships (OR 2.69, 95% CI 2.03–3.55)—and with living alone for >5 years—ranging from 6 to 9 years (OR 1.73, 95% CI 1.30–2.29) to ≥10 years (OR 2.55, 95% CI 2.04–3.55). We found an interaction between the number of job-losses and of broken partnerships in relation to very excessive drinking.
 

Very excessive drinking is related to number of job-losses, broken partnerships, living alone and duration of unemployment. 

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Request Reprint E-Mail:    makr@sund.ku.dk

 

Network Support as a Prognostic Indicator of Drinking Outcomes: The COMBINE Study

To increase understanding of the interrelationship between a patient's social network and patient drinking, the Important People and Activities (IPA) instrument was developed. 

To meet the aims of the COMBINE (Combining Medications and Behavioral Interventions) Study, the IPA was modified to create the Important People Inventory (IPI), which was used to measure the contextual influence of the patient's social network on patient outcomes and treatment effects. 

The aims of the present article were to describe the IPI and its differences from the IPA and to test the relationship of network support as measured by the IPI in predicting drinking during and following treatment. 

Alcohol-dependent patients (N = 1,373) seeking outpatient treatment in the COMBINE randomized clinical trial were administered the IPI before treatment. Six network constructs were tested for predicting patient drinking. 

As unique effects, alcohol-specific support, as measured by network drinking and opposition to patient drinking, is predictive of patient abstinent days during and following treatment and heavy drinking days following treatment.
 
Other measures of network support have variable relationships to patient drinking at different phases: Some are predictive of patient drinking during treatment but diminish, whereas others are unrelated to drinking during treatment but become increasingly predictive of drinking as time from treatment increases.

The IPI is a useful instrument for describing network support of alcohol-use disorder patients entering treatment. Measures of alcohol-specific support are prognostic of drinking outcomes. The patient's network support should be systematically assessed prior to tailored treatment planning.



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Request Reprint E-Mail:  Richard_Longabaugh@Brown.EDU
 

Subpopulations of Older Foster Youths With Differential Risk of Diagnosis for Alcohol Abuse or Dependence

Distinctive combinations of factors are likely to be associated with serious alcohol problems among adolescents about to emancipate from the foster care system and face the difficult transition to independent adulthood.

This study identifies particular subpopulations of older foster youths that differ markedly in the probability of a lifetime diagnosis for alcohol abuse or dependence. 

Classification and regression tree (CART) analysis was applied to a large, representative sample (N = 732) of individuals, 17 years of age or older, placed in the child welfare system for more than 1 year. CART evaluated two exploratory sets of variables for optimal splits into groups distinguished from each other on the criterion of lifetime alcohol-use disorder diagnosis. 

 Each classification tree yielded terminal groups with different rates of lifetime alcohol-use disorder diagnosis.

Notable groups in the first tree included one characterized by high levels of both delinquency and violence exposure (53% diagnosed) and another that featured lower delinquency but an independent-living placement (21% diagnosed). 

Notable groups in the second tree included African American adolescents (only 8% diagnosed), White adolescents not close to caregivers (40% diagnosed), and White adolescents closer to caregivers but with a history of psychological abuse (36% diagnosed). 

Analyses incorporating variables that could be comorbid with or symptomatic of alcohol problems, such as delinquency, yielded classifications potentially useful for assessment and service planning. 

Analyses without such variables identified other factors, such as quality of caregiving relationships and maltreatment, associated with serious alcohol problems, suggesting opportunities for prevention or intervention.

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Posttraumatic Stress Disorder and Alcohol Dependence in Young Women

The aim of the current study is to characterize the relationship between posttraumatic stress disorder (PTSD) and alcohol dependence (AD) in women, distinguishing PTSD-specific influences on AD from the contribution of co-occurring psychiatric conditions and from the influences 

Trauma histories and DSM-IV lifetime diagnoses, including PTSD and AD, were obtained via telephone interview from 3,768 female twins. Based on PTSD status and trauma history, participants were categorized as no trauma (43.7%), trauma without PTSD (52.6%), or trauma with PTSD (3.7%). Cox proportional hazards regression analyses were conducted using trauma/PTSD status to predict AD, first adjusting only for ethnicity and parental problem drinking, then including conduct disorder, major depressive disorder, regular smoking, and cannabis abuse. 

