WHO global forum: Addressing the challenge of noncommunicable diseases

Non Communicable Diseases (NCDs) - cardiovascular diseases, cancers, chronic lung diseases and diabetes - kill 3 out of 5 people on the planet, this is over 36 million annually. Alcohol is the second leading cause of NCDs, next to tobacco, poor diet and physical inactivity.

It is estimated that a quarter of NCD deaths are of people in prime of their lives, who are under 60.

First global ministerial conference on healthy lifestyles and NCD control was held in Moscow 28-29 April with Ministers and the national delegations from some 94 member participating.

The conference highlighted the magnitude and socio economic impact of NCDs and emphasised the need to strengthen global and national initiatives to prevent NCDS as part of national health efforts.

The meeting concluded with launch of a Moscow declaration.

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An evaluation of a screening and brief intervention pilot project for hazardous and harmful drinkers within the accident and emergency department of Manchester Royal Infirmary

Hazardous and harmful drinkers make up a significant percentage of A and E attendees, and brief interventions have been shown to reduce harm among this particular group. 

This paper evaluates a pilot project which introduced a screening and brief intervention programme within the A and E department.

This project aimed to screen and offer brief interventions to attendees and to refer on to local alcohol services if required.

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Request Reprint E-Mail: mozzarmn@aol.com   

Alcohol outlets and clusters of violence

Alcohol related violence continues to be a major public health problem in the United States. In particular, there is substantial evidence of an association between alcohol outlets and assault. However, because the specific geographic relationships between alcohol outlets and the distribution of violence remains obscured, it is important to identify the spatial linkages that may exist, enhancing public health efforts to curb both violence and morbidity.

The present study utilizes police-recorded data on simple and aggravated assaults in Cincinnati, Ohio. Addresses of alcohol outlets for Cincinnati, including all bars, alcohol-serving restaurants, and off-premise liquor and convenience stores were obtained from the Ohio Division of Liquor Control and geocoded for analysis. A combination of proximity analysis, spatial cluster detection approaches and a geographic information system were used to identify clusters of alcohol outlets and the distribution of violence around them.

A brief review of the empirical work relating to alcohol outlet density and violence is provided, noting that the majority of this literature is cross-sectional and ecological in nature, yielding a somewhat haphazard and aggregate view of how outlet type(s) and neighborhood characteristics like social organization and land use are related to assaultive violence. The results of the statistical analysis for Cincinnati suggests that while alcohol outlets are not problematic per se, assaultive violence has a propensity to cluster around agglomerations of alcohol outlets. This spatial relationship varies by distance and is also related to the characteristics of the alcohol outlet agglomeration. Specifically, spatially dense distributions of outlets appear to be more prone to clusters of assaultive violence when compared to agglomerations with a lower density of outlets.

With a more thorough understanding of the spatial relationships between alcohol outlets and the distribution of assaults, policymakers in urban areas can make more informed regulatory decisions regarding alcohol licenses. Further, this research suggests that public health officials and epidemiologists need to develop a better understanding of what actually occurs in and around alcohol outlets, determining what factors (whether outlet, neighborhood, or spatially related) help fuel their relationship with violence and other alcohol-related harm.

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Do Community Characteristics Predict Alcohol-Related Crime?

Alcohol-related crime is a substantial community problem. There is evidence to suggest that certain geographic areas experience higher rates of alcohol-related crime and that both individual and community factors are associated with alcohol-related crime. There is limited research at the community level despite communities being the target of interventions designed to reduce alcohol-related harm. 

This study aims to determine whether there are differences in alcohol-related crime at the community level and examines whether certain community characteristics are associated with increased alcohol-related crime.  

Routinely collected police data from 20 rural communities in New South Wales, Australia were analysed. The ratio of alcohol to non-alcohol-related criminal incidents was used as a proxy for alcohol-related crime. Predictor variables were population-adjusted community characteristics, including demographic and resource variables.

Regression analyses suggest that there are differences between communities in alcohol-related crime. Less socioeconomic disadvantage and more GPs and licensed premises (pubs and clubs) are associated with greater alcohol-related crime at the community level.  

