ICAP Periodic Review on Drinking and Culture

Alcohol consumption is an integral part of the social fabric in many countries. Yet the role occupied by drinking is quite different across countries and cultures, and is reflected in local customs, patterns, and attitudes. Despite this wide diversity, the lingua franca of the alcohol field is English, as are the publications that provide the evidence base most commonly used in international policy discussions. As a result, much of the research published in other languages and reflecting different cultural contexts and approaches escapes broader notice.

The ICAP Periodic Review on Drinking and Culture is an electronic publication that seeks to help remedy this disparity. Its key objectives are to:

(1) give greater exposure to research not currently published or widely available in English;

(2) broaden the range of cultural perspectives and the evidence base used in the crafting of policy and prevention.

Each issue of the Periodic Review presents English translations of abstracts of articles appearing in language areas currently underrepresented in major English-lanage research databases. Coverage of the Periodic Review is limited to psychosocial and socio-cultural research, to focus on drinking culture, behavior, patterns, and psychosocial outcomes.

Identification and selection of key research to be featured and all editorial decisions are carried out by an Editorial Group, consisting of experts from diverse geographic, linguistic, and disciplinary areas

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What is the ICAP Periodic Review on Drinking and Culture?

Background, objectives, and features.

· Members of the Editorial Group

· Guidelines for Editorial Group of ICAP Periodic Review on Drinking and Culture

· ICAP Periodic Review on Drinking and Culture: ISSUE 1

The first issue of the Periodic Review features abstracts of journal articles published in the past five years in Central, Southern, and Eastern Europe. The abstracts are grouped by topic and country.

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Transforming Mental Health and Substance Abuse Data Systems in the United States
Psychiatr Serv 59:1257-1263, November 2008


State efforts to improve mental health and substance abuse service systems cannot overlook the fragmented data systems that reinforce the historical separateness of systems of care. These separate systems have discrete approaches to treatment, and there are distinct funding streams for state mental health, substance abuse, and Medicaid agencies.

Transforming mental health and substance abuse services in the United States depends on resolving issues that underlie separate treatment systems—access barriers, uneven quality, disjointed coordination, and information silos across agencies and providers.

This article discusses one aspect of transformation—the need for interoperable information systems. It describes current federal and state initiatives for improving data interoperability and the special issue of confidentiality associated with mental health and substance abuse treatment data.

Some achievable steps for states to consider in reforming their behavioral health data systems are outlined. The steps include collecting encounter-level data; using coding that is compliant with the Health Insurance Portability and Accountability Act, including national provider identifiers; forging linkages with other state data systems and developing unique client identifiers among systems; investing in flexible and adaptable data systems and business processes; and finding innovative solutions to the difficult confidentiality restrictions on use of behavioral health data.

Changing data systems will not in itself transform the delivery of care; however, it will enable agencies to exchange information about shared clients, to understand coordination problems better, and to track successes and failures of policy decisions.

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Request Reprint E-Mail: rosanna.coffey@thomsonreuters.com
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Column - Focus on Alcohol & Drug Abuse: Improving Service Delivery for Individuals With Co-occurring Disorders: New Perspectives on the Quadrant Model
Psychiatr Serv 59:1251-1253, November 2008

This column summarizes findings of a study that examined the usefulness of the quadrant model for improving service delivery for persons with co-occurring disorders.

The authors discuss treatment recommendations, goals and barriers related to delivering care, policy recommendations for implementing evidence-based interventions, and strengths and limitations of the model.

They conclude that although the quadrant model is useful for conceptualizing systems-level factors for improving delivery, its further development is unlikely to result in improved care at the clinical level.

They call for research to develop and implement evidence-based practices targeted to specific populations of persons with co-occurring disorders.

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Request Reprint E-Mail: keyser@rand.org

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ALCOHOL DRINKING AND RISK OF HOSPITALIZATION FOR COPD
CHEST Meeting 2008; 134: 19004S.

COPD Evaluation and Outcomes
Tuesday, October 28, 2008

1:00 PM - 2:15 PM

Limited data suggest that moderate alcohol drinkers may be at lower risk of COPD than abstainers. Important potential confounders are smoking, concomitant coronary artery disease (CAD), and inclusion of former drinkers among abstainers. With more data needed, we performed a cohort study in a large multiethnic population.

We studied 126,263 men and women who supplied baseline data at 1978–85 health examinations. Through 2004 a subsequent primary hospitalization diagnosis of COPD (ICD-9 codes 491–6, except 493) was made in 760 persons. COPD risk was estimated by Cox proportional hazards models including age, sex, ethnicity, education, smoking, body mass index, and 7 alcohol intake categories. Some models included a yes vs. no composite CAD risk/symptoms covariate.

