Is There a College Substance Abuse Crisis?

Maia Szalavitz, March 21, 2007 Are things really getting worse or did Columbia’s National Center on Addiction and Substance Abuse get the media’s attention through the selective use of statistics? Are we “Wasting the Best and the Brightest?” as the latest report on use of alcohol and other drugs by college students by Columbia’s National Center on Addiction and Substance Abuse claims? Or is what Stats has dubbed the “Center for Abuse of Statistical Analysis” (and others have labeled the “Center for Alcohol Statistics Abuse”) up to its old tricks? Unfortunately, while cliché watchers will have a field day with this report, so too will those who need examples of misleading uses of statistics for their Stats 101 classes. In this case, the problem is not CASA’s usual confusion of correlation and cause, but rather its selectively choosing a date with which to compare college students so as to make today’s kids look worse than previous generations and, by implication, worse than those who do not attend college. Careful readers of the report – a category which excludes almost all the journalists who reported its findings verbatim – may have wondered why CASA chose to look at trends in alcohol and other drug use from 1993 to 2005, rather than from the more obvious ten-year starting point, 1995 – or from the 1970s, when statistics on the issue first began to be kept. Informed readers might also be curious about why the comparison point wasn’t the highest level of drug use measured in teens (which occurred in 1979-81, depending on the particular drug); and they also might wish to know why the students were compared with the general population rather than with others their own age who do not attend college. If such readers go to the source for most of CASA’s data, the government’s Monitoring the Future (MTF) and National Household Survey on Drug Use and Health (NHSDUH) studies, they will rapidly discover why. Take, for example, the startling claim that in 2005 “almost one in four college students (22.9%) met the medical criteria for substance abuse or dependence, almost triple the proportion (8.5%) in the general population.” The source of this statistic appears to be a re-analysis of data collected for MTF or NHSDUH done by CASA. This makes it appear as though college students are more likely to be addicts or alcoholics than non-college students, which is something that confounds common sense when you consider that the most severe cases of addiction start young and often result in failure to complete high school, let alone attend college – and that addiction itself often causes college dropout. (Note: “substance dependence” is the medical term for addiction; “substance abuse” is the medical term for use of substances that is potentially harmful but is not characterized by compulsion or long-term problems). When you look at the NHSDUH figures for the general population age 18-25, you find a rate of substance abuse or dependence for 2005 of 21.8%. While this sounds equally as horrifying, the reason the rate is probably slightly higher for college attendees is that college binge drinking can often result in a “substance abuse” diagnosis: in other words, it’s potentially dangerous but is not necessarily indicative of a long-term problem. What CASA fails to point out (but is hinted at in the 8.5% substance abuse/dependence rate for the general population) is that the vast majority of college binge-drinking ends when graduates realize it is not compatible with employment that requires 9am cognitive clarity at work. The substance/abuse dependence rate for those over 26 is just 7.1%. In other words, stop the presses: many young people experiment with drugs and alcohol before they settle down and grow up. CASA was forced to admit that college binge drinking itself has been steady between 1993 and 2005, so they problematized this as being an instance of “no significant decline” and pointed out minor changes in subcategories like a 16% increase in binge drinking “three or more times in the past two weeks.” In the field, this is known as “data dredging:” Your main finding is not really that significant, so you parse enough subcategories in order to find something that looks scary or important. (Which, naturally enough, media reports in the vein of the Associated Press’s “Binge Drinking Rises at Colleges,” via Forbes.com, repeat without qualification or analysis). Now we come to the curious choice of 1993 as the comparison year for the findings taken from Monitoring the Future . CASA notes that during that period the number of daily marijuana users more than doubled, going from 1.9% to 4%. If they had chosen 1995, however, the figure would have been 3.7%, which would have made the increase far less impressive. Even less scary would have been to note that in 1980, in the peak period of U.S. drug use, 7.2% of college students smoked marijuana daily and the nation did not collapse (in fact, this is the generation that produced the Internet boom). CASA’s focus on a “tripling” of past-year heroin use is even more misleading: In 1993, 0.1% of college students reported past-year heroin use; in 2005, the figure was 0.3%. But this “tripling” had happened by 1995 and had bounced all the way up to 0.6% in 1998, before falling back to 0.1% again in 2002. In other words, if they’d used 1995 as a starting point, they’d have been forced to say that heroin use was unchanged. And this was probably true because most researchers believe that because heroin use is so rare, trends in these numbers among college students (who are less likely to use heroin than high school graduates, drop-outs and non-students) probably don’t mean much anyway. CASA’s highlighting of a “52% increase” in use of “drugs other than marijuana” since 1993 shares the cut-off problem with the other figures. The 1993 statistic is 5.4% but by 1995 it’s already up to 6.3%, yielding only a 30% rise to hit 2005’s 8.2%. The comparable 1980 figure is a whopping 20.7%. The same problem is seen in the cocaine trend as well. CASA did point out what appears to be a genuine recent increase in misuse of prescription drugs, but it buries the fact that this is far less common among college students than among those who do not attend college, failing to mention this in the press release or introductory letter. In fact, nearly twice as many of those who are not enrolled in college misused prescription opioids like Vicodin in the past month (5.6%) compared to 3.1% for college students. CASA says it wants to take the “high” out of “higher education;” but because college graduates are far less likely to have long term substance misuse problems than those who do not attend or do not graduate, maybe it should focus more on keeping students in school rather than hyping fears about college drinking and other drug use. That college graduates remain less likely to get or stay addicted to alcohol or other drugs despite vastly expanded enrolment suggests that while “stay in school” may be a boring message, it may be the best widely-applicable form of addiction prevention we have yet to develop.