Decreasing the socioeconomic well-being of a community is not appropriate; however, introducing additional taxes to increase the cost of alcohol may decrease consumption and therefore alcohol-related crime. Reducing or capping the number of licensed premises, specifically the number of pubs and clubs, may be an appropriate strategy to reduce alcohol-related crime in rural communities. 


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Request Reprint E-Mail:  courtney.breen@unsw.edu.au 

Mortality 6 years after inpatient treatment of female Japanese patients with eating disorders associated with alcoholism

This study was conducted to clarify the mortality of patients with eating disorders associated with alcoholism. We focused on the mortality rate 6 years after inpatient treatment of patients with eating disorders associated with alcoholism compared with eating disorder patients without alcoholism and alcoholic patients without eating disorders.

The subjects were 164 female Japanese patients 30 years of age or younger with eating disorders or alcoholism who were inpatients at some time during the period from 1990 to 1998 at the Japanese National Hospital Organization, Kurihama Alcoholism Center. A semi-structured interview concerning alcohol problems, eating problems, psychiatric disorders and other clinical characteristics was conducted at the time of the first admission. A survey concerning survival was conducted in October 2001, and 100% of the patients were followed up.

The mortality of the 47 eating disorder patients with alcoholism, 86 eating disorder patients without alcoholism, and 31 alcoholics without eating disorders was 27.7%, 3.5%, and 19.4%, respectively, at 6 years after inpatient treatment, showing significant differences. On the Kaplan–Meier survival curves, the mortality of the eating disorder patients with alcoholism was significantly higher than that of the patients without alcoholism, but not significantly higher than that of young female alcoholics without eating disorders. The 13 eating disorder patients with alcoholism who had died were five anorexia nervosa and seven bulimia nervosa patients.

The results of the study suggest that comorbid alcoholism is a major factor in the death of anorexia nervosa and bulimia nervosa patients.



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Request Reprint E-Mail:   suzuki-k@d9.dion.ne.jp  

The Global Alcohol Policy Conference 2011 in Bangkok in November

The consumption of alcohol makes a significant contribution to alcohol related harm globally. In emerging markets and among younger groups increased consumption is apparent. Effective policy is not implemented as widely as is needed. A concerted effort in controlling alcohol related harm is greatly needed and will involve multiple partners, including academia, civil society organizations and government bodies. Global cooperation can play a significant role in supporting and complementing worldwide national and local actions.

The Global Alcohol Policy Conference 2011 is jointly organized by government, intergovernmental and the NGO sector. The Thai Ministry of Public Health, the World Health Organization, the Global Alcohol Policy Alliance and the Thai Health Promotion Foundation are co hosts of the Global Alcohol Policy Conference 2011. The conference will mark an important milestone for global alcohol control efforts following on from the endorsement of the WHO Global Strategy on Alcohol in 2010. The conference will bring together leaders from all over the world who are committed to working towards the development and implementation of effective alcohol policy free from commercial influence. It will provide an opportunity for policy makers, advocates, academics, and campaigners to share and exchange their knowledge and experience. The conference will also be a platform for developing a truly global network and for discussing future efforts at the global level to reduce problems from alcohol.

The year 2011 also highlights the 10th anniversary of the establishment of the Thai Health Promotion Foundation, the forefront organization that fight against the harmful use of alcohol in Thailand. 

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Experts Say Alcohol Marketing Encourages Harmful Drinking

Efforts by alcoholic beverage makers to boost sales by appealing to younger drinkers contribute to drinking patterns that are harmful to health, said experts at a panel discussion on “Alcohol, Chronic Noncommunicable Diseases and Public Health,” held this week at the Pan American Health Organization (PAHO).

While alcoholic beverage makers say their ads are aimed only at consumers who are at or over the legal purchase age, research shows that viewing of alcohol ads by under-age youths has increased by nearly 70 percent over the past decade, said David Jernigan, associate professor at the Johns Hopkins Bloomberg School of Public Health. > > > >  Read More

FASD News - 19/2011

Wales Online (Wales) - Birth defects caused by drinking in pregnancy soar in Wales

THE number of babies born with birth defects linked to women drinking too much alcohol during pregnancy has risen by 10% in Wales in a year. Although the numbers remain small, the sharp rise in cases of foetal alcohol syndrome has been met with concern by experts.