Before accounting for psychiatric covariates, elevated rates of AD were evident in both trauma-exposed groups, but those with PTSD were at significantly greater risk for AD than those without PTSD. This distinction was no longer statistically significant when psychiatric covariates were included in the model, but both trauma-exposed groups continued to show elevated odds of developing AD compared with the no trauma group.

 The elevated rates of AD in women who have experienced trauma are not accounted for in full by psychiatric conditions that commonly co-occur with AD and trauma exposure. The greater likelihood of developing AD in the subset of trauma-exposed individuals who develop PTSD may reflect higher levels of distress and/ or higher rates of psychopathology associated with traumas that lead to PTSD rather than PTSD-specific influences. 


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Request Reprint E-Mail: 

carolyn@WUSTL.EDU

 

Preference for ethanol in zebrafish following a single exposure

Ethanol is one of the most widely abused drugs in the world. Its addictive property is believed to primarily stem from its ability to influence the brain reinforcement pathway evolved for mediating natural rewards. Although dopamine is a known component of the reinforcement pathway, clear molecular and cellular compositions of this pathway and its sensitivity to ethanol remain not well understood. 

Zebrafish has been increasingly used to model and understand human disease states, due to its genetic tractability and ease of maintenance.

In this study, we determine whether adult zebrafish develop ethanol preference after a single exposure using a conditioned place preference (CPP) paradigm. Moreover, we establish a procedure that can be carried out in an automated and relatively high-throughput fashion. 

We find that zebrafish of the AB strain display significantly increased preference for the compartment where they received ethanol during a single 20-min exposure.

The largest increase in preference is in response to a 1.5% ethanol administered in the tank water. 

The results demonstrate robust ethanol preference in zebrafish. Such a relatively high-throughput assay with automated tracking and response to a single ethanol exposure provides a potential means for a large-scale screening aimed at understanding the brain reinforcement pathway and its sensitivity to ethanol in this genetically tractable vertebrate.


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Request Reprint E-Mail:  su.guo@ucsf.edu  

Is catechol-O-methyl transferase 472G/A gene polymorphism a marker associated with alcoholism?

The available published evidence from the genetic association studies on the association between alcoholism and catechol-O-methyl transferase 472G/A gene polymorphism have produced inconclusive results. 

To interpret these results, a meta-analysis of all available studies was conducted.

PubMed database and HuGE Navigator were searched for all relevant genetic association studies. In the meta-analysis, the random effect pooled odds ratio (OR) was estimated. The heterogeneity between studies was tested using the Q statistic and the I2 metric. A spectrum of genetic contrasts was examined and the existence of potential bias was investigated. Cumulative meta-analysis was also performed. In addition, the pooled generalized OR (ORG), which uses the complete genotype distribution, was calculated.

Data from eight gene-candidate studies were included in the meta-analysis.

The main analysis for the allele contrast derived a nonsignificant association (OR=1.14, confidence interval: 0.95-1.36) and large heterogeneity (PQ=0.03, I2=56%). In subgroup analysis, the genetic effects were consistent across ethnicities, and sex, with the associations being nonsignificant. 

The associations according to violent behaviour status were also nonsignificant. Heterogeneity varied from low to high. A lack of differential magnitude of effect in large versus small studies was revealed. Cumulative meta-analysis indicated a trend towards association as evidence accumulates. The ORG was also nonsignificant (ORG=1.14, confidence interval: 0.94-1.41), (PQ=0.04, I2=53%). 

The genome-wide and the family-based association studies did not produce significant associations.

There is no conclusive evidence that catechol-O-methyl transferase 472G/A is a marker associated with alcoholism. More evidence is needed to draw safe conclusions regarding this association.


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Request Reprint E-Mail: zintza@med.uth.gr  

Alcohol-seeking behavior is associated with increased glutamate transmission in basolateral amygdala and nucleus accumbens as measured by glutamate-oxidase-coated biosensors

Relapse is one of the most problematic aspects in the treatment of alcoholism and is often triggered by alcohol-associated environmental cues.

