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, August 16, 2013

A Genome-Wide Association Study of Behavioral Disinhibition

We report results from a genome wide association study (GWAS) of five quantitative indicators of behavioral disinhibition: nicotine, alcohol consumption, alcohol dependence, illicit drugs, and non-substance related behavioral disinhibition.

The sample, consisting of 7,188 Caucasian individuals clustered in 2,300 nuclear families, was genotyped on over 520,000 SNP markers from Illumina’s Human 660W-Quad Array.

Analysis of individual SNP associations revealed only one marker-component phenotype association, between rs1868152 and illicit drugs, with a p value below the standard genome-wide threshold of 5 × 10−8. Because we had analyzed five separate phenotypes, we do not consider this single association to be significant.

However, we report 13 SNPs that were associated at p < 10−5 for one phenotype and p < 10−3 for at least two other phenotypes, which are potential candidates for future investigations of variants associated with general behavioral disinhibition.
Biometric analysis of the twin and family data yielded estimates of additive heritability for the component phenotypes ranging from 49 to 70 %, GCTA estimates of heritability for the same phenotypes ranged from 8 to 37 %.

Consequently, even though the common variants genotyped on the GWAS array appear in aggregate to account for a sizable proportion of heritable effects in multiple indicators of behavioral disinhibition, our data suggest that most of the additive heritability remains “missing”.

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ICAP Blue Book

The ICAP Blue Book: Practical Guides for Alcohol Policy and Prevention Approaches offers a comprehensive guide to the key issues in alcohol policy development and an integrated approach to prevention. It draws upon the best available research and experience from around the world.

As a policy guide, the ICAP Blue Book is based on three key elements:

  • drinking patterns and their outcomes as a sound scientific basis for policy development;
  • targeted interventions that address specific “at-risk” populations, potentially harmful contexts, and drinking patterns;
  • partnerships that allow the inclusion of the public and private sectors, the community, civil society, and others all working toward a common goal.

The Blue Book is intended as a tool to assist those seeking guidance in developing policy and prevention approaches, be they governments, intergovernmental organizations, public health officials and specialists, researchers, nongovernmental organizations, the beverage alcohol industry and its related bodies, or civil society groups. It can be used to address simple issues or to craft broader and more comprehensive approaches to policy.

The Blue Book is intended to be a living document, taking into account new materials and responsive to the needs of its users.

Thursday, August 15, 2013

New Report Recommends Public Health Focus on Harmful Drinking vs. Eliminating Consumption

 The traditional public health perspective on alcohol and noncommunicable diseases (NCDs) is challenged in a new paper from the International Center for Alcohol Policies (ICAP), Alcohol misuse and global health: The case for an inclusive approach to harmful drinking. ICAP has announced the publication of the paper as part of a collection of submissions on the role of health in the post-2015 development agenda. This new agenda, the World We Want, follows on from the Millennium Development Goals.

"The setting of a post-2015 development agenda offers a unique opportunity to bring non-communicable diseases into the next iteration of Millennium Development Goals," said ICAP President Marcus Grant, co-author of the submission. "As we have that discussion, it is important to note that the traditional public health perspective on alcohol consumption has focused on a narrow group of stakeholders, and in this paper, we propose a more comprehensive model that involves a broader group of stakeholders and resources, including alcohol producers."

In the past decade, there has been greater recognition of the impact of NCDs in both developed and developing countries. Harmful alcohol consumption is a contributing lifestyle factor for several of the most widespread of these diseases, with alcohol misuse accounting for 4% of global disease burden.  > > > >  Read More

Global Actions: Commitments to Reduce Harmful Drinking August


Global Actions in Focus
stimulants added to alcohol beverages:
Research review and discussion paper
The Stimulants Added to Alcohol Beverages: Research Review and Discussion paper was recently posted on the Beer, Wine and Spirits Producers’ Commitments website. The paper addresses the commitment to provide consumer information and responsible product innovation, and discusses stimulants such as caffeine that are added to beverages, including beverage alcohol.
As outlined in the report, the term “stimulant” refers to substances associated with demonstrable or claimed improvements in cognitive, psychomotor or physical performance, increased alertness or wakefulness, or with energy-giving properties. The most common added stimulant in beverage alcohol is caffeine.
The paper classifies beverages with added stimulants into three categories: “energy drinks,” beverage alcohol mixed with energy drinks, and “caffeinated alcohol beverages.”
Prior to the emergence of energy drinks, caffeine and beverage alcohol were commonly combined through consumption of beverage alcohol with caffeinated mixers or activities such as drinking coffee after a meal with beverage alcohol. In recent years, research has focused on the physiological and behavioral effects of consuming energy drinks mixed with beverage alcohol or premixed alcohol beverages containing caffeine. The report reviews potential interactions between beverage alcohol and caffeine in this context and considers key points of debate raised in the literature. It also addresses how the body processes and metabolizes caffeine and cites research into the time needed to eliminate caffeine from the system.
Key Recent Milestones
· China: The Chinese Center for Disease Control and Prevention (CCDC) and Global Actions hosted a meeting to develop a capacity building toolkit for drink driving prevention in Beijing on August 13, 2013.
What's Happening Next
· USA: ICAP Program Manager Shushanna Mignott will be attending the Roadway Culture Safety Summit, hosted by the Transportation Research Board, in Washington, D.C., on August 20 and 21, 2013. The summit will focus on ways to effectively reduce the number and severity of road traffic crashes.

