The Varieties of Recovery Experience: A Primer for Addiction Treatment Professionals and Recovery Advocates

The study of alcohol and other drugs (AOD) is historically marked by three stages:

1) the investigation of AOD-related social and personal pathologies,

2) the development of personal and social interventions aimed at resolving AOD problems, and

3) a focus on the prevalence and patterns of long-term recovery from AOD problems.

This essay honors this transition from addiction and treatment paradigms to a recovery paradigm by exploring the growing varieties of pathways and styles through which people are resolving serious and persistent AOD-related problems. A review of scientific and mutual aid literature is used to catalogue variations in:

• scope of recovery (primary and secondary chemical health and global health)

• depth of recovery (partial, full and enriched)

• types of recovery (abstinence-based, moderation-based, medication-assisted)

• context of recovery initiation (solo, peer-assisted, treatment-assisted)

• frameworks of recovery initiation (religious, spiritual, secular)

• temporal styles of recovery initiation (transformative change, incremental change, drift)

• recovery identity (positive, neutral, negative)

• recovery relationships (acultural, bicultural and enmeshed styles; virtual recovery)

• recovery stability/durability (At what point does present remission predict future remission?), and

• recovery termination (Is recovery ever completed?).

After exploring the wide diversity of recovery styles and experiences that exist within Twelve Step fellowships and other recovery mutual aid societies, the article explores the implications of the wide diversity in recovery experiences to the design and conduct of addiction treatment.




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Global Actions July 15, 2011

Global Actions in Focus: China

In Nanjing, the launch event of the project “Respect Life and Say No to Drink Driving” commenced with a training workshop for policymakers on July 5 and drew a large number of key stakeholders. The workshop combined educational sessions, focus groups, and group discussions, helping to promote broader understanding about the problem of drink driving. A Memorandum of Understanding (MOU) was signed by the Jiangsu Provincial CDC and ICAP; a project agreement was also initiated with the Jiangsu Provincial Institute for Health Education.

In its second focus city, ICAP and CCHE introduced Global Actions and the drink driving initiative capacity-building plan with a launch event in Xi’an on July 7. The workshop concluded with a Memorandum of Understanding (MOU) signed by ICAP and the Xi’an Institute for Health Education. With the support of local stakeholders, Global Actions will implement a series of activities, including facilitation of the training workshops for local government, planning and developing local interventions, and implementation of surveys before and after the interventions to evaluate the effectiveness of the project in the 2011-2012 time frame.

What’s Happening Next

· Global Actions Nigeria is launching a landmark road safety event in Abuja on July 18. Stakeholders participating in the strategic planning session will include representatives of the Federal Road Safety Commission (FRSC), the Advertising Practitioners Council of Nigeria (APCON), the chief representatives of local sponsors of Global Actions, Nigeria Breweries PLC and Guinness Nigeria PLC, and members of the law enforcement, transportation, and public health communities.

· In Vietnam, we will host a Publicity Campaign capacity-building workshop on July 21-22. The two-day Skills to Develop, Implement, and Evaluate a Drink Driving Coordinated Campaign training course will bring together 30 members of the Da Nang project team and teach key concepts and processes for developing and launching a road safety campaign.

· Also in Vietnam, final preparation for Blood Alcohol Content (BAC) training for medical staff will occur in late July. The testing training is for 20 to 30 medical staff of the Da Nang project team who are responsible for taking and testing blood samples of the road traffic victims in local hospitals and reporting the BAC results to the project evaluation team.

The PhenX Toolkit: Get the Most From Your Measures

The potential for genome-wide association studies to relate phenotypes to specific genetic variation is greatly increased when data can be combined or compared across multiple studies.

To facilitate replication and validation across studies, RTI International (Research Triangle Park, North Carolina) and the National Human Genome Research Institute (Bethesda, Maryland) are collaborating on the consensus measures for Phenotypes and eXposures (PhenX) project.

The goal of PhenX is to identify 15 high-priority, well-established, and broadly applicable measures for each of 21 research domains. PhenX measures are selected by working groups of domain experts using a consensus process that includes input from the scientific community. The selected measures are then made freely available to the scientific community via the PhenX Toolkit.

Thus, the PhenX Toolkit provides the research community with a core set of high-quality, well-established, low-burden measures intended for use in large-scale genomic studies. PhenX measures will have the most impact when included at the experimental design stage. The PhenX Toolkit also includes links to standards and resources in an effort to facilitate data harmonization to legacy data.

Broad acceptance and use of PhenX measures will promote cross-study comparisons to increase statistical power for identifying and replicating variants associated with complex diseases and with gene-gene and gene-environment interactions.