Evidence indicates that glutamate neurotransmission plays a critical role in cue-induced relapse-like behavior, as inhibition of glutamate neurotransmission can prevent reinstatement of alcohol-seeking behavior.

However, few studies have examined specific changes in extracellular glutamate levels in discrete brain regions produced by exposure to alcohol-associated cues.

The purpose of this study was to use glutamate oxidase (GluOx)-coated biosensors to monitor changes in extracellular glutamate in specific brain regions during cue-induced reinstatement of alcohol-seeking behavior. Male Wistar rats were implanted with indwelling jugular vein catheters and intracerebral guide cannula aimed at the basolateral amygdala (BLA) or nucleus accumbens (NAc) core, and then trained to self-administer alcohol intravenously. A separate group of animals were trained to self-administer food pellets. Each reinforcer was accompanied by the presentation of a light/tone stimulus. Following stabilization of responding for alcohol or food reinforcement, and subsequent extinction training, animals were implanted with pre-calibrated biosensors and then underwent a 1-hour cue-induced reinstatement testing period.

As determined by GluOx-coated biosensors, extracellular levels of glutamate were increased in the BLA and NAc core during cue-induced reinstatement of alcohol-seeking behavior. 

The cumulative change in extracellular glutamate in both regions was significantly greater for cue-induced reinstatement of alcohol-seeking behavior versus that of food-seeking behavior. 

These results indicate that increases in glutamate transmission in the BLA and NAc core may be a neurochemical substrate of cue-evoked alcohol-seeking behavior.

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Request Reprint E-Mail:  gass@musc.edu  

Gene Variant Linked to Depression in Alcohol-Dependent Individuals

A study highlighting the co-occurrence of alcohol dependence and depressive symptoms was presented here at the American Society of Human Genetics 60th Annual Meeting by first author Darlene A. Kertes, PhD, from the Department of Psychology, University of Florida, Gainesville.

The study demonstrated the value of considering comorbidities when designing genetic association studies. The research also highlighted the association between a variant of GABRA2 and depressive symptoms in alcohol-dependent populations.

Dr. Kertes described the high level of co-occurrence between depression and alcohol dependence; in people who have one disorder, the risk of developing the other is 2 to 4 times higher. This comorbidity is important clinically, as evidenced in the higher relapse frequency of alcohol-dependent individuals who also experience symptoms of depression.  > > > >

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Test of a Clinical Model of Drinking and Suicidal Risk

There are few data on the role of drinking patterns in suicidal thoughts or behavior among alcohol-dependent individuals (ADIs) and meager data on variables that may influence the role of drinking in suicidal thoughts and behavior. 

This study tested a heuristic model that predicts that drinking promotes suicidal thoughts and behavior, the association is mediated (accounted for) by depressive symptoms, and that anger moderates (increases) the risk associated with intense drinking.

Data from Project MATCH, a multisite alcohol use disorders treatment trial, were analyzed using structural equation modeling. There were 1,726 participants including 24% women and a mean age of 40.2 ± 11.0 years. Subjects were assessed at baseline and at 3-, 9-, and 15-month follow-up. Two categorical measures (presence/absence) of suicidal ideation (SI) were used that were analyzed in separate models. Predictors of interest were continuous assessments of average drinking intensity (i.e., drinks per drinking day or DDD), drinking frequency (i.e., percent days abstinent or PDA), depression, and anger.

Both DDD and PDA were associated with SI at a statistically significant level, with PDA showing an inverse association. Depression scores served as a partial mediator or a full mediator of the drinking–SI relationship depending on the measure of SI used in the analysis. The models testing anger scores as a moderator fit the data poorly and did not support that anger serves as a moderator of the drinking–SI association.

Conclusions:  Greater drinking intensity and drinking frequency predict SI among ADIs and depression serves as a mediator of these associations, but anger does not appear to serve as a moderator. 

Further research is required to clarify whether depression serves as a partial or full mediator and to see whether the results herein extend to suicidal behavior (i.e., suicide attempt, suicide).


