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 29, 2011

Lifestyle Practices and Cardiovascular Disease Mortality in the Elderly: The Leisure World Cohort Study

Modifiable behavioral risk factors are major contributing causes of death, but whether the effects are maintained in older adults is uncertain. 

We explored the association of smoking, alcohol consumption, caffeine intake, physical activity, and body mass index on cardiovascular disease (CVD) mortality in 13,296 older adults and calculated risk estimates using Cox regression analysis in four age groups (<70, 70–74, 75–79, and 80+ years). 

The most important factor was current smoking, which increased risk in all age-sex groups. In women, alcohol consumption (≤3 drinks/day) was related to decreased (15–30%) risk in those <80 years old; in men, 4+ drinks/day was associated with reduced (15–30%) risk. Active 70+ year olds had 20–40% lower risk. Both underweight and obese women were at increased risk. 

Lifestyle practices impact CVD death rates in older adults, even those aged 80+ years. 

Not smoking, moderate alcohol consumption, physical activity, and normal weight are important health promoters in our aging population.

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An acute psychosocial stressor increases drinking in non-treatment-seeking alcoholics

Although studies suggest that stress is an important reason for relapse in alcoholics, few controlled studies have been conducted to examine this assumption. 

Evidence of stress-potentiated drinking would substantiate this clinical observation and would contribute to the development of a model that would be valuable to alcohol treatment research. 

The hypothesis was tested that an acute psychosocial stressor, the Trier Social Stress Test (TSST), increases alcohol consumption in non-treatment-seeking alcoholics. 

Seventy-nine alcohol-dependent participants (40 women) were randomly assigned to receive the TSST or a no-stress condition. Immediately afterward, all participants received an initial dose of their preferred alcoholic beverage to achieve a target blood alcohol concentration of 0.03 g/dl (to prime subsequent drinking in the laboratory). Participants then participated in a mock taste test of two glasses of beer. Primary dependent measures were whether s/he drank all of the beer available (yes/no) and total amount of beer consumed (milliliters). 

Stressed participants were twice as likely as non-stressed participants to drink all of the beer available, a significant effect. Although the stressed group drank more milliliters than the non-stressed group, this effect failed to reach significance, likely due to ceiling effects. There were no significant stress group x gender effects on either outcome. 

This study supports that stress-potentiated drinking is valid and can be modeled in a clinical laboratory setting.

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Hazardously Drinking Women Leaving Jail: Time to First Drink

This study evaluated time to first drink in women being released from jail to determine predictors of early relapse among women with hazardous drinking and HIV risk behaviors. 

Between February 2004 and June 2007, 245 participants were recruited from the Rhode Island Department of Corrections. Following the baseline assessment, participants were randomized to a motivational intervention group or to a control condition. Follow-up assessments at 1, 3, and 6 months were completed for 210 participants. 

Alcohol use during follow-up occurred in 86.7% of participants, 42.4% initiated alcohol use on Day 1. 

The rate of initiation was associated with norms favorable to using alcohol (p < .01) and having a partner with an alcohol problem (hazard ratio [HR] = 1.62, p < .01). 

The rate of drink initiation decreased significantly (HR = 0.82, p < .05) as length of incarceration increased. 

The intervention was not associated with decreased drinking. 

Interventions to maintain abstinence need to reach women within their first days postrelease. 

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What Choline Metabolism Can Tell Us About the Underlying Mechanisms of Fetal Alcohol Spectrum Disorder

The consequences of fetal exposure to alcohol are very diverse and the likely molecular mechanisms involved must be able to explain how so many developmental processes could go awry. 

If pregnant rat dams are fed alcohol, their pups develop abnormalities characteristic of fetal alcohol spectrum disorders (FASD), but if these rat dams were also treated with choline, the effects from ethanol were attenuated in their pups. 

Choline is an essential nutrient in humans, and is an important methyl group donor. Alcohol exposure disturbs the metabolism of choline and other methyl donors. Availability of choline during gestation directly influences epigenetic marks on DNA and histones, and alters gene expression needed for normal neural and endothelial progenitor cell proliferation. Maternal diets low in choline alter development of the mouse hippocampus, and decrement memory for life. Women eating low-choline diets have an increased risk of having an infant with a neural tube or orofacial cleft birth defect. 

Thus, the varied effects of choline could affect the expression of FASD, and studies on choline might shed some light on the underlying molecular mechanisms responsible for FASD. 

