The 2nd National Emergency Department survey of Alcohol Identification and Intervention activity

Alcohol identification and brief advice (IBA) in the Emergency Department is an effective and cost effective method to reduce levels of alcohol consumption and alcohol related harm. This finding has been translated into UK alcohol policy guidelines by the Department of Health. The recent NICE guidelines “Preventing the development of hazardous and harmful drinking” also commend the use of screening tools and the delivery of brief advice in the ED. To determine the extent to which the continuing recommendations for the provision of alcohol screening and brief advice have been adopted by EDs, a survey of all English EDs was undertaken. This survey followed up on our previous National Survey, with more specific questions regarding access to training on screening and brief interventions.

A cross sectional survey targeting all 187 consultant led Emergency Departments in England. A questionnaire based upon the previous national survey was developed and made available in both print and online versions. Anonymity of respondents was preserved by utilising an Identity Number.
In the first instance, a questionnaire was sent to the “Lead Clinician” of each ED. Each questionnaire also contained a return address, a link to the online version of the survey and details to allow the return of completed materials via electronic methods. Two weeks after the initial mail-shot, non-responding departments were sent an Email version of the cover letter and questionnaire. Two weeks after the initial email contact, a second wave of emails was sent to remaining non-responders, and two weeks after that a final round of telephone and email contacts was undertaken.

A total of 153 departments (of 187 contacted) responded to the survey (81.8% response rate). There was a significant reduction (-17.9%) in participating departments compared to the previous national survey, however over 80% of EDs did complete the questionnaire.

When compared to the results of the previous National Survey there have been significant increases in routine questioning about alcohol consumption (+35.0%), the use of a formal alcohol screening questionnaire (+49.6%), the provision of help / advice about alcohol problems (+22.1%) and access to Alcohol Health Workers (AHW) or Clinical Nurse Specialists (CNS) (+54.9%).

More than half of all departments (57.6%) indicated that their ED had an “alcohol champion” – a specific member of staff who took responsibility for alcohol issues. There was a significant association between the presence of a champion and access to training on screening.

Almost every department (98.7%) asked adult patients about their alcohol consumption with about half asking such questions routinely and using a standardised screening tool. The Paddington Alcohol Test was the most frequently used screening tool (40.5%), with the AUDIT-C (23.0%) and FAST (14.9%) also accounting for most screening activity.

Every department offers some sort of help or advice (i.e. leaflets, advice or specialist referrals) for patients who might have an alcohol problem. The help / advice provided by about half of all departments was a referral to their own “in house” specialist team, with about a quarter referring patients to an external agency. Some department staff also provided an intervention themselves as either a leaflet or “Brief Advice” (1-2 minutes of structured advice about their level of alcohol consumption). The majority of departments had access to at least one Alcohol Health Worker/ Community Nurse Specialist, usually based on-site.

The results of this survey of alcohol identification and brief advice activity show that, compared to the earlier 2006 survey, levels of screening, provision of help / advice and access to AHW / CNS services have all increased significantly. Departments are beginning to identify local alcohol “champions”, and this is associated with an increase in the provision of training in both identification and brief intervention. The increased use of formal alcohol screening measures, often applied routinely, suggests that English EDs are beginning to maximise the likelihood of identifying those patients who may benefit from further help or advice about their alcohol consumption. The four fold increase in access to specialist services for such patients should serve to also ensure that those who require help are exposed to interventions that are both effective and cost effective. To conclude; alcohol no longer represents a missed opportunity in the ED. Departments are to be commended upon their progress towards the integration of alcohol IBA into routine practice; this increased focus upon alcohol affords a chance to instigate change for the betterment of the patient, the department and the wider health service.

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Ethanol consumption impairs the hemodynamic response to hemorrhagic shock in rats

Alcohol intoxication can exacerbate hemodynamic instability following hemorrhagic shock. Impairment of hormonal, neurohumoral, and immune responses can contribute to such instability; however, the relationship between blood alcohol levels and the progression of hemorrhagic shock accompanied with these responses has not been clearly demonstrated. 

Herein, we examined this relationship in rats treated with various dose of alcohol. After oral administration of alcohol and then hemorrhage, the recovery of mean blood pressure (MBP); increase in plasma level of norepinephrine, epinephrine, and vasopressin; and survival interval decreased in a dose-dependent manner as the blood alcohol level increased. 

There were no significant differences in the production of proinflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-1β among the groups. 

The present results demonstrated alcohol aggravates hemorrhagic shock in a dose-dependent manner not by alerting the immune response, but by suppressing hormonal and neurohumoral responses, thereby inhibiting hemodynamic autoregulation and shortening the survival interval.


