Aims
Wednesday, September 7, 2011
Implementation of brief interventions evaluated in Scotland
Genetic Polymorphisms of Genes Coding to Alcohol-Metabolizing Enzymes in Western Mexicans: Association of CYP2E1*c2/CYP2E1*5B Allele with Cirrhosis an
Alcoholic cirrhosis constitutes a major public health problem in the world where ADH1B, ALDH2, and CYP2E1 polymorphisms could be playing an important role. We determined ADH1B*2, ALDH2*2, and CYP2E1*c2 allele frequencies in healthy control individuals (C) and patients with alcoholic cirrhosis (AC) from western Mexico.
Ninety C and 41 patients with AC were studied. Genotype and allele frequency were determined through polymerase chain reaction-restriction fragment length polymorphisms.
Polymorphic allele distribution in AC was 1.6%ADH1B*2, 0.0%ALDH2*2, and 19.5%CYP2E1*c2; in C: 6.1%ADH1B*2, 0%ALDH2*2, and 10.6%CYP2E1*c2. CYP2E1*c2 polymorphic allele and c1/c2 genotype frequency were significantly higher (p < 0.05 and p < 0.01, respectively) in patients with AC when compared to C. Patients with AC, carrying the CYP2E1*c2 allele, exhibited more decompensated liver functioning evaluated by total bilirubin and prothrombin time, than c1 allele carrying patients (p < 0.05). Cirrhosis severity, assessed by Child’s Pugh score and mortality, was higher in patients carrying the c2 allele, although not statistically significant.
In this study, CYP2E1*c2 allele was associated with susceptibility to AC; meanwhile, ADH1B*2 and ALDH2*2 alleles were not. CYP2E1*c2 allele was associated with AC severity, which could probably be attributed to the oxidative stress promoted by this polymorphic form. Further studies to clearly establish CYP2E1*c2 clinical relevance in the development of alcohol-induced liver damage and its usefulness as a probable prognostic marker, should be performed. Also, increasing the number of patients and including a control group conformed by alcoholic patients free of liver damage may render more conclusive results. These findings contribute to the understanding of the influence of gene variations in AC development among populations, alcohol metabolism, and pharmacogenetics.
Request Reprint E-Mail: bastidas@cencar.udg.mx
The Effects of Age at Drinking Onset and Stressful Life Events on Alcohol Use in Adulthood: A Replication and Extension Using a Population-Based Twin
A study by Dawson and colleagues (Alcohol Clin Exp Res 2007; 31:69) using data from National Epidemiologic Survey on Alcohol and Related Condition found earlier drinking onset age, and higher levels of past-year stressful life events (SLE) were associated with higher past-year alcohol consumption. The aims of our study were as follows: (i) to attempt to replicate this interaction; (ii) to extend it by examining sex and event dependence as potential moderators of the effect; and (iii) to estimate the roles of genetic and environmental factors in mediating the overlap of early drinking onset and SLE in their relations with alcohol consumption.
Data were from 1,382 female and 2,218 male drinkers interviewed as part of the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Regression models were used to evaluate the main and interactive effects of early drinking onset and moderate or severe past-year SLE on past-year drinking density (PYDD), a weighted quantity-frequency measure of alcohol consumption. Analyses adjusted for demographic covariates and were stratified by sex and whether SLE were independent or dependent on the person’s actions, as rated by interviewers. Structural twin models were used to estimate the degree to which early drinking onset, SLE, and their interaction accounted for additive genetic, common environmental and individual-specific variance in PYDD.
We replicated the prior finding of a main effect of higher alcohol consumption among individuals reporting earlier drinking onset. Age at drinking onset accounted for about 5% of the variation in PYDD, and this association was mostly attributable to overlapping genetic influences. Evidence for an interaction between onset age and SLE was generally weak, possibly because of lower power and other methodological differences from Dawson and colleagues’ study. However, there was some evidence consistent with an interaction of higher PYDD among early drinking men who experienced independent SLE and early drinking women with dependent SLE.
