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, January 22, 2011

How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-Disciplinary Perspectives

Evidence from multiple lines of research supports the effectiveness and practical importance of Alcoholics Anonymous and Narcotics Anonymous. 

Conference presenters discussed the relationship between 12-Step participation and abstinence among various populations, including adolescents, women, and urban drug users. 

Insight from the arts and humanities placed empirical findings in a holistic context.

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Chapter 91 The Alcohol Drinking History

Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition.
Walker HK, Hall WD, Hurst JW, editors.
Boston: Butterworths; 1990.
The American Psychiatric Association (DSM-III, 1980) has defined alcoholism and alcohol abuse as follows: alcoholism (or alcohol dependence) is "either a pattern of pathological alcohol use or impairment in social or occupational functioning due to alcohol, and either tolerance or withdrawal." A simplified interpretation of this definition is presented in Figure 91.1. Alcohol abuse is defined as "a pattern of pathological use for at least a month that causes impairment in social and occupational functioning." Few definitions in medicine have incited as much discussion as that of "alcoholism," mainly because excessive drinking may manifest as a medical problem (e.g., withdrawal seizures), a psychiatric problem (e.g., depression), or a social problem (e.g., involvement in an automobile accident). On the other hand, a person with a single episode of an alcohol-related problem is not necessarily an alcoholic; in such a case, the condition may be better termed "alcohol abuse."
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How many versus how much: 52 weeks of alcohol consumption in emerging adults

In previous research using timeline follow-back methods to closely monitor drinking and related variables over the first year of college (9 months), we showed that drinking varied considerably over time in accord with academic requirements and holidays. 

In a new community sample (N = 576) of emerging adults (18- and 19-year-olds who reported having begun drinking prior to recruitment), we used similar methods to compare drinking patterns in college and noncollege individuals over a full calendar year (including summer). To reduce the extreme distortion in computations of average drinking over restricted time spans (i.e., 1 week) that arise because large numbers of even regular drinkers may not consume any alcohol, we analyzed data using recently developed two-part latent growth curve modeling. 

This modeling distinguished consumption levels from numbers of individuals drinking in a given period. 

Results showed that drinking levels and patterns generally did not differ between college and noncollege drinkers, and that both groups responded similarly to even those contexts that may have seemed unique to one (i.e., spring break). 

We also showed that computation of drinking amounts without accounting for “zero drinkers” could seriously distort estimates of mean drinking on some occasions; for example, mean consumption in the total sample appeared to increase on Thanksgiving, whereas actual average consumption for those who were drinking diminished.

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Friday, January 21, 2011

Pharmacogenetic Approach at the Serotonin Transporter Gene as a Method of Reducing the Severity of Alcohol Drinking

Severe drinking can cause serious morbidity and death. Because the serotonin transporter (5-HTT) is an important regulator of neuronal 5-HT function, allelic differences at that gene may modulate the severity of alcohol consumption and predict therapeutic response to the 5-HT3 receptor antagonist, ondansetron. 

The authors randomized 283 alcoholics by genotype in the 5'-regulatory region of the 5-HTT gene (LL/LS/SS), with additional genotyping for another functional single-nucleotide polymorphism (T/G), rs1042173, in the 3'-untranslated region, in a double-blind controlled trial. Participants received either ondansetron (4 µg/kg twice daily) or placebo for 11 weeks, plus standardized cognitive-behavioral therapy.  

Individuals with the LL geno-type who received ondansetron had a lower mean number of drinks per drinking day (–1.62) and a higher percentage of days abstinent (11.27%) than those who received placebo. Among ondansetron recipients, the number of drinks per drinking day was lower (–1.53) and the percentage of days abstinent higher (9.73%) in LL compared with LS/SS individuals. LL individuals in the ondansetron group also had a lower number of drinks per drinking day (–1.45) and a higher percentage of days abstinent (9.65%) than all other genotype and treatment groups combined. For both number of drinks per drinking day and percentage of days abstinent, 5'-HTTLPR and rs1042173 variants interacted signicantly. LL/TT individuals in the ondansetron group had a lower number of drinks per drinking day (–2.63) and a higher percentage of days abstinent (16.99%) than all other geno-type and treatment groups combined.  