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Friday, January 28, 2011

Alcohol Consumption after the Recognition of Pregnancy and Correlated Factors among Indigenous Pregnant Women in Taiwan

To examine the rates and factors associated with alcohol consumption after the recognition of pregnancy among indigenous pregnant women, as well as the rates and factors associated with continuing alcohol consumption after the recognition of pregnancy among indigenous pregnant women who drank alcohol before the recognition of pregnancy in 10 hospitals in southern and eastern Taiwan. 
A total of 806 indigenous women who had just given birth in 10 hospitals in southern and eastern Taiwan were recruited. They were interviewed to collect their substance use information, demographic characteristics, psychological health status, history of physical abuse, and pregnancy history. 
The rates of alcohol consumption after the recognition of pregnancy in all indigenous pregnant women and the rates of continuing alcohol consumption after the recognition of pregnancy among those who drank alcohol before the recognition of pregnancy were calculated. The factors relating to alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were examined using logistic regression analyses. 
The results of this study found that 26.6% of indigenous pregnant women drank alcohol at any stage after the recognition of pregnancy, and 52.5% of indigenous pregnant women who drank alcohol before the recognition of pregnancy persisted in drinking alcohol after the recognition of pregnancy. 
Multiple parities, smoking or chewing betel quid after the recognition of pregnancy, and a higher frequency of drinking alcohol before the recognition of pregnancy were significantly associated with alcohol consumption and continuing alcohol consumption after the recognition of pregnancy. 
Meanwhile, being single or divorced, and intimate partner violence after the recognition of pregnancy were significantly associated with alcohol consumption after the recognition of pregnancy. 
High prevalence rates of alcohol consumption and continuing alcohol consumption after the recognition of pregnancy were found among indigenous pregnant women in Taiwan. 
Early detection of alcohol consumption and effective intervention for alcohol consumption during pregnancy are needed. 
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Major Habitual Dietary Patterns Are Associated with Acute Myocardial Infarction and Cardiovascular Risk Markers in a Southern European Population

Most dietary pattern analyses in southern Europe have relied on a priori food approaches using Mediterranean-style diet indexes. These methods may not reflect the current population's food consumption.

To assess the association of a posteriori dietary patterns with acute myocardial infarction (AMI) and cardiovascular risk markers in the general adult population of Porto, Portugal.

A population-based case-control study was conducted. Information was collected by trained interviewers. Diet was assessed with a validated 82-item food frequency questionnaire.

Cases were patients consecutively hospitalized for an incident non-fatal AMI (n=820), and controls were individuals free of previous AMI selected from the hospitals' catchment area (n=2,196).

Dietary patterns, representing mutually exclusive clusters of individuals, were identified by multivariate finite mixture models among controls. Odds ratios (OR) and their 95% confidence intervals (CIs) were obtained from unconditional logistic regression, with adjustment for main confounders.

In comparison to women with a “healthy” dietary pattern, those with a “low fruit and vegetables” pattern and a “red meat and alcohol” (also characterized by lower intake of dairy products and vegetables) pattern showed a higher risk of AMI (OR 1.85, 95% CI 1.01 to 3.39 and OR 1.91, 95% CI 1.17 to 3.12, respectively). Female controls with the “red meat and alcohol” pattern also had a higher total to high-density lipoprotein cholesterol ratio. In comparison to men with a “healthy” pattern, those with the “red meat and alcohol” pattern, similar to the counterpart found in women, were more likely to experience an AMI (OR 1.98, 95% CI 1.35 to 2.92); male controls with this pattern had higher diastolic and systolic blood pressure, C-reactive protein, and uric acid levels.

A dietary pattern with lower fruit and vegetable intakes in women, and a pattern characterized by higher consumption of red meat and alcohol (and lower of dairy products and vegetables) in both sexes, were associated with an increased risk of AMI and adverse cardiovascular risk profiles. 

These findings highlight the importance of sustained recommendations for fruit and vegetable intake and cautious guidance on consumption of alcoholic beverages, which clusters with less healthy dietary patterns of men and women.

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New Releases

Alcohol and other drug treatment services in New South Wales 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for New South Wales. Other data bulletins are available ... Published 28 January 2011.

Alcohol and other drug treatment services in Queensland 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for Queensland. Other data bulletins are available for most ... Published 28 January 2011.

Alcohol and other drug treatment services in South Australia 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for South Australia. Other data bulletins are available for ... Published 28 January 2011.

Alcohol and other drug treatment services in Tasmania 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for Tasmania. Other data bulletins are available for most ... Published 28 January 2011.

