Aims

To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.

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Monday, February 21, 2011

Correlated genotypes in friendship networks



It is well known that humans tend to associate with other humans who have similar characteristics, but it is unclear whether this tendency has consequences for the distribution of genotypes in a population. 

Although geneticists have shown that populations tend to stratify genetically, this process results from geographic sorting or assortative mating, and it is unknown whether genotypes may be correlated as a consequence of nonreproductive associations or other processes. 

Here, we study six available genotypes from the National Longitudinal Study of Adolescent Health to test for genetic similarity between friends. 

Maps of the friendship networks show clustering of genotypes and, after we apply strict controls for population stratification, the results show that one genotype is positively correlated (homophily) and one genotype is negatively correlated (heterophily). 

A replication study in an independent sample from the Framingham Heart Study verifies that DRD2 exhibits significant homophily and that CYP2A6 exhibits significant heterophily. 

These unique results show that homophily and heterophily obtain on a genetic (indeed, an allelic) level, which has implications for the study of population genetics and social behavior. 

In particular, the results suggest that association tests should include friends’ genes and that theories of evolution should take into account the fact that humans might, in some sense, be metagenomic with respect to the humans around them. 


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A.A. VIDEOS FOR PROFESSIONALS







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NIAAA Director's Report on Institute Activities to the 126th Meeting of the National Advisory Council on Alcohol Abuse and Alcoholism - February 17, 2011





A.  Legislation, Budget, and Policy F. News Media Interactions
B. Director's Activities G. NIAAA Staff and Organization
C. Staff/Grantees Honors H. NIAAA Program Annoucement and Request for Applications Information
D. Press Releases I. NIAAA Research Programs
E. Multi-Media Products
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Building an evidence base on alcohol supply points: A pilot project to generate intelligence for managing areas with licensed premises


This report presents the findings of a twelve month study conducted by the Applied Criminology Centre, University of Huddersfield. This pilot project sought to generate intelligence for managing areas with licensed premises by building an evidence base on alcohol supply points (ASPs). For the purposes of this project, ASPs are considered to be any licensed premises that can sell alcohol for consumption on and/or off the premise, for example public houses, bars, nightclubs, restaurants, corner shops, off licenses, hotels, cinemas, and social clubs.  > > > >  Read More
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Illinois slashes ALL state funding for drug and alcohol abuse treatment in massive cuts programme



Tens of thousands of Illinois residents are expected to be affected when drug and alcohol treatment and prevention centres across the state have their budgets cut from March 15.

The harsh budget cuts, proposed by Illinois governor Pat Quinn, who is a Democrat, will mean that from next month, all state funding will be cut. 

After that date, only federal (national) Medicaid dollars will be available to fund the state's drug and alcohol treatment and prevention programmes, which means that some centres are facing closure. > > >  >  Read More
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'Can nudging improve population health?' asks BMJ


The British Medical Journal (BMJ) has published a free article assessing the nudge approach now popular with US and UK health policy makers. Judging nudging: can nudging improve population health? explores the concept of 'nudge' and whether it can make an impact on areas such as alcohol harm and obesity.  > > > >  Read More
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Alcohol Consumption, Blood Pressure, and the Risk of Stroke


A synergistic effect of alcohol and hypertension has been suggested to increase the risk for stroke. 

However, the contribution of alcohol-induced hypertension to stroke morbidity and mortality may be greater than observed, because the effects of different drinking patterns have not been separately investigated.

Alcohol-induced transient peaks in systolic blood pressure may predispose to stroke. Recent studies have measured time trends of blood pressure elevations in relation to alcohol consumption. They found a significant morning surge in blood pressure, which was related to alcohol intake in a dose-dependent manner and was independent of smoking. 

Men with a severe form of hypertension showed a 12-fold increased risk for cardiovascular disease mortality associated with heavy binge drinking. Binge drinking is a significant risk factor for stroke. 

Hypertensive patients should be warned about the risks of alcohol and urged to avoid binge drinking because of an increased risk for all subtypes of stroke. 



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matti.hillbom@oulu.fi.
   
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Drinking in context: the influence of gender and neighbourhood deprivation on alcohol consumption



Findings from contextual studies have shown that living in both poor and affluent neighbourhoods increases the risk of drinking and drug use, but few studies have examined the connection between neighbourhood context and drinking from a gender perspective. 