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Request Reprint E-Mail:  h-sato@med.uoeh-u.ac.jp

Effect of dissolved oxygen in alcoholic beverages and drinking water on alcohol elimination in humans

Oxygen plays an important role in the metabolism of alcohol. An increased dissolved oxygen level in alcoholic beverages reportedly accelerates the elimination of alcohol. Therefore, we evaluated the effect of dissolved oxygen in alcohol and the supportive effect of oxygenated water on alcohol pharmacokinetics after the excessive consumption of alcohol, i.e., 540 ml of 19.5% alcohol (v/v).

Fifteen healthy males were included in this randomized, 3 × 3 crossover study. Three combinations were tested: X, normal alcoholic beverage and normal water; Y, oxygenated alcoholic beverage and normal water; Z, oxygenated alcoholic beverage and oxygenated water. Blood alcohol concentrations (BACs) were determined by conversion of breath alcohol concentrations. Four pharmacokinetic parameters (C_max, T_max, K_el, and AUCall) were obtained using non-compartmental analysis and the times to reach 0.05% and 0.03% BAC (T_0.05% and T_0.03%) were compared using one-way analysis of variance (ANOVA) and Duncan's post hoc test. 

With combination Z, the BAC decreased to 0.05% significantly faster (p < 0.05) than with combination X.

Analyzing the pharmacokinetic parameters, the mean K_el was significantly higher for combination Z than for combinations X and Y (p < 0.05), whereas the mean values of C_max, T_max and AUCall did not differ significantly among the combinations. 

Dissolved oxygen in drinks accelerates the decrease in BAC after consuming a large amount of alcohol. However, the oxygen dissolved in the alcoholic beverage alone did not have a sufficient effect in this case. 

We postulate that highly oxygenated water augments the effect of oxygen in the alcoholic beverage in alcohol elimination. Therefore, it is necessary to investigate the supportive effect of ingesting additional oxygenated water after heavy drinking of normal alcoholic beverages.


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Request Reprint E-Mail:    kwon@cnu.ac.kr

Severity of alcohol dependence in the Swedish adult population: Association with consumption and social factors

The severity of alcohol dependence can be estimated by the number of DSM-IV criteria that are fulfilled for this disorder. This paper describes the proportions in a general population sample that meet different numbers of diagnostic criteria for alcohol dependence and their association with drinking and social background factors.

Data came from a random, cross-sectional, self-report survey of adults from 12 Swedish communities. 28,800 persons, age 19–70, were surveyed through postal questionnaires. 14,706 questionnaires (51%) could be used for analysis. Alcohol dependence was assessed by questions relating to the seven DSM-IV criteria for alcohol dependence. Alcohol consumption and social background factors were examined in relation to alcohol dependence. 

A total of 73.8% of the general population fulfilled no criteria for alcohol dependence; 4.0% reported 3 or more criteria and qualified for the diagnosis of alcohol dependence. There were trends toward an increasing number of dependence criteria with increasing consumption levels and negative social background factors. The majority of people with alcohol dependence however did not drink at the highest consumption levels, did not live alone, and were not unemployed.

Given the current definition of alcohol dependence the majority of people have few criteria fulfilled (3 or 4) and few social problems. This has important implications for treatment as dependence with low severity may require less treatment and less specialist involvement.


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Request Reprint E-Mail:  sven.andreasson@ki.se

Dose–response relationship between in-hospital mortality and alcohol following acute injury

Although the relationship between alcohol and injury incidence is well researched, there continues to be dispute about the relationship between alcohol and mortality following an injury. Findings from past studies have varied primarily because of methodological issues and have failed to characterize the dose–response relationship. 

The main objective of this study was to evaluate the dose response relationship of in-hospital mortality and blood alcohol concentration (BAC). This study was a retrospective analysis of traumatic injuries occurring between 1995 and 2009 as reported by all level 1 and 2 trauma units in the State of Illinois. 

The study includes all patients with blood alcohol toxicological examination levels ranging from zero to 500 mg/dl (N = 190,612). The Illinois trauma registry includes all patients sustaining traumatic injuries and admitted to a trauma center for ≥12 h. A total of 6733 patients meeting the inclusion criteria died following admission. Patients that were dead on arrival and those that died during the initial assessment within the emergency room were excluded. 

In the adjusted multivariable model, a decrease in in-hospital mortality was strongly associated with an increase in blood alcohol concentration (adjusted OR = 0.83 per 100 mg/dl units change in BAC; CI 95%: 0.80, 0.85; p < 0.001). The direction of the dose response relationship was consistent across the stratified models, with the exception of patients suffering burns.