We confirmed prior findings of an association between early age at drinking onset with higher past-year drinking among young- and middle-aged adults and found limited evidence supporting a replication for higher stress-related drinking among early-onset drinkers. The association is consistent with early onset and stress-related drinking being attributable to overlapping genetic liability. Among early drinkers, our results suggest sex differences in consumption with regard to event dependence.
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Request Reprint E-Mail: cprescot@usc.edu
The Role of the Asn40Asp Polymorphism of the Mu Opioid Receptor Gene (OPRM1) on Alcoholism Etiology and Treatment: A Critical Review
The endogenous opioid system has been implicated in the pathophysiology of alcoholism as it modulates the neurobehavioral effects of alcohol.
A variant in the mu opioid receptor gene (OPRM1), the Asn40Asp polymorphism, has received attention as a functional variant that may influence a host of behavioral phenotypes for alcoholism as well as clinical response to opioid antagonists.
This paper will review converging lines of evidence on the effect of the Asn40Asp SNP on alcoholism phenotypes, including: (i) genetic association studies; (ii) behavioral studies of alcoholism; (iii) neuroimaging studies; (iv) pharmacogenetic studies and clinical trials; and (v) preclinical animal studies.
Together, these lines of research seek to elucidate the effects of this functional polymorphism on alcoholism etiology and treatment response.
Request Reprint E-Mail: lararay@psych.ucla.edu
Parent–teen communication and pre-college alcohol involvement: A latent class analysis
Although parent–adolescent communication has been identified as important in delaying the onset and escalation of alcohol use, both the strength and direction of observed associations have varied in prior research with adolescents and college students. The current study categorizes parents according to alcohol-related communication and relates these categories to other parenting factors and late adolescent alcohol involvement.
As part of a larger study, 1007 college-bound teens and their parents were assessed. Teens were asked to report on their drinking behavior, and parents were asked about the occurrence of several specific alcohol-related communications with their teen, as well as additional parenting characteristics. Profiles of parent alcohol-related communication were derived using latent class analysis. Once the best fitting solution was determined, covariates were entered predicting class membership and investigating how classes were associated with additional parenting characteristics and teen alcohol use.
A five-class solution provided the best fit to the data: Frequent, All Topics (28%); Moderate, All Topics (25%); Frequent, General Topics (25%); Frequent, Consequences and Limits (12%); and Infrequent, All Topics (10%). Covariate analyses demonstrated class differences with regard to parental modeling, monitoring, knowledge, and parent–teen relationship satisfaction, as well as for students' intentions to join fraternities/sororities and alcohol use.
Findings from the current study add to a small but growing literature supporting the continuing influence of parents in late adolescence and suggest that the frequency and specificity of parent–teen communication are potentially informative for refined parent-based preventive interventionsRead Full Abstract
Request Reprint E-Mail: caitlin_abar@brown.edu
Fetal Alcohol Spectrum Disorders
Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. Learn more about signs, treatments, and what you can do about FASDs. > > > > Read More
Alcohol Consumption at Midlife and Successful Ageing in Women: A Prospective Cohort Analysis in the Nurses' Health Study
Observational studies have documented inverse associations between moderate alcohol consumption and risk of premature death. It is largely unknown whether moderate alcohol intake is also associated with overall health and well-being among populations who have survived to older age. In this study, we prospectively examined alcohol use assessed at midlife in relation to successful ageing in a cohort of US women.
Alcohol consumption at midlife was assessed using a validated food frequency questionnaire. Subsequently, successful ageing was defined in 13,894 Nurses' Health Study participants who survived to age 70 or older, and whose health status was continuously updated. “Successful ageing” was considered as being free of 11 major chronic diseases and having no major cognitive impairment, physical impairment, or mental health limitations. Analyses were restricted to the 98.1% of participants who were not heavier drinkers (>45 g/d) at midlife. Of all eligible study participants, 1,491 (10.7%) achieved successful ageing. After multivariable adjustment of potential confounders, light-to-moderate alcohol consumption at midlife was associated with modestly increased odds of successful ageing. The odds ratios (95% confidence interval) were 1.0 (referent) for nondrinkers, 1.11 (0.96–1.29) for ≤5.0 g/d, 1.19 (1.01–1.40) for 5.1–15.0 g/d, 1.28 (1.03–1.58) for 15.1–30.0 g/d, and 1.24 (0.87–1.76) for 30.1–45.0 g/d. Meanwhile, independent of total alcohol intake, participants who drank alcohol at regular patterns throughout the week, rather than on a single occasion, had somewhat better odds of successful ageing; for example, the odds ratios (95% confidence interval) were 1.29 (1.01–1.64) and 1.47 (1.14–1.90) for those drinking 3–4 days and 5–7 days per week in comparison with nondrinkers, respectively, whereas the odds ratio was 1.10 (0.94–1.30) for those drinking only 1–2 days per week.