We investigated the association between gender, neighbourhood deprivation and weekly drinking behaviour (number of drinks) in a national sample of 93 457 Canadians using multilevel zero-inflated Poisson regression. A cross-level interaction between gender and neighbourhood deprivation was examined while controlling for other potential risk factors. 

53% of Canadians reported having at least one drink in the last year (men=61%; women=46%). Among respondents who were drinkers, the average number of drinks per week was 6.4 with male drinkers reporting an average of 7.9 and female drinkers reporting an average of 4.6. Neighbourhood material deprivation was independently associated with weekly drinking. 

Findings from multilevel analysis showed a u-shaped curve between neighbourhood deprivation and drinking, but only for men. Men living in the poorest neighbourhoods drank more weekly (8.5 drinks) than men living in neighbourhoods of wealthy (4.5 drinks) and mid-range deprivation (3.7 drinks). No difference in drinking by neighbourhood material deprivation was observed among women. 

Men, like women, experience gender-specific health difficulties (eg, alcohol-related problems) suggesting the need for a gendered focus on policies and services related to women's and men's health. 

The challenge for public health and primary care is to work together to target risk-taking behaviours among men through treatment, prevention and cultural/educational messages aimed at building healthy lifestyles. 


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Alcohol Consumption in Early Adulthood and Schooling Completed and Labor Market Outcomes at Midlife by Race and Gender




We assessed the relation of alcohol consumption in young adulthood to problem alcohol consumption 10 years later and to educational attainment and labor market outcomes at midlife. We considered whether these relations differ between Blacks and Whites.

We classified individuals on the basis of their drinking frequency patterns with data from the 1982 to 1984 National Longitudinal Survey of Youth 1979 (respondents aged 19–27 years). We assessed alcohol consumption from the 1991 reinterview (respondents aged 26–34 years) and midlife outcomes from the 2006 reinterview (respondents aged 41–49 years).

Black men who consumed 12 or more drinks per week at baseline had lower earnings at midlife, but no corresponding relation for Black women or Whites was found. Black men and Black women who consumed 12 or more drinks per week at baseline had lower occupational attainment than did White male non-drinkers and White female non-drinkers, respectively, but this result was not statistically significant.

The relation between alcohol consumption in young adulthood and important outcomes at midlife differed between Blacks and Whites and between Black men and Black women, although Blacks’ alcohol consumption at baseline was lower on average than was that of Whites.


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Male and female reproductive toxicity induced by sub-chronic ethanol exposure in CF-1 mice



Since genetic damage induced by ethanol exposure is controversial and incomplete and because germ and somatic cells constitute bioindicators for monitoring reproductive toxicity and genotoxic actions of ethanol consumption, the purpose of the present investigation was to evaluate morphological sperm, oocyte alterations and parental genotoxic effects after sub-chronic ethanol intake in the CF-1 outbred mouse strain
 
Ethanol 10% was administered to CF-1 adult male (treated males, TM) and female (treated females, TF) mice for 27 days, whereas water was given to controls from both sexes too (CM and CF). Post-treatment micronucleus frequency (MN-PCE/1,000/mouse) and gamete morphology were evaluated.
 
To test whether change of female reproductive status results in maternal genotoxicity, CF-1 females received ethanol 10% (exposed group, periconceptionally treated females (PTF)) or water (control group, pregnant control females (PCF)) in drinking water for 17 days previous and up to 10 days of gestation. 
 
TM had a high percentage of abnormal spermatozoa vs CM (p < 0.001) and elevated parthenogenetic activated oocyte frequency appeared in TF vs CF (p < 0.001). Sub-chronic ethanol ingestion induced increased MN frequency in TM and TF (p < 0.01). 
 
In PTF, where blood alcohol concentrations were between 19–28 mg/dl, very significantly increased MN frequency was found vs PCF (p < 0.01), whereas MN values were similar to TF. 
 
These results show that sub-chronic alcohol ingestion in CF-1 mice produces sperm head dysmorphogenesis and oocyte nuclear anomalies, suggesting that morphological abnormalities in germ cells are probably related to parental genotoxicity after ethanol consumption. 
 
