ICAP Reviews 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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Excessive alcohol consumption is blocked by glial cell line–derived neurotrophic factor
Alcohol Volume 43, Issue 1, February 2009, Pages 35-43

We previously found that activation of the glial cell line–derived neurotrophic factor (GDNF) pathway in the ventral tegmental area (VTA) reduces moderate alcohol (ethanol) intake in a rat operant self-administration paradigm.

Here, we set out to assess the effect of GDNF in the VTA on excessive voluntary consumption of ethanol.

Long–Evans rats were trained to drink large quantities of a 20% ethanol solution in an intermittent-access two-bottle choice drinking paradigm. The rats were given three 24-h sessions per week, and GDNF's actions were measured when rats achieved a baseline of ethanol consumption of 5.5 g/kg/24 h.

We found that microinjection of GDNF into the VTA 10 min before the beginning of an ethanol-drinking session significantly reduced ethanol intake and preference, but did not affect total fluid intake.

We further show that GDNF greatly decreased both the first bout of excessive ethanol intake at the beginning of the session, and the later consummatory activity occurring during the dark cycle.

These data suggest that GDNF is a rapid and long-lasting inhibitor of “binge-like” ethanol consumption.

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Ethanol disrupts NMDA receptor and astroglial EAAT2 modulation of Kv2.1 potassium channels in hippocampus
Alcohol Volume 43, Issue 1, February 2009, Pages 45-50

Delayed-rectifier Kv2.1 channels are the principal component of voltage-sensitive K+ currents (IK) in hippocampal neurons and are critical regulators of somatodendritic excitability.

In a recent study, we demonstrated that surface trafficking and phosphorylation of Kv2.1 channels is modulated by NMDA-type glutamate receptors and that astroglial excitatory amino acid transporters 2 (EAAT2) regulate the coupling of NMDA receptors and Kv2.1 channels.

Because ethanol is known to acutely inhibit NMDA receptors, we sought to determine if NMDA receptor and astroglial EAAT2 modulation of Kv2.1 channels is impaired by ethanol in the rodent hippocampus.

As expected, bath application of NMDA to hippocampal cultures reduced the size of Kv2.1 clusters and produced a hyperpolarizing shift in the voltage-dependent activation of IK that was associated with dephosphorylated Kv2.1 channels.

Ethanol, applied acutely, prevented the hyperpolarizing shift in activation of IK induced by NMDA and restored Kv2.1 clustering and phosphorylation to near control levels. Ethanol also attenuated the dephosphorylation of Kv2.1 channels produced by the EAAT2 selective inhibitor dihydrokainic acid.

These data demonstrate that acute ethanol disrupts changes in Kv2.1 channels that follow NMDA receptor activation and impairs astroglial regulation of the functional coupling between NMDA receptors and Kv2.1 channels.

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Chronic ethanol consumption resulting in the downregulation of insulin receptor-β subunit, insulin receptor substrate-1, and glucose transporter 4 expression in rat cardiac muscles
Alcohol Volume 43, Issue 1, February 2009, Pages 51-58

The objective of this study was to investigate the effect of chronic ethanol intake on the expression of insulin receptor β subunit (IR-β), insulin receptor substrate-1 (IRS-1), and glucose transporter 4 (Glut4) in rat cardiac muscle.

Forty-eight male Wistar rats were randomly classified into four groups and to each group, ethanol was administered daily at the respective doses of 0 (control, C), 0.5 g kg−1 (low ethanol, L), 2.5 g kg−1 (middle ethanol, M), and 5 g kg−1 (high ethanol, H). Twenty-two weeks later, the rats were anesthetized, and the left ventricle muscles were excised. The IR-β, IRS-1, and Glut4 mRNA levels in the cardiac muscle tissues were detected by reverse-transcription polymerase chain reaction (RT-PCR); The IR-β, tyrosine phosphorylation of IR-β (PY-IR-β), IRS-1, tyrosine phosphorylation of IRS-1 (PY-IRS-1), and Glut4 protein levels were measured by Western blotting.

Compared to the control group, the IR-β, IRS-1, and Glut4 mRNA levels in groups H and M decreased remarkably. In addition, the protein levels of IR-β, IRS-1, and Glut4 showed a corresponding decline in ethanol-treated groups, especially in group H. Moreover, the PY-IR-β and PY-IRS-1 protein levels decreased in the hearts of ethanol-treated rats with corresponding changes in the IR-β and IRS-1 protein levels.

The present study showed that chronic ethanol intake could downregulate the expression levels of IR-β, IRS-1, and Glut4 in rat cardiac muscles.

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Effect of exercise training on ethanol-induced oxidative damage in aged rats

Alcohol Volume 43, Issue 1, February 2009, Pages 59-64

It is well known that lipid peroxidation increases with age, and alcohol drinking further exacerbates this damage.

The present study determined the effect of regular exercise training on alcohol-induced oxidative damage and antioxidant status in the liver of aged animals.

The age-matched Wistar albino rats (3 months young, n = 24; 18 months old, n = 24) were evenly divided into four groups: control (C), exercise trained (Ex), ethanol drinking (Et), and exercise plus ethanol drinking (Ex + Et).

