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, April 15, 2013

Alcohol News - 15/2013

 
 
 
Xinhua - Alcohol, drugs cause low birth weight: Australian study

Women with drug or alcohol related mental disorders are up to four times more likely to have a low- birth weight baby, an Australian study revealed.


YLE.fi (Helsinki) - Yle: Government planning outright ban on public alcohol advertising

Government is considering an outright ban on public alcohol advertising, Yle reports. The ban would also affect advertisements in media such as radio and the social networking site Facebook . However ads would still be permitted in sports sponsorships and will remain visible in stadia and on sports gear.


Marketingblog.fi (Finland) - Finnish government says NO to alcohol advertising

According to a recent news from Helsingin Sanomat, a Finnish government is planning to ban all alcohol outdoor advertising. While this would sound a good and educational solution for any modern nation who has already took steps towards more healthier world, especially in Finland where excess alcohol usage is a common health problem, plans do not fit for everyone.


The Local (Sweden) - Alcohol seizures down despite tough new law

Despite the introduction of a new law strengthening the powers of customs officials, the number of seizures of alcohol ordered online has declined dramatically in 2013.


Daily Nation (Kenya) - Governors urged to curb alcohol abuse, insecurity

County governments in Central region have an uphill task of curbing insecurity and alcoholism. “Alcoholism is expected to pose a great challenge to the new leaders,” said outgoing Central Provincial Commissioner Japhter Rugut.


News-Medical.net (USA) - Report outlines role of health departments, community coalitions in regulating alcohol outlet density

Regulating alcohol outlet density, or the number of physical locations in which alcoholic beverages are available for purchase in a geographic area, is an effective strategy for reducing excessive alcohol consumption and associated harms.


Vibe Ghana (Ghana) - Check excessive alcohol ads on TV and radio

Reverend Joseph Bosomah, Acting Chairman of the Central Presbytery of the Presbyterian Church of Ghana, has expressed concern about the excessive alcohol ads on television and radio.


Telegraph.co.uk (UK) - Pubs demand minimum alcohol price

The heads of pubs, nightclubs and breweries are pleading with David Cameron to stick to his plans to introduce a mininum alcohol price.


Irish Times (Ireland) - Gastroenterologists call for action on cheap alcohol

The Irish Society of Gastroenterology has called on the Government to introduce a 1 per cent levy on alcohol advertising and sponsorship expenditure.


EPHA (EU) - Evening reception - alcohol & cancer: a report from the Royal College of Physicians & the Alcohol Health Alliance UK

The current EU framework in the area of alcohol - the EU Strategy to support Member States in reducing alcohol related harm - came to an end in 2012 but Europe still remains the world heaviest drinker.


Thanh Nien Daily (Vietnam) - HCMC gov’t rejects police proposal to limit alcohol trade

The Ho Chi Minh City municipal administration has rejected a suggestion made by its police to place limits on the trade of alcoholic drinks after 10 p.m. as an attempt to reduce traffic accidents.


News-Medical.net - Baylor University study shows acute dose of alcohol may cause greater impairment in elderly

An acute dose of alcohol may cause greater impairment in coordination, learning and memory in the elderly than in young people, according to a study by Baylor University.


Guardian (Russia) - The Last Man in Russia, and the Struggle to Save a Dying Nation by Oliver Bullough – review

If Russia is dying, Bullough suggests one doesn't have to look far to find the cause. Russians are literally drinking themselves to death. If Bullough is right, then the staggering figure of Boris Yeltsin is a more accurate symbol for the nation that Putin's gung-ho, karate black-belt.


Haringey Independent (UK) - Annual Health Report ‘Is Haringey over the limit?’ sets out Haringey Borough Council plans to tackle alcohol

A senior doctor says harm from alcohol is one of the biggest challenges facing the borough. This year’s Annual Health Report, entitled ‘Is Haringey over the limit?’, sets out how Haringey Borough Council plans to tackle drink-related harm in the borough.


Legalbrief (South Africa) - Alcohol adverts Bill will curb misuse, says Minister

Anti-alcohol organisations argue Health Minister Aaron Motsoaledi's announcement that a Bill restricting alcohol advertising is likely to be presented to the Cabinet this week is a step in the right direction to curb alcohol misuse, says a report in The Mercury.