 
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The Role of Person-Environment Interactions in Increased Alcohol Use in the Transition to College



Even among those at risk for problematic alcohol use, there is variability in developmental trajectories of drinking and related problems. 

This prospective study examined the role of person-environment interactions in increased drinking during the transition to college.  

The authors followed a sample of recent high school graduates to test whether protective environmental factors could delay increases in drinking among those high in trait-level risk factors.
 
Participants completed Web-based survey
 
A sample of 1,784 students in the incoming class of 2004 at a large public United States university completed high-school and first-semester-of-college assessments. 

Participants completed self-report measures of alcohol use, alcohol-related problems, perceived awareness and caring from parents and other adults, sensation seeking, and impulsivity.
 
In the transition to college, high sensation seekers from more protective high school parental environments increased their alcohol use and problems more than did other students. Increases in alcohol problems were also high among more impulsive students from less protective environments. Whereas high sensation seekers drank equivalently in college regardless of high school perceived awareness and caring, those who had greater high school perceived awareness and caring did not experience as many alcohol-related problems in college.

Differences in drinking trajectories may be a function of person-environment interactions. Risk associated with high sensation seeking may be masked among adolescents in protective environments, but its emergence in the college transition predicts increases in alcohol use and related problems.



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The Check Effect Reconsidered



The “check effect” refers to the use of disability payments to purchase illegal drugs or alcohol. 

This article describes subsequent research concerning three interrelated issues: the check effect, whether receipt of disability payments is associated with more overall substance use, and potential policy responses to misuse of disability payments for substances. 

Review and synthesis of published articles. 

Increased substance use at the beginning of the month has been described in a variety of settings. The tendency to purchase substances at the beginning of the month is impacted by household wealth, the tendency to discount future rewards, and cyclical economic activity. 

However, in naturalistic observational cohort studies, beneficiaries who receive disability payments had no greater substance use than those without disability payments. 

Potential policy responses to misspending of disability checks include financial counseling that discourages spending on drugs, and the assignment of a representative payee to prevent misuse of benefits for substances. 

Assignment of a representative payee per se has not been associated with reduced substance use but payeeship administered by agencies that integrate payee practice into treatment has been. 

Disability payments impact the timing of substance use, but receipt of disability payments is not associated with more overall substance use than unalleviated poverty.

Money management-based clinical interventions, which may involve assignment of a representative payee, can minimize the purchase of substances with disability payments.



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Alcohol expectancy moderates attentional bias for alcohol cues in light drinkers



Theoretical models suggest that attentional bias for alcohol-related cues develops because cues signal the availability of alcohol, and the expectancy elicited by alcohol cues is responsible for the maintenance of attentional bias among regular drinkers. 

We investigated the moderating role of alcohol expectancy on attentional bias for alcohol-related cues. 

On a trial-by-trial basis, participants were informed of the probability (100%, 50%, 0%) that they would receive beer at the end of the trial before their eye movements towards alcohol-related and control cues were measured. 

Heavy social drinkers showed an attentional bias for alcohol-related cues regardless of alcohol expectancy. However, in light social drinkers, attentional bias was only seen on 100% probability trials, i.e. when alcohol was expected imminently.
 
Attentional bias for alcohol-related cues is sensitive to the current expectancy of receiving alcohol in light social drinkers, but it occurs independently of the current level of alcohol expectancy in heavy drinkers.