With lifelong abstainers as referent, adjusted relative risks (RR), 95 % confidence intervals (CI) for COPD were: exdrinkers = 1.29 (0.95–1.74), < day =" 0.83"> 1–2 dr/day = 0.76 (0.61–0.94, p = 0.01), 3–5 dr/day = 0.85 (0.65–1.12), and > 6 dr/day = 1.52 (1.04–2.24, p = 0.03). This alcohol-COPD J-curve was present in whites, African-Americans, ex-smokers, light smokers, heavy smokers, younger and older persons, and in subjects with either chronic bronchitis or other COPD diagnoses. However, the apparent benefit at moderate drinking levels was concentrated in women and subjects free of CAD history/symptoms. E.g., comparing persons reporting 1–2 drinks per day vs. lifelong abstainers, the RR (CI)'s were: men = 0.9 (0.7–1.3), women = 0.7 (0.5–0.9), CAD composite "yes" = 1.2 (0.6–2.5), and CAD composite "no" = 0.4 (0.1–1.1). Frequent wine drinking, both of red and white wine, was independently related to lower COPD risk. Covariate relations to COPD risk were as expected, with higher risk for older persons, men, smokers, and persons with low educational level.

These data show that, independent of smoking and CAD, moderate alcohol drinkers are at lower risk than lifelong abstainers of hospitalization for COPD.

Drinking moderate amounts of alcoholic beverages may have benefit for COPD.

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ICAP Review 3: Noncommercial Alcohol in Three Regions

A significant portion of alcohol produced, sold, and consumed around the world is not reflected in official statistics. This ICAP Review focuses on the prevalence of "noncommercial alcohol" in Sub-Saharan Africa, central and eastern Europe, and southern Asia. "Noncommercial alcohol" is defined as traditional drinks produced for home consumption or limited local trade, unregistered and counterfeit products, and nonbeverage, or surrogate, alcohols.

The Review papers are written by regional experts familiar with local research and regional trends. Each paper provides a literature review and introduces new data. This ICAP Review contributes to a better understanding of the informal alcohol sector, identifies available local and international research, and highlights areas for further work.

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'We should teach pupils aged just five about alcohol'

31 October 2008

By SHÂN ROSS

CHILDREN as young as five should be taught about the dangers of alcohol misuse, a leading figure in the drinks industry said yesterday.

Waiting until they are in their early teens is leaving it too late to avoid the dangers of binge drinking, warned Richard Paterson, master blender with the Glasgow-based whisky company White & Mackay.

. . . . .

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Light drinking in pregnancy may be good for baby boys, says study

• Sarah Boseley, health editor
• The Guardian,
• Friday October 31 2008

Researchers find fewer behavioural problems and higher test scores at age 3

Boys born to mothers who drank lightly during pregnancy are better behaved and score more highly in tests at the age of three than the sons of women who abstained, according to a study published today.

Researchers found there was no link between light drinking in pregnancy - defined as one to two units a week, or on occasion - and any behavioural or cognitive problems in children at the age of three.

Surprisingly, the University College London study found that some of the children of light-drinking mothers appeared to be doing better than the babies of those who abstained.

. . . . . .

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Light drinking in pregnancy, a risk for behavioural problems and cognitive deficits at 3 years of age?
IJE Advance Access published online on October 30, 2008


The objective of this study was to determine whether there was an association between mothers’ light drinking during pregnancy and risk of behavioural problems, and cognitive deficits in their children at age 3 years.

Data from the first two sweeps of the nationally representative prospective UK Millennium Cohort study were used. Drinking patterns during pregnancy and behavioural and cognitive outcomes were assessed during interviews and home visits. Behavioural problems were indicated by scores falling above defined clinically relevant cut-offs on the parent-report version of the Strengths and Difficulties Questionnaire (SDQ). Cognitive ability was assessed using the naming vocabulary subscale from the British Ability Scale (BAS) and the Bracken School Readiness Assessment (BSRA).

There was a J-shaped relationship between mothers drinking during pregnancy and the likelihood of high scores (above the cut-off) on the total difficulties scale of the SDQ and the conduct problems, hyperactivity and emotional symptom SDQ subscales. Children born to light drinkers were less likely to score above the cut-offs compared with children of abstinent mothers. Children born to heavy drinkers were more likely to score above the cut-offs compared with children of abstinent mothers. Boys born to mothers who had up to 1–2 drinks per week or per occasion were less likely to have conduct problems (OR 0.59, 95% CI 0.45–0.77) and hyperactivity (OR 0.71, 95% CI 0.54–0.94). These effects remained in fully adjusted models. Girls were less likely to have emotional symptoms (OR 0.72, 95% CI 0.51–1.01) and peer problems (OR 0.68, 95% CI 0.52–0.92) compared with those born to abstainers. These effects were attenuated in fully adjusted models. Boys born to light drinkers had higher cognitive ability test scores [standard deviations, (95% CI)] BAS 0.15 (0.08–0.23) BSRA 0.24 (0.16–0.32) compared with boys born to abstainers. The difference for BAS was attenuated on adjustment

Children born to mothers who drank up to 1–2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of abstinent mothers. Heavy drinking during pregnancy appears to be associated with behavioural problems and cognitive deficits in offspring at age 3 years whereas light drinking does not.