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Alcohol Exposure In Utero Leads to Enhanced Prepubertal Mammary Development and Alterations in Mammary IGF and Estradiol Systems

Exposure to alcohol during fetal development increases susceptibility to mammary cancer in adult rats.

This study determined if early changes in mammary morphology and the insulin-like growth factor (IGF)/estradiol axis are involved in the mechanisms that underlie this increased susceptibility.

Pregnant Sprague-Dawley rats were fed a liquid diet containing 6.7% ethanol (alcohol), an isocaloric liquid diet (pair-fed), or rat chow ad libitum from days 11 to 21 of gestation. At birth, female pups were cross-fostered to ad libitum-fed control dams. Offspring were euthanized at postnatal days (PND) 20, 40, or 80. Animals were injected with BrdU before euthanasia, then mammary glands, serum, and livers were collected.

Mammary glands from animals exposed to alcohol in utero displayed increased epithelial cell proliferation and aromatase expression at PND 20 and 40. Mammary IGF-I mRNA was higher in alcohol-exposed animals relative to controls at PND 20, while mammary IGFBP-5 mRNA was lower in this group at PND 40. Hepatic IGF-I mRNA expression was increased at all time points in alcohol-exposed animals, however, circulating IGF-I levels were not altered.

These data indicate that alcohol exposure in utero may advance mammary development via the IGF and estradiol systems, which could contribute to increased susceptibility to mammary cancer later in life.



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Request Reprint E-Mail: cohick@aesop.rutgers.edu

News Release - Purdue students to take AlcoholEdu course starting Friday

Purdue University on Friday (July 15) will roll out AlcoholEdu, an online course about the impact and responsibilities associated with drinking.

"This program will enhance our existing efforts to encourage healthy choices and impact the alcohol culture and behavior," said Melissa Exum, vice president for student affairs. "Our goal is to provide an environment that will help our students develop both personally and academically."

Students expected to take the course include first-time undergraduates; transfer students under age 21; and students living in University Residences, fraternities, sororities and cooperative housing, as well as residence hall advisers and team leaders for Boiler Gold Rush, the university's orientation program.

AlcoholEdu for College, a curriculum created by Outside the Classroom, is available to 36 percent of all first-year students at America's four-year higher education institutions. It is designed to challenge students' expectations about alcohol and:

* Change high-risk behavior

* Teach alcohol's impact on academic and personal success

* Encourage safer decision-making

* Empower students to create a healthy campus community

> > > > Read More

Protecting the unborn baby from alcohol, 7 September 2011, European Parliament, Brussels

Hosted by MEP Elzbieta Lukacijewska (EPP, Poland)
Key note speaker European Commissioner for Health and Consumer Policy Mr John Dalli

Place: European Parliament – Brussels
Date: Wednesday 7^th September
Time: 12h30 – 15h00
Room: A3 E2

This event is jointly organized by European Alcohol Policy Alliance (Eurocare) and the Polish State Agency for State Agency for Prevention of Alcohol-Related Problems (PARPA) to mark International Foetal Alcohol Spectrum Disorders (FASD) Day. > > > > Read More

Stopping smoking during first year of substance use treatment predicted 9-year alcohol and drug treatment outcomes

This study examined the association between stopping smoking at 1 year after substance use treatment intake and long-term substance use outcomes.

Nine years of prospective data from 1185 adults (39% female) in substance use treatment at a private health care setting were analyzed by multivariate logistic generalized estimating equation models.

At 1 year, 14.1% of 716 participants who smoked cigarettes at intake reported stopping smoking, and 10.7% of the 469 non-smokers at intake reported smoking.

After adjusting for sociodemographics, substance use severity and diagnosis at intake, length of stay in treatment, and substance use status at 1 year, those who stopped smoking at 1 year were more likely to be past-year abstinent from drugs, or in past-year remission of drugs and alcohol combined, at follow-ups than those who continued to smoke (OR = 2.4, 95% CI: 1.2–4.7 and OR = 1.6, 95% CI: 1.1–2.4, respectively).

Stopping smoking at 1 year also predicted past-year alcohol abstinence through 9 years after intake among those with drug-only dependence (OR = 2.4, 95% CI: 1.2–4.5).

We found no association between past-year alcohol abstinence and change in smoking status at 1 year for those with alcohol dependence or other substance use diagnoses when controlling for alcohol use status at 1 year.

Stopping smoking during the first year after substance use treatment intake predicted better long-term substance use outcomes through 9 years after intake.

Findings support promoting smoking cessation among smoking clients in substance use treatment.

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Request Reprint E-Mail: jtsoh@lppi.ucsf.edu

Alcohol-related deaths and deaths among people who were alcohol dependent in Ireland, 2004 to 2008

Statistics published by the Health Research Board (HRB) today showed a rise in alcohol-related deaths in Ireland for the years 2004-2008. The findings are from the first ever national report on trends in alcohol-related deaths and deaths among people who were alcohol dependent from the National Drug-Related Deaths Index (NDRDI).