The largest reduction of in-hospital case fatality rates by blood alcohol concentration was observed among patients suffering penetrating or severe injuries (Injury Severity Score ≥ 16). In the clinical setting, it is important to understand not only how to recognize intoxicated patients, but also how alcohol may affect the course of treatment. 

The consistency of the findings across the multivariable models indicates that blood alcohol concentration is strongly associated with lower in-hospital mortality among those that survive long enough to receive treatment in specialized trauma units.


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Request Reprint E-Mail:      lfriedman@tspri.org

Effect of repetitive daily ethanol intoxication on adult rat brain: Significant changes in phospholipase A2 enzyme levels in association with increased PARP-1 indicate neuroinflammatory pathway activation

Collaborating on studies of subchronic daily intoxication in juvenile and adult rats, we examined whether the repetitive ethanol treatments at these two life stages altered levels of key neuroinflammation-associated proteins—aquaporin-4 (AQP4), certain phospholipase A2 (PLA2) enzymes, PARP-1 and caspase-3—in hippocampus (HC) and entorhinal cortex (EC). Significant changes in the proteins could implicate activation of specific neuroinflammatory signaling pathways in these rats as well as in severely binge-intoxicated adult animals that are reported to incur degeneration of vulnerable neurons in HC and EC. 

Male Wistar rats, ethanol-intoxicated (3 g/kg i.p.) once daily for 6 days over an 8-day interval beginning at 37 days old and repeated at age 68–75 days, were sacrificed 1 h after the day 75 dose (blood ethanol, 200– 230 mg/dl). 

Analysis of HC with an immunoblot technique showed that AQP4, Ca+2-dependent PLA2 (cPLA2 IVA), phosphorylated (activated) p-cPLA2, cleaved (89 kD) PARP (c-PARP), and caspase-3 levels were significantly elevated over controls, whereas Ca+2-independent PLA2 (iPLA2 VIA) was reduced ∼70%; however, cleaved caspase-3 was undetectable. 

In the EC, AQP4 was unchanged, but cPLA2 and p-cPLA2 were significantly increased while iPLA2 levels were diminished (∼40%) similar to HC, although just outside statistical significance (p = 0.06). In addition, EC levels of PARP-1 and c-PARP were significantly increased. 

The ethanol-induced activation of cPLA2 in association with reduced iPLA2 mirrors PLA2 changes in reports of neurotrauma and also of dietary omega-3 fatty acid depletion. 

Furthermore, the robust PARP-1 elevations accompanied by negligible caspase-3 activation indicate that repetitive ethanol intoxication may be potentiating non-apoptotic neurodegenerative processes such as parthanatos. 

Overall, the repetitive ethanol treatments appeared to instigate previously unappreciated neuroinflammatory pathways in vivo. 

The data provide insights into mechanisms of binge ethanol abuse that might suggest new therapeutic approaches to counter neurodegeneration and dementia.


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Request Reprint E-Mail:    mcollin@lumc.edu

Confounding and studies of ‘moderate’ alcohol consumption: the case of drinking frequency and implications for low-risk drinking guidelines

Many observational studies suggest that increased drinking frequency is associated with reduced mortality among those with low-dose alcohol consumption. The purpose of this paper was to examine whether frequent drinkers consume lower-risk amounts during drinking days or have favorable risk factor profiles compared with those who drink less frequently, and discuss implications for the larger debate about the limitations of non-randomized studies about ‘moderate’ drinking and the development of low-risk drinking guidelines.

Data from the 2008 Behavioral Risk Factor Surveillance System survey were used to characterize alcohol consumption characteristics and their relationship with risk factors among adult drinking men who consumed an average of fewer than two drinks per day and adult drinking adult women who consumed an average of less than one drink per day.

Those who drank relatively infrequently (14 or fewer days per month) consumed more during drinking days, were more likely to exceed the US Dietary Guidelines drinking limits (41.0% versus 9.7%) and had a larger proportion of drinking days that included binge drinking (13.4% versus 4.3%). Infrequent drinkers also had a higher prevalence of 13 of 15 risk factors assessed. Findings from analyses of those aged ≥40 years were similar.

Among those with low average alcohol consumption, infrequent drinkers drink more during drinking days and have unfavorable risk factors profiles compared with more frequent drinkers, suggesting that confounding may contribute to favorable associations with ‘moderate’ average alcohol consumption and increased drinking frequency observed in non-randomized studies.


