Alcohol marketing research: the need for a new agenda

This paper aims to contribute to a rethink of marketing research priorities to address policy makers' evidence needs in relation to alcohol marketing.

Discussion paper reviewing evidence gaps identified during an appraisal of policy options to restrict alcohol marketing.

Evidence requirements can be categorized as follows: (i) the size of marketing effects for the whole population and for policy-relevant population subgroups, (ii) the balance between immediate and long-term effects and the time lag, duration and cumulative build-up of effects and (iii) comparative effects of partial versus comprehensive marketing restrictions on consumption and harm. These knowledge gaps impede the appraisal and evaluation of existing and new interventions, because without understanding the size and timing of expected effects, researchers may choose inadequate time-frames, samples or sample sizes. To date, research has tended to rely on simplified models of marketing and has focused disproportionately on youth populations. The effects of cumulative exposure across multiple marketing channels, targeting of messages at certain population groups and indirect effects of advertising on consumption remain unclear.

It is essential that studies into marketing effect sizes are geared towards informing policy decision-makers, anchored strongly in theory, use measures of effect that are well-justified and recognize fully the complexities of alcohol marketing efforts.




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Request Reprint E-Mail:  p.meier@sheffield.ac.uk  

Effects of Acetaldehyde on Hepatocyte Glycerol Uptake and Cell Size: Implication of Aquaporin 9

The effects of ethanol and acetaldehyde on uptake of glycerol and on cell size of hepatocytes and a role Aquaporin 9 (AQP9), a glycerol transport channel, were evaluated.

The studies were done in primary rat and mouse hepatocytes. The uptake of [¹⁴C] glycerol was determined with hepatocytes in suspension. For determination of cell size, rat hepatocytes on coated dishes were incubated with a lipophilic fluorochrome that is incorporated into the cell membrane and examined by confocal microscopy. A three-dimensional z scan of the cell was performed, and the middle slice of the z scan was used for area measurements.

Acute exposure to acetaldehyde, but not to ethanol, causes a rapid increase in the uptake of glycerol and an increase in hepatocyte size, which was inhibited by HgCl₂, an inhibitor of aquaporins. This was not observed in hepatocytes from AQP9 knockout mice, nor observed by direct application of acetaldehyde to AQP9 expressed in Xenopus Laevis oocytes. Prolonged 24-hour exposure to either acetaldehyde or ethanol did not result in an increase in glycerol uptake by rat hepatocytes. Acetaldehyde decreased AQP9 mRNA and AQP9 protein, while ethanol decreased AQP9 mRNA but not AQP9 protein. Ethanol, but not acetaldehyde, increased the activities of glycerol kinase and phosphoenolpyruvate carboxykinase.

The acute effects of acetaldehyde, while mediated by AQP9, are probably influenced by binding of acetaldehyde to hepatocyte membranes and changes in cell permeability. The effects of ethanol in enhancing glucose kinase, and phosphoenolpyruvate carboxykinase leading to increased formation of glycerol-3-phosphate most likely contribute to alcoholic fatty liver.


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Request Reprint E-Mail:  emezey@jhmi.edu  

The Mu Opioid Receptor Is Not Involved in Ethanol-Stimulated Dopamine Release in the Ventral Striatum of C57BL/6J Mice

The mu opioid receptor (MOR) has previously been found to regulate ethanol-stimulated dopamine release under some, but not all, conditions. A difference in ethanol-evoked dopamine release between male and female mixed background C57BL/6J-129SvEv mice led to questions about its ubiquitous role in these effects of ethanol. Using congenic C57BL/6J MOR knockout (KO) mice and C57BL/6J mice pretreated with an irreversible MOR antagonist, we investigated the function of this receptor in ethanol-stimulated dopamine release.

Microdialysis was used to monitor dopamine release and ethanol clearance in MOR -/-, +/+, and +/− . male and female mice after intraperitoneal (i.p.) injections of 1.0, 2.0, and 3.0 g/kg ethanol (or saline). We also measured the increase in dopamine release after 5 mg/kg morphine (i.p.) in male and female MOR+/+ and −/− mice. In a separate experiment, male C57BL/6J mice were pretreated with either the irreversible MOR antagonist beta funaltrexamine (BFNA) or vehicle, and dopamine levels were monitored after administration of 2 g/kg ethanol or 5 mg/kg morphine.

