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.


Friday, June 1, 2012

Contrasting medical models of alcohol problems in Victoria around 1900

This paper examines four specialist medical inebriety institutions in Victoria, Australia between 1870 and 1930, which positioned themselves in distinct ways. It analyses how the treatment in each institution was located within wider medical approaches and contemporary medical ideas and practice.

Medical journals and texts, newspaper articles, government reports and institutional archives are used in the analysis.

Alcohol treatment institutions in the late 19th and early 20th centuries were of several types, differentiated according to treatment approaches and their underlying premises as to the nature of the disease being treated, the particular patient groups for which they catered and their funding models and capacity to take patients committed for treatment under legislation. The institutional types identified in other Anglophone countries in this period can be extended to Australia, with some local variations in the timing of the appearance of the models, the longevity of institutions and gender of patients. In Australia there was no tradition of mutual patient support, as seen at the time in the United States. Each institution represented itself differently, in particular in terms of its particular medical model, although the treatments in practice differed less than in theory. The models employed allowed each institution to position itself in relation to trends in medical theory and practice, in particular to different conceptualizations of the type of disease being treated. Evaluating treatment models for alcohol problems in terms of medical theory and practice of the time can explain contrasting approaches.

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Alcohol licensing in Scotland: a historical overview

This paper provides a historical overview of licensing law in Scotland. It seeks to put important contemporary policy developments into their historical context and to draw attention to key themes in licensing policy debates across the United Kingdom.

Based on a survey of statutes, commissions of enquiry and consumption and retail data, this paper draws together historical evidence to present a synopsis of Scottish licensing history.

The article focuses on Scotland, but also discusses UK-wide licensing policy over a 250-year period.

Scottish licensing has diverged from licensing in England and Wales and has addressed some historical licensing weaknesses, including problems of accountability, overprovision and systemic oversight regarding off-sales. Distinctive features of current Scottish legislation include public health protection as a statutory licensing objective; local Licensing Forums and Licensing Standards Officers; a requirement for explicit policies on the ‘overprovision’ of licensed premises; mandatory restrictions on price promotions in the on- and off-trades; and limitations on opening hours for off-licences.

Scotland has developed alcohol policies several times addressing long-standing licensing weaknesses throughout the United Kingdom. Some Scottish alcohol policies have later become the norm in England and Wales

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Alcohol Research UK reports: Internet influences on adolescents; Gender, Alcohol & interventions; Identifiying promising approaches to reducing alcoho

Reports recently published from Alcohol Research UK include:

Internet Influences on Adolescent Attitudes to Alcohol
This study, carried out by the Institute of Alcohol Studies, examined the characteristics and influence of actual Internet content experienced by young people.

Gender, Alcohol and Interventions

This research, led by Dr Richard de Visser at Sussex University, was co-funded with Comic Relief and investigated how gender attributes and attitudes affect young men’s and women’s alcohol use, and whether different health promotion interventions were required for young men and women.

Identifying promising approaches and initiaties to reducing alcohol related harm

This project, co-funded by the Joseph Rowntree Foundation and led by Dr Rachel Herring at Middlesex University, aimed to identify promising approaches that could be included in multi-component programmes (MCPs) to reduce alcohol related harm at local level in the UK. Following on from this study, the group held a workshop in March this year to explore the experiences of working with ‘Frequent Flyers’, who form a set of clients repeatedly admitted to hospital or attending A&E for treatment for alcohol-related conditions. > > > > Read More

Global Actions June 1, 2012

Key Recent Milestones:

· Worldwide: ICAP has released a comprehensive reference guide to publications, policy tools, and briefings: ICAP Resources. The guide provides links to resources for use in addressing particular issues relating to policy and interventions.

Global Actions in Focus: Self-Regulation in Mexico

Self-Regulation initiatives are moving along in Mexico with a recent industry milestone. In May, the Board of Self-Regulation and Ethics (CONAR) and the Commission of the Wine and Spirit Industry (CIVyL) gathered in Mexico City to sign an agreement for the administration of a code of advertising standards for development and sale of alcoholic beverages in Mexico.

The Federal Commission for Protection against Health Risks (COFEPRIS) and the Social Research Foundation AC (FISAC) were present to witness the signing.

The contract represents a commitment of the wine and spirits industry to ensure full compliance with the advertising self-regulatory code signed in January 2012 with COFEPRIS. Under the agreement, CONAR will act as administrator among members of CIVyL and COFEPRIS in activities arranged by the Code of Advertising Standards.

ICAP’s Brett Bivans spoke about the importance of trust between government, industry, and marketers. “This agreement shows the leadership of the signatories to the future,” Bivans said.

President of CIVyL Santaella Randy McCann said the agreement reflects a job well done between society, industry, and government.

“The CONAR-CIVyL agreement is the culmination of over two years work and represents a turning point in alcohol self-regulation in Mexico,” said Stephen Loerke, Managing Director of the World Federation of Advertisers (WFA). WFA looks forward to working closely with CONAR and our other partners in implementing this agreement.”