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Request Reprint E-Mail: y.kelly@ucl.ac.uk
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Millions Put Health At Risk With Drink
Wednesday October 29, 2008

More than 10 million people are drinking more than they should, an official body is warning.

Around a third of men (31%) and a fifth of women (20%) by regularly drinking more than the recommended levels are putting their health at risk, says the National Audit Office.

In a report into health services in England for alcohol misuse, the NAO criticises health providers for failing to have a clear picture of alcohol problems and required spending in their areas.

Hospital admissions for alcohol-related liver disease, mental health disorders linked to alcohol and acute intoxication doubled in the 11 years between 1995-96 and 2006-07.

And the number of deaths from alcohol-related causes doubled to 8,758 between 1991 and 2006.

The report from the Government's spending watchdog calls for Primary Care Trusts (PCTS) to be encouraged to focus more on preventative care, such as advice from doctors.

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Mutual Support Resources

Faces & Voices thanks Ernest and Linda Kurtz for developing our Guide to Mutual Support Resources. They launched it in 2001 for Behavioral Health Recovery Management. In 2005, Faces & Voices of Recovery assumed responsibility for the Guide that includes comprehensive information on mutual aid groups and recovery support resources. As Ernie, who has managed the site for the last three years, moves on, we extend a special thanks to him for the many hours that he has given to researching newly developing groups and providing monthly updates on mutual support resources.

The Guide to Mutual Support Resources will live on, with regular updates about useful resources for people seeking or in long-term recovery from addiction to alcohol or other drugs, family members, friends and loved ones. We’re pleased to announce that Lora Passetti, a Chestnut Health System research manager who has studied recovery support groups for young people, will be working with Bill White to manage the Guide going forward. Thank you Lora and Bill! Thank you also to Michael Boyle, Linda Kurtz and Keith Humphreys for their advice and assistance.

As you begin to review and use the information in this section, please take a moment to look at About Mutual Support, Encouraging Local Group Development, and References to find out more about mutual aid and support. If you are working with people seeking or in recovery from addiction to alcohol or other drugs, you will also be interested in checking out For Professionals.

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Estonia’s battle with alcoholism

Oct 29, 2008
By Jana Belugina

TALLINN - “Alcohol is a ubiquitous toxin that can harm almost any system or organ of the body. Beverages which contain alcohol are in essence marketed products, whose identities are built with a complex mix of marketing technologies… and these are currently regulated by both statutory and non-statutory means,” claims Enforcement of National Laws and Self-Regulation on Advertising and Marketing of Alcohol (ELSA) in its report on the impact of alcohol advertising.

From the first day of November, a new amendment to the advertising legislation, one that focuses on alcohol advertisements, is taking effect in Estonia. The government is hoping to reduce the drinking problems of Estonian citizens by such measures. Alcoholism is the most wide spread addiction in Estonia and according to statistics every tenth adult is consuming alcohol.

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Externalizing Psychopathology in Adulthood: A Dimensional-Spectrum Conceptualization and Its Implications for DSM–V
Journal of Abnormal Psychology 2005, Vol. 114, No. 4, 537–550


Mental disorders involving antisocial behavior and substance use are genetically linked and vary continuously.

The authors present a review and integrative conceptualization of these observations in terms of a dimensional and hierarchically organized externalizing spectrum. As a foundation for this conceptualization, the authors introduce a quantitative, model-based approach to comparing categorical and continuous conceptions of psychopathology and apply this approach in an empirical study of patterns of comorbidity among externalizing disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders.

The authors present evidence that comorbidity among externalizing disorders is best modeled by an underlying normally distributed continuum of risk for multiple disorders within the externalizing spectrum.

The authors conclude by discussing implications of the externalizing spectrum conceptualization for classification of disorders in the upcoming 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.

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Trade and health: how World Trade Organization (WTO) law affects alcohol and public health
Addiction Published Online: 5 Sep 2008

The alcohol field is becoming more aware of the consequences of world trade law for alcohol policies. However, there is a need for greater clarity about the different effects of trade on alcohol-related harm.

A comprehensive review of all literature on alcohol and world trade [including World Trade Organization (WTO) disputes on alcohol], supported by a more selective review of other relevant cases, academic reports and the grey literature on trade and health.

