Ethnic differences in drinking outcomes following a brief alcohol intervention in the trauma care setting

Evidence suggests that brief interventions in the trauma care setting reduce drinking, subsequent injury and driving under the influence (DUI) arrest. However, evidence on the effectiveness of these interventions in ethnic minority groups is lacking.

The current study evaluates the efficacy of brief intervention among whites, blacks and Hispanics in the United States.

All three ethnic groups evidenced reductions in drinking at 6- and 12-month follow-up independent of treatment assignment. Among Hispanics, BMI reduced alcohol intake significantly as measured by average volume per week, percentage days heavy drinking and maximum amount consumed in 1 day.

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Request Reprint E-Mail: craig.field@austin.utexas.edu
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Continuities and changes in self-change research

A substantial literature demonstrates that natural recoveries from substance use disorders not only occur but are a common pathway to recovery.

This article reviews selectively and comments on the current state-of-the-art in natural recovery research.

Although considerable progress has occurred in natural recovery research, several topics deserving of further research are identified, and implications for policy practice are discussed.

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Rerquest Reprint E-Mail: harald.klingemann@dgsp.uzh.ch

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Failure to reduce drinking and driving in France: a 6-year prospective study in the GAZEL cohort

An unprecedented decline in alcohol consumption and road mortality has been observed recently in France, but it is still unclear whether or not these changes affected driving while alcohol-intoxicated (DWI).

The objective of the study was to estimate prospectively trends of excessive speed on the roads, alcohol consumption and DWI between 2001 and 2007 in a large cohort of experienced drivers.

A recent crackdown on road violations by the French government has failed to deter DWI. Given that DWI seems to be a sporadic and rarely punished behaviour, its prevention requires more coercive measures, such as using a breath alcohol ignition interlock device.

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Request Reprint E-Mail: aymery.constant@isped.u-bordeaux2.fr ______________________________________

PM under pressure to raise drinking age

A LEADING mental health advocate, Ian Hickie, has called for the Prime Minister to push for the drinking age to be lifted to 19 to break the connection between school leaving and drinking. . . . . .

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Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa

Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked.

Physiological and behavioural research indicates that alcohol independently affects decision-making concerning sex, and skills for negotiating condoms and their correct use.

More than 20 studies in Africa have reported higher occurrence of HIV among people with problem drinking; a finding strongly consistent across studies and similar among women and men. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa.

Reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence.

Brief interventions for people with problem drinking (an important component of primary health care), must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Interventions to reduce alcohol harm among HIV-infected persons are also an important element in positive-prevention initiatives.

Most importantly, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.

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Variance-components methods for linkage and association analysis of ordinal traits in general pedigrees

Many complex human diseases such as alcoholism and cancer are rated on ordinal scales. Well-developed statistical methods for the genetic mapping of quantitative traits may not be appropriate for ordinal traits.

We propose a class of variance-component models for the joint linkage and association analysis of ordinal traits. The proposed models accommodate arbitrary pedigrees and allow covariates and gene-environment interactions.

We develop efficient likelihood-based inference procedures under the proposed models. The maximum likelihood estimators are approximately unbiased, normally distributed, and statistically efficient. Extensive simulation studies demonstrate that the proposed methods perform well in practical situations.

An application to data from the Collaborative Study on the Genetics of Alcoholism is provided.

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Request Reprint E-Mail: gdiao@gmu.edu
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IMPLICATIONS OF COMORBID ALCOHOL DEPENDENCE AMONG INDIVIDUALS WITH SOCIAL ANXIETY DISORDER

Social anxiety disorder (SAD) is highly comorbid with alcohol use disorders (AUD) yet the nature of this comorbidity remains unclear. To better understand these associations, we first examined whether SAD was related to AUD above and beyond relevant covariates. Second, we examined the psychosocial impairment associated with the comorbidity of SAD and AUD versus SAD without AUD. Third, the temporal sequencing of SAD and AUD among comorbid individuals was examined.

Together, these data lend support for the contention that SAD may serve as a risk for alcohol dependence and indicate that the co-occurrence of these two conditions may result in greater personal and public health care costs.

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Dr. Nancy:Sober and drinking?

A new study challenges the core belief of Alcoholics Anonymous that total abstinence is the only way to control an alcohol problem.

Play Video
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A New View of Alcoholism

In her Personal Health column in Science Times, New York Times reporter Jane Brody touches on the issue of how much is too much when it comes to drinking alcohol. This week, Dr. Mark L. Willenbring, director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism and clinical professor of psychiatry at George Washington University School of Medicine, joins the Consults blog to answer readers’ questions about alcoholism. . . . . .

Read More
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How Much is Too Much

For our next report, a key question when it comes to alcohol abuse is How Much is Too Much. To learn more, we talked to Dr. Mark Willenbring, the Director of the Treatment and Recovery Research Division in the National Institute on Alcohol Abuse and Alcohol. His first point stresses the importance of understanding what a drink is…

Play Video
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Past conference presentations

Presentations:

• Preemption in Alcohol Control: Lessons Learned the Hard Way

• Failure of Self-Regulation of Alcohol Advertising

• Public Health and Alcohol Policy - Dispelling Myths, Forging Solutions

• Big Alcohol and Underage Drinking

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Psychological Distress in Non-Drinkers: Associations with Previous Heavy Drinking and Current Social Relationships

The aim of this paper is to investigate two possible explanations for the higher levels of psychological distress observed among alcohol abstainers relative to light and moderate drinkers, and to investigate possible moderating effects of age on this association.

The possible explanations were that: (i) the higher level of psychological distress among abstainers is due to the presence of a subset of former heavy drinkers in this group; and (ii) abstainers have poorer social relationships than light/moderate drinkers.

Significantly increased psychological distress of abstainers compared to light/moderate drinkers was demonstrated only in the oldest age group (40–42 years). The higher distress reported by abstainers in this age group was partially explained by abstainers having poorer social relationships than light/moderate drinkers.

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Request Reprint E-Mail: Nina.Lucas@mcri.edu.au
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Israel Cabinet communique

At the weekly Cabinet meeting on Sunday, 15 November 2009:

1. Prime Minister Benjamin Netanyahu said that today's meeting would be devoted to the national effort to reduce alcohol use, especially among young people. He made the following remarks:

"We face an epidemic. In the last three years there has been a 15% rise in alcohol use in Israel. One-third of all young people between the ages of 12-18 report that they became intoxicated in the past year, which is a terrible statistic. Here is another statistic: Approximately 20% of sixth grade boys claim that they consume an alcoholic drink once a week. Sixth grade. That is the second highest in Europe.

We must act against this. We will take three immediate steps: One, we are initiating a legislative change to restrict the sale of alcohol to minors, expand the ban on alcohol use, and seriously increase the penalty for those who break the law in this respect. Second, we will increase enforcement of the prohibition against alcohol sales in many places. Third, we intend to create a public atmosphere which is against alcohol use, especially amongst youth, by means of various public educational activities. To this end, we will today allocate NIS 27 million for their immediate start. . . . . .

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Alcohol price controls suggested by World Health Organisation

Minimum price controls should be imposed on alcohol and tougher drink-driving laws introduced, policy options circulated by the World Health Organisation (WHO) suggest.

Details in the global consultation process have emerged as the government is resisting demands from health professionals for alcohol to become more expensive.

The draft recommendations – so far not widely distributed – have been released in the run up to a formal decision by member states next year. . . . . .

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The Recovery Revolution: Will it include children, adolescents, and transition age youth?

Systems transformation efforts to shift addiction treatment from a model of acute stabilization to a model of sustained recovery management and to nest addiction treatment within a larger recovery-oriented system of care are underway at federal, state, and local levels, but these innovations to date have focused on the redesign of adult services.

This paper explores the potential and limitations of recovery as an organizing concept for services to children, adolescents, and transition age youth, and offers recommendations on how services for these populations can be integrated into recovery- and resiliency-focused, behavioral health care systems transformation efforts.

Read Full Text (PDF) ____________________________________________

Long-term strategies to reduce the stigma attached to addiction, treatment, and recovery within the City of Philadelphia

The purpose of this document is to:

1) review the historical and scientific research on the social/professional stigma related to addiction, with a particular focus on the stigma experienced by people in medication-assisted treatment and long-term medication-assisted recovery, and

2) outline strategies that could be used by the Philadelphia Department of Behavioral Health and Mental Retardation Services and its many community partners to reduce addiction/recovery-related stigma.

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Exploring productivity outcomes from a brief intervention for at-risk drinking in an employee assistance program.

Brief intervention (BI) research has traditionally examined alcohol and drug use outcomes; however it is unknown whether BIs can also impact on-the-job productivity.

This exploratory study examines changes in workplace productivity and related costs for clients receiving a BI for at-risk drinking in the employee assistance program (EAP).

