To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, November 5, 2011

Strategies to increase community-based intervention research aimed at reducing excessive alcohol consumption and alcohol-related harm

There is a need for evidence to guide alcohol harm reduction programs at the population, system or community level. Such evidence should be derived from methodologically rigorous intervention research. Furthermore, overviews of research output indicate that while interventions are occurring in this field, the dominance of descriptive research continues.

Here we present suggestions regarding the most important facilitators of producing high-quality intervention research aimed at reducing alcohol consumption and alcohol-related harm at the population or community level.

These suggestions are guided and supported by researchers in the field, whose perceptions were sought through a Web-based survey. Routine collection of relevant data, publication of negative results and reconsideration of funding priorities were ranked highest in terms of their importance in increasing intervention research.

The importance of the strategies is marred by limitations of feasibility, clearly acting as a barrier to their adoption. It is likely to be necessary to overcome these limitations in order to achieve change.

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Is there a ‘low-risk’ drinking level for youth? The risk of acute harm as a function of quantity and frequency of drinking

Drinking guidelines have rarely provided recommendations for different age groups despite evidence of significant age effects on alcohol consumption and related risks. This study attempted to quantify the degree of risk associated with lower levels of consumption for people under 25 years of age, with the broader purpose of informing the development of Canadian low-risk drinking guidelines.

A random community-based sample of 540 youth aged 16–23 (54.4% female) completed an interview concerning alcohol consumption patterns and a broad range of acute health and social harms. Logistic regression analyses were designed to test whether there were discernible thresholds of risk as a function of both gender and age.

A significant proportion of young people consumed in excess of adult drinking limits recommended by the Centre for Addiction and Mental Health (CAMH) to minimise risk of alcohol-related harm. Compared with abstainers, rates of reported harm increased linearly with increasing frequency and quantity levels. However, problems were most strongly associated with consumption in excess of two drinks per occasion and a frequency of more than once a week. No independent effects of age or gender were identified.

The CAMH guidelines for adult drinkers do not adequately address acute risks for young people. More specific guideline recommendations for young people could be considered with a more prominent focus on drinking quantity (one to two drinks per occasion), and a recommended frequency of consumption (once a week).

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Lessons from South East Alcohol Innovation Programme

Over recent years the South East Alcohol Innovation Programme (SEAIP) delivered a variety of projects aiming to reduce alcohol-related harm across the South East. The programme was commissioned by the Government Office for the South East and delivered by the Centre for Public Innovation.

The evaluation, supported by Lundbeck pharmaceutical company, covers 10 projects, assessing their performance and potential for cost savings over the period between 2009-2011. Key findings support recommendations from the Alcohol Improvement Programme's list of High Impact Changes. > > > > Read More

Stimulant use trajectories and the longitudinal risk of heavy drinking: Findings from a rural population-based study

The extant literature offers little information about the longitudinal course of alcohol use among stimulant users, particularly those in rural areas, but it is plausible that reductions in stimulant use are accompanied by increases in heavy drinking.

The objective of this study was to examine the longitudinal relationships between heavy drinking days and latent trajectories of powder cocaine, crack cocaine, and methamphetamine use.

Participants (n = 710) were identified via Respondent-Driven Sampling in 3 rural communities in each of 3 states, with interviews conducted every 6 months over 3 years. Latent trajectory classes for powder cocaine, crack cocaine, and methamphetamine use were identified by conducting latent class growth analysis (LCGA). Generalized linear models (GLM) were conducted to examine how these latent classes were associated with the number of heavy drinking days in the past 30 days.

Heavy drinking days did not significantly change over time when adjusting for covariates. Compared to those with a “fast low” trajectory of crack use, those with “steady high” and “declining” trajectories had more heavy drinking days. Compared to those with a “fast low” trajectory of powder cocaine use, those with a “steady moderate” trajectory had more heavy drinking days. Trajectories of methamphetamine use were not significantly associated with heavy drinking days.

In conclusion, heavy alcohol use changes little over time among rural stimulant users. Many rural cocaine users could potentially benefit from interventions aimed at curtailing heavy drinking.

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Heavy drinking occasions in relation to ischaemic heart disease mortality— An 11–22 year follow-up of the 1984 and 1995 US National Alcohol Surveys

The relationship between alcohol consumption and ischaemic heart disease (IHD) risk is complex and several issues remain unresolved because many studies used rather crude exposure measures often based on one or two questions. The objective of this study was to investigate the association between heavy drinking occasions and IHD mortality while controlling for average daily alcohol intake and separating former drinkers from lifetime abstainers.