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New Developments in Brief Interventions to Treat Problem Drinking in Nonspecialty Health Care Settings

The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited.

In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs.

Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups.

Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers.

Influential BI components include high-quality change plans and provider characteristics.

Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care.



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Alcohol-involved Assault: Associations with posttrauma alcohol use, consequences, and expectancies

Victim alcohol consumption is common prior to sexual assault, and a burgeoning literature suggests that victims who were intoxicated during assault may differ in post-assault adjustment compared to those who were not impaired. Less is known about potential relationships between experiencing an alcohol-involved assault (AIA) and later drinking behavior.

In this study, we examined the relationships between sexual assault, subsequent drinking behavior and consequences, and alcohol expectancies in a sample of 306 undergraduate women who reported current alcohol use and reported either no trauma history (n = 53), non-AIA (n = 69), or AIA (n = 184).

Differences emerged for alcohol use (F(2, 298) = 12.78, p < .001), peak blood alcohol content (F(2, 298) = 9.66, p < .001), consequences (F(2, 296) = 7.38, p < .005), and positive alcohol expectancies (F(14, 796) = 1.93, p < .05).

In particular, women with an AIA reported greater alcohol use and positive expectancies compared to women with no trauma history and women with a non-alcohol influenced assault.

In addition, both assault groups reported greater drinking consequences than women with no trauma history.

Findings suggest that it is the women who are assaulted while under the influence of alcohol who evidence more alcohol use and alcohol-related problems following assault.

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Pregnancy, Alcohol Intake, and Intimate Partner Violence among Men and Women Attending Drinking Establishments in a Cape Town, South Africa Township

The highest rates of fetal alcohol syndrome worldwide can be found in South Africa. Particularly in impoverished townships in the Western Cape, pregnant women live in environments where alcohol intake during pregnancy has become normalized and interpersonal violence (IPV) is reported at high rates.

For the current study we sought to examine how pregnancy, for both men and women, is related to alcohol use behaviors and IPV. We surveyed 2,120 men and women attending drinking establishments in a township located in the Western Cape of South Africa.

Among women 13.3% reported being pregnant, and among men 12.0% reported their partner pregnant. For pregnant women, 61% reported attending the bar that evening to drink alcohol and 26% reported both alcohol use and currently experiencing IPV. Daily or almost daily binge drinking was reported twice as often among pregnant women than non-pregnant women (8.4% vs. 4.2%).

Men with pregnant partners reported the highest rates of hitting sex partners, forcing a partner to have sex, and being forced to have sex.

High rates of alcohol frequency, consumption, binge drinking, consumption and binge drinking were reported across the entire sample. In general, experiencing and perpetrating IPV were associated with alcohol use among all participants except for men with pregnant partners.

Alcohol use among pregnant women attending shebeens is alarmingly high. Moreover, alcohol use appears to be an important factor in understanding the relationship between IPV and pregnancy.

Intensive, targeted, and effective interventions for both men and women are urgently needed to address high rates of drinking alcohol among pregnant women who attend drinking establishments.



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Request Reprint E-Mail: saanne.eaton@gmail.com

Neurological complications of alcohol and misuse of drugs

The nature of many of the symptoms associated with substance and alcohol use means that patients often present to neurologists. The frequently catastrophic consequences of overlooking these patients makes this an important cause to identify.

Here I will discuss various acute and non-acute substance misuse associated presentations, with particular emphasis on the neurology. As neurological sequelae are particularly common in alcohol use, there will be an emphasis on this drug while other substances are included when relevant, extending to the recently notorious ‘legal highs’.

I hope this review will increase vigilance to the possibility of substance use disorder, and persuade neurologists that they have a role in the detection and treatment of these conditions.



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Request Reprint E-Mail: killian.welch@nhslothian.scot.nhs.uk

Alcohol Use Among Latinos: A Comparison of Pre-Immigration, Post-Immigration, and US Born Latinos

US born Latinos have higher rates of alcohol use than Latino immigrants. Yet, little is known about drinking patterns of Latinos before their immigration to the US.

This exploratory study compares the past month regular, binge, and heavy alcohol use patterns of Latino immigrants prior to immigration with that of post-immigration and US born Latinos.

Data on past month alcohol use prior to immigration was collected from 516 recent adult Latino immigrants. Results were compared with US born and post-immigration Latinos using national aggregate data.

Alcohol use patterns among Latino immigrants prior to immigration were similar to that of US born Latinos. Alcohol use patterns were lower among Latinos after immigration when compared to pre-immigration and US born Latinos.