Participants were 44 clients attending the EAP for behavioral health concerns, screened for at-risk drinking, assigned to BI + Usual Care (n = 25) or UC alone (n = 19), and who completed 3-month follow-up. Absenteeism, presenteeism, and productivity costs were derived as outcomes.

At follow-up, participants in the BI + UC group had improved productivity when at work (presenteeism) compared to the UC group. The estimated cost savings from improved productivity for the BI + UC group was $1200 per client over the UC group. Groups did not differ by absenteeism (missed days of work).

Preliminary evidence suggests the broad impact BIs may have. Implications for future BI research are discussed.

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Request Reprint E-Mail: karenc@rand.org
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News Release - Huge fall in alcohol consumption in first six months of 2009

UK alcohol consumption is falling at the fastest rate for more than 60 years according to new official figures released today by the British Beer & Pub Association (BBPA).

The amount we drink fell by over eight per cent to 3.81 litres per head in the first half of 2009 compared with 4.15 litres per head in the same period of 2008. The last time the nation’s alcohol consumption fell by more than this was during 1948 when it fell by 11 per cent over the course of the year. The numbers are from official HM Revenue & Customs data and have been compiled by the BBPA.

The amount we drink has now been on a strong downward trend for four and a half years, since a peak in 2004. On current trends, by the end of this year, the amount we drink could be down to the levels of ten years ago – 14 per cent down on 2004.

The numbers call into serious question alcohol policies designed to reduce drinking in the whole population, says the BBPA. Claims by some academics and medical lobby groups that a fall in total consumption would lead to significant social benefits, such as a fall in alcohol related hospital admissions, are not being borne out by the facts. . . . . . .

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Upcoming Event - The Social Cost of Alcohol: Passive drinking. 2 December 2009. Brussels

Place: European Parliament – Brussels (Room: tbc)

Date: Wednesday, 2 December 2009
Time: 12h30 – 14h30 (Lunch will be provided)

Drinking alcohol is a deeply ingrained part of the European society; each year, the average intake per adult is equivalent to 1,400 small beers (11 litres of pure alcohol).

The consequences of drinking go far beyond the individual drinker’s health and well-being. They include acts of drunken violence, vandalism, sexual assault, road accidents, harm to the unborn fetus, child abuse, and a huge health burden carried by both the National Health Systems and friends and family who care for those damaged by alcohol.

Each year in Europe, alcohol causes:

• Some 50% of all violent crime to the person
• Some 40% of all domestic violence
• 2,000 homicides (4 in 10 of all murders)
• 10,000 deaths in drink-driving accidents for people other than the drink-driver
• 5 million people born with mental disorders and birth defects because of their mothers’ drinking
• 16% of all child abuse / neglect
• 5-9 million children living in families adversely affected by alcohol

DRAFT PROGRAMME
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Video - NIH Scientific Management Review Board Meeting

The Scientific Management Review Board was authorized by the NIH Reform Act of 2006 and signed into law by the President in January 2007. The NIH Reform Act provides certain organizational authorities to HHS and NIH officials regarding NIH institutes and centers and the Office of the Director. The purpose of the Scientific Management Review Board is to advise HHS and NIH officials on the use of those organizational authorities.

This Working Group of the SMRB is convened to recommend to the full Board whether organizational change within NIH could further optimize research into substance use, abuse, and addiction and maximize human health and/or patient well being. In addressing this issue, the SUAA Working Group will consider the scientific opportunities, public health needs, and research technologies in substance use, abuse, and addiction, in addition to research in these areas under the existing NIH structure.

November 13, 2009, 8:30:00 AM

Runtime:

322 minutes

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Drugs: Guidance for Schools

Drugs: Guidance for Schools provides guidance on all matters relating to drug education, the management of drugs within the school community, supporting the needs of pupils with regard to drugs and drug policy development. The document defines drugs as including alcohol, tobacco and illegal drugs, as well as medicines and volatile substances.

Read the consultation document on-line
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Fighting the ravages of alcoholism

Overconsumption of alcoholic beverages among Vietnamese, especially young ones, is posing a threat to society and the national economy. As much as 4.4 percent of the population is faced with health problems caused by drinking, according to statistics released by the Institute for Medical Policy Strategies. . .. . . .

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Government launches anti-alcohol campaign

The government approved Sunday the national program for the reduction of alcohol consumption at the cost of NIS 27 million (about $7.15 million) over a period of three years. Some NIS 8 million ($2.12 million) will be immediately invested in a public relations campaign to target both teens and adults.

As part of the program's first stage the government is planning to legislate laws for the reduction of alcohol consumption. The second stage will include creating alcohol rehabilitation centers for youths.

In addition, the State is also slated to track teens drinking alcohol in the streets. The second stage will also include the creation of an inter-ministerial committee which will draft recommendations to be submitted to the government within 45 days. . . . . .

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Alcohol is killing Israel

Alcohol consumption in Israel has been on the rise for two decades now. The especially worrisome trend is the fact that the age of people who consume alcohol is gradually declining – 75% percent of boys and 25% of girls in elementary school drink over the weekend at home, or during the week while celebrating outside the house. . . . . .

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Acute ethanol exposure elevates muscarinic tone in the septohippocampal system

The septohippocampal system has been implicated in the cognitive deficits associated with ethanol consumption, but the cellular basis of ethanol action awaits full elucidation. In the MS/DB, a muscarinic tone, reflective of firing activity of resident cholinergic neurons, regulates that of their non-cholinergic, putatively GABAergic, counterparts.

Here we tested the hypothesis that ethanol alters this muscarinic tone.

The spontaneous firing activity of cholinergic and non-cholinergic MS/DB neurons were monitored in acute MS/DB slices from C57Bl/6 mice.

Exposing the entire slice to ethanol increased firing in both cholinergic and non-cholinergic neurons. However, applying ethanol focally to individual MS/DB neurons increased firing only in cholinergic neurons. The differential outcome suggested different mechanisms of ethanol action on cholinergic and non-cholinergic neurons. Indeed, with bath-perfused ethanol, the muscarinic antagonist methyl scopolamine prevented the increase in firing in non-cholinergic, but not cholinergic, MS/DB neurons.

Thus, the effect on non-cholinergic neuronal firing was secondary to ethanol's direct action of acutely increasing muscarinic tone.

We propose that the acute ethanol-induced elevation of muscarinic tone in the MS/DB contributes to the altered net flow of neuronal activity in the septohippocampal system that underlies compromised cognitive function.

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Request Reprint E-Mail: hermes.yeh@dartmouth.edu

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Virtual Reality Cues for Binge Drinking in College Students

We investigated the ability of virtual reality (VR) cue exposure to trigger a desire for alcohol among binge-drinking students.

Fifteen binge-drinking college students and eight students who were nonbingers were immersed into a neutral-cue environment or room (underwater scenes), followed by four alcohol-cue rooms (bar, party, kitchen, argument), followed by a repeat of the neutral room. The virtual rooms were computer generated via head-mounted visual displays with associated auditory and olfactory stimuli. In each room, participants reported their subjective cravings for alcohol, the amount of attention given to the sight and smell of alcohol, and how much they were thinking of drinking. A 2×6 (type of drinker by VR room) repeated measures ANOVA was conducted on the responses to each question.

After alcohol exposure, binge drinkers reported significantly higher cravings for and thoughts of alcohol than nonbinge drinkers, whereas differences between the groups following the neutral rooms were not significant.

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Request Reprint E-Mail: ryan@ucmo.edu
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Changes in Alcohol-Related Mortality and its Socioeconomic Differences After a Large Reduction in Alcohol Prices: A Natural Experiment Based on Regist

The authors examined the effect of a large reduction in the price of alcohol in Finland in 2004 on alcohol-related mortality by age and socioeconomic group.

Alcohol-related mortality increased by 16% among men and by 31% among women; 82% of the increase was due to chronic causes, particularly liver diseases. The increase in absolute terms was largest among men aged 55–59 years and women aged 50–54 years. Among persons aged 30–59 years, it was biggest among the unemployed or early-age pensioners and those with low education, social class, or income. The relative differences in change between the education and social class subgroups were small. The employed and persons aged <35 years did not suffer from increased alcohol-related mortality during the 2 years after the change.

These results imply that a large reduction in the price of alcohol led to substantial increases in alcohol-related mortality, particularly among the less privileged, and in chronic diseases associated with heavy drinking.

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'Make minimum alcohol price 45p per unit'

A GOVERNMENT adviser has called for the minimum price for alcohol to be set at 45p per unit to cover the social, policing and health costs of binge drinking in Scotland.

Professor Anne Ludbrook, the head of Aberdeen University’s health and economics research unit, said the charge was the minimum required to cover the £2.25 billion annual cost of problem drinking. . . . . . .