Alcohol and other drug treatment services in the Australian Capital Territory 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for the Australian Capital Territory. Other data bulletins are ... Published 28 January 2011.

Alcohol and other drug treatment services in the Northern Territory 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for the Northern Territory. Other data bulletins are available ... Published 28 January 2011.

Alcohol and other drug treatment services in Victoria 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for Victoria. Other data bulletins are available for most ... Published 28 January 2011.

Alcohol and other drug treatment services in Western Australia 2008-09: findings from the National Minimum Data Set (NMDS)

This data bulletin summarises the main findings from the 2008-09 Alcohol and Other Drug Treatment Services National Minimum Data Set (AODTS-NMDS) for Western Australia. Other data bulletins are available for ... Published 28 January 2011.

Alcohol craving and the dimensionality of alcohol disorders

ICD-10 includes a craving criterion for alcohol dependence while DSM-IV does not. Little is known about whether craving fits with or improves the DSM-IV criteria set for alcohol-use disorders.

Data were derived from current drinkers (n=18 352) in the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES), a nationally representative survey of US adults >17 years of age. The Alcohol Use Disorder and Associated Disabilities Interview Schedule was used to assess the eleven DSM-IV dependence and abuse criteria, and alcohol craving. Exploratory factor, item response theory, and regression analyses were used to evaluate the psychometric properties and concurrent validity of DSM-based alcohol disorder criteria with the addition of alcohol craving.
The past 12-month prevalence of craving was 1.3%. Craving formed part of a unidimensional latent variable that included existing DSM-IV criteria. Craving demonstrated high severity on the alcohol-use disorder continuum, resulting in an improved dimensional model with greater discriminatory ability compared with current DSM-IV criteria. Correlates of the diagnosis did not change with the addition of craving, and past 12-month craving was associated with prior alcohol dependence, depression, and earlier age of alcohol disorder onset among those with current DSM-IV alcohol dependence.

The addition of craving to the existing DSM-IV criteria yields a continuous measure that better differentiates individuals with and without alcohol problems along the alcohol-use disorder continuum. Few individuals are newly diagnosed with alcohol dependence given the addition of craving, indicating construct validity but redundancy with existing criteria.

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Thursday, January 27, 2011

Don’t ask don’t tell: substance abuse and addiction among nurses

The purpose of this manuscript is to illustrate the challenges faced by nurses who abuse substances and to promote international dialogue about what practitioners, administrators, health care providers and students can do when they suspect someone in the profession is abusing substances, or they may themselves be suffering from addiction.
Addiction among nurses has been recognised by professionals in the field for over 100 years, and current estimates place rates of substance misuse, abuse and addiction rates as high as 20% among practicing nurses. Unfortunately, fear of punishment and discipline may keep nurses or students from asking for help for themselves or from reporting a colleague or friend who is in need of help.
This paper synthesises the results of three previous papers conducted on substance abuse policies in the nursing profession. In the first paper, the authors reviewed the history of addiction in nursing and compared disciplinary and alternative-to-discipline policies. The second focused on the development of an alternative-to-dismissal policy for substance abuse in a school of nursing and using telephone and email interviews, and the final paper reported findings of what types of polices seem to be working to retain and rehabilitate nurses who suffer from addiction in the USA. Lastly, this paper introduces international policy for nurses with addictions.

Poor or ineffective policies that mandate punitive action endanger the public by making it difficult for impaired students or professionals to ask for help. Providing early intervention and assistance is essential in helping colleagues and students recover from an addictive disorder and providing a non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care. Many territories and countries throughout the world now offer confidential, non-punitive, assistance for nurses suffering from addictions.
Recognition of a colleague’s need of treatment is the important first step in the rehabilitation process. Early intervention and assistance are essential for helping colleagues and students to recover from an addictive disorder and providing a confidential, non-punitive atmosphere of support may well be a life-saving first step for nurses and those in their care.

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Press Release - Drinkaware annual conference brings together public health and industry representatives

More than 100 representatives from the public health community and drinks industry attended the first Drinkaware Annual Conference on Monday 24th January 2011 at Westminster Central Hall, London.  

The event focused on how best to address under-18 alcohol misuse and acted as a springboard for future collaboration between the sectors.  The conference included an address by Andrew Lansley CBE, Secretary of State for Health and a panel discussion hosted by journalist Sheena McDonald.  