The burden of WTO law on alcohol policies depends upon the type of policy in question. Purely protectionist policies are likely to be struck down, which may lead to increases in alcohol-related harm. Partly protectionist and partly health-motivated policies are also at risk of being struck down. However, purely health-motivated policies are likely to be defended by the WTO—and to the extent that policy makers misunderstand this, they are needlessly avoiding effective ways of reducing alcohol-related harm.

WTO agreements contain genuine and substantial risks to alcohol policies, and various ways of minimizing future risks are suggested. However, the 'chilling effect' of mistakenly overestimating these constraints should be avoided. Health policy makers should decide on which policies to pursue based primarily on considerations of effectiveness, ethics and politics rather than legality. As long as any effect of these policies on trade is minimized, they are overwhelmingly likely to win any challenges at the WTO.

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Request Reprint E-Mail: b.p.baumberg@lse.ac.uk

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Genetic and environmental contributions to the diversity of substances used in adolescent twins: a longitudinal study of age and sex effects
Addiction Volume 103 Issue 10, Pages 1744 - 1751


To determine how genetic and environmental contributions affecting the number of psychoactive substances used varies with age and gender over the course of adolescence

The average diversity of substances used increased over time for both males and females, and males generally reported a wider diversity of substances used than females. Influences of genetic factors increased with age and were greater for males than for females at ages 14 and 17 years. Genetic factors remained consistent (i.e. highly correlated) across ages for both males and females, as did shared environmental influences for males. Non-shared environmental factors for both sexes and females' shared environmental factors were age-specific.

Regardless of sex, the proportion of variance in substances used attributable to genetic factors increases during adolescence, although it is greater for males than females at later ages. These findings indicate that prevention interventions may be most effective if they target early adolescence when environmental factors account for the majority of variance in substance use.

The high correlation of genetic factors across ages suggests that early use may sometimes signal an early expression of a developmentally stable genetic predisposition.

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Request Reprint E-Mail: derri032@umn.edu

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Detection Times for Urinary Ethyl Glucuronide and Ethyl Sulfate in Heavy Drinkers during Alcohol Detoxification
Alcohol and Alcoholism Advance Access published online on October 29, 2008



Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are conjugated ethanol metabolites formed in low amounts after alcohol consumption. Compared with ethanol, EtG and EtS are excreted in urine for a prolonged time, making them useful as sensitive alcohol biomarkers. This study determined the detection times for EtG and EtS in alcoholic patients undergoing alcohol detoxification.

The detection time for urinary EtG was weakly correlated (r = 0.434, P = 0.013) with the initial alcohol concentration (range 1.0–3.4 g/L). For EtG, the individual time range until return to below the applied cut-off limit (<0.5> was 40–130 h (median 78) with a similar time course observed for EtS. After correction for urine dilution, the time until an EtG/creatinine ratio <0.5 src="http://alcalc.oxfordjournals.org/math/sim.gif" alt="~" border="0">40– 90 h (median 65). The detection times after an estimated zero ethanol concentration were 30–110 h (median 66) for EtG and 30– 70 h (median 56) for EtG/creatinine. The EtG results by LC-MS and the immunoassay were in good agreement.

During alcohol detoxification, EtG and EtS remained detectable in urine for several days. The detection times showed wide inter-individual variations, also after adjusting values for urine dilution and to the estimated times for a completed ethanol elimination.

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Request reprint E-Mail: anders.helander@ki.se
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The Novel µ-Opioid Receptor Antagonist, [N-Allyl-Dmt¹]Endomorphin-2, Attenuates the Enhancement of GABAergic Neurotransmission by Ethanol
Alcohol and Alcoholism Advance Access published online on October 29, 2008



We investigated the effects of [N-allyl-Dmt¹]endomorphin-2 (TL-319), a novel and highly potent µ-opioid receptor antagonist, on ethanol (EtOH)-induced enhancement of GABA_A receptor-mediated synaptic activity in the hippocampus.

TL-319 had no effect on the baseline amplitude of eIPSCs or the frequency of sIPSCs. However, it induced a dose-dependent suppression of an ethanol-induced increase of sIPSC frequency with full reversal at concentrations of 500 nM and higher. The non-specific competitive opioid receptor antagonist naltrexone also suppressed EtOH-induced increases in sIPSC frequency but only at a concentration of 60 µM.

These data indicate that blockade of µ-opioid receptors by low concentrations of [N-allyl-Dmt¹]endomorphin-2 can reverse ethanol-induced increases in GABAergic neurotransmission and possibly alter its anxiolytic or sedative effects.

This suggests the possibility that high potency opioid antagonists may emerge as possible candidate compounds for the treatment of ethanol addiction.