Cox regression analyses were used with IHD mortality as the outcome in a sample of 9934 participants of the US National Alcohol Surveys conducted in 1984 and 1995.

To the end of 2006, 326 deaths from IHD were recorded in the 11- to 22-year follow-up period. Any past heavy drinking occasions in former drinkers [hazard ratio (HR) = 2.06; 95% confidence interval (95% CI): 1.10–3.85] compared with former drinkers without such drinking occasions, and any heavy drinking occasion in current drinkers at baseline (HR = 2.05; 95% CI: 1.03–3.98) compared with current drinkers with average daily intake of one to two drinks, were associated with higher IHD mortality in men and any heavy drinking occasions among drinkers of up to 1 drink average consumption in women with similar effect size. Confounding effects from age, race, education, employment, income, marital status, geographical region, depression score, survey period or other drug use were small.

Among former and current drinkers, heavy drinking occasions should be taken into account when examining the complex association of alcohol consumption on IHD mortality risk.

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Friday, November 4, 2011

Alcohol consumption and female urinary incontinence: A community-based study in Japan

To investigate the association between alcohol consumption and urinary incontinence among Japanese women.

A total of 300 women aged 40–75 years were recruited from the community in middle and southern Japan. A validated food frequency questionnaire was given face-to-face to obtain information on dietary intake and habitual alcohol consumption. Urinary incontinence status was ascertained using the International Consultation on Incontinence Questionnaire-Short Form.

Among the 298 eligible participants, 82 women (27.5%) experienced urine leakage. The prevalence of alcohol drinking and mean ethanol intake were slightly higher among the incontinent women (39%; 7.1, standard deviation 24.1 g/day) than others without the condition (35.6%; 4.3, standard deviation 10.7 g/day). Relative to non-drinkers, the adjusted odds ratios of urinary incontinence were 1.31 (95% confidence interval 0.74–2.33) for alcohol drinking and 1.69 (95% confidence interval 0.42–6.81) for ethanol intake over 32 g/day, though the increases in risk did not reach statistical significance.

Little association is evident between alcohol consumption and urinary incontinence in middle-aged and older Japanese women. Further studies are required to define the role of alcohol as a contributing factor of this distressing condition.

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Premature cardiovascular mortality and alcohol consumption before death in Arkhangelsk, Russia: an analysis of a consecutive series of forensic autops

High cardiovascular diseases (CVD) mortality among the middle aged is a major cause of reduced life expectancy in Russia, especially among men. Hazardous alcohol consumption is suspected to be a powerful contributing factor.

All men (1099) and women (519) aged 30–70 years who died between 1 January 2008 and 31 August 2009 from CVD in the city of Arkhangelsk, north-west Russia, were included. CVD mortality was stratified by age, gender and diagnosis. For the cases diagnosed by forensic pathologists, the blood alcohol concentration (BAC) was determined. The forensic autopsy rate was 72% for men and 62% for women.

Age-standardized CVD mortality rate (all age groups) in men was higher than in women. The largest male–female ratio (4.3) was observed in the age group of 50–59 years. Alcoholic and unspecified cardiomyopathies were the most dominant of CVD mortalities in women, and second in men aged <50 years; they accounted for 50 and 25% of deaths, respectively. About one-third of men and women who died from CVD aged <60 years had consumed alcohol shortly before death. This occurred most frequently among the diagnostic groups ‘other acute or subacute cardiac ischaemia’, ‘atherosclerotic heart disease’ and ‘cardiomyopathies’. Alcohol was more likely to be found at autopsy in men than in women (odds ratio 1.55; 95% confidence interval 1.14–2.10). No difference was found for those who died from myocardial infarction, cerebrovascular diseases and cardiomyopathies. Of the deceased, <1% had a BAC of ≥4 g/l.

A high proportion of subjects who died from CVD in Arkhangelsk consumed alcohol shortly before death. It was highest among males aged 50–59 years. The largest gender difference in mortality, highest absolute number of premature CVD deaths, and the highest proportion of alcohol-positive autopsies occurred among them. Since associations with alcohol consumption varied considerably between the types of CVD diagnoses, this observation should be taken into account when planning future research. Our study does not provide evidence that cardiovascular deaths are misclassified cases of acute alcohol poisoning.

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Thursday, November 3, 2011

Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians

As a component of comprehensive pediatric care, adolescents should receive appropriate guidance regarding substance use during routine clinical care.

This statement addresses practitioner challenges posed by the spectrum of pediatric substance use and presents an algorithm-based approach to augment the pediatrician's confidence and abilities related to substance use screening, brief intervention, and referral to treatment in the primary care setting.

Adolescents with addictions should be managed collaboratively (or comanaged) with child and adolescent mental health or addiction specialists.

This statement reviews recommended referral guidelines that are based on established patient-treatment–matching criteria and the risk level for substance abuse.

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Frontal White Matter Integrity Predictors of Adult Alcohol Treatment Outcome

Previous research has associated abnormalities in frontal lobe functioning with alcohol relapse. In this study, we used diffusion tensor imaging to investigate whether frontal white matter integrity measured at the start of treatment differs between persons with alcohol use disorders (AUD) who sustain treatment gains and those who return to heavy use after treatment.

Forty-five treatment-seeking AUD inpatients and 30 healthy control subjects were included in the study. Six months after completing treatment, 16 of the AUD participants had resumed heavy use (RHU) and 29 others remained abstinent or drank minimally (treatment sustainers [TS]). Voxel-wise group comparisons (TS vs. RHU) were performed on fractional anisotropy (FA), radial diffusivity (RD), and axial diffusivity maps generated from each subject's diffusion tensor imaging scan at the start of treatment.

We found significantly lower FA and significantly higher RD in the frontal lobes of the RHU group, relative to the TS group. The RHU group data are consistent with previous reports of abnormal frontal white matter tract abnormalities in persons with AUD.

It is possible that the lower FA and higher RD in the RHU group reflect microstructural injury to frontal circuitries, and these may underlie the reduced cognitive control amid heightened reward sensitivity associated with resumption of heavy drinking.

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Global Actions November 2, 2011

Recent Highlights:

· Global Actions China met with the China Alcoholic Drinks Industry Association (CADIA) and the China Association of National Advertisers (CANA) last week to discuss the Self-Regulation project. Meetings were also held with Corporate Social Responsibility in Asia (CSR Asia) in order to develop a social responsibility survey for the beverage alcohol industry in China.

Global Actions in Focus: Colombia

Global Actions recently joined PACTOS project leaders in six cities across Colombia. The “Pactos por la Vida” (Pact for Life) program was originated by the Ministry of Social Protection three years ago to reduce harmful drinking and illicit drug use.

Working with mayors’ offices, PACTOS provides a framework for cities to develop their own unique projects. ICAP is assisting these leaders with tools for planning and evaluation which they can use to strengthen future projects and to highlight their current achievements. “We noticed a lack of evaluation tools in the cities,” said Global Actions Colombia Country Manager Mario Lleras. “In order to show progress and results, it’s important for the cities to use standardized evaluation methods so that when they expand their projects, they can see how these projects were developed, the structure, and what the outcome will be.”

ICAP has worked with Research Associate Alberto Bouroncle to develop an evaluation method that is now being shared in PACTOS workshops. “Each city has strengths as well as areas for improvement,” said Lleras. “Some are working with universities and students to develop moderate drinking culture, others with bars and clubs, and still others with traffic inspectors and police forces. Cities can learn from each other when developing these projects.”

The next step is for the cities to collect their experiences and lesson learned into a good practice booklet. Once approved by the Ministry of Social Protection and Fondo de Prevencion Vial, the booklet will be presented to the cities’ mayors.

View more photos from Bucaramanga, Barranquilla, Cali, Ibague, Neiva, and Medellin on our Facebook page.

What’s Happening Next:

· Vietnam: On November 17, Global Actions will hold a drink driving capacity building workshop for bus drivers in Dak Lak province.

· Global Actions will attend an industry meeting on best practices in Latin America from November 30-December 2 in Miami.

Critique 060: A new analysis from the Nurses’ Health Study on the association of alcohol with risk of breast cancer — 3 November 2011

Forum Comments

Background: A large percentage of observational prospective studies have shown that women who consume alcohol show an increase in their risk of developing breast cancer. In general, the relation seems to be stronger for women who drink in binges, are also taking post-menopausal hormonal therapy, and/or have low intakes of dietary folate. Most studies have shown that heavier drinkers are at the greatest risk.

The present analysis is from the Nurses’ Health Study, which is one of the first prospective studies to point out an association between alcohol consumption and breast cancer. It attempts to determine if both the amount of alcohol and the frequency of drinking affect risk, and also whether the cumulative alcohol intake over the adult years relates to the risk of breast cancer.

Comments on present paper: As is usual from the Nurses’ Health Study, the present analyses are very well done. Theoretically, the repeated assessments of consumption over time should provide a better estimate of long-term alcohol intake. It is interesting, however, that in these analyses, the risks of cancer associated with alcohol were almost the same whether based on the amounts of alcohol consumed at baseline in 1980 or on the cumulative average based on repeated assessments of intake through the years.

When adjusting for the cumulative lifetime consumption, there was no effect of the frequency of consumption (1-2, 3-4, or 5-7 days per week). This is different from the usual findings for the association between alcohol intake and cardiovascular disease, where more frequent intake is associated with greater protection.

Again, when adjusting for cumulative intake, there was only a weak relation with cancer from the reported maximum number of drinks per day; While there was not a clear trend, the highest risk ratio (RR = 1.21, CI 0.99-1.47) was for women reporting 6 or more drinks/day.

Both for the reported intake between ages 18 and 40 (based on recall) and the intake after age 40, the adjusted estimate of cancer risk showed a sharp increase at 10-19.9 g/day, although an increase in risk was present to a lesser degree in both age groups at 5 – 9.9 g/day. There was little difference in the effects of intake before 40 years and intake thereafter. No differences in association with breast cancer risk were seen according to type of beverage consumed.

Several reviewers pointed out that observational studies report “associations,” and often provide hypotheses to explain their findings; but “causation” cannot be proved from such studies alone. As one Forum reviewer stated: “The authors correctly present data as associations. Sometimes, the general population, health authorities, and the media automatically assume that an association clearly identifies a cause, and often advise very stringent measures based on such observational data.”

Modification of breast cancer risk associated with alcohol consumption by folate: A primary concern of several Forum reviewers was that the investigators did not evaluate folate intake as a potential confounder, even though the Nurses’ Health Study has extensive dietary data on its subjects. Previous reports from this study suggest that the excess risk of breast cancer associated with alcohol consumption may be reduced (or eliminated) by adequate folate intake.1,2 These investigators had previously reported that the risk of breast cancer associated with alcohol intake was strongest among women with total folate intake of less than 300 μg/d (for alcohol intake >15 g/d versus less than 15 g/d, multivariate RR 1.32, CI 1.15-1.50). For women who consumed at least 300 μg/d of total folate, the multivariate RR for intake of at least 15 g/d of alcohol versus less than 15 g/d was 1.01 (CI 0.92-1.20).

Similarly, Baglietto et al3 reported that the estimated hazard ratio for breast cancer of an alcohol consumption of 40 g/day or more was 2.00 (CI 1.14-3.49) for women with intakes of 200 μg/day of folate and 0.77 (0.33-1.80) for those with intakes of 400 μg/day of folate. Further, Beilby et al4 observed marked reductions in odds ratios for breast cancer among women with higher levels of serum folate, as have many others.5-10

Tjønneland et al11 also reported that an association between alcohol intake and risk of breast cancer was present mainly among women with low folate intake. A RR of 1.19 (CI 0.99-1.42) per 10 g average daily alcohol intake was found for women with a daily folate intake below 300 μg, while among women with a folate intake higher than 350 μg, they could not show an association between the alcohol intake and the breast cancer incidence rate (e.g., for folate intake >400 μg, the RR was 1.01, CI 0.85-1.20). On the other hand, Feigelson et al12 found no evidence of an interaction between levels of dietary folate and alcohol and associations with breast cancer risk.

One reviewer stated: “This is a well conducted cohort study, with good assessment of the exposure variable and good assessment of the outcome variable. While a number of potential confounders have been considered and controlled for, it is unfortunate that diet as a potential confounder has not been taken into account.”

Another reviewer commented: “The results are plausible from the pathophysiological point of view: alcohol intake increases estrogen levels and this means that women have a slightly lower risk for osteoporosis and a slightly higher risk for breast cancer. When we tell the public that current data suggest small to moderate amounts of alcohol protect against cardiovascular disease, osteoporosis, diabetes mellitus, and vascular dementia, we should also state that breast cancer risk in women is slightly increased.”

He adds that the authors of this paper put their findings into perspective when they conclude: “An individual will need to weigh the modest risks of light to moderate alcohol use on breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption.”

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Externalizing Behaviors are Associated with SNPs in the CHRNA5/CHRNA3/CHRNB4 Gene Cluster

There is strong evidence for shared genetic factors contributing to childhood externalizing disorders and substance abuse. Externalizing disorders often precede early substance experimentation, leading to the idea that individuals inherit a genetic vulnerability to generalized disinhibitory psychopathology.

Genetic variation in the
CHRNA5/CHRNA3/CHRNB4 gene cluster has been associated with early substance experimentation, nicotine dependence, and other drug behaviors.

This study examines whether the
CHRNA5/CHRNA3/CHRNB4 locus is correlated also with externalizing behaviors in three independent longitudinally assessed adolescent samples.

We developed a common externalizing behavior phenotype from the available measures in the three samples, and tested for association with 10 SNPs in the gene cluster. Significant results were detected in two of the samples, including rs8040868, which remained significant after controlling for smoking quantity.

These results expand on previous work focused mainly on drug behaviors, and support the hypothesis that variation in the
CHRNA5/CHRNA3/CHRNB4 locus is associated with early externalizing behaviors.

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Wednesday, November 2, 2011

Alcohol prevention in Swedish primary health care

The objectives of this thesis are to: (1) highlight the impact of alcohol on patients’ health; (2) describe alcohol-related attitudes among general practitioners and district nurses who work with patients whose alcohol consumption is too high or risky; and (3) focus on the achievements of the Swedish Risk Drinking Project (RDP). Special attention has been devoted totwo themes: the gender perspective and general practitioners (GPs) perceptions on the limits of sensible/safe drinking.

Two main data sources constitute the basis for this thesis. For studies I and II, the material is based on a postal survey that was carried out
from December 2001 to February 2002 of all GPs and nurses working in primary health care (PHC) in the County of Skaraborg. For studies III and
IV, the material is based on two national postal surveys that were carried out to evaluate the effect of the RDP.

One of the surveys was conducted between
November 2005 and February 2006 and the other between November 2008 and April 2009. They targeted all GPs, districts nurses (DNs) and registrars working in Sweden.

To evaluate if a change in clinical practice that could be
related to RDP activities had occurred, we triangulated the results with two population surveys (Vårdbarometern and Monitor surveys) in which the participants reported whether they had been asked about alcohol when visiting PHC in the last year. We also studied changes in the number of alcohol-related diagnoses in PHC in western Sweden between 2005 and 2009.

The importance of drinking alcohol moderately, using counselling skills to reduce alcohol consumption and perceived current effectiveness in helping patients to reduce their alcohol consumption ranked lower than working with other lifestyle behaviours such as smoking, overweight, exercise and stress for both GPs and nurses.

For alcohol, the GPs assessed
their role adequacy, role legitimacy and motivation higher than the nurses did. The main obstacles for the GPs to carry out alcohol intervention were
lack of training in counselling on reducing alcohol consumption, time constraints, and the fact that the doctors did not know how to identify
problem drinkers who had no obvious symptoms of excess consumption.

Both the gender of the patients and of the GPs influenced the advice and the
referrals that the patients received. Men were more often recommended to reduce drinking (83%) than women (47%) as they were more often advised to stop drinking. Men were less often referred to any treatment, odds ratio 0.33. Male GPs referred excessive drinkers less often to any treatment than female GPs (odds ratio 0.26).

The upper limit of alcohol consumption before GPs advised the patient to cut down was significantly higher for GPs with an AUDIT-C score ≥3. The limit was 146 g/week for male patients and 103 g/week for female patients.
Corresponding figures for GPs with an AUDIT-C score ≤2 were 89 and 68 g/week. The mean recommended upper limit for safe drinking was
7.8 standard drinks/week for male patients and 5.3 drinks for female patients.

Respondents lacking postgraduate education on handling risk drinking stated
significantly lower limits (6.9 drinks for males and 4.7 for females) thanthose with half a day or shorter education (8.0 drinks for males and 5.5 for females). GPs with higher self-perceived alcohol-related competence
suggested significantly higher limits than those who stated lower competence. Fifty-five percent of the participants in the 2009 survey had participated in alcohol-related education in the past 3 years.

For all three competence-related
parameters analysed, discussion, knowledge and effectiveness of perceived competence in handling risk drinking, the increase was significant during these 3 years, particularly among DNs.

However, the population surveys
showed no changes in the patients being asked about their alcohol consumption. There was only a small increase in alcohol-related diagnoses in
this time period; 9% in western Sweden from a very low number (in 2006, 1,443 patients had an alcohol-related diagnosis compared with 1,723 patients in 2008).

GPs and DNs estimated their alcohol-related competence as lower compared with many other health-related lifestyles issues. These results can possibly be explained by lack of practical skills and lack of training in suitable intervention techniques; thus unsupportive working
environments and negative attitudes may also have an influence. All these elements must be considered when planning secondary alcohol prevention programs in PHC. Male patients were less likely to be advised to stop drinking altogether than female patients and were also less likely to be referred to other treatments. Taking into account that male patients have a higher prevalence of alcohol problems, this may be of considerable importance for men’s health outcomes.

These findings show that there is a need for increased awareness of excessive
drinking in men and that gendered perceptions might bias alcohol management recommendations. We found that 9 out of 10 GPs stated limits that were lower than the widely applied recommended levels in Sweden of 14 standard drinks per week for men and 9 for women.

Assuming that the GPs would take action at the limits
they proposed in this study, it would mean that they would intervene with a very large proportion of their patients, many of whom consume rather modest amounts of alcohol and who do not feel that they have any problems with their alcohol intake. It can be questioned as to whether this is the best approach for screening and brief intervention.

The national RDP is a likely cause of enhanced self-perceived competence in
the alcohol field among nurses and GPs. Using a combination of data sources to evaluate the impact of the RDP, it is uncertain whether this mainly educational effort has been sufficient to increase screening and brief intervention in PHC in Sweden.

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Press Release - Moderate Alcohol Consumption is Associated with Small Intestinal Bacterial Overgrowth

Just one drink per day for women—two for men—could lead to small intestinal bacterial overgrowth (SIBO) and subsequently cause gastrointestinal symptoms like bloating, gas, abdominal pain, constipation and diarrhea, according to the results of a new study unveiled today at the American College of Gastroenterology’s (ACG) 76th Annual Scientific meeting in Washington, DC.

The retrospective review, “Moderate Alcohol Consumption is Associated with Small Intestinal Bacterial Overgrowth,” looked at the charts of 198 patients who underwent lactulose hydrogen breath testing (LHBT) to determine the presence of SIBO, and found that any current alcohol consumption was significantly associated with the presence of SIBO—and neither smoking nor use of heartburn drugs called PPIs was associated with an increased risk of SIBO.
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Investigating Ethnic Differences in Adolescent Alcohol Use and Peer Norms Using Semi-Continuous Latent Growth Models

To investigate whether ethnic differences in vulnerability to peer norms supportive of alcohol use is a viable, partial explanation for the ethnic differences in reported prevalence and amount of alcohol use during high school.

Survey data from a sample of 680 adolescents from Project STAR (Students Taught Awareness and Resistance) of the Midwestern Prevention Project were used. Hypotheses were tested using sequential, semi-continuous growth curve models.

Relative to Black adolescents, White adolescents reported greater peer alcohol use during middle school and were much more likely to consume alcohol during high school. General peer norms in seventh grade and middle school growth in alcohol use norms among close friends was predictive of a greater propensity to consume alcohol in ninth grade among White adolescents.

Lower peer norms for alcohol use among Black adolescents might better account for differences between Black and White adolescents than the possibility that White adolescents are more vulnerable to peer norms.

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Mentorship for Alcohol Problems (MAP): A Peer to Peer Modular Intervention for Outpatients

This is a Stage I open pilot to develop a new intervention, Mentorship for Alcohol Problems (MAP), for individuals with alcohol-use disorders in community treatment programs.

Ten mentors participated for 6 months until 30 mentees received MAP for 12 weeks. Behavioral and biological measures were conducted in addition to fidelity measures. Four focus groups were held with participants and clinician feedback surveys were completed.

Feasibility and acceptance data in the domains of patient interest, safety and satisfaction were promising. Mentees reduced their alcohol and substance use and the majority of mentors sustained abstinence. Fidelity measures indicated that mentors adhered to the delivery of treatment.

MAP shows promise to be incorporated into professionally run outpatient alcohol treatment programs to assist in the reduction of alcohol and substance use.

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Alcohol News - 44/2011

Helsingin Sanomat (Finland) - Consumption and private imports of alcohol continue to fall
In the early part of 2011 the Finns bought less alcohol than in the same period a year before. The same applied to drinks purchased from abroad: a clearly smaller amount of alcoholic beverages were brought in as souvenirs from overseas than a year earlier.
CBS (USA) - Amy Winehouse death puts alcohol poisoning in spotlight
"Death by misadventure." That was an English coroner's curiously quaint way of saying Amy Winehouse drank herself to death. The troubled singer was found with empty vodka bottles in her room and more than five times the legal limit for drinking in England, coroner Suzanne Grennaway said on Wednesday.
BBC News (UK) - Children claim alcohol intake of 28 units a week
A small number of children as young as 12 claimed they drank the equivalent of 19 glasses of wine a week when questioned for a health survey.
BBC News (UK) - Alcohol warnings 'still being ignored', minister says
Many people still do not accept the harm that alcohol can do to their bodies, despite government warnings, the public health minister has said.
eGov monitor (Scotland) - Nicola Sturgeon Welcomes Rising Support For Minimum Pricing For Alcohol
A leading Canadian academic and major player in the alcohol industry have added their names to the growing list of supporters backing the Scottish Government's bid to introduce a minimum price for alcohol.
Newswise - Moderate Alcohol Consumption is Associated with Small Intestinal Bacterial Overgrowth
Just one drink per day for women—two for men—could lead to small intestinal bacterial overgrowth (SIBO) and subsequently cause gastrointestinal symptoms like bloating, gas, abdominal pain, constipation and diarrhea, according to the results of a new study unveiled today at the American College of Gastroenterology’s (ACG) 76th Annual Scientific meeting in Washington, DC.
The Republic - Medical: Alcohol's impact affected by genes, studies show
And there's plenty of evidence that light to moderate alcohol consumption can have health benefits for many people but carries grave risks for others. The trick lies in figuring out just who falls in which pathway.
News Tonight - Limit Alcohol Intake To Avoid Lung Cancer, Says Study
Lung cancer is a deadly form of cancer that can be considered as a leading cause of deaths across the globe. The disease is already known to have a close association with poor lifestyle and habits such as tobacco consumption.
New Vision (Uganda) - Excessive Alcohol consumption: A key driver of chronic poverty
Excessive Alcohol Consumption is a key ‘driver and maintainer’ of chronic poverty in Uganda. Discussions on excessive alcohol consumption in the country have for long been in the back –seat of what is considered as ‘personal choices’ making alcohol a new frontier for chronic poverty in Uganda.
Scotsman (Scotland) - Alcohol and drugs lead to one in seven house fires
ALCOHOL and drug misuse were linked to at least one in seven house fires in Scotland last year, according to a new Scottish Government report. (USA) - Medicare to cover screening for alcohol misuse
The Centers for Medicare & Medicaid Services has announced two new national coverage determinations that cover screenings for alcohol misuse and depression for Medicare beneficiaries.
PR Newswire (USA) - Calif. Study Shows 24/7 Alcohol Bracelets Curb Future DUIs
A newly released study of DUI offender data in Riverside County shows that Hard Core Drunk Drivers (HCDDs) who were monitored with 24/7 alcohol bracelets saw a re-arrest rate of nearly one-half the state average for repeat DUI offenders.
Irish Times (Ireland) - New drink-driving limits come into effect at midnight
LOWER DRINK-driving limits come into effect from midnight, reducing the maximum blood-alcohol level to 20mg per 100ml of blood in some cases.
Medical News Today - Fearing Stigmatizing The Patient - Doctors Will Cite Alcohol As Cause Of Death, But Not Smoking
Not wanting to stigmatize the deceased, UK doctors are not in general citing smoking as a cause of death on death certificates, although they will cite alcohol in cases where alcohol is a clear cause.
OHS Canada (Canada) - Random drug and alcohol testing approved
Public transit workers in Toronto will soon be subject to random drug and alcohol testing as the city's transit service was given the go-ahead to begin testing employees in safety-sensitive positions.
Daily Mail - All-day drinking brings 670,000 surge in 'sickies'... and women are FIVE times more likely to bunk off work
Around 670,000 working days a year are being lost because of the relaxation of the drinking laws, researchers claim.
Independent Online (South Africa) - Govt to look into booze ads ban
The Health Department has agreed to look into an alternative solution to the proposed ban on alcohol advertising during a meeting held on Friday with health Department officials and outdoor media company Kena Media.
Namibia Economist (Namibia) - Alcohol misuse a “graving” concern
While alcohol is often said to provide employment and income for the people who sell it, it has the opposite effect in the household of many patrons. It is for this reason that the availability of alcohol should be decreased or at the extreme totally eradicated in the country.
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News Wales (Wales) - 494 alcohol deaths in Wales and 152 from drugs
There were 494 alcohol related deaths in Wales in 2010 and 152 drug misuse related deaths. From 2006 to 2010, admissions for mental and behavioural disorders due to opioids have increased overall by 53.2 per cent (44.4 per cent in males and 68.1 per cent in females).
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Bromsgrove Advertiser (UK) - New county campaign to tackle sexual and drink related violence
A NEW campaign that aims to tackle sexual and drink related violence during the festive season has been launched in Worcestershire.
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Hong Kong Standard (Hong Kong) - No limits set in battle of the booze
An action plan launched to reduce dangers related to alcohol abuse has no drinking guidelines. The World Health Organization has identified the use of alcohol as the third leading risk factor when it comes to noncommunicable diseases, which cause about 2.5 million deaths worldwide every year.
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South China Morning Post (China) - Call for crackdown on teenage alcohol abuse
The government is being urged to take a tougher stance on a growing youth drinking problem by reinstating a wine duty or imposing age restrictions.
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Medscape - Liver Cancer is 'Largely Amenable to Primary Prevention'
"Hepatocellular carcinoma, one of the most lethal human cancers, is largely amenable to primary prevention with existing knowledge and technology," according to American researchers. They report a study showing strong links between liver cancer and the modifiable risk factors of smoking, heavy alcohol consumption, and obesity, and between liver cancer and chronic infection with hepatitis B and C.
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Herald Scotland (Scotland/France) - There is a strong case for taxing fizzy drinks, perhaps on the French model
While it is difficult for a dentist to disagree with the central thrust of your editorial (“Time to take more of the fizz out of the family diet”, The Herald, October 25), it missed the key issue as did the article (“Fizzy drinks are linked to increased teen violence”, October 25) and indeed the original study which led to it.
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Austrian Independent (Austria) - Beer to become more costly
Beer drinkers may have to brace for price hikes. Officials at Austria’s leading breweries admitted considering price increases in the foreseeable future after Germany’s biggest producer of the beverage decided to jack up its prices.
Read more (Italy) - Report: Youth drinking a problem in Italy
Italians are generally drinking less although consumption is up among the country's young people, a report by an Italian think-tank says.
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Scotland's minimum pricing plans outlined

The Scottish National Party (SNP) has outlined its plans to introduce a minimum price per unit of alcohol. The Minimum Pricing Bill has not yet set out the proposed price but has commissioned further work by the University of Sheffield to model its likely impact. The SNP's previous attempt at a 45 pence minimum price was blocked by opposition parties when the SNP had a smaller majority. > > > > Read More

Tuesday, November 1, 2011

News Release - Alcohol Consumption Over a Woman’s Lifetime Associated With Risk of Breast Cancer

Consumption of 3 to 6 alcoholic drinks per week is associated with a small increase in the risk of breast cancer, and consumption in both earlier and later adult life is also associated with an increased risk, according to a study in the November 2 issue of JAMA.

“In many studies, higher consumption of alcohol has been associated with an increased risk of breast cancer. However, the effect of low levels of drinking as is common in the United States has not been well quantified,” according to background information in the article. “In addition, the role of drinking patterns (i.e., frequency of drinking and ‘binge’ drinking) and consumption at different times of adult life are not well understood.”

Wendy Y. Chen, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues examined the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption. The study included 105,986 women enrolled in the Nurses' Health Study who were followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments. The primary outcome the researchers measured was the risk of developing invasive breast cancer.

During the follow-up period, there were 7,690 cases of invasive breast cancer diagnosed among the study participants. Analyses of data indicated that a low level of alcohol consumption (5.0 to 9.9 grams per day, equivalent to 3-6 glasses of wine per week) was modestly but statistically significantly associated with a 15 percent increased risk of breast cancer. In addition, women who consumed at least 30 grams of alcohol daily on average (at least 2 drinks per day) had a 51 percent increased risk of breast cancer compared with women who never consumed alcohol. > > > > Read More

Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk

Multiple studies have linked alcohol consumption to breast cancer risk, but the risk of lower levels of consumption has not been well quantified. In addition, the role of drinking patterns (ie, frequency of drinking and “binge” drinking) and consumption at different times of adult life are not well understood.

To evaluate the association of breast cancer with alcohol consumption during adult life, including quantity, frequency, and age at consumption.

Prospective observational study of 105 986 women enrolled in the Nurses' Health Study followed up from 1980 until 2008 with an early adult alcohol assessment and 8 updated alcohol assessments.

Relative risks of developing invasive breast cancer.

During 2.4 million person-years of follow-up, 7690 cases of invasive breast cancer were diagnosed. Increasing alcohol consumption was associated with increased breast cancer risk that was statistically significant at levels as low as 5.0 to 9.9 g per day, equivalent to 3 to 6 drinks per week (relative risk, 1.15; 95% CI, 1.06-1.24; 333 cases/100 000 person-years). Binge drinking, but not frequency of drinking, was associated with breast cancer risk after controlling for cumulative alcohol intake. Alcohol intake both earlier and later in adult life was independently associated with risk.

Low levels of alcohol consumption were associated with a small increase in breast cancer risk, with the most consistent measure being cumulative alcohol intake throughout adult life. Alcohol intake both earlier and later in adult life was independently associated with risk.

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