The authors propose a new pharmacogenetic approach using ondansetron to treat severe drinking and improve abstinence in alcoholics.

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Reward-Related Behavioral Paradigms for Addiction Research in the Mouse: Performance of Common Inbred Strains

The mouse has emerged as a uniquely valuable species for studying the molecular and genetic basis of complex behaviors and modeling neuropsychiatric disease states. 

While valid and reliable preclinical assays for reward-related behaviors are critical to understanding addiction-related processes, and various behavioral procedures have been developed and characterized in rats and primates, there have been relatively few studies using operant-based addiction-relevant behavioral paradigms in the mouse.

Here we describe the performance of the C57BL/6J inbred mouse strain on three major reward-related paradigms, and replicate the same procedures in two other commonly used inbred strains (DBA/2J, BALB/cJ). 

We examined Pavlovian-instrumental transfer (PIT) by measuring the ability of an auditory cue associated with food reward to promote an instrumental (lever press) response. 

In a separate experiment, we assessed the acquisition and extinction of a simple stimulus-reward instrumental behavior on a touchscreen-based task. Reinstatement of this behavior was then examined following either continuous exposure to cues (conditioned reinforcers, CRs) associated with reward, brief reward and CR exposure, or brief reward exposure followed by continuous CR exposure. 

The third paradigm examined sensitivity of an instrumental (lever press) response to devaluation of food reward (a probe for outcome insensitive, habitual behavior) by repeated pairing with malaise. 

Results showed that C57BL/6J mice displayed robust PIT, as well as clear extinction and reinstatement, but were insensitive to reinforcer devaluation. 

DBA/2J mice showed good PIT and (rewarded) reinstatement, but were slow to extinguish and did not show reinforcer devaluation or significant CR-reinstatement. 

BALB/cJ mice also displayed good PIT, extinction and reinstatement, and retained instrumental responding following devaluation, but, unlike the other strains, demonstrated reduced Pavlovian approach behavior (food magazine head entries). 

Overall, these assays provide robust paradigms for future studies using the mouse to elucidate the neural, molecular and genetic factors underpinning reward-related behaviors relevant to addiction research.

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Mast Cells and Ethanol Consumption: Interactions in the Prostate, Epididymis and Testis of UChB Rats

Alcoholism has reached alarming proportions while fertility rates slowing in populations. 

The assessment of inflammatory effects with emphasis on the variation of the mast cells comparing ethanol chronic ingestion on reproductive organs deserves attention.
The mast cells were investigated with light microscopy using toluidine blue to locate and count total mast cells and immunohistochemistry to identify the connective tissue mast cells (CTMC).
The increase in total mast cells in the prostate, total and degranulated mast cells in epididymis of UChB rats was accompanied by a greater proportion of mucosal mast cells (MMC) in these organs. In addition, a lower incidence of degranulated mast cells was observed in epididymis of control rats.
Ethanol increases the number of total and degranulated mast cells in the prostate and epididymis, as well as associated with increasing MMC, and therefore, it could be leading to inflammation in these organs.

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The Role of Social Support in Collegiate Recovery Communities: A Review of the Literature

In the past decades one response to the increase of college drinking is the growing prevalence of Collegiate Recovery Communities (CRC). 

Numerous publications on these programs exist, yet a review does not. With a growing need for evidence-based model programs to address the concerns of alcohol abuse and dependence on college campuses, the importance of a collection on the effectiveness of CRCs exists. 

The goal of this article is to compile a thorough overview of data on CRCs in the United States, focusing specifically on the role of social support in recovery maintenance. 

Recommendations for future directions are discussed.

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Alcoholics Anonymous-Related Helping and the Helper Therapy Princ

The helper therapy principle (HTP) observes the helper's health benefits derived from helping another with a shared malady. 

The HTP is embodied by the program of Alcoholics Anonymous as a method to diminish egocentrism as a root cause of addiction. 