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Request Reprint E-Mail: HSS@duke.edu
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Tough new restrictions for NSW pubs

October 30, 2008

The NSW government is moving to curb alcohol-related violence with a ban on new 24-hour licences and mandatory lock-outs for high-risk pubs and clubs.

NSW Premier Nathan Rees says any new licences will be limited to 18 hours.

In measures aimed at tackling violence at venues identified by police as high risk, beer glasses would be replaced by plastic after midnight, limits would be placed on drink purchases and a 2am lockout would be mandatory, he said.

. . . . .

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Naltrexone aversion and treatment efficacy are greatest in humans and rats that actively consume high levels of alcohol
Neurobiology of Disease Article in Press 1 October 2008


The opioid antagonist naltrexone is the standard pharmacotherapy for alcoholism, although compliance is often low. The mechanism by which naltrexone reduces drinking is yet unclear.

Here we show that in active alcoholics the magnitude of naltrexone treatment efficacy is correlated with the level of naltrexone-induced aversive side effects. This correlation is not observed when subjects are sober, but emerges following alcohol administration, when subjects are intoxicated. In contrast, there is no correlation following placebo administration.

To clarify these results, naltrexone was administered to ethanol-consuming rats prior to quantification of naltrexone aversion. Ethanol consumption preceding naltrexone treatment was again correlated with subsequent naltrexone-induced aversion, and this aversion correlated with subsequent decrease in ethanol consumption. In contrast, when naltrexone was given to ethanol-free rats, aversion was not predictive of ethanol consumption.

We conclude that naltrexone treatment efficacy is greater during active ethanol consumption and may be partly due to aversive side effects.

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Request Reprint E-Mail: jennifer.mitchell@ucsf.edu
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Effects of prenatal alcohol exposure on hippocampal volume, verbal learning, and verbal and spatial recall in late childhood
Journal of the International Neuropsychological Society (2008), 14:1022-1033



Children with prenatal alcohol exposure (PAE) show deficits in verbal learning and spatial memory, as well as abnormal hippocampal development. The relationship between their memory and neuroanatomic impairments, however, has not been directly explored.

Given that the hippocampus is integral for the synthesis and retrieval of learned information and is particularly vulnerable to the teratogenic effects of alcohol, we assessed whether reduced learning and recall abilities in children with fetal alcohol spectrum disorders (FASDs) are associated with abnormal hippocampal volumes.

Nineteen children with FASDs and 18 typically developing controls aged 9 to 15 years were assessed for verbal learning and verbal and spatial recall and underwent structural magnetic resonance imaging. Images were analyzed for total intracranial volume and for right and left hippocampal volumes.

Results revealed smaller left hippocampi and poorer verbal learning and verbal and spatial recall performance in children with FASDs than controls, as well as positive correlations between selective memory indices and hippocampal volumes only in the FASD group.

Additionally, hippocampal volumes increased significantly with age in controls only, suggesting that PAE may be associated with long-term abnormalities in hippocampal development that may contribute to impaired verbal learning and verbal and spatial recall.

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Request Reprint E-Mail: joanne.rovet@sickkids.
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National Audit Office Press Notice - Reducing Alcohol Harm: Health services in England for alcohol misuse

Alcohol-related ill-health is an increasing burden for the National Health Service. Alcohol misuse costs the health service in the order of £2.7 billion a year, but efforts to address it locally are not in general well-planned, the National Audit Office reported today. The Department of Health is however raising the profile of alcohol misuse by providing information and guidance to underpin local action, centred on encouraging PCTs to gauge their performance against the rate of alcohol-related hospital admissions.

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Read Full Audit Report (PDF)

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Does outdoor alcohol advertising around elementary schools vary by the ethnicity of students in the school?
Ethnicity & Health Published Online 27 September 2008


The objectives of this study were to determine: (1) if the number of outdoor alcohol advertisements around schools varied by ethnicity of students in the school; and (2) how the content of alcohol advertising around schools varied by the ethnicity of students in the school.

Youth attending schools with 20% or more Hispanic students were exposed to 6.5 times more alcohol advertising than students attending schools with less than 20% Hispanic students. Schools with 20% or more Hispanic students were also surrounded by more beer advertising and alcohol advertisements on bars and liquor stores.

Alcohol advertising is more prevalent around schools with 20% or more Hispanic students. Policies should be considered to reduce the amount of alcohol advertising around schools.

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Request Reprint E-Mail: pasch@epi.umn.edu
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Exclusive: Credit crunch puts plans to shelve cheap alcohol on ice

By James Lyons 27/10/2008

Plans to ban bargain booze have been shelved – because of the credit crunch.