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Services that manage the care needs of drunk and incapable people: a review of the literature

The Scottish Government have released a review of the literture on 'Services that Manage the Care Needs of Drunk and Incapable People'. From the summary page:

'The main focus of this report is on "sobering-up services" - services which provide an overnight place of safety for people who are identified as intoxicated (either with alcohol or drugs) in a public place, and who are incapable of looking after themselves because of their intoxication. . . . . . .

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New report says Indiana binge drinking rate up

Indiana college students are binge drinking at a rate higher the national average, according to a new report.

A report released Friday by the Indiana Collegiate Action Network found that 48 percent of Hoosier students surveyed reported binge drinking in a two-week period, compared to 40 percent nationally. . . . . . .

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Indiana College Substance Use Survey

Key Findings

Eight in ten Indiana college students reported drinking alcohol in the past year, including three‐fourths of the students under 21 years of age. . . . . .

Three‐fourths (74.6%) of the Indiana students reported using alcohol in the past month, compared to 69% nationally (Johnston et al., 2009). . . . . .

In Indiana, almost half of the students surveyed reported binge drinking in the past two weeks, with male students reporting statistically higher rates than female students. . . . . .

Read Full Report (PDF)
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24-hour drinking 'leaves police dangerously stretched,' warns assistant chief constable

The introduction of 24-hour drinking has backfired as alcohol-fuelled disorder in cities now persists throughout the night leaving police dangerously stretched, an assistant chief constable has warned.

Garry Shewan, of Greater Manchester Police (GMP), called for the legislation to be reversed.

He also warned of the "real risks" associated with recession-busting all-you-can drink "Carnage" nights and cheap alcohol in supermarkets that people buy to get drunk before going out. . . . . . . .

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Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agenc

An evaluation of a two-year project that aimed to move the practice of two specialist substance misuse treatment teams towards greater involvement of family members.

The conclusion is drawn that the project was successful in changing team practice in the desired direction: by the end of the project both teams were capable of acting as demonstration sites for family-oriented alcohol and drug problems treatment.

The paper includes details of the family work conducted and its perceived benefits. Also discussed are the initial barriers to family involvement, a number of issues that remained unresolved, and the question of whether such changes are sustainable.

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Request Reprint E-Mail: j.f.orford@bham.ac.uk
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Fancy a pint?: Alcohol use and smoking in soap operas

This study examined the frequency and portrayal of alcohol use and smoking in soap operas aired on British nonsatellite television.

Fifty-four hours of programing were analyzed, monitoring the type of alcohol act, who was carrying it out, and why, where, and what consequences of the acts were depicted.

Results supported previous findings that illustrate the prominent use of alcohol in popular soaps. More than 90% of the episodes viewed included some alcohol-related acts, with an average of 7.65 acts per episode, most of which were shown without any consequences. Female characters were drinking alcohol more often than expected and were also more likely to drink at home as a short-term means of coping. Alternatively, male characters were more often depicted as social drinkers, with more drinking inside pubs than expected.

The frequency of smoking was also investigated. This was rarely shown in the episodes viewed, with 82.41% of the episodes containing no smoking acts. Eastenders accounted for 78.57% of all smoking acts but even this soap only had, on average, 32 s per episode of smoking in the foreground.

Implications of the findings are discussed with regards to the possible influence on the socialization of younger viewers.

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Request Reprint E-Mail: smcoyne@byu.edu

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The latent structure of alcohol dependence in female federal prisoners

Results obtained from a structured interview of substance abuse diagnoses were subjected to taxometric analysis in a group of 459 low and minimum security female federal prisoners applying for admission to a comprehensive drug treatment program.

Drawing indicators from a DSM-IV diagnosis of alcohol dependence (tolerance/withdrawal, loss of control, negative social/psychological consequences) the authors conducted a taxometric analysis using the following procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIG), and latent mode factor analysis (L-Mode).

Results were generally consistent with taxonic (categorical) latent structure for a DSM-IV diagnosis of alcohol dependence.

The implications and limitations of this study are examined and recommendations for future research are offered.

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Request Reprint E-Mail: gwalters@bop.gov



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Who receives confrontation in recovery houses and when is it experienced as supportive?

The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that measures a construct of confrontation defined as warnings about potential harm associated with alcohol and drug use.

This analysis describes the characteristics of individuals entering residential recovery homes (N = 323) who received confrontation and when it was experienced as supportive.

A large proportion reported receiving at least one confrontational statement (80%), most commonly from family/friends (71%). Individuals who did and did not receive confrontation did not differ by demographics, but those receiving confrontation had more recent substance use, higher perceived costs of sobriety and more severe family and psychiatric problems. Differences were noted in confrontation from the criminal justice system versus family/friends.

Overall, residents experienced confrontation as supportive regardless of who confronted them. Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.

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Request Reprint E-Mail: dpolcin@arg.org
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Denial in alcohol and other drug use disorders: A critique of theory

Despite the centrality of the construct in the field of alcohol and other drug (AOD) addiction, denial remains poorly conceptualized. One reason for this narrow conceptualization is the recent unilateral devotion to the Transtheoretical Model (TTM).

In an effort to demonstrate denial's theoretical complexity, the TTM and five additional intuitively appealing theories of denial will be summarized. The strengths and weaknesses of each theory and possible treatment implications based on each theory will also be presented.

The article concludes with a recommendation for future research to evaluate multiple theories of denial using consistent and rigorous research methodology in order to develop a comprehensive theory of denial. This will promote evolution of the deductive research process, and eventually lead to the development of empirically generated interventions which address the complex nature and etiology of denial.

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Request Reprint E-Mail: P.STODDARDDARE@csuohio.edu

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Industry Drug and Alcohol Testing Program

The Omnibus Transportation Employee Testing Act of 1991 requires drug and alcohol testing of safety-sensitive transportation employees in aviation.

The Drug Abatement Division develops and implements regulations for DOT/FAA drug and alcohol testing. These regulations cover employers, safety-sensitive employees and service agents. These rules are encompassed in 49 Code of Federal Regulations (CFR) Part 40 and 14 CFR Part 120.

The division also oversees the aviation industry’s compliance with drug and alcohol testing regulations. This oversight is accomplished with on-site inspections, guidance documents, and policies.

A Message from the Secretary: Why this Program is so
Important (PDF)
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News Release - FDA To Look Into Safety of Caffeinated Alcoholic Beverages Agency Sends Letters to Nearly 30 Manufacturers

The Food and Drug Administration today notified nearly 30 manufacturers of caffeinated alcoholic beverages that it intends to look into the safety and legality of their products.

“The increasing popularity of consumption of caffeinated alcoholic beverages by college students and reports of potential health and safety issues necessitates that we look seriously at the scientific evidence as soon as possible,” said Dr. Joshua Sharfstein, principal deputy commissioner of food and drugs.

Of the combined use of caffeine and alcohol among U.S. college students in the few studies on this topic, the prevalence was as high as 26 percent.

Under the Federal Food, Drug, and Cosmetic Act, a substance added intentionally to food (such as caffeine in alcoholic beverages) is deemed “unsafe” and is unlawful unless its particular use has been approved by FDA regulation, the substance is subject to a prior sanction, or the substance is Generally Recognized As Safe (GRAS). FDA has not approved the use of caffeine in alcoholic beverages and thus such beverages can be lawfully marketed only if their use is subject to a prior sanction or is GRAS. For a substance to be GRAS, there must be evidence of its safety at the levels used and a basis to conclude that this evidence is generally known and accepted by qualified experts. . . . . .

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You can cut back on alcohol

Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol in a book by the same name. The failed businessman contended that, as an alcoholic, he had to "hit bottom" before changing his life and that sobriety could only be achieved through complete abstention.

For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.

They now say that many drinkers can evaluate their habits and -- using new knowledge about genetic and behavioral risks of addiction -- change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts education, ruins careers and damages health.

In short, say some of the nation's leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol -- and most never reach that point.

"We're on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation's leading authority on alcoholism and the major provider of funds for alcohol research. "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence." . . . . . .

Read More

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The Content of Substance Abuse and Mental Health Counseling Reported by Patients in a National Survey

This study examined counseling content reported by a national sample of persons receiving care for alcohol, drug or mental health (ADM) problems in a year.

The sample included 2,722 individuals over 18 who reported past year mental health or substance abuse care or assessments in a nationally representative survey conducted in 2000–2001.

Counseling domains approximating commonly practiced or evidence-based approaches for depression, anxiety, or substance abuse were assessed.

Patient self-report may be one useful way of tracking whether components of standard therapies are implemented in practice.

Read Full Abstract

Request Reprint E-Mail: cmlandry@ucla.edu
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Correlates of Past Homelessness in the National Epidemiological Survey on Alcohol and Related Conditions

This study sought to investigate correlates of past homelessness, especially mental illness and substance abuse, using data from the National epidemiological survey on alcohol and related conditions (NESARC), a large nationally representative survey conducted in 2001–2002.

Multivariate analyses showed that the factors most strongly related to past homelessness were diagnoses of behavioral health conditions which showed consistently stronger association than sociodemographic characteristics, measures of economic well being, or general health indicators.