Although ethanol-stimulated dopamine release at all the 3 doses of alcohol tested, there were no differences between MOR+/+, −/−, and +/− mice in these effects. Female mice had a more prolonged effect compared to males at the 1 g/kg dose. Administration of 2 g/kg ethanol also caused a similar increase in dopamine levels in both saline-pretreated and BFNA-pretreated mice. Five mg/kg morphine caused a significant increase in dopamine levels in MOR+/+ mice but not in MOR−/− mice and in saline-pretreated mice but not in BFNA-pretreated mice. Intraperitoneal saline injections had a significant, albeit small and transient, effect on dopamine release when given in a volume equivalent to the ethanol doses, but not in a volume equivalent to the 5 mg/kg morphine dose. Ethanol pharmacokinetics were similar in all genotypes and both sexes at each dose and in both pretreatment groups.

MOR is not involved in ethanol-stimulated dopamine release in the ventral striatum of C57BL/6J mice.



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Request Reprint E-Mail:   rgonzales@mail.utexas.edu 

The Change of Plasma Ghrelin and Leptin Levels by the Development of Type 2 Diabetes Mellitus in Patients With Alcohol Dependence

There have been lots of studies about the relationship between chronic use of alcohol and the development of type 2 diabetes mellitus (T2DM). Chronic use of alcohol can be affected by the altered level of ghrelin and leptin which regulate food-seeking behavior having similar mechanism of controlling alcohol-craving behavior. Those peptides are known to be correlated with T2DM. Ghrelin and leptin also have been regarded as possible regulators of glucose metabolism and insulin function. Hence, there is the possibility that ghrelin and leptin can be related with deteriorated pathophysiology of T2DM in alcoholic patients.

Patients with alcohol dependence diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) underwent an 75 g oral glucose-tolerance test (OGTT), to classify them to normal glucose tolerance (NGT, n = 52), pre-diabetes including impaired glucose tolerance (IGT), impaired fasting glucose level (IFG) and combination of IGT and IFG (Pre-DM, n = 26) and T2DM (n = 24) groups. Fasting plasma ghrelin and leptin levels were compared among groups.

There was no difference of ghrelin concentration among the groups but the leptin concentration was significantly different between NGT and T2DM group (p < 0.05). Increased leptin levels were significantly correlated with body mass index (BMI), insulin level, and insulin resistance.

Chronic alcohol drinking might produce leptin resistance which makes leptin significantly correlated with fasting insulin concentration and insulin resistance. Therefore, we suppose that increased level of leptin by chronic alcohol use could be one of the main mechanisms that develop insulin resistance in alcoholic patients.



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Request Reprint E-Mail:  kdj922@catholic.ac.kr  

Moderate Prenatal Alcohol Exposure and Serotonin Genotype Interact to Alter CNS Serotonin Function in Rhesus Monkey Offspring

Moderate prenatal alcohol exposure can contribute to neurodevelopmental impairments and disrupt several neurotransmitter systems. We examined the timing of moderate level alcohol exposure, serotonin transporter gene polymorphic region variation (rh5-HTTLPR), and levels of primary serotonin and dopamine (DA) metabolites in cerebrospinal fluid (CSF) in rhesus monkeys.

Thirty-two 30-month old rhesus monkeys (Macaca mulatta) from 4 groups of females were assessed: (i) early alcohol-exposed group (n = 9), in which mothers voluntarily consumed 0.6 g/kg/d alcohol solution on gestational days 0 to 50; (ii) middle-to-late gestation alcohol-exposed group (n = 6), mothers consumed 0.6 g/kg/d alcohol solution on gestational days 50 to 135; (iii) a continuous-exposure group (n = 8), mothers consumed 0.6 g/kg/d alcohol solution on gestational days 0 to 135; and (iv) controls (n = 9), mothers consumed an isocaloric control solution on gestational days 0 to 50, 50 to 135, or 0 to 135. Serotonin transporter promoter region allelic variants (homozygous s/s or heterozygous s/l vs. homozygous l/l) were determined. We examined CSF concentrations of the 5-HT and DA metabolites, 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), respectively, at baseline and 50 hours after separation from cage-mates, when the monkeys were 30 months old.

Early- and middle-to-late gestation-alcohol exposed monkeys carrying the short allele had lower concentrations of 5-HIAA in CSF relative to other groups. Concentrations of 5-HIAA in CSF were lower for s allele carriers and increased from baseline relative to pre-separation values, whereas 5-HIAA levels in l/l allele carriers were not affected by separation. Monkeys carrying the short allele had lower basal concentrations of HVA in CSF compared with monkeys homozygous for the long allele.