Ministers wanted to impose minimum alcohol prices to end below-cost deals on beer, wine and spirits in supermarkets and stores.

It was feared the deals were fuelling the binge-drinking culture and the hope was that a price limit – expected to be about 35p per unit of alcohol – would also make it too expensive for youngsters.

But the deepening economic gloom has prompted a rethink.

. . . . .

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Expert calls for advert ban on booze

• Annie Lawson
• October 27, 2008

ADOPTING an anti-drinking campaign that mirrors the successful anti-smoking program will help curb excessive drinking among young adults, an expert told a binge drinking forum in Melbourne last night.

Adolescent psychiatrist Michael Carr-Gregg advocates a "boozer-pays" tax and believes a ban on alcohol advertising would discourage teenagers from over-indulging.

. . . . .

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Major industry campaign to tackle attitudes to drunkeness

27 October, 2008

By James Wilmore

On-trade and off-trade uniting to address alcohol issues

A major new industry-wide marketing campaign to tackle alcohol misuse is currently being discussed with the government, thePublican.com can reveal.

Currently operating under the banner Project 10, the initiative is aiming to challenge attitudes around the “social acceptability of drunkenness” and persuade people to change their behaviour.

Companies from across the on-trade and off-trade – large and small – are understood to have given their backing “in principle” to the campaign being devised by leading marketing experts, which could run for five years.

. . . . . .

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Resuscitation room blood alcohol concentrations: one-year cohort study
Emergency Medicine Journal 2008;25:752-756;

To clarify the relationship between presenting clinical condition and blood alcohol concentration (BAC) among adult patients admitted to a resuscitation room (RR) of an emergency department (ED) in order to help guide clinical practice.

291 (15%) of 1908 presentations had a positive BAC (ie, BAC >10 mg/100 ml) ranging from 11 to 574 mg/100 ml, of which almost 40% were over 240 mg/100 ml (ICD-10 code Y90.8). In addition to collapse from alcohol/drugs, almost half of those presenting following self-harm or assault had a positive BAC. Those with a positive BAC had a higher rate of ED re-attendance in the following 6 months. 10% of all presentations were due to trauma.

The following five presentations to the RR are associated with a positive BAC: collapse from alcohol/drugs, self-harm, trauma, gastrointestinal bleeding (ICD-10 code K92.2) and non-cardiac chest pain (ICD-10 code R07). Patients with a positive BAC demonstrate a very wide range of pathology, some with severe levels of misuse. This highlights the opportunity for prompt feedback when sober, to ensure all is done to encourage patients to contemplate change in order to reduce re-attendance.

This work follows directly on from our first paper: "Use of blood alcohol concentrations in resuscitation room patients",1 which covers ethical, judicial and insurance issues. Alcohol misuse is a very common problem confronting all healthcare staff working in emergency departments (ED) worldwide.2 The value of screening and brief intervention in ED by an alcohol nurse specialist is established,3 with one less return visit to the ED over 12 months for every two people referred to an alcohol nurse specialist.4 At our hospital early identification of alcohol misuse is by the Paddington alcohol test (PAT) facilitating brief advice (with possible referral for brief intervention).5

Identification of patients with alcohol problems in the ED may be by history (PAT), clinical examination or blood alcohol concentration (BAC). PAT application is usually not possible for patients who are potentially critically ill and the need is for urgent assessment and treatment. Clinical examination for possible alcohol use is limited for the obtunded patient and has variable concordance with BAC.6 A degree of tolerance, thereby camouflaging clinical signs, for the "experienced" drinker is also well recognised.7 Measurement of BAC may provide a means of assessing the influence of alcohol use on the person’s presentation and management,8–10 but our ED staff were blinded to results (BAC requests not previously being routinely available at our hospital). Requesting the BAC without prior consent is acceptable to potentially critically ill patients, provided that feedback is given when patients are in a sufficiently improved clinical state.1 11

The extent of concurrent alcohol use among all categories of patients treated specifically in the resuscitation room (RR) of an ED has not previously been reported; every ED in the UK has a specific RR, usually between two and six bays, for potentially critically ill patients.12 We therefore set out to determine which RR patients were most likely to have a positive BAC and to explore associations with clinical outcomes, now that early identification with the giving of brief advice has been shown to be effective in reducing ED re-attendance.

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Request Reprint E-Mail: robin.touquet@imperial.nhs.uk

Increased White Matter Signal Hyperintensities in Long-Term Abstinent Alcoholics Compared with Nonalcoholic Controls
Alcoholism: Clinical and Experimental ResearchPublished Online: 23 Oct 2008

The harmful effects of alcohol dependence on brain structure and function have been well documented, with many resolving with sufficient abstinence. White matter signal hyperintensities (WMSH) are thought to most likely be consequences secondary to the vascular (i.e., hypertension and atherosclerosis) effects of AD.