The results presented here confirm in a nationally representative sample a number of single site studies that have also demonstrated the over representation of both mental illness and substance abuse disorders in homeless populations.

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Request Reprint E-Mail: greg.greenberg@yale.edu
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Establishment of a Low Birth Weight Registry and Initial Outcomes

The study was conducted to evaluate a regional, prospective database of information on mothers of low birth weight (LBW) infants.

The database informs on unidentified or under-reported modifiable risk factors from which evidence-based, targeted community intervention strategies could be designed to lower the rate of low birth weight in the region. The LBW Registry is based on informed consent, a semi-structured face-to-face (FTF) interview with the mother of the newborn LBW infant, medical record review, and birth certificate worksheet data collection.

High rates of modifiable risk factors among mothers of low birth weight infants (October 2007–October 2008) include smoking (44%), alcohol consumption (16%), and drug abuse (14%). Preconception vitamin use was low (34%). The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers (5.4 vs. 1.5%), as was alcohol use during pregnancy (16 vs. 1.3%).

More than half (52%) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy. Additionally there were higher than average rates of unmarried mothers (62%), unintended pregnancies (67%), and Medicaid beneficiaries (57%). Mothers repeatedly expressed excessive demands in their lives, straining their coping abilities and resources.

The LBW Registry provides expanded local data on potentially modifiable risk factors to aid in designing targeted prevention and intervention strategies.

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Request Reprint E-Mail: e.eisenhauer@att.net
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Empirically supported religious and spiritual therapies

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues.

Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality. Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort. Read Full Abstract Rerquest Reprint E-Mail: eworth@vcu.edu _____________________________________________

New Reports Highlight Important Gender Differences in Substance Use and Mental Health for Adolescents in Each State and the District of Columbia

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed 52 new short reports providing key information about the level of substance use and mental health problems and treatment among adolescents (age 12 to 17 years) in each state, the District of Columbia and for the country as a whole. The reports provide first-of-a-kind, state–by–state breakdowns by gender on substance abuse and mental health problems experienced by adolescents. In addition, the reports provide data on adolescent treatment facilities and admission factors for each state, the District of Columbia and for the country as a whole.

“These reports provide state and local authorities vital information about substance using behaviors and service needs of adolescents in their communities,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “The public health community can use these data to develop programs targeted to the specific needs of adolescent boys and girls.”

Entitled Adolescent Behavioral Health: States in Brief, the reports provide the following information for each individual state, the District of Columbia and the country as a whole through a variety of charts, graphs and accompanying text:

• Adolescents’ risk perceptions associated with substance use
• Prevalence of illicit substance and alcohol use
• Number and type of substance abuse treatment facilities
• Numbers and trends on those seeking treatment for substance abuse
• Levels of those needing, but not receiving substance abuse treatment
• Levels of underage smoking
• Mental health indicators

The data included in these States in Brief reports are drawn from three large national surveys sponsored by SAMHSA - the National Survey on Drug Use and Health, the Treatment Episode Data Set and the National Survey on Substance Abuse Treatment Services.

These reports are available on the web at http://samhsa.gov/statesinbrief/

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Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for al

The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined.

Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence , lifetime history of injection drug use , lifetime history of needle sharing. As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT and a downward shift in baseline CDT . When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT , and with decreases in CDT .

These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.

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Request Reperint E-Mail: plebani_j@mail.trc.upenn.edu

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Drinking motives, drinking restraint and drinking behaviour among young adults

Motives to drink alcohol are widely thought to be the proximal cognitive factors involved in the decision to consume alcohol beverages. However it has also been argued that the ability to restrain drinking may be a more proximal predictor of drinking behaviour.

The current study aimed to examine the relationships between drinking motives, drinking restraint and both alcohol consumption and alcohol-related problems in a sample of young adults. A sample of 221 young adults (aged 17–34 years) completed self-report measures assessing drinking behaviour, motives for drinking and drinking restraint.

Multiple regression analyses revealed that coping, enhancement and social motives were related to alcohol consumption and alcohol-related problems, while Cognitive and Emotional Preoccupation with drinking was related to all criterion variables. Further, the relationship between coping motives and drinking behaviour was mediated by preoccupation with drinking.

The results are discussed in light of the roles of drinking motives and drinking restraint in risky drinking among young people, and implications for prevention and early intervention are presented.

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Request Reprint E-Mail: mlyvers@bond.edu.au

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Alcohol cue reactivity task development

The physiological and cognitive reactions provoked by alcohol cues, as compared to non-alcohol cues, can predict future drinking. Alcohol cue reactivity tasks have been developed; however, most were created for use with alcohol use disordered individuals and utilize limited or only partially standardized stimuli.

This project systematically created an alcohol cue reactivity task for studies with non-drinkers, using well-characterized stimuli.

The long-term objectives of this project are to utilize this task with non-drinking youth to investigate how reactivity to alcohol stimuli may predict alcohol use initiation and escalation, to help identify the role of exposure to alcohol stimuli on the subsequent development of alcohol-related problems.

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Request Reprint E-Mail: cpulido@ucsd.edu

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A cognitive model for the intergenerational transference of alcohol use behavior

A family history of alcoholism has shown to be one of the greatest consistent risk factors in the intergenerational transference of alcohol problems. Whereas a large number of studies have attempted to identify the processes responsible for this interfamilial transfer, the mechanisms remain unclear.

Family, twin and adoption studies, and environmental theories have resulted in a number of unanswered questions regarding the extent that these factors influence the transmission of alcohol behavior. Recently, cognitive theories have suggested that the observation of parental drinking habits contributes to the child's beliefs and expectations of alcohol's effects.

A hypothesised cognitive model will be proposed suggesting that the mechanism for the transference of particular drinking styles from parent to offspring may be further explained by the transference of alcohol cognitions, in particular, alcohol expectancies and drinking refusal self-efficacy.

This review focuses on research of bio/psycho/social factors that perpetuate alcohol misuse across generations, and will delineate the proposed cognitive mechanisms for the interfamilial transference of alcohol problems and discuss the implications of the proposed model.

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Request Reprint E-Mail: oei@psy.uq.edu.au

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Deficits in amygdaloid cAMP-responsive element–binding protein signaling play a role in genetic predisposition to anxiety and alcoholism

We investigated the role of cAMP-responsive element–binding protein (CREB) in genetic predisposition to anxiety and alcohol-drinking behaviors using alcohol-preferring (P) and -nonpreferring (NP) rats.

The levels of CREB, phosphorylated CREB, and neuropeptide Y (NPY) were innately lower in the central amygdala (CeA) and medial amygdala (MeA), but not in the basolateral amygdala (BLA), of P rats compared with NP rats. P rats displayed higher baseline anxiety-like behaviors and consumed higher amounts of alcohol compared with NP rats.

Ethanol injection or voluntary intake reduced the higher anxiety levels in P rats. Ethanol also increased CREB function in the CeA and MeA, but not in the BLA, of P rats.

Infusion of the PKA activator Sp-cAMP or NPY into the CeA decreased the alcohol intake and anxiety-like behaviors of P rats. PKA activator infusion also increased CREB function in the CeA of P rats.

On the other hand, ethanol injection or voluntary intake did not produce any changes either in anxiety levels or on CREB function in the amygdaloid structures of NP rats. Interestingly, infusion of the PKA inhibitor Rp-cAMP into the CeA provoked anxiety-like behaviors and increased alcohol intake in NP rats. PKA inhibitor decreased CREB function in the CeA of NP rats.

These novel results provide the first evidence to our knowledge that decreased CREB function in the CeA may be operative in maintaining the high anxiety and excessive alcohol-drinking behaviors of P rats.

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Minimum pricing needed now, argues Lib Dem MP

Blaming pubs for the problems of “Binge Britain” is often wrong and minimum pricing is now the best way to tackle “pocket money” off-trade prices, according to a senior Liberal Democrat.

Don Foster, Lib Dem shadow culture secretary, slammed the supermarkets’ policy on alcohol and pledged his support for pubs, during the Business In Sport and Leisure conference today in London.

“There is no doubt that Booze Britain is causing real problems… but far too often the problems are laid at the door of hard pushed pub landlords and club owners,” he said. . . . . . .

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Alcohol use and related harms in school students in the USA and Australia

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA.

Sampling methods were matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002.

Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls).

Relative to Washington, the students in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use.

These findings reveal considerable variation in international rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study.

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Request Reperint E-Mail: john.toumbourou@deakin.edu.au

Cluster-randomized Controlled Trial of Dissemination Strategies of an Online Quality Improvement Programme for Alcohol-related Disorders

This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany.

Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034)

No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable.