This article reviews recent evidence of the HTP in alcohol populations, extends to populations with chronic conditions beyond addiction, and concludes with new directions of empirical inquiry. 

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Thursday, January 20, 2011

Confirmatory Factor Analysis of Concept Mapping-Based Dimensions of Faith-Based Substance Abuse Treatment

Confirmatory factor analysis (CFA) techniques are used to evaluate the fit of a seven-dimensional concept mapping-based model of key dimensions of faith-based substance abuse treatment, using data from 310 staff and clients of 12 faith-based Teen Challenge programs. 

The initial seven-dimensional model fit poorly (fit indices of .62-.64), though, after trimming items with low loadings or redundant item content, model fit was increased substantially (fit indices of .87-.89). 

Overall, the current analyses provide preliminary support for the meaningfulness of the seven-dimensional model of faith-based treatment programs, despite different statistical approaches. 

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Differences of Acute versus Chronic Ethanol Exposure on Anxiety-Like Behavioral Responses in Zebra

Zebrafish, a vertebrate model organism amenable to high throughput screening, is an attractive system to model and study the mechanisms underlying human diseases. 

Alcoholism and alcoholic medical disorders are among the most debilitating diseases, yet the mechanisms by which ethanol inflicts the disease states are not well understood. 

In recent years zebrafish behavior assays have been used to study learning and memory, fear and anxiety, and social behavior.

It is important to characterize the effects of ethanol on zebrafish behavioral repertoires in order to successfully harvest the strength of zebrafish for alcohol research. 

One prominent effect of alcohol in humans is its effect on anxiety, with acute intermediate doses relieving anxiety and withdrawal from chronic exposure increasing anxiety, both of which have significant contributions to alcohol dependence. 

In this study, we assess the effects of both acute and chronic ethanol exposure on anxiety-like behaviors in zebrafish, using two behavioral paradigms, the novel tank diving test and the light/dark choice assay. 

Acute ethanol exposure exerted significant dose-dependent anxiolytic effects. However, withdrawal from repeated intermittent ethanol exposure disabled recovery from heightened anxiety. 

These results demonstrate that zebrafish exhibit different anxiety-like behavioral responses to acute and chronic ethanol exposure, which are remarkably similar to these effects of alcohol in humans. 

Because of the accessibility of zebrafish to high throughput screening, our results suggest that genes and small molecules identified in zebrafish will be of relevance to understand how acute versus chronic alcohol exposure have opposing effects on the state of anxiety in humans.

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Ischemic Heart Disease Mortality and Morbidity Rates in Former Drinkers: A Meta-Analysis

Current abstainers from alcohol have been identified as an inadequate reference group in epidemiologic studies of the effects of alcohol, because inclusion of former drinkers might lead to overestimation of the protective effects and underestimation of the detrimental effects of drinking alcohol. 

The authors’ objective in the current study was to quantify this association for ischemic heart disease (IHD). 

Electronic databases were systematically searched for relevant case-control or cohort studies published from 1980 to 2010. Thirty-eight articles fulfilled the inclusion criteria, contributing a total of 5,613 IHD events and 12,097 controls among case-control studies and 1,387 events with combined endpoints and 7,183 events stratified by endpoint among 232,621 persons at risk among cohort studies.

Pooled estimates for the subset stratified by sex and endpoint showed a significantly increased risk among former drinkers compared with long-term abstainers for IHD mortality ( among men; relative risk = 1.25, 95% confidence interval: 1.15, 1.36; among women relative risk = 1.54, 95% confidence interval: 1.17, 2.03).

For IHD morbidity, the estimates for both sexes were close to unity and not statistically significant. Results were robust in several sensitivity analyses. 

In future studies, researchers should separate former drinkers from the reference category to obtain unbiased effect estimates. 

Implications for the overall beneficial and detrimental effects of alcohol consumption on IHD are discussed below.

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Evaluation of the Neurological Status in Experimental Acute Alcohol Intoxication

Approaches to evaluation of the severity of neurological disorders in animals with experimental acute severe alcohol intoxication were developed. 