Stuff.co.nz (New Zealand) - Teens avoid harm from relaxed booze laws

Lowering the drinking age to 18 has not led to more binge-drinking or alcohol-related road accidents among young people, researchers have found.


Times of India - Reduced alcohol intake cuts dependency

A potential new treatment for alcoholism called nalmefene has been found to be effective and safe for reducing alcohol consumption in alcohol dependent individuals.

 
 
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Dr. Chan will protect alcohol policy from industry

 
In a comment to an article in the British Medical Journal on 11 April 2013, Dr. Chan stated that the WHO global alcohol strategy stipulates that “member states have a primary responsibility for formulating, implementing, monitoring and evaluating public policies to reduce the harmful use of alcohol. The development of alcohol policies is the sole prerogative of national authorities. In the view of WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.”  > > > >   Read More
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Underage drinking: Prevalence and risk factors associated with drinking experiences among Argentinean children




The aim of this study was to describe the prevalence and predictors of alcohol drinking behavior in children.

Data were obtained from 367 children, aged 8–12 years (M = 10.44 years, SD = 1.21 years; 61.9% female) from the city of Córdoba, Argentina. Several scales were used to assess risk factors, including personality traits, alcohol expectancy (i.e., beliefs about the consequences of using alcohol), and perceived peer alcohol use, for alcohol drinking and alcohol drinking experiences. Hierarchical regression analysis was used to determine the contribution of multiple risk factors to the quantity of alcohol consumed.

The results showed that 58% of the children had tasted alcohol, and approximately one-third drank alcohol again after the first drinking experience. Twelve-year-old children had a significantly higher prevalence of tasting and drinking alcohol and a significantly greater frequency and quantity of alcohol consumed than younger children. Eighty percent of the children who liked alcohol during their first drinking experience reported that they drank alcohol again. Among the children who did not like alcohol during their first drinking experience, only 31% drank alcohol again.

Underage drinking usually occurred under adult supervision in family settings when parents or other relatives allowed them to drink or were aware of their children's drinking.

The hierarchical regression analysis showed that being older and male, having more peers that drink alcohol, having higher levels of extroversion, and having alcohol expectancy for social facilitation increased the risk for greater alcohol use. The final model explained 33% of the total variance.


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Request Reprint E-Mail:   angepilatti@gmail.com
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Beer Flavor Provokes Striatal Dopamine Release in Male Drinkers: Mediation by Family History of Alcoholism




Striatal dopamine (DA) is increased by virtually all drugs of abuse, including alcohol. However, drug-associated cues are also known to provoke striatal DA transmission- a phenomenon linked to the motivated behaviors associated with addiction. To our knowledge, no one has tested if alcohol’s classically-conditioned flavor cues, in the absence of a significant pharmacologic effect, are capable of eliciting striatal dopamine release in humans.
Employing positron emission tomography (PET), we hypothesized that beer’s flavor alone can reduce the binding potential of [11C]raclopride (a reflection of striatal DA release) in the ventral striatum, relative to an appetitive flavor control.

Forty-nine men, ranging from social to heavy drinking, mean age 25, with a varied family history of alcoholism underwent two [11C]raclopride PET scans: one while tasting beer, and one while tasting Gatorade®.

Relative to the control flavor of Gatorade, beer flavor significantly increased self-reported desire to drink, and reduced [11C]raclopride binding potential, indicating that the alcohol-associated flavor cues induced dopamine release.

Binding potential reductions were strongest in subjects with first-degree alcoholic relatives. These results demonstrate that alcohol-conditioned flavor cues can provoke ventral striatal dopamine release absent significant pharmacologic effects, and that the response is strongest in subjects with a greater genetic risk for alcoholism.

Striatal DA responses to salient alcohol cues may thus be an inherited risk factor for alcoholism.