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Request Reprint E-Mail:  

kenneth_conner@urmc.rochester.edu

Nicotine as a Factor in Stress Responsiveness Among Detoxified Alcoholics

The effect of transdermal nicotine on stress reactivity was investigated in currently smoking, detoxified, substance-dependent individuals (65% alcohol dependent, n = 51; 31 male) following a psychosocial stressor.

 

Using a randomized, double-blind, placebo-controlled design, subjects were assigned to receive either active transdermal nicotine (low or high dose) or placebo. Six hours following nicotine administration, subjects performed a laboratory psychosocial stressor consisting of two 4-min public-speaking sessions.

 

Consistent with prior reports, substance-dependent individuals displayed a blunted stress response. However, a review of the cortisol distribution data encouraged additional analyses. 

Notably, a significant minority of the substance-dependent individuals (33%) demonstrated elevated poststress cortisol levels. This group of responders was more likely to be alcohol dependent and to have received the high dose of nicotine [χ²(2) = 32, P < 0.0001], [χ²(2) = 18.66, P < 0.0001]. Differences in salivary cortisol responses between responders and nonresponders could not be accounted for by the length of sobriety, nicotine withdrawal levels, anxiety or depressive symptomatology at the time of the psychosocial stressor. 

 

These results suggest that nicotine administration may support a normalization of the salivary cortisol response following psychosocial stress in subgroups of substance-dependent individuals, particularly those who are alcohol dependent. Given the association between blunted cortisol levels and relapse, and the complex actions of nicotine at central and peripheral sites, these findings support the systematic study of factors including nicotine, which may influence stress reactivity and the recovery process in alcohol-dependent individuals. 

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Request Reprint E-Mail:  gilbertr@lycoming.edu

  

Partial Agonists of the α3β4* Neuronal Nicotinic Acetylcholine Receptor Reduce Ethanol Consumption and Seeking in Rats

Alcohol use disorders (AUDs) impact millions of individuals and there remain few effective treatment strategies. Despite evidence that neuronal nicotinic acetylcholine receptors (nAChRs) have a role in AUDs, it has not been established which subtypes of the nAChR are involved. 

Recent human genetic association studies have implicated the gene cluster CHRNA3–CHRNA5–CHRNB4 encoding the α3, α5, and β4 subunits of the nAChR in susceptibility to develop nicotine and alcohol dependence; however, their role in ethanol-mediated behaviors is unknown due to the lack of suitable and selective research tools.

To determine the role of the α3, and β4 subunits of the nAChR in ethanol self-administration, we developed and characterized high-affinity partial agonists at α3β4 nAChRs, CP-601932, and PF-4575180. 

Both CP-601932 and PF-4575180 selectively decrease ethanol but not sucrose consumption and operant self-administration following long-term exposure. 

We show that the functional potencies of CP-601932 and PF-4575180 at α3β4 nAChRs correlate with their unbound rat brain concentrations, suggesting that the effects on ethanol self-administration are mediated via interaction with α3β4 nAChRs. 

Also varenicline, an approved smoking cessation aid previously shown to decrease ethanol consumption and seeking in rats and mice, reduces ethanol intake at unbound brain concentrations that allow functional interactions with α3β4 nAChRs.
 

Furthermore, the selective α4β2^* nAChR antagonist, DHβE, did not reduce ethanol intake. 

Together, these data provide further support for the human genetic association studies, implicating CHRNA3 and CHRNB4 genes in ethanol-mediated behaviors.

CP-601932 has been shown to be safe in humans and may represent a potential novel treatment for AUDs.

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Request Reprint E-Mail: hans.rollema@pfizer.com 

Alcohol & Young People: a toolkit for supporting vulnerable young people

Calling Time, the South West Alcohol Improvement Programme (AIP) has published Alcohol and Young People: A Toolkit [pdf]. The toolkit aims to inform and guide professionals and carers concerned with looked after children and young people with special educational needs. It was produced in partnership with Alcohol Concern and builds on relevant policy, research and guidance and is informed by consultation with a number of professionals and young people from across the South West and in particular from Torbay.