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Request Reprint E-Mail: daniela.ruf@uniklinik-freiburg.de
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Planned and Unplanned Discharge from Alcohol Services in Scotland, 2004–2008

Available data suggests that the rate of unplanned discharge from alcohol treatment services is an international problem reflective, perhaps, of ambivalence surrounding treatment in general. Given Scotland's escalating prevalence of alcohol misuse, a preliminary study of Scottish dropout rates would make a useful contribution to the international scene.

Of 48,299 cases, 52.23% (n = 25,231) were unplanned discharges. Data showed a general increasing trend in the rate of planned discharges across the examined 4-year period, from 41.66% in 2004–2005 to 51.94% in 2007–2008. Inspection of the data revealed marked regional variations in ratios of planned to unplanned discharge, with only four of the 10 regions examined reporting a planned discharge rate >50%.

More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.

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Request Reprint E-Mail: rosemary.e.newham@strath.ac.uk
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News Release - EUROPEAN SPONSORSHIP BODY REJECTS ACADEMICS’ ALCOHOL CLAIMS

The European Sponsorship Association (ESA) has seen the promotional release from the journal 'Addiction' and wishes to clarify a number of points.

ESA is the trade body representing the sponsorship industry in Europe. The Association's 240 members include sports governing bodies, arts companies, sports clubs, sponsorship consultancies, suppliers to the sector and also sponsors. Sponsor members include brands such as Visa, Coca-Cola, McDonald’s, National Express, Guardian Newspapers, Aviva and Castrol.

ESA has a number of drinks industry members which account for three percent of its membership. The Association's agenda is independent as it looks after the benefits of sponsorship in general and its views are not set by the drinks sector.

Karen Earl, ESA Chairman, acknowledges that the alcohol sector is an important source of sponsorship revenue and says that ESA is highly mindful of the way that alcohol sponsorship has become linked in the press and in some people's minds with problem drinking. . . . . .

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Press Release - Athletes on performance enhancers more likely to abuse alcohol, other drugs

PISCATAWAY, NJ – College athletes who use performance-enhancing substances may be at heightened risk of misusing alcohol and using recreational drugs as well, according to new research in the Journal of Studies on Alcohol and Drugs.

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Rethinking “community”: addiction, recovery, and globalisation

The notion of “community” is central to the thought, philosophy, and practice of the emerging recovery movement.

This presentation explores how the processes of globalisation engender reconfigured conceptions of “community” and how this reconfiguration impacts on the recovery movement.

To do this, I will argue that the capitalisation of the addict in the treatment economy (a corollary of the first-cause of globalisation, the free market) has resulted in the subjugation of “recovery knowledge” and that grassroots communities of recovery represent key sites of resistance against this totalising, reductive trend.

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Role of the GABAB receptor system in alcoholism and stress: focus on clinical studies and treatment perspectives

Alcoholism and stress share some common neurobiological circuits, including the GABAergic system. In particular, the GABA_B receptor seems to play an important role.

The GABA_B receptor agonist baclofen has been studied as a treatment for alcohol-dependent subjects. Baclofen administration in alcohol-dependent patients was able to promote abstinence, inducing the remission of withdrawal symptoms, reducing alcohol craving, and reducing alcohol intake.

Baclofen also reduced anxiety in alcohol-dependent subjects, probably acting on brain stress circuitry and/or on other neuroendocrine systems. Baclofen also showed excellent safety and tolerability, even in alcohol-dependent patients with advanced liver disease (i.e., cirrhosis).

Future studies should investigate which alcoholic subtype may better benefit of the administration of baclofen in the treatment of alcohol dependence.

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Request Reprint E-Mail: g.addolorato@rm.unicatt.it

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Role of the GABAB receptor in alcohol-seeking and drinking behavior

The present paper summarizes experimental data demonstrating the reducing effect of direct agonists and positive allosteric modulators (PAMs) of the γ-aminobutyric acid_B (GABA_B) receptor on different alcohol-related behaviors.

Different lines of evidence indicate that direct agonists, including baclofen, effectively suppress acquisition and maintenance of alcohol drinking behavior, relapse-like drinking, and alcohol's reinforcing, rewarding, stimulating, and motivational properties in rats and mice.

More recently, the discovery of a positive allosteric modulatory binding site, together with the synthesis of in vivo effective ligands, opened a new avenue of research in GABA_B pharmacology.

Accumulating lines of evidence suggest that PAMs retain baclofen's capcity to suppress alcohol consumption and alcohol's reinforcing and motivational properties in rats; these effects occur at doses far from those producing behavioral toxicity.

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Request Reprint E-Mail: colomb@unica.it
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Contribution of early environmental stress to alcoholism vulnerability

The most problematic aspects of alcohol abuse disorder are excessive alcohol consumption and the inability to refrain from alcohol consumption during attempted abstinence. The root causes that predispose certain individuals to these problems are poorly understood but are believed to be produced by a combination of genetic and environmental factors.

Early environmental trauma alters neurodevelopmental trajectories that can predispose an individual to a number of neuropsychiatric disorders, including substance abuse. Prenatal stress (PNS) is a well-established protocol that produces perturbations in nervous system development, resulting in behavioral alterations that include hyperresponsiveness to stress, novelty, and psychomotor stimulant drugs (e.g., cocaine, amphetamine).

Moreover, PNS animals exhibit enduring alterations in basal and cocaine-induced changes in dopamine and glutamate transmission within limbic structures, which exhibit pathology in drug addiction and alcoholism, suggesting that these alterations may contribute to an increased propensity to self-administer large amounts of drugs of abuse or to relapse after periods of drug withdrawal.

Given that cocaine and alcohol have actions on common limbic neural substrates (albeit by different mechanisms), we hypothesized that PNS would elevate the motivation for, and consumption of, alcohol. Accordingly, we have found that male C57BL/6J mice subject to PNS exhibit higher operant responding and consume more alcohol during alcohol reinforcement as adults.

Alterations in glutamate and dopamine neurotransmission within the forebrain structures appear to contribute to the PNS-induced predisposition to high alcohol intake and are induced by excessive alcohol intake.

Accordingly, we are exploring the interactions between neurochemical changes produced by PNS and changes induced by consumption of alcohol in adulthood to model the biological bases of high vulnerability to alcohol abuse.

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Request Reprint E-Mail: kippin@psych.ucsb.edu
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Stress, alcohol craving, and relapse risk: mechanisms and viable treatment targets

Article Outline

Stress and relapse to drug seeking: an update (Y. Shaham)

Role and treatment target potential of groups I and II metabotropic glutamate receptors in stress-induced drug seeking (F. Weiss)

Stress-induced reinstatement of alcohol seeking: studies with the α2 noradrenergic receptor antagonist yohimbine (A.D. Le)

A human laboratory model of risk factors for relapse in alcohol dependence and for predicting medication efficacy (B.J. Mason)

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Request Reprint E-Mail: mason@scripps.edu
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Ethanol and acetaldehyde action on central dopamine systems: mechanisms, modulation, and relationship to stress

There has been a great deal of activity in recent years in the study of the direct effects of ethanol on the dopamine reward system originating in the ventral tegmental area (VTA). In addition, recent evidence suggests that acetaldehyde formed from ethanol in the brain or periphery may be a crucial factor in the central effects of ethanol.

This critical review examines the actions of ethanol and acetaldehyde on neurons of the VTA and the possible interactions with stress, with a focus on electrophysiological studies in vivo and in vitro.

Ethanol has specific effects on dopamine neurons and there is recent evidence that some of the in vivo and in vitro effects of ethanol are mediated by acetaldehyde. Stress has some analogous actions on neuronal activity in the VTA, and the interactions between the effects of stress and alcohol on VTA neurons may be a factor in ethanol-seeking behavior.

Taken together, the evidence suggests that stress may contribute to the activating effects of ethanol on dopamine VTA neurons, that at least some actions of ethanol on dopamine VTA neurons are mediated by acetaldehyde, and that the interaction between stress and alcohol could play a role in susceptibility to alcoholism.

The link between acetaldehyde and ethanol actions on brain reward pathways may provide a new avenue for the development of agents to reduce alcohol craving.

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Request Reprint E-Mail: mbrodie@uic.edu

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The role of neuroactive steroids in ethanol/stress interactions: proceedings of symposium VII at the Volterra conference on alcohol and stress, May 20

This report summarizes the proceedings of the symposium VII on the role of neuroactive steroids in stress/alcohol interactions.

The production of GABAergic neuroactive steroids, including (3α,5α)-3-hydroxypregnan-20-one and (3α,5α)-3,21-dihydroxypregnan-20-one is a consequence of both acute stress and acute ethanol exposure. Acute, but not chronic ethanol administration elevates brain levels of these steroids and enhances GABA_A receptor activity. Neuroactive steroids modulate acute anticonvulsant effects, sedation, spatial memory impairment, anxiolytic-like, antidepressant-like, and reinforcing properties of ethanol in rodents.