This study provides a foundation for further exploration of the drinking patterns of Latinos in the US before they immigrated to this country.

Findings suggest more research is needed to uncover the underlying factors associated with the higher rates of alcohol use among Latinos prior to their immigration when compared to alcohol use patterns of post-immigration Latinos.



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Request Reprint E-Mail: delarosa@fiu.edu

Alcohol Consumption and Oxidative DNA Damage

To examine the effects of alcohol consumption on cancer risk, we measured oxidative DNA damage and its repair activity in the livers and esophagi of rats fed with ethanol.

Using our previously designed protocol for feeding rats with a high concentration of ethanol, we examined the effects of ethanol consumption on 8-oxo-Gua generation and repair activity in the livers and esophagi of rats. We found that a high concentration of ethanol accompanied with a vitamin-depleted diet increased 8-oxo-Gua and its repair activity. 8-Oxo-Gua is known to induce point mutations, leading to carcinogenesis.

Therefore, these results suggested that a high concentration of ethanol and an irregular diet increased liver and esophageal cancer risk. On the other hand, we showed that a low concentration of ethanol decreased 8-oxo-Gua and its repair activity in the livers of mice treated with a carcinogen.

Taken together, the effects of ethanol consumption on cancer risk depend on the ethanol concentration and the diet pattern.



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COMBINE A Multisite Trial of Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence

The COMBINE Study (often times referred to as COMBINE) is the largest pharmacotherapy trial conducted for alcoholism in the United States, recruiting 1383 alcohol dependent patients, 31% women and 23% ethnic minorities, from 11 sites. This double-blind, randomized placebo-controlled trial evaluated the efficacy of naltrexone and acamprosate, both alone and in combination, in the context of medical management with and without Combined Behavioral Intervention (CBI). CBI is a therapy that integrates aspects of cognitive behavioral therapy, motivational interviewing and 12-step facilitation. The duration of treatment was four months with follow-ups for one year post treatment. There were nine groups including a CBI only group with no pills and no medical management. The main findings were published in JAMA 295:2003-2017, 2006. Other articles either published, or in press, can be found at the COMBINE Study website as indicated below. Individuals requesting the data set for specific analyses are urged to view the website to better understand what has been previously published.

The data set was prepared by staff of the trial’s CoordinatingCenter at the University of North Carolina and reviewed by CSR Incorporated. The project’s website, www.cscc.unc.edu/combine, will carry the most recent information regarding the data set, a list of publications, and other information concerning the trial. > > > > Read More

Media Release - NEW CONSUMER MESSAGES ON ALCOHOL PRODUCTS

As part of its ongoing community education activities, DrinkWise Australia collaboration with its producer members who represent 80% (by volume) of the alcohol sold in Australia, today launched new on the labels of alcohol products.

Four messages will be available to adopt and integrate with alcohol product labelling. > > > > Read More

Alcohol products to carry warnings

HEALTH warnings will appear on most beer, wine and spirit products as a result of a liquor industry decision to take voluntary measures after years of government dithering.

The warnings, aimed at young people, pregnant women and problem drinkers will be carried by alcohol products representing 80 per cent of the market, including supermarket chain brands. The interchangeable warnings are: ''Is your drinking harming yourself or others?'', ''Kids and alcohol don't mix'' and ''It is safest not to drink while pregnant''. An image discouraging drink when pregnant is also available.

Industry-funded educational organisation DrinkWise Australia and the liquor industry have developed the labels. > > > > Read More

Circadian Modulation of Acute Alcohol Sensitivity But Not Acute Tolerance in Drosophila

An increased understanding of the factors affecting behavioral and neurological responses to alcohol and alcohol physiology is necessary given the tremendous toll alcohol abuse and alcoholism exert on individuals and society.

At the behavioral and molecular levels, the response to alcohol appears remarkably conserved from Drosophila to humans, suggesting that investigations across model species can provide insight into the identification of common modulatory factors.

We investigated the interaction between the circadian clock and alcohol sensitivity, alcohol tolerance, and alcohol absorbance in Drosophila melanogaster. Using a loss-of-righting reflex (LoRR) assay, we found that flies exhibit a circadian rhythm in the LoRR, with the greatest sensitivity to alcohol occurring from mid to late night, corresponding to the flies' inactive phase.

As predicted, a circadian rhythm in the LoRR was absent in circadian mutant flies and under conditions in which the circadian clock was nonfunctional. Circadian modulation of the response to alcohol was not due to circadian regulation of alcohol absorbance.

Similar to other animals, Drosophila develop acute and chronic tolerance to alcohol upon repeat exposures. We found that the circadian clock did not modulate the development of acute alcohol tolerance measured as the difference in sensitivity to alcohol between naïve and pre-exposed flies.