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Wwl.com (USA) - New mom angered by questions about abortion, smoking and drinking

Should new moms be required to tell the state if they smoked cigarettes or drank alcohol during pregnancy? How about if they have ever had an abortion? "The ACLU of Louisiana called on the Louisiana Department of Health and Hospitals today to clarify that new mothers do not have to disclose private medical information before birth certificates are issued for their newborns," said Executive Director Marjorie Esman in a news release.

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Stuff.co.nz (New Zealand) - Making better babies

LoulaGeorge was surprised by the attention given to an announcement by the prime minister's chief science adviser, Sir Peter Gluckman, that he had discovered a link between a mother's diet during pregnancy and the chances of her baby later being obese.

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Daily Press (USA) - Substance-abuse program helps pregnant women deliver healthy babies

Nicole Billiot faced a choice: Go to jail, or go to the South-Eastern Family Project. She chose the latter. As a result, she will give her baby the chance to be born drug and alcohol free.

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KSBY San Luis Obispo News (USA) - Program may have to help fewer kids who 'got a hard start in the world'

A program that helps local children who suffered parental abuse before they were even born faces severe budget cuts. Martha's Place, in San Luis Obispo, specializes in treating kids up to age 5 born with Fetal Alcohol Syndrome. It also helps children abused as infants.

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Cape Breton Post (Australia) - Bar association president offers insight on several initiatives

The president of the Canadian Bar Association has some key initiatives he’ll be working on during his term including discussions on how best to deal with offenders suffering with fetal alcohol syndrome and how to make the justice system more accessible to the middle class.

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Northern News Services (Canada) - Manual offers tips to employers on helping workers with FASD

The Yellowknife Association for Community Living has created a manual, FASD -- A Practical Guide For Employers, to help educate businesses about the disorder and ways they can accommodate employees with the condition.

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RESEARCH:

Western Journal of Nursing Research - Effects of a Motivational Interviewing Intervention to Decrease Prenatal Alcohol Use

This study determined the effectiveness of motivational interviewing (MI) to decrease prenatal alcohol use, while examining mechanisms of behavior change based on self-determination theory that may have evoked decreases in drinking behaviors.

Read more

Journal of Studies on Alcohol and Drugs - Field Trial of Alcohol-Server Training for Prevention of Fetal Alcohol Syndrome

Supplemental responsible beverage service training for alcohol servers to aid in the prevention of fetal alcohol exposure can be effective in reducing the serving of alcohol to visibly pregnant women, with robust effects continuing over the subsequent year in the New Mexico establishments.

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Journal of Studies on Alcohol and Drugs - Effects of Premature Birth on the Risk for Alcoholism Appear to Be Greater in Males Than Females

The results suggest that neurodevelopmental sequelae of premature birth are associated with gender-specific effects on the development of alcoholism in the male baby: small, premature, or growth-delayed male babies appear to be selectively vulnerable to alcoholic drinking years later. The findings implicate neurodevelopmental influences in alcoholism pathophysiology in males and suggest the possibility of distinct, gender-specific pathways in the etiology of severe problem drinking.

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MATERIALS

VIDEOCAST:

CC Grand Rounds Lecture: (1) Fetal Alcohol Syndrome: Etiology, Epidemiology, and Advances in Diagnosis (2) Nicotine Pharmacology Versus Nicotine Addiction: Different Sites, Different Mechanisms

Wednesday, April 27, 2011

(1) Kenneth R. Warren, PhD, Acting Director, NIAAA

(2) Elliot A. Stein, PhD, Chief, Neuroimaging Research Branch, Intramural Research Program, NIDA

Download VIDEO - http://videocast.nih.gov/Summary.asp?File=16613&download=1

SOMETHING FROM LONG TIME AGO: IHE Consensus Development Conference

http://www.fasd-cmc.alberta.ca/education-training/archived-sessions/categories/ihe-consensus-development-conference/

PUBLICATIONS:

Three recent publications available from Public Health Agency of Canada’s FASD Initiative

Early primary school outcomes associated with maternal use of alcohol and tobacco during pregnancy and with exposure to parent alcohol and tobacco use postnatally

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An Inventory of Education and Training Programs: FASD and the Judicial/Criminal Justice System

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Assessment and Diagnosis of FASD Among Adults: A National and International Systematic Review

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CONTROVERSIAL:

Institute for Ethics and Emerging Technologies - Ban Baby-Making Unless Parents Are Licensed

For the sake of the children, let’s control human breeding. No one should be permitted to reproduce until they pass a battery of tests. Does that proposal enrage you? Go ahead, hate me. Call me vile names like “Neo-Nazi-Elitist-Baby-Killing-Totalitarian-Sicko.” Or simply “Eugenicist.” I don’t care. I know I’m right.

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IN OTHER LANGUAGES:

Kehitysvammaliitto (Finland) - Uusi kirja raskaudenaikaisesta alkoholinkäytöstä ja sen aiheuttamista sikiövaurioista

Mitä jos äiti joi raskauden aikana? Minkälaisia vaurioita lapselle voi tulla ja minkälaista on alkoholin vaurioittaman lapsen elämä? Näihin kysymyksiin vastaa VTL Suvi Vaarlan toimittama teos Alkoholin vaurioittamat. Raskaudenaikaisen alkoholinkäytön vaikutukset lapsen elämään. (Kehitysvammaliitto 2011).

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DELFI.lv (Latvia) - Augļa alkohola sindroms

Augļa alkohola sindroms ir grūtniecības laikā lietoto alkoholisko dzērienu radītās etanola sekas bērnam. Augļa alkohola sindromu, kas iekļauts arī Starptautiskajā slimību klasifikatorā, raksturo triāde.

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Press Release - Momentum to tackle world’s leading cause of death

Today is World Health Day and the World Health Organization (WHO) and its partners use this opportunity to both cherish the advan­ces made in world health and to gather mo­mentum for tackling existing problems.

 

IOGT International strongly participates in the commemoration as Mr Sven-Olov Carlsson, President of IOGT International, points out: “IOGT International has for more than 160 years been part of the global efforts to promote development by improving public health. The­refore World Health Day is important to reflect what is left to do: still today we face major thre­ats to global health and positive societal deve­lopment. Non-communicable diseases (NCDs) are one such key issue because they kill three out of five humans in the world.”  > > > >  Read More

National Conference on Addiction Disorders

National Conference on Addiction Disorders
September 17-21, 2011
Town & Country Hotel | San Diego, California

NCAD.11 will feature content that focuses on the following:

• The prevention, intervention, treatment, and recovery support of addiction disorders
• Counseling and clinical skill development
• Addiction Studies Education
• Multicultural issues faced in addiction treatment
• Healthcare systems and technology trends and solutions that improve business operations and patient care
• Professional development, business and workforce administration management and operations, including:
  • process improvement
  • performance-based contracting and accountability
  • career development
  • community-based services                                                      > > > >  Read More

Dopaminergic genes modulate response inhibition in alcohol abusing adults

Compulsion in alcohol use disorders (AUD) has been attributed to impairment in response inhibition. Because genes that regulate dopamine (DA) have been implicated not only for risk for AUD but also for impulsivity based on behavioral studies, we set out to examine the underlying neural mechanisms associated with these effects. 

We collected functional magnetic resonance imaging images on 53 heavy drinking but otherwise healthy adults while performing the Go/NoGo task. 

We predicted that genetic variants previously reported in the literature to be associated with substance abuse, specifically the DRD2 rs1799732 and DRD4 VNTR, will modulate neural processes underlying response inhibition. 

Our results showed differential neural response for the DRD4 VNTR during successful inhibition in the inferior frontal gyrus (IFG) (cluster-corrected P < 0.05, z = 1.9). 

Similarly, DRD2 rs1799732 groups were significantly different in the precuneus and cingulate gyrus during successful response inhibition (cluster-corrected P < 0.05, z = 1.9). 

These findings provide further evidence for the role of DAergic genes in modulating neural response in areas that underlie response inhibition and self-monitoring processes. 