With ethanol drinking, hepatic malondialdehyde (MDA) level was significantly elevated above control (P < .001), whereas glutathione (GSH) and ascorbic acid (vitamin C) contents were significantly decreased below control. These changes were found to be greater in the aged rats than those of the young rats. For both age groups, exercise training significantly reversed the increase in MDA and decreases in GSH and ascorbic acid induced by ethanol drinking.

The present study showed that ethanol-induced deterioration in lipid peroxidation and reduction in antioxidant status in the liver were exacerbated with age. Here, we found that exercise training significantly reversed the adverse conditions that were caused by ethanol in aged rats.

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Alcohol consumption and lipodystrophy in HIV-infected adults with alcohol problems

Alcohol Volume 43, Issue 1, February 2009, Pages 65-71

Lipodystrophy is a common long-term complication of HIV infection that may lead to decreased quality of life and less adherence to antiretroviral therapy (ART). A complete understanding of the etiology of HIV-associated lipodystrophy has not yet been achieved, although factors related to the virus, per se, and use of ART appear to be related.

Alcohol use is common among HIV-infected patients and has biological effects on fat distribution, yet alcohol's relationship to HIV-associated lipodystrophy has not been examined.

The goal of this clinical study was to assess the effect of alcohol consumption on lipodystrophy in HIV-infected adults with alcohol problems. This was a prospective study (2001–2006) of 289 HIV-infected persons with alcohol problems. The primary outcome was self-reported lipodystrophy, which was assessed at one time point (median 29 months after enrollment). Alcohol use was assessed every 6 months and classified as: abstinent at all interviews; ≥1 report of moderate drinking but no heavy drinking; 1 or 2 reports of heavy drinking; or ≥3 reports of heavy drinking. Multivariable logistic regression models were fit to the data.

Fifty-two percent (150/289) of subjects reported lipodystrophy. Alcohol consumption was: 34% abstinent at all interviews; 12% ≥1 report of moderate drinking, but no heavy drinking; 34% 1–2 reports of heavy drinking; and 20% ≥3 reports of heavy drinking. Although not statistically significant, subjects with alcohol use had a higher odds of lipodystrophy (adjusted odds ratios and 95% confidence interval: ≥1 report of moderate drinking, 2.36 [0.89, 6.24]; 1–2 reports of heavy drinking, 1.34 [0.69, 2.60]; ≥3 reports of heavy drinking, 2.07 [0.90, 4.73]).

Alcohol use may increase the odds of developing HIV-associated lipodystrophy among subjects with alcohol problems. However, larger studies are needed to fully elucidate the role and impact of alcohol consumption on the development of this common long-term complication of HIV infection and its treatment.

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HTR3B is associated with alcoholism with antisocial behavior and alpha EEG power—an intermediate phenotype for alcoholism and co-morbid behaviors

Alcohol Volume 43, Issue 1, February 2009, Pages 73-84

Alcohol use disorders (AUD) with co-morbid antisocial personality disorder (ASPD) have been associated with serotonin (5-HT) dysfunction. 5-HT3 receptors are potentiated by ethanol and appear to modulate reward. 5-HT3 receptor antagonists may be useful in the treatment of early-onset alcoholics with co-morbid ASPD. Low-voltage alpha electroencephalogram (EEG) power, a highly heritable trait, has been associated with both AUD and ASPD.

A recent whole genome linkage scan in one of our samples, Plains American Indians (PI), has shown a suggestive linkage peak for alpha power at the 5-HT3R locus. We tested whether genetic variation within the HTR3A and HTR3B genes influences vulnerability to AUD with comorbid ASPD (AUD + ASPD) and moderates alpha power.

Our study included three samples: 284 criminal alcoholic Finnish Caucasians and 234 controls; two independent community-ascertained samples with resting EEG recordings: a predominantly Caucasian sample of 191 individuals (Bethesda) and 306 PI. In the Finns, an intronic HTR3B SNP rs3782025 was associated with AUD + ASPD (P = .004).

In the Bethesda sample, the same allele predicted lower alpha power (P = 7.37e−5). Associations between alpha power and two other HTR3B SNPs were also observed among PI (P = .03). One haplotype in the haplotype block at the 3′ region of the gene that included rs3782025 was associated with AUD + ASPD in the Finns (P = .02) and with reduced alpha power in the Bethesda population (P = .00009). Another haplotype in this block was associated with alpha power among PI (P = .03). No associations were found for HTR3A.

Genetic variation within HTR3B may influence vulnerability to develop AUD with comorbid ASPD. 5-HT3R might contribute to the imbalance between excitation and inhibition that characterize the brain of alcoholics.

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Request Reprint E-Mail: Francesca.Ducci@iop.kcl.uk

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Young People and Alcohol Guidance

The Secretary of State for Children, Schools and Families has launched a consultation on alcohol guidance, advice and information for parents, children, young people. We would welcome the views of children, young people, parents, carers and those organisations and professionals working with young people in health, children’s services and education settings.