Half of all drinkers exceed national guidelines

New research has further dispelled the myth that alcohol misuse is confined to a minority of Australians finding that over half (51.6%) of all drinkers consume alcohol in excess of the country’s guidelines.

Produced by the Centre for Alcohol Policy Research (CAPR) the research analysed the 2010 National Drug Strategy Household Survey to identify how many Australian drinkers consume in excess of the National Health and Medical Research Council’s Australian guidelines to reduce health risks from drinking alcohol.

Over the limit: A profile of Australians who drink in excess of the recommended guidelines also found that 25.9 per cent of drinkers consumed alcohol in excess of guideline one, consuming more than two standard drinks per day. Almost half (49%) of Australian drinkers consumed alcohol in excess of guideline two, consuming more than four standard drinks on a single occasion more than once in the previous year, with 40 per cent doing so at least monthly.  > > >  Read More

The importance of age composition of 12-step meetings as a moderating factor in the relation between young adults’ 12-step participation and abstinence

Participation in 12-step mutual help organizations (MHO) is a common continuing care recommendation for adults; however, little is known about the effects of MHO participation among young adults (i.e., ages 18–25 years) for whom the typically older age composition at meetings may serve as a barrier to engagement and benefits. This study examined whether the age composition of 12-step meetings moderated the recovery benefits derived from attending MHOs.

Young adults (n=302; 18–24 years; 26% female; 94% White) enrolled in a naturalistic study of residential treatment effectiveness were assessed at intake, and 3, 6, and 12 months later on 12-step attendance, age composition of attended 12-step groups, and treatment outcome (Percent Days Abstinent [PDA]). Hierarchical linear models (HLM) tested the moderating effect of age composition on PDA concurrently and in lagged models controlling for confounds.

A significant three-way interaction between attendance, age composition, and time was detected in the concurrent (p=0.002), but not lagged, model (b=0.38, p=0.46). Specifically, a similar age composition was helpful early post-treatment among low 12-step attendees, but became detrimental over time.

Treatment and other referral agencies might enhance the likelihood of successful remission and recovery among young adults by locating and initially linking such individuals to age appropriate groups. Once engaged, however, it may be prudent to encourage gradual integration into the broader mixed-age range of 12-step meetings, wherein it is possible that older members may provide the depth and length of sober experience needed to carry young adults forward into long-term recovery.

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Neonatal ethanol exposure results in dose-dependent impairments in the acquisition and timing of the conditioned eyeblink response and altered cerebellar interpositus nucleus and hippocampal CA1 unit activity in adult rats

Exposure to ethanol in neonatal rats results in reduced neuronal numbers in the cerebellar cortex and deep nuclei of juvenile and adult animals. This reduction in cell numbers is correlated with impaired delay eyeblink conditioning (EBC), a simple motor learning task in which a neutral conditioned stimulus (CS; tone) is repeatedly paired with a co-terminating unconditioned stimulus (US; periorbital shock). Across training, cell populations in the interpositus (IP) nucleus model the temporal form of the eyeblink-conditioned response (CR). The hippocampus, though not required for delay EBC, also shows learning-dependent increases in CA1 and CA3 unit activity.

In the present study, rat pups were exposed to 0, 3, 4, or 5 mg/kg/day of ethanol during postnatal days (PD) 4–9. As adults, CR acquisition and timing were assessed during 6 training sessions of delay EBC with a short (280 ms) interstimulus interval (ISI; time from CS onset to US onset) followed by another 6 sessions with a long (880 ms) ISI. Neuronal activity was recorded in the IP and area CA1 during all 12 sessions.