> > > >

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Alcohol News - 44/2010

The Copenhagen Post (Denmark) - Boozy Copenhagen
Approximately 800 inflatable bottles were floated out on to Peblinge Lake on Monday to represent the consumption of alcohol by Copenhagen residents.
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Jp.dk (Denmark) - City council: widespread sale of alcohol to underaged
MPs say upholding alcohol purchase laws is seller’s responsibility Although sales of beer, wine and spirits to anyone under 16 is illegal, 84 percent of the city's 15-year-olds have purchased alcohol at least once within the past month.
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Mmegi Online (Norway/Botswana) - Blue Cross calls for more tax on alcohol
An alcohol policy training manager for Blue Cross Norway has called on the government of Botswana to increase taxation in such a way that the alcohol industry covers all the expenditure created by alcohol consumption.
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New York Daily News - Alcohol is more harmful than heroin or crack: study
Alcohol is even worse than heroin and crack on the list of "most harmful" drugs, according to a new study published in the British medical journal, The Lancet.
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Adelaidenow (Australia) – Flawed stats veil alcohol usage
An article published yesterday by the Medical Journal of Australia argues that the Australian Bureau of Statistics has significantly underestimated alcohol consumption for years, a mistake that undermines alcohol policies.
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White Lake Beacon (USA) - ‘Super’ drunk law starts Sunday with enhanced penalties
Starting Sunday, Michigan's new high blood alcohol content (BAC) drunk driving law takes effect, with enhanced penalties for first-time drivers convicted of operating with a BAC of .17 or higher.
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TVNZ – Study shows link between buying and bingeing
A new study has found that people with off-licence liquor outlets near their home are more likely to be binge-drinkers.
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TheMedGuru - Boozers need help to reduce alcohol consumption over time—study
As per a new research study, heavy drinkers may cut down on their alcohol consumption over the period of time, but even then they cannot really bring it down to the level of an average adult drinker.
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Irish Examiner (Ireland) - Drinks industry calls for 20% cut in alcohol excise duty
A package of stimulus measures to stem the tide of shoppers buying alcohol across the border were unveiled today by alcohol manufacturers and sellers.
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BBC News (Wales) - Drinking banning orders to help tackle drink crime
Magistrates in parts of Wales have new powers to ban people convicted of alcohol-related offences from pubs for up to two years.
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Times LIVE (South Africa) - Minister draws the line on alcohol abuse
Health Minister Aaron Motsoaledi wants new laws to regulate South Africa's alcohol industry. Motsoaledi said the plan would be "extensive" and similar to the campaign launched against the tobacco industry which also led to a ban on cigarette advertising.
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Pediatric SuperSite - Drug and alcohol consumption linked to popularity in adolescents
Popular adolescents are more likely to consume larger amounts of alcohol and drugs than their less popular peers, according to study results announced in a press release.
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AllAfrica.com (Kenya) - Cut the Lectures - Alcohol is a Drug - a Ruinous One
Using drugs is dangerous - a social vice that must be stamped out. Experimenters are surveyors and probers, while users are slack-jawed, mouth breathing degenerates.
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The Local.se (Sweden) - Efforts to curb youth drinking 'ineffective'
A new report released on Monday has questioned the efficacy of the Swedish government's investment of about 900 million kronor ($135.81 million) over the last 10 years in reducing youth alcohol consumption.
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Hurriyet Daily News (Turkey) - Turkish tourism industry displeased with tax hike on alcohol
Turkish tourism industry representatives have strongly criticized a recent increase in the private consumption tax, or ÖTV, on alcoholic drinks.
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Independent (UK) - Government urged to tackle 'passive drinking'
The Government must tackle the damaging effects of "passive drinking" and give communities greater influence over licensing laws, campaigners said today.
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The Way (UK) - Alcohol puts a Brit in hospital every 7 minutes
A Briton is admitted to hospital with alcohol-related issues every seven minutes, according to official figures. Data from the NHS Information centre highlights that there has been a 54 per cent rise in the number of alcohol-related hospital visits in the past decade, as binge drinking takes its toll on the UK population.
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Herald Scotland (Scotland) - Scots council is first to call time on new liquor licences
New pubs, clubs or off-sales will be banned from opening across a Scottish local authority area in a highly controversial move designed to tackle the area’s chronic alcohol record.
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AOL Health - Alcohol, Flu May Trigger Strokes
Tossing back a few drinks during a night out with friends. Coming down with a cold or the flu. These might seem like harmless and seemingly unrelated events. But they all have something in common: They could raise your risk of having a stroke -- at least temporarily, a new study examining stroke triggers finds.
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Role for mammalian target of rapamycin complex 1 signaling in neuroadaptations underlying alcohol-related disorders