Furthermore, these steroids participate in the homeostatic regulation of the hypothalamic–pituitary–adrenal axis. Therefore, it is not surprising that neuroactive steroids are involved in ethanol/stress interactions. Nevertheless, the interactions are complex and not well understood.

This symposium addressed the role of neuroactive steroids in both stress and alcohol responses and their interactions. Professor Giovanni Biggio of the University of Cagliari, Italy presented the effects of juvenile isolation stress on neuroactive steroids, GABA_A receptor expression, and ethanol sensitivity.

Professor Howard Becker of the Medical University of South Carolina, USA presented evidence for neuroactive steroid involvement in ethanol dependence and drinking behavior.

Professor Patrizia Porcu of the University of North Carolina, USA described a potential neuroactive steroid biomarker that may predict heavy drinking in monkeys and mice.

These presentations provide a framework for new theories on the nature of ethanol/stress interactions that may be amenable to therapeutic interventions.

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Request Reprint E-Mail: morrow@med.unc.edu

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Neurobiological mechanisms contributing to alcohol–stress–anxiety interactions

This article summarizes the proceedings of a symposium that was presented at a conference entitled “Alcoholism and Stress: A Framework for Future Treatment Strategies.” The conference was held in Volterra, Italy on May 6–9, 2008 and this symposium was chaired by Jeff L. Weiner.

The overall goal of this session was to review recent findings that may shed new light on the neurobiological mechanisms that underlie the complex relationships between stress, anxiety, and alcoholism.

Dr. Danny Winder described a novel interaction between D1 receptor activation and the corticotrophin-releasing factor (CRF) system that leads to an increase in glutamatergic synaptic transmission in the bed nucleus of the stria terminalis.

Dr. Marisa Roberto presented recent data describing how protein kinase C epsilon, ethanol, and CRF interact to alter GABAergic inhibition in the central nucleus of the amygdala.

Dr. Jeff Weiner presented recent advances in our understanding of inhibitory circuitry within the basolateral amygdala (BLA) and how acute ethanol exposure enhances GABAergic inhibition in these pathways.

Finally, Dr. Brian McCool discussed recent findings on complementary glutamatergic and GABAergic adaptations to chronic ethanol exposure and withdrawal in the BLA.

Collectively, these investigators have identified novel mechanisms through which neurotransmitter and neuropeptide systems interact to modulate synaptic activity in stress and anxiety circuits. Their studies have also begun to describe how acute and chronic ethanol exposure influence excitatory and inhibitory synaptic communication in these pathways.

These findings point toward a number of novel neurobiological targets that may prove useful for the development of more effective treatment strategies for alcohol use disorders.

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Request Reprint E-Mail: jweiner@wfubmc.edu

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Young Investigator Award Symposium

This article highlights the research presented at the inaugural meeting of Alcoholism and Stress: A Framework for future Treatment Strategies. This meeting was held on May 6–8, 2008 in Volterra, Italy. It is an international meeting dedicated to developing preventive strategies and pharmacotherapeutic remedies for stress- and alcohol-related disorders.

For the first time, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conferred a Young Investigator Award to promote the work of young researchers and highlight their outstanding achievements in the fields of addiction medicine and stress disorders.

The awardees were Dr. Katie Witkiewitz (University of Washington), Dr. Andrew Holmes (NIAAA), Dr. Lara A. Ray (Brown University), Dr. James Murphy (University of Memphis), and Dr. Heather Richardson (The Scripps Research Institute).

The symposium was chaired by Drs. Fulton Crews and Antonio Noronha.

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Request Reprint E-Mail: mroberto@scripps.edu

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Stress-related neuropeptides and alcoholism: CRH, NPY, and beyond

This article summarizes the proceedings of a symposium held at the conference on “Alcoholism and Stress: A Framework for Future Treatment Strategies” in Volterra, Italy, May 6–9, 2008.

Chaired by Markus Heilig and Roberto Ciccocioppo, this symposium offered a forum for the presentation of recent data linking neuropetidergic neurotransmission to the regulation of different alcohol-related behaviors in animals and in humans.

Dr. Donald Gehlert described the development of a new corticotrophin-releasing factor receptor 1 antagonist and showed its efficacy in reducing alcohol consumption and stress-induced relapse in different animal models of alcohol abuse.

Dr. Andrey Ryabinin reviewed recent findings in his laboratory, indicating a role of the urocortin 1 receptor system in the regulation of alcohol intake.

Dr. Annika Thorsell showed data supporting the significance of the neuropeptide Y receptor system in the modulation of behaviors associated with a history of ethanol intoxication.

Dr. Roberto Ciccocioppo focused his presentation on the nociceptin/orphanin FQ (N/OFQ) receptors as treatment targets for alcoholism.

Finally, Dr. Markus Heilig showed recent preclinical and clinical evidence suggesting that neurokinin 1 antagonism may represent a promising new treatment for alcoholism.

Collectively, these investigators highlighted the significance of neuropeptidergic neurotransmission in the regulation of neurobiological mechanisms of alcohol addiction. Data also revealed the importance of these systems as treatment targets for the development of new medication for alcoholism.

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Request Reprint E-Mail: roberto.ciccocioppo@unicam.it
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Relationship Between Potentially Modifiable Lifestyle Factors and Risk of Second Primary Contralateral Breast Cancer Among Women Diagnosed With Estrog

An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited.

We evaluated the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors.

Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

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Request Reprint E-Mail: cili@fhcrc.org
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Alcohol-Induced Psychotic Disorder: A Comparative Study on the Clinical Characteristics of Patients With Alcohol Dependence and Schizophrenia

Alcohol-induced psychotic disorder (AIPD) is a rare complication of excessive alcohol use for which limited comparative studies are available. The aim of this study was to prospectively investigate demographic and psychopathological characteristics in patients with AIPD, schizophrenia, and uncomplicated alcohol dependence.

We postulated that AIPD is a discrete clinical entity that can be differentiated from schizophrenia and uncomplicated alcohol dependence by means of standardized clinical assessments.

Patients with AIPD had a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment compared with patients with schizophrenia.

The study provides further supportive evidence that AIPD can be clinically distinguished from schizophrenia.

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Request Reprint E-Mail: rae@sun.ac.za
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Patient Reactance as a Moderator of the Effect of Therapist Structure on Posttreatment Alcohol Use

We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment.

The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites.

This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process.

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Request Reprint E-Mail: karno@ucla.edu.
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Risk Profile of Male College Athletes Who Use Performance-Enhancing Substances

There is a general perception that use of performance-enhancing substances (PESs) does not fit the standard profile of substance use.

This study sought to determine whether users of PESs report high-risk patterns of alcohol and other drug use and demonstrate risk behaviors associated with problematic substance use.

Male athlete PES users (n = 73) compared with nonusers (n = 160) reported more problematic alcohol-use behaviors and more alcohol- and drug-use-related problems. The former compared with the latter was also more likely to report past-year use of tobacco products, marijuana, cocaine, psychedelics, and prescription drugs without a prescription. In addition, PES users demonstrated higher sensation seeking, and greater coping and enhancement motivations for drinking and marijuana use than non-PES users.

Although banned PESs are not typically viewed as having a high addiction potential, male athletes who use these drugs may be more likely to participate in other problematic substance-use behaviors. Importantly, the male athletes in this study who reported PES use also participated in substance-use behaviors that can have profound negative effects on athletic performance. More research on the use of PESs in college athletes is needed.

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Request Reprint E-Mail: jbuckman@rutgers.edu

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Disturbed Sleep and Its Relationship to Alcohol Use

To review evidence of an association between disturbed sleep and alcohol use.

Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association.

The association of insomnia with alcohol use disorders suggests that the clinical evaluation of patients with sleep problems should include a careful assessment of alcohol use. Future studies of this relationship should employ prospective designs with standardized, validated measures of both sleep and alcohol use. Rigorous treatment studies for chronic insomnia in alcohol dependent patients are also needed.

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Deletion of vanilloid receptor (TRPV1) in mice alters behavioral effects of ethanol

The vanilloid receptor TRPV1 is activated by ethanol and this may be important for some of the central and peripheral actions of ethanol.

To determine if this receptor has a role in ethanol-mediated behaviors, we studied null mutant mice in which the Trpv1 gene was deleted.

Mice lacking this gene showed significantly higher preference for ethanol and consumed more ethanol in a two-bottle choice test as compared with wild type littermates. Null mutant mice showed shorter duration of loss of righting reflex induced by low doses of ethanol (3.2 and 3.4 g/kg) and faster recovery from motor incoordination induced by ethanol (2 g/kg).

However, there were no differences between null mutant and wild type mice in severity of ethanol-induced acute withdrawal (4 g/kg) or conditioned taste aversion to ethanol (2.5 g/kg).