The high-dose rats learned the most slowly and, with the moderate-dose rats, produced the longest CR peak latencies over training to the short ISI. The low dose of alcohol impaired CR performance to the long ISI only. The 3E (3 mg/kg/day of ethanol) and 5E (5 mg/kg/day of ethanol) rats also showed slower-than-normal increases in learning-dependent excitatory unit activity in the IP and CA1. The 4E (4 mg/kg/day of ethanol) rats showed a higher rate of CR production to the long ISI and enhanced IP and CA1 activation when compared to the 3E and 5E rats.

The results indicate that binge-like ethanol exposure in neonatal rats induces long-lasting, dose-dependent deficits in CR acquisition and timing and diminishes conditioning-related neuronal excitation in both the cerebellum and hippocampus.

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Alcohol questionnaires and HDL: Screening scores as scaled markers of alcohol consumption

Improving the quality of alcohol-related care requires practical approaches to assessing alcohol consumption to guide management and monitor outcomes. Given the increasing use of alcohol screening questionnaires to identify alcohol misuse it would be ideal if scores on screening questionnaires were also indicators of average alcohol consumption. However, the questionnaires were not designed for this purpose and include dimensions of drinking that may not reflect average consumption (e.g. heavy episodic drinking, alcohol-related problems)

In a general population sample, scores on the AUDIT-C screen correlated with reports of alcohol consumption in detailed interviews, but the relationship is unknown for clinical populations and other questionnaires. Serum high-density lipoprotein cholesterol (HDL) is a biomarker routinely obtained in clinical care and is known to rise with average alcohol consumption.

This cross-sectional study of 11,175 male U.S. Veterans Affairs patients enrolled in a primary care study used HDL as an objective biomarker to evaluate whether average alcohol consumption increased as scores increased on 3 brief alcohol screens – the AUDIT-C, AUDIT Question #3 (a single-item screen), and the CAGE questionnaire.

Mean HDL progressively increased as screening scores increased for the AUDIT-C and AUDIT Question #3: about 12 mg/dL from the lowest to the highest scores. The association was much weaker for the CAGE questionnaire. Results were minimally affected by adjustment for covariates (e.g. age, race, medical comorbidity, smoking, medication count, and depression) but the association was modified (p = 0.008) and mildly attenuated by adherent use of lipid-lowering medications.

This study using HDL as a biomarker of average alcohol consumption adds to evidence that some alcohol screening scores may also serve as scaled markers of average alcohol consumption.

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Wednesday, August 14, 2013

Minimum pricing: commons briefing note provides policy overview

A Commons standard note on minimum pricing was recently published, outlining 'minimum pricing' terminology and the policy context. 
The briefing includes clarification on the differences between a 'below cost ban' and minimum unit pricing (MUP) and the various policy shifts over recent years. It also covers Scotland, where the SNP are pushing ahead with their MUP plans despitelegal challenges led by the Scotch Whisky Association.
The British Government recently confirmed it would not be introducing minimum unit pricing despite its 2012 commitment. In publishing itsresponse to the alcohol strategy consultation a proposed ban on multi-buy promotions was also dropped. However previous plans for a 'below cost ban' were resurrected alongside other policies, meaning alcohol will not be sold at lower than duty+VAT to 'stop the worst cases of heavy discounting'.  > > >   Read More

A Qualitative Study of Alcohol, Health and Identities among UK Adults in Later Life

Increasing alcohol consumption among older individuals is a public health concern. Lay understandings of health risks and stigma around alcohol problems may explain why public health messages have not reduced rates of heavy drinking in this sector. A qualitative study aimed to elucidate older people's reasoning about drinking in later life and how this interacted with health concerns, in order to inform future, targeted, prevention in this group.

In 2010 a diverse sample of older adults in North East England (ages 50–95) participated in interviews (n = 24, 12 male, 12 female) and three focus groups (participants n = 27, 6 male, 21 female). Data were analysed using grounded theory and discursive psychology methods. When talking about alcohol use older people oriented strongly towards opposed identities of normal or problematic drinker, defined by propriety rather than health considerations. Each of these identities could be applied in older people's accounts of either moderate or heavy drinking.

Older adults portrayed drinking less alcohol as an appropriate response if one experienced impaired health. However continued heavy drinking was also presented as normal behaviour for someone experiencing relative wellbeing in later life, or if ill health was construed as unrelated to alcohol consumption. Older people displayed scepticism about health advice on alcohol when avoiding stigmatised identity as a drinker.

Drinking patterns did not appear to be strongly defined by gender, although some gendered expectations of drinking were described. Identities offer a useful theoretical concept to explain the rises in heavy drinking among older populations, and can inform preventive approaches to tackle this. Interventions should engage and foster positive identities to sustain healthier drinking and encourage at the community level the identification of heavy drinking as neither healthy nor synonymous with dependence.