Carrying the s allele of the 5-HT transporter increased the probability of reduced 5-HIAA in early- and middle-to-late gestation alcohol-exposed monkeys and reduced HVA at baseline. These findings that prenatal alcohol exposure altered central 5-HT activity in genetically sensitive monkeys raise questions about whether abnormal serotonin biological pathways could underlie some of the psychiatric disorders reported in fetal alcohol spectrum disorder.




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Request Reprint E-Mail:  schneider@education.wisc.edu

Postdisaster Course of Alcohol Use Disorders in Systematically Studied Survivors of 10 Disasters

Although several studies have suggested that alcohol use may increase after disasters, it is unclear whether any apparent postdisaster increases regularly translate into new cases of alcohol use disorders.

To determine the relationship of predisaster and postdisaster prevalence of alcohol use disorders and to examine the incidence of alcohol use disorders in relation to disasters.

Data from 10 disasters, studied within the first few postdisaster months and at 1 to 3 years postdisaster, were merged and examined.

Six hundred ninety-seven directly exposed survivors of 10 disasters.

The Diagnostic Interview Schedule for DSM-III-R provided lifetime diagnoses of alcohol abuse and dependence, and onset and recency questions allowed a determination of whether the disorder had been present either prior to or following the event, or both.

While the postdisaster prevalence of alcohol use disorders was 19%, only 0.3% of the sample developed an acute new postdisaster alcohol use disorder. Most of those in recovery, however, consumed alcohol after the disaster (83%) and coped with their emotions by drinking alcohol (22%). Those with a postdisaster alcohol use disorder were more than 4 times as likely as those without to cope with their disaster-related emotions by drinking alcohol (40% vs 9%).

The vast majority of postdisaster alcohol use disorders represented the continuation or recurrence of preexisting problems. Findings suggest that those in recovery as well as those who drink to cope with their emotions represent groups warranting potential concern for postdisaster mental health intervention. Further research is needed to clarify the clinical significance of changes in alcohol use after disasters.


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Request Reprint E-Mail:   carol.north@utsouthwestern.edu  

Do Christian Denominations Exhibit Higher Rates of Alcohol Consumption? A Study of Korean American Women in California

Although Korean American women show high levels of involvement in religious practices and high prevalence of alcohol consumption, no studies have assessed the association between religious denomination and alcohol intake among this group of women. 

This cross-sectional study examined the associations of religious denomination and religious commitment to alcohol consumption among Korean American women in California. 

Polychotomous regression models were used to provide estimates of the associations between religious denomination and religious commitment to alcohol consumption.
 
Catholic Korean American women (OR 5.61 P\0.01) and Independent Christian women (OR 4.87 P\0.01) showed stronger associations to heavy alcohol consumption when compared to Conservative Christian Korean American women. 

Path analysis suggested that specific denominations had both direct and indirect effects on the outcome of interest, and that religious commitment and drinking models served as moderators for this phenomenon.


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Alcohol consumption and binge drinking in adolescents: comparison of different migration backgrounds and rural vs. urban residence - a representative study

Binge drinking is a constant problem behavior in adolescents across Europe. Epidemiological investigations have been reported. However, epidemiological data on alcohol consumption of adolescents with different migration backgrounds are rare. Furthermore representative data on rural-urban comparison concerning alcohol consumption and binge drinking are lacking. 

The aims of the study are the investigation of alcohol consumption patterns with respect to a) urban-rural differences and b) differences according to migration background.

In the years 2007/2008, a representative written survey of N = 44,610 students in the 9th. grade of different school types in Germany was carried out (net sample). The return rate of questionnaires was 88 % regarding all students whose teachers respectively school directors had agreed to participate in the study. Weighting factors were specified and used to make up for regional and school-type specific differences in return rates. 27.4 % of the adolescents surveyed have a migration background, whereby the Turkish culture is the largest group followed by adolescents who emigrated from former Soviet Union states. The sample includes seven large cities (over 500,000 inhabitants) (12.2 %), independent smaller cities ("urban districts") (19.0 %) and rural areas ("rural districts") (68.8 %).

Life-time prevalence for alcohol consumption differs significantly between rural (93.7 %) and urban areas (86.6 % large cities; 89.1 % smaller cities) with a higher prevalence in rural areas. The same accounts for 12-month prevalence for alcohol consumption. 57.3 % of the rural, respectively 45.9 % of the urban adolescents engaged in binge drinking in the 4 weeks prior to the survey. Students with migration background of the former Soviet Union showed mainly drinking behavior similar to that of German adolescents. Adolescents with Turkish roots had engaged in binge drinking in the last four weeks less frequently than adolescents of German descent (23.6 % vs. 57.4 %). However, in those adolescents who consumed alcohol in the last 4 weeks, binge drinking is very prominent across the cultural backgrounds.