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Alcohol News - 8/2011





The Local (Sweden) - Drunk driving Swedish police rarely fired: report
Despite 55 serving police officers being caught drink driving over the past five years, only one has lost his job, the Metro daily reported on Thursday.
Helsinkin Sanomat (Finland) - Alcohol consumption in Finland declined for third year in succession
Last year the Finns drank less alcohol than in 2009. As the consumption of alcohol has now declined for three consecutive years, the trend is no longer coincidental, believes planning officer Marke Jääskeläinen from the National Institute for Health and Welfare (THL).
fyiLIVING (Finland) - Increased Alcohol Consumption in Men Linked to Cancer
There is a dearth of information on the relationship between alcohol and total cancer risk. Spurred by this, researchers in Finland carried out a study to examine this relationship. On analyzing data from a population-based study of 2,627 men from Eastern Finland, it was seen that the risk of cancer increased with alcohol use; around 6.7 percent of the cancer patients in this study were linked to alcohol use.
sciencenewsline (Finland) - Why problem drinking during adolescence is never a 'phase'
The Rutgers Alcohol Problem Index (RAPI) is widely used to assess adolescent drinking-related problems. Rose and his colleagues assessed 597 Finnish twins (300 male, 297 female) at age 18 with RAPI, and later interviewed them at age 25 with the Semi-Structured Assessment of the Genetics of Alcoholism to assess alcohol abuse and dependence diagnoses.
The Local (Sweden) - Swedes drink less alcohol: study
Swedish average alcohol consumption declined in 2009, in comparison with 2008, but remains high in a historical perspective, a new report published on Friday showed.
The Copenhagen Post (Denmark) - Parties with drugs and booze finish in emergency room
The number of emergency room admittances due to poisoning and overdoses from drugs like cocaine and amphetamines has doubled in ten years, reports Berlingske newspaper.
ERR (Estonia) - Estonia Ranked Sixth in World for Drinking
Drinkers throughout Estonia may be raising their glasses in a self-pitying toast this weekend - a freshly-published report by the World Health Organization has ranked the nation sixth in the world for alcohol consumption.
The Baltic Course (Lithuania) - Kubilius: authorities should not assume responsibility for the offences of their subordinates in free time
The Lithuanians should realise that driving under influence is a conscious preparation for a crime, thus, there is no difference whether it is done by a builder, police officer or a representative of any other profession, Prime Minister Andrius Kubilius says.
WebMD (USA) - Many Kids Get Alcohol From Family Members
Almost 6% of young people between the ages of 12 and 14 drank alcohol in the past month, and close to half of them got it at home or from family members, a study shows.
Telegraph.co.uk (UK) - Prof Ian Gilmore: UK faces rising alcohol related deaths
In the paper published on Monday, Prof Ian Gilmore, a former president of the Royal College of Physicians, along with colleagues at the University of Southampton and Queen's Medical Centre, University Hospital, Nottingham, claims that up to 30,000 people a year die of liver disease in England and Wales each year.
Reuters - Alcohol linked to complications after joint surgery
The more people drink before having a hip or knee replaced, the higher their risk for complications
right after the surgery, a new study suggests.
Stuff.co.nz (New Zealand) - Youth drinking cheap spirits a 'real problem'
It is not surprising that the amount of potent spirits is on the rise, with young people the likely consumers, an Otago University professor says.
Salt Lake Tribune (USA) - Mandatory signs going up to alert pregnant women to alcohol risks
Pediatrician Susan Lewin was horrified to overhear a pregnant woman telling friends that she knew the dangers alcohol posed for her unborn child, but she was OK because she was only drinking beer.
RIA Novosti (Moldova) - WHO names Moldova world's leader in alcohol consumption
Moldovans consume more alcohol per head than citizens of any other country, the World Health Organization (WHO) said in its report.
Adnkronos International English (Italy) - Italy: Alcohol sales banned for Tunisian illegal immigrants
None of the thousands of illegal immigrants who have reached the tiny Italian island of Lampedusa will be able to celebrate their arrival with a drink, according to a new law.
Daily Mail (UK) - Children as young as FIVE are being treated in hospital for alcohol abuse
A hospital trust has revealed it treated four children aged just five for drinking dangerous levels of alcohol.
 
 
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Editorial - Minimum alcohol pricing in England



Since the BMJ last highlighted the health harms of alcohol, there has been a welcome acknowledgement by government in England that cheap drink is an important factor in driving these harms. Ministers recently revealed plans to set a minimum price by imposing a ban on selling alcohol for less than the combined tax and duty paid on it. This would result in minimum prices of £0.21 (€0.25; $0.34) per unit of beer and £0.28 per unit of spirits, which equate to £0.38 for a can of weak lager, £2.03 for a bottle of wine, and £10.71 for a litre of spirits. Although, in principle, this is an important step, in practice the price floor has been set so low that it will have no effect whatsoever on the health of the nation . 