The Social History of Alcohol and Drugs: An Interdisciplinary Journal (SHAD)

Volume 20 Number 2 (Spring 2006)

Contents (Available for Download as PDFs)

Editor's Note - 183 (PDF)

Essays

Drug Consumption in London and Western Berlin during the 1960s and 1970s: Local and Transnational Perspectives
Klaus Weinhauer - 187 (PDF)

Prohibition Possibly Prohibited: Iowans Voicing Temperance Concerns, 1929-1933
Lisa Ossian - 225 (PDF)

Temperance Internationalism: Guy Hayler and the World Prohibition Federation
David Fahey - 247 (PDF)

Addiction Concepts and International Control
Robin Room - 276 (PDF)

Reflection Essay

Teaching Alcohol and Drug History to Undergraduates
Cheryl Krasnick Warsh - 290 (PDF)

Book Reviews (PDF)

Jean Vigreux, La vigne du maréchal Pétain ou un faire-valoir bourguignon de la Révolution nationale (2005)
Joseph Bohling - 296

Eric Tagliacozzo, Secret Trades, Porous Borders: Smuggling and States Along a Southeast Asian Frontier, 1865-1915 (2005)
Anne L. Foster - 298

Richard W. Thatcher, Fighting Firewater Fictions: Moving Beyond the Disease Model of Alcoholism in First Nations (2004)
Greg Marquis - 300

Sarah W. Tracy, Alcoholism in America: From Reconstruction to Prohibition (2005)
Thomas R. Pegram - 302

Martin Torgoff, Can't Find My Way Home: America in the Great Stoned Age (2004)
Alexine Fleck - 306

Alfredo Molano, Loyal Soldiers in the Cocaine Kingdom: Tales of Drugs, Mules, and Gunmen (2004)
Daniel Weimer - 307

Philip J. Hilts, Protecting America's Health: The FDA, Business, and One Hundred Years of Regulation (2003)
Stephen Ceccoli - 309

A Pilot Double-Blind Treatment Trial of Memantine for Alcohol Dependence


Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007

• Suzette M. Evans^1,2
• ¹New York State Psychiatric Institute, New York, New York;
  
• ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York,
• Frances R. Levin^1,2
• ¹New York State Psychiatric Institute, New York, New York;
  
• ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York,
• Daniel J. Brooks¹
• ¹New York State Psychiatric Institute, New York, New York; , and
• Fatima Garawi¹
• ¹New York State Psychiatric Institute, New York, New York;

• ¹New York State Psychiatric Institute, New York, New York; ²Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York

This research was supported by NIAAA Grant R01 AA12599 and KO2 00465. We want to thank the staff of the Substance Treatment and Research Service (STARS) of the New York State Psychiatric Institute for their medical, clinical, and research support.

Reprint requests: Suzette M. Evans, PhD, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 66, New York, NY 10032; Fax: 212-543-6018; E-mail: se18@columbia.edu

Abstract

Background:

There is growing evidence that N-methyl-d-aspartate (NMDA) receptor antagonists may have potential for the treatment of alcohol disorders. Memantine is a selective noncompetitive NMDA receptor antagonist that has been shown to decrease alcohol craving in moderate drinkers.

This 16-week double-blind outpatient pilot clinical trial determined if memantine was more effective than placebo at reducing alcohol use in actively drinking alcohol-dependent patients.

Methods:

Forty-four treatment-seeking alcohol-dependent individuals were enrolled, with 34 patients stratified to either the memantine group (n=19; maximum dose of 40 mg/d) or the placebo (PBO; n=15) group.

The primary outcome measures were related to alcohol use (average drinks per day, average drinks per drinking day, percentage of heavy drinking days, and percentage of days abstinent) based on the timeline follow-back (TLFB).

Secondary outcome measures included the Obsessive Compulsive Drinking Scale, Clinical Global Impression ratings, and γ-glutamyltransferase (GGT), a biomarker of recent alcohol use.

To enhance retention, patients received voucher incentives for clinic attendance.

Results:

Of those randomized, approximately 80% (27) completed the entire 16-week trial.

Longitudinal analysis of drinks per day and drinks per drinking day showed a significant reduction in alcohol use, but no difference between the 2 groups. Further, the percentage of heavy drinking days indicated that both groups showed a significant decrease in drinking behavior, but there was significant treatment effect in favor of the PBO group.

Similarly, for the percentage of days abstinent, the PBO group achieved a significantly greater percentage of days abstinent at a faster rate than the memantine group.

Lastly, the memantine group reported a greater number of side effects compared with the PBO group, such that 26% of patients had their drug dose decreased or discontinued due to memantine-related side effects.

Conclusions:

The results of this double-blind placebo-controlled pilot trial do not support the use of memantine for the treatment of actively drinking alcohol-dependent patients.

However, voucher incentives did facilitate retention.

Psychiatric Comorbidity in Long-Term Abstinent Alcoholic Individuals
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007


A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples.

In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48).

We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder?

Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses.

Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis.

Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse.

Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence.

The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.

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Spousal Concordance for Alcohol Dependence: Evidence for Assortative Mating or Spousal Interaction Effects?

Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007

• Julia D. Grant¹
• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ,
• Andrew C. Heath¹
• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ,
• Kathleen K. Bucholz¹
• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ,
• Pamela A.F. Madden¹
• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ,
• Arpana Agrawal¹
• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ,
• Dixie J. Statham²
• ²Queensland Institute of Medical Research, Brisbane, Australia, and
• Nicholas G. Martin²
• ²Queensland Institute of Medical Research, Brisbane, Australia

• ¹Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri; and ²Queensland Institute of Medical Research, Brisbane, Australia

Sources of support: AA11998, AA07535, AA00728, AA10249.

Reprint requests: Julia D. Grant, PhD, Department of Psychiatry, Washington University School of Medicine, Campus Box 8134, St. Louis, MO 63110; Fax: 314 286 2243; E-mail: grantj@msnotes.wustl.edu

Abstract

Background:

Alcohol dependence (AD) is among the most common psychiatric disorders, and impacts the health and well-being of problem drinkers, their family members, and society as a whole.

Although previous research has consistently indicated that genetic factors contribute to variance in risk for AD, little attention has been paid to nonrandom mating for AD. When assortative mating occurs for a heritable trait, spouses are genetically correlated and offspring are at increased risk of receiving high-risk genes from both parents.

The primary goal of the present analyses is to test hypotheses about the source(s) and magnitude of spousal associations for AD using a twin-spouse design.

Methods:

DSM-IV AD (without the clustering criterion) was assessed via telephone interview for 5,974 twin members of an older cohort of the Australian Twin Register (born 1902–1964) and 3,814 spouses of the twins.

Quantitative genetic modeling was used to determine the extent to which variability in risk for AD was influenced by genetic factors, the extent of spousal association for AD, and whether the association was attributable to assortative mating, reciprocal spousal interaction, or both processes.

Results:

Genetic factors explained 49% of the variance in risk for AD.

There was no evidence of gender differences in the spousal interaction effect, the degree of rater bias, or the association between the twin's report of spouse AD and the spouse's AD phenotype.

Either the assortative mating parameter or the spousal interaction parameter could be removed from the model without a significant decrement in fit, but both could not be dropped simultaneously, suggesting a lack of power to differentiate between these 2 causes of spousal correlation.

When both effects were included in the model, the spousal correlation was 0.29, the assortative mating coefficient was 0.45 (i.e., "like marries like"), and the reciprocal spousal interaction coefficient was −0.10 (i.e., after controlling for assortative mating, the additional impact of spousal interactions is slightly protective).

Conclusions:

These analyses provide evidence of significant spousal associations for AD, with assortative mating increasing spouse similarity and spousal interaction effects decreasing it after controlling for assortative mating.

Although the genetic impact is modest, assortative mating results in an increased proportion of offspring exposed to 2 alcoholic parents and the associated detrimental environmental sequelae, and increases the likelihood of offspring inheriting high-risk genes from both parents.

Ethanol-Associated Cues Produce General Pavlovian-Instrumental Transfer

Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007

• Laura H. Corbit¹
• ¹Department of Neurology, Ernest Gallo Clinic and Research Center, University of California, San Francisco, California and
• Patricia H. Janak¹
• ¹Department of Neurology, Ernest Gallo Clinic and Research Center, University of California, San Francisco, California

• ¹Department of Neurology, Ernest Gallo Clinic and Research Center, University of California, San Francisco, California

The research reported in this paper was supported by funds from the state of California for medical research on alcohol and substance abuse through the University of California, San Francisco.

Reprint requests: Laura H. Corbit, PhD, Department of Neurology, Ernest Gallo Clinic and Research Center, 5858 Horton St. Suite 200, Emeryville, CA 94608; Fax: 510-985-3101; E-mail: lcorbit@gallo.ucsf.edu

Abstract

Background:

Conditioned stimuli are thought to play an important role in maintaining ethanol use and inducing relapse. Therefore, understanding the mechanisms through which such stimuli trigger ethanol seeking is of interest in the study and treatment of alcoholism.

Methods:

This series of experiments examined the impact of ethanol-associated cues on ethanol-seeking behavior using a Pavlovian-instrumental transfer design. Rats received Pavlovian training in which an auditory stimulus predicted ethanol (10%) delivery. In a separate instrumental training phase, animals were trained to press a lever for ethanol. In the test phase, the impact of the stimulus on instrumental performance was assessed in extinction by presenting the stimulus while animals were free to perform the lever-press response. Experiment 2 assessed the selectivity of the transfer effect; rats received training with 2 auditory stimuli which predicted either ethanol or sucrose (2%) delivery and were trained to perform 2 instrumental responses, one earning ethanol and the other earning sucrose. Finally, Experiment 3 examined the selectivity of PIT using 2 natural rewards (sucrose and polycose).

Results:

The results from Experiment 1 show that ethanol supports excitatory conditioning and that ethanol-associated cues facilitate instrumental performance for ethanol. When the selectivity of the transfer effect was examined in Experiment 2, the ethanol-paired stimulus was found to have a general excitatory effect on reward-seeking behavior, affecting both ethanol-directed and sucrose-directed responding equally. In contrast, the sucrose-paired stimulus had a selective effect, elevating sucrose-directed responding only. Experiment 3 confirms that selective transfer is observed when 2 natural rewards are used to reinforce responding.

