Editor's Notes

Editor's Notes

A message from Robert West, Editor-in-Chief

It is with great sadness that I have to announce that Professor Griffith Edwards has died. Griffith was a towering figure in our field and he was active in the journal and filled with extra-ordinary intellectual and creative energy to the end. We will be setting up a number of projects to respect his memory and take his vision forward. If you wish to send message of goodwill to his family, please email Gill Rangel: gill@addictionjournal.org

Blood Alcohol Levels for American Indian Mothers and Newborns

Very little is known about the alcohol elimination rates of newborns who have had chronic alcohol exposure in utero.

In these case reports, blood alcohol levels were taken immediately before delivery, at delivery, and postdelivery for 2 mothers who drank alcohol during their pregnancies and 3 single-birth newborns.

Newborn A1 of Mother A had no physical characteristics of fetal alcohol syndrome (FAS). The initial blood alcohol level for this newborn was 38.4 mg/dL 129 minutes after birth, with a subsequent blood alcohol level of 5.5 mg/dL 304 minutes after delivery, resulting in an alcohol elimination rate of 11.3 mg/dL per hour. The blood alcohol level for Mother A was 87.4 mg/dL 66 minutes before delivery.

Newborn A2 of mother A had FAS. Sixty minutes after delivery, the blood alcohol level for this newborn was 39.5 mg/dL, and the alcohol level of the mother was 42.1 mg/dL.

Newborn B1 of mother B had FAS. At 67 minutes after birth, newborn B1 had a blood alcohol level of 246.5 mg/dL, which dropped to 178.7 mg/dL 302 minutes after birth, resulting in an alcohol elimination rate of 17.3 mg/dL per hour. This alcohol elimination rate is within the metabolism range (15–49 mg/dL per hour) of adults with alcoholism. The maternal blood alcohol level was 265.9 mg/dL 27 minutes before delivery.

Blood alcohol levels drawn on both the mother and newborn at delivery and 2 or 3 hourly follow-up levels can provide evidence that fetal alcohol dehydrogenase activity is induced by chronic maternal alcohol use.


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Global Actions September 13, 2012

Key Recent Milestones:

· Worldwide: More speakers have been added to the agenda for the international conference Global Actions: Initiatives to Reduce Harmful Drinking to be held October 8 and 9, 2012 in Washington, D.C. Visit the event website for a full agenda.

Global Actions in Focus: Drink Driving Progress in China

Global Actions drink driving initiatives are progressing in Xi’an and Nanjing, China with successful public awareness campaigns in place. Education materials have been widely distributed in both cities and major media outlets have reported on the campaigns.

A total of 40,000 fans containing drink driving safety education information were distributed to primary and middle school students in Xi’an (see photo). Billboards and posters have been set up at bus stations, taxi companies, and driver schools, and 3,000 fans distributed to drivers and passengers.

Education information is now available on flat panel displays (pictured) in the back seats of 15,000 taxis in Xi’an. In addition, the Xi’an Health Inspection Station has distributed 4,000 posters to catering and entertainment venues.

Similar interventions are being implemented in Nanjing, with 23,000 educational brochures given to drivers, and billboards set up at vehicle inspection stations. In residential areas throughout Nanjing, 27,000 brochures have been handed to citizens. Five one-hour lectures were organized and administered to over 200 drink driving offenders.

Local media outreach is a key component of the campaign. Xi’an’s television station welcomed Xi’an Bureau of Public Security’s Mr. Tianjun, Xi’an Hospital Deputy Director Ms. Zhi Yiqin, and Xi’an Institute for Health Education Director Ms. Chen as invited guests. Newspapers, television, and radio stations across Xi’an and Nanjing have lent support with extensive coverage of the initiatives.

Enhanced enforcement operations by traffic police are currently underway in both cities. Global Actions partners in this initiative include the Nanjing Traffic Management Bureau and the Xi’an Institute for Health Education.


What’s Happening Next:

· France: The second HEC Paris Workshop on “Regulation: Regulating Lifestyle Risks in Europe - The Case of Alcohol, Tobacco, Unhealthy Diets & Gambling” will take place September 20 and 21, 2012. Visit the HEC website for program information.

Efficacy of brief alcohol screening intervention for college students (basics): a meta-analysis of randomized controlled trials

Many studies reported that brief interventions are effective in reducing excessive drinking. This study aimed to assess the efficacy of a protocol of brief intervention for college students (BASICS), delivered face-to-face, to reduce risky alcohol consumption and negative consequences.