COFEPRIS Commisioner Mikel Arriola Penalosa spoke about the importance of a self-regulation agreement. “This is one of the best tools we have for purposes of facilitating the free exchange of goods and services,” he said.

What’s Happening Next:

· Belgium: The Global Road Safety Partnership (GRSP) will hold its annual meeting in Belgium on June 1. ICAP’s Brett Bivans will be among the participants. ICAP is a founding member of GRSP

California Court of Appeal Invalidates Distilled Spirits Regulations

According to the California Third District Court of Appeal ruling in Diageo-Guinness USA, Inc., et al. v. State Board of Equalization, California’s Alcoholic Beverage Tax Regulations 2558, 2558.1, 2559, 2559.1, 2559.3, and 2559.5, defining “distilled spirits” and “wine” for taxation purposes have been invalidated.

Manufacturers, wine growers and importers should return to the prior practice of reporting beer, wine and distilled spirits transactions for alcoholic beverage tax purposes consistent with the classifications established by the Department of Alcoholic Beverage Control. Manufacturers, wine growers and importers of these beer and wine products are hereby advised to stop reporting these products at the higher distilled spirits tax rate effective immediately.
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Interactive Effects of Childhood Maltreatment and Recent Stressful Life Events on Alcohol Consumption in Adulthood

Childhood maltreatment is associated with early alcohol use initiation, alcohol-related problem behaviors, and alcohol use disorders in adulthood. Heavy drinking risk among individuals exposed to childhood maltreatment could be partly attributable to stress sensitization, whereby early adversity leads to psychobiological changes that heighten sensitivity to subsequent stressors and increase risk for stress-related drinking. We addressed this issue by examining whether the association between past-year stressful life events and past-year drinking density, a weighted quantity–frequency measure of alcohol consumption, was stronger among adults exposed to childhood maltreatment.

Drinking density, stressful life events, and child maltreatment were assessed using structured clinical interviews in a sample of 4,038 male and female participants ages 20–58 years from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders. Stress sensitization was examined using hierarchical multiple regression analyses to test whether stressful events moderated the association between maltreatment and drinking density. Analyses were stratified by sex and whether the impact was different for independent stressful events or dependent stressful events as related to a participant's actions.

Independent stressful events were associated with heavier drinking density among women exposed to maltreatment. In contrast, drinking density was roughly the same across independent stressful life events exposure among women not exposed to maltreatment. There was little evidence for Maltreatment × Independent Stressor interactions in men or Maltreatment × Dependent Stressor interactions in either gender.

Early maltreatment may have direct effects on vulnerability to stress-related drinking among women, particularly in association with stressors that are out of one's control.

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Associations Between Adolescent Heavy Drinking and Problem Drinking in Early Adulthood: Implications for Prevention

We assessed how heavy episodic drinking (HED) in adolescence (Time 1) was related to hazardous drinking as well as symptoms of alcohol problems and dependence in early adulthood (Time 2). The key question was to what extent preventive measures targeted at underage HED may have a potential to reduce problem drinking in early adulthood. \

Data are from the 1992 (Time 1, ages 14–17 years) and 2005 (Time 2) waves of the Young in Norway Longitudinal Study (N = 1,764). In addition to odds ratios and relative risks, we calculated population-attributable fractions to estimate how the prevalence of hazardous drinking and alcohol problems in early adulthood would be affected if adolescent HED at various frequencies were eliminated. The results were adjusted for age, gender, and measures on impulsivity and delinquency.

The risk of problem drinking at Time 2 increased with increasing frequency of HED at Time 1, but a great deal of discontinuity in drinking behaviors was also observed. The population-attributable fractions indicated that if all instances of HED at Time 1 were eliminated, the expected reduction in hazardous drinking and alcohol problems at Time 2 would be 11% and 15%, respectively.

Because of a marked discontinuity in drinking behaviors from adolescence to early adulthood, the potential long-term effects of interventions targeted at HED among youth are likely to be limited.

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Alcohol Use at Time of Injury and Survival Following Traumatic Brain Injury: Results From the National Trauma Data Bank

Premised on biological evidence from animal research, recent clinical studies have, for the most part, concluded that elevated blood alcohol concentration levels are independently associated with higher survival or decreased mortality in patients with moderate to severe traumatic brain injury (TBI). This study aims to provide some counterevidence to this claim and to further future investigations.

Incident data were drawn from the largest U.S. trauma registry, the National Trauma Data Bank, for emergency department admission years 2002–2006. TBI was identified according to the National Trauma Data Banks definition using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), codes. To eliminate confounding, the exact matching method was used to match alcohol-positive with alcohol-negative incidents on sex, age, race/ethnicity, and facility. Logistic regression compared in-hospital mortality between 44,043 alcohol-positive and 59,817 matched alcohol-negative TBI incidents, with and without causes and intents of TBI and Injury Severity Score as covariates. A sensitivity analysis was performed within a subsample of isolated moderate to severe TBI incidents.