Conclusions:

These data provide further evidence that ethanol-associated cues can drive ethanol-seeking behaviors. Because ethanol-associated cues also enhanced seeking behavior for a nonalcohol reward, these results additionally suggest that the modulation of reward-directed behaviors by cues associated with ethanol versus natural rewards may rely on different behavioral and neural mechanisms.

Morphometry of Dorsal Raphe Nucleus Serotonergic Neurons in Alcoholism

Alcoholism: Clinical and Experimental Research (OnlineEarly Articles).
22 March 2007

• Mark D. Underwood^1,2
• ¹Department of Neuroscience, New York State Psychiatric Institute, New York, New York; and
• ²Department of Psychiatry, College of Physicians & Surgeons of Columbia University, New York, New York,
• J. John Mann^1,2
• ¹Department of Neuroscience, New York State Psychiatric Institute, New York, New York; and
• ²Department of Psychiatry, College of Physicians & Surgeons of Columbia University, New York, New York, and
• Victoria Arango^1,2
• ¹Department of Neuroscience, New York State Psychiatric Institute, New York, New York; and
• ²Department of Psychiatry, College of Physicians & Surgeons of Columbia University, New York, New York

• ¹Department of Neuroscience, New York State Psychiatric Institute, New York, New York; and ²Department of Psychiatry, College of Physicians & Surgeons of Columbia University, New York, New York.

This work was supported by AA11293, AA09004, MH40210, MH46745, and MH47097.

Reprint requests: Mark Underwood, PhD, Department of Neuroscience, New York State Psychiatric Institute, 1051 Riverside Drive Box 42, New York, NY 10032; Fax: 212-543-5998; E-mail: undie@neuron.cpmc.columbia.edu

Abstract

Background:

Reduced serotonergic function is hypothesized in alcohol abuse and dependence. Serotonergic innervation of the cortex arises predominantly from the dorsal raphe nucleus (DRN). We sought to determine the number and morphometric characteristics of DRN serotonergic neurons postmortem in alcoholic individuals (n=9; age: 16–66years; 8M:1F) compared with psychiatrically normal, nonalcoholic controls (n=6; age: 17–74 years; 4M:2F).

Methods:

Brainstems were collected at autopsy, fixed and cryoprotected. Alcohol dependence or abuse was determined by psychological autopsy (DSM-IV), the presence of liver fatty changes or cirrhosis and/or high blood alcohol level. Tissue was sectioned at 50 μm (−25°C). A series of 1:10 sections was immunoreacted with antiserum to tryptophan hydroxylase (TPH), the rate-limiting enzyme in the biosynthesis of serotonin. The total number of TPH-immunoreactive (IR) DRN neurons was determined by stereology. Neuron morphometry indices were determined using a video-based imaging system attached to a microscope. We identified TPH-IR neurons every 1,000 μm in each brainstem and measured neuron area, total cross sectional neuron area, and the total area and density of immunolabeled processes.

Results:

Dorsal raphe nucleus neuron number (controls: 80,386±10,238; alcoholic individuals: 85,884±12,478) was not different between groups but TPH-IR was greater in alcoholic individuals throughout the rostrocaudal extent of the DRN. The volume of the DRN was 66±9 mm³ in controls and 55±5 mm³ in alcoholic individuals (p>0.05). The average size of DRN neurons did not differ between groups (353±12 μm² for controls vs 360±15 μm² for alcoholic subjects). However, the area occupied by neuron processes (area of processes/DRN area) was 2.2-fold greater in alcoholic individuals compared with controls (p<0.05).>

Conclusions:

The increased area occupied by neuron processes in alcoholic individuals may represent sprouting and, together with greater TPH-IR, be a compensatory response to impaired serotonergic transmission or cumulative effects of alcohol on the serotonin system.

Trysh Travis finds something to like about HBO's Addiction project

Barbara Koppel’s “Steamfitters Local Union 638” is the most compelling of the nine mini-documentaries that make up HBO’s Addiction. I think I’ve made my skepticism about the multi-platform project’s obsession with addiction as a “scientifically-proven brain disease” clear in previous posts, but let me risk going just a little further over the top by saying that I think that the reason Koppel’s piece is more satisfying as cinema is directly related to its lack of interest in “disease.”

....more

Source: Alcohol and Drugs History Society

Does matching matter? Examining matches and mismatches between patient attributes and therapy techniques in alcoholism treatment.

Addiction. 2007 Apr;102(4):587-96

• Karno MP, Email: karno@ucla.edu

• Longabaugh R.

Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA.

Abstract

Aims

This study assessed the predictive validity of the level of matching and mismatching between patients' personal attributes and aspects of outpatient psychotherapy they received.

Design and participants

On the basis of patient-by-treatment interactions observed for this sample in previous research, patients with alcohol abuse or dependence (n = 137) were designated retrospectively as being matched, unmatched or mismatched on each of four patient and treatment variable pairings. These pairings included (1) patient depressive symptoms and therapy emotion focus, (2) patient trait anger and therapy confrontation, (3) patient interpersonal reactance and therapy confrontation and (4) patient interpersonal reactance and therapy structure.

Measurements

Analyses of variance and logistic regression were used to assess the individual and additive effects of being matched and mismatched on the percentage of abstinent days (PDA) and recovery status in the year after treatment.

Findings

Being mismatched on any of the four patient-treatment pairings was a significant predictor of more frequent alcohol use post-treatment. Being matched on only two pairings predicted less frequent alcohol use, namely matches on therapy emotion focus with patient depressive symptoms and therapy structure with patient reactance.