These data suggest that regular, moderate consumption of alcohol at midlife may be related to a modest increase in overall health status among women who survive to older ages.
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Alcohol imagery and branding, and age classification of films popular in the UK
Exposure to alcohol products in feature films is a risk factor for use of alcohol by young people. This study was designed to document the extent to which alcohol imagery and brand appearances occur in popular UK films, and in relation to British Board of Film Classification (BBFC) age ratings intended to protect children and young people from harmful imagery.
Alcohol appearances (classified as ‘alcohol use, inferred alcohol use, other alcohol reference and alcohol brand appearances’) were measured using 5-min interval coding of 300 films, comprising the 15 highest grossing films at the UK Box Office each year over a period of 20 years from 1989 to 2008.
At least one alcohol appearance occurred in 86% of films, at least one episode of alcohol branding in 35% and nearly a quarter (23%) of all intervals analysed contained at least one appearance of alcohol. The occurrence of ‘alcohol use and branded alcohol appearances’ was particularly high in 1989, but the frequency of these and all other appearance categories changed little in subsequent years. Most films containing alcohol appearances, including 90% of those including ‘alcohol brand appearances’, were rated as suitable for viewing by children and young people. The most frequently shown brands were American beers: Budweiser, Miller and Coors. Alcohol appearances were similarly frequent in films originating from the UK, as from the USA.
Alcohol imagery is extremely common in all films popular in the UK, irrespective of BBFC age classification. Given the relationship between exposure to alcohol imagery in films and use of alcohol by young people, we suggest that alcohol imagery should be afforded greater consideration in determining the suitability of films for viewing by children and young people.
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Monday, September 5, 2011
The size and burden of mental disorders and other disorders of the brain in Europe 2010
To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.
Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY).
Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8 million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165 m vs. 2005: 82 m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (N4%), ADHD (5%) in the young, and dementia (1–30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment.
Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke.
In every year over a third of the total EU population suffers from mental disorders. The true size of “disorders of the brain” including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs.
We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.
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Brief Intervention for Heavy-Drinking College Students: 4-Year Follow-Up and Natural History
This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking.
A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years.
High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences.
Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends.
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Alcohol News - 36/2011
The Mail (UK) - Number of off-licences in an area linked to teen drinking hospital admissions, research reveals
A clear link between the number of off-licences in an area and teenagers ending up in hospital through drink has been established by researchers.
Financial Times (Scotland) - Scotland in push for minimum alcohol price
Scotland’s determination to introduce a minimum selling price for alcohol has set it on collision course with shopkeepers, distillers and brewers, as well as the European courts and Westminster, which could find itself obliged to defend a policy dismissed by the UK.
Times of India - Alcohol dulls brain into making mistakes
A new study says that alcohol dulls the brain signal warning people about mistakes, reducing their self control.
Sydney Morning Herald (Australia) - Wine tax reform plan to hit purse but help the body
TAXING wine in the same way as beer would cut overall alcohol consumption by 9 per cent, according to economic modelling to be presented today.
Nursing in Practice - Mental health link to alcohol problems
People diagnosed with mental health problems like depression, bipolar disorder and anxiety disorder are at much higher risk of developing a dependence on alcohol, according to an Australian study.
BBC News (Scotland) - Task force sets plan to blitz Glasgow's booze culture
Plain clothes police officers are to be deployed on Glasgow's transport network to cut alcohol-related disorder.
Independent Online (South Africa) - Alcohol adverts face being canned
Severe restrictions on alcohol advertising will be tabled before the cabinet within two months, Social Development Minister Bathabile Dlamini confirmed on Tuesday.