Alcohol use at the time of injury was found to be significantly associated with an increased risk for TBI. Including varied causes and intents of TBI and Injury Severity Score as potential confounders in the regression model explained away the statistical significance of the seemingly protective effect of alcohol against TBI mortality for all TBIs and for isolated moderate to severe TBIs.

The null finding shows that the purported reduction in TBI mortality attributed to positive blood alcohol likely is attributable to residual confounding. Accordingly, the risk of TBI associated with alcohol use should not be overlooked.

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Posttraumatic Stress Disorder Symptoms Mediate the Relationship Between Traumatic Experiences and Drinking Behavior Among Women Attending Alcohol-Serv

South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship.

A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0–7) and drinking behavior.

The mean Alcohol Use Disorders Identification Test score in the sample was 12.15 (range: 0–34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT ≥ 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3),with 20.9% meeting symptom criteria for PTSD (PTSD Checklist with 20.9% meeting symptom criteria for PTSD (PTSD Checklist–Civilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior.

Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas.

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Factors Associated With First Utilization of Different Types of Care for Alcohol Problems

The purpose of this research was to investigate whether factors associated with first obtaining care for alcohol problems vary by source of care.

This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions to examine initiation of different types of care over a 3-year follow-up interval among individuals with baseline alcohol use disorders who had not previously obtained any care (n = 2,170). Three hierarchical, mutually exclusive types of care were compared: substance use disorder (SUD) specialty sources, general medical but no SUD specialty sources, and nonmedical sources only.

Having injured oneself or someone else because of drinking was associated with initiating all three types of care. Additional factors associated with initiating care from SUD specialty treatment sources (vs. no care) comprised male sex, alcohol use disorder severity, major financial problems, and nondependent tobacco/drug use. Factors associated with initiating care from general medical but not SUD specialty sources (vs. no care) comprised marriage/cohabitation, college student status, number of medical conditions, and other substance dependence. Factors associated with obtaining care only from nonmedical sources (vs. no care) comprised low income and anxiety disorder. When direct comparisons were made among types of care, factors drawing individuals into general medical care for reasons not necessarily related to alcohol problems were those that primarily distinguished utilization of general medical sources from the other two types of care.

Results support the importance of screening in general medical practice and student health services as an important means of identifying individuals in need of brief intervention or more intensive SUD treatment and reiterate the importance of nonmedical sources for individuals whose alcohol problems might never be addressed in routine medical visits

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Theme of the conference is combatting over-serving and public drunkenness. Several enforcement experts present their most successful law enforcement methods and strategies. Key peaker of the conference is Professor Mark Bellis. Director of the Centre for Public Health (at Liverpool John Moores University).

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Thursday, May 31, 2012

Combining Abuse and Dependence in DSM-5

Dear Editor:
The conceptual formulations of Griffith Edwards’s dependence syndrome (Edwards and Gross, 1976) have had an enormous influence on the measurement of substance use disorders, particularly regarding the formulations of the alcohol and drug dependence categories in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R; American Psychiatric Association, 1987), DSM-IV (American Psychiatric Association, 1994), and
the International Classification of Diseases, 10th Revision (ICD-10; World Health Organization, 1992). In a thoughtful letter (Edwards, 2012—p. 699 this issue), Dr. Edwards asks several important questions about substance use disorders in DSM-5. We are currently preparing a review article that goes into these issues and others in considerable detail. However,in the meantime, responding now to the specific issues raised by Dr. Edwards provides the rationale for some of the DSM- 5 changes more rapidly and to a wider audience than would otherwise be possible, and this format also allows presentation
of the material in a more narrative fashion.

Dr. O’Brien has responded regarding the terminology for the disorders (O’Brien, 2012—p. 705 this issue). Here, I address the concern about combining abuse and dependence, thereby eliminating the abuse category.
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Editor’s Corner: Editorial in Reply to the Comments of Griffith Edwards

I HAVE HAD THE GOOD FORTUNE to serve on the Substance Use Disorders Work Groups for both the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994), and the DSM-5. Each committee met regularly for about 5 years, and in the decade of discussions I observed compromises that are likely to be inherent in any decision-making process. Through that experience, I formed some opinions about the
diagnostic manuals (these are my thoughts and not necessarily those of the Journal or of the DSM-5 Work Group), and this editorial reflects my view of things, not a golden “truth”with which everyone is likely to agree.