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National Survey of Substance AbuseTreatment Services (N-SSATS): 2007
Data on Substance Abuse Treatment Facilities

This report presents results from the 2007 National Survey of Substance Abuse Treatment Services (N-SSATS), an annual census of facilities providing substance abuse treatment. Conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), N-SSATS is designed to collect data on the location, characteristics, and use of alcoholism and drug abuse treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions.

Highlights

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Regional WHO consultation meetings on a global alcohol strategy are starting late February
2009-01-28

Dates are now set for the regional consultation meetings between WHO and the Member States. They are part of the process towards a Global Strategy to reduce Harmful Use of Alcohol. The first meeting will take place in Bangkok in the end of February.

See dates here...





Conference on the prevention of alcohol-related harm in East Africa
2009-01-28

Arusha, Tanzania: East African conference with a strong appeal for evidence-based alcohol policies in the region.


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Professor Thomas Babor: Effective and Evidence-base Interventions to reduce Alcohol-related Harm
2009-01-26

A video presentation of the WHO sponsored study “Alcohol: No Ordinary Commodity” by Professor Thomas Babor can be studied here.

Read more...




Substance use in conflict and disaster situations
2009-01-26

The UN High Commissioner on Refugees and the World Health Organization have produced a field guide for how to address alcohol and drug problems in populations affected by disaster or conflict.

Read more...


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Alcohol-use disorders

The Lancet, Early Online Publication, 26 January 2009

Alcohol dependence and alcohol abuse or harmful use cause substantial morbidity and mortality. Alcohol-use disorders are associated with depressive episodes, severe anxiety, insomnia, suicide, and abuse of other drugs. Continued heavy alcohol use also shortens the onset of heart disease, stroke, cancers, and liver cirrhosis, by affecting the cardiovascular, gastrointestinal, and immune systems.

Heavy drinking can also cause mild anterograde amnesias, temporary cognitive deficits, sleep problems, and peripheral neuropathy; cause gastrointestinal problems; decrease bone density and production of blood cells; and cause fetal alcohol syndrome. Alcohol-use disorders complicate assessment and treatment of other medical and psychiatric problems.

Standard criteria for alcohol dependence—the more severe disorder—can be used to reliably identify people for whom drinking causes major physiological consequences and persistent impairment of quality of life and ability to function. Clinicians should routinely screen for alcohol disorders, using clinical interviews, questionnaires, blood tests, or a combination of these methods.

Causes include environmental factors and specific genes that affect the risk of alcohol-use disorders, including genes for enzymes that metabolise alcohol, such as alcohol dehydrogenase and aldehyde dehydrogenase; those associated with disinhibition; and those that confer a low sensitivity to alcohol.

Treatment can include motivational interviewing to help people to evaluate their situations, brief interventions to facilitate more healthy behaviours, detoxification to address withdrawal symptoms, cognitive-behavioural therapies to avoid relapses, and judicious use of drugs to diminish cravings or discourage relapses.

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Childhood sleep problems, early onset of substance use and behavioral problems in adolescence

Sleep Medicine Article in Press, 12 January 2009

Very few prospective studies examine the relationship between childhood sleep problems and subsequent substance use. In this study, we examined how sleep problems at ages 3–8 predicted onset of alcohol, cigarette, and marijuana use in adolescence. We also investigated the relationships between childhood sleep problems and adolescent internalizing and externalizing problems

Controlling for parental alcoholism, sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use among boys and onset of alcohol use among girls. Childhood sleep problems were related to maternal ratings of internalizing and externalizing problems during adolescence for both boys and girls. Adjusting for these problems did not weaken the effects of sleep problems on onset of substance use.

This is to our knowledge the first study that prospectively examines gender differences in the relationship between sleep problems and early onset of substance use. Childhood sleep problems predicted early onset of substance use for boys but not girls. If childhood sleep problems indeed increase the probability of substance use onset, greater attention by parents to sleep problems in children and adolescents would potentially have ameliorative long-term effects. Parents are encouraged to explore different ways to help their children sleep better, including obtaining information and suggestions from their primary care physicians.

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Alcohol policy: battle of the binge

Published: 08 December 2008
Author: Stuart Shepherd

As drink gets cheaper and licensing hours get longer, stemming the effect on the nation's health and the NHS budget is causing headaches. Stuart Shepherd reports
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[Commentary] ALCOHOLIC BEVERAGE TAXES, PRICES AND DRINKING
Addiction Volume 104 Issue 2, Pages 191 - 192


Wagenaar et al.’s [1] meta-analysis assessing the impact of price on drinking in this issue of Addiction is a true tour de force that will serve as an invaluable resource for researchers, public health practitioners, alcohol ontrol advocates and policy makers for many years to come.
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Effects of beverage alcohol price and tax levels on drinking: a meta-analysis of 1003 estimates from 112 studies

Addiction Volume 104 Issue 2, Pages 179 - 190


We conducted a systematic review of studies examining relationships between measures of beverage alcohol tax or price levels and alcohol sales or self-reported drinking. A total of 112 studies of alcohol tax or price effects were found, containing1003 estimates of the tax/price–consumption relationship.