Matches appeared to optimize otherwise good outcomes, while mismatches had larger effect sizes and tended to predict relatively poor outcomes.

The data supported the presence of an additive effect for mismatches on post-treatment PDA. The group with the most mismatches fared considerably worse than a group with fewer mismatches. Several matches and mismatches also predicted recovery status, with some support found for additive effects.

Conclusions

Mismatches between patient attributes and treatment appear to have serious consequences, and this effect is magnified with multiple mismatches. Matches, on the other hand, while beneficial, may not be necessary to achieve good outcomes.

Press Release - $24M Grant For OHSU-Led Alcohol Research Consortium

March 20, 2007 Contact: Jonathan Modie 503-494-8231 Email Jonathan Modie

PORTLAND, Ore. - The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has funded a five-year, $24 million Integrative Neuroscience Initiative on Alcoholism grant to support a consortium led by an Oregon Health & Science University researcher.

Of the total grant, OHSU will receive about $6.3 million over five years, funding projects in the laboratories of Kathleen A. Grant, Ph.D., professor of behavioral neuroscience in the OHSU School of Medicine. The consortium, Integrative Neuroscience Initiative on Alcoholism: Stress, Anxiety and Alcoholism, or INIAstress, extends a cross species approach in exploring neural mechanisms that link stress, anxiety, and excessive alcohol intake.

Alcohol abuse and alcoholism result from a complex interplay of genetic and environmental factors. Many aspects of an individual's response to the environment activate the hypothalamic-pituitary-adrenal (HPA) axis and are therefore labeled as "stress." Much of the stress in modern society is a subjective state of anxiety, where competing goals generate conflict and activate brain mechanisms involved in arousal and attention. These stressful states are often seemingly relived by drinking alcohol and may be a primary factor in establishing excessive alcohol consumption.

While there is a great deal of evidence supporting stress-alcohol interactions, less is known about how these interactions alter the brain at the molecular, cellular and systems levels to maintain excessive drinking and alcoholism and why this addiction is so difficult to treat. This consortium is tackling the larger picture of genetic influences on the brain mechanisms that mediate the response to alcohol, the response to stress, and the reciprocal relationship between excessive drinking, the physiological state of stress and the subjective state of anxiety.

The consortium's main approach will be to characterize the genetic basis of key neural mechanisms in stress and anxiety in order to clearly assess individual risk for the development of alcoholism or to develop tailored therapeutic approaches to treating the anxious alcoholic.

The grant represents the first competitive renewal for the INIA consortium, which is made up of 20 lead investigators from 11 institutions from the United States and Europe. The group received its initial round of funding in 2001. The other institutions involved are: University of Tennessee Health Sciences Center; Medical University of South Carolina; Wake Forest University; University of Texas Southwest; Virginia Commonwealth University; Oak Ridge National Laboratory; Vanderbilt University; University of Oklahoma Health Sciences Center; Furman University; University of Maine; and University of Cagliari, Italy.

To date, the consortium has made significant scientific progress. Accomplishments include: The consortia has published over 100 articles on the topic of genetic and environmental components of alcohol-stress interactions, the production of unique, genetically altered, mice for addressing the role of key genes in stress, anxiety and alcoholism, a growing data base of translational research linking findings from mice, non human primates and human beings, and supporting the inclusion of new investigators into the realm of alcohol research.

The NIAAA is one of the 18 institutes that comprise the National Institutes of Health. It supports and conducts biomedical and behavioral research on the causes, consequences, treatment, and prevention of alcoholism and alcohol-related problems. Visit www.niaaa.nih.gov for more information.

About Oregon Health & Science University
OHSU is the state's only comprehensive public academic health center. Its fundamental purpose is to improve the health and well being of people in Oregon and beyond. As part of its multifaceted public mission, OHSU strives for excellence in education, research and scholarship, clinical practice and community service. Through its dynamic interdisciplinary environment, OHSU stimulates the spirit of inquiry, initiative, and cooperation among students, faculty and staff. OHSU is made up of the schools of Medicine, Dentistry, Nursing, and School of Science & Engineering.

Kettil Bruun Society Early Career Scientist Award

The Kettil Bruun Society is an international and multidisciplinary society, aiming to promote social and epidemiological research which fosters comparative understanding of the social aspects of alcohol problems in different countries and across different sub-populations.

The purpose of the KBS Early Career Scientist Award is to recognize the excellence of the papers presented by early career scientists at the KBS Annual Symposium held each year in early June. The award is a cash prize of 250 Euros and two years membership of the Kettil Bruun Society.

The best paper presented by an early career scientist will be selected by a scientific committee, based on its contribution to advancing knowledge in alcohol research and on its theoretical and methodological quality.

The winner will be announced and the award presented towards the end of the meeting.

Eligibility:

Applicants who:

- are students studying for their masters or doctoral degree or early career scientists who have obtained their doctoral degree within the last two years.
- are presenting a paper as a first author.

Application

The June 2006 award has been presented. For the future, applicants must send their full conference paper to Tim Stockwell, KBS President (timstock@uvic.ca) along with a covering letter stating how long the applicant has been engaged in social and/or epidemiological research on alcohol and the year they obtained their PhD if applicable.

2006 Selection committee

Tim Stockwell , Henk Garretsen, Deborah Dawson and Kate Graham.