I write this editorial after reading Griffith Edwards’s
(2012—p. 699 this issue) well-written and thought-provoking letter to the editor and the two responses from Drs. O’Brien (2012—p. 705 this issue) and Hasin (2012—p. 702 this issue). The following are some of my own reflections and biases on the important issues raised by Griffith.
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Rationale for Changes in DSM-5

Dear Editor:
Thank you for the opportunity to respond to Professor Edwards’s (2012—p. 699 this issue) interesting commentary on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). As usual, he has written a letter that is at once erudite, thoughtful, and informative. I would like to explain that his position on “dependence” is a rare example of two long-time friends in disagreement. I spend a good deal of time teaching medical students and general physicians about addictive disorders. It is not easy to explain why compulsive drug-taking behavior is called “dependence” in DSM-IV (American Psychiatric Association, 1994) and is known in the vernacular as “addiction,” whereas “dependence” in a patient strictly following doctor’s orders is considered “normal” even while the patient is becoming tolerant to beta-blockers for hypertension, antidepressants for a mood disorder, benzodiazepines for anxiety, or opioids for pain. In the course of medical treatment for pain, when
tolerance and withdrawal are observed, the average physician concludes, “dependence equals addiction” and begins
to restrict the analgesic, resulting in needless suffering on the part of the patient.
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CORRESPONDENCE “The Evil Genius of the Habit”: DSM-5 Seen in Historical Context

Dear Editor:
In 1804, Thomas Trotter published a founding text on alcohol problems (Trotter, 1804). His advice to physicians was that it would inevitably be of no avail to treat a drinker’s gout, gastritis, or any other of the then-recognized alcoholrelated disorders if the practitioner failed to deal with what he termed “the evil genius of the habit” (p. 178). Trotter used that evocative phrase to identify a syndrome, the elements of which he detailed. He saw “habit” as the pathological basis
for the recognizable clinical entity that he designated as “a disease of the mind” (p. 179). He did not, however, introduce any new terminology for this condition, but rested content ith “the habit of drunkenness” (p. 181). The quest to find a name for Trotter’s syndrome, and the status to be given it, continues to this day, most recently with the debate provoked by the proposed handling of the topic in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) (Addiction, Vol. 106, pp. 866–897). This letter
will attempt to give current concerns their historical context before commenting on the present situation. > > > > Read More

The 2011 ESPAD Report

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15–16-year-old European students in order to monitor trends within as well as between countries.

So far, five data-collection waves have been conducted in the framework of the project. The first study was carried out in 26 countries in 1995, while data collection in 2011 was performed in 37 countries. However, results for 2011 are available only for 36 countries, since the Isle of Man collected data but unfortunately did not have the possibility to deliver any results.

This summary presents key results from the 2011 survey in the ESPAD countries as well as findings regarding the long-term trends. An initial section gives a short overview of the methodology.

Full report

Extended Summary - EMCDDA

Statistics on Alcohol: England, 2011

This statistical report acts as a reference point for health issues relating to alcohol use and misuse, providing information obtained from a number of sources in a user-friendly format. It covers topics such as drinking habits and behaviours among adults (aged 16 and over) and school children (aged 11 to 15), drinking-related ill health and mortality, affordability of alcohol and alcohol-related costs. The report contains previously published information and also includes additional new analyses. The new analyses are mainly obtained from The NHS Information Centre's Hospital Episodes Statistics (HES) system and Prescribing data. The report also include up to date information on the latest alcohol related government policies and targets and contains links to further sources of useful information.

Key facts

  • In England, in 2009, 69 per cent of men and 55 per cent of women (aged 16 and over) reported drinking an alcoholic drink on at least one day in the week prior to interview. 10 per cent of men and 6 per cent of women reported drinking on every day in the previous week.
  • There has been an increase from 54 per cent in 1997 to 75 per cent in 2009 in the percentage of people in Great Britain who had heard of daily drinking limits. Throughout the period, differences between men and women have been slight.
  • In 2007, 33 per cent of men and 16 per cent of women (24 per cent of adults) were classified as hazardous drinkers. This includes 6 per cent of men and 2 per cent of women estimated to be harmful drinkers, the most serious form of hazardous drinking, which means that damage to health is likely.
  • Among adults aged 16 to 74, 9 per cent of men and 4 per cent of women showed some signs of alcohol dependence. The prevalence of alcohol dependence is slightly lower for men than it was in 2000 when 11.5 per cent of men showed some signs of dependence. There was no significant change for women between 2000 and 2007.
  • In 2009/10, there were 1,057,000 alcohol related admissions to hospital. This is an increase of 12 per cent on the 2008/09 figure (945,500) and more than twice as many as in 2002/03 (510,800).
  • In 2010, there were 160,181 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 6 per cent on the 2009 figure (150,445) and an increase of 56 per cent on the 2003 figure (102,741).
  • In 2010, 290 prescription items per 100,000 population were dispensed for alcohol dependency in England. Among Strategic Health Authorities (SHAs) this varied from 515 and 410 items per 100,000 population in North West SHA and North East SHA respectively, to 130 items per 100,000 population in London SHA.
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Cut alcohol intake to just a quarter pint of beer a day, experts advise

People should drink just a half unit of alcohol daily in order to cut the number of deaths from cancer, liver disease and other conditions linked to drinking, health experts are urging.

The government's safe drinking guidelines should be revised downwards to make the recommended limits much closer to half a unit – the equivalent of barely a quarter of a pint of lager – they say.