Using the method of statistical analysis, we selected criteria, which can be used for evaluation of the severity of inhibition of the nervous system in studies of the alcoholism pathogenesis and for improvement of methods for correction of severe intoxication at the preclinical stage of drug efficiency evaluation.

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Quality standard topic: Alcohol dependence and harmful alcohol use

Quality standard topic: Alcohol dependence and harmful alcohol use

Diagnosis and management of alcohol dependence and harmful alcohol use in people 10 years and older in all NHS-funded settings, including: screening and brief interventions, identification and diagnosis, assessment, prevention of Wernicke-Korsakoff syndrome, management of withdrawal, and pharmacological and psychosocial interventions including relapse prevention.

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Risk Factors for Mortality in the Nurses’ Health Study: A Competing Risks Analysis

Few studies have examined multiple risk factors for mortality or formally compared their associations across specific causes of death. 

The authors used competing risks survival analysis to evaluate associations of lifestyle and dietary factors with all-cause and cause-specific mortality among 50,112 participants in the Nurses’ Health Study. 

There were 4,893 deaths between 1986 and 2004: 1,026 from cardiovascular disease, 931 from smoking-related cancers, 1,430 from cancers not related to smoking, and 1,506 from all other causes. 

Age, body mass index at age 18 years, weight change, height, current smoking and pack-years of smoking, glycemic load, cholesterol intake, systolic blood pressure and use of blood pressure medications, diabetes, parental myocardial infarction before age 60 years, and time since menopause were directly related to all-cause mortality, whereas there were inverse associations for physical activity and intakes of nuts, polyunsaturated fat, and cereal fiber. 

Moderate alcohol consumption was associated with decreased mortality.

A model that incorporated differences in the associations of some risk factors with specific causes of death had a significantly better fit compared with a model in which all risk factors had common associations across all causes. 

In the future, this new model may be used to identify individuals at increased risk of mortality. 

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Alcohol preference drinking in a mouse line selectively bred for high drinking in the dark

We have selectively bred mice that reach very high blood ethanol concentrations (BECs) after drinking from a single bottle of 20% ethanol. 

High Drinking in the Dark (HDID-1) mice drink nearly 6g/kg ethanol in 4h and reach average BECs of more than 1.0mg/mL. 

Previous studies suggest that DID and two-bottle preference for 10% ethanol with continuous access are influenced by many of the same genes. We therefore asked whether HDID-1 mice would differ from the HS/Npt control stock on two-bottle preference drinking. 

We serially offered mice access to 3–40% ethanol in tap water versus tap water. For ethanol concentrations between 3 and 20%, HDID-1 and HS/Npt controls did not differ in two-bottle preference drinking. 

At the highest concentrations, the HS/Npt mice drank more than the HDID-1 mice. We also tested the same mice for preference for two concentrations each of quinine, sucrose, and saccharin. Curiously, the mice showed preference ratios (volume of tastant/total fluid drunk) of about 50% for all tastants and concentrations. 

Thus, neither genotype showed either preference or avoidance for any tastant after high ethanol concentrations. Therefore, we compared naive groups of HDID-1 and HS/Npt mice for tastant preference. 

Results from this test showed that ethanol-naive mice preferred sweet fluids and avoided quinine but the genotypes did not differ. 

Finally, we tested HDID-1 and HS mice for an extended period for preference for 15% ethanol versus water during a 2-h access period in the dark. After several weeks, HDID-1 mice consumed significantly more than HS. 

We conclude that drinking in the dark shows some genetic overlap with other tests of preference drinking, but that the degree of genetic commonality depends on the model used.

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Ethanol withdrawal activates nitric oxide–producing neurons in anxiety-related brain areas

The present study investigated whether nitric oxide (NO)–producing neurons localized in brain areas related to anxiety are also activated after ethanol withdrawal. 

Male Wistar rats were subjected to an oral ethanol self-administration procedure, in which they were offered 6–8% (vol/vol) ethanol solution for a period of 21 days followed by abrupt discontinuation of the treatment. Control animals received control dietary fluid for similar periods of time. Twenty-four or 48h after ethanol discontinuation, the animals were exposed to the open field for 10min. Two hours later, their brains were removed and processed for Fos immunohistochemistry and nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry (which is used to detect NO-producing neurons). 