Nursing in Practice (UK) - New commissioning guide for alcohol services
The National Institute for Health and Clinical Excellence (NICE) has today published a guide to help improve the identification and treatment of hazardous drinking, harmful drinking and alcohol dependence in children, young people and adults. The guide can help the NHS and local authorities to make best use of resources.
TNT Magazine - Children from divorced parents 'more likely' to become binge drinkers
A "tough love" style of parenting, which combines discipline and warmth, has been found the most effective in ensuring children don't develop an unhealthy relationship with alcohol.
FoodAndDrinkEurope.com - Drinks industry needs to tighten up on social media marketing, report
Stricter controls are needed for alcohol advertising on social media platforms in order to restrict children’s access to marketing intended for adults, according to UK charity agency Alcohol Concern.
Indian Country Today Media Network.com (USA) - Fetal Alcohol Syndrome Rate Higher Among American Indians
A mother rouses from sleep, cradles her newborn infant and yawns. She then gets up and carries the baby, all soft and not quite ready to wail for food, into the kitchen. She reaches for a bottle, but it isn’t a baby bottle. It’s glass. It has a screw-top. It’s 80 proof. The mother opens the bottle, smells it and takes a drink.
East Coast Radio (South Africa) - Alcohol abuse costs SA billions
To try and get locals to cut back on their drinking, South Africa's Trade and Industry Department has launched Sobriety Week in Pretoria today.
Ninemsn (Australia) - Older people 'most likely to drink daily'
Older Australians are the hidden statistics of those at risk of alcohol and drug addiction, a health group says.
Telegraph.co.uk - Drink-driving risk for obesity surgery patients
Obese people who undergo weight-loss surgery become drunk more easily and may inadvertently find themselves over the limit, an academic has warned.
Tasmania Mercury (Tasmania) - Study targets teen drinkers
THE attitude of Tasmanian parents towards supplying their children with alcohol will be the focus of a new five-year study looking at links between early drinking and alcohol problems.
Irish Times (Ireland) - Born with a craving for alcohol
WOMEN IN Ireland who drink while pregnant are creating children three times more likely to crave alcohol, according to a leading specialist in the field.
New Zealand Herald (New Zealand) - Public split on cheap alcohol stuns expert
The public are almost evenly split on whether supermarkets should be able to offer wine at rock-bottom prices by selling at below cost, the latest Herald DigiPoll survey shows.
Ormskirk & Skelmersdale Advertiser (UK) - Ormskirk and Skelmersdale children alcohol abuse levels shock – report
SHOCKING rates of alcohol abuse by children in Ormskirk and Skelmersdale have been revealed by new research.
Belarus Digest (Belarus) - Cheap Booze for the People of Belarus
As the economic crisis deepens prices on nearly all products rise sharply in Belarus with one remarkable exception - alcohol. These days a bottle of vodka in Belarusian restaurants often costs less than a packet of orange juice - US$3.
Austrian Independent (Austria) - Alcohol addiction warning issued
Around 900,000 of the 8.5 million residents of Austrian are consuming health-threatening amounts of alcohol, experts have warned.
Bloomberg (Hungary) - Hungary to Raise Taxes, Delay Spending for Budget, Orban Says
The tax increases will affect alcohol, tobacco and gambling, Orban said in a TV2 interview today. The measures will be approved Sept. 5 or 6 and will be announced Sept. 7, he said.
New York Times (Russia) - In Russia, Harsh Remedy for Addiction Gains Favor
The treatment center does not handcuff addicts to their beds anymore. But caged together on double-decker bunks with no way out, they have no choice but to endure the agonies of withdrawal, the first step in a harsh, coercive approach to drug treatment that has gained wide support in Russia.
thenews.pl (Poland) - Bar opens on Polish trains
A communist-era law that prohibits the sale of alcohol on trains will no longer be in effect as of 1 September.
News Release - Off-licence density linked to alcohol harm in under-18s
New research commissioned by Alcohol Concern shows a positive link between the density of off-licensed premises and harm from alcohol in underage drinkers.