In attendance were a range of organisations including the Royal College of Nursing, the Alcohol Education Research Council, the British Beer and Pub Association, the Portman Group and University College London.  
 > > > >   Read More

Smoking and drinking among adults 2009

The Department of Health estimates that the harmful use of alcohol costs the NHS around £2.7bn a year and 7 per cent of all hospital admissions are alcohol related. Drinking can lead to over 40 medical conditions, including cancer, stroke, hypertension, liver disease and heart disease. The General LiFestyle Survey (GLF) and its predecessor the General Household Survey (GHS) have, between them, been measuring drinking behaviour for over 30 years.
Questions about drinking alcohol were included in the General Household Survey (GHS) every two years from 1978 to 1998. Following the review of the GHS, the questions about drinking in the last seven days form part of the continuous survey, and have been included every year from 2000 onwards. Questions designed to measure average weekly alcohol consumption were included from 2000 to 2002 and in 2005 and 2006. The General LiFestyle Survey (GLF) has included both sets of questions in both 2008 and 2009. Before 1988 questions about drinking were asked only of those aged 18 and over, but since then respondents aged 16 and 17 have answered the questions using a self-completion questionnaire.

This report presents information on the frequency of drinking alcohol, the amounts consumed in the week before the interview took place and average weekly consumption. It also presents data on the association between consumption of alcohol and characteristics of individuals such as sex, age, socio-economic classification, and region of residence.

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ONS data: fall in alcohol related deaths; lifestyle survey highlights drinking differences

The Office for National Statistics (ONS) has released data showing alcohol-related deaths have fallen since 2008, but remain significantly higher than the the early 1990s. Results from the General LiFestyle Survey (GLF), formerly the General Household Survey (GHS), were also released highlighting drinking and smoking differences between between socio-economic groups.  > > > >   Read More

Scale for the Measurement of Attitudes Towards Alcohol

The aim was to analyse the characteristics of, and validate, a new instrument in Italian, ‘Scale for the measurement of attitudes towards alcohol’. The instrument is a means for assessing young people's risk profile regarding the use of alcohol and identifying the factors that contribute to determining this attitude.  

The test was initially composed of 60 items divided into three domains and administered to a sample of 41 subjects. The results revealed the necessity of adapting the test's conceptual structure: consequently, the items were reduced to 35, divided into five domains. This second version was administered to a sample of 467 students attending upper secondary schools and vocational training schools in the municipality of Siena. Following this second experiment, a third version was realized, which comprised 25 items divided into the same five domains; it was administered to 100 subjects, with an equal number of males and females and an age range of 14–30 years. Analysis of the data obtained resulted in a final structure formed of 15 items in three domains. 

The final structure of the test has good psychometric properties in terms of both reliability and validity. 
The ‘Scale for the measurement of attitudes towards alcohol’ can be seen as an instrument for evaluating the factors capable of conditioning the behaviour of people between 18 and 26 years of age towards alcoholic substances. 

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Early Treatment for Women with Alcohol Addiction (EWA) Reduces Mortality: A Randomized Controlled Trial with Long-Term Register Follow-up

To compare the mortality of female alcoholics randomly assigned to the woman-only programme ‘Early treatment for Women with Alcohol Addiction’ (EWA) versus those who received mixed gender ‘Treatment As Usual’ (TAU). 

Randomized controlled trial involving 2-year follow-up by personal interview and mortality register data through 27 years of 200 women first time treated for alcohol use disorder (AUD; EWA, n = 100 and TAU, n = 100), who were consecutively recruited during 1983–1984. Data from the Causes of Death Register were used to test for mortality differences related to group interaction predictors such as age, inpatient versus outpatient status at intake and 2-year drinking outcome.  

Significantly lower mortality was found among younger women who participated in EWA compared with those who received TAU. This difference lasted nearly 20 years after intake to treatment. For women who only needed outpatient treatment, reduced mortality was found in the EWA group, even for older women. Increased mortality was found for TAU women who did not attend the 2-year follow-up compared with those who attended; no such difference was found for EWA women. This indicates different attrition mechanisms in the two groups. Thus, previously reported treatment effects may have been underestimated. EWA was a more comprehensive programme than TAU while also being single gender.  

EWA, specifically developed to meet a broad spectrum of problems among women with AUDs, was more effective than TAU, a mixed gender programme. It was not possible to separate whether this was in part because it was a more comprehensive programme, as well as being single gender. 

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Decline in Alcohol Consumption in Estonia: Combined Effects of Strengthened Alcohol Policy and Economic Downturn

To describe alcohol policy changes in parallel to consumption changes in 2005–2010 in Estonia, where alcohol consumption is among the highest in Europe. 

Review of pertinent legislation and literature.  