Variants within these genes appear to influence processes related to impulsive behavior, which may increase one's risk for alcohol abuse and dependence.

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Request Reprint E-Mail:   francesca.filbey@utdallas.edu  

AKT Signaling Pathway in the Nucleus Accumbens Mediates Excessive Alcohol Drinking Behaviors

Neuroadaptations within the nucleus accumbens (NAc) have been implicated in molecular mechanisms underlying the development and/or maintenance of alcohol abuse disorders. We recently reported that the activation of mammalian target of rapamycin complex 1 (mTORC1) signaling pathway in the NAc of rodents, after exposure to alcohol, contributes to alcohol drinking behaviors. The kinase AKT is a main upstream activator of the mTORC1 pathway. We therefore hypothesized that the activation of AKT in the NAc in response to alcohol exposure plays an important role in mechanisms that underlie excessive alcohol consumption.

Western blot analysis was used to assess the phosphorylation levels of enzymes. Acute exposure of mice to alcohol was achieved by the administration of 2 g/kg alcohol intraperitoneally (IP). Two-bottle choice and operant self-administration procedures were used to assess drinking behaviors in rats.

We found that acute systematic administration of alcohol and recurring cycles of excessive voluntary consumption of alcohol and withdrawal result in the activation of AKT signaling in the NAc of rodents. We show that inhibition of AKT or its upstream activator, phosphatidylinositol-3-kinase (PI3K), within the NAc of rats attenuates binge drinking as well as alcohol but not sucrose operant self-administration.

Our results suggest that the activation of the AKT pathway in the NAc in response to alcohol exposure is an important contributor to the molecular mechanisms underlying alcohol-drinking behaviors. AKT signaling pathway inhibitors are therefore potential candidates for drug development for the treatment of alcohol use and abuse disorders.


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Request Reprint E-Mail:   dron@gallo.ucsf.edu 

Alcohol use and mental distress as predictors of non-response in a general population health survey: the HUNT study

To investigate to what degree alcohol use and mental distress are associated with non-response in a population-based health study.

 

From 1995 to 1997, 91,488 persons were invited to take part in a health study at Nord-Trøndelag, Norway, and the response rate was 69.2%. Demographics were available for everyone. Survey answers from a previous survey were available for most of the participants and a majority of non-participants. In addition, the survey responses from spouses and children of the invitees were used to predict participation in the aforementioned study. Crude and adjusted ORs for a number of predictors, among these alcohol consumption and mental distress, are reported.

 

Both heavy drinkers (OR = 1.27) and abstainers (OR = 1.64) had a higher probability of dropping out in comparison to people who usually do not drink. High levels of mental distress (OR = 1.84) also predicted attrition.

 

Alcohol use and mental distress are moderately associated with non-response, though probably not a major cause, as controlling for other variables weakened the associations. Nevertheless, the moderate but clear underrepresentation at the crude level of people with high alcohol consumption, abstainers and people with poor mental health should be taken into consideration when interpreting results from health surveys.

 

 

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Request Reprint E-Mail:   fartein.torvik@fhi.no.

Alcohol Consumption as a Risk Factor for Esophageal Adenocarcinoma in North China

The incidence of esophageal adenocarcinoma has been rising in many countries, while esophageal squamous cell carcinoma has remained stable or even declined in the same populations over the identical periods. These differences in trends indicate that these cancer subtypes may have a different etiology, which may be caused by lifestyle factors such as alcohol consumption and cigarette smoking. 

Therefore, a matched case-control study to clarify the risk factors of alcohol and tobacco intake on the development of esophageal adenocarcinoma was collected in Hebei Province of China. The life expectancy of the study area was around 70 years old. In the present study, 98 patients younger than 65 years who were diagnosed with esophageal adenocarcinoma and had initial surgeries (cases) were matched with 294 healthy adults (controls) at a ratio of 1:3 according to sex and age. 

We found the proportions of drinkers and smokers among cases were 48.0% and 60.2%, respectively, versus 21.2% and 43.5% among controls. Univariate conditional logistic regression analyses revealed that the odds ratios (ORs) showed a nearly monotonic increase for the duration of alcohol consumption and duration of tobacco smoking. 