The study One on every corner finds that, excluding London, on average a 2:1 relationship exists between the number off-licences per 100,000 of population and hospital admissions by underage drinkers for alcohol specific admissions such as alcohol poisoning or intoxication. For every two off-licences per 100,000 of population there was one under-18 year old per 100,000 of population being admitted to hospital due to drinking according to the analysis, meaning that on average in areas with a higher concentration of off-licences, there are higher numbers of young people going to hospital as a result of drinking. > > > > > Read More
Drinking to enhance and to cope: A daily process study of motive specificity
Daily process studies of internal drinking motives have not examined motive specificity, i.e., whether theoretically plausible trait and situational antecedents differ in their ability to predict the extent to which alcohol consumption on any given day is motivated by coping or enhancement.
University students (N = 81) completed trait measures of coping and enhancement-motivated drinking (trait CM and EM), sensation seeking, and conscientiousness, and then completed a 14-day online diary assessing daily completion of tasks, daily alcohol use, and (on days when alcohol was consumed) the extent to which drinking was motivated by coping or enhancement (daily CM and EM).
Hierarchical linear models revealed unique situational and trait antecedents of daily CM and EM. In the daily EM drinking model, main effects of daily positive affect (b = 0.11, p < 0.05), trait EM (b = 2.88, p < 0.01), and trait sensation seeking (b = 0.36, p < 0.01) were qualified by cross-level interactions between daily task accomplishment and trait conscientiousness (b = 0.03, p < 0.01), and daily task accomplishment and trait sensation seeking (b = 0.03, p < 0.01). In the daily CM drinking model, main effects of daily positive affect (b = − 0.08, p < 0.05), daily negative affect (b = 0.13, p < 0.05), and trait CM (b = 4.40, p < 0.01), were qualified by cross-level interactions between trait CM and daily positive affect (b = − 0.12, p < 0.05), trait CM and daily negative affect (b = 0.18, p < 0.01), and trait conscientiousness and daily task accomplishment (b = 0.01, p < 0.01).
Our results replicated and extended Cooper et al.'s (1995) findings on the differential roles of sensation seeking and negative affect in CM and EM drinking at the daily level, and call into question the view that drinking motives should be solely conceptualized as individual difference variables. Theoretical and applied implications of the findings are discussed.
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Request Reprint E-Mail: cam.wild@ualberta.ca
Alcohol consumption and associated factors in a city in Northeast Brazil
This cross-sectional study focused on alcohol consumption according to gender, age, income, and schooling in Jequié, Bahia State, Brazil.
The random sample consisted of 270 individuals over 14 years of age living in the urban area of Jequié from January to March 2010. Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test (AUDIT).
Of the total sample, 21.8% consumed four or more drinks on a typical day, 14.1% admitted having caused any harm after drinking, and 26.3% reported that someone had already suggested they should stop drinking. Forty percent of men had more than four drinks on a typical day, and 50.5% of young people drank frequently.
Distribution of the variables was consistent with higher frequency and greater amounts of alcohol among men and young people. There was a large proportion of heavy episodic alcohol consumption.
The study identified vulnerable groups that are still not addicted to alcohol, and that should be targeted for public health promotion and prevention policies.
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Addressing Trauma in Mental Health and Substance Use Treatment
Individuals with histories of violence, abuse, and neglect from childhood onward make up the majority of clients served by public mental health and substance abuse service systems.
The greater the trauma, the greater the risk for alcoholism and alcohol abuse, depression, illicit drug use, suicide attempts, and other negative outcomes.
Clearly, we cannot begin to address the totality of an individual’s healthcare, or focus on promoting health and preventing disease, unless we address trauma.
Trauma-informed care is now the expectation, not the exception, in behavioral health treatment systems.
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Request Reprint E-Mail: MeenaD@thenationalcouncil.org
Differential prevalence of alcohol use among 2-year and 4-year college students
To determine whether alcohol use behaviors and alcohol-related consequences differed among students attending two-year versus four-year colleges.