Alcohol consumption decreased since 2008, while alcohol excise tax, sales time restrictions and ad bans have increased since 2005. An economic downturn started in 2008. 

The precise roles of policy changes and the economic downturn in the decline of alcohol consumption, and whether the decrease will be sustained, are still unclear. 

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Wednesday, January 26, 2011

Changes in women's alcoholic, antisocial, and depressive symptomatology over 12 years: A multilevel network of individual, familial, and neighborhood influences

In a sample of 273 adult women and their families, we examined the effects of women's psychopathology history, their social support, their husbands' and children's symptomatology, family stress, and neighborhood environment on their alcohol problems, antisocial behavior, and depression over a 12-year period during their 30s and early 40s. 

Women's alcohol problems and antisocial behavior decreased but their depression symptoms increased over time. 

Women's disorder history and their partners' parallel symptomatology were associated with their symptoms. 

For women's antisocial behavior, their own history of alcoholism and their partners' alcohol problems were also significant risk factors. 

Higher levels of social support were associated with lower levels of depression in women. 

Children's externalizing behavior was positively correlated with their mothers' alcohol problems and antisocial behavior, whereas children's internalizing behavior was positively correlated with their mothers' depression. 

Neighborhood residential instability was associated with higher levels of alcoholic and depressive symptomatology in women. 

Intervention efforts might target women with young children by improving social support, educational or professional training opportunity, access to family counseling, and neighborhood environment.

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Influence of Age on the Relationship between Alcohol Consumption and Metabolic Syndrome

Relationships between alcohol consumption and risks for metabolic syndrome in general populations are very controversial. It is unknown whether age influences the relationship between alcohol intake and the prevalence of metabolic syndrome.  

The purpose of this study was to determine whether age influences the relationship between alcohol consumption and metabolic syndrome.  

Men aged ≧35 and <45 years (younger group) and those aged ≧65 years (older group), matched for alcohol intake and smoking history, were divided into four subgroups by alcohol intake [non-, light (<22 g ethanol/day), heavy (≧22 and <44 g ethanol/day) and very heavy (≧44 g ethanol/day) drinkers]. Odds ratios (ORs) versus nondrinkers for each risk factor and metabolic syndrome were compared between the younger and older groups.  

Both in the younger and older groups, ORs for high blood pressure and low HDL cholesterol were significantly high and low, respectively, in all drinker groups. In younger subjects, the OR for large waist circumference was significantly low in light drinkers, and the OR for high hemoglobin A1c was significantly low in light and heavy drinkers, while these associations were not found in older subjects. 

The OR for metabolic syndrome was significantly low in light and heavy drinkers in the younger subjects but was not significant in any drinker groups in older subjects.  

Age influences the relationships between alcohol consumption and atherosclerotic risk factors, and there is a significant association between alcohol intake and a lower risk for metabolic syndrome in young men but not in elderly men.

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Nicotinic acetylcholine receptors containing the α4 subunit are critical for the nicotine-induced reduction of acute voluntary ethanol consumption

Recently, we investigated the molecular mechanisms of the smoking cessation drug varenicline, a nicotinic acetylcholine receptor (nAChR) partial agonist, in its ability to decrease voluntary ethanol intake in mice. 

Previous to our study, other labs had shown that this drug can decrease ethanol consumption and seeking in rat models of ethanol intake. 

Although varenicline was designed to be a high affinity partial agonist of nAChRs containing the α4 and β2 subunits (designated as α4β2*), at higher concentrations it can also act upon α3β2*, α6*, α3β4* and α7 nAChRs. 

Therefore, to further elucidate the nAChR subtype responsible for varenicline-induced reduction of ethanol consumption, we utilized a pharmacological approach in combination with two complimentary nAChR genetic mouse models, a knock-out line that does not express the α4 subunit (α4 KO) and another line that expresses α4* nAChRs hypersensitive to agonist (the Leu9′Ala line). 

We found that activation of α4* nAChRs was necessary and sufficient for varenicline-induced reduction of alcohol consumption. 

Consistent with this result, here we show that a more efficacious nAChR agonist, nicotine, also decreased voluntary ethanol intake, and that α4* nAChRs are critical for this reduction.

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Do men with excessive alcohol consumption and social stability have an addictive personality?

The existence of an “addictive” personality has been extensively debated. 

The current study investigated personality in male individuals with excessive alcohol consumption (= 100) in comparison to a population-based control group (= 131). The individuals with excessive alcohol consumption were recruited by advertisements in a regional daily newspaper and controls from a population based Swedish Twin Registry. Personality was assessed by the Karolinska Scales of Personality (KSP). 