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Request Reprint E-Mail:   dkareken@iupui.edu.
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Latest Findings alcohol bulletins: Public Health framework reviewed; alcohol counsellor skills; text advice can work & more







Recent bulletins from the Drug and Alcohol Findings, supporting evidence-based responses to substance misuse drug and alcohol bank:
Public health objectives for England including drugs and alcohol

Sets out the structure and objectives of the public health system for England effective from April 2013 and how progress against these objectives will be measured, including addiction treatment completions, alcohol-related hospital admissions, and prisoners identified as needing treatment for alcohol/drug problems.
Seminal studies of the impact of alcohol counsellor skills and support
In the alcohol treatment world, arguably studies don’t get more important than these landmarks in the relatively scarce literature about what makes some alcohol counsellors, therapists and treatment services more effective than others

'Treatment-resistant' skid-row alcoholics react to organised empathy
Later to become founding director of the US National Institute on Alcohol Abuse and Alcoholism, in the late 1950s Dr Morris Chafetz of Massachusetts General Hospital conducted a remarkable series of studies which proved that an alcohol clinic's intake and performance can be transformed by the simple application of empathy and organisation.

Post-emergency visit text message advice moderates drinking
For the first time this US study tried mobile phone text messaging as a way to monitor and moderate the hazardous drinking of young adults screened at emergency departments. Compared to merely monitoring, text-based advice did cut drinking – but why did monitoring-only patients actually start to drink more?

Nurse-led hepatitis education cost-effective way to curb drinking in methadone patients
At Californian methadone clinics, group education sessions led by a nurse and focused on the risks of aggravating hepatitis infection led to the same substantial reductions in drinking as one-to-one or group motivational interviewing conducted by highly trained counsellors, offering a cost-effective means to reduce alcohol-related risks.
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Commentary on Maclennan et al. (2013): Evolution of local alcohol policy research. What's next?


Alcohol control advocates, policymakers and researchers in several countries have discovered—or, perhaps, rediscovered—local policy. For example, in the United States, the Community Preventive Services Task Force’s Guide to Community Preventive Services (the ‘Community Guide’) recommends a number of interventions that, in at least some jurisdictions, can be put into place by enacting—or preventing the reversal of—local policy.
These include maintaining limits on days and hours of sale, regulation of alcohol outlet density and preventing privatization of retail alcohol sales [1]. Other local policies, such as social host ordinances, have diffused widely in the United States, although there is not yet a scientific evidence base supporting their effectiveness [2]. Maclennan and colleagues offer an important contribution towards establishing a better understanding of local
alcohol policy development by presenting case studies from the experiences in three New Zealand communities [3].   > > > >   Read More


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Vested Interests in Addiction Research and Policy. Alliance between tobacco and alcohol industries to shape public policy



 

The tobacco and alcohol industries share common policy goals when facing regulation, opposing policies such as tax increases and advertising restrictions. The collaboration between these two industries in the tobacco policy arena is unknown. This study explored if tobacco and alcohol companies built alliances to influence tobacco legislation and, if so, how those alliances worked.
 
Analysis of previously secret tobacco industry documents.
 
In the early 1980s, tobacco companies started efforts to build coalitions with alcohol and other industries to oppose cigarette excise taxes, clean indoor air policies and tobacco advertising and promotion constraints. Alcohol companies were often identified as a key partner and source of financial support for the coalitions. These coalitions had variable success interfering with tobacco control policy-making.
 
The combined resources of tobacco and alcohol companies may have affected tobacco control legislation. These alliances helped to create the perception that there is a broader base of opposition to tobacco control. Advocates should be aware of the covert alliances between tobacco, alcohol and other industries and expose them to correct this misperception.


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Request Reprint E-Mail:    pling@medicine.ucsf.edu
 
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Population-Based Input Function Modeling for [(18)F]FMPEP-d 2, an Inverse Agonist Radioligand for Cannabinoid CB1 Receptors: Validation in Clinical Studies.


Population-based input function (PBIF) may be a valid alternative to full blood sampling for quantitative PET imaging. PBIF is typically validated by comparing its quantification results with those obtained via arterial sampling. However, for PBIF to be employed in actual clinical research studies, its ability to faithfully capture the whole spectrum of results must be assessed. The present study validated a PBIF for [18F]FMPEP-d2, a cannabinoid CB1 receptor radioligand, in healthy volunteers, and also attempted to utilize PBIF to replicate three previously published clinical studies in which the input function was acquired with arterial sampling.

The PBIF was first created and validated with data from 42 healthy volunteers. This PBIF was used to assess the retest variability of [18F]FMPEP-d2, and then to quantify CB1 receptors in alcoholic patients (n = 18) and chronic daily cannabis smokers (n = 29). Both groups were scanned at baseline and after 2–4 weeks of monitored drug abstinence.