Current official advice is that women should drink no more than two or three units of alcohol a day up to a maximum of 14 units a week and men no more than three or four units daily and no more than 21 units weekly, though that is being reviewed and may be changed.

But the half-unit suggestion, made in a new study in the medical journal BMJ Open, sparked claims that the idea is "extreme" and will be disregarded as unrealistic. > > > > Read More

Alcohol harms you, others and the society - why does Europe need an alcohol strategy?

Date: 27th June
Time: 9h00 till 12h00
Place: European Parliament, Brussels

The current EU Alcohol Strategy is coming to an end in 2012. However Europe is still the world’s heaviest drinking region. Alcohol is the world’s number one risk factor for ill-health and premature death amongst the 25 – 59 year old age group, a core of the working age population.

Alcohol is an economic commodity that crosses borders and several elements related to alcohol policy must be solved at the European level.

This event will build on the Call for Action from 88 health and social NGOs from across Europe and will be an opportunity to address the issue in the European Parliament to ensure continuation of the efforts to tackle alcohol related harm.

Alcohol harms you, others and the society - why does Europe need an alcohol strategy?

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High Versus Low Level of Response to Alcohol: Evidence of Differential Reactivity to Emotional Stimuli

The low level of response (LR) or sensitivity to alcohol is genetically influenced and predicts heavy drinking and alcohol problems. Functional magnetic resonance imaging (fMRI) studies using cognitive tasks suggest that subjects with a low-LR process cognitive information differently after placebo and alcohol than those with a high LR, but no studies have evaluated whether similar LR group differences are seen during an emotional processing task.

The fMRI data were gathered from 116 nonalcoholic subjects (60 women) after oral placebo or approximately .7 mL/kg of ethanol while performing a modified emotional faces processing task. These included 58 low- and high-LR pairs matched on demography and aspects of substance use.

Blood alcohol levels and task performance were similar across LR groups, but low-LR subjects consumed approximately .8 drinks more/occasion. Thirteen brain regions (mostly the middle and inferior frontal gyri, cingulate, and insula) showed significant LR group or LR × placebo/alcohol condition interactions for emotional (mostly happy) faces relative to non-face trials. Low-LR subjects generally showed decreasing blood-oxygen level-dependent response contrasts across placebo to alcohol, whereas high LR showed increasing contrasts from placebo to alcohol, even after controlling for drinking quantities and alcohol-related changes in cerebral blood flow.

Thus, LR group fMRI differences are as prominent during an emotional face task as during cognitive paradigms. Low-LR individuals processed both types of information in a manner that might contribute to an impaired ability to recognize modest levels of alcohol intoxication in a range of life situations.

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Male Germline Transmits Fetal Alcohol Adverse Effect on Hypothalamic Proopiomelanocortin Gene Across Generations

Neurons containing proopiomelanocortin (POMC)-derived peptides, known to control stress axis, metabolic, and immune functions, have a lower function in patients with a family history of alcoholism, raising the possibility that alcohol effects on the POMC system may transmit through generations. Here we describe epigenetic modifications of Pomc gene that transmit through generation via male germline and may be critically involved in alcoholism-inherited diseases.

Whether an epigenetic mechanism is involved in causing a Pomc expression deficit in fetal alcohol-exposed rats is studied by determining Pomc gene methylation, expression, and functional abnormalities and their normalization following suppression of DNA methylation or histone acetylation. Additionally, transgenerational studies were conducted to evaluate the germline-transmitted effect of alcohol.

Fetal alcohol-exposed male and female rat offspring showed a significant deficit in POMC neuronal functions. Associated with this was an increased methylation status of several CpG dinucleotides in the proximal part of the Pomc promoter region and altered level of histone-modifying proteins and DNA methyltransferases levels in POMC neurons. Suppression of histone deacetylation and DNA methylation normalized Pomc expression and functional abnormalities. Fetal alcohol-induced Pomc gene methylation, expression, and functional defects persisted in the F2 and F3 male but not in female germline. Additionally, the hypermethylated Pomc gene was detected in sperm of fetal alcohol-exposed F1 offspring that was transmitted through F3 generation via male germline.

Trangenerational epigenetic studies should spur new insight into the biological mechanisms that influence the sex-dependent difference in genetic risk of alcoholism-inherited diseases.

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Wednesday, May 30, 2012

What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average cons

To estimate the impact of achieving alternative average population alcohol consumption levels on chronic disease mortality in England.

A macro-simulation model was built to simultaneously estimate the number of deaths from coronary heart disease, stroke, hypertensive disease, diabetes, liver cirrhosis, epilepsy and five cancers that would be averted or delayed annually as a result of changes in alcohol consumption among English adults. Counterfactual scenarios assessed the impact on alcohol-related mortalities of changing (1) the median alcohol consumption of drinkers and (2) the percentage of non-drinkers.

Risk relationships were drawn from published meta-analyses. Age- and sex-specific distributions of alcohol consumption (grams per day) for the English population in 2006 were drawn from the General Household Survey 2006, and age-, sex- and cause-specific mortality data for 2006 were provided by the Office for National Statistics.