Multivariate conditional logistic regression analysis indicated that only alcohol consumption was a significant risk factor for esophageal adenocarcinoma. 

Additional analysis of the combination of amount and duration of alcohol consumption indicated that heavy drinkers (> 30 ml/day) had significantly higher ORs, irrespective of the duration of alcohol consumption. 

In conclusion, heavy alcohol consumption increases the risk for esophageal adenocarcinoma independent of the duration of such consumption.

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Common genetic influences on depression, alcohol, and substance use disorders in Mexican-American families†

Multiple genetic and environmental factors influence the risk for both major depression and alcohol/substance use disorders. In addition, there is evidence that these illnesses share genetic factors. 

Although, the heritability of these illnesses is well established, relatively few studies have focused on ethnic minority populations. 

Here, we document the prevalence, heritability, and genetic correlations between major depression and alcohol and drug disorders in a large, community-ascertained sample of Mexican-American families.

A total of 1,122 Mexican-American individuals from 71 extended pedigrees participated in the study. All subjects received in-person psychiatric interviews. Heritability, genetic, and environmental correlations were estimated using SOLAR. 

Thirty-five percent of the sample met criteria for DSM-IV lifetime major depression, 34% met lifetime criteria for alcohol use disorders, and 8% met criteria for lifetime drug use disorders. 

The heritability for major depression was estimated to be h² = 0.393 (P = 3.7 × 10⁻⁶). Heritability estimates were higher for recurrent depression (h² = 0.463, P = 4.0 × 10⁻⁶) and early onset depression (h² = 0.485, P = 8.5 × 10⁻⁵). 

While the genetic correlation between major depression and alcohol use disorders was significant (ρ_g = 0.58, P = 7 × 10⁻³), the environmental correlation between these traits was not significant. 

Although, there is evidence for increased rates of depression and substance use in US-born individuals of Mexican ancestry, our findings indicate that genetic control over major depression and alcohol/substance use disorders in the Mexican-American population is similar to that reported in other populations.


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Request Reprint E-Mail:  olverar@uthscsa.edu  

Extended Telephone-Based Continuing Care for Alcohol Dependence: 24 Month Outcomes and Subgroup Analyses

Determine whether 18 months of telephone continuing care improves 24 month outcomes for patients with alcohol dependence. Subgroup analyses were done to identify patients who would most benefit from continuing care.

Comparative effectiveness trial of continuing care that consisted of monitoring and feedback only (TM) or monitoring and feedback plus counseling (TMC). Patients were randomized to treatment as usual (TAU), TAU plus TM, or TAU plus TMC, and followed quarterly for 24 months.

Publicly funded intensive outpatient programs (IOP)

252 alcohol dependent patients (49% with current cocaine dependence) who completed 3 weeks of IOP.

Percent days drinking, any heavy drinking, and a composite good clinical outcome.

In the intent to treat sample, group differences in alcohol outcomes out to 18 months favoring TMC over TAU were no longer present in months 19-24. Approximately 50% of participants met criteria for Good Clinical Outcomes throughout treatment and follow-up with a non-significant trend for TMC to perform better than usual care. Overall significant effects favoring TMC and TM over TAU were seen for women; and TMC was also superior to TAU for participants with social support for drinking, low readiness to change, and prior alcohol treatments. Most of these effects were obtained on at least 2 of 3 outcomes. However, no effects remained significant at 24 months.

The benefits of an extended telephone-based continuing care programme to treat alcohol dependence did not persist after the end of the intervention. A post-hoc analysis suggested that women and individuals with social support for drinking, low readiness to change, or prior alcohol treatments may benefit from the intervention.


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Request Reprint E-Mail:  mckay_j@mail.trc.upenn.edu/ 

Effects of a Motivational Interviewing Intervention to Decrease Prenatal Alcohol Use

This study determined the effectiveness of motivational interviewing (MI) to decrease prenatal alcohol use, while examining mechanisms of behavior change based on self-determination theory that may have evoked decreases in drinking behaviors.