Binge drinking is a common problem behavior in German adolescents. Obviously adolescents with rural residence have fewer alternatives for engaging in interesting leisure activities than adolescents living in cities. This might be one reason for the more problematic consumption patterns there. Common expectations concerning drinking behavior of adolescents of certain cultural backgrounds ('migrants with Russian background drink more'/ 'migrants from Arabic respectively Oriental-Islamic countries drink less') are only partly affirmed. Possibly, the degree of acculturation to the permissive German alcohol culture plays a role here.

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Alcohol in Canada: reducing the toll through focused interventions and public health policies

Alcohol consumption has risen in Canada while controls have been eroded, a situation that may increase an already high burden of harms that include acute and chronic disease, trauma and social problems. 

Giesbrecht and colleagues present evidence for a comprehensive response that includes restructured alcohol prices, controlled availability, curtailed marketing, lowered legal limits on blood alcohol concentration, improved access to services for high-risk drinkers and public education.

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Request Reprint E-Mail:  norman_giesbrecht@camh.net  

Alcohol News - 6/2011

nordicwelfare.org (Norway) - Trends in alcohol consumption, harms and policy: Norway 1990 – 2010

Over the past two decades recorded alcohol sales in Norway have increased by almost 50%. Although control policy measures are somewhat weakened over this period, the increase should also be viewed in light of the significant increase in purchase power, implying that alcohol has become relatively cheaper for the consumers.

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nordicwelfare.org (Sweden) - Trends in alcohol consumption, harms and policy: Sweden 1990–2010

Over the past two decades, alcohol consumption in Sweden has grown by 20 per cent as a result of an increasing consumption of wine and strong beer. The rise is driven by a combination of factors such as the higher physical availability and lower real prices of alcohol, which suggests that alcohol has become much more affordable.

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nordicwelfare.org (Finland) - Trends in alcohol consumption, harms and policy:Finland 1990 – 2010

This article reports developments in the Finnish alcohol field from 1990 to 2010, focusing on changes and trends in alcohol consumption, drinking habits and alcohol-related harm. We pay special attention to changes in alcohol availability and alcohol policy and look at the factors behind changes in alcohol policies.

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Reuters (Russia) - Battle for alcohol in Muslim Russia is deadly business

A masked guard clad in camouflage pokes his AK-47 rifle into the shoulder of a vodka-guzzling client in a hotel bar in Russia's Muslim Ingushetia region, and orders him to leave immediately.

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USA Today (USA) - Polls: Young non-drinkers up in down economy

The tough economy appears to be having a sobering effect — literally — on incoming college freshmen. Some new surveys of high school students suggest increasing numbers are beginning college as teetotalers.

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Voxy (New Zealand) - Medical Evidence Shows Drinking Age Should Be 21

A new report examining the medical evidence argues that the drinking age should be raised to 21. The report "YOUNG PEOPLE AND ALCOHOL: What Does the Medical Evidence Tell Us About the Legal Drinking Age in New Zealand?" was commissioned by Family First NZ, and prepared by UK psychologist Dr Aric Sigman. Dr Sigman is a Fellow of the Society of Biology, an Associate Fellow of the British Psychological Society, and a recipient of the Chartered Scientist Award from the Science Council.

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AFP (Turkey) - Booze enters Turkey's political battlefield

Braving snowy sub-zero weather, hundreds of people gathered in downtown Ankara at the weekend for an unprecedented anti-government protest, brandishing not flags and banners but... beer cans and glasses of champagne.

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Irish Health (Ireland) - Many unaware of alcohol-cancer link

Ireland's next government has been urged to introduce explicit health warnings on alcohol products, particularly in relation to cancer. Alcohol Action Ireland (AAI), the national charity for alcohol-related issues, made its appeal to coincide with World Cancer Day (February 4). It pointed out that there is ‘an undeniable link' between alcohol and many cancers, however some drinkers are unaware of this.

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Sydney Morning Herald (Australia) - Liver disease soars among young

THE risk of young people being admitted to hospital with alcohol-related liver disease has risen more than tenfold over five years. Researchers say the figures show anti-drinking campaigns are failing to reach teenagers.