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Request Reprint E-Mail:    tim.naimi@bmc.org

Recruitment of medial prefrontal cortex neurons during alcohol withdrawal predicts cognitive impairment and excessive alcohol drinking

Chronic intermittent access to alcohol leads to the escalation of alcohol intake, similar to binge drinking in humans. Converging lines of evidence suggest that impairment of medial prefrontal cortex (mPFC) cognitive function and overactivation of the central nucleus of the amygdala (CeA) are key factors that lead to excessive drinking in dependence. However, the role of the mPFC and CeA in the escalation of alcohol intake in rats with a history of binge drinking without dependence is currently unknown.

To address this issue, we examined FBJ murine osteosarcoma viral oncogene homolog (Fos) expression in the mPFC, CeA, hippocampus, and nucleus accumbens and evaluated working memory and anxiety-like behavior in rats given continuous (24 h/d for 7 d/wk) or intermittent (3 d/wk) access to alcohol (20% vol/vol) using a two-bottle choice paradigm. 

The results showed that abstinence from alcohol in rats with a history of escalation of alcohol intake specifically recruited GABA and corticotropin-releasing factor (CRF) neurons in the mPFC and produced working memory impairments associated with excessive alcohol drinking during acute (24–72 h) but not protracted (16 –68 d) abstinence.

 Moreover, abstinence from alcohol was associated with a functional disconnection of the mPFC and CeA but not mPFC and nucleus accumbens. 

These results show that recruitment of a subset of GABA and CRF neurons in the mPFC during withdrawal and disconnection of the PFC–CeA pathway may be critical for impaired executive control over motivated behavior, suggesting that dysregulation of mPFC interneurons may be an early index of neuroadaptation in alcohol dependence.


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Request Reprint E-Mail:   ogeorge@scripps.edu

The Overlooked Obstacles for Achieving Millenium Development Goals

In an article on the web site of IOGT InternationalI Mr. Sumanasekara describes alcohol use as one of the overlooked obstacles for achieving the Millenium Development Goals (MDGs). Sumanasekara is the Executive Director of the Alcohol and Drug Information Centre in Colombo, Sri Lanka. His article was published on the International Day for the Eradication of Poverty.


- Ending the Violence of Extreme Poverty is possible only if alcohol issue is addressed as part of a comprehensive approach to eradicating poverty. Alcohol has diverse negative influences on people’s economic status while economic status in turn affects alcohol use in many ways. Alcohol can push people into poverty and lock them, their families and entire communities there over generations, says the Board Member of IOGT.

Effectiveness of a Proactive Mail-Based Alcohol Internet Intervention for University Students: Dismantling the Assessment and Feedback Components in a Randomized Controlled Trial

University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs.

To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se.

This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned.

Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback.

This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group.


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NICE release 'alcohol public health' briefing to assist local authorities

The National Institute for Clinical Excellence (NICE) have released an alcohol briefing (PHB6) as part of its suite of public health briefings for local government - see NICE press release.

NICE have based the guidance on its comprehensive set of resources, guidance and quality standards for the prevention and treatment of alcohol problems. NICE reccomond a two-pronged approach to alcohol misuse, with a combination of interventions aimed at the whole population and individuals.

The briefing aims to support local government in its public health role, including its leadership of Health and Wellbeing boards forthcoming duty to commission alcohol misuse prevention and treatment interventions. As of April 2013 public health functions will be formally transferred from Primary Care Trusts to local authorities, some challenges explored in a recent Guardian public health article.  > > > >  Read More

Dealing Responsibly with the Alcohol Industry in London

The 2012 UK Government's Alcohol Strategy for England and Wales has been welcomed broadly and resulted only in muted criticism within the UK public health community. This is despite strong continuities with previous alcohol industry constructions of the nature of the problem and preferred policy responses. This is probably because the strategy shows progress on the public health lobby's key issue of pricing of alcohol beverages. There are, however, many problems with the wider content of the strategy, showing little interest in much needed industry regulation other than on price, and an absence of commitment to investment in research. Some dilemmas posed for the research community are discussed.  > > > >  Read More

Moderate drinking? Alcohol consumption significantly decreases neurogenesis in the adult hippocampus

Drinking alcohol in moderation is often considered a health-conscious behavior, associated with improved cardiovascular and brain health. However, “moderate” amounts of alcohol include drinking 3–4 alcohol beverages in a day, which is closer to binge drinking and may do more harm than good. 

Here we examined how daily drinking of moderate-high alcohol alters the production of new neurons in the adult hippocampus. 

Male and female adult Sprague–Dawley rats were provided free access to a liquid replacement diet that was supplemented with either 4% ethanol or Maltodextrin for a period of 2 weeks. Proliferating cells were labeled with 5-bromo-2-deoxyuridine (BrdU) and the number of BrdU-positive cells in the hippocampus was assessed after the final day of drinking. A subset of rats was also exposed to a motor skill or associative learning task to examine the functional effects of alcohol consumption. The drinking regime resulted in an average blood alcohol concentration of approximately 0.08%, which is comparable to the human legal driving limit in many countries. 