Participants (N = 13,700) from 7 two-year and 11 four-year colleges completed the 2010 College Student Health Survey. Alcohol use behaviors included past year alcohol use, past month alcohol use, and binge drinking over the past two weeks. Alcohol-related factors included average calculated blood alcohol level and average number of alcohol-related consequences. Cross-sectional mixed-effects regression analyses were conducted to determine if the prevalence of alcohol-related behaviors and consequences differed among two-year and four-year students.
Students attending four-year colleges, particularly males, were more likely to report past year alcohol use, past month alcohol use, and binge drinking, as well as a higher average blood alcohol content and a greater number of alcohol-related consequences than their two-year counterparts (p < 0.05). Among female students there were fewer differences between two-year and four-year college students. Many differences remained after adjusting for socio-demographic factors (e.g., age, race/ethnicity), however, with the addition of living situation as a covariate, several of the differences among males were no longer significant.
Significant differences in alcohol-related behaviors and consequences exist among students attending two-year versus four-year colleges. While the prevalence of alcohol-related behaviors and consequences was lower among two-year college students, they are not a population to be over-looked. The prevalence of alcohol use remains high among both two-year and four-year college students, making it important for researchers to design appropriate interventions for all students regardless of the type of institution being attended.
Request Reprint E-Mail: cayleywarner@mail.utexas.edu
Clinical Experience with Baclofen in the Management of Alcohol-Dependent Patients with Psychiatric Comorbidity: A Selected Case Series
To illustrate the potential indications for, and adverse effects of, baclofen pharmacotherapy for alcohol dependence in patients with co-existing psychiatric illness.
Audit of the files of alcohol-dependent patients treated for comorbid non-psychotic psychiatric illness in a specialist detoxification unit with integrated outpatient treatment. Files were selected of patients who had been offered treatment with baclofen because other alcohol pharmacotherapies had previously been unsuccessful in preventing relapse or were contraindicated.
Of the 21 selected patients, 13 attended for outpatient treatment, with follow-up periods ranging from 4 days to 27 months, and the outcomes could be rated. Prescribed baclofen doses ranged from 30 to 275 mg daily. Common side effects at lower doses included tiredness and sedation; one patient on 120 mg/day developed reversible severe back pain, and a patient taking up to 275 mg/day developed somnolence, dizziness and incontinence. Seven patients maintained significant periods of abstinence, and one patient reduced daily consumption to non-problematic levels. Two patients consumed an overdose of other central nervous system (CNS) depressants, while taking baclofen in the first week of treatment, were briefly unwell, were given emergency monitoring, but made a full recovery.
While more than half the patients reported significant reduction in alcohol use, it is not possible to draw definite conclusions about the effectiveness of baclofen, given that it was combined with other psychiatric and alcohol treatments, and because there was no control or comparison group. We recommend caution when offering baclofen to patients with a history of recurrent overdosing or a history of other substance misuse. When prescribing in conjunction with other medications with CNS depressant action, close monitoring is recommended at initiation and during dose escalation.
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Request Reprint E-Mail: gdore@nsccahs.health.nsw.gov.au
Why Drivers Start Drinking and Driving—A Prospective Study Over a 6-Year Period in the GAZEL Cohort
To estimate the frequency with which a group of formerly safe drivers adopt driving while alcohol-intoxicated (DWI), and to determine the factors associated with DWI adoption.
Participants were current employees or recent retirees of the French national electricity and gas company. An annual cohort questionnaire that includes two questions about overall alcohol consumption is sent each year to participants. A Driving Behaviour and Road Safety (DBRS) questionnaire was administered in 2001, 2004 and 2007. Only drivers who participated in the 2001 survey received the 2004 and 2007 questionnaires.
More than 462 participants ceased DWI between 2001 and 2007, while 511 adopted this behaviour for the first time. Multivariate analysis showed that the risk of adopting DWI was associated with male gender and with several changes over the preceding years: increased alcohol consumption, increased number of close friends, decreased number of close relatives and decreased attitudes in favour of strict enforcement/regulations.
A large number of offenders stopped DWI between 2001 and 2007, concomitantly with an increased crackdown on road violations in France. But this success was compromised by the occurrence of new drunk drivers. Preventive strategies should target factors that facilitate DWI adoption—in particular, increased alcohol consumption and low acceptance of law enforcement initiatives.