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The Guardian (UK) - The price of a drink: survey reveals cost of alcohol abuse

The toll that alcohol takes on many people's lives is laid bare in a survey which has prompted fresh calls for action to tackle widespread chronic drinking across Britain.

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TVNZ - Study shows alcohol and sport a bad mix

There is a clear link between alcohol-related sponsorship of sport and heightened rates of problem drinking, new Australian research shows.

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Metro (UK) - £55 bottle of beer with 32 per cent alcohol on sale

If you fancy a beer at home before going out, best avoid Tactical Nuclear Penguin – at 32 per cent it could send you to sleep instead.

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Deutsche Welle (Germany) - German teenagers are drinking less alcohol, but more irresponsibly

Over the past 30 years, alcohol consumption among German teens has dropped by half, according to a federal study. Though officials view the results as largely positive, concern remains about youth binge drinking.

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Informante (Namibia) - Fight against alcohol abuse – which way Namibia?

As a young person, I was very happy when I firstly heard the Governor’s plan to close a certain police canteen because of unbecoming behaviour officers engage in.  The issue of alcohol abuse is a national issue that needs unified efforts from all patriotic Namibians.

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The Hindu (India) - “Control availability of alcohol, tobacco”

Chancellor of VIT University G. Viswanathan has urged the Central and State governments to take stringent measures to control the availability and use of alcohol and tobacco to save the youth from cancer.

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24-7PressRelease.com (USA) - DWI: What Would It Cost To Reduce The Numbers?

A series of blog entries in the New York Times discuss drunk-driving law and what the law generally seeks to prevent--fewer alcohol-related injuries and deaths--but how we go about achieving it without severely overstepping constitutional boundaries to due process is a major challenge.

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The London Daily News (UK) - Why the Heineken deal is good for the wallet but bad for the "legacy"

With confirmation that leading brewer Heineken will be the official "lager supplier" at the London Olympic Games next year, and sponsor of the 2012 Games, in a city which has seen its accident and emergency departments swamped by drunks, there should be a hard long look at this deal.

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European Public Health Alliance (EU) - 2010 - Overview of activities in implementation of EU Alcohol Strategy

Between September and November 2010 all the existing EU structures working on alcohol conducted their meetings. You can find below reports of the following : the Open Alcohol and Health Forum, the European Alcohol and Health Forum, the Forum Science Group, as well as the Committee on National Policy and Action.

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In Search of Alcoholism Genes

Millions of Americans know all too painfully that alcoholism runs in families.

Children of alcoholic parents are four times as likely to develop drinking problems as the general population. Sons of alcoholic fathers face up to nine times the usual risk. Even babies of alcoholics adopted into non-drinking homes have nearly the same risk of alcoholism as they would if they'd stayed with their biological parents, studies have shown.

But untangling just which genes pass along the predisposition for problem drinking is devilishly difficult—largely because alcoholism itself is so complex. Genes that affect how fast the liver metabolizes alcohol and how the brain reacts to stress, reward and pleasure have all been implicated, as have genes for anxiety and depression. Some overlap with genes for nicotine, cocaine and other addictions.  > > > >  Read More

Supporting Our Greatest Resource: Addressing Substance Use, Misuse and Relapse in the Addiction Treatment Workforce

This toolkit is designed for provider organizations in the addictions field, their executives, managers and human resources staff. It includes practical resources and information to guide and assist providers as they face workforce issues associated with substance use, misuse and recovery among employees. More broadly, it will assist employers in creating a work environment that supports the needs of employees, engages and retains employees in the addictions field, and in the case of use, misuse and relapse, intervenes in a way that is effective while being legally and corporately responsible.



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The cost of substance abuse to society has reached unsustainable levels. With the annual cost of alcohol use in California at $38.4 billion and illicit drug abuse at $23.8 billion, the combined toll on the state ($62.2 billion) cannot be sustained from a fiscal standpoint.

This, in conjunction with the very real human toll the disease of addiction takes on individuals, families and communities, makes it critical for policy makers to take a proactive role in addressing the complex substance abuse issues facing the state.
 
Recognizing the costly nature of addiction on many public service systems, California’s publicly funded Alcohol and Other Drug (AOD) services system has been on a path over the last several years to increase effectiveness and cost efficiency of services to those Californians in need. The AOD Field has made much progress in instituting evidence based practices, process improvements and performance measures to increase effectiveness of services as part of its Continuum of Services System Re-engineering efforts.
 