Two behavioral phenotypes (decreased sensitivity to ethanol-induced sedation and faster recovery from ethanol-induced motor incoordination) seen in null mutant mice were reproduced in wild type mice by injection of a TRPV1 antagonist, capsazepine (10 mg/kg). These two ethanol behaviors were changed in the opposite direction after injection of capsaicin, a selective TRPV1 agonist, in wild type mice.

The studies provide the first evidence that TRPV1 is important for specific behavioral actions of ethanol.

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Neural Substrates of Alcohol-Induced Smoking Urge in Heavy Drinking Nondaily Smokers

A strong link exists between cigarette smoking and alcohol use, which may be explained by the experimental observation that alcohol ingestion promotes cigarette craving and precipitates smoking.

At the neuroanatomic level, it is unclear where and how alcohol exerts these effects, although the process likely involves the ventral striatum given its function in motivational salience and appetitive reinforcement.

In a double-blinded, placebo-controlled, crossover study, heavy drinking nondaily social smokers (ie, light smokers or 'chippers') were examined using functional magnetic resonance imaging after they ingested an acute dose of alcohol or placebo.

We probed reactivity in the ventral striatum and other brain regions during exposure to visual smoking vs nonsmoking control cues. We found that alcohol enhanced self-reported ratings of desire to smoke, and in this context, significantly increased ventral striatum responses to smoking compared with control cues. I

n exploratory analyses, we observed that alcohol dampened orbitofrontal activity across both cue types, whereas dorsolateral prefrontal and anterior cingulate cortex activation to smoking cues was not affected by alcohol.

This study bridges a pharmacological challenge approach to the study of brain reactivity to smoking cues, extends prior cigarette cue imaging studies to nondependent smokers, and elucidates a potential neurobiological mechanism to explain the co-consumption of alcohol and cigarettes in nondependent users.

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Request Reprint E-Mail: aking@bsdad.uchicago.edu
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Have I Had One Drink Too Many? Assessing Gender Differences in Misperceptions of Intoxication Among College Students

The present study extends the literature on factors involved in college students' drinking tendencies by examining differences between men and women in their ability to accurately estimate personal intoxication. The study also assessed whether men and women who typically consume large quantities of alcohol when they attend parties have more difficulty accurately assessing intoxication compared with lighter drinkers.

The study revealed that approximately 20% (n = 710) of participants underestimated their blood alcohol concentration using the ECA. Among participants who made underestimation errors, gender differences were observed in that women made significantly more underestimation errors in the scenarios that contained four to five drinks and men made more underestimation errors in the scenarios that contained six to seven drinks.

In addition, a three-way interaction revealed that female students who reported typically drinking larger amounts of alcohol in party settings were more likely to make errors when estimating their intoxication for moderately high numbers of drinks (e.g., four to five drinks).

The results are discussed in terms of examining the importance of college student drinking, gender, typical alcohol consumption at a party, and estimation of intoxication. Implications of gender effects in relation to high-risk drinking activities (i.e., pregaming and drinking games) as well as prevention efforts are discussed.

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Request Reprint E-Mail: kmallett@psu.edu
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At-Risk and Heavy Episodic Drinking, Motivation to Change, and the Development of Alcohol Dependence Among Men

The purpose of this study was to analyze whether general hospital inpatients with at-risk and heavy episodic drinking (ARHE) have a higher motivation to change drinking habits and a higher risk of developing alcohol dependence than individuals with at-risk drinking only (AR) or heavy episodic drinking only (HE).

At baseline, multinomial regressions revealed that individuals with ARHE had higher odds of taking action to change drinking habits than individuals with HE or AR . At follow-up, individuals with ARHE had higher odds of having alcohol dependence, as defined by the Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition, compared with individuals with AR.

Inpatients with ARHE indicated greater readiness to change drinking habits than those with AR or HE, and they had higher odds for short-term development of alcohol dependence than those with AR. Brief alcohol intervention should include risk-specific information based on the risky drinking pattern.

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Request Reprint E-Mail: coder@uni-greifswald.de
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Exploring Religious Mechanisms for Healthy Alcohol Use: Religious Messages and Drinking Among Korean Women in California

This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California.

Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1.10 (1.22) drinks on drinking days. About 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability) of any lifetime drinking. also, each congregant's message was associated with a 13.8% lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate.

Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors.

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Request Reprint E-Mail: rhofstet@mail.sdsu.edu
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Childhood Exposure to Adversity and Risk of Substance-Use Disorder in Two American Indian Populations: The Meditational Role of Early Substance-Use In

We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure.

The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder.

Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter.

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Request Reprint E-Mail: : nancy.whitesell@uchsc.edu
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Alcoholism risk moderation by a socio-religious dimension

Religious affiliation is inversely associated with the development of alcohol-dependence symptoms in adolescents, but the mechanisms of this effect are unclear. The degree to which religious affiliations accommodate to or differentiate from cultural values may influence attitudes about alcohol use.

We hypothesized that, given permissive cultural norms about alcohol in the United States, if a religious affiliation differentiates itself from cultural norms, then high-risk adolescents (those with parents having a history of alcoholism) would exhibit fewer alcohol-dependence symptoms compared with other affiliations and nonreligious adolescents.

Findings indicated that (1) parental alcohol history robustly predicted increased offspring alcohol-dependence symptoms, (2) religious rearing appeared protective (offspring exhibited fewer alcohol-dependence symptoms), (3) religious differentiation accounted for most of the protective effect, (4) other religious variables did not account for the differentiation effect, and (5) black religious adolescents were more frequently raised with differentiating affiliations and exhibited greater protective effects.

Results demonstrate that religious differentiation accounts for most of the protective influence of religious affiliation. This may be because religious differences from cultural norms (that include permissive alcohol norms) counteract these social influences given alternative "higher" religious ideals

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Request Reprint E-Mail: rhaber@pgsp.edu
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Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a Polish Emergency Department: Three-Month Outcomes of a Randomized, Controlled Cl

A randomized, controlled trial of screening, brief intervention, and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers was conducted in an emergency department (ED) in Sosnowiec, Poland, among patients ages 18 years and older.

At 3-month follow-up, both groups showed significant decreases in the proportion who were positive for at-risk drinking, the primary outcome variable. Both groups also showed significant decreases in drinking days per week, drinks per drinking day, maximum

Using analysis of covariance to control for baseline measures and demographic characteristics, no difference in outcome measures was found between intervention and assessment conditions. Subgroup analysis found some significant interactions between intervention and secondary outcomes.

Although the main findings were similar to those from other brief-intervention studies in Western cultures, findings here also suggest that intervention may have differential benefits for specific subgroups of patients in the ED, an area of research that may warrant additional study of brief intervention in the ED setting.

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Request Reprint E-Mail: ccherpitel@arg.org
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Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol-Related Problems Across Hispanic National Groups

The purpose of this study was to examine the prevalence and correlates of alcohol-related problems across four Hispanic national groups: Mexican Americans, Puerto Ricans, Cuban Americans, and South/Central Americans.

Cuban Americans had the lowest prevalence of alcohol-related problems. Significant differences across national group for zero versus two or more problems and for one versus two or more problems existed among men. Puerto Rican women were most likely to report two or more problems. The presence of zero versus two or more problems varied significantly across groups. There was variation in problem type across national groups among both men and women. Regression analyses showed that all groups were more likely than Cuban Americans to report two or more problems (vs zero). Heavy episodic drinking less than once a month was associated with two or more problems . Heavy episodic drinking one or more times a month was associated with one problem and two or more problems.

It is important to recognize that Hispanics are not a homogenous group.

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Request Reprint E-Mail: patrice.vaeth@utsouthwestern.edu
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Drinking Histories in Alcohol-Use-Disordered Youth: Preliminary Findings on Relationships to Platelet Serotonin Transporter Expression With Genotypes

The serotonin (5-HT) transporter (5-HTT) is thought to play a key role in the onset of alcohol use, with potential behavioral and biological mechanisms mediated by the level of 5-HT in the synapse and in cerebral spinal fluid. Although 5-HT dysregulation has been related to poor impulse control, the biological mechanism is unknown, although functional control of the serotonergic system has been shown to be regulated in part by differential expression of the 5-HTT. The gene responsible for encoding 5-HTT has a functional polymorphism at the 5'-regulatory promoter region, which results in two forms: long (L) and short (S). The LL genotype is hypothesized to play a key role in the early onset of alcohol use and may be related to poor impulse control.

The objective of this pilot study is to determine whether adolescents with a current alcohol-use disorder (AUD) (N = 21) have platelet measures of the 5-HTT functioning that are related to 5-HTT genotype and poor impulse control. Specifically, we wanted to examine the relationships between the following: platelet 5-HTT and 5-HTT genotype; platelet 5-HTT parameters and age at onset, as well as duration of drinking; and 5-HTT genotype and impulse control.

Our main findings showed significantly higher paroxetine binding (density of 5-HTT) in LL genotype versus S carriers (SS or SL genotypes); also, the LL group had a significantly earlier age at onset of drinking and longer duration of drinking, and poorer impulse control.