Comparisons were made with normative data. Furthermore, by using a multivariate projection-based approach (Principal Component Analysis; PCA), hidden structures of traits and possible relationships among the individuals with excessive consumption and the controls was investigated. 

The individuals with excessive alcohol consumption as well as the controls had mean values within the normative range in all scales of the KSP. Moreover, the PCA analysis revealed no systematic between-group separation. 

Taken together, this result demonstrates that male individuals with excessive alcohol consumption do not have a personality different from that of a general population, which supports the notion of no “addictive personality”.

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Common biology of craving across legal and illegal drugs – a quantitative meta-analysis of cue-reactivity brain response

The present quantitative meta-analysis set out to test whether cue-reactivity responses in humans differ across drugs of abuse and whether these responses constitute the biological basis of drug craving as a core psychopathology of addiction. 

By means of activation likelihood estimation, we investigated the concurrence of brain regions activated by cue-induced craving paradigms across studies on nicotine, alcohol and cocaine addicts. 

Furthermore, we analysed the concurrence of brain regions positively correlated with self-reported craving in nicotine and alcohol studies. 

We found direct overlap between nicotine, alcohol and cocaine cue reactivity in the ventral striatum. In addition, regions of close proximity were observed in the anterior cingulate cortex (ACC; nicotine and cocaine) and amygdala (alcohol, nicotine and cocaine). 

Brain regions of concurrence in drug cue-reactivity paradigms that overlapped with brain regions of concurrence in self-reported craving correlations were found in the ACC, ventral striatum and right pallidum (for alcohol). 

This first quantitative meta-analysis on drug cue reactivity identifies brain regions underlying nicotine, alcohol and cocaine dependency, i.e. the ventral striatum. The ACC, right pallidum and ventral striatum were related to drug cue reactivity as well as self-reported craving, suggesting that this set of brain regions constitutes the core circuit of drug craving in nicotine and alcohol addiction.

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Predictors of addiction treatment providers' beliefs in the disease and choice models of addiction

Addiction treatment providers working in the United States (n = 219) and the United Kingdom (n = 372) were surveyed about their beliefs in the disease and choice models of addiction, as assessed by the 18-item Addiction Belief Scale of J. Schaler (1992). 

Factor analysis of item scores revealed a three-factor structure, labeled “addiction is a disease,” “addiction is a choice,” and “addiction is a way of coping with life,” and factor scores were analyzed in separate hierarchical multiple regression analyses. 

Controlling for demographic and addiction history variables, treatment providers working in the United States more strongly believe addiction is a disease, whereas U.K.-based providers more strongly believe that addiction is a choice and a way of coping with life.

Beliefs that addiction is a disease were stronger among those who provide for-profit treatment, have stronger spiritual beliefs, have had a past addiction problem, are older, are members of a group of addiction professionals, and have been treating addiction longer. 

Conversely, those who viewed addiction as a choice were more likely to provide public/not-for-profit treatment, be younger, not belong to a group of addiction professionals, and have weaker spiritual beliefs. 

Additionally, treatment providers who have had a personal addiction problem in the past were significantly more likely to believe addiction is a disease the longer they attend a 12-step–based group and if they are presently abstinent.

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Teaching physicians to address unhealthy alcohol use: A randomized controlled trial assessing the effect of a Web-based module on medical student performance

The authors developed and evaluated an interactive, Web-based module to train medical students in screening and brief intervention (SBI) for unhealthy alcohol use.

First-year students were randomized to module versus lecture. Change in knowledge, attitudes, and confidence were compared. Performance was assessed by objective structured clinical examination (OSCE) and analyzed by intention to treat and treatment received.

Of 141 consenting students, 64% (n = 90) completed an intervention (54% lecture vs. 70% Web assigned). Knowledge, confidence, and attitudes improved in both groups, with more improvement in Advise–Assist knowledge for Web students (14% vs. −3%, p = .003). Web students outperformed their lecture peers in both general communication (65% vs. 51% items well done, p = .004) and alcohol-specific tasks (54% vs. 41%, p = .021) on OSCE. Analysis by treatment received enhanced between-group differences.

Use of a Web-based module to teach SBI is associated with greater knowledge gain and skills performance compared with a lecture covering similar content. The module provides an efficient means for training in this area.

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Alcohol use problem among patients in methadone maintenance treatment in Taiwan

To examine the prevalence rate and predictors of alcohol use problems among patients undergoing methadone maintenance treatment (MMT).