The state Department of Alcohol and Drug Programs (ADP) has taken the next step in reengineering efforts by instituting system improvements through development of a data informed planning and decision making process. The Statewide Needs Assessment and Planning (SNAP) process has been established within ADP business operations to fill that role. This first report represents the beginning of the assessment phase of the process which will culminate in establishing state-level priorities. This is followed by a planning, implementation and evaluation phase.
 
Based on the data analysis in this report the following recommendations were developed to be considered in establishing state-level priorities.

Recommendations for the Continuum of Services

 Employ more science-based population level prevention strategies.
 Identify new funding or resource strategies to expand Prevention activities in California.
 Build the AOD system capacity for early intervention strategies such as SBIRT.
 Continue to focus on increasing treatment effectiveness through strategies such as evidence-based practices, process improvements, performance measures, etc.
 Build the AOD system capacity for Recovery Support Services including identifying funding or other resource strategies.
 
Recommendations for Health Care Reform

 Develop a plan based on the “knowns” of health care reform and add to it as further information and details come to light.
 Consider how to partner with and educate the primary care system on AOD issues.
 A thorough examination of the Medicaid and California's Medi-Cal system must be undertaken in relation to impacts on the AOD system and services.
 Understanding and planning for the uninsured population will be just as important as building capacity to serve additional insured individuals.
 Appropriately preparing and developing the AOD workforce will be a critical step.

Recommendations for Specific Substances

 Institute specific programs aimed at preventing and reducing the high rate of underage and excessive alcohol use and abuse.
 Institute strategies to arrest the growth of prescription drug and opiate abuse.

Recommendations for Specific Populations

 To address overall need:
o Target youth aged 12 through 20 for evidence-based universal prevention strategies.
o Target youth aged 16 and 17 years old for evidence-based selective prevention strategies.
o Target young adults aged 21 through 25 for evidence-based early intervention strategies.
o Target youth aged 18 through 25 for evidence-based prevention, early intervention, and treatment services.
 Complete an in-depth analysis of race/ethnicity data to understand its relationship to the AOD service needs in California to inform program decisions.
 Consider instituting programs to increase the treatment capacity for the following subpopulations in the listed order:
o Veterans
o Individuals with SMI and a concurrent AOD problem
o Pregnant women
o Homeless individuals
 
These are all strategies that the data in this report indicate would be of most value in impacting the state’s substance use issues. Decisions related to the setting of state-level priorities will be made by senior leaders within the AOD Field at the state and county levels. While the data suggest certain courses of action, decisions must also factor in resource and other environmental issues.



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Evaluation of the California Outcomes Measurement System (CalOMS) Final Report 2008

During the past several years, the landscape of substance abuse problems and treatments has continued to change in the State of California.  The emergence of new drug abuse problems (e.g., prescription drugs), the impact of precursor restrictions on the domestic production of methamphetamine and the compensatory increases in methamphetamine importation, the development and expanded use of medications for addiction, and the increasing awareness of the chronic nature of alcohol and other drug (AOD) conditions have dramatically transformed the way we conceptualize treatment for addiction, what we expect from treatment, and how we evaluate treatment.

Given that most treatment for substance use disorders is provided through public funding, there is considerable interest in ensuring that treatment programs in California are using public dollars responsibly by performing efficiently (providing quality services) and producing positive client outcomes.  As part of this effort to improve treatment accountability and outcomes, the California Department of Alcohol and Drug Programs (ADP) developed the California Outcomes Measurement System (CalOMS) for treatment, the first statewide data collection and management system implemented in all 58 counties to comprehensively measure AOD client outcomes.  The CalOMS core data set includes questions on client functioning across medical, psychiatric, employment, legal, family/social, and alcohol and drug use areas.  Treatment programs are responsible for collecting this core data from all clients at treatment admission and discharge. 

One year after the implementation of CalOMS, the Integrated Substance Abuse Programs (ISAP) group from the University of California, Los Angeles (UCLA), conducted the first evaluation of CalOMS under the guise of four objectives:

Objective 1:      Use CalOMS data to improve knowledge of AOD treatment services in California           

Objective 2:      Enhance the capability of county administrators to use CalOMS data to improve treatment service

Objective 3:      Evaluate the quality and validity of CalOMS data

Objective 4:      Develop recommendations for improvement of the CalOMS system

This final report is divided into eight chapters that address research questions specific to each of the four evaluation objectives. While information in each chapter is relevant to each of the four objectives, the first five chapters provide information that responds to Objective 1, Chapter 6 specifically addresses Objective 2, Chapter 7 is in response to Objective 3, and the last chapter responds to Objective 4.