Alcohol addiction is a chronically relapsing disorder that includes certain maladaptive learning and memory. The serine and threonine kinase complex, mammalian target of rapamycin complex 1 (mTORC1), has been implicated in synaptic plasticity, learning, and memory by controlling protein translation.

Here we show that administration of alcohol and excessive voluntary consumption of alcohol induce the activation of the mTORC1-mediated signaling pathway in the nucleus accumbens (NAc) of rodents.

We further show that the protein expression levels of GluR1 and Homer, two synaptic proteins whose translation has been shown to be modulated by mTORC1, are up-regulated in the NAc of rodents with a history of excessive alcohol consumption. 

In addition, our results document that the Food and Drug Administration-approved inhibitor of mTORC1, rapamycin, decreases expression of alcohol-induced locomotor sensitization and place preference, as well as excessive alcohol intake and seeking in preclinical rodent models of alcohol abuse. 

Together, our results suggest that mTORC1 within the NAc is a contributor to molecular mechanisms underlying alcohol-drinking behaviors.

Furthermore, despite its massive health and socioeconomic impact worldwide, pharmacotherapies for alcohol abuse and addiction remain limited.

Our data therefore put forward the possibility that targeting the mTORC1 signaling cascade is an innovative and valuable strategy for the treatment of alcohol use and abuse disorders. 

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Request Reprint E-Mail:  dron@gallo.ucsf.edu.   

Long-Lasting Adaptations of the NR2B-Containing NMDA Receptors in the Dorsomedial Striatum Play a Crucial Role in Alcohol Consumption and Relapse

A growing number of studies suggest that the development of compulsive drug seeking and taking depends on dorsostriatal mechanisms.

We previously observed that ex vivo acute exposure of the dorsal striatum to, and withdrawal from, alcohol induces long-term facilitation (LTF) of the activity of NR2B-containing NMDA receptors (NR2B-NMDARs) in a mechanism that requires the Src family protein tyrosine kinase (PTK), Fyn (Wang et al., 2007).

In the present study, we first compared alcohol's actions in rat dorsomedial (DMS) and the dorsolateral (DLS) subregions of the striatum, which differ in their anatomical connectivity and function.

We found that alcohol-mediated induction of LTF of NR2B-NMDAR activity is centered in the DMS. 

Next, we tested whether in vivo exposure of rats to alcohol leads to long-term adaptations of the NMDAR system in the DMS. 

We observed that repeated daily administration of alcohol results in a long-lasting increase in the activity of the NR2B-NMDARs in the DMS. The same procedure leads to a prolonged activation of Fyn, increased NR2B phosphorylation, and membrane localization of the subunit. Importantly, similar electrophysiological and biochemical modifications were observed in the DMS of rats that consumed large quantities of alcohol.
 
Finally, we show that inhibition of NR2B-NMDARs or Src family PTKs in the DMS, but not in the DLS, significantly decreases operant self-administration of alcohol and reduces alcohol-priming-induced reinstatement of alcohol seeking. Our results suggest that the upregulation of NR2B-NMDAR activity within the DMS by alcohol contributes to the maladaptive synaptic changes that lead to excessive alcohol intake and relapse.



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Request Reprint E-Mail:  dron@gallo.ucsf.edu  

Per capita alcohol consumption in Australia: will the real trend please step forward?

To estimate the national trend in per capita consumption (PCC) of alcohol for Australians aged 15 years and older for the financial years 1990–91 to 2008–09. 