We hypothesized that such effects would persist into long-term abstinence, and evaluated them in middle-aged long-term abstinent alcoholics (LTAA) compared with age and gender comparable nonalcoholic controls (NAC).

Long-term abstinent alcoholics had more WMSH than NAC. There was a significant group by age interaction, with WMSH increasing with age in LTAA, but not in NAC. Within LTAA, WMSH load was independently positively associated with alcohol burden and with age. No associations were evident between WMSH volumes and abstinence duration, family drinking history, years of education, or psychiatric or cognitive variables.

The magnitude of alcohol abuse was related to increased WMSH volume. The presence of an age effect in the LTAA but not the controls indicates a synergistic effect wherein alcohol advances the onset of aging-related WMSH formation. The increased WMSH load did not appear to have any significant clinical correlates, indicating that the white matter lesions in our sample may not have been severe enough to manifest as cognitive deficits. A limitation of the study is that we did not have data on the presence or severity of lifetime or current indices of vascular risk factors such as hypertension, smoking, or diabetes.

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Request Reprint E-Mail: george@nbresearch.com

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The Hispanic Americans Baseline Alcohol Survey (HABLAS): The association between birthplace, acculturation and alcohol abuse and dependence across Hispanic national groups
Drug and Alcohol Dependence Article in Press, 21 October 2008

Hispanics are heterogeneous in national origin, evidenced by wide ranges of alcohol abuse and dependence rates across different Hispanic national groups.

This paper examines associations between 12-month rates of DSM-IV alcohol abuse and dependence with birthplace and acculturation. The 2006 Hispanic Americans Baseline Alcohol Survey, using a multistage cluster sample design, interviewed 5224 adults (18+ years) in five selected U.S. metropolitan areas: Miami, New York, Philadelphia, Houston, and Los Angeles. Comprehensive data on drinking behavior were collected and the analyses include bivariate and multivariate regression techniques.

Alcohol abuse and dependence rates were higher among U.S.-born Puerto Ricans and South/Central Americans compared to their foreign-born counterparts, while no such differences were found for Cuban and Mexican Americans. Overall, those with higher acculturation report higher rates of abuse and dependence (statistically significant only for abuse among Puerto Ricans).

Risk factors for abuse include being male and being in the high acculturation group. Risk factors for dependence include being male, being Puerto Rican or Mexican American, having less than a college education, and being U.S.-born.

Hispanics were found to share several common risk factors with the larger U.S. population for abuse and dependence, such as male gender, lower education, and lower income.

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Request Reprint E-Mail: Raul.Caetano@UTSouthwestern.edu
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A latent class analysis of underage problem drinking: Evidence from a community sample of 16−20 year olds

Drug Alcohol Depend. 2006 July 27; 83(3): 199–209.

The aim of this paper is to shed light on the nature of underage problem drinking by using an empirically based method to characterize the variation in patterns of drinking in a community sample of underage drinkers.

A total of 4056 16−20-year-old current drinkers from 212 communities in the US were surveyed by telephone as part of the National Evaluation of the Enforcing Underage Drinking Laws (EUDL) Program. Latent class models were used to create homogenous groups of drinkers with similar drinking patterns defined by multiple indicators of drinking behaviors and alcohol-related problems.

Two types of underage problem drinkers were identified; risky drinkers (30%) and regular drinkers (27%). The most prominent behaviors among both types of underage problem drinkers were binge drinking and getting drunk. Being male, other drug use, early onset drinking and beliefs about friends drinking and getting drunk were all associated with an increased risk of being a problem drinker after adjustment for other factors.

Beliefs that most friends drink and current marijuana use were the strongest predictors of both risky problem drinking (OR = 4.0; 95% CI = 3.1, 5.1 and OR = 4.0; 95% CI = 2.8, 5.6, respectively) and regular problem drinking (OR = 10.8; 95% CI = 7.0, 16.7 and OR = 10.2; 95% CI = 6.9, 15.2). Young adulthood (ages 18−20) was significantly associated with regular problem drinking but not risky problem drinking. The belief that most friends get drunk weekly was the strongest discriminator of risky and regular problem drinking patterns (OR = 5.3; 95% CI = 3.9, 7.1).

These findings suggest that underage problem drinking is most strongly characterized by heavy drinking behaviors which can emerge in late adolescence and underscores its association with perceptions regarding friends drinking behaviors and illicit drug use.

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Cross-Cultural Patterns in College Student Drinking and its Consequences—A Comparison between the USA and Sweden

Alcohol Alcohol. 2008 Nov–Dec; 43(6): 698–705.

The aim of the study was to compare alcohol use, consequences and common risk factors between American and Swedish college students.