Thus, the circadian clock modulates some, but not all, of the behavioral responses to alcohol exposure, suggesting that specific mechanisms underlie the observed circadian modulation of LoRR

This study provides valuable new insights in our understanding of the circadian modulation of alcohol-induced behaviors that ultimately could facilitate preventative measures in combating alcohol abuse and alcoholism




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Request Reprint E-Mail: lyons@bio.fsu.edu

The relation between HPA axis activity and age of onset of alcohol use

HPA axis activity may prove a viable biomarker for identifying those susceptible to alcohol use disorders. The purpose of this study was to examine the relation of the age at which adolescents begin drinking with diurnal and stress cortisol.

Adolescents’ diurnal cortisol levels on a normal day and cortisol levels during a stress procedure were examined in relation to the age of onset of alcohol use.

All adolescents (14 to 20 years old) were part of a general population study in the Netherlands.

Ten assessments of salivary cortisol taken on a normal day (diurnal cortisol), as well as during a social stress procedure (stress cortisol) were used as indicators of HPA axis activity.

The age at which the first alcoholic drink was consumed varied as a function of cortisol levels at the onset of as well as during the stress procedure. Those who began drinking at an earlier age showed lower cortisol levels at the onset of the stressful tasks (R²= .14, p < .001) and during the stressful tasks (R²= .10, p < .05) though not after the tasks (cortisol recovery). Effects were strongest for anticipatory pre-task cortisol levels. Differences in diurnal cortisol levels did not explain variance in the age at which adolescents had begun drinking.

Lessened activity of the HPA axis at the onset of and during a stress procedure is present in adolescents who begin drinking at an early age.



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Request Reprint E-Mail: A.C.Huizink@uva.nl

The Distribution of Alcohol Consumption and the Prevention Paradox in Brazil

To examine the proportion of self-reported alcohol consumed by different gender and age groups in Brazil over the past year, and to examine whether the “prevention paradox” applies to Brazilian data on alcohol-related problems.

A multistage cluster sample, representative of the Brazilian household population 14 years of age or older (N=3007). The response rate was 66.4%.

The top 2.5% of the drinkers by volume consume 14.9%, the top 5% consume 27.4%, and the top 10% consume 44.2% of all alcohol consumed in Brazil. Men consume 77.8% of the total alcohol, and 18 to 29 year olds consume 40.3%. Individuals below risky drinking guidelines for weekly volumetric intake account for 49-50% of all problem drinkers and 45-47% of all problem types reported. Individuals who do not binge or who binge infrequently (1-3 times/year) account for 50-51% of all problem drinkers and 45-46% of all reported problem types. Most binge drinkers are low volume drinkers.

Consistent with the prevention paradox literature, the majority of drinking problems in Brazil are associated with low or moderate drinkers. Binge drinking better accounts for the distribution of alcohol problems than total volume consumed.



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Request Reprint E-Mail: Raul.Caetano@UTSouthwestern.edu

Women's Alcohol Consumption and Risk for Alcohol-Exposed Pregnancies in Russia

Alcohol-exposed pregnancies (AEP) are the direct cause of Fetal Alcohol Spectrum Disorders (FASD). This study examines drinking patterns among pregnant and non-pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world.

Cross-sectional survey.

7 public women's clinics in two locations: St. Petersburg (SPB) and the Nizhny Novgorod region (NNR).

648 pregnant and non-pregnant childbearing age women.

A face-to-face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition.

89% of non-pregnant women reported consuming alcohol and 65% reported binge drinking in the past three months. 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at-risk for AEP. There was a significant decline in drinking after pregnancy identification. 20% of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive.

Russian women substantially reduce drinking after pregnancy recognition compared to pre-pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The preconception period presents a risk window and, therefore, a prevention opportunity.

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Request Reprint E-Mail: tatiana-balachova@ouhsc.edu

Does sponsorship improve outcomes above Alcoholics Anonymous attendance? A latent class growth curve analyses

To construct AA attendance, sponsorship, and abstinence latent class trajectories to test the added benefit of having a sponsor above the benefits of attendance in predicting abstinence over time.

Prospective with 1-, 3-, 5-, and 7-year follow-ups.

Alcoholic-dependent individuals from two probability samples, one from representative public and private treatment programs and another from the general population (n = 495).

Individuals in the low attendance class (4 classes identified) were less likely than those in the high, descending, and medium attendance classes to be in high (vs. low) abstinence class (3 classes identified). No differences were found between the other attendance classes as related to abstinence class membership. Overall, being in the high sponsor class (3 classes identified) predicted better abstinence outcomes than being in either of two other classes (descending and low), independent of attendance class effects. Though declining sponsor involvement was associated with greater likelihood of high abstinence than low sponsor involvement, being in the descending sponsor class also increased the odds of being in the descending abstinence class.