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Request Reprint E-Mail: aymery.constant@ehesp.fr
Race-Specific Associations Between Trauma Cognitions and Symptoms of Alcohol Dependence in Individuals with Comorbid PTSD and Alcohol Dependence
Posttraumatic Stress Disorder (PTSD) changes the way people think about themselves, others, and the safety of the world. These cognitions may play a role in alcohol dependence, where alcohol dependence is maintained as an attempt to manage posttraumatic anxiety.
The current study examined black-white differences in various PTSD cognitions and their relationship to symptoms of alcohol dependence in a dually diagnosed sample (N = 167).
Analyses revealed racial differences in trauma cognitions and their impact on symptoms of alcohol dependence, suggesting that trauma cognitions are more strongly associated with adverse consequences of drinking and alcohol craving severity among African Americans than European Americans.
Additional relationships between ethnic identification and trauma-related cognitions are described and theoretical and clinical implications of these findings are discussed.
Request Reprint E-Mail: monnica@mail.med.upenn.edu
Ways of problem solving as predictors of relapse in a group of alcohol dependent male inpatients
The purpose of this study was to identify how remitters and relapsers view their everyday problem solving strategies.
A total of 128 male alcohol dependent male inpatients who were hospitalized at the Ankara University Psychiatry Clinic, Alcohol and Substance Abuse Treatment Unit were recruited for the study. Subjects demographic status and alcohol use histories were assessed by a self-report questionnaire. Also, patients were evaluated with The Coopersmith Self-esteem Inventory (CSI), The Spielberger State-Trait Anxiety Scale (STAI-I-II), and The Problem Solving Inventory (PSI). Patients were followed for six months with monthly intervals after hospital discharge. Drinking status was assessed in terms of abstinence and relapse. Data were assessed with Student t-test, and univariate and multivariate analysis. In the logistic regression analysis, age, marital status, employment status and PSI subscores were taken as the independent variables and drinking state at the end of six months as the dependent variable.
There were significant differences in reflective and avoidant styles, and monitoring style of problem solving between abstainers and relapses. It was found that subjects who perceived their problem solving style as less avoidant and less reflective were at greater risk to relapse.
The findings demonstrated that active engagement in problem solving like utilizing avoidant and reflective styles of problem solving enhances abstinence. In treatment, expanding the behavior repertoire and increasing the variety of ways of problem solving ways that can be utilized in daily life should be one of the major goals of the treatment program.
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Request Reprint E-Mail: demirbashatice@hotmail.com
Sunday, September 4, 2011
FASD News - 35/2011
The Virtual Medical Centre (Australia) - Alcohol health warnings protect mums and babies
Researchers at Perth's Telethon Institute for Child Health Research support calls for mandatory health warning labels on alcohol products.
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Queens County Advance - FASD: Supporting mother during pregnancy key
Fetal Alcohol Spectrum Disorder is one of the few illnesses that is completely preventable, however it is also the one that comes with the most stigma. Sept. 9 is FASD awareness day, and the South Shore Family Resource Centre bringing awareness to the issue with the help of several community partners.
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Canada Views (Canada) - Alberta recognizes International Fetal Alcohol Spectrum Disorder Awareness Day
September 9 is International Fetal Alcohol Spectrum Disorder (FASD) Awareness Day. Each year on the ninth day of the ninth month, this day serves as a reminder to people around the world that during the nine months of pregnancy, a woman should abstain from alcohol.
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Irish Times (Ireland) - Born with a craving for alcohol
WOMEN IN Ireland who drink while pregnant are creating children three times more likely to crave alcohol, according to a leading specialist in the field.
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The West Australian (Australia) - Alcohol in pregnancy can harm babies
Fetal Alcohol Spectrum Disorder is now being revealed as a tragic legacy of alcohol misuse. And the condition is not isolated to marginalised, disadvantaged communities, researchers say.
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Patch.com (USA) - For Whom The Bells Will Toll
At 9:09 a.m., on September 9, the bells of the Community Church of Douglaston and Zion Episcopal Church will ring in an effort to help raise awareness about fetal alcohol syndrome.