The NSDUH Report:
Co-Occurring Major Depressive Episode and Alcohol Use Disorder among Adults


Combined data from SAMHSA's 2004 and 2005 National Surveys on Drug Use and Health were used to examine co-occurring alcohol use and depression as well as treatment for these disorders in adults aged 18 or older.

The following prevalence were found: An estimated 7.6% of adults aged 18 or older (approximately 16.4 million adults) had experienced at least one major depressive episode during the past year. An estimated 8% (17.3 million adults) met criteria for alcohol use disorder in the past year. An estimated 1.2% (2.7 million adults) had co-occurring major depressive episode and alcohol use disorder in the past year.

Among adults with past year co-occurring major depressive episode and alcohol use disorder, 48.6% received treatment only for major depressive episode, 1.9% received treatment at a specialty facility only for alcohol use disorder, and 8.8% received treatment for both problems. About 40% received no treatment.

The rate of past year alcohol use disorder was over twice as high among adults who had experienced a major depressive episode (16.2%) compared with adults who had not experienced a major depressive episode in the past year (7.3%).

The NSDUH Report: Health Insurance and Substance Use Treatment Need

• Health insurance and the need for and receipt of substance abuse treatment among adults aged 18 or older was examined based on combined 2004 and 2005 SAMHSA National Surveys on Drug Use and Health. Types of health insurance included Medicare, Medicaid/CHIP, military health care, and private insurance. An annual average of 85.4% adults had some type of health insurance in the past year and 70.5% had private health insurance. Adults needing substance abuse treatment in the past year were less likely to have some type of health insurance coverage in the past year than adults not needing treatment (74.4% vs. 86.6%).
  
• About half (51.2%) of the adults needing treatment whose last treatment in the past year was at a specialty substance abuse treatment reported that some type of health insurance (private insurance, Medicare, Medicaid, military health care, or other insurance) paid for the services.

Download full report

30^thAnnual Scientific Meeting of the Research Society on Alcoholism

July 7-12, 2007
Hyatt Regency, Chicago, Illinois

Following is a list of all of the information that can be found on our Meeting Page. If you will be attending the meeting, after you register, please take a moment to fill out the �Please Help Us� form. Also, be sure to send us your verification letters if you are a non-member student or non-member post-doc. Any questions, please do not hesitate to contact us at DebbyRSA@sbcglobal.net or 512-454-0022. See you in Chicago.

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CADCA Broadcast Explores Impact of Stress on Substance Abuse

March 15, 2007

All of us have stress in our lives, but stress means different things to different people and causes varying reactions. While some can handle life stresses internally, others look for something to make them feel better—such as drugs and alcohol. Scientific research has shown a strong link between stress and substance abuse and it´s also one of the most powerful triggers for relapse, even after long periods in recovery. During an hour-long broadcast hosted by CADCA, experts will discuss the brain´s response to stress and the link between stress and substance abuse.

Stress-Induced Substance Abuse will be held on March 29, 2007 from 1-2 p.m. EST.

The broadcast will feature leading experts in the fields of substance abuse research and treatment, and mental health, including:

• Doctor William Shoemaker, Associate Professor of Psychiatry, University of Connecticut. He has many years of experience researching the effects of alcohol and other drugs on the brain and how stress often triggers drug use.

• Kay Daughty, Vice President of Family and Community Services, Operation PAR, Pinellas Park, FL

• Bert Bauer, Licensed Clinical Social Worker, Pathways New Learning Center, Atlanta, GA; and recently retired from the Army Reserve Command after 40 years of military service, where he provided mental health services to the active duty military.

• Edward Carlson, Executive Director, Odyssey House Louisiana

• John King, Executive Director, Council on Alcohol and Drug Abuse for Greater New Orleans


During the broadcast, panelists will discuss why stress may lead to substance abuse and how the brain responds to stressful situations or events. See how rates of alcohol and drug abuse increase after traumatic events such as military service, terrorist attacks, and natural disasters. Hear first-hand how many people struggling with the aftermath of Hurricane Katrina are looking for stress relief, often in dangerous ways, and find out how to identify who is at risk and see what treatment options work.

The broadcast will be webcast live at www.MCTFT.com and www.cadca.org. It can also be viewed at no cost from any site with a satellite dish having C-band downlink capabilities. All viewing sites must register in advance to receive the necessary satellite coordinates. To register, contact Ed Kronholm at 877-820-0305 or dlnets@aol.com. To register online, visit: www.dlnets.com/MCTFT2nd.htm.

CDontributor: Don Phillips

Increased QT interval variability index in acute alcohol withdrawal

Drug and Alcohol Dependence
Article in press 9 March 2007

Karl-Jürgen Bär^a , Email: Karl-Juergen.Baer@med.uni-jena.de

Michael Karl Boettger^b,

Mandy Koschke^a,

Silke Boettger^a,

Marei Grotelüschen^a,

Andreas Voss^c and

Vikram K. Yeragani<sup>d, e

a</sup>Department of Psychiatry, Friedrich-Schiller-University, Jena, Germany
^bInstitute of Physiology I, Friedrich-Schiller-University, Jena, Germany
^cDepartment of Medical Engineering, University of Applied Sciences, Jena, Germany
^dDepartment of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, USA
^eDepartment of Psychiatry, University of Alberta, Edmonton, Canada

Received 13 September 2006; revised 14 January 2007; accepted 17 January 2007. Available online 9 March 2007.