 

With the use of data obtained from Australian Bureau of Statistics’ catalogues and World Advertising Research Centre reports, three alternative series of annual totals of PCC of alcohol for the past 20 years (1990–91 to 2008–09) were estimated based on different assumptions about the alcohol content of wine. For the “old” series, the alcohol content of wine was assumed to have been stable over time. For the “new” series, the alcohol content of wine was assumed to have increased once in 2004–05 and then to have remained stable to 2008–09. For the “adjusted” series, the alcohol content of wine was assumed to have gradually increased over time, beginning in 1998–99. Linear trend analysis was applied to identify significant trends.

National trend in annual PCC of alcohol 1990–91 to 2008–09.

The new and adjusted series of annual totals of PCC of alcohol showed increasing trends; the old series was stable.

Until recently, official national annual totals of PCC of alcohol were underestimated and led to the mistaken impression that levels of alcohol consumption had been stable since the early 1990s. In fact, Australia’s total PCC has been increasing significantly over time because of a gradual increase in the alcohol content and market share of wine and is now at one of its highest points since 1991–92. 

This new information is consistent with evidence of increasing alcohol-related harm and highlights the need for timely and accurate data on alcohol sales and harms across Australia.

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Drug harms in the UK: a multicriteria decision analysisprint

Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK.

Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance.

MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places.

These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.

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Request Reprint E-Mail:  d.nutt@imperial.ac.uk  

Alcohol screening and brief intervention in primary care: Absence of evidence for efficacy in people with dependence or very heavy drinking

Although screening and brief intervention (BI) in the primary-care setting reduces unhealthy alcohol use, its efficacy among patients with dependence has not been established. 

This systematic review sought to determine whether evidence exists for BI efficacy among patients with alcohol dependence identified by screening in primary-care settings.

We included randomised controlled trials (RCTs) extracted from eight systematic reviews and electronic database searches published through September 2009. These RCTs compared outcomes among adults with unhealthy alcohol use identified by screening who received BI in a primary-care setting with those who received no intervention.

Sixteen RCTs, including 6839 patients, met the inclusion criteria. Of these, 14 excluded some or all persons with very heavy alcohol use or dependence; one in which 35% of 175 patients had dependence found no difference in an alcohol severity score between groups; and one in which 58% of 24 female patients had dependence showed no efficacy.

Alcohol screening and BI has efficacy in primary care for patients with unhealthy alcohol use, but there is no evidence for efficacy among those with very heavy use or dependence. As alcohol screening identifies both dependent and non-dependent unhealthy use, the absence of evidence for the efficacy of BI among primary-care patients with screening-identified alcohol dependence raises questions regarding the efficiency of screening and BI, particularly in settings where dependence is common. 

The finding also highlights the need to develop new approaches to help such patients, particularly if  screening and BI are to be disseminated widely.


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Request Reprint E-Mail:  rsaitz@bu.edu 

Conducting economic evaluations of screening and brief intervention for hazardous drinking: Methods and evidence to date for informing policy

Many policy review articles have concluded that alcohol screening and brief intervention (SBI) is both cost-effective and cost-beneficial. Yet a recent cost-effectiveness review for the United Kingdom's National Institute for Health and Clinical Excellence suggests that these conclusions may be premature.

This article offers a brief synopsis of the various types of economic analyses that may be applied to SBI, including cost analysis, cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis and other types of economic evaluation. 

A brief overview of methodological issues is provided, and examples from the SBI evaluation literature are provided.

The current evidence base is insufficient to draw firm conclusions about the cost, cost-effectiveness or cost-benefit of SBI and about the impact of SBI on health-care utilisation.

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Request Reprint E-Mail:    cowell@rti.org

Internet-based interventions for problem drinkers: From efficacy trials to implementation

Internet-based interventions (IBIs) for problem drinkers have been in existence for over a decade. In that time, IBIs have increased in sophistication and there is the beginning of a solid research base suggesting their efficacy. A growing number of problem drinkers are using IBIs and attempts have been made to explore how IBIs can be integrated within primary care and other health-care settings. 

This symposium provided an overview of IBIs for problem drinkers and highlighted some of the important issues in their development and implementation.

IBIs appear to be at a ‘cusp’ as technology and intervention practices are merged together in an attempt to provide better health care for problem drinkers. 