Any pattern of AA attendance, even if it declines or is never high for a particular 12-month period, is better than little or no attendance in terms of abstinence. Greater initial attendance carries added value. There is a benefit for maintaining a sponsor over time above that found for attendance.

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Request Reprint E-Mail: wtbrodt@arg.org

The Influence of Alcohol Intake and Alcohol Expectations on the Recognition of Emotions

To investigate the effects of actual and expected alcohol intake on the detection and interpretation of the basic emotions happiness and anger in facial expressions.

n = 102 healthy participants performed a dynamic emotion recognition task before and after receiving a drink which contained either a moderate alcohol dose or no alcohol in a double-blind design.

The actual alcohol intake had no effect on detecting and interpreting facial expressions. However, subjects who expected to drink alcohol judged facial expressions significantly more often as happy. No effects were observable for the recognition of anger in facial expressions.

Our results corroborate recent studies that found that the belief of consuming alcohol does not increase anger recognition or aggressive behavior but decreases aggression and social stress.



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Request Reprint E-Mail: nora.walter@uni-bonn-diff.de

Questionable Health Claims by Alcohol Companies

For years, food companies have used advertising, packaging, and brand image to lead people to believe certain products are healthier than they really are. Whether it’s putting a sports star’s face on a Coca-Cola ad, labeling junk food as a “smart
choice,” or attaching arbitrary designations such as “all natural” to foods high in fat, sugar, and salt, the food industry knows it must attract health-conscious shoppers.

Over the past few years, alcohol companies have begun appropriating many of these misleading advertising techniques. Spirits companies are positioning their vodka as “all natural,” even though the products haven’t changed. Beer companies are sponsoring marathons and running ads showing toned drinkers meeting up at a bar after a work-out. Superstars of grueling, high-endurance sports are being tapped to promote alcoholic beverages.

These advertising practices are legally tenuous, morally unsound,and potentially dangerous. Alcohol consumption costs society billions of dollars annually while causing immeasurable human suffering every day. Using health messages to sell products that can cause such widespread harm is not only unethical, it’s illegal, and yet the regulatory system has failed miserably
to protect the American public.

Because market research shows purchase intent and consumption of a brand increase when people believe alcoholic products are all-natural or fitness-friendly, intense scrutiny and strict regulation of such misleading claims is essential.

This report examines this disturbing trend to promote alcohol as a health and fitness product, analyzes the potential legal implications, and makes policy recommendations.



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Scientific evidence and policy change: lowering the legal blood alcohol limit for drivers to 0.08% in the USA

The United States (US) Centers for Disease Control and Prevention (CDC), and key partners conducted a systematic review of the effectiveness of 0.08% blood alcohol concentration (BAC) laws on alcohol-related traffic mortality.

Review findings of strong evidence of effectiveness were presented by partners during US Congressional hearings contributing to the passage of a bill requiring states to lower the legal BAC limit to 0.08% (80 mg of alcohol/100 ml of blood) or lose a portion of their federal highway funds. The bill was signed into law, making 0.08 the new national standard.

Extensive and targeted dissemination of the evidence and recommendations to key stakeholders and partners built support for policy change at the state level.


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DDs6@cdc.gov

Integrating field methodology and web-based data collection to assess the reliability of the Alcohol Use Disorders Identification Test (AUDIT)

Field methodologies offer a unique opportunity to collect ecologically valid data on alcohol use and its associated problems within natural drinking environments. However, limitations in follow-up data collection methods have left unanswered questions regarding the psychometric properties of field-based measures.

The aim of the current study is to evaluate the reliability of self-report data collected in a naturally occurring environment – as indexed by the Alcohol Use Disorders Identification Test (AUDIT) – compared to self-report data obtained through an innovative web-based follow-up procedure.

Individuals recruited outside of bars (N = 170; mean age = 21; range 18–32) provided a BAC sample and completed a self-administered survey packet that included the AUDIT. BAC feedback was provided anonymously through a dedicated web page. Upon sign in, follow-up participants (n = 89; 52%) were again asked to complete the AUDIT before receiving their BAC feedback.

Reliability analyses demonstrated that AUDIT scores – both continuous and dichotomized at the standard cut-point – were stable across field- and web-based administrations.

These results suggest that self-report data obtained from acutely intoxicated individuals in naturally occurring environments are reliable when compared to web-based data obtained after a brief follow-up interval.

Furthermore, the results demonstrate the feasibility, utility, and potential of integrating field methods and web-based data collection procedures.