Addressing these objectives will help ADP improve the quality and performance of AOD treatment services in California and maximize the usability of CalOMS data to enhance treatment policies and 

practices in California.

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RE-AIM Evaluation of the Alcohol and Pregnancy Project: Educational Resources to Inform Health Professionals About Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). 

The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. 

The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. 

The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. 

One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). 

The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD. 

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Request Reprint E-Mail:    janp@ichr.uwa.edu.au

 

Effects of Cue-Exposure Treatment on Neural Cue Reactivity in Alcohol Dependence: A Randomized Trial

In alcohol-dependent patients, alcohol-associated cues elicit brain activation in mesocorticolimbic networks involved in relapse mechanisms. Cue-exposure based extinction training (CET) has been shown to be efficacious in the treatment of alcoholism; however, it has remained unexplored whether CET mediates its therapeutic effects via changes of activity in mesolimbic networks in response to alcohol cues. 

In this study, we assessed CET treatment effects on cue-induced responses using functional magnetic resonance imaging (fMRI).

In a randomized controlled trial, abstinent alcohol-dependent patients were randomly assigned to a CET group (n = 15) or a control group (n = 15). All patients underwent an extended detoxification treatment comprising medically supervised detoxification, health education, and supportive therapy. The CET patients additionally received nine CET sessions over 3 weeks, exposing the patient to his/her preferred alcoholic beverage. Cue-induced fMRI activation to alcohol cues was measured at pretreatment and posttreatment.

Compared with pretreatment, fMRI cue-reactivity reduction was greater in the CET relative to the control group, especially in the anterior cingulate gyrus and the insula, as well as limbic and frontal regions. Before treatment, increased cue-induced fMRI activation was found in limbic and reward-related brain regions and in visual areas. After treatment, the CET group showed less activation than the control group in the left ventral striatum.

The study provides first evidence that an exposure-based psychotherapeutic intervention in the treatment of alcoholism impacts on brain areas relevant for addiction memory and attentional focus to alcohol-associated cues and affects mesocorticolimbic reward pathways suggested to be pathophysiologically involved in addiction.


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Request Reprint E-Mail:  s.vollstaedt-klein@zi-mannheim.de  

Activation of Nuclear PPARγ Receptors by the Antidiabetic Agent Pioglitazone Suppresses Alcohol Drinking and Relapse to Alcohol Seeking.

Pioglitazone and rosiglitazone belong to the class of thiazolidinediones (TZDs). They were first developed as antioxidants and then approved for the clinical treatment of insulin resistance and Type 2 diabetes. TZDs bind with high affinity and activate peroxisome proliferator-activated receptor-gamma (PPARγ) receptors, which in the brain are expressed both in neurons and in glia.

We evaluated the effect of PPARγ activation by TZDs on alcohol drinking, relapse-like behavior, and withdrawal in the rat. We also tested the effect of TZDs on alcohol and saccharin self-administration.

We showed that activation of PPARγ receptors by pioglitazone (0, 10, and 30 mg/kg) and rosiglitazone (0, 10 and 30 mg/kg) given orally selectively reduced alcohol drinking. 

The effect was blocked by pretreatment with the selective PPARγ antagonist GW9662 (5 μg/rat) given into the lateral cerebroventricle, suggesting that this TZD's effect is mediated by PPARγ receptors in the central nervous system. 

Pioglitazone abolished reinstatement of alcohol seeking, a relapse-like behavior, induced by yohimbine, a pharmacologic stressor, but did not affect cue-induced relapse. In the self-administration experiments, pioglitazone reduced lever pressing for alcohol but not for saccharin. Finally, pioglitazone prevented the expression of somatic signs of alcohol withdrawal.

These findings provide new information about the role of brain PPARγ receptors and identify pioglitazone as candidate treatments for alcoholism and possibly other addictions.


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Request Reprint E-Mail:  roberto.ciccocioppo@unicam.it  

Functional Role of the Polymorphic 647 T/C Variant of ENT1 (SLC29A1) and Its Association with Alcohol Withdrawal Seizures

Adenosine is involved in several neurological and behavioral disorders including alcoholism. In cultured cell and animal studies, type 1 equilibrative nucleoside transporter (ENT1, slc29a1), which regulates adenosine levels, is known to regulate ethanol sensitivity and preference. Interestingly, in humans, the ENT1 (SLC29A1) gene contains a non-synonymous single nucleotide polymorphism (647 T/C; rs45573936) that might be involved in the functional change of ENT1.
 