The timing of the 2009 International Network on Brief Interventions for Alcohol Problems Conference was ideal for a presentation and discussion of the role that IBIs play now that IBIs have started to shift into the mainstream of services for problem drinkers.

The presentations in this symposium covered the ‘bench to bedside’ aspects of the development and evaluation of IBIs. They included a systematic review of the research to-date in this field, a report on the results from a just completed randomised controlled trial, a report on an effectiveness trial of implementing IBIs in multiple university settings and a consideration of the cost-effectiveness of IBIs.


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Request Reprint E-Mail:    john_cunningham@camh.net 

What process research tells us about brief intervention efficacy

This article explores mechanisms of the efficacy of brief intervention (BI).

We conducted a BI trial at the emergency department of the Lausanne University Hospital, of whom 987 at-risk drinkers were randomised into BI and control groups.

The overall results demonstrated a general decrease in alcohol use with no differences across groups. The intention to change was explored among 367 patients who completed BI. Analyses of 97 consecutive tape-recorded sessions explored patient and counsellor talks during BI, and their relationship to alcohol use outcome.

Evaluation of the articulation between counsellor behaviours and patient language revealed a robust relationship between counsellor motivational interviewing (MI) skills and patient change talk during the intervention.

Further exploration suggested that communication characteristics of patients during BI predicted changes in alcohol consumption 12 months later.
Moreover, despite systematic training, important differences in counsellor performance were highlighted. Counsellors who had superior MI skills achieved better outcomes overall, and maintained efficacy across all levels of patient ability to change, whereas counsellors with inferior MI skills were effective mostly with patients who had higher levels of ability to change.
Finally, the descriptions of change talk trajectories within BI and their association with drinking 12 months later showed that final states differed from initial states, suggesting an impact resulting from the progression of change talk during the course of the intervention.

These findings suggest that BI should focus on the general MI attitude of counsellors who are capable of eliciting beneficial change talk from patients.
 

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Request Reprint E-Mail:    mailto:jean%E2%80%90bernard.daeppen@chuv.ch

Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy

Screening and brief interventions form a vital plank in England's plans to reduce alcohol-related harm. 

This article clarifies the use of terminology in England to describe various drinking categories and screening and brief interventions. It details efforts to implement these interventions, including recent incentive packages that have been put in place to encourage primary care to implement these interventions.

It describes the Screening and Intervention Programme for Sensible Drinking research program that is underway to clarify tools and methods to introduce and support these interventions.

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Request Reprint E-Mail:    don.lavoie@dh.gsi.gov.uk

Community pharmacy service users' views and perceptions of alcohol screening and brief intervention

Community pharmacists have the potential to deliver alcohol screening and brief interventions (SBI) to pharmacy users. However, little is known if SBI would be utilised and views of people who might use the service. Therefore, the aim was to investigate potential barriers and enablers of pharmacy SBI.

Purposive sampling was used to select four pharmacies within the London borough of Westminster, UK. Semistructured interview schedule recorded participants' views of pharmacy SBI. The Alcohol Use Disorder Identification Test-Consumption (AUDIT-C) was incorporated to record views of high and low-risk drinkers. Categorical data were analysed and content analysis undertaken.

Of the 237 participants (149 female) approached 102 (43%) agreed to be interviewed (63 female). Of these 98 completed AUDIT-C, with 51 (52%) identified as risky drinkers. Risky drinkers were significantly identified among the younger age group (χ² = 11.03, P = 0.004), professional occupations (χ² = 10.41, P = 0.015), with higher qualifications (χ² = 10.46, P = 0.033), were least frequent visitors to a pharmacy (χ² = 11.58, P = 0.021) and more frequently identified in multiple pharmacy establishments than independents (χ² = 8.52, 0.004). Most were willing to discuss drinking (97, 96%) and accept written information (99, 98%). Accessibility and anonymity were reported as positive aspects and concerns were expressed about lack of privacy and time (pharmacist and user).

This study reports the first results of pharmacy users' views on SBI. Regardless of drinking status, most were willing to utilise the service and positive about pharmacists' involvement.

 
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Request Reprint E-Mail:  ranjita.dhital@kcl.ac.uk