Decreased exploratory activity was observed in animals subjected to 24-h withdrawal, characterized by a shorter distance traveled in the open field. 

Additionally, increased Fos expression was detected in brain areas, such as the cingulate and piriform cortices, several hypothalamic nuclei, amygdaloid nuclei, most subdivisions of the periaqueductal gray matter, and dorsal raphe nucleus (DRN). Ethanol withdrawal activated NO-producing neurons in the paraventricular nucleus (PVN) of the hypothalamus, dorsolateral periaqueductal gray matter (DLPAG), and DRN. 

The results show that ethanol withdrawal activates NO-producing neurons in the PVN, DLPAG, and DRN, which are brain areas implicated in the modulation of emotional, autonomic, and motor expression of anxiety-like behaviors.

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Altered anxiety-like behavior and long-term potentiation in the bed nucleus of the stria terminalis in adult mice exposed to chronic social isolation, unpredictable stress, and ethanol beginning in adolescence

Alcohol and chronic stress exposure, especially during adolescence, can lead to an increased risk in adulthood of developing alcohol use disorders. 

To date, however, no study has assessed the potential long-term effects of chronic intermittent and unpredictable ethanol (EtOH) exposure in mice chronically stressed beginning in adolescence on brain function and anxiety-like behaviors in adulthood. In particular, alterations in function of the bed nucleus of the stria terminalis (BNST), a brain region heavily implicated in anxiety-related behaviors and altered plasticity following EtOH exposure, may play a key role in the pathological responses to chronic stress and EtOH. 

In the present study, adolescent and adult C57Bl/6J mice were exposed to a regimen of chronic social isolation and unpredictable stressors and EtOH (or air [sham]; CSI-CUS-EtOH and CSI-CUS-Sham, respectively) for 8–10 weeks. 

In adulthood, mice were tested for altered anxiety-like behavior (elevated plus maze [EPM] and modified social interaction [SI] test). Following behavioral testing, mice were reexposed to CSI-CUS-EtOH (and CSI-CUS-Sham for controls) for an additional 3 days. Four to six hours following the final EtOH (or air) exposure, field potential recordings of the dorsal-lateral (dl)BNST were performed. 

Mice first exposed during adolescence to CSI-CUS-EtOH displayed lower levels of anxiety-like behavior on the EPM compared with mice first exposed to CSI-CUS-EtOH during adulthood and control mice only exposed to CSI-CUS-Sham, regardless of age of first exposure. 

However, mice first exposed to CSI-CUS-EtOH during adulthood displayed lower levels of anxiety-like behavior on the SI test compared with mice first exposed during adolescence and control CSI-CUS-Sham mice. 

CSI-CUS-EtOH exposure, regardless of age, produced blunted expression of long-term potentiation (LTP) in the dlBNST compared with CSI-CUS-Sham mice. 

This study demonstrates age-dependent effects of chronic unpredictable ethanol exposure in chronically stressed mice on anxiety-like behaviors during adulthood. 

Further, CSI-CUS-EtOH exposure results in blunted LTP expression in the adult dlBNST.

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The influence of family and friends on young people's drinking

This Round-up examines family and friendship influences on young people's drinking habits, in order to shed light on how the negative aspects of young people's drinking culture in the UK might be changed.
Drawing on five research projects, it concludes that:
  • prevention and harm reduction approaches need to take into account how family circumstances vary;
  • public health messages need to connect more with the realities of parents' attitudes and practices;
  • interventions should consider group behaviour, not just individuals' behaviour;
  • the potential for using price as a harm reduction measure and the need for more appealing spaces for young people to socialise require further consideration.  
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Substance Misuse in Wales – quarterly data1

This statistical article provides quarterly statistics on Substance Misuse in Wales, including data on activity by drug and alcohol treatment services in Wales for the current quarter. Data on this subject is already published in an annual report and in this article we are exploring introducing a new series of outputs relating to quarterly data. In order to help us decide whether to introduce this analysis as a regular quarterly output we would welcome any comments on the content and usefulness of this analysis to the email address below.
Key results
Latest quarter (July-September 2010 (provisional))
• There were 7,726 referrals for treatment of alcohol or drug misuse notified to the database. During the quarter 4,732 assessments were carried out by treatment services and 3,483 treatments commenced.