Future research should test and assess such approaches.

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Excessive Drinking Costs U.S. $223.5 Billion

A new study finds that excessive alcohol consumption cost the United States $223.5 billion in 2006, or about $1.90 per drink. By implementing effective community-based prevention strategies, we can reduce excessive alcohol consumption and its costs.  > > >    Read More

Trend analysis and modelling of gender-specific age, period and birth cohort effects on alcohol abstention and consumption level for drinkers in Great Britain using the General Lifestyle Survey 1984-2009

British alcohol consumption and abstinence rates have substantially increased in the last three decades. This study aims to disentangle age, period and birth cohort effects to improve our understanding of these trends and suggest groups for targeted interventions to reduce resultant harms.
Age, period, cohort analysis of repeated cross-sectional surveys using separate logistic and negative binomial models for each gender.
Britain 1984-2009.
Annual nationally representative samples of approximately 20,000 adults (16+) within 13,000 households.
Age (8 groups: 16-17 to 75+), period (6 groups: 1980-84 to 2005-09) and birth cohorts (19 groups: 1900-1904 to 1990-1994). Outcome measures were abstinence and average weekly alcohol consumption. Controls were income, education, ethnicity and country.
After accounting for period and cohort trends, 18-24 year-olds have the highest consumption levels) and lowest abstention rates. Consumption generally decreases and abstention rates increase in later life. Until recently, successive birth cohorts’ consumption levels were also increasing. However, for those born post-1985, abstention rates are increasing and male consumption is falling relative to preceding cohorts. In contrast, female drinking behaviours have polarised over the study period with increasing abstention rates accompanying increases in drinkers’ consumption levels.
Rising female consumption of alcohol and progression of higher consuming birth cohorts through the life course are key drivers of increased per capita alcohol consumption in the UK. Recent declines in alcohol consumption appear attributable to reduced consumption and increased abstinence rates amongst the most recent birth cohorts, especially males, and general increased rates of abstention across the study period.

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To investigate longitudinally the effect of alcohol consumption and related acute alcohol-related dysfunction on employment status

1143 men aged 25-55 years in regular paid employment and resident in the city of Izhevsk, Russia were interviewed between 2003-6 and then re-interviewed (2008-9) and their employment status ascertained.
Exposures of interest were baseline alcohol intake (yearly total volume of ethanol consumed and non-beverage alcohols) and alcohol-related dysfunction, measured by a latent variable defined in terms of frequency of alcohol-related dysfunctional behaviours and by one or more episodes of zapoi (a period of continuous drunkenness lasting two or more days). The outcome of interest was whether men were still in regular paid employment at follow up. The inter-relationship between these variables was investigated using structural equation modelling.
Total volume of ethanol consumed had no substantive effect on future employment status; however, taking into account education and other socio-demographic factors, there was strong evidence that loss of regular paid employment at follow up was influenced by non-beverage alcohol consumption (odds ratio 2.30 for non-beverage drinkers compared with beverage only drinkers (95% CI 1.21, 4.40)), latent acute alcohol-related dysfunction (odds ratio 1.50 per standard deviation increase in dysfunction score (95% CI 1.20, 1.88)), and zapoi (odd ratio 3.08 (95% CI 1.71, 5.55)). Acute alcohol-related dysfunction was an important mediator of the relationship between non-beverage alcohol use and employment status.
Acute alcohol-related dysfunction is an important factor in determining whether men remain in employment and an important mediator of the effects of alcohol intake.

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Cumulative and Recent Psychiatric Symptoms as Predictors of Substance Use Onset: Does Timing Matter?

We examined two questions about the relationship between conduct disorder (CD), depression, and anxiety symptoms and substance use onset: (1) what is the relative influence of recent and more chronic psychiatric symptoms on alcohol and marijuana use initiation and (2) are there sensitive developmental periods when psychiatric symptoms have a stronger influence on substance use initiation?