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Request Reprint E-Mail: mcelio1@binghamton.edu

Association of life course socioeconomic disadvantage with future problem drinking and heavy drinking: gender differentials in the west of Scotland

To examine gender differentials in the association between life course socioeconomic disadvantage and the risk of exceeding internationally recognised weekly and daily guidelines for ‘sensible’ alcohol consumption and problem drinking.

A population-representative cohort study of 1,218 men and women from the west of Scotland, UK was conducted. Data on life course socioeconomic position were collected in 1987/1988 (at around 35 years of age). Alcohol consumption patterns (detailed 7-day recall) and problem drinking (CAGE questionnaire) were ascertained in 1990/1992.

There was evidence of marked gender divergence in the socioeconomic position–alcohol intake/problem gradients. Typically, disadvantage in men conferred an increased risk of exceeding ‘sensible’ guidelines for weekly consumption (for own education and adult social class) and having alcohol problems (for employment status, income, adult social class and car ownership). In contrast, a reverse gradient was evident in women where adverse social status was generally associated with a reduced prevalence of these outcomes.

Investigators should consider more carefully socioeconomic patterning of alcohol intake, and possibly other health-related behaviours, separately in men and women.



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Request Reprint E-Mail: david.batty@ucl.ac.uk

A spatial analysis of the moderating effects of land use on the association between alcohol outlet density and violence in urban areas

While there is substantial evidence of an association between alcohol outlet density and assault, it is unlikely this association is constant across the urban environment.

This study tested the moderating influence of land use on the outlet–violence association.

Cross-sectional ecological study that controlled for spatial autocorrelation.

Police-recorded data on simple and aggravated assaults were obtained for all 302 block groups (mean population = 1038) in Cincinnati, Ohio, USA. Addresses of alcohol outlets for Cincinnati were obtained from the Ohio Division of Liquor Control, geocoded to the street level, and aggregated to census block groups. Data on eight categories of land use were obtained from the Cincinnati Area Geographic Information System, with location quotients computed for each block group.

We found substantial evidence that the impact of total alcohol outlet density, bar density and carryout density on assault density was moderated by land use.

By taking into account local characteristics, policy-makers can make more informed decisions when regulating the placement and density of alcohol licenses in urban areas. Similarly, more systematic knowledge of how the association between alcohol outlet density and assault varies across the urban landscape should reduce harm and promote responsible retailing. Nevertheless, ours is one of the first studies to address the moderating effect of land use and we encourage further research to test the stability and generalisability of our results.

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Request Reprint E-Mail: wpridemo@indiana.edu

The effects of head circumference (HC) and lifetime alcohol consumption (AC) on cognitive function in the elderly

Smaller premorbid brain volume is known to be related to cognitive deterioration in older adults, supporting a reserve hypothesis of brain aging. Heavy lifetime alcohol consumption (AC) may also increase the risk of cognitive impairment.

The aim of this study was to examine the effects of head circumference (HC) and lifetime AC on cognitive function in the elderly. This study is part of a large, longitudinal study of men aged 60 years or older in the Korean community.

We studied 1569 subjects with complete demographic, anthropometric and AC data. Cognitive function was assessed by the Korean version of Mini Mental State Examination (K-MMSE). Participants reported at the time of interview their lifetime alcohol drinking patterns. HC was also measured. We did a cross-sectional analysis the relation between two factors to cognitive function.

After a multivariable adjustment, the interactive effect between HC and lifetime AC was shown to be significantly associated with cognitive function (F = 2.55, p = 0.038). Simple main effect analysis showed that smaller HC and a high level of lifetime AC were related with decreased cognitive function.

All these findings suggest the possibility that lifetime AC and HC have synergistic effects on cognitive impairment.

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Pre-Teen Alcohol Use as a Risk Factor for Victimization and Perpetration of Bullying among Middle and High School Students in Georgia

We examined the association between pre-teen alcohol use initiation and the victimization and perpetration of bullying among middle and high school students in Georgia.

We computed analyses using data from the 2006 Georgia Student Health Survey (N=175,311) of students in grades 6, 8, 10 and 12. The current analyses were limited to students in grades 8, 10 and 12 (n=122,434). We used multilogistic regression analyses to determine the associations between early alcohol use and reports of both victimization and perpetration of bullying, perpetration only, victimization only, and neither victimization or perpetration, while controlling for demographic characteristics, other substance use, peer drinking and weapon carrying.

Pre-teen alcohol use initiation was significantly associated with both bullying perpetration and victimization relative to non drinkers in bivariate analyses (OR=3.20 95%CI:3.03–3.39). The association was also significant between pre-teen alcohol use initiation and perpetration and victimization of bullying in analyses adjusted for confounders (Adj.OR=1.74; 95%CI:1.61–1.89). Overall, findings were similar for boys and girls.