These findings provide partial support for the hypothesis that, among currently drinking adolescents with an AUD, differential expression of 5-HTT may play an important role in the onset of adolescent AUD.

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Request Reprint E-Mail: dawes@uthscsa.edu
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Drinking trajectories from adolescence to the fifties among alcohol-dependent men

Although it has been recognized that the course of alcoholism may differ across individuals, little work has characterized drinking trajectories from drinking onset to midlife.

The current study examined trajectories of alcohol dependence from adolescence to the mid-50s in a sample of 420 men with a lifetime diagnosis of alcohol dependence.

Latent growth mixture modeling was used to define four drinking trajectories: young-adult, late-onset, severe-nonchronic, and severe-chronic alcoholics. Further analyses with other diagnostic variables, other drinking variables, alcohol expectancies, personality scales, and religiousness scores were completed to differentiate men best categorized by each trajectory.

Extension of Latent Growth Mixture Modeling (LGMM) into the mid-50s revealed that, although some individuals remain chronic alcohol users, others decline in alcohol problem use.

Differences seen among these groups may help in the treatment of alcohol dependence, such that more energy can be spent treating those likely to be in the more severe trajectories.

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Request Reprint E-Mail: tjacob@odd.stanford.edu

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Alcohol Use Among Older Adults in the National Epidemiologic Survey on Alcohol and Related Conditions: A Latent Class Analysis

We examined latent classes of alcohol use among current drinkers ages 60 and older and explored risk factors associated with class.

Latent class analysis identified three latent classes. Individuals in the low-risk drinker class (89.17%) displayed low endorsement of heavy episodic use, at-risk consumption, and alcohol abuse/dependence criteria. Individuals in the moderate-risk drinker class (9.65%) were more likely to exceed consumption guidelines, and those in the high-risk drinker class (1.17%) displayed high probabilities of both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and risky alcohol consumption items.

Female gender, older age, and African-American race were associated with decreased risk of being a moderate-risk drinker. Being the adult child of an alcoholic, being a previous smoker, and being a current smoker were associated with increased risk. Female gender, older age, and college education were associated with decreased odds of being a high-risk drinker. having major depression, being the child of an alcoholic, and being a current smoker were associated with increased odds of being a high-risk drinker.

Individuals classified in the high-risk drinker class had significantly lower self-rated mental and physical health than low-risk drinkers.

A subpopulation of older drinkers may exceed consumption guidelines without DSM-defined alcohol-related problems. However, for some older drinkers, risky alcohol use is part of a larger pattern of health risks including current smoking, major depression, and alcohol abuse/dependence history.

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Request Reprint E-Mail: psacco@gwbmail.wustl.edu
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Managing the Needs of Drunk and Incapable People in Scotland: a Literature Review and Needs Assessment

This is the final report of a research study commissioned by the Scottish Government and conducted by Griesbach & Associates between June and November 2008.

The purpose of this research was to carry out a needs assessment, to identify what need there is in Scotland for services for people who become drunk and incapable in public. This involved not only estimating the size and nature of the problem, but also looking in detail at how the needs of this population are currently being addressed, both in Scotland and elsewhere, and how those needs may be addressed most effectively.

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TIP 49: Treating Alcohol Use Disorders with Medication

People with alcohol use disorders (AUDs) now have more options in seeking help. A new resource from SAMHSA provides clinical guidelines for the proper use of medications in the treatment of AUDs.

Treatment Improvement Protocol (TIP) 49, Incorporating Alcohol Pharmacotherapies Into Medical Practice, provides the basic information, evidence- and consensus-based guidelines, tools, and resources necessary to help health care providers treat patients with AUDs. . . . . .

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Acute alcohol impairs conditioning of a behavioural reward-seeking response and inhibitory control processes—implications for addictive disorders

To investigate whether acute alcohol would affect performance of a conditioned behavioural response to obtain a reward outcome and impair performance in a task measuring inhibitory control to provide new knowledge of how the acute effects of alcohol might contribute to the transition from alcohol use to dependence.

These results demonstrate that alcohol is affecting inhibitory control of behavioural responses to external signals even when associated with punishment, contributing in this way to the transition from alcohol use to dependence.

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Request Reprint E-Mail: t.duka@sussex.ac.uk
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The age-21 minimum legal drinking age: a case study linking past and current debates

The minimum legal drinking age (MLDA) in the United States (U.S.) has raised debate over the past several decades. During the 1970s many states lowered their MLDAs from age 21 to 18, 19, or 20. However, as a result of studies showing that these lower MLDAs were associated with increases in traffic crashes, state-level movements began in the later1970s to return MLDAs to age 21. A new movement has arisen to again lower the MLDA in the U.S.

The aim is to discuss this current MLDA debate within the context of the long history of the U.S. MLDA.

The complexity of state movements to change their MLDAs is illustrated by the Michigan experience, where strong political forces on both sides of the issue were involved, resulting in the MLDA returning to 21. Because the 21st Constitutional amendment prevents the federal government from mandating a MLDA for all states, a federal policy was proposed to provide incentives for all states to implement age-21 MLDAs. Due largely to strong research evidence, the National Minimum Legal Drinking Age Act was enacted in 1984, stipulating that states set their MLDA to 21 or face loss of federal highway funds. By 1988, all states had an age-21 MLDA.

Any current debate about the MLDA should be informed by the historical context of this policy and the available research.

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Request Reprint E-Mail: toome001@umn.edu

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Press Release - Health researchers call for alcohol industry to prove no harm in funding of sports

Researchers from Australia and the UK are calling for a new approach to the debate over whether alcohol industry sponsorship of sports increases drinking among sports participants. They want to shift the burden of proof to the alcohol industry.

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An open label study of quetiapine in patients with schizophrenia and alcohol disorders

Preliminary studies suggest that quetiapine, a mixed dopaminergic and serotonergic agent used for the treatment of psychosis, may decrease substance use in patients with schizophrenia.

Quetiapine may have a positive impact on alcohol use in patients with co-occurring schizophrenia/schizoaffective disorder and alcohol use disorder. Randomized, controlled trials are needed to clarify whether quetiapine has a specific effect on alcohol use in patients with such co-occurring disorders.

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Request Reprint E-Mail: Mary.f.brunette@dartmouth.edu __________________________________________

Predictors of completing treatment and achieving abstinence during inpatient dual diagnosis treatment

Little is known about predictors of successful inpatient treatment of dual diagnosis patients.

No significant predictors were found of completing treatment. High thought disturbance, anxiety and severity of dependence were associated with drug or alcohol use during community linkage. A diagnosis of alcohol dependence was associated with abstinence during community linkage.

Dual diagnosis patients with severe substance dependence, as well as patients with elevated thought disturbance and anxiety, represent a challenge in a milieu therapeutic setting. Implications for treatment for patients with these complex problems will be addressed in the discussion.

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Request Reprint E-Mail: mh@crf.au.dk _____________________________________________

Change factors in depression and substance use treatment: a longitudinal integrative model

While psychotherapy efficacy has been largely supported, patient change processes across time are still less clear. This is specially true for complex clinical populations, such as dually diagnosed individuals.

A Latent Growth Model was tested to describe change in depression and substance use in patients from two Randomized Clinical Trials (RTCs). The model tested the impact of the alliance and four evidence-based change principles as predictors of symptomatic change during treatment and follow-up, in addition to advancing the premise that initial treatment matching to non-diagnostic patient characteristics improved the quality of the therapeutic alliance.

A good fit was found for a quadratic change function for both outcome measures, that is, symptoms decreased in a curve shape followed by a small increase. Full predictive models yielded acceptable fit. Patients high on subjective distress at treatment-entry benefited from affective-focused interventions in terms of their substance use. Matching patient coping style (externalizing vs. internalizing) with treatment focus (symptom change vs. insight-oriented) predicted a better alliance.

Effects of both relationship and interventions were found, as well as their interplay.

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Request Reprint E-Mail: carla.moleiro@iscte.pt
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Externalizing disorders: Cluster 5 of the proposed meta-structure for DSM-V and ICD-11

The extant major psychiatric classifications DSM-IV and ICD-10 are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of the etiology. In an attempt to group mental disorders on the basis of etiology, five clusters have been proposed. We consider the validity of the fifth cluster, externalizing disorders, within this proposal.

We reviewed the literature in relation to 11 validating criteria proposed by the Study Group of the DSM-V Task Force, in terms of the extent to which these criteria support the idea of a coherent externalizing spectrum of disorders.

This cluster distinguishes itself by the central role of disinhibitory personality in mental disorders spread throughout sections of the current classifications, including substance dependence, antisocial personality disorder and conduct disorder. Shared biomarkers, co-morbidity and course offer additional evidence for a valid cluster of externalizing disorders.

Externalizing disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

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Request Reprint E-Mail: rkrueger@artsci.wustl.edu)

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