Abstract

Objective

Acute alcohol withdrawal is associated with increased cardiovascular mortality, most likely due to cardiac arrhythmias. As the QT interval reflects the most critical phase for the generation of reentry and thus for arrhythmia, we examined QT variability in patients suffering from acute alcohol withdrawal.

Methods

High resolution electrocardiographic recordings were performed in 18 male unmedicated patients suffering from acute alcohol withdrawal, 18 matched controls and 15 abstained alcoholics. From these, parameters of beat-to-beat heart rate and QT variability such as approximate entropy and QT variability index (QTvi) were calculated. Measures were correlated with the severity of withdrawal symptoms and with serum electrolyte concentrations.

Results

Heart rate and QTvi were significantly increased in acute alcohol withdrawal. Abstained alcoholics did not significantly differ from controls. While QTvi correlated with the severity of alcohol withdrawal symptoms, the mean QT interval duration showed an inverse relationship with serum potassium concentrations.

Conclusion

Our data indicate increased QT variability and thus increased repolarization lability in acute alcohol withdrawal. This might add to the elevated risk for serious cardiac arrhythmias. In part, these changes might be related to increased cardiac sympathetic activity or low potassium, thus suggesting the latter as possible targets for adjuvant pharmacological therapy during withdrawal.

Corresponding author at: Department of Psychiatry, Friedrich-Schiller-University Jena, Philosophenweg 3, 07743 Jena, Germany. Tel.: +49 3641 935282; fax: +49 3641 936217.

Experts call for booze crackdown

The pressure group is concerned over the availability of cheap drink

A pressure group has called for a Scottish Parliament inquiry into alcohol-related health problems.

March 20, 2007

The move comes a month after Health Minister Andy Kerr announced a strategy for tackling alcohol abuse.

Scottish Health Action on Alcohol Problems (SHAAP) is particularly worried about low-cost drink promotions in supermarkets and off-licences.

The group will present a petition to the parliament on Tuesday and will publish its parliamentary manifesto.

The organisation wants the health and community care committee to lead an inquiry into Scotland's alcohol problems.

It wants the Scottish Executive to look at extending the promotions mechanism in the Licensing (Scotland) Act to cover supermarkets, off-licences and shops as a means of preventing the low-cost promotion and sale of alcohol.

Stricter enforcement

The SHAAP manifesto calls for alcohol to be displayed separately from other goods in shops.

It recommends stricter enforcement of laws relating to alcohol use and residential programmes for people with alcohol problems throughout Scotland.

The appeal comes after school pupils last year petitioned parliament over concerns about the health implications of cheap alcohol and urged ministers to investigate.

The youngsters from All Saints School in Glasgow found that alcohol was often cheaper than bottled water.

The lower the cost of alcohol, the more alcohol is consumed and the worse our alcohol-related health problems become Dr Bruce Ritson

Dr Bruce Ritson, chair of SHAAP, said alcohol was undermining the nation's health.

"The association between price and increased consumption of alcohol is well established in academic and medical circles, but perhaps less well known publicly," he said.

"Speaking plainly, the lower the cost of alcohol, the more alcohol is consumed and the worse our alcohol-related health problems become."

The executive published its strategy on alcohol abuse last month which included rolling out a scheme to crack down on retailers who sold alcohol to under-18s.

SHAAP is a medical advocacy group set up by the Scottish Medical Royal Colleges and Faculties to raise awareness of the costs of excessive alcohol consumption.

Multi-component programmes


An approach to prevent and reduce alcohol-related harm
Betsy Thom and Mariana Bayley

This report reviews international experience of community-based prevention programmes to
address alcohol-related harms at local level.

Debate following the publication of the Alcohol Harm Reduction Strategy for England
(2004) and the implementation of the Licensing Act (2003) raised concerns about the cost of
alcohol misuse to individuals and communities. A key part of national strategy is a focus on
local responsibility for policy implementation and an expectation that stakeholders – local
authorities, professional groups, the alcohol trade and ‘communities’ – will work together to
reduce the problems.

The report describes a ‘multi-component’ model to prevent and reduce harm, with evidence
from programmes in the USA, Australia and Scandinavia. The approach typically requires
a programme of multiple, co-ordinated initiatives rather than ‘stand-alone’ projects, and an
emphasis on encouraging change in local policies, structures, systems and drinking cultures.
The involvement of local communities is central to most programmes. The report reveals
problems in implementing and sustaining this approach as well as the advantages it offers.
Discussions with a small group of professionals showed widespread use of ‘partnership’
approaches and suggested that the use of a more explicit multi-component model would be
helpful to map alcohol-related problems and design local strategies.

Multi-component programmes will be of interest to policymakers, researchers and professionals
working at local level.

Download the report free of charge (PDF, 438KB)

The lack of CB1 receptors prevents neuroadapatations of both NMDA and GABA_A receptors after chronic ethanol exposure

Journal of Neurochemistry (OnlineAccepted Articles).
12 March 2007

• Vincent Warnault*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France,
• Hakim Houchi*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France,
• Estelle Barbier*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France,
• Olivier Pierrefiche*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France,
• Catherine Vilpoux*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France,
• Catherine Ledent
• Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université libre de Bruxelles, Bât C, Bruxelles, Belgium.,
• Martine Daoust*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France and
• Mickaël Naassila*
• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France

• *Equipe Région INSERM 24 (ERI24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, Amiens, France; Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (IRIBHM), Université libre de Bruxelles, Bât C, Bruxelles, Belgium.