• 56 per cent (4,305) of referrals related to misuse of alcohol, 35 per cent (2,690) related to misuse of drugs and 9 per cent (731) of referrals had no main substance reported.

• Of those where a main substance was reported 62 per cent of referrals were for alcohol and 38 per cent for drugs. Heroin accounted for 49 per cent of all referrals for which drugs were specified as the main substance, with cannabis (20 per cent) and amphetamines (8 per cent) the next most common drugs.

• Males accounted for the majority of all referrals for both alcohol (64 per cent) and drugs (73 per cent).

• 68 per cent of referrals for any substance were assessed within 10 working days of referral and 89 per cent of people were given treatment within 10 working days of assessment.

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Apparent Consumption of Alcohol: Extended Time Series, 1944-45 to 2008-09

This publication provides estimates of apparent consumption of alcohol based on the availability of alcoholic beverages in Australia. It provides estimates of the quantity of pure alcohol available for consumption from beer, wine, spirits, and ready to drink (pre-mixed) beverages, plus estimates of the total volume of beer and wine available for consumption.

For beer, data is available for 1944-45 onwards. For wine, estimates of pure alcohol are available for 1960-61 onwards while estimates of the volume of wine are available from 1944-45 onwards. For spirits, estimates of pure alcohol are available for 1960-61 onwards.

Using a Mobile Laboratory to Study Mental Health, Addictions and Violence: A Research Plan

This paper describes an innovative new research program, Researching Health in Ontario Communities (RHOC), designed to improve understanding, treatment and prevention of co-occurring mental health, addictions, and violence problems. 
RHOC brings together a multi-disciplinary team of investigators to implement an integrated series of research studies (including pilot studies and full studies). 
The project involves use a mobile research laboratory to collect a wide range of biological, behavioral and social data in diverse communities across Ontario, Canada, including remote and rural communities, areas experiencing poverty and social disorganization, urban areas, and Aboriginal communities. 
This paper describes the project background and research plan as well as the anticipated contributions of the project to participating Ontario communities and to broader scientific knowledge.
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Wednesday, January 19, 2011

In Vivo Ethanol Experience Increases D2 Autoinhibition in the Ventral Tegmental Area

Alcoholism is characterized by compulsive alcohol intake after a history of chronic consumption. A reduction in mesolimbic dopaminergic transmission observed during abstinence may contribute to the negative affective state that drives compulsive intake. 

Although previous in vivo recording studies in rodents have demonstrated profound decreases in the firing activity of ventral tegmental area (VTA) dopamine neurons after withdrawal from long-term ethanol exposure, the cellular mechanisms underlying this reduced activity are not well understood. Somatodendritic dopamine release within the VTA exerts powerful feedback inhibition of dopamine neuron activity via stimulation of D2 autoreceptors and subsequent activation of G protein-gated inwardly rectifying K+ (GIRK) channels. 

Here, by performing patch-clamp recordings from putative dopamine neurons in the VTA of mouse brain slices, we show that D2 receptor/GIRK-mediated inhibition becomes more potent and exhibits less desensitization after withdrawal from repeated in vivo ethanol exposure (2g/kg, i.p., three times daily for 7 days). 

In contrast, GABAB receptor/GIRK-mediated inhibition and its desensitization are not affected. 

Chelating cytosolic Ca2+ with BAPTA augments D2 inhibition and suppresses its desensitization in control mice, while these effects of BAPTA are occluded in ethanol-treated mice. 

Furthermore, inositol 1,4,5-trisphosphate (IP3)-induced intracellular Ca2+ release and Ca2+/calmodulin-dependent protein kinase II are selectively involved in the desensitization of D2, but not GABAB, receptor signaling. Consistent with this, activation of metabotropic glutamate receptors that are coupled to IP3 generation leads to cross-desensitization of D2/GIRK-mediated responses. 