Pre-teen alcohol use initiation is an important risk factor for both the perpetration and victimization of bullying among boys and girls in Georgia. Increased efforts to delay and reduce early alcohol use through clinical interventions, education and policies may also positively impact other health risk behaviors, including bullying.

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The Impact of Truant and Alcohol-Related Behavior on Educational Aspirations: A Study of US High School Seniors

Truancy and alcohol use are quality indicators of academic achievement and success. However, there remains a paucity of substantive research articulating the impact these deviant behaviors have on an adolescent's educational aspirations.

The purpose of this study is to assess whether recent alcohol use and truancy impact students' educational aspirations among a nationally representative sample of US high school seniors.

This study conducted a secondary data analysis of the Monitoring the Future project data, 2006. Logistic regression was conducted to assess how alcohol use and truancy affected educational aspirations. Subsequent interaction effects were assessed in the final multivariable model. Demographic variables such as age, sex, race, and father and mother's educational level were included as covariates in the regression model.

Results indicate that as students engage in increased alcohol use and/or truancy, educational aspirations decrease. Thus, students who indicated a desire to attend a 4-year college/university were less likely to engage in high-risk drinking behavior and/or truancy. Moreover, in testing the interaction between truancy and alcohol use, as it relates to educational aspirations, the logistic regression model found both of these independent variables to be statistically significant predictors of the likelihood students would attend a 4-year college/university.

To ensure that adolescents further their education and maximize their potential life opportunities, school and public health officials should initiate efforts to reduce alcohol consumption and truancy among students. Furthermore, future research should examine the risk and protective factors that may influence one's educational aspirations.

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Theoretical Frameworks and Mechanistic Aspects of Alcohol Addiction: Alcohol Addiction as a Reward Deficit Disorder.

Alcoholism can be defined by a compulsion to seek and take drug, loss of control in limiting intake, and the emergence of a negative emotional state when access to the drug is prevented.

Alcoholism impacts multiple motivational mechanisms and can be conceptualized as a disorder that includes a progression from impulsivity (positive reinforcement) to compulsivity (negative reinforcement).

The compulsive drug seeking associated with alcoholism can be derived from multiple neuroadaptations, but the thesis argued here is that a key component involves the construct of negative reinforcement. Negative reinforcement is defined as drug taking that alleviates a negative emotional state.

The negative emotional state that drives such negative reinforcement is hypothesized to derive from dysregulation of specific neurochemical elements involved in reward and stress within the basal forebrain structures involving the ventral striatum and extended amygdala, respectively.

Specific neurochemical elements in these structures include not only decreases in reward neurotransmission, such as decreased dopamine and γ-aminobutyric acid function in the ventral striatum, but also recruitment of brain stress systems, such as corticotropin-releasing factor (CRF), in the extended amygdala.

Acute withdrawal from chronic alcohol, sufficient to produce dependence, increases reward thresholds, increases anxiety-like responses, decreases dopamine system function, and increases extracellular levels of CRF in the central nucleus of the amygdala. CRF receptor antagonists also block excessive drug intake produced by dependence.

A brain stress response system is hypothesized to be activated by acute excessive drug intake, to be sensitized during repeated withdrawal, to persist into protracted abstinence, and to contribute to the compulsivity of alcoholism.

Other components of brain stress systems in the extended amygdala that interact with CRF and that may contribute to the negative motivational state of withdrawal include norepinephrine, dynorphin, and neuropeptide Y.

The combination of loss of reward function and recruitment of brain stress systems provides a powerful neurochemical basis for a negative emotional state that is responsible for the negative reinforcement driving, at least partially, the compulsivity of alcoholism.



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Request Reprint E-Mail: gkoob@scripps.edu.

Substitution therapy for alcoholism: time for a reappraisal?

A number of compounds already in use as medications for various indications substitute for ethanol at clinically relevant brain pathways, in particular, at gamma-aminobutyric acid (GABA) receptors. Nevertheless, although substitute medications have been recognized for heroin and tobacco dependence, patients with alcohol dependence are rarely offered an analogous approach.

Benzodiazepines may have paradoxical effects, and abuse and dependence are known. Baclofen (GABA_B agonist) has not been associated with dependence or misuse and has been effective in several trials in preventing relapse, although research is required to establish the optimal dosing regimen. GABA-ergic anticonvulsants, helpful in treating withdrawal, have yet to emerge as effective in relapse prevention.

Clomethiazole and sodium oxybate, the latter having been shown to be effective in relapse prevention, have incurred a reputation for dependence and abuse.

However, data have emerged showing that the risk of abuse of sodium oxybate is lower than many clinicians had foreseen.

For a condition where existing therapies are only effective in a proportion of patients, and which has high morbidity and mortality, the time now seems right for reappraising the use of substitute prescribing for alcohol dependence.



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