A systematic review with meta-analysis was performed by searching for randomized controlled trials (RCTs) in Medline, PsycInfo, Web of Science and Cochrane Library databases. A quality assessment of RCTs was made by using a validated scale. Combined mean effect sizes, using meta-analysis random-effects models, were calculated.

18 studies were included in the review. The sample sizes ranged from 54 to 1275 (median = 212). All studies presented a good evaluation of methodological quality and four were found to have excellent quality. After approximately 12 months of follow-up, students receiving BASICS showed a significant reduction in alcohol consumption (difference between means = -1.50 drinks per week, 95% CI: -3.24 to -0.29) and alcohol-related problems (difference between means = -0.87, 95% CI: -1.58 to -0.20) compared to controls.

Overall, BASICS lowered both alcohol consumption and negative consequences in college students. Gender and peer factors seem to play an important role as moderators of behavior change in college drinking. Characteristics of BASICS procedure have been evaluated as more favorable and acceptable by students in comparison with others interventions or control conditions. Considerations for future researches were discussed.

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Willing consumers? Alcohol Concern Cyrmu 2012 marketing conference presentations

Presentations from Alcohol Concern Cymru's annual conference on 6 September 2012 have been made available. The event explored 'how alcohol marketing promotes a positive image of drinking, and how we can effectively challenge it' and received coverage on Wales Online and the BBC.

Presentations included:

• Andrew Misell, Alcohol Concern Cymru Manager: Alcohol marketing in Wales
• Maran Waran, London School of Marketing: Marketing fundamentals
• Gerard Hastings, Stirling School of Management: Alcohol marketing
• Alan Tapp and Katie Collins, Bristol Social Marketing Centre: Social marketing techniques to achieve social good
• Tom Smith, Alcohol Concern Youth Policy Project: Young people challenging alcohol marketing
• Colin Shevills, Balance North-East: Sam's snaps: Hitting them where it hurts
• Conference agenda

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Heavy alcohol intake and intracerebral hemorrhage Characteristics and effect on outcome

To identify associated factors and influence on long-term outcome of heavy alcohol intake in a large prospective cohort of consecutive patients with a spontaneous intracerebral hemorrhage (ICH).

Between November 2004 and March 2009, we prospectively recruited 562 consecutive adults with a spontaneous ICH. We excluded patients without information on drinking habit (n = 22). Heavy alcohol intake was defined as a regular consumption of more than 300 g alcohol/week. We performed bivariate and multivariate analyses (logistic regression) based on demographic and radiologic models. Survival analyses were performed using Kaplan-Meier statistics.

Among 540 patients with ICH, 137 (25) were heavy alcohol drinkers (median age 60 vs 74 years in nonabusers; p < 0.0001). In the multivariate demographic model, heavy alcohol drinkers were less likely to be older (odds ratio [OR] 0.97 per 1-year increase, 95% confidence interval [CI] 0.95−0.98) and to have a history of ischemic heart disease (OR 0.34, 95% CI 0.15−0.77) and more likely to be smokers (OR 3.96, 95% CI 2.43−6.46). In the radiologic model, independent factors were nonlobar location of ICH (OR 1.71, 95% CI 1.05−2.77) and less severe leukoaraiosis (OR 0.76 per 1-step increase, 95%CI 0.62−0.73). Platelet counts and prothrombin ratio were significantly lower among heavy alcohol drinkers (respectively, p = 0.01 and p = 0.017). Heavy alcohol intake was predictive of 2 years mortality only among patients younger than 60 years with nonlobar ICH (hazard ratio 1.96, 95% CI 1.06−3.63).

Heavy alcohol intake is associated with the occurrence of ICH at a young age. However, the underlying vasculopathy remains unexplored in these patients. Indirect markers suggest small-vessel disease at an early stage that might be enhanced by moderate hemostatic disorders.

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Request Reprint E-Mail: charlotte.cordonnier@chru-lille.fr

Webcast - Building Communities of Recovery: How Community-Based Partnerships and Recovery Support Organizations Make Recovery Work

The goal of recovery is for individuals to lead successful, satisfying, and healthy lives integrated in the community. This requires the availability of prevention, healthcare, treatment and recovery support services.