Secondary analysis of longitudinal data from the Pittsburgh Youth Study, a cohort study of boys followed annually from 7-19 years of age.
Recruitment occurred in public schools in Pittsburgh, Pennsylvania, USA.
Five hundred and three boys.
The primary outcomes were age of alcohol and marijuana use onset. Discrete-time hazard models were used to determine whether (a) recent (prior year); and (b) cumulative (from age 7 until 2 years prior to substance use onset) psychiatric symptoms were associated with substance use onset.
Recent anxiety symptoms (HR= 1.10, 95% CI=1.03-1.17), recent (HR=1.59, 95% CI=1.35-1.87), cumulative (HR=1.45, 95% CI=1.03-2.03) CD symptoms, and cumulative depression symptoms (HR= 1.04, 95% CI=1.01-1.08) were associated with earlier alcohol use onset. Recent (HR=1.39, 95% CI=1.22-1.58) and cumulative CD symptoms (HR=1.38, 95% CI=1.02-1.85) were associated with marijuana use onset. Recent anxiety symptoms were only associated with alcohol use onset among black participants.
Timing matters in the relationship between psychiatric symptoms and substance use onset in childhood and adolescence, and the psychiatric predictors of onset are substance-specific. There is no single sensitive developmental period for the influence of psychiatric symptoms on alcohol and marijuana use initiation.

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Welcome to the Alcohol Policy Information System

The Alcohol Policy Information System (APIS) provides detailed information on a wide variety of alcohol-related policies in the United States at both State and Federal levels. Detailed, state-by-state, information is available for the 33 policies listed below. APIS also provides a variety of informational resources of interest to alcohol policy researchers and others involved with alcohol policy issues. 

Choose a topic below to see information on a specific policy area:

Beer Taxes
Wine Taxes
Distilled Spirits Taxes
Underage Drinking
Possession/Consumption/Internal Possession
Age of Server-On-Premises
Age of Seller-Off-Premises
Use/Lose: Driving Privileges
Hosting Underage Drinking Parties
False Identification
Blood Alcohol Concentration (BAC) Limits
Adult Drivers
Drivers Under 21
Recreational Boaters
Open Container
Vehicular Insurance: Losses due to Intoxication

Retail Sales
Keg Registration
Beverage Service Training
Sunday Sales
Alcohol Control Systems
Distilled Spirits-Retail
Distilled Spirits-Wholesale
Pregnancy and Alcohol
Warning Signs: Drinking During Pregnancy
Criminal Prosecution
Civil Commitment
Priority Treatment
Child Abuse/Neglect
Reporting Requirements
Health Care Services and Financing
Health Insurance: Losses due to
Intoxication ("UPPL")
Health Insurance Parity


The NSW Government does not estimate or report the total cost of alcohol abuse. The Audit Office of New South Wales’ sponsored research estimates it costs the government over $1 billion a year, or around $416 from each NSW household.   > > > >  Read More

Alcohol consumption and electrocardiographic left ventricular hypertrophy and mediation by elevated blood pressure in older Chinese men: The Guangzhou Biobank Cohort Study

Chinese people have a markedly lower alcohol consumption than people in the West. Whether alcohol consumption at such levels is associated with left ventricular hypertrophy, and the role of blood pressure (BP) in this relationship is unclear. We investigated the association between alcohol consumption and electrocardiographic left ventricular hypertrophy (ECG-LVH) and the mediating role of BP in Chinese men aged ≥50 years.
A case–control analysis was conducted on baseline cross-sectional data from the community-based Guangzhou Biobank Cohort Study (2003–2008), using standard 12-lead resting electrocardiograms. By comparing 191 new ECG-LVH cases with 4311 controls, excessive drinking (>210 g/week) showed excess risks for ECG-LVH (odds ratio [OR] = 1.90, 95% confidence interval [CI] = 1.12–3.24), after adjusting for education, income, occupation, physical activity, smoking, body mass index, fasting glucose, triglyceride, total cholesterol, high-density lipoprotein cholesterol, BP, and antihypertensive medication. Mediation analysis showed a significant mediating effect of BP on the association between excessive drinking and ECG-LVH: systolic (31%) and diastolic (16%). After multivariate adjustment, no significant association was found between occasional drinking (<once/week: OR = 1.20, 95% CI = 0.80–1.80) and moderate drinking (≥once/week to ≤210 g/week: OR = 0.88, 95% CI = 0.53–1.47) with increased/decreased risk of ECG-LVH.
Alcohol consumption at >210 g/week in Chinese men is an independent risk factor for ECG-LVH. Low power prevented us from examining whether drinking at

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Status report on alcohol and health in 35 European countries 2013

People in the WHO European Region consume the most alcohol per head in the world. In the European Union (EU), alcohol accounts for about 120 000 premature deaths per year: 1 in 7 in men and 1 in 13 in women. Most countries in the Region have adopted policies, strategies and plans to reduce alcohol-related harm. In 2012, the WHO Regional Office for Europe collected information on alcohol consumption and related harm, and countries policy responses to contribute to the Global Information System for Alcohol and Health; this report presented a selection of the results for 35 countries – EU Member States and candidate countries, Norway and Switzerland – individually and in groups distinguished by their drinking patterns and traditions.

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