This level of intoxication did not impair motor skill learning or function in either sex, nor did the alcohol consumption disrupt associative learning 2 days after drinking. 

Therefore, moderate alcohol consumption did not disrupt basic sensory, motor or learning processes. However, the number of cells produced in the dentate gyrus of the hippocampus was reduced by nearly 40%. Thus, even moderate consumption of alcohol for a relatively short period of time can have profound effects on structural plasticity in the adult brain.


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Request Reprint E-Mail:    shors@rutgers.edu

Polyphosphoinositide Metabolism and Golgi Complex Morphology in Hippocampal Neurons in Primary Culture is Altered by Chronic Ethanol Exposure

 Ethanol affects not only the cytoskeletal organization and activity, but also intracellular trafficking in neurons in the primary culture. Polyphosphoinositide (PPIn) are essential regulators of many important cell functions, including those mentioned, cytoskeleton integrity and intracellular vesicle trafficking. Since information about the effect of chronic ethanol exposure on PPIn metabolism in neurons is scarce, this study analysed the effect of this treatment on three of these phospholipids. 

Phosphatidylinositol (PtdIns) levels as well as the activity and/or levels of enzymes involved in their metabolism were analysed in neurons chronically exposed to ethanol. The levels of phospholipases C and D, and phosphatidylethanol formation were also assessed. The consequence of the possible alterations in the levels of PtdIns on the Golgi complex (GC) was also analysed. 

We show that phosphatidylinositol (4,5)-bisphosphate and phosphatidylinositol (3,4,5)-trisphosphate levels, both involved in the control of intracellular trafficking and cytoskeleton organization, decrease in ethanol-exposed hippocampal neurons. In contrast, several kinases that participate in the metabolism of these phospholipids, and the level and/or activity of phospholipases C and D, increase in cells after ethanol exposure. Ethanol also promotes phosphatidylethanol formation in neurons, which can result in the suppression of phosphatidic acid synthesis and, therefore, in PPIn biosynthesis. This treatment also lowers the phosphatidylinositol 4-phosphate levels, the main PPIn in the GC, with alterations in their morphology and in the levels of some of the proteins involved in structure maintenance

The deregulation of the metabolism of PtdIns may underlie the ethanol-induced alterations on different neuronal processes, including intracellular trafficking and cytoskeletal integrity.


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Request Reprint E-Mail:    renau_jai@gva.es

SAMHSA's Latest Inservice Training

Based on Treatment Improvement Protocol (TIP) 41, Substance Abuse Treatment: Group Therapy Inservice Training provides seven scripted modules to assist treatment program staff in understanding and implementing evidence-based group therapy practices. The modules include:

• Groups and Substance Abuse Treatment
• Types of Groups Used in Substance Abuse Treatment
• Criteria for the Placement of Clients in Groups
• Group Development and Phase-Specific Tasks
• Stages of Treatment
• Group Leadership, Concepts, and Techniques
• Supervision

Download Substance Abuse Treatment: Group Therapy Inservice Training (Based on TIP 41

TACR1 Genotypes Predict fMRI Response to Alcohol Cues and Level of Alcohol Dependence

The tachykinin receptor 1 (TACR1) gene is a promising candidate gene in the search for the genetic basis of alcohol dependence (AD); TACR1 antagonists improve symptomology not only in preclinical models of AD but also in a clinical sample of detoxified alcoholics (George et al., Science 319:1536, 2008). The purpose of the current study was to determine whether TACR1 single nucleotide polymorphisms (SNPs) were associated with (i) blood oxygen level dependent (BOLD) activation in response to gustatory alcohol cues in a sample of heavy drinkers and (ii) Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision (DSM-IV-TR) AD symptom count in a large, publicly available data set—the Study of Addictions: Genetics and Environment Genome Wide Association study (SAGE GWAS) (Bierut et al., 2010).

First, we examined relationships between TACR1 genotypes and neural responses during a craving task in 326 individuals with alcohol use disorders. Next, correlational analyses between 69 TACR1 SNPs and DSM-IV-TR AD symptoms were performed on the SAGE data set.

rs3771863, rs3755459, and rs1106855 predicted BOLD activation in response to alcohol cues in those same reward and reinforcement brain areas, especially in the medial prefrontal cortex, striatum, and insula. rs3771863 also predicted AD symptom count in the SAGE data set and BOLD activation in the mesocorticolimbic pathway response to alcohol cues.