On the positive side, for the first time recent statistics suggest an overall reduction in harm associated with alcohol, with a 6% decline in alcohol related deaths and 6% reduction in consumption in 2009. 2 3 However, these are data from a single year on a background of marked increases in consumption and … 


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Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Detection of Recent Drinking in an Outpatient Treatment Program for Alcohol and Drug Dependence




This study determined the information about recent alcohol consumption obtained when urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS) were introduced as a routine test in outpatient treatment programs for alcohol and drug dependence.
 
Outpatients (21 men and 3 women) undergoing treatment for alcohol (N = 8) or drug (N = 10) dependence, or in methadone maintenance therapy (N = 6) volunteered for the study. Twice weekly in connection with return visits to the unit, patients gave a urine sample and completed an anonymous single-question form about any drinking in the past 3 days. Urinary EtG and EtS were determined by liquid chromatography-mass spectrometry.
   
Totally, 214 urine samples (4–14 samples/patient; mean 9) and 211 self-reports were collected over a 2–8-week period. Altogether 26% of the urine samples from 12 of 24 patients tested positive for EtG (0.5–434 mg/l) and/or EtS (0.1–87 mg/l). In one patient, samples were only positive for EtS. In 21% of 211 self-reports from 11 patients, alcohol ingestion was admitted in the past 3 days. In 87% of the 211 complete cases, the self-report information agreed with the EtG/EtS results (i.e. true positives and true negatives). The highest frequency of drinking was seen in the drug-dependent group with only 20% of the patients being abstinent according to both measures. This compares with 62.5% abstinence in the alcohol-dependent group and 50% in the methadone maintenance therapy group.

Although based on a limited number of subjects, these results indicated that urinary EtG and EtS testing is a useful tool for objective identification of recent drinking in outpatients treated for alcohol and drug dependence. 



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The Pricing Policy of Alcohol Monopolies: the Case of Sweden and Quebec ERASMUS



Alcohol is the reason behind a lot of valuable social interaction, but on the other side also causes a lot of harm.  This harm is created by externalities that people do not take into account when they drink. 

A good example of this is drunk-driving. One policy measure to tackle the problem is to restrict the freedom in the market. One such way is for the government to take control over the sale and distribution of alcoholic beverages. Such alcohol monopolies exist for example in parts of North America and Scandinavia. 

This thesis is designed to take a closer look at the pricing policy of such alcohol monopolies to see how these companies try to reach the goals they have. To do this the pricing policies of the alcohol monopolies in Sweden and Quebec are analyzed. 

Generally speaking North American alcohol monopolies are found to have tax collection as a main goal, while Scandinavian alcohol monopolies are mainly concerned about improving upon the public health situation. 

Because this difference and other factors, alcohol monopolies cannot be judged as a whole. However, a very general conclusion is that alcohol monopolies have a higher price for their products than other free retailers and that especially cheap spirits are relatively expensive in Sweden, which supports their health goals.

Furthermore, the pricing in Quebec raises the question whether this alcohol monopoly acts different than a privately-owned company would.





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Sunday, February 20, 2011

Projections of alcohol deaths—a wake-up call



According to WHO, morbidity attributable to alcohol in countries with an established market economy (10·3% of disability adjusted life years) comes second only to that of tobacco (11·7%). Liver disease is responsible for 70% of the directly recorded mortality from alcohol, and perhaps a quarter of the total attributable mortality; the true total is uncertain but is probably between 18 000 and 30 000 per year in England and Wales. Alcohol causes around 80% of deaths from liver disease, and trends in liver mortality reflect trends in overall alcohol-related harm; liver death rates are a measure of the damage caused to society by alcohol, and a good measure for the success of alcohol policy.

 
Few can doubt that there is a particular problem in the UK. Compared with the UK, the Netherlands, Sweden, Norway, Australia, and New Zealand have similar cultures, genetic backgrounds and drinking cultures, and in 1986 they had broadly similar liver death rates. The most recent WHO liver death rates for these countries range from 2·6 per 100 000 (New Zealand) to 5·3 (Sweden); whereas in the UK liver death rates more than doubled from 4·9 to 11·4 since 1986.3 A liver death rate of around 4 per 100 000 is therefore a reasonable and achievable aspiration for an outcomes-based alcohol policy.
We projected outcomes in terms of liver death rates according to four different policy scenarios. With the black scenario, liver deaths increase at a similar rate to that seen in the UK as a whole over the past 10 years. A green scenario would see a reduction in UK death rates with the same gradient as that for France—the country with the most profound reductions in mortality. The intermediate scenarios, amber and red, would see liver deaths reduce along the gradients followed by the rates in Italy or in the European Union as a whole.  > > > >   Read More
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A new AMPHORA: an introduction to the project Alcohol Measures for Public Health Research Alliance


The AMPHORA Project is a 4 years project funded by the 7th Framework Programme of the European Commission which aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. 