Simple means of reported elasticities are −0.46 for beer, −0.69 for wine and −0.80 for spirits. Meta-analytical results document the highly significant relationships (P < 0.001) between alcohol tax or price measures and indices of sales or consumption of alcohol (aggregate-level r = −0.17 for beer, −0.30 for wine, −0.29 for spirits and −0.44 for total alcohol). Price/tax also affects heavy drinking significantly (mean reported elasticity = −0.28, individual-level r = −0.01, P < 0.01), but the magnitude of effect is smaller than effects on overall drinking

A large literature establishes that beverage alcohol prices and taxes are related inversely to drinking. Effects are large compared to other prevention policies and programs. Public policies that raise prices of alcohol are an effective means to reduce drinking.


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The consequence of fetal ethanol exposure and adolescent odor re-exposure on the response to ethanol odor in adolescent and adult rats

An epidemiologic predictive relationship exists between fetal ethanol exposure and the likelihood for adolescent use. Further, an inverse relationship exists between the age of first experience and the probability of adult abuse. Whether and how the combined effects of prenatal and adolescent ethanol experiences contribute to this progressive pattern remains unknown. Fetal ethanol exposure directly changes the odor attributes of ethanol important for both ethanol odor preference behavior and ethanol flavor perception. These effects persist only to adolescence.

We tested whether adolescent ethanol odor re-exposure: (Experiment 1) augments the fetal effect on the adolescent behavioral response to ethanol odor; and/or (Experiment 2) perpetuates previously observed adolescent behavioral and neurophysiological responses into adulthood.

Experiment 1: Relative to fetal or adolescent exposure alone, adolescent re-exposure enhanced the behavioral response to ethanol odor in P37 animals. Compared to animals with no ethanol experience, rats receiving a single experience (fetal or adolescent) show an enhanced, yet equivalent, ethanol odor response. Fetal ethanol experience also increased olfactory-guided following of an intoxicated peer. Experiment 2: Combined exposure yielded persistence of the behavioral effects only in adult females. We found no evidence for persistence of neurophysiological effects in either sex.

Fetal ethanol exposure influences adolescent re-exposure, in part, by promoting interactions with intoxicated peers. Re-exposure subsequently enhances ethanol odor responsivity during this "at risk" age for emergent abuse patterns. While persistence of behavioral effects occurred in females, the level of re-exposure necessary to uniformly yield persistence in both sexes remains unknown.

Our results highlight an important relationship between fetal and adolescent experiences that appears essential to the progressive pattern of developing ethanol abuse.

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Booze Taxes Lower Drinking Rates


By Alan Mozes
HealthDay Reporter

THURSDAY, Jan. 15 (HealthDay News) -- The more alcohol costs, the less people drink it.

That's the conclusion of a new analysis of data from more than 100 studies gauging the impact of higher booze pricing -- typically in the form of higher taxes -- on American drinking habits.
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Alcohol sale, advertising policy in pipeline

PIUS RUGONZIBWA in ArushaDaily News;
Thursday,January 15, 2009

TANZANIA is in a process to formulate policy that will administer sale, advertisements, promotions and general consumption of alcoholic beverages and products. The Director of Mental Health and Substance Abuse at the Ministry of Health and Social Welfare, Dr Joseph Mbatia, told the 'Daily News' here on Wednesday that the country had no such policy and was now planning to involve stakeholders to see how it can be introduced and implemented.
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Potential Role of the Placenta in Fetal Alcohol Spectrum Disorder

Pediatric Drugs, Volume 11, Number 1, 2009 , pp. 26-29(4)

Mediators of susceptibility to alcohol-related toxicity in the prenatal environment are relatively unknown. The placenta has been proposed as a potential source of variability in the fetal environment, primarily through its significant metabolic capabilities. Meconium is a toxicological matrix unique to the developing fetus that offers an opportunity to quantify fetal exposure to alcohol through the analysis of fatty acid ethyl esters (FAEE) [nonoxidative ethanol metabolites].

To explore the role of the placenta as a potential source of variability in mediating fetal alcohol exposure via meconium analysis of FAEE, by combining a clinical case report involving human dizygotic twins and a series of guinea pig littermates.

The dizygotic twin pair yielded positive meconium FAEE results (>2.00 nmoL/g) in the female twin (2.21 nmoL/g) and no detectable FAEE in the male twin. A total of 15 meconium samples were collected from 15 pups of five pregnant guinea pig litters. With the exception of one pair of littermates, meconium FAEE concentrations differed substantially within each litter (FAEE expressed in units of nmoL/g): litter 1 (0.996, 4.43, 1.36); litter 2 (5.17, 4.15, 0.00); litter 3 (5.16, 5.27); litter 4 (18.57, 8.26, 7.46); litter 5 (0.00, 4.32, 0.00, 1.27).

Identical maternal ethanol exposure levels produced differing levels of fetal exposure in a dizygotic human twin pair and a series of guinea pig littermates as evidenced through FAEE meconium analysis. These data indicate that the placenta may have a previously unappreciated role in mediating ethanol-induced fetal injury.

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Outcomes of conduct problems in adolescence: 40 year follow-up of national cohort

BMJ 2009;338;a2981

To describe long term outcomes associated with externalising behaviour in adolescence, defined in this study as conduct problems reported by a teacher, in a population based sample.