Each of the 5 SNPs in the TACR1 gene that was significantly related to AD severity in the SAGE data set and/or the BOLD response to the craving task is near the 3′ or 5′ areas of the gene and may therefore be near mutations with potential functional significance.


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Request Reprint E-Mail:   sara.blaine@colorado.edu

Combined Proteomic Analysis of Liver Tissue and Serum in Chronically Alcohol-Fed Rats

Proteomic approaches may provide new insights into pathological conditions associated with alcoholism. The aim of this study was to conduct a proteomic analysis of liver tissue and serum in chronically alcohol-fed rats using agarose 2-dimensional gel electrophoresis (2-DE) and 3-step serum proteome analysis.

A total of 12 rats were pair-fed nutritionally adequate liquid diet containing ethanol as 36% of the total energy or an isocaloric control diet for 2 months. Rat liver homogenates and cytosol fractions were subjected to agarose 2-DE. Serum samples were subjected to 3-step serum proteome analysis involving immunodepletion of abundant proteins followed by fractionation using reverse-phase high-performance liquid chromatography and 1-dimensional sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Candidate proteins were digested with trypsin and identified using mass spectrometry. Observed differences in protein expression levels were confirmed using Western blotting.

A total of 46 protein spots were found to be differentially expressed in the liver homogenates and cytosol fractions of alcohol-fed rats relative to pair-fed controls. The most notable change was down-regulation of a 29-kDa protein, which was subsequently identified as carbonic anhydrase III (CA III). Down-regulation of this protein in alcohol-fed rats was confirmed by Western blotting. The messenger RNA level of CA III was decreased as well. In rat serum, a total of 41 proteins were differentially expressed. Of these proteins, only betaine–homocysteine methyltransferase (BHMT) was also found to be differentially expressed in the liver.

A combined proteomic analysis of liver tissue and serum in chronically alcohol-fed rats revealed that the expression of CA III is significantly down-regulated in the liver of alcohol-fed rats. Our results also showed that BHMT expression is up-regulated in both the liver and serum of alcohol-fed rats.


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Request Reprint E-Mail:    fnomura@faculty.chiba-u.jp

Effect of Predictive Cuing on Response Inhibition in Children with Heavy Prenatal Alcohol Exposure

Heavy prenatal exposure to alcohol leads to widespread cognitive deficits, including problems with attention and response inhibition. This study examined blood oxygen level-dependent response in children with and without histories of heavy prenatal alcohol exposure during a task of response inhibition consisting of cued and noncued trials.

Children and adolescents (ages 8 to 18 years) with (alcohol-exposed [AE] = 20) and without (control [CON] = 15) histories of heavy prenatal exposure to alcohol underwent functional magnetic resonance imaging while performing a go/no-go task. Unbeknownst to subjects, a predictive cue preceded the no-go stimulus in 87% of trials.

Groups were matched on demographic variables and did not differ on most measures of task performance. However, following cued stimuli, the AE group demonstrated a lower hit rate to go stimuli and more conservative response bias than the CON group. AE participants demonstrated more activation during no-go trials (inhibition) relative to go trials in the left precuneus, cingulate gyrus, anterior cingulate, and right medial frontal gyrus. During cue-dependent response inhibition, the AE group demonstrated less activation in the left precentral and postcentral gyrus compared to the CON group.

Consistent with previous studies of response inhibition, the AE group demonstrated greater frontal and parietal activation when attempting to inhibit prepotent responses than the CON group, despite similar rates of commission errors. This study further demonstrated that the AE group had impaired behavioral performance on cued trials and demonstrated less activation in precentral and postcentral gyri relative to the CON group on these trials. This investigation provides evidence of impaired behavioral and neural processing of sequential information in fetal alcohol spectrum disorders, which can help improve inhibition in typical populations.


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Request Reprint E-Mail:   smattson@sunstroke.sdsu.edu

'Protecting People, Promoting Health: A public health approach to violence prevention for England'

A new report has been released by the North West Public Health Observatory (NWPHO):
'Protecting People, Promoting Health: A public health approach to violence prevention for England' [pdf]

'The report describes the major roles public health and health care services can play in reducing levels of violence across the country alongside their functions in dealing with the impacts of violence on health. The documents contain new figures on the cost of violence, estimating national costs to the NHS of £2.9 billion annually and a wider cost to society of £29.9 billion each year.  > > > >  Read More

Media Release - Health survey shows we drink and smoke less, but we've packed on the kilos

First results from the Australian Health Survey have some good and bad news; smoking rates continue to fall, as do rates of drinking at risky levels, but the number of people who are overweight and obese continues to rise.   > > >  Read More

Alcohol News - 44/2012

Medical Daily (Finland) - Just One Alcoholic Drink a Day Could Lower Your Ability to Learn New Things

New study, from researchers at Rutgers University and the University of Jyvaskyla in Finland, has suggested that even moderate drinking could place drinkers at risk. Lead author Megan Anderson and her colleagues state that moderate drinking could place imbibers at risk for lower production of brain cells and decreased ability for certain types of learning.