PBIF yielded accurate results in the 42 healthy subjects (average Logan-distribution volume (VT) was 13.3±3.8 mL/cm3 for full sampling and 13.2±3.8 mL/cm3 for PBIF; R2 = 0.8765,)  and test-retest results were comparable to those obtained with full sampling (variability: 16%; intraclass correlation coefficient: 0.89). PBIF accurately replicated the alcoholism study, showing a widespread ~20% reduction of CB1 receptors in alcoholic subjects, without significant change after abstinence. However, a small PBIF-VT bias of −9% was unexpectedly observed in cannabis smokers. This bias led to substantial errors, including a VT decrease in regions that had shown no downregulation in the full input function. Simulated data showed that the original findings could only have been replicated with a PBIF bias between −6% and +4%.

Despite being initially well validated in healthy subjects, PBIF may misrepresent clinical protocol results and be a source of variability between different studies and institutions.


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Long lasting alterations to DNA methylation and ncRNAs may underlie the effects of fetal alcohol exposure


Fetal Alcohol Spectrum Disorders (FASD) are characterized by life long changes in gene expression, neurodevelopment, and behavior. What mechanisms initiate and maintain these changes are not known, but current research suggests a role for alcohol induced epigenetic changes.

In this report we assessed alterations to adult mouse brain tissue by assaying DNA cytosine methylation and small noncoding RNA (ncRNA) expression, specifically the microRNA (miRNA) and small nucleolar RNA (snoRNA) subtypes.

We found long lasting alterations in DNA methylation as a result of fetal alcohol exposure, specifically in the imprinted regions of the genome harboring ncRNAs and sequences interacting with regulatory proteins. A large number of major nodes from the identified networks, such as Pten signaling, contained CTCF binding sites in their promoters, illustrating the functional consequences of alcohol induced changes to DNA methylation.

Next, we assessed ncRNA expression using two independent array platforms and qPCR. The results identified 34 genes that are targeted by the deregulated miRNAs. Of these, four (Pten, Nmnat1, Slitrk2, and Otx2) were viewed critical in the context of FASD given their roles in the brain.

Furthermore, ~20% of the altered ncRNAs mapped to three imprinted regions: Snrpn-Ube3a, Dlk1-Dio3, and Sfmbt2, which showed differential methylation and have been previously implicated in neurodevelopmental disorders.

The findings of this report help to expand on the mechanisms behind the long lasting changes in the brain transcriptome of FASD individuals. The observed changes may contribute to the initiation and maintenance of the long lasting effect of alcohol.


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Medicaid care management: Description of high-cost addictions treatment clients




High utilizers of alcohol and other drug treatment (AODTx) services are a priority for healthcare cost control.

We examine characteristics of Medicaid-funded AODTx clients, comparing three groups: individuals < 90th percentile of AODTx expenditures (n = 41,054); high-cost clients in the top decile of AODTx expenditures (HC; n = 5,718); and 1760 enrollees in a chronic care management (CM) program for HC clients implemented in 22 counties in New York State. Medicaid and state AODTx registry databases were combined to draw demographic, clinical, social needs and treatment history data.

HC clients accounted for 49% of AODTx costs funded by Medicaid. As expected, HC clients had significant social welfare needs, comorbid medical and psychiatric conditions, and use of inpatient services. The CM program was successful in enrolling some high-needs, high-cost clients but faced barriers to reaching the most costly and disengaged individuals.


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Request Reprint E-Mail:    cneighbors@casacolumbia.org
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Sunday, April 14, 2013

FASD News - 14/2013

 
 
 
NEWS and ARTICLES

CBC Toronto (Canada) - Alcohol And Pregnancy

Matt Galloway spoke about an ad campaign on downtown streets, with Gal Koren. He is the president of FASworld Toronto . The ad campaign is spreading awareness of Fetal Alcohol Spectrum Disorder.


Standard Digital (Kenya) - Pregnancy and alcohol don’t mix

Have you ever seen a pregnant woman drinking a certain brand of alcohol. Not in the hidden but openly? I have. And the person who was proudly refilling her glass was her husband.


Nanaimo Daily News (Canada) - Signs warn of risk in mixing booze, pregnancy

Nanaimo's liquor-service sector will soon be required to warn patrons about the dangers of mixing alcohol with pregnancy. Nanaimo city council is set to approve a new bylaw mandating liquor-licensed establishments to post warning signs about drinking while pregnant. Restaurants, pubs and liquor stores will have until January to put up the new signage or owners could the risk of facing a $100 fine.