In this introductory article we describe the background of the Project and its main features. 

The research areas covered by AMPHORA are wide and diverse. 

Some of the most relevant are: an update on European epidemiological data; the definition of standard common indicators of alcohol consumption and harm; the measurement of the strength of alcohol policies; the study of contextual determinants of alcohol consumption, the analysis of the impact of marketing on youth; the availability of treatments at a European level; and two areas of harm reduction (contamination of illegal or surrogate alcohols and the reduction of harm in drinking venues).



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Science and alcohol policy: a case study of the EU Strategy on Alcohol



To describe the extent to which the content of the European Commission's Communication on alcohol reflects public health-based scientific evidence.

Although the Communication acknowledges and supports existing interventions which have high evidence for effectiveness, such as enforcing blood alcohol concentration (BAC) limits for drivers, it extensively promotes other interventions which have been shown to be ineffective; for example, recommending education and persuasion strategies as a measure across all its five priority areas.

Measures to influence price are mentioned only once in relation to sales in drinking venues limiting two-for-one drinks offers. Measures to control physical availability are mentioned infrequently.
The Communication reflects the science, in that it acknowledges the significance of alcohol as a social and health determinant in Europe. However, it places more emphasis on policy actions with less evidence for effectiveness than on those with strong evidence.

It also focuses its efforts more on mapping member state actions and coordinating knowledge exchange than on providing concrete recommendations for action or developing Europe-wide policy measures. This may be a compromise between the rights of Member States to develop national policy and legislation and the obligation of the European Union as a collaborative body to protect health.

Furthermore, it has been suggested that the European Union's roots as a trading block emphasizes collaboration with industry stakeholders and this influences the ability to prioritize health over trade considerations.




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Reflections on science and the governance of alcohol policy



To consider, briefly, science's role in informing alcohol policy, and how science could help reframe the present governance of alcohol policy.
Expression of the two project coordinators’ reflections based on discussions during project meetings of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project.
Three endeavours are considered important for science's role in informing alcohol policy: modelling studies that help predict the outcomes of differing policy approaches; studying the impact of live policy changes as a powerful set of natural experiments; and, improved study of the impact of integrated, coordinated and joined up alcohol policies, as opposed to the impact of individual alcohol policy measures.

Three areas where science can contribute to strengthened alcohol policy governance include: analysis of different governance architectures that might promote joined-up actions between different sectors; the design of better metrics that measure the impact of public and private sector actions on health; and, by identifying incentives that help consumers make choices on the use of alcohol that improve health.
The impact of science on better alcohol policy governance can only happen if there is more and better dialogue between scientists and those who design alcohol policy.



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Indicators of alcohol consumption and attributable harm for monitoring and surveillance in European Union countries



Alcohol is a major risk factor for burden of disease and injury in Europe, and contributes markedly to between region differences in life expectancy. Monitoring and surveillance systems have shown to be a key factor in implementing effective policies. 

The aim of this paper is to propose a system of indicators for alcohol consumption and attributable harm which can be used as an over-time monitoring tool at the country level as well as for comparisons between countries. 
A systematic research in electronic data bases was conducted but most of the information was derived from ongoing international efforts to establish alcohol monitoring and surveillance systems.
Adult per capita alcohol consumption, prevalence of abstention, and frequency of drinking more than 60g pure alcohol in one occasion are proposed as a minimal set of alcohol exposure indicators, which can quickly be implemented in all EU countries. 

With respect to health harm indicators, the best minimal choice which can be implemented quickly in all countries of the EU would be alcohol-attributable years of life lost due to premature death. 