In all, 67 pregnant women who reported previous-year alcohol use were randomly assigned to an MI intervention or comparison group, with 56 women completing all study procedures. Both groups were assessed at baseline and 4- to 6-week follow-up for alcohol use and mechanisms of behavior change (basic psychological needs satisfaction and autonomous motivation). Only the MI group received the intervention after baseline assessments.

Although MI was not found effective in decreasing prenatal drinking behaviors in this study, nonspecific factors were identified, such as treatment structures, participant motivation for improvement, and provider qualities, which may have influenced these results. 

More research is needed to determine theory-based specific and nonspecific factors that drive effective nursing interventions to decrease alcohol use during pregnancy. 

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Request Reprint E-Mail:  robin.osterman@uc.edu   

Substance Abuse Treatment Admissions Aged 12 to 14

In 2008, approximately 23,770 substance abuse treatment admissions were adolescents aged 12 to 14. 

The two most frequently reported primary substances of abuse among these admissions were marijuana (63.0 percent) and alcohol (20.8 percent). 

Nearly one half (45.5 percent) of admissions aged 12 to 14 reported multiple substances of abuse at admission, and almost one quarter (24.7 percent) had a psychiatric disorder in addition to their substance use problem. 

Nearly one fifth (17.3 percent) had been admitted to treatment at least once prior to their current admission. 

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Alcohol effects on simulated driving in frequent and infrequent binge drinkers

Compared with non-bingers, binge drinkers are more likely to drive while intoxicated. The extent to which binge frequency impacts confidence in driving and subsequent driving impairment is unknown. 

This study compared the effects of an experimenter-delivered alcohol binge on subjective impairment and simulated driving ability in female high-frequency and low-frequency bingers.

 

Female drinkers were assigned to high-frequency (n = 30) or low-frequency (n = 30) binge groups based on their Alcohol Use Questionnaire responses. At 30-min intervals within a 2-h period, participants received either a placebo drink (n = 15 per group) or a 0.2 g/kg dose of alcohol (n = 15 per group; cumulative dose 0.8 g/kg). Self-reported impairment, driving confidence, and simulated driving were then measured.

 

Self-reported confidence in driving was significantly lower after alcohol than after placebo in low-frequency but not high-frequency bingers. Self-reported impairment and collisions during simulated driving were significantly greater after alcohol than after placebo in both low-frequency and high-frequency bingers.

 

The impairing effects of a single alcohol binge on driving ability in women are not influenced by binge frequency. However, high binge frequency may be associated with a less cautious approach to post-binge driving.


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Request Reprint E-Mail: aliguori@wfubmc.edu   

The effects of a modest dose of alcohol on executive functioning and prospective memory

Acute alcohol intoxication selectively impairs executive functioning and prospective memory (PM). Much previous researches in this area have used laboratory-based tasks that may not mimic functions that individuals with dysexecutive syndrome have problems with in their everyday life. 

The present study aimed to assess the effects of a modest dose of alcohol on executive functioning and PM using a virtual reality task and investigate the role of executive planning in PM performance.

 

Forty healthy participants were administered 0.4 g/kg alcohol or matched placebo in a double-blind design. Executive function and PM were assessed using the Jansari–Agnew–Akesson–Murphy (JAAM) task, requiring participants to play the role of an office worker.

 

Alcohol intoxication selectively impaired executive function and PM. The participants in the alcohol condition performed worse on the planning, prioritisation, creativity and adaptability executive subscales and also on the time-based and event-based PM tasks. However, alcohol did not impair the selection executive function task or the action-based PM task.

 

The results provide further support for the effects of alcohol on executive functioning and PM. In addition, the results suggest that such deficits may be present at relatively modest doses of alcohol and in the absence of a subjective feeling of intoxication.


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Request Reprint E-Mail:  c.a.montgomery@ljmu.ac.uk  

Expansion of Substance Use Disorder Treatment Within Reach Through Health Care Reform

National health care reform provides California with the best opportunity to date to significantly expand and improve the care for people requiring substance use disorder (SUD) treatment. The Patient Protection and Affordable Care Act (PPACA2010) requires that all health plans include treatment for substance use disorders among their basic benefits. This act greatly expands coverage to people for whom treatment is unavailable. At the same time, the Mental Health Parity and Addiction Equity Act (MHPAEA2008) assures these disorders are covered in the same way as all other medical and surgical benefits. Together, these landmark acts improve the availability and quality of care for people with SUD.
 