Brandon Sun (USA) - Campaign targets drinking, pregnancy

THE North Point Douglas Women's Centre is trying to get the message out to expectant mothers about the dangers of FASD, one poster at a time.


Adelaide Now (Australia) - Foetal alcohol syndrome linked to binge drinking by mums

YOUNG women who binge drink while pregnant are producing a new wave of school children with learning difficulties, experts say.


Deccan Chronicle (India) - Booze turns A womb killer

Here is a case which should make parents who consume alcohol unmindful of the effects it would have on their yet to be born progeny sit up and take note. Fetal Alcohol Syndrome is not something to be taken casually, say docs.


West Virginia Public Broadcasting (USA) - Substance Abuse Prevention Partnership focuses on addicted babies

The Cabell County Substance Abuse Partnership hosted its seventh annual summit recently as it educates the public on the growing issues of substance abuse in pregnant moms.


CBC.ca (Canada) - Peer support reinforces breast-feeding benefits

While the percentage of women breastfeeding their babies continues to increase across the country, a Lakehead University researcher says that's not the case with Aboriginal women.


Oregon.gov (USA) - Alcohol Use by Pregnant Women

Fetal alcohol syndrome usually results from alcohol exposure at 3-8 weeks gestation. Because of this many women may be drinking while they are unaware that they are pregnant. As a result, reported alcohol use just before pregnancy may be the most accurate measure of use in early pregnancy.




UPCOMING EVENTS

First International Conference on Prevention of FASD - September 23 - 25, 2013

This is the first international conference to address the primary, secondary and tertiary prevention of FASD.


FASD: Best Practices in the Last Frontier – May 22-24 2013

The Arctic FASD Regional Training Center and the UAA Center for Behavioral Health Research and Services invites you to attend the 2013 conference on FASDs – FASD: Best Practices in the Last Frontier.




MATERIALS and VIDEOS

Human Relations Media - DRUGS, ALCOHOL & PREGNANCY

One out of ten babies in the U.S. has been exposed to drugs like cocaine and alcohol in the womb. The results are often tragic: undersized, unresponsive babies with nerve damage, seizures, deformities, impaired motor skills and (as they grow older) behavior and learning disabilities.


VancouverSunOnline - What are the Effects of Alcohol on Pregnancy?

Alcohol is a toxin and its effects on your baby if you drink to excess are well documented. Dr. Karen Buhler, family physician, discusses the effects of alcohol on pregnancy.


docstoc - Read the history of FASD - Alcohol and Pregnancy and Fetal


Gov.ma – Girls, Women and Alcohol: Making informed Choices

This resource was written by women for women to give you useful information about alcohol and help you make healthy and well-informed choices about your alcohol use. It is not designed to make women stop drinking alcohol.


New website – KnowFASD


SAMSHA - Addressing Fetal Alcohol Spectrum Disorders (FASD) In Women’s Residential Substance Abuse Treatment


SAMSHA - Integrating Sustainable Fetal Alcohol Spectrum Disorders (FASD) Services in Your Existing Service Setting




RESEARCH

PLOS - Cost of Fetal Alcohol Spectrum Disorder Diagnosis in Canada

As a result of using the most conservative approach, the cost of FASD diagnostic services presented in the current study is most likely underestimated. The reasons for this likelihood and the limitations of the study are discussed.


PubMed - Alcohol use in pregnancy: insights in screening and intervention for the clinician

Alcohol consumption during pregnancy remains a common occurrence and is associated with a multitude of adverse birth and long-term outcomes. Binge drinking in particular is shown to be particularly harmful to the developing fetus. Effects include full fetal alcohol syndrome, with characteristic facial dysmorphology, growth restriction, and developmental to delays.


Alcoholism - Diffusion Tensor Imaging Correlates of Saccadic Reaction Time in Children with Fetal Alcohol Spectrum Disorder

Eye movement tasks provide a simple method for inferring structural or functional brain deficits in neurodevelopmental disorders. Oculomotor control is impaired in children with fetal alcohol spectrum disorder (FASD), yet the neuroanatomical substrates underlying this are not known.