In addition, country specific indicators could be added, when alcohol places specific burden on specific diseases.
National and European Union-wide monitoring systems for alcohol exposure and attributable harm to inform public health-related policy decisions could be implemented easily. The establishement of such monitoring systems would follow the recent World Assembly resolution for a global strategy to reduce alcohol-related harm.


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Epidemiology and alcohol policy in Europe

 
To describe three aspects of the epidemiology of alcohol-attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation.
The absolute risk of dying from an alcohol-attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point. 

Over 2/3 of all alcohol-attributable deaths occurring amongst the 20–64 year old population of the European Union (minus Cyprus and Malta) occur in the 45–64 year olds. 

About 25% of the difference in life expectancy between western and eastern Europe for men aged 20–64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns.
Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol-related death. 

There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol-related health inequalities, with the specific recommendations for policy depending on the cost-effectiveness of interventions related to the epidemiological profile of the country or region under consideration.

Fortunately, there are evidence-based policy options that reduce the amount of alcohol consumed and many alcohol-related harms with immediate effect, that reduce the risk of an alcohol-related death in middle age, and that would help to close the health gap between eastern and western Europe.


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Do infrastructures impact on alcohol policy making?



The importance of building and strengthening effective infrastructures within the field of public health has increasingly been recognized. A wide variety of actors and structures can be identified for alcohol policy, including systems for policy development, monitoring, research and work-force development, but too little is known about the complex systems of infrastructure available across European countries and their impact on alcohol policy.
This study is part of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, and aims to map existing infrastructures, but also to examine the relationship between infrastructures and alcohol policy change.
A survey of alcohol policy infrastructure and infrastructure needs at the national level will be conducted using an updated and adapted questionnaire based on the Health Promotion (HP) Source Project tool. Case studies involving in-depth interviews will be conducted for a selection of countries. Data will be analysed descriptively, mapping alcohol policy infrastructure and identifying needs to reveal any relationship between infrastructure and alcohol policy.
This study can contribute to building the scientific knowledge base on this topic as well to policy development. First, the Alcohol Measures for Public Health Research Alliance will produce an extended map of alcohol policy infrastructures in a wide range of European countries. Secondly, the Alcohol Measures for Public Health Research Alliance will foster a better understanding and expand the knowledge base on the role and influence of infrastructure on alcohol policy and practice. 

Recommendations deriving from this study will identify the need for better utilization of existing infrastructures and for the development of new infrastructures, necessary to develop and implement effective alcohol policy from a public health perspective.

 
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Environmental factors in drinking venues and alcohol-related harm: the evidence base for European intervention



Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. 

This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe.
A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm.
Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies.
Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm.


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STEPS Outpatient Program Improves Alcohol Treatment Outcomes in Ukrainian Regional Narcologic Dispensary


Alcohol abuse is of epidemic proportions in Ukraine, including the Vinnitsya Oblast (county), a midsized urban area in central Ukraine. Care for persons with alcohol disorders, provided in regional narcologic dispensaries, consists primarily of inpatient medical detoxification and short-term psychologic care. Structured outpatient and aftercare programs have not been investigated systematically for potential widespread dissemination.
This study investigated the feasibility and efficacy of adding a 12 step-based outpatient and aftercare program (STEPS) to inpatient Regional Narcological Dispensary (RND) treatment using a randomized controlled design. 

Persons with alcohol disorders (N=68) were recruited from the Vinnitsya RND. After approximately 30 days of inpatient RND treatment, controls were discharged whereas experimental participants voluntarily entered 2 months of STEPS outpatient day treatment, plus 1 month of aftercare and 1 month of sponsors' group.
Both RND and STEPS produced positive alcohol-related outcomes at 2 months that were sustained at 4 months. 

However, adding STEPS resulted in outcomes superior to RND alone. At 4-month follow-up, STEPS reduced average total drinking days in the last 30 days from 18.2 to 2.5 days; average number of drinks per drinking day from 13.6 to 2.9 drinks; and heavy drinking days from 7.7 to 0.4 days. 

Participation in STEPS also was associated with fewer negative alcohol-related consequences, less depression, and better signs of mental health as compared with RND treatment alone.
Adding a 12 step-based outpatient and aftercare intervention to standard inpatient alcohol detoxification was feasible and efficacious for alcohol-dependent patients in a midsized Ukrainian city.


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