Main outcome measures Mental disorder, alcohol abuse, relationship difficulties, highest level of education, social class, unemployment, and financial difficulties at ages 36-53.

348 adolescents were identified with severe externalising behaviour, 1051 with mild externalising behaviour, and 2253 with no externalising behaviour. All negative outcomes measured in adulthood were more common in those with severe or mild externalising behaviour in adolescence, as rated by teachers, compared with those with no externalising behaviour. Adolescents with severe externalising behaviour were more likely to leave school without any qualifications (65.2%; adjusted odds ratio 4.0, 95% confidence interval 2.9 to 5.5), as were those with mild externalising behaviour (52.2%; 2.3, 1.9 to 2.8), compared with those with no externalising behaviour (30.8%). On a composite measure of global adversity throughout adulthood that included mental health, family life and relationships, and educational and economic problems, those with severe externalising behaviour scored significantly higher (40.1% in top quarter), as did those with mild externalising behaviour (28.3%), compared with those with no externalising behaviour (17.0%).

Adolescents who exhibit externalising behaviour experience multiple social and health impairments that adversely affect them, their families, and society throughout adult life.

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Ethanol and Stress Activate Catecholamine Synthesis in the Adrenal
Annals of the New York Academy of Sciences Volume 1148 Issue Stress, Neurotransmitters, and Hormones Neuroendocrine and Genetic Mechanisms, Pages 542 - 551

Ethanol consumption and mental stress activate the sympathetic nervous system, which can adversely affect bone.

We compared six groups of 10 young adult rats, three with and three without 2 h daily restraint stress. Two groups consumed food and water ad libitum, two received food and 6% (w/v) ethanol as drinking water, and two received the amount of food consumed by ethanol rats the previous day plus water ad libitum (pairfed). After 6 weeks, rats were killed. Plasma, femurs, lumbar vertebrae, and adrenals were harvested. Femoral dimensions were measured and biomechanical properties were tested by three-point bending. Plasma osteocalcin, vertebral osteocalcin mRNA levels, and adrenomedullary tyrosine hydroxylase (TH), dopamine beta-hydroxylase (DBH), and phenylethanolamine N-methyl transferase (PNMT) mRNA levels were quantified.

Daily restraint decreased weight gain and femoral length compared to dietary controls, and appeared to partially preserve bone strength, especially in calorie-restricted pairfed rats. Femoral strength was significantly affected by treatment in that bones of pairfed controls were weakest, ethanol drinkers were intermediate, and ad libitum restrained were strongest. Femoral yield load, displacement, and work at yield load were negatively correlated with TH and DBH mRNA levels, but not PNMT, suggesting a negative influence of norepinephrine.

Plasma osteocalcin and dry weight of lumbar 3–5 vertebrae were unaffected; however, osteocalcin mRNA in second lumbar vertebrae was positively correlated with TH, DBH, and PNMT levels.

Ethanol consumption at this level had little effect on femur morphology or strength. In contrast, the data suggested possible stimulation rather than inhibition of vertebral bone formation.

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Central Neuropeptide Y in Anxiety- and Stress-related Behavior and in Ethanol Intake

Annals of the New York Academy of Sciences Volume 1148 Issue Stress, Neurotransmitters, and Hormones

Neuroendocrine and Genetic Mechanisms, Pages 136 - 140

One of the most profound properties of central neuropeptide Y (NPY) is its anxiolytic, or anti-anxiety, effect. This has been demonstrated repeatedly in a number of animal models. In addition, stressors affect NPY expression in the central nervous system, with acute and repeated (chronic) stress having differential effects.

Here, a brief summary of some work performed in our laboratory is presented that supports a role for NPY in regulation of stress responses and behaviors.

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Alcohol Use and Patterns of Delinquent Behaviour in Male and Female Adolescents
Alcohol and Alcoholism Advance Access published online on January 8, 2009

The overall aim was to study patterns of delinquent behaviour in relation to adolescent alcohol use. The more specific aims were to examine whether alcohol use varied between groups of adolescents with different patterns of delinquent behaviour, and to explore whether the association between delinquent behaviour patterns and alcohol use was similar for males and females.

The results revealed that the occurrence of excessive alcohol use and drunkenness varied between groups of adolescents with different delinquency patterns, and that the associations between alcohol use and patterns of delinquent behaviours were relatively similar for males and females.

Adolescents with patterns characterized by more serious non-violent delinquency or by violent delinquency reported the highest occurrence of alcohol use and frequency of drunkenness. Adolescents with well-adjusted behaviour or occasional minor delinquency were less likely to report drinking large amounts of alcohol or to the point of feeling drunk.

The present results further emphasize the importance of distinguishing between different offender groups when examining the relationship between delinquent behaviour and associated problems, such as excessive alcohol use.

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Request Reprint E-Mail: jenny.eklund@chess.su.se
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Media Relase - New Plan to Deliver Increased Support for Tasmanians Affected by Alcohol and Drugs


A new five year plan has been released paving the way for additional and improved services for Tasmanians affected by alcohol and drugs.