The optimum median consumption level for drinkers in the model was 5 g/day (about half a unit), which would avert or delay 4579 (2544 to 6590) deaths per year. Approximately equal numbers of deaths from cancers and liver disease would be delayed or averted (∼2800 for each), while there was a small increase in cardiovascular mortality. The model showed no benefit in terms of reduced mortality when the proportion of non-drinkers in the population was increased.

Current government recommendations for alcohol consumption are well above the level likely to minimise chronic disease. Public health targets should aim for a reduction in population alcohol consumption in order to reduce chronic disease mortality.

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Alterations of Homocysteine Serum Levels during Alcohol Withdrawal Are Influenced by Folate and Riboflavin: Results from the German Investigation on N

Various studies have shown that plasma homocysteine (HCY) serum levels are elevated in actively drinking alcohol-dependent patients a during alcohol withdrawal, while rapidly declining during abstinence. Hyperhomocysteinemia has been associated not only with blood alcohol concentration (BAC), but also with deficiency of different B-vitamins, particularly folate, pyridoxine and cobalamin.

Our study included 168 inpatients (110 men, 58 women) after admission for detoxification treatment. BAC, folate, cobalamin, pyridoxine, thiamine and riboflavin were obtained on admission (Day 1). HCY was assessed on Days 1, 7 and 11.

HCY levels significantly declined during withdrawal. General linear models and linear regression analysis showed an influence of BAC, folate and riboflavin on the HCY levels on admission as well as on HCY changes occurring during alcohol withdrawal. No significant influence was found for thiamine, cobalamin and pyridoxine.

These findings show that not only BAC and plasma folate levels, but also plasma levels of riboflavin influence HCY plasma levels in alcohol-dependent patients.

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Study on the affordability of alcoholic beverages in the EU

The European Commission DG SANCO has published a study on the affordability of alcoholic beverages in the EU, with a focus on excise duty pass-through, on- and off-trade sales, price promotions and pricing regulations.

The new study focused on the following four areas of inquiry:

  • the link between changes in excise duties and changes in alcohol consumer prices
  • the trends in the ratio of on-trade to off-trade consumption of alcohol, and their drivers

  • the scale of alcohol price promotions and discounts in the on- and off-trade across the EU

  • regulations in Member States on price promotions and discounts, their compliance and effectiveness.

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Dual orexin receptor antagonism by almorexant does not potentiate impairing effects of alcohol in humans

The orexin system plays a pivotal role in the regulation of the sleep/wake state. Almorexant is a selective, orally available dual orexin receptor antagonist. This study evaluated the pharmacokinetic (PK) and pharmacodynamic (PD) interactions between almorexant (200 mg p.o.) and alcohol (0.6 g/L i.v. ethanol clamp for 5 h) using various cognitive and psychomotor performance tests in healthy subjects (n=20; 10 males and 10 females) in a 4-way crossover study.

No effect of almorexant on ethanol PK was observed. The effects of ethanol on the PK of almorexant were limited, its exposure (AUC) increased by 21%; the median difference in
tmax was 1.2 h; t1/2 and Cmax of almorexant were unchanged.

Almorexant showed decreases in adaptive tracking performance, saccadic peak velocity, and subjective alertness as assessed by visual analog scale (VAS) of Bond and Lader, but had no or small effects on smooth pursuit eye movements, body sway, VAS for alcohol intoxication, and a memory test.

Almorexant administered together with ethanol showed additive effects for adaptive tracking performance, saccadic peak velocity, subjective alertness and, possibly, calmness, but not on body sway, smooth pursuit, VAS for alcohol intoxication, or memory testing.

To conclude, administration of almorexant together with ethanol was associated with additive effects for some of the measured cognitive and psychomotor performance tests. No indications of synergistic effects of almorexant and ethanol for any measured variable were observed.

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Trauma and posttraumatic stress symptoms predict alcohol and other drug consequence trajectories in the first year of college.

College matriculation begins a period of transition into adulthood, one that is marked by new freedoms and responsibilities. This transition also is marked by an escalation in heavy drinking and other drug use as well as a variety of use-related negative consequences. Trauma and symptoms of posttraumatic stress disorder (PTSD) may affect alcohol and drug problems and, thus, may be a point of intervention. Yet, no studies have examined trauma, PTSD, and alcohol and drug problem associations during this developmental period. The present study provides such an examination.

Matriculating college students (N = 997) completed surveys in September (Time 1) and at 5 subsequent time points (Time 2–Time 6) over their 1st year of college. With latent growth analysis, trajectories of alcohol- and drug-related consequences were modeled to examine how trauma (No Criterion A Trauma, Criterion A Only, No PTSD Symptoms) and PTSD (partial or full) symptom status predicted these trajectories.

