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, July 22, 2013

Latest Findings alcohol bulletins: naltrexone finds favour for treatment; acamprosate as effective for womean; engaging in treatment; street drinkings 'bans' reviewed




Recent bulletins from the Drug and Alcohol Findings, supporting evidence-based responses to substance misuse drug and alcohol bank:

Largest US study yet favours naltrexone as alcoholism medication
Reanalyses of major US study confirmed that either naltrexone or psychological therapy improved outcomes more than medical care and placebos, while the two in combination or acamprosate added little. They also revealed previously invisible benefits when certain types of patients received certain treatments – and some hidden negatives, including a suggestion that acamprosate is counterproductive for the most needy but also most motivated alcoholics.

Acamprosate as effective for alcohol-dependent women as for men
First comprehensive analysis of whether acamprosate treatment works as well for alcohol-dependent women as for men definitively concludes that across 22 mainly European trials it had a virtually identical impact. The analysis also offers an updated and extended assessment of the drug's overall impact, finding that it helps prevent heavy drinking as well as fostering abstinence.
Clinicians can learn how to help alcohol patients stay in treatment and take medication
Getting patients to take their medication is a major issue across medicine. This US alcohol treatment study enhanced compliance with treatment through a novel and manageable approach combining brief motivational interviewing with structured clinical counselling involving feedback on the patient's real-time pill-taking record.

Winners and losers from street drinking bans
So-called 'alcohol-free zones' have proliferated across the UK, preventing an individual drinking in public if police believe their drinking is causing a problem. This review finds such measures do reassure communities, but at the expense of further marginalising street drinkers.
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Efficacy of As-Needed Nalmefene in Alcohol-Dependent Patients with at Least a High Drinking Risk Level: Results from a Subgroup Analysis of Two Randomized Controlled 6-Month Studies

 


The aim of the study was to investigate the efficacy and safety of as-needed use of nalmefene 18 mg versus placebo in reducing alcohol consumption in patients who did not reduce their alcohol consumption after an initial assessment, i.e. the pooled subgroup of patients with at least a high drinking risk level (men: >60 g/day; women: >40 g/day) at both screening and randomization from the two randomized controlled 6-month studies ESENSE 1 (NCT00811720) and ESENSE 2 (NCT00812461).

 Nalmefene 18 mg and placebo were taken on an as-needed basis. All the patients also received a motivational and adherence-enhancing intervention (BRENDA). The co-primary outcomes were number of heavy drinking days (HDDs) and mean total alcohol consumption (g/day) in Month 6 measured using the Timeline Follow-back method. Additionally, data on clinical improvement, liver function and safety were collected throughout the study.

The pooled population consisted of 667 patients: placebo n = 332; nalmefene n = 335. There was a superior effect of nalmefene compared with placebo in reducing the number of HDDs [treatment difference: −3.2 days (95% CI: −4.8; −1.6); P < 0.0001] and total alcohol consumption [treatment difference: −14.3 g/day (−20.8; −7.8); P < 0.0001] at Month 6. Improvements in clinical status and liver parameters were greater in the nalmefene group compared with the placebo group. Adverse events and adverse events leading to dropout were more common with nalmefene than placebo.

As-needed nalmefene was efficacious in reducing alcohol consumption in patients with at least a high drinking risk level at both screening and randomization, and the effect in this subgroup was larger than in the total population.


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Discriminant Profile of Young Adulthood Driving Behavior among Brazilian Drivers.Discriminant Profile of Young Adulthood Driving Behavior among Brazilian Drivers.


The aim of this article was to describe the driving behavior profile of drivers aged 18 to 25 years old.

Four hundred young adults were interviewed, 320 (80%) of them male and 80 (20%) female.

Cluster analysis identified a group characterized by sensation-seeking behavior (Cluster 1), a group that did not show any risky driving behavior (Cluster 2), and a group engaged in transgressive behavior and driving under the influence of alcohol and/or drugs (Cluster 3).

Discriminant analysis classified successfully and correctly 81.3% of the young adults into their original profiles. Function 1 distinguished cluster 1 from clusters 2 and 3, on the basis of the following factors: higher frequency of alcohol consumption, intrusive behavior, and motorcycle riding, as well as younger age, more aggressive behavior, and lower education level. Function 2 distinguished cluster 3 from cluster 1 and 2, especially as to higher amounts of alcohol consumption, higher frequency of marijuana use and delinquent behavior, larger number of traffic tickets and motor vehicle accidents, higher paternal education level, which were the variables with discriminant values above .20.

Characteristics of vulnerability were identified, especially those related to alcohol consumption, drug use, and externalizing issues.



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GENDER DIFFERENCES IN ALCOHOL DEMAND: A SYSTEMATIC REVIEW OF THE ROLE OF PRICES AND TAXES



Gender differences in drinking patterns are potentially important for public policies, especially policies that rely extensively on higher alcohol taxes and prices.

This paper presents a systematic review of alcohol prices and gender differences in drinking and heavy drinking by adults and young adults.

Starting with a database of 578 studies of alcohol demand and other outcomes, 15 studies are reviewed of adult drinking including discussion of samples, measurement issues, econometric models, special variables, and key empirical results. A similar discussion is presented for eight studies of drinking by young adults, ages 18–26 years.

Four conclusions are obtained from the review. First, adult men have less elastic demands compared with women. Second, there is little or no price response by heavy-drinking adults, regardless of gender. Third, although the sample is small, price might be important for drinking participation by young adults. Fourth, the results strongly suggest that heavy drinking by young adults, regardless of gender, is not easily dissuaded by higher prices.

Policy implications, primary study limitations, and suggestions for future research are discussed. 



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Alcohol dependence and health care utilization in African Americans.


Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non-alcohol-dependent African Americans.

A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non-alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. Xl Test and analysis of variance were used to analyze the data.

Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p<.001), loss of consciousness (p=.001), and sexually transmitted diseases: (p<.001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p<.001).

This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups.


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Trace amine associated receptor 1 modulates behavioral effects of ethanol.





Few treatment options for alcohol use disorders (AUDs) exist and more are critically needed. Here, we assessed whether trace amine associated receptor 1 (TAAR1), a modulator of brain monoamine systems, is involved in the behavioral and reinforcement-related effects of ethanol and whether it could potentially serve as a therapeutic target.

Wild-type (WT) and TAAR1 knockout (KO) mice (75% C57J/BL6 and 25% 129S1/Sv background) were compared in tests of ethanol consumption (two-bottle choice