The Chief Executive of Mental Health and Statewide Services, Dr John Crawshaw, said the plan would guide spending and set direction for the sector.

Dr Crawshaw said the plan represented an important milestone in the reform process.
. . . . .

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Tellus 3 - Ofsted survey of young people

A major new survey of almost 150,000 10 to 15 year-olds in England reveals that a large majority are happy, healthy and feel safe in their schools and local areas – but almost half are worried about their future.

The annual Tellus3 survey of children and young people published today also found that bullying was still a problem, and that smoking, drinking and drugs remain concerns. The study, staged during spring this year, asked children and young people in Years 6, 8 and 10 from 3114 schools in 145 local authorities in England how they viewed their lives - and how good local authorities are at providing services for young people.

Results indicate a positive picture for the vast majority, though there remain long-standing problems, with the level of drinking, drug use and smoking needing to be addressed.

Download the full publication and available documents

Available Downloads

Tellus3 National Report.pdf

TellUs3 National Report.xls

Tellus3_ Key questions by Year group and Gender.doc

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Convergent genome wide association results for bipolar disorder and substance dependence
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published Online 6 January 2009

Twin studies document substantial heritability for substance dependence and bipolar disorder [Shih et al. ([2004]); Uhl et al. ([2008a])]. Individuals with bipolar disorder display substance use disorders at rates that are much higher than those in the general population [Krishnan ([2005])].

We would thus predict: 1) substantial overlap between different genome wide association (GWA) studies of bipolar disorder 2) significant overlap between results from bipolar disorder and substance dependence.

Recent GWA studies [Baum et al. ([2007]); Sklar et al. ([2008]); Uhl et al. ([2008a]); Wellcome Trust Consortium (2007)] allow us to test these ideas, although 1) these datasets display difficult features that include use of differing sets of SNPs, likely polygenic genetics, likely differences in linkage disequilibrium between samples, heterogeneity both between and within loci and 2) several, though not all, reports have failed to identify any allele of any single nucleotide polymorphism (SNP) (same SNP same allele) that is reproducibly associated with bipolar disorder with genome wide significance.

We now report analyses that identify clustered, SNPs within genes that overlap between the bipolar samples . Overlapping data from at least three of these studies identify 69 genes. 23 of these genes also contain overlapping clusters of nominally-positive SNPs for substance dependence.

Variants in these addiction/bipolar genes are candidates to influence the brain in ways that manifest as enhanced vulnerabilites to both substance dependence and bipolar disorder.


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Bulletins provide further insight into implications of Brief Interventions

Drug and Alcohol findings, a project that aims to bridge the gap between research and practice, has released a series of bulletins focusing on learnings relating to alcohol Screening and Brief Interventions in the UK.
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Summer Programmes - Alcohol, Drugs and Addiction

- updated 11 - 24 July 2009 (tentative)

Courses, seminars and dialogues in Amsterdam on theories and concepts as they have been developed in the field of addiction studies. The Summer Institute on Addiction is an intensive two week summer programme, which focuses on the study of addiction across cultures and is taught by an international faculty team.

Professionals have the option to attend either one or both weeks.
The Institute welcomes individuals with a focused interest in addiction research and treatment, Master's and PhD students, NGO staff working on addiction-related issues, professionals in human services, practitioners, advocates and participants in other International School programmes

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CALIFORNIA STATE BOARD OF EQUALIZATION

SPECIAL NOTICE TO WINE GROWERS AND IMPORTERS

The Board of Equalization (BOE) approved regulations necessary to clarify the definition of “distilled spirits” under the Alcoholic Beverage Tax Law. The regulations were approved by the Office of Administrative Law (OAL) and became fully operative on October 1, 2008.

The regulations create a rebuttable presumption that all alcoholic beverages, except wine, as defined by Business and Professions Code section 23007, contain 0.5 percent or more alcohol by volume derived from flavors or other ingredients containing alcohol obtained from the distillation of fermented agricultural products and are “distilled spirits.” The regulations also prescribe a procedure for rebutting this presumption.

Accordingly, unless a manufacturer files the attached form BOE-505 Alcoholic Beverage Tax Report for Board of Equalization Rebutting Regulation 2559 to rebut the presumption, any product (including any wine-based products) that does not meet the definition of wine under Business and Profession Code section 23007, is presumed to be a distilled spirit for purposes of the Alcoholic Beverage Tax Law.

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What advice should be given to patients with NAFLD about the consumption of alcohol?