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KARE (USA) - Pregnant drinking: Social experiment at the Minnesota State Fair
The idea by the Minnesota Organization on Fetal Alcohol Syndrome was simple; plant a visibly pregnant woman at the state fair, have her drink a few beers and wait to see if people would intervene.
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SignOnSanDiego.com - Healthy pregnancy equals a healthy baby
Preparing for a baby’s arrival is important — but charting a course for mom’s health during pregnancy is even more vital. Here are some tips for planning a healthy pregnancy.
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Vanguard - When you drink for two, your child becomes damaged
Imagine when your pregnancy is scanned for the first time so you could see your precious baby growing in the womb, suddenly its whole body gives a shudder and the foetus appears to jump. Such a movement is known as the startle reflex, and the scan described above are from photographs from scans that were taken by Peter Hepper, a professor of psychology at Queens University, Belfast and an expert on the effects of alcohol on unborn babies.
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Jakcsonville.com - Ask the health experts: Is it OK to have a glass of wine during pregnancy?
Is it OK for me to have a glass of wine during my pregnancy? I have heard it might help me sleep, and that an occasional alcoholic beverage won't harm my baby.
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COMING UP
Protecting the unborn baby from alcohol, 7 September 2011, European Parliament, Brussels
This event is jointly organized by European Alcohol Policy Alliance (Eurocare) and the Polish State Agency for Prevention of Alcohol-Related Problems (PARPA) to mark International Foetal Alcohol Spectrum Disorders (FASD) Day.
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MATERIALS
Blogcritics.org - Interview: Carole Eglash-Kosof, Author of The Human Spirit
Carole Eglash-Kosof is a graduate of UCLA and has spent the majority of her career in business and teaching. After tragedy struck in 2006, causing her to lose her husband, mother and brother within a month of one another, she knew she needed to reevaluate her life. She was sent to South Africa to teach as part of the American Jewish World Service. The Human Spirit is the tale of the people of this land who show a level of caring unrivaled by most. They are apartheid’s unheralded heroes and The Human Spirit is their story.
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Best Start – Best Start Resource Centre
Check out alcohol and pregnancy resources on the Best Start Resource Centre site, including the stylish Mocktails for Mom brochure.
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IN OTHER LANGUAGES
MediUutiset (Finland) - Alkoholin vaurioittamat vauvat jäävät ilman diagnoosia
Vain kymmenen prosenttia äidin raskauden aikaisen alkoholinkäytön takia fetaalialkoholioireyhtymän (FAS) saaneista lapsista saa diagnoosin.
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Kehitysvammaliitto (Finland) - 9.9. muistuttaa yhdeksän kuukauden raittiudesta
Kansainvälisenä FASD-päivänä 9.9. kiinnitetään huomiota raskaudenaikaisen alkoholinkäytön vaaroihin. FASD on uusi lääketieteellinen termi, jolla viitataan lapselle aiheutuneiden vaurioiden kirjoon. Read more
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Experienced Acetaldehyde Reaction Does Not Improve Treatment Response in Outpatients Treated With Supervised Disulfiram
The major mode of action of disulfiram is assumed to be a psychological deterrence of an acetaldehyde reaction after alcohol consumption. However, it is still unclear whether patients need to experience an acetaldehyde reaction with the help of a "test drink" at the beginning of the therapy to achieve a better efficacy. Therefore, in this study, we test the hypothesis if an experienced acetaldehyde reaction during the therapy with disulfiram predicts better treatment outcome in alcohol-dependent patients.
We evaluated outcome data of 46 patients treated with supervised disulfiram with experienced versus not experienced acetaldehyde reaction.
Alcohol consumption during outpatient disulfiram treatment was reported by 46% of the patients. Ninety percent of these patients reported typical symptoms of an acetaldehyde reaction. Comparing the course of abstinence rates, our results suggest that the experience of an acetaldehyde reaction was not associated with any differences in treatment outcome but with a significant earlier discontinuation of the therapy.
This study supports the position that the experience of an acetaldehyde reaction is not necessary for disulfiram's action and does not lead to a better treatment outcome. Hence, there is no evidence for the necessity of a test drink before the initiation of a supervised disulfiram therapy.
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