Alcoholism - Comments and Reflections on Ethics in Screening for Biomarkers of Prenatal Alcohol Exposure

Early identification of and intervention for fetal alcohol spectrum disorder (FASD) has been shown to optimize outcomes for affected individuals. Detecting biomarkers of prenatal alcohol exposure (PAE) in neonates may assist in the identification of children at risk of FASD enabling targeted early interventions.


PNAS - Understanding variability in ethanol teratogenicity

Ethanol is the most widely used psychoactive drug and, when used inappropriately, can have deleterious effects. The developing fetus is particularly sensitive to the deleterious effects of ethanol.




IN OTHER LANGUAGES

Tribuna (Romania) - Consecinţele consumului de droguri asupra fătului şi nou–născutului

Abuzul de droguri reprezintă o problemă de sănătate publică şi nu una legală şi este, în conformitate cu afirmaţiile American Committee of Obstetrics and Gynaecology (ACOG, 1984) unul din riscurile majore ale obstetricii contemporane atât pentru mamă cât şi pentru făt.

 
 
 
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Modafinil Modulates Resting-State Functional Network Connectivity and Cognitive Control in Alcohol-Dependent Patients


Chronic alcohol abuse is associated with deficits in cognitive control functions. Cognitive control is likely to be mediated through the interaction between intrinsic large-scale brain networks involved in externally oriented executive functioning and internally focused thought processing. Improving the interaction between these functional brain networks could be an important target for treatment.

Therefore, the current study aimed to investigate the effects of the cognitive enhancer modafinil on within-network and between-network resting-state functional connectivity and cognitive control functions in alcohol-dependent patients.

In a double-blind, placebo-controlled cross-over design, resting-state functional magnetic resonance imaging and a Stroop task were employed in alcohol-dependent patients (n = 15) and healthy control subjects (n = 16). Within-network and between-network functional connectivity was calculated using a combination of independent component analysis and functional network connectivity analysis.

Modafinil significantly increased the negative coupling between executive networks and the default mode network, which was associated with modafinil-induced improvement in cognitive control in alcohol-dependent patients.

These findings demonstrate that modafinil at least partly exerts its effects by targeting intrinsic functional relationships between large-scale brain systems underlying cognitive control. The current study therefore provides a neurobiological rationale for implementing modafinil as an adjunct in the treatment of alcohol dependence, although clinical studies are needed to substantiate this promise.


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Request Reprint E-Mail:  lianschmaal@gmail.com
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Saturday, April 13, 2013

This is the Southern African Alcohol Policy Alliance


In November 2012, delegates from civil society organisations working in various capacities on alcohol met in Johannesburg to build a platform for collaboration on alcohol-related issues. The delegates represented civil society organizations from seven countries in the region, as well as NGOs from Kenya, Sierra Leone, Sweden and Norway.

The Forum allowed delegates to exchange experiences from policy and prevention work and to discuss a closer regional collaboration. These discussions led to the formation of the Southern African Alcohol Policy Alliance, which is affiliated to the Global Alcohol Policy Alliance (GAPA).    > > > >  Read More
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Interoceptive Awareness, Tension Reduction Expectancies and Self-Reported Drinking Behavior




Recent accounts have suggested the involvement of interoceptive processes in consumption behavior for alcohol and other drugs. However, there is a paucity of empirical support for a direct association with physiologically assessed individual differences in interoceptive awareness (IA). The current research explored this postulated link and examined the interplay with positive outcome expectancies of alcohol consumption.

IA of alcohol-dependent adult in- and outpatients was measured with an objective electrocardiogram heart rate tracking task. Tension reduction expectancies (TRE) and drinking compulsions/obsessions were assessed with self-report questionnaires.

No direct associations of IA with drinking compulsions/obsessions were found. However, IA and TRE interacted as predictors of drinking compulsions and drinking obsessions.

The results corroborate the suggestion that neglect of bodily feedback might be a maintaining factor for drinking behavior.          



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Request Reprint E-Mail:   afschmidt@uni-bonn.de    
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Editorial - What neuroimaging has and has not yet added to our

 



 

Neuroscientists have collected valuable information on neurofunctional and neurostructural characteristics accompanying addiction. This editorial argues for three
prerequisites to making neuroimaging practically relevant for addiction medicine: the integration of imaging findings, the identification of concrete neuroimaging risk factors for the individual and the ability to inform the development of treatment regimens.