Nature Clinical Practice Gastroenterology & Hepatology (2009) 6, 18-19

Nonalcoholic fatty liver disease (NAFLD) is one of the most common liver diseases in the Western world. NAFLD is associated with chronic metabolic disorders such as obesity, type 2 diabetes, and dyslipidemia. Several studies have shown that individuals with NAFLD are more likely to have atherosclerosis and a heightened risk of cardiovascular disease than individuals without NAFLD. In fact, cardiovascular disease is the single most common cause of death in patients with NAFLD.1

Although heavy alcohol use has many detrimental effects, the cardiovascular benefits of moderate alcohol consumption are beyond doubt. In a prospective study of 490,000 people, Thun et al. demonstrated that individuals who consumed one alcoholic drink daily had a decrease in mortality from all causes of 20% and cardiovascular-associated mortality of 30–40% compared with nondrinkers.2 In the Copenhagen City Heart Study, individuals who consumed between three and five drinks of wine daily had a decreased relative risk of death from all causes, including cardiovascular and cerebrovascular events, of 50% compared with non-wine drinkers. No risk reduction was seen, however, with consumption of beer or liquor, suggesting that the nonalcohol constituents of wine were accountable for the protective effects observed in this study.3 A systematic review that evaluated the effects of alcohol on the incidence and progression of diabetes found that moderate alcohol consumption was associated with a decreased incidence of diabetes and with a decreased incidence of cardiovascular events in those already diagnosed with diabetes.4 These data raise the dilemma of whether patients with NAFLD who have a heightened risk of cardiovascular disease should, or should not, consume alcohol.

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Recovery coaches and substance exposed births: An experiment in child welfare
Child Abuse & Neglect Volume 32, Issue 11, November 2008, Pages 1072-1079


Substance exposed infants present a major challenge to child welfare and public health systems. Prenatal substance exposure and continued substance abuse in the home are associated with a wide range of adverse social, emotional, and developmental outcomes.

The objective of the current study is to evaluate the use of recovery coaches in child welfare.

The current study is longitudinal and utilizes an experimental design. The sample includes 931 substance abusing women enrolled in a Title IV-E Waiver Demonstration, 261 in the control group, and 670 in the experimental group. Women in the experimental group received traditional services plus the services of a recovery coach. Administrative records are used to indicate substance exposure at birth.

Of the 931 women enrolled in the waiver demonstration, 21% of the control group and 15% of the experimental group were associated with a subsequent substantiated allegation indicating substance exposure at birth. Cox proportional hazards modeling indicates that women in the experimental group were significantly less likely to be associated with a new substance exposed birth.

The use of recovery coaches in child welfare significantly decreases the risk of substance exposure at birth. Integrated and comprehensive approaches are necessary for addressing the complex and co-occurring needs of families involved with child protection.

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Mental Health and Substance Use Problems of Parents Involved With Child Welfare: Are Services Offered and Provided?
Psychiatr Serv 60:56-60, January 2009


This study examined service delivery to parental caregivers with mental health problems, substance use problems, or both. The study sought to determine whether, once need is identified, suitable services are offered and then provided.

Of parents with mental problems, 77.9% were offered services and 84.0% of those were provided services. Of parents with substance use problems, 65.7% were offered treatment and 67.5% of those were provided it. Other problems included lack of parenting skills, lack of education and job skills, parent-child conflict, and lack of income.

Significant associations were found between caseworkers' identifying problems and offering relevant services. Caregivers with substance use problems were less likely to be offered substance treatment services than caregivers with both mental health and substance use problems.

The child welfare system may facilitate service use for caregivers. More research is needed to understand the process of service delivery to caregivers, including why services are not offered to some caregivers and why some services are not provided after being offered.

Future research should examine why caregivers with substance use problems are vulnerable to not receiving treatment and whether and how service use varies for other problems not examined in this study.

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Request Reprint E-Mail: mstaudt@utk.edu
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Substance Use Disorders as Risk Factors for Psychiatric Hospitalization in Bipolar Disorder
Psychiatr Serv 60:50-55, January 2009


This study developed risk profiles of psychiatric hospitalization for veterans diagnosed as having bipolar disorder.

In this sample 20% of the patients with bipolar disorder were hospitalized psychiatrically during the one-year study period. Patients diagnosed as having both an alcohol use disorder and polysubstance dependence and who also were separated from their spouse or partner had a 100% risk of psychiatric hospitalization; risk of psychiatric hospitalization decreased to 52% if the patients were not separated from their partner. Patients who were not diagnosed as having alcohol use disorders or polysubstance dependence and who were not separated from their partners exhibited the lowest risk of psychiatric hospitalization (12%). Among patients with a psychiatric hospitalization, 41% had longer lengths of stay (<14 days), with the strongest predictor of a longer length of stay being an age older than 77 years, which conferred a 77% risk.

Alcohol use and polysubstance dependence can significantly affect the course of bipolar disorder, as evidenced by their associations with psychiatric hospitalizations. Increased focus on substance abuse among older adults with bipolar disorder may decrease length of psychiatric hospitalization. Our findings suggest that implementing substance treatment programs early in the course of bipolar disorder could reduce health service use.

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The Quality of Asthma Care Among Adults With Substance-Related Disorders and Adults With Mental Illness
Psychiatr Serv 60:43-49, January 2009


The purpose of this study was to investigate whether the presence of substance-related disorders or mental illness may affect the quality of medication management in asthma care.

Odds of achieving the HEDIS measure were lower for patients with substance-related or schizophrenia disorders in two states (range of odds ratio [OR]=.69, 95% confidence interval [CI]=.53–.90, to OR=.81, 95% CI=.69–.96), but the odds increased for patients with depressive disorders in two states (OR=1.34, CI= 1.12–1.61; OR=1.37, CI=1.05–1.77) and for patients with bipolar disorder in one state (OR=1.69, CI=1.13–2.55). Odds of achieving the ratio measure were lower for patients with substance-related disorders in four states (range of OR=.63, CI=.47–.88, to OR=.75, CI=.62–.92) and higher for patients with depressive disorders, although only in one state (OR=1.25, CI=1.03–1.53).