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Helsinki Times (Finland) - The disadvantages of alcohol increased five-fold in 20 years

“THE disadvantages for society caused by drinking in Finland have increased five-fold in 20 years, a yet unpublished study by the University of Eastern Finland reports. This year alone will result in a loss of a billion euro, as the loss is compared with Finland’s gross domestic product. In 1990 the drinking deficit amounted to 212 million euro.

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Norwegian Institute of Public Health (Norway) - Alcohol plus medicine – a dangerous combination in traffic

The accident risk is very high if a driver combines alcohol with hypnotic or sedative medicines. This is the finding from a recent study by researchers at the Norwegian Institute of Public Health, in collaboration with Oslo University Hospital, Ullevaal and the Norwegian Institute for Alcohol and Drug Research.

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Baltimore Sun (USA) - Alcohol companies target African-American youth

It is no secret that for decades, tobacco companies have filled disadvantaged communities with advertising and marketing attracting generations of young people of color to the products they peddle. A new report from the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health finds that alcohol companies are taking a page from the tobacco industry's playbook.

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BBC News (UK) - Norwich alcohol sales ban proposed after crime rise

Reductions to late-night drinking hours are a step closer in Norwich following a vote by a city council committee.

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AllAfrica.com (South Africa) - South Africa: Alcohol Advertising Ban Still a Hot Debate

The advertising industry, civil society, academia and government, earlier this week, deliberated on the issue of banning alcohol advertising in a heated debate held in Johannesburg.

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The Australian (Australia) - Indigenous MPs call for choice on grog

ABORIGINAL members of the Northern Territory parliament have spoken out in support of returning control over grog restrictions to local communities.

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GlobalPost (USA) - Drug and alcohol problems in US rose by 70% over past decade: study

The number of drug and alcohol problems diagnosed by doctors in the US has increased 70 percent between 2001 and 2009, according to new research.

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Stuff.co.nz (New Zealand) - MP defends proposed changes to alcohol law

Invercargill MP Eric Roy has defended the Government's Alcohol Reform Bill but says it does not always go far enough. The debate over the bill is expected to take up to 27 hours, or three weeks, of Parliamentary time, and feature a succession of unwhipped votes, where MPs do not have to vote with their party.

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The Independent (UK) - Cheap alcohol is 'devastating' life in the North East

Doctors in the North East of England have urged the Government to set a 50p minimum price per unit on alcohol following concerns about its “devastating impact” on the region's health.

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BBC News (Scotland) - Scottish minimum price law for alcohol tested in court

The drinks industry is going to court to challenge Scottish government plans for a minimum price per unit of alcohol.

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Scientific American - Alcoholism and Social Exclusion

Treating alcoholism is incredibly difficult on many levels. One of the most difficult areas to deal with is social interaction, how people with alcoholism can interact with others.

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Coastal Times (Canada) - Minimum pricing benefits not just small beer – study

THE evidence in favour of minimum pricing for alcohol is so strong it is only a matter of time before it is introduced, says the author of new research finding the policy had drastic effects when it was implemented overseas.

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The Conversation (Australia) - The government has it wrong on alcohol’s role in chronic diseases

The Commonwealth government looks set to lose its top position in preventative health measures. Despite its world-first efforts on tobacco control, when the government next steps onto the world stage, it will be not be as a leader – its position on alcohol is out of step with the World Health Organization and contrary to evidence.

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RIA Novosti (Russia) - Russia May Ban Cheap Wine

The Russian government may set minimum prices for wines to compensate domestic winemakers for rising world prices due to poor grape harvests in Russia and Europe, Izvestia daily reported on Monday.

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Fleet News Online (France) - Car breathalyser fine enforcement delayed in France until March 2013

Fines to enforce the new law, which was introduced earlier this year, were due to come into effect on 1st November, but this has now been delayed until March 2013. At present, drivers including visitors from the UK face caution if caught driving in France without the compulsory kit.

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BBC News (Scotland) - Scotland requests more drink-drive powers from UK government

More powers over drink-driving should be devolved to Scotland, Justice Secretary Kenny MacAskill has said.

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Voxy (New Zealand) - Local alcohol policies 'must be made compulsory'

New Zealand First says the Government must make it compulsory for every district and city council to adopt local alcohol policies.