Californians with substance use disorders are grossly underserved. According to the 2007 state estimates from the National Survey on Drug Use and Health, 764,000 Californians needed but didn’t receive treatment for drug use and 2.3 million Californians needed but did not receive treatment for alcohol use.1 The Affordable Care Act breeches this disparity by expanding Medicaid eligibility to everyone, including childless adults, up to 133 percent of federal poverty level, and requires that all receive basic benefits that include SUD treatment. These benefits extend to poor and uninsured Californians – such as the homeless, ex-offenders, unemployed and others – who today have little access to effective SUD treatment. In California, 6 million individuals who were previously uninsured will receive basic medical benefits. The Act extends coverage through other means, including by mandating SUD treatment in private coverage plans and allowing parents to maintain children on their health plans until age 27, and also bans denial of coverage for any pre-existing condition. Many of these changes impacting SUD treatment do not go into effect until 2014.  > > > >  Read More

Toward DSM-V: Mapping the alcohol use disorder continuum in college students

The present study examined the dimensionality of DSM-IV Alcohol Use Disorder (AUD) criteria using Item Response Theory (IRT) methods and tested the validity of the proposed DSM-V AUD guidelines in a sample of college students.

Participants were 396 college students who reported any alcohol use in the past 90 days and were aged 18 years or older. We conducted factor analyses to determine whether a one- or two-factor model provided a better fit to the AUD criteria. IRT analyses estimated item severity and discrimination parameters for each criterion. Multivariate analyses examined differences among the DSM-V diagnostic cut-off (AUD vs. No AUD) and severity qualifiers (no diagnosis, moderate, severe) across several validating measures of alcohol use.

A dominant single-factor model provided the best fit to the AUD criteria. IRT analyses indicated that abuse and dependence criteria were intermixed along the latent continuum. The “legal problems” criterion had the highest severity parameter and the tolerance criterion had the lowest severity parameter. The abuse criterion “social/interpersonal problems” and dependence criterion “activities to obtain alcohol” had the highest discrimination parameter estimates. Multivariate analysis indicated that the DSM-V cut-off point, and severity qualifier groups were distinguishable on several measures of alcohol consumption, drinking consequences, and drinking restraint.

Findings suggest that the AUD criteria reflect a latent variable that represents a primary disorder and provide support for the proposed DSM-V AUD criteria in a sample of college students. Continued research in other high-risk samples of college students is needed.


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Request Reprint E-Mail: hagman@usf.edu  

Intensive referral to 12-step dual-focused mutual-help groups

This study implemented and evaluated procedures to help clinicians effectively refer dually diagnosed (substance use and psychiatric disorders) patients to dual-focused mutual-help groups (DFGs).

Using a cohort cyclical turnover design, individuals with dual diagnoses beginning a new outpatient mental health treatment episode (N = 287) entered a standard- or an intensive-referral condition. Participants provided self-reports of 12-step mutual-help (DFG and substance-focused group [SFG]) attendance and involvement and substance use and psychiatric symptoms at baseline and six-month follow-up. The intensive referral intervention focused on encouraging patients to attend DFG meetings.

Compared to patients in the standard condition, those in the intensive referral intervention were more likely to attend and be involved in DFGs and SFGs, and had less drug use and better psychiatric outcomes at follow-up. 

Attending more intensive-referral sessions was associated with more DFG and SFG meeting attendance. 

More need fulfillment in DFGs, and more readiness to participate in SFGs, were associated with better alcohol and psychiatric outcomes at six months. 

However, only 23% of patients in the intensive-referral group attended a DFG meeting during the six-month follow-up period.

The intensive referral intervention enhanced participation in both DFGs and SFGs and was associated with better six-month outcomes. The findings suggest that intensive referral to mutual-help groups focus on its key components (e.g., linking patients to 12-step volunteers) rather than type of group.


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