We propose that enhancement of D2 receptor-mediated autoinhibition via attenuation of a Ca2+-dependent desensitization mechanism may contribute to the hypodopaminergic state during ethanol withdrawal.

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Vitamin D and Nutritional Status are Related to Bone Fractures in Alcoholics

Bone fractures are common in alcoholics.  

To analyse which factors (ethanol consumption; liver function impairment; bone densitometry; hormone changes; nutritional status, and disrupted social links and altered eating habits) are related to bone fractures in 90 alcoholic men admitted to our hospitalization unit because of organic problems.  

Bone homoeostasis-related hormones were measured in patients and age- and sex-matched controls. Whole-body densitometry was performed by a Hologic QDR-2000 (Waltham, MA, USA) densitometer, recording bone mineral density (BMD) and fat and lean mass; nutritional status and liver function were assessed. The presence of prevalent fractures was assessed by anamnesis and chest X-ray film.  

Forty-nine patients presented at least one fracture. We failed to find differences between patients with and without fractures regarding BMD parameters. Differences regarding fat mass were absent, but lean mass was lower among patients with bone fracture. The presence of fracture was significantly associated with impaired subjective nutritional evaluation (χ2 = 5.79, P = 0.016), lower vitamin D levels (Z = 2.98, P = 0.003) and irregular eating habits (χ2 = 5.32, P = 0.02). Reduced lean mass and fat mass, and altered eating habits were more prevalent among patients with only rib fractures (n = 36) than in patients with multiple fractures and/or fractures affecting other bones (n = 13). These last were more closely related to decompensated liver disease. Serum vitamin D levels showed a significant relationship with handgrip strength (ρ = 0.26, P = 0.023) and lean mass at different parts of the body, but not with fat mass. By logistic regression analysis, only vitamin D and subjective nutritional evaluation were significantly, independently related with fractures.

 Prevalent fractures are common among heavy alcoholics. Their presence is related more closely to nutritional status, lean mass and vitamin D levels than to BMD. Lean mass is more reduced, nutritional status is more impaired and there is a trend to more altered eating habits among patients with rib fractures, whereas multiple fractures depend more heavily on advanced liver disease. 

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Effects of Socialization and Family Factors on Adolescent Excessive Drinking in Spain

Adolescent drinking has an important health and social impact in many countries. In Spain, this behavior often takes place in groups and in open areas (known as “botellón”). 
The aim of this study is to describe the prevalence of excessive drinking among Spanish adolescents and its association with socialization and family factors. 
A national school survey was conducted in 2006 among 26,454 students aged 14–18 years who were selected by two-stage cluster sampling (schools and classrooms). The questionnaire was self-completed with paper and pencil. The outcomes were: habitual excessive drinking or HED (average consumption ≥30 g/day of alcohol among men, and ≥20 g/day among women), binge drinking (drinking 5 or more standard alcohol units in a 2-hour interval), and drunkenness. Logistic regression models were used to estimate the effect of socialization and family factors. 

Monthly prevalence of HED, binge drinking and drunkenness was 11.2%, 30.9% and 25.6%, respectively. 
The main factors positively associated with HED were: frequently going out for fun in the evenings, high proportion of friends who drink or get drunk, early onset of alcohol use, low perceived risk of drinking, truancy, illegal drug use, and amount of money spent for personal needs. Family factors were weakly associated with outcomes. Socialization in leisure environments with friends who drink excessively is an important predictor of adolescent excessive drinking in Spain. 
Thus, prevention must also focus on the community level, limiting alcohol access, building socialization environments without alcohol, and increasing adolescents’ risk perception of drinking. 

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    Preventing Early Child Maltreatment: Implications from a Longitudinal Study of Maternal Abuse History, Substance Use Problems, and Offspring Victimization

    In the interest of improving child maltreatment prevention science, this longitudinal, community based study of 499 mothers and their infants tested the hypothesis that mothers’ childhood history of maltreatment would predict maternal substance use problems, which in turn would predict offspring victimization.