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WHO EXPERT COMMITTEE ON DRUG DEPENDENCE Thirty-fifth report

Contents
Abbreviations 9
Introduction 10
1. Revision of guidelines 12
2. Work of international bodies concerned with controlled substances 13
3. Critical review of psychoactive substances 14
3.1 Substance recommended for change in scheduling
γ-Hydroxybutyric acid (GHB) 14
3.2 Other substance critically reviewed
Ketamine (INN) 16
4. Pre-review of psychoactive substances 17
4.1 Dextromethorphan (pINN) 18
4.2 Tapentadol (INN) 19
4.3 Piperazines 19
4.3.1 N-Benzylpiperazine (BZP) 19
4.3.2 1-(3-Trifluoromethylphenyl)piperazine (TFMPP) 20
4.3.3 1-(3-Chlorophenyl)piperazine (mCPP) 20
4.3.4 1-(4-Methoxyphenyl)piperazine (MeOPP) 21
4.3.5 1-(3,4-Methylenedioxybenzyl)piperazine (MDBP) 21
4.4 γ-Butyrolactone (GBL) 22
4.5 1,4-Butanediol (1,4-BD) 22
5. Issues identified for consideration at future ECDD meetings 23
6. Other matters 24
6.1 Use of terms 24
6.2 Use of pharmacovigilance data for the assessment of abuse and dependence potential 25
6.3 Balancing medical availability and prevention of abuse of medicines manufactured from controlled substances 25
6.4 Improving the process for substance evaluation 27
Acknowledgements 27
References 27



pg. 23    "There was a brief discussion as to whether ethanol (ethyl alcohol) should be considered for pre-review. The Secretariat informed the Expert Committee that WHO Secretariat and Member States are in the process of implementing the WHO Global Strategy to Reduce the Harmful Use of Alcohol, which was adopted by the World Health Assembly (WHA) in 2010 (Resolution WHA63.13) (23). Noting this, the Expert Committee referred the matter for consideration at a future Expert Committee meeting."


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A genome-wide association study of alcohol-dependence symptom counts in extended pedigrees identifies C15orf53

Several studies have identified genes associated with alcohol-use disorders (AUDs), but the variation in each of these genes explains only a small portion of the genetic vulnerability. The goal of the present study was to perform a genome-wide association study (GWAS) in extended families from the Collaborative Study on the Genetics of Alcoholism to identify novel genes affecting risk for alcohol dependence (AD).

To maximize the power of the extended family design, we used a quantitative endophenotype, measured in all individuals: number of alcohol-dependence symptoms endorsed (symptom count (SC)). Secondary analyses were performed to determine if the single nucleotide polymorphisms (SNPs) associated with SC were also associated with the dichotomous phenotype, DSM-IV AD.

This family-based GWAS identified SNPs in C15orf53 that are strongly associated with DSM-IV alcohol-dependence symptom counts (P=4.5 × 10⁻⁸, inflation-corrected P=9.4 × 10⁻⁷). 

Results with DSM-IV AD in the regions of interest support our findings with SC, although the associations were less significant. Attempted replications of the most promising association results were conducted in two independent samples: nonoverlapping subjects from the Study of Addiction: Genes and Environment (SAGE) and the Australian Twin Family Study of AUDs (OZALC). Nominal association of C15orf53 with SC was observed in SAGE. 

The variant that showed strongest association with SC, rs12912251 and its highly correlated variants (D′=1, r² 0.95), have previously been associated with risk for bipolar disorder.



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Request Rerprint E-Mail:    jcwang@psychiatry.wustl.edu

News & updates Oct 2012: minimum pricing battles re-heating; warning over alcohol budgets; 'baby boomers' under fire; MPs to debate duty escalator & forthcoming events

Minimum pricing battles re-heating

The alcohol pricing battleground has been re-heating with the imminent release of the consultation on proposals within the alcohol strategy, and as Scotland attempt to implement a 50 pence per unit minimum price.

With the actual minimum price for England still to be set, arguments for and against minimum pricing are being re-stated. Supporters have recently claimed a new Canadian study provides further evidence it would have a beneficial impact - a notion much disputed by Diageo's Mark Baird.   > > > >  Read More

Editorial - Health-care reform provides an opportunity for evidence-based alcohol treatment in the USA: the National Institute for Health and Clinical Excellence (NICE) guideline as a model

The USA is entering an era of major change in the financing and delivery of health-care services, including a greater  emphasis on evidence-based treatment.

Mainstream US alcohol treatment is an amalgam of
experience- and evidence-based approaches; the National
Institute for Health and Clinical Excellence (NICE)
alcohol guideline could provide a model for reform in
the USA.


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