Our functional analysis showed that prolonged ethanol exposure increased adenosine uptake activity of mutant cells (ENT1-216Thr) compared to wild-type (ENT1-216Ile) transfected cells, which might result in reduced extracellular adenosine levels. 

We found that mice lacking ENT1 displayed increased propensity to ethanol withdrawal seizures compared to wild-type littermates. 

We further investigated a possible association of the 647C variant with alcoholism and the history of alcohol withdrawal seizures in subjects of European ancestry recruited from two independent sites. 

Analyses of the combined data set showed an association of the 647C variant and alcohol dependence with withdrawal seizures at the nominally significant level.
 

Together with the functional data, our findings suggest a potential contribution of a genetic variant of ENT1 to the development of alcoholism with increased risk of alcohol withdrawal-induced seizures in humans.


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Parenting to Prevent Childhood Alcohol Use

Drinking alcohol undoubtedly is a part of American culture, as are conversations between parents and children about its risks and potential benefits. However, information about alcohol can seem contradictory. Alcohol affects people differently at different stages of life—small amounts may have health benefits for certain adults, but for children and adolescents, alcohol can interfere with normal brain development. Alcohol’s differing effects and parents’ changing role in their children’s lives as they mature and seek greater independence can make talking about alcohol a challenge. Parents may have trouble setting concrete family policies for alcohol use. And they may find it difficult to communicate with children and adolescents about alcohol-related issues.

Research shows, however, that teens and young adults do believe their parents should have a say in whether they drink alcohol. Parenting styles are important—teens raised with a combination of encouragement, warmth, and appropriate discipline are more likely to respect their parents’ boundaries. Understanding parental influence on children through conscious and unconscious efforts, as well as when and how to talk with children about alcohol, can help parents have more influence than they might think on a child’s alcohol use. Parents can play an important role in helping their children develop healthy attitudes toward drinking while minimizing its risk. > > > >   Read More

Privatizing kills! Or does it?

STATS critiques a new study claiming that private liquor stores are hazardous to our health, while government liquor stores save lives.

A study making waves in Canada has spilled over into Virginia’s debate over privatizing state liquor stores. When researchers charged that British Columbia’s privatization program has increased alcohol-related deaths, Virginia and Washington D.C.-based media were quick to play up the local angle. For example, under the headline “Research adds a new twist to Virginia liquor debate,” the Norfolk-based Virginian Pilot reported on January 20:   > > > >    Read More

Alcohol exposure during late gestation adversely affects myocardial development with implications for postnatal cardiac function

Prenatal exposure to high levels of ethanol is associated with cardiac malformations, but the effects of lower levels of exposure on the heart are unclear. 

Our aim was to investigate the effects of daily exposure to ethanol during late gestation, when cardiomyocytes are undergoing maturation, on the developing myocardium. 

Pregnant ewes were infused with either ethanol (0.75g/kg) or saline for one hour each day from gestational days 95 to 133 (term ~145 days); tissues were collected at 134 d. In sheep, cardiomyocytes mature during late gestation as in humans. Within the left ventricle (LV), cardiomyocyte number was determined using unbiased stereology and cardiomyocyte size and nuclearity determined using confocal microscopy. Collagen deposition was quantified using image analysis. Genes relating to cardiomyocyte proliferation and apoptosis were examined using quantitative real-time PCR. 

Fetal plasma ethanol concentration reached 0.12g/dL after EtOH infusions. Ethanol exposure induced significant increases in relative heart weight, relative LV wall volume and cardiomyocyte cross-sectional area. Ethanol exposure advanced LV maturation in that the proportion of binucleated cardiomyocytes increased by 12% and the number of mononucleated cardiomyocytes was decreased by a similar amount. 

Apoptotic gene expression increased in the ethanol-exposed hearts, although there were no significant differences between groups in total cardiomyocyte number or interstitial collagen. 

Daily exposure to a moderate dose of ethanol in late gestation accelerates the maturation of cardiomyocytes and increases cardiomyocyte and LV tissue volume in the fetal heart. These effects on cardiomyocyte growth may program for long-term cardiac vulnerability. 

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Request Reprint E-Mail:    jane.black@med.monash.edu.au

 

Alcohol Use Among Arab Americans: What is the Prevalence?

Information is limited on alcohol use among Arab Americans. 

 

The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. 

 

Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. 

 

In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). 

 

Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. 

 

Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated. 

 

 

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Request Reprint E-Mail:   carfken@med.wayne.edu