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Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high range alcohol concentrations




To characterise sudden or unnatural deaths with very high range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1/1/1997-31/12/2011.
 
Case series.
 
Sydney, Australia.
 
263 cases of sudden or unnatural death with a BAC of ≥0.300g/100ml.
 
Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology.
 
The mean age of decedents was 46.7 yrs and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (34.6%), combined alcohol/other drug toxicity (14.8%), accidents (18.7%), natural disease (13.4%), suicide (11.0%), homicide (6.9%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371g/100ml (range 0.300-0.820g/100ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410g/100ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%), cerebellar atrophy (9.0%).
 
Unnatural deaths with very high range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle aged males, with long histories of alcohol problems.


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Request Reprint E-Mail:  s.darke@unsw.edu.au
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Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and its implication in executive functions in adult offspring of alcohol-dependent probands




Impairment of executive functions (EFs) mediated by the prefrontal lobe is regarded as a cognitive endophenotype of alcohol dependence, being observed both in probands and in healthy offspring. Given its impact on the anatomy of the prefrontal cortex, the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism may well be involved in this specific endophenotype.

Forty-six healthy adult children of alcoholics (HACA) and 82 healthy controls (HC) took part in the study. All the participants were assessed with the Diagnostic Interview for Genetic Studies, and their family histories of alcohol and substance use were assessed with the Family Informant Schedule and Criteria. The Trail Making Test, Arithmetic Switching Task, Stroop Color-Word Test and Wisconsin Card Sorting Test were administered to assess EFs. An overall executive factor score was calculated using factorial analyses. Genotyping of the BDNF Val66Met polymorphism was performed using the TaqMan® allelic discrimination assay.

HACA had significantly lower EFs performance than HC. Genetic analysis showed that BDNF genotype distributions were in Hardy–Weinberg equilibrium in the HACA and HC. Genotype and allele distributions did not differ significantly between the two groups. Participants with the Met allele performed significantly more poorly than participants with the Val allele, and a group by allele interaction was observed, the BDNF Met allele being associated with a poorer executive factor score in the HACA group.

These results suggest that the BDNF Val66Met polymorphism may contribute to alcohol dependence vulnerability via lower EFs performance.


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Request Reprint E-Mail:  fbenzerouk@chu-reims.fr
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Extending the Treatment Options in Alcohol Dependence: A Randomized Controlled Study of As-Needed Nalmefene



There is a large treatment gap in alcohol dependence, and current treatments are only moderately effective in preventing relapse. New treatment modalities, allowing for reduction of alcohol consumption as a treatment goal are needed. This study evaluated the efficacy of as-needed use of the opioid system modulator nalmefene in reducing alcohol consumption in patients with alcohol dependence.

Six hundred and four patients (placebo = 298; nalmefene = 306),≥18 years of age, with a diagnosis of alcohol dependence,≥6 heavy drinking days, and average alcohol consumption≥World Health Organization medium drinking risk level in the 4 weeks preceding screening, were randomized (1:1) to 24 weeks of as-needed placebo or nalmefene 18 mg.

Patients taking placebo (n = 289) and patients taking nalmefene (n = 290) were included in the efficacy analyses. At Month 6, there was a significant effect of nalmefene compared with placebo in reducing the number of heavy drinking days (−2.3 days [95% confidence interval:−3.8 to−.8]; p = .0021) and total alcohol consumption (−11.0 g/day [95% confidence interval:−16.8 to−5.1]; p = .0003). Improvements in Clinical Global Impression and liver enzymes were larger in the nalmefene group compared with placebo at Week 24. Adverse events (most mild or moderate) and dropouts due to adverse events were more common with nalmefene than placebo. The number of patients with serious adverse events was similar in the two groups.

Nalmefene provides clinical benefit, constitutes a potential new pharmacological treatment paradigm in terms of the treatment goal and dosing regimen, and provides a method to address the unmet medical need in patients with alcohol dependence that need to reduce their alcohol consumption.


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Request Reprint E-Mail:     karl.mann@zi-mannheim.de
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Friday, April 12, 2013

Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets


Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets — the number of physical locations in which alcoholic beverages are available for purchase either per area or per population — through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms.

We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska.
Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems.


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