    Mothers (35% White/non-Latina, 34% Black/non-Latina, 23% Latina, 7% other) were recruited and interviewed during pregnancy, and child protective services records were reviewed for the presence of the participants’ target infants between birth and age 26 months. Mediating pathways were examined through structural equation modeling and tested using the products of the coefficients approach. 
    The mediated pathway from maternal history of sexual abuse to substance use problems to offspring victimization was significant (standardized mediated path [ab] = .07, 95% CI [.02, .14]; effect size = .26), as was the mediated pathway from maternal history of physical abuse to substance use problems to offspring victimization (standardized mediated path [ab] = .05, 95% CI [.01, .11]; effect size = .19).

    There was no significant mediated pathway from maternal history of neglect. 

    Findings are discussed in terms of specific implications for child maltreatment prevention, including the importance of assessment and early intervention for maternal history of maltreatment and substance use problems, targeting women with maltreatment histories for substance use services, and integrating child welfare and parenting programs with substance use treatment. 

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    Alcohol pricing research

    In early 2010, the previous government commissioned three pieces of research on alcohol pricing. This research has been considered as part of the review of alcohol pricing and the individual reports are available to download below.
    Date: Tue Jan 18 10:45:00 GMT 2011

    Drinking Culture

    2 February 2011
    10:00 hrs - 16:00 hrs

    About the event

    This event will launch a new report from the Joseph Rowntree Foundation (JRF), Teenage drinking cultures.

    The research by Andrew Percy and a team at Queen’s University Belfast, School of Sociology, Social Policy and Social Work, investigates small-group underage drinking cultures, with the aim of improving understanding of how these cultures vary between groups and within groups over time.

    The meeting will be chaired by Quintin Oliver, Northern Ireland Adviser to JRF.   > > > >   Read More

    Family and peer influences on young people’s drinking

    26 January 2011
    10:00 hrs - 16:00 hrs

    About the event

    This event, supported by the Scottish Government, will examines key influences on young people's alcohol consumption, and explore what implications this may have for policy and practice.
    Speakers include:
    • Peter Seaman
      Who will present key findings from the recent JRF and Glasgow Centre for Population Health report Young people and alcohol: influences on how they drink. The research investigates the influences, motivators and decision-making underpinning the drinking choices of young adults aged between 18 and 25.
    • Douglas Eadie, University of Stirling
      Who will present his recent findings Pre-teens learning about alcohol: drinking and family contexts. This research examines childhood experiences and how they are crucial to forming future drinking habits – focusing on how children learn about alcohol in so-called "ordinary families".    > > > >  Read More

    Smoking behaviours, access to cigarettes and relationships with alcohol in 15- and 16-year-old schoolchildren

    Adolescent smoking is a significant public health concern in the UK and across Europe. 

    This study examines smoking behaviours, methods of accessing cigarettes and use of non-commercial (fake, foreign and single) cigarettes across a sample of schoolchildren. Relationships with alcohol consumption, deprivation, personal income and extra-curricular activities are also explored. 

    A cross-sectional survey of 9833 15- and 16-year-old schoolchildren in the North West of England.  

    Cigarettes were most commonly accessed from off-licences and newsagents, but pupils also reported non-commercial access through friends, family and street sellers/neighbours. A high percentage of smokers had bought foreign (57%), fake (28%) and single (54%) cigarettes. Frequent binge drinking, not participating in extra-curricular activities, receiving greater personal income, and having parents that smoked were significantly associated with being a regular and heavier smoker. Frequent binge drinking was also significantly associated with buying foreign/fake or single cigarettes. A higher percentage of those living in deprived areas were current smokers, although deprivation was not an independent predictor of cigarette use.  

    Strategies that restrict commercial access to cigarettes among adolescents may increase their reliance on social methods of access, and use of fake, foreign and single cigarettes. Interventions to reduce adolescent smoking must recognize the critical role of parents and communities in discouraging smoking and preventing social access to cigarettes in children. 

    A joint approach to prevention is required that targets children at risk of smoking, heavy alcohol use and associated health-damaging behaviours. 

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