Results showed substantial risk for alcohol- and other drug-related negative consequences that is conferred by the presence of PTSD at matriculation. Those with both partial and full PTSD started the year with more alcohol and drug consequences. These individuals showed a steeper decrease in consequences in the 1st semester, which leveled off as the year progressed. Both alcohol and drug consequences remained higher for those in the PTSD group throughout the academic year. Hyperarousal symptoms showed unique effects on substance consequence trajectories. Risk patterns were consistent for both partial and full PTSD symptom presentations. Trajectories did not vary by gender.

Interventions that offer support and resources to students entering college with PTSD may help to ameliorate problem substance use and may ultimately facilitate a stronger transition into college and beyond.

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Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change.

Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence.

The present study is a secondary analysis of data from the COMBINE study (COMBINE Study Research Group, 2003), a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the present study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n = 776; 31% female, 23% non-White, average age = 44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to 1 year following treatment.

Participants (n = 302) who received drink refusal skills training had significantly fewer drinking days during treatment (d = 0.50) and up to 1 year following treatment (d = 0.23). In addition, the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47).

Drink refusal training is an effective component of CBI, and some of the effectiveness may be attributed to changes in client self-efficacy.

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North East has highest rate of Young People in alcohol treatment say Balance

Balance North East say the region has the highest rate of young people under 18 years old in specialist alcohol treatment in England - more than twice the national rate. Balance are calling for people to sign a petition to protect children and young people from alcohol advertising.

In the North East more than 600 young people were in treatment in 2010-2011, 7% of the total number of all people in treatment in the region. Colin Shevills, Director of Balance, stated the "Our children are vulnerable, with a higher likelihood of being a victim of crime, of unprotected sex, saying yes to drugs and damaging their education and potentially their future." > > > > Read More

Acute Ethanol Does Not Always Affect Delay Discounting in Rats Selected to Prefer or Avoid Ethanol

The purpose of this study was to determine whether animals predisposed to prefer alcohol possess an altered acute response to alcohol on a delay discounting task relative to animals predisposed to avoid alcohol.

We used rats selected to prefer or avoid alcohol to assess whether genotype moderates changes in delay discounting induced by acute ethanol exposure. Selectively bred rat lines of Sardinian alcohol-preferring (sP; n = 8) and non-preferring (sNP; n = 8) rats, and alko alcohol (AA, n = 8) and alko non-alcohol (ANA, n = 8) rats were trained in an adjusting amount task to assess delay discounting.

There were no significant effects of line on baseline discounting; however, both lines of alcohol-preferring rats exhibit slowed reaction times. Acute ethanol (0, 0.25, 0.5 g/kg) treatment also had no effect on delay discounting in any of the selectively bred rat lines.

Our data indicate that in these lines of animals, alcohol preference or avoidance has no impact on delay discounting following acute ethanol exposure. It is possible that other genetic models or lines may be differentially affected by alcohol and exhibit qualitatively and quantitatively different responses in delay discounting tasks.

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Tuesday, May 29, 2012

People in Recovery from Addictions and Mental Health Problems in Dialogue Building Bridges

Recaps a meeting to consider a unified definition of recovery that would capture the essential experiences of individuals recovering from addictions or mental illness.

Summarizes dialogue themes, outcomes, and recommendations for further consideration.

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Caffeinated Alcohol Beverages: A Public Health Concern

Consumption of alcohol mixed with caffeinated energy drinks is becoming popular, and the number of pre-mixed caffeinated alcohol products on the worldwide market is increasing.

There is public health concern and even occasional legal restriction relating to these drinks, due to associations with increased intoxication and harms.

The precise nature and degree of the pharmacological relationship between caffeine and alcohol is not yet elucidated, but it is proposed that caffeine attenuates the sedative effects of alcohol intoxication while leaving motor and cognitive impairment unaffected. This creates a potentially precarious scenario for users who may underestimate their level of intoxication and impairment.

While legislation in some countries has restricted production or marketing of pre-mixed products, many individuals mix their own energy drink-alcohol ‘cocktails’.

Wider dissemination of the risks might help balance marketing strategies that over-emphasize putative positive effect.

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Why the Scots die younger: Synthesizing the evidence

To identify explanations for the higher mortality in Scotland relative to other European countries, and to synthesize those best supported by evidence into an overall explanatory framework.

Review and dialectical synthesis.

Candidate hypotheses were identified based on a literature review and a series of research dissemination events. Each hypothesis was described and critically evaluated in relation to the Bradford-Hill criteria for causation in observational epidemiology. A synthesis of the more convincing hypotheses was then attempted using a broadly ‘dialectical’ approach.

Seventeen hypotheses were identified including: artefactual explanations (deprivation, migration); ‘downstream explanations’ (genetics, health behaviours, individual values); ‘midstream’ explanations (substance misuse; culture of boundlessness and alienation; family, gender relations and parenting differences; lower social capital; sectarianism; culture of limited social mobility; health service supply or demand; deprivation concentration); and ‘upstream’ explanations (climate, inequalities, de-industrialization, political attack). There is little evidence available to determine why mortality rates diverged between Scotland and other European countries between 1950 and 1980, but the most plausible explanations at present link to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality has been driven by unfavourable health behaviours, and it seems quite likely that these are linked to an intensifying climate of conflict, injustice and disempowerment. This is best explained by developing a synthesis beginning from the political attack hypothesis, which suggests that the neoliberal policies implemented from 1979 onwards across the UK disproportionately affected the Scottish population.