* Address correspondence and reprint requests to Dr M Naassila, Equipe Région INSERM 24 (ERI 24), Groupe de Recherche sur l'Alcool et les Pharmacodépendances (GRAP), Université de Picardie Jules Verne, Faculté de Pharmacie, 1 rue des Louvels, 80000 Amiens, France, Tél: +33 3 22 82 77 58, Fax: +33 3 22 82 76 72. E-mail: mickael.naassila@u-picardie.fr

Abstract

Because the contribution of CB1 receptors in the neuroadaptations following chronic alcohol exposure is unknown we investigated the neuroadaptations induced by chronic alcohol exposure on both NMDA and GABA_A receptors in CB1-/- mice.

Our results show that basal levels of hippocampal [³H]MK-801 binding sites were decreased in CB1-/- mice and that these mice were also less sensitive to the locomotor effects of MK-801.

Basal level of both hippocampal and cerebellar [³H]muscimol binding was lower and sensitivity to the hypothermic effects of diazepam and pentobarbital was increased in CB1-/- mice.

GABA_A α1, β2, γ2 and NMDA NR1, NR2B subunit mRNA levels were altered in striatum of CB1-/- mice.

Our results also showed that [³H]MK-801 binding sites were increased in cerebral cortex and hippocampus after chronic ethanol ingestion only in wild-type mice.

Chronic ethanol ingestion did not modify the sensitivity to the locomotor effects of MK-801 in both genotypes. Similarly, chronic ethanol ingestion reduced the number of [³H]muscimol binding sites in cerebral cortex, but not in cerebellum, only in CB1+/+ mice.

We conclude that lifelong deletion of CB1 receptors impairs neuroadaptations of both NMDA and GABA_A receptors after chronic ethanol exposure and that the endocannabinoid/CB1 receptor system is involved in alcohol dependence.

___________________________________________________________________

Integrated Treatment to Persons With Mental Disorders and co-Occurring Substance Use Disorders (ROP)

This study is not yet open for patient recruitment.
Verified by SINTEF Health Research March 2007

Sponsors and Collaborators: SINTEF Health Research The Research Council of Norway University of Oslo Information provided by: SINTEF Health Research ClinicalTrials.gov Identifier: NCT00447733

Purpose

The purpose of this study is to determine whether integrated treatment is effective in the treatment of mental disorders and co-occurring substance use disorders.

Condition	Intervention	Phase
Anxiety Disorders Mood Disorders Substance Use Disorders	Behavior: Integrated mental health and substance misuse treatment	Phase II Phase III

MedlinePlus related topics: Anxiety; Drug Abuse; Mental Health

Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Efficacy Study

Official Title: Effects of Integrated Treatment to Persons With Mental Disorders and co-Occurring Substance Use Disorders

Further study details as provided by SINTEF Health Research:

Primary Outcomes: alcohol and drug use at baseline, six and twelve months; Psychopathology at baseline, six and twelve months; Global functioning at baseline, six and twelve months
Secondary Outcomes: Quality of life at baseline, six and twelve months; Therapist alliance at six and twelve months; Treatment fidelity at six and twelve months
Expected Total Enrollment: 150

Study start: March 2007; Expected completion: December 2008

Patients with mental disorders and co-occuring substance use disorders are characterized by high suicide and treatment drop-out rates, and long-lasting interpersonal, work, school, health and legal problems. And because mental disorders and substance use disorders interact and co-exists, it may be important to provide treatment that integrates their substance misuse and mental health problems in a comprehensive way. The health services for patients with mental health and substance use disordes are usually provided by different services and health professionals that rarely cooperate or have qualifications on both kinds of disorders. The over-all aim of the study is to evaluate the effects of evidence-based integrated and comprehensive treatment of mental health problems and co-occurring substance use disorders. The effects of the treatment will be assesses on substance use,psychopathology, and quality of life.

Comparison: patients receiving treatment-as-usual or non-manualized treatment at general mental health outpatients clinics.

Eligibility

Ages Eligible for Study: 18 Years and above, Genders Eligible for Study: Both

Criteria

Inclusion Criteria:

• clinical diagnosis of substance use disorder
• clinical diagnosis of anxiety disorders
• clinical diagnosis of nonpsychotic mood disorders
• written consent
• planning to live in the catchment area during the treatment

Exclusion Criteria:

• schizophrenia spectrum disorders
• other psychotic disorders
• mental retardation
• having nicotine abuse/dependency only

Location and Contact Information

Please refer to this study by ClinicalTrials.gov identifier NCT00447733

Rolf W. Grawe, Ph.D 92221971 Ext. 0047 rolf.w.grawe@sintef.no
Amund Aakerholt, Ph.D 97599473 Ext. 0047 amund.aakerholt@iris.no

Norway
SINTEF Health Research, Trondheim, 7465, Norway

Rolf W. Gråwe, Ph.D 92221971 Ext. 0047 rolf.w.grawe@sintef.no

Study chairs or principal investigators

Rolf W. Gråwe, Ph.D, Principal Investigator, SINTEF Health Research

More Information

substance abuse treatment for persons with co-occurring disorders

Study ID Numbers: 78i068; NFR175394/V50
Last Updated: March 14, 2007
Record first received: March 14, 2007
ClinicalTrials.gov Identifier: NCT00447733
Health Authority: Norway: Norwegian Social Science Data Services
ClinicalTrials.gov processed this record on 2007-03-19