Community-based organizations play a vital role in addressing the diverse needs of people in recovery from mental and/or substance use disorders. Partnerships and networks within communities serve to leverage the particular contribution that individual community-based organizations have to offer.
Recovery support organizations, those that focus on the recovery needs of individuals, are becoming an increasingly important part of the solution. Housing, employment, education, and socialization are all pieces of the puzzle the fit together to achieve overall behavioral health objectives.

This show will describe how communities are organizing and networking to provide recovery support. The show will also highlight efforts to change the culture of communities to accept and embrace people in recovery.


Complete Program

Order the program from the SAMHSA Store

Probing the Modulation of Acute Ethanol Intoxication by Pharmacological Manipulation of the NMDAR Glycine Co-Agonist Site

Stimulating the glycine_B binding site on the N-methyl-d-aspartate ionotropic glutamate receptor (NMDAR) has been proposed as a novel mechanism for modulating behavioral effects of ethanol (EtOH) that are mediated via the NMDAR, including acute intoxication. Here, we pharmacologically interrogated this hypothesis in mice.

Effects of systemic injection of the glycine_B agonist, d-serine, the GlyT-1 glycine transporter inhibitor, ALX-5407, and the glycine_B antagonist, L-701,324, were tested for the effects on EtOH-induced ataxia, hypothermia, and loss of righting reflex (LORR) duration in C57BL/6J (B6) and 129S1/SvImJ (S1) inbred mice. Effects of the glycine_B partial agonist, d-cycloserine (DCS), the GlyT-1 inhibitor, N-[3-(4′-fluorophenyl)-3-(4′-phenylphenoxy)propyl]sarcosine (NFPS), and the glycine_B antagonist, 5,7-dichlorokynurenic (DCKA), on EtOH-induced LORR duration were also tested. Interaction effects on EtOH-induced LORR duration were examined via combined treatment with d-serine and ALX-5407, d-serine and MK-801, d-serine and L-701,324, as well as L-701,324 and ALX-5407, in B6 mice, and d-serine in GluN2A and PSD-95 knockout mice. The effect of dietary depletion of magnesium (Mg), an element that interacts with the glycine_B site, was also tested.

Neither d-serine, DCS, ALX-5407, nor NFPS significantly affected EtOH intoxication on any of the measures or strains studied. L-701,324, but not DCKA, dose-dependently potentiated the ataxia-inducing effects of EtOH and increased EtOH-induced (but not pentobarbital-induced) LORR duration. d-serine did not have interactive effects on EtOH-induced LORR duration when combined with ALX-5407. The EtOH-potentiating effects of L-701,324, but not MK-801, on LORR duration were prevented by d-serine, but not ALX-5407. Mg depletion potentiated LORR duration in B6 mice and was lethal in a large proportion of S1 mice.

Glycine_B site activation failed to produce the hypothesized reduction in EtOH intoxication across a range of measures and genetic strains, but blockade of the glycine_B site potentiated EtOH intoxication. These data suggest endogenous activity at the glycine_B opposes EtOH intoxication, but it may be difficult to pharmacologically augment this action, at least in nondependent subjects, perhaps because of physiological saturation of the glycine_B site.

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Request Reprint E-Mail: andrew.holmes@nih.gov

Chronic alcohol remodels prefrontal neurons and disrupts NMDAR-mediated fear extinction encoding

Alcoholism is frequently co-morbid with post-traumatic stress disorder, but it is unclear how alcohol affects the neural circuits mediating recovery from trauma.

We found that chronic intermittent ethanol (CIE) impaired fear extinction and remodeled the dendritic arbor of medial prefrontal cortical (mPFC) neurons in mice. CIE impaired extinction encoding by infralimbic mPFC neurons in vivo and functionally downregulated burst-mediating NMDA GluN1 receptors.

These findings suggest that alcohol may increase risk for trauma-related anxiety disorders by disrupting mPFC-mediated extinction of fear.

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Request Reprint E-Mail: holmesan@mail.nih.gov

Towards Measuring Brain Function on Groups of People in the Real World

In three studies, EEGs from three groups of participants were recorded during progressively more real world situations after drinking alcoholic beverages that brought breath alcohol contents near the limit for driving in California 30 minutes after drinking.

A simple equation that measured neurophysiological effects of alcohol in the first group of 15 participants performing repetitive cognitive tasks was applied to a second group of 15 operating an automobile driving simulator, and to a third group of 10 ambulatory people recorded simultaneously during a cocktail party.