This was a prospective follow-up study.

Study population included 438 patients who underwent more than 6 months of MMT.

Demographic and clinical characteristics were collected for each patient prior to treatment, and treatment-related variables were collected during treatment process. Hazardous drinking, alcohol abuse, and dependence were measured using a Chinese version of the Alcohol Use Disorders Identification Test (AUDIT) and by measuring breath alcohol concentration.

The prevalence rates of alcohol use problems, indicated by hazardous drinking are 31.4%. The protective predictors of alcohol use problems among MMT patients include an attendance rate of more than 90% (odds ratio [OR] = 0.54, 95% confidence interval [CI] = 0.30–0.97) and being older than 36 years (OR = 0.48, 95% CI = 0.27–0.86), and alcohol drinking problem at intake of study is a risk factor (OR = 5.30, 95% CI = 2.87–9.76).

High attendance rate, which is regarded as a component of clinical policy and a key component of therapeutic context, should be incorporated with brief interventions to lower alcohol use problems among MMT patients.

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Wine, supermarkets and British alcohol policy

  • Recent concerns over cheap drink have led to a policy debate on minimum unit pricing and the banning of the 'below-cost' sale of alcohol. Such interventions target off-licenses and supermarkets, since alcohol in pubs is generally sold above proposed minimum prices.
  • While pricing interventions often target high-strength beers, cider and spirits, concern has also been expressed over price promotions and three-for-two offers on wine. A dramatic increase in wine drinking has contributed significantly to the marked rise in per capita consumption of alcohol over the last forty years. In recent years alcohol awareness campaigns have drawn attention to excessive wine consumption in the home.
  • Supermarkets and off-licenses have played a pivotal role in the expansion of domestic wine drinking in the UK. The modern system of wine retail and off-licenses was established by William Gladstone in 1860. The debates surrounding Gladstone's reforms have clear parallels with debates over off-licence retail and domestic wine-drinking today.
  • In 1860, public debate centered on issues such as the relationship between pricing and consumption, the monopolistic power of the drinks industry, the role of licensing authorities, British drinking cultures, and the relationship between the 'on' (pubs, bars and restaurants) and 'off' (off-licence and supermarket) trades. Similar concerns remain a feature of contemporary debates on alcohol policy.
  • While the Conservative-Liberal Democrat Coalition supports banning 'below-cost' alcohol retail, political action on alcohol pricing is constrained by concerns over breaching both the spirit and rules of the free market. In Scotland, for example, minimum unit pricing was removed from the 2010 Alcohol Bill partly over fears that it breached EU rules on price competition. In 1860, free trade arguments were also central to licensing and duty reform.
  • The historical record suggests that consensus for licensing and duty reform can be achieved in the face of strong industry resistance, but usually needs to carry with it the support of 'moderate' drinkers.
  • While the alcohol industry has a long history of vigorously defending itself against legislative interventions, it became more fragmented after 1860. Today, the 'drinks industry' has fragmented further, allowing politicians and lobby groups to form alliances which cut across competing industry interests.
  • Policy discussions tend to dwell on the negative impacts of public drinking; a more critical focus on domestic drinking may be appropriate in future.  > > > > Read More

Tuesday, January 25, 2011

Type 7 Adenylyl Cyclase is Involved in the Ethanol and CRF Sensitivity of GABAergic Synapses in Mouse Central Amygdala

The GABAergic system in the central amygdala (CeA) plays a major role in ethanol dependence and in the anxiogenic response to ethanol withdrawal. 

Previously, we found that both ethanol and corticotropin releasing factor (CRF) increase GABAergic transmission in mouse and rat CeA neurons, in part by enhancing the release of GABA via activation of presynaptic CRF1 receptors. CRF1 receptors are coupled to the enzyme adenylyl cyclase (AC), which produces the second messenger cyclic AMP. 

There are nine isoforms of AC, but we recently found that CRF1 receptors in the pituitary were coupled to the Type 7 AC (AC7). Therefore, using an in vitro electrophysiological approach in brain slices, here we have investigated a possible role of the AC7 signaling pathway in ethanol and CRF effects on CeA GABAergic synapses of genetically modified mice with diminished brain Adcy7 activity (HET) compared to their littermate male wild-type (WT) mice. 

We found no significant differences in basal membrane properties, mean baseline amplitude of evoked GABAA receptor-mediated inhibitory postsynaptic potentials (IPSPs), or paired-pulse facilitation (PPF) of GABAA-IPSPs between HET and WT mice. 