Patients with substance-related disorders and those with schizophrenia disorders may be receiving lower-quality asthma care, whereas patients with some other forms of mental illness may be receiving higher-quality care. Further studies are needed to identify the determinants of high-quality asthma care and the validity of quality measures based on administrative data in these populations.

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Request Reprint E-Mail: jeff.baxter@umassmed.edu
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Impact of Substance Disorders on Medical Expenditures for Medicaid Beneficiaries With Behavioral Health Disorders
Psychiatr Serv 60:35-42, January 2009

This study measured the impact of substance use disorders on Medicaid expenditures for behavioral and physical health care among beneficiaries with behavioral health disorders.

A total of 148,457 beneficiaries met selection criteria, and 43,457 (29.3%) had a substance use diagnosis. Compared with other beneficiaries with behavioral health disorders, individuals with diagnoses of substance use disorders had significantly higher expenditures for physical health problems in five of six states. Approximately half of the additional care and expenditures were for treatment of physical conditions. Differences declined but remained statistically significant after adjustment for higher overall disease burden among beneficiaries with addictions. Medical expenditures for individuals with diagnoses of substance use disorders increased significantly with age in five of six states, whereas behavioral health expenditures were stable or declined. Hospital admissions for psychiatric and general medical reasons were higher for those with diagnoses of substance use disorders.

The impact of addiction on Medicaid populations with behavioral health disorders is greater than the direct cost of mental health and addictions treatment. Higher medical expenditures can be partly attributed to greater prevalence of co-occurring physical disorders, but expenditures remained higher after adjustment for disease burden. Spending estimates based only on behavioral health diagnoses may significantly underestimate addictions-related costs, particularly for older adults.

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Request Reprint E-Mail: robin.clark@umassmed.edu
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Is alcohol consumption good for you? Results from the 2005 Canadian Community Health Survey

Addiction Research & Theory, Volume 16, Issue 6 December 2008 , pages 553 - 563

Data from the Statistics Canada 2005 Canadian Community Health Survey is used to test the hypothesis that classification errors of the type noted by Fillmore et al. (2006) could invalidate the statistical results on the effects of alcohol consumption on self-rated health and the incidence of heart disease and diabetes.

The results obtained in this study show that the beneficial effects of moderate alcohol use that so many studies have found, still appear even when the correct classification of alcohol use is employed.

However, parameter biases and inferential errors can occur when researchers fail to distinguish between former drinkers and never drinkers within the non-drinking group.

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Alcohol and the burden of disease
Addiction Research & Theory, Volume 16, Issue 6 December 2008 , pages 541 - 552



World Health Organization (WHO) lists alcohol consumption as a leading risk to health, contributing 4% to the global burden of disease. This serves as justification for far-reaching preventive interventions.

The purpose of this article is to recapitulate in narrative some of the assumptions upon which WHO conclusions rest and to interpret their validity accordingly.

First, it may be misleading to include 'alcohol use' as a risk to health. As alcohol use has beneficial, protective as well as harmful properties, burden assessment should be based on harmful aspects only, e.g., 'hazardous patterns of alcohol use'.

Second, assessments of interventions aimed at reducing risks from alcohol use to disease burden should also consider such interventions' impact on dimensions other than health or disease-in particular, psychosocial benefits of alcohol consumption.

Third, the uncertainties associated with both the database and methodology for estimating the disease burden attributable to alcohol are high and need to be considered in the interpretation of findings.

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Who receives confrontation in recovery houses and when is it experienced as supportive?
Addiction Research & Theory Early View 10 November 2008


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

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

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

Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.

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Alcohol's excise taxes bringing in less state revenue

BY PAUL HUGHES REPUBLICAN-AMERICAN

People in Connecticut don't seem to be drowning their economic blues in brews, booze or Beaujolais.

Slumping tax collections suggest folks are buying less beer, liquor and wine amid some of the most depressing times since the Great Depression. The revenue figures also indicate the distribution and sale of alcohol aren't recession-proof businesses, either.
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A new blueprint for alcohol and other drug treatment services 2009-2013 Client-centred, service-focused

Overview

A new blueprint for alcohol and other drug treatment services, 2009–2013 has just been released. It will promote treatment services that respond to the range of needs of clients and are high quality and evidenced based.

The Victorian alcohol and other drug treatment sector has an impressive track record of collaborative work and there are excellent examples of partnership initiatives that are helping to rebuild lives. We need to build on that good work and consolidate a system that provides high quality, evidence-based, integrated services.

The blueprint will sit alongside and complement other related government initiatives including Restoring the balance - Victoria’s alcohol action plan 2008–2013, the forthcoming amphetamine-type (ATS) substances and related drugs strategy, the whole-of-government alcohol and drug prevention strategy and the new mental health strategy.

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Blueprint for alcohol and other drug treatment services, 2009–2013 (PDF file 1.62MB)

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