The equation derived from the first group quantified alcohol’s effect by combining measures of higher frequency (beta) and lower frequency (theta) power into a single score. It produced an Area Under the Receiver Operator Characteristic Curve of .73 (p<.05; 67% sensitivity in recognizing alcohol and 87% specificity in recognizing placebo). Applying the same equation to the second group operating the driving simulator, AUC was .95, (p<.0001; 93% sensitivity and 73% specificity), while for the cocktail party group AUC was .87 (p<.01; 80% sensitivity and 80% specificity).

EEG scores were significantly related to breath alcohol content in all studies. Some individuals differed markedly from the overall response evident in their respective groups.

The feasibility of measuring the neurophysiological effect of a psychoactive substance from an entire group of ambulatory people at a cocktail party suggests that future studies may be able to fruitfully apply brain function measures derived under rigorously controlled laboratory conditions to assess drug effects on groups of people interacting in real world situations.


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The 10 Year Course of AA Participation and Long-Term Outcomes: A Follow-up Study of Outpatient Subjects in Project MATCH

This study investigates the 10-year course and impact of AA-related helping (AAH), step-work, and meeting attendance on long-term outcomes.

Data were derived from 226 treatment-seeking alcoholics recruited from an outpatient site in Project MATCH and followed for 10 years post-treatment. Alcohol consumption, AA participation, and other-oriented behavior were assessed at baseline, end of the 3-month treatment period, and one year, three years, and 10 years post-treatment.

Controlling for explanatory baseline and time-varying variables, results showed significant direct effects of AAH and meeting attendance on reduced alcohol outcomes and a direct effect of AAH on improved other-oriented interest.



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Request Reprint E-Mail: maria.pagano@case.edu

Conference - Alcohol and Dementia: improving understanding and practice

Where : Iris Murdoch Building, University of Stirling

When : 20th November 2012 (9 30 am - 3 15 pm)

Aim of the event

The conference aims to improve practitioner’s knowledge and understanding of the links between alcohol and dementia and of conditions that fall under the umbrella of alcohol related brain damage (ARBD). The conference will also provide evidence of best practice in services for people with ARBD that will enable attendees to improve care and support for people with ARBD in their own area.

Who is it for?

Health and social care professionals supporting people with dementia and staff working in addiction services.

This event will also be of interest to members of alcohol & drug partnership groups and voluntary organisations.

Summary of event:

Evidence would suggest that the numbers of people with ARBD are increasing and as a result of this the condition is increasingly recognised by policy makers and practitioners alike. The focus of the conference is individuals with cognitive impairment, probably dementia, which has resulted from alcohol consumption. There are many terms for such conditions so the catch-all term of ARBD is used to encompass these. Treatment, care and support for this group can be challenging and in the past individuals have often fallen between existing services: dementia services can’t manage as the individual has alcohol problems and alcohol services can’t manage as the person has cognitive impairment. However, this is changing and there are growing numbers of specialist practitioners and services developing across the UK and this is reflected in the speakers at this conference.

The conference brings together a multi-disciplinary group of academics and practitioners and the presentations will provide opportunities for improved knowledge, understanding and practice for attendees. The speakers include clinicians providing diagnosis, assessment, and ongoing support and rehabilitation; practitioners who provide care and support for people with ARBD; as well as academics from social and biological sciences. This mix of presenters will ensure that a broad range of knowledge and best practice is presented.

This event will cover:

• Alcohol and dementia, an overview
• Cognitive/neuropsychological rehabilitation for people with ARBD
• Designing environments for people with ARBD
• Training frontline staff to work with people with ARBD
• Case management for people with ARBD
• Nutrition, alcohol and the brain
  
  

Additional Information

Alcohol News - 36/2012

Science a Gogo - Alcohol rewires brain for PTSD

Heavy drinking appears to impair the brain's ability to recover from trauma and may put people at greater risk for post-traumatic stress disorder (PTSD), say scientists from the University of North Carolina and the National Institute on Alcohol Abuse and Alcoholism.
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BBC News (Scotland) - NHS report says Scots are drinking less alcohol

People in Scotland are drinking less alcohol, according to an NHS report analysing retail sales.

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Medical News Today - Alcohol-Related Liver Diseases Detected With Blood Test

A color-coded "traffic light" blood test can diagnose liver cirrhosis and fibrosis in heavy alcohol drinkers much more easily and accurately than present diagnostic approaches, researchers from the University of Southampton and Southampton General Hospital, England, reported in the British Journal of General Practice.