In CeA neurons of WT mice, ethanol superfusion significantly augmented (by 39%) GABAA-IPSPs and decreased PPF (by 25%), suggesting increased presynaptic GABA release. 

However, these effects were absent in HET mice. CRF superfusion also significantly augmented IPSPs (by 38%) and decreased PPF (by 23%) in WT CeA neurons, and still elicited a significant but smaller (by 13%) increase of IPSP amplitude, but no effect on PPF, in HET mice. 

These electrophysiological data suggest that AC7 plays an important role in ethanol and CRF modulation of presynaptic GABA release in CeA and thus may underlie ethanol-related behaviors such as anxiety and dependence.

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Predictors for the Efficacy of Naltrexone Treatment in Alcohol Dependence: Sweet Preference

To analyse the possible associations between sweet preference and the efficacy of naltrexone treatment of alcohol dependence.
The preference for different concentrations of sucrose was evaluated in 78 participants diagnosed with alcohol dependence after treatment for 32 weeks with naltrexone or placebo without prior detoxification. 

A significant difference between naltrexone and placebo groups was found in the association between the preference for higher sucrose concentrations and relapses to heavy drinking. Higher sweet preference was significantly related to successful treatment measures in the naltrexone group but not in the placebo group. 

Sweet preference has a strong correlation to treatment outcomes with naltrexone, and sweet preference might be used as a predictor for better treatment results in alcoholics. Our study offers one possible new explanation of the clinical observation that naltrexone is not effective for every patient. 

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Alcohol-related amnesia and dementia: Animal models have revealed the contributions of different etiological factors on neuropathology, neurochemical dysfunction and cognitive impairment

Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment.

However, the relative contributions of different etiological factors to the development of alcohol-related neuropathology and cognitive impairment are questioned. 

One reason for this quandary is that both alcohol toxicity and thiamine deficiency result in brain damage and cognitive problems. 

Two alcohol-related neurological disorders, alcohol-associated dementia and Wernicke-Korsakoff syndrome have been modeled in rodents. 

These pre-clinical models have elucidated the relative contributions of ethanol toxicity and thiamine deficiency to the development of dementia and amnesia. 

What is observed in these models—from repeated and chronic ethanol exposure to thiamine deficiency—is a progression of both neural and cognitive dysregulation. 

Repeated binge exposure to ethanol leads to changes in neural plasticity by reducing GABAergic inhibition and facilitating glutamatergic excitation, long-term chronic ethanol exposure results in hippocampal and cortical cell loss as well as reduced hippocampal neurotrophin protein content critical for neural survival, and thiamine deficiency results in gross pathological lesions in the diencephalon, reduced neurotrophic protein levels, and neurotransmitters levels in the hippocampus and cortex. 

Behaviorally, after recovery from repeated or chronic ethanol exposure there is impairment in working or episodic memory that can recover with prolonged abstinence. 

In contrast, after thiamine deficiency there is severe and persistent spatial memory impairments and increased perseverative behavior. 

The interaction between ethanol and thiamine deficiency does not produce more behavioral or neural pathology, with the exception of reduction of white matter, than long-term thiamine deficiency alone.

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Moderating effects of a craving intervention on the relation between negative mood and heavy drinking following treatment for alcohol dependence.

Negative affect is a significant predictor of alcohol relapse, and the relation between negative affect and drinking has been shown to be strongly mediated by alcohol craving. 

Thus, targeting craving during treatment could potentially attenuate the relation between negative affect and drinking. 

The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. 

Our goal in the current study was to examine whether a treatment module that targeted craving would predict changes in negative mood during the 16-week combined behavioral intervention (n = 776) and the relation among changes in mood, craving, and changes in heavy drinking during treatment and 1 year posttreatment. 

Changes in negative mood were significantly associated with changes in heavy drinking during treatment (f2 = 0.78). Participants (n = 432) who received the craving module had significantly fewer heavy drinking days during treatment (d = 0.31), and receiving the module moderated the relation between negative mood and heavy drinking during treatment (f2 = 0.92) and 1 year posttreatment (f2 = 0.03). 

Moderating effects of the craving module were mediated by changes in craving during treatment. Within-subject analyses indicated significant pre- to postmodule reductions in negative mood. 

Additionally, postmodule craving significantly mediated the association between negative mood and heavy drinking during treatment and at posttreatment. 

The craving module of the combined behavioral intervention may weaken the relation between negative affect and heavy drinking by fostering greater decreases in craving during treatment.

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