A secondary comparative analysis from one American and two Swedish studies in college settings.

Swedish freshmen report higher alcohol use than US freshmen students. Swedish residence hall students report higher alcohol use than US residence hall students, but lower than American fraternity/sorority members. US students were less likely to be drinkers. Controlling for age, country moderated the relationship between family history and harmful drinking scores for women (stronger in the USA), and between expectancies and harmful drinking scores for men (stronger in Sweden), though in both cases this represented a small effect and patterns were similar overall.

Swedish students are at higher risk for alcohol use than US students, but similar patterns between aetiological predictors and outcomes in both countries suggest that research from the USA is generalizable to Swedish students and vice versa. More research is needed to better understand unique relationships associated with age and family history.

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Early-onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins
Addiction Published Online: 8 Oct 2008

To explore the developmental relationships between early-onset depressive disorders and later use of addictive substances.

Early-onset depressive disorders predicted daily smoking [odds ratio (OR) 2.29, 95% confidence interval (CI) 1.49–3.50, P < or =" 2.00," class="i">P = 0.001), frequent illicit drug use (OR = 4.71, 95% CI 1.95–11.37, P = 0.001), frequent alcohol use (OR = 2.02, 95% CI 1.04–3.92, P = 0.037) and recurrent intoxication (OR = 1.83, 95% CI 1.18–2.85, P = 0.007) 3 years later. ORs remained significant after adjustment for comorbidity and exclusion of baseline users. In within-family analysis of depression-discordant co-twins (analyses that control for shared genetic and familial background factors), early-onset depressive disorders at age 14 predicted significantly frequent use of smokeless tobacco and alcohol at age 17.5.

Our results suggest important predictive associations between early-onset depressive disorders and addictive substance use, and these associations appear to be independent of shared familial influences.

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Request Reprint E-Mail: sihvola@helsinki.fi

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Youth in China Not Concerned About Drinking Too Much

By Gary Feuerberg

WASHINGTON—In the United States, most people are aware of the pernicious health and social consequences of consuming alcohol beverages, like accidents, disease, and domestic violence. By contrast, for most Chinese people, the social ills resulting from drinking do not come to mind as in the West, according to new research, sponsored by the International Center for Alcohol Policies (ICAP).

While Chinese are aware of the negative side of drinking, such as traffic crashes or alcoholism, they express surprise that anyone would want to single out drinking for its problems.

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Treasury figures show why pubs are closing

• Gaby Hinsliff
• The Observer,
• Sunday October 26 2008

Alcohol is up to a third cheaper in shops than it was a decade ago, say new Treasury figures, prompting a warning that cheap supermarket promotions are pushing pubs out of business.

The figures will increase pressure on the government to curb irresponsible price-cutting, blamed for fuelling Britain's binge culture, as part of a planned review of alcohol prices due to be published next month.

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One little glass can't hurt an alcoholic, can it?

The Times

October 27, 2008

Can a recovering alcoholic still have the occasional drink, or is it the road back to oblivion?

Claire had been sober for two years when she began a relationship with another recovering alcoholic. One evening at his house he made a suggestion. “How do you think we would react if we had just one drink?” he asked.

“I couldn't resist the challenge,” says Claire. “Within minutes we had downed the first glass of whisky and then another and another until the bottle was empty. That was the start of a two-day bender that ended up in hospital after I knocked myself out. I understand now that I can't ever have just one drink. I never could stop at one.”

What Claire discovered the hard way - and there is no other way for someone to acknowledge the extent of their dependency on alcohol - is the received wisdom that only abstinence will enable her to control her drinking. For those who are dependent, just one drink is not an option. They must stop and never start again.

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Review of alcohol-related harm in Wigan and Leigh

An estimated 1.55 million people in England drink at harmful levels and a further 6.6 million drink hazardously 1 . In Wigan, alcohol consumption is particularly high (NWPHO, 2007a). Approximately a quarter of the population is reported to drink at hazardous levels and a further 7.0% at harmful levels. Excessive consumption can be linked to a range of harms including alcohol-related violence, accidents and injuries, ill health and early mortality. In order to fully understand the impacts of alcohol on the local area, Wigan Drug and Alcohol Action Team commissioned the Centre for Public Health at Liverpool John Moores University to conduct a review examining areas such as alcohol-related ill health and alcohol-related crime.

A number of different sources informed this review including data published by the Centre for Public Health and the North West Public Health Observatory, in-depth analysis of hospital episodes data, external sources such as the Office for National Statistics and the Department for Culture, Media and Sport and data collected and held locally in Wigan. A Stakeholder meeting was also held to discuss the impact of alcohol in Wigan and Leigh, existing interventions and possible recommendations for the future.

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