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GoodTherapy.org - Alcohol Use and Conduct Disorder in Adolescence Predicts Antisocial Behavior

Adult antisocial behavior (ASB) has been studied extensively in recent years. Determining the factors that contribute to and predict the onset of ASB is essential in order to identify those most at risk. In existing research, links between ASB and adolescent and childhood conduct disorder (CD) have been found.

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Technorati - A Single Sip of Alcohol Could put Children at Risk of Alcoholism

Parents often think that letting their children have a sip of alcohol at home is a safe way to promote responsible drinking but this could put their child at future risk.

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Counsel & Heal - Alcohol Permanently Damages Blood Stem Cells

A new study by researchers from the Medical Research Council (MRC) Laboratory of Molecular Biology claims that stem cells in the body's 'blood cell factory' -the bone marrow - are extremely sensitive to the main byproduct of alcohol, which causes a permanent damage to their DNA.

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Toronto Star (Canada) - Turning around Ontario lives hurt by fetal alcohol spectrum disorder

Fetal alcohol spectrum disorder is the most common of developmental disabilities, affecting an estimated one in 100 Canadians or 130,000 Ontarians. But this province lags far behind the rest of the country in addressing this complex yet preventable disability, and is unnecessarily relegating far too many people to the margins of society.

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BBC News (UK) - MPs demand action on lost alcohol taxation

The UK's tax authorities should prosecute more people for alcohol smuggling, a committee of MPs says. The Public Accounts Committee says there were no more than six successful prosecutions each year, in the four years to 2009-10.

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Donegal Democrat (Ireland) - ‘The more drink is available, 
the more people will drink’ - Dr Gerry Lane, consultant

Dr Gerry Lane, a consultant in emergency medicine at Letterkenny General Hospital, is widely known and respected for his unflinching honesty in a national road safety campaign on television. This week, he was equally hard-hitting about the effects of excess drink on people of all ages in Donegal.

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New Zealand Herald (New Zealand) - Alcohol reformers keep pushing

MPs and lobby groups say once-in-a-generation alcohol reforms must be salvaged after one of the core measures was defeated in Parliament.

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Voxy (New Zealand) - National MP admits Govt looking after alcohol industry

Nikki Kaye, National MP for Auckland Central, speaking on national television this morning (TV1 Breakfast) admitted that the government has the well-being of the alcohol industry very much in mind as it manages the current alcohol reform process.

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British Journal of Psychiatry (UK) - The price of a drink: the potential of alcohol minimum unit pricing as a public health measure in the UK

The UK has seen a dramatic increase in alcohol consumption and alcohol-related harm over the past 30 years.

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Addressing Substance Abuse and Violence in Substance Use Disorder Treatment and Batterer Intervention Programs

Substance use disorders and perpetration of intimate partner violence (IPV) are interrelated, major public health problems.

We surveyed directors of a sample of substance use disorder treatment programs (SUDPs; N=241) and batterer intervention programs (BIPs; N=235) in California (70% response rate) to examine the extent to which SUDPs address IPV, and BIPs address substance abuse.

Generally, SUDPs were not addressing co-occurring IPV perpetration in a formal and comprehensive way. Few had a policy requiring assessment of potential clients, or monitoring of admitted clients, for violence perpetration; almost one-quarter did not admit potential clients who had perpetrated IPV, and only 20% had a component or track to address violence. About one-third suspended or terminated clients engaging in violence. The most common barriers to SUDPs providing IPV services were that violence prevention was not part of the program's mission, staff lacked training in violence, and the lack of reimbursement mechanisms for such services. In contrast, BIPs tended to address substance abuse in a more formal and comprehensive way; e.g., one-half had a policy requiring potential clients to be assessed, two-thirds required monitoring of substance abuse among admitted clients, and almost one-half had a component or track to address substance abuse. SUDPs had clients with fewer resources (marriage, employment, income, housing), and more severe problems (both alcohol and drug use disorders, dual substance use and other mental health disorders, HIV+ status). We found little evidence that services are centralized for individuals with both substance abuse and violence problems, even though most SUDP and BIP directors agreed that help for both problems should be obtained simultaneously in separate programs.

SUDPs may have difficulty addressing violence because they have a clientele with relatively few resources and more complex psychological and medical needs. However, policy change can modify barriers to treatment integration and service linkage, such as reimbursement restrictions and lack of staff training.


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