The reasons for the high Scottish mortality between 1950 and 1980 are unclear, but may be linked to particular industrial, employment, housing and cultural patterns. From 1980 onwards, the higher mortality is most likely to be accounted for by a synthesis which begins from the changed political context of the 1980s, and the consequent hopelessness and community disruption experienced. This may have relevance to faltering health improvement in other countries, such as the USA.

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Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five Eu

The aim of this study was to investigate the association of perceived stress, depressive symptoms and religiosity with frequent alcohol consumption and problem drinking among freshmen university students from five European countries.

2529 university freshmen (mean age 20.37, 64.9% females) from Germany (n=654), Poland (n=561), Bulgaria (n=688), the UK (n=311) and Slovakia (n=315) completed a questionnaire containing the modified Beck Depression Inventory for measuring depressive symptoms, the Cohen's perceived stress scale for measuring perceived stress, the CAGE-questionnaire for measuring problem drinking and questions concerning frequency of alcohol use and the personal importance of religious faith.

Neither perceived stress nor depressive symptoms were associated with a high frequency of drinking (several times per week), but were associated with problem drinking. Religiosity (personal importance of faith) was associated with a lower risk for both alcohol-related variables among females. There were also country differences in the relationship between perceived stress and problem drinking.

The association between perceived stress and depressive symptoms on the one side and problem drinking on the other demonstrates the importance of intervention programs to improve the coping with stress.

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Deep Brain Stimulation of Nucleus Accumbens Region in Alcoholism Affects Reward Processing

The influence of bilateral deep brain stimulation (DBS) of the nucleus nucleus (NAcc) on the processing of reward in a gambling paradigm was investigated using H2[15O]-PET (positron emission tomography) in a 38-year-old man treated for severe alcohol addiction.

Behavioral data analysis revealed a less risky, more careful choice behavior under active DBS compared to DBS switched off. PET showed win- and loss-related activations in the paracingulate cortex, temporal poles, precuneus and hippocampus under active DBS, brain areas that have been implicated in action monitoring and behavioral control. Except for the temporal pole these activations were not seen when DBS was deactivated.

These findings suggest that DBS of the NAcc may act partially by improving behavioral control.

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Cdc42-Dependent Activation of NADPH Oxidase Is Involved in Ethanol-Induced Neuronal Oxidative Stress

It has been suggested that excessive reactive oxygen species (ROS) and oxidative stress play an important role in ethanol-induced damage to both the developing and mature central nervous system (CNS). The mechanisms underlying ethanol-induced neuronal ROS, however, remain unclear.

In this study, we investigated the role of NADPH oxidase (NOX) in ethanol-induced ROS generation.

We demonstrated that ethanol activated NOX and inhibition of NOX reduced ethanol-promoted ROS generation. Ethanol significantly increased the expression of p47phox and p67phox, the essential subunits for NOX activation in cultured neuronal cells and the cerebral cortex of infant mice. Ethanol caused serine phosphorylation and membrane translocation of p47phox and p67phox, which were prerequisites for NOX assembly and activation.

Knocking down p47phox with the small interfering RNA was sufficient to attenuate ethanol-induced ROS production and ameliorate ethanol-mediated oxidative damage, which is indicated by a decrease in protein oxidation and lipid peroxidation.

Ethanol activated cell division cycle 42 (Cdc42) and overexpression of a dominant negative (DN) Cdc42 abrogate ethanol-induced NOX activation and ROS generation.

These results suggest that Cdc42-dependent NOX activation mediates ethanol-induced oxidative damages to neurons.

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Monday, May 28, 2012

The Economic Gains of Achieving Reduced Alcohol Consumption Targets for Australia

To inform prevention policy, we estimated the economic benefits to health, production, and leisure in the 2008 Australian population of a realistic target reduction in per capita annual adult alcohol consumption.

We chose a target of 6.4 liters annually per capita on average. We modeled lifetime health benefits as fewer incident cases of alcohol-related disease, deaths, and disability adjusted life years. We estimated production gains with surveyed participation and absenteeism rates. We valued gains with friction cost and human capital methods. We estimated and valued household production and leisure gains from time-use surveys.

A reduction of 3.4 liters of alcohol consumed annually per capita would result in one third fewer incident cases of disease (98 000), deaths (380), working days lost (5 million), days of home-based production lost (54 000), and a A$ 789-million health sector cost reduction. Workforce production had a A$ 427 million gain when we used the friction cost method. By contrast, we estimated a loss of 28 000 leisure days and 1000 additional early retirements.

Economic savings and health benefits from reduced alcohol consumption may be substantial—particularly in the health sector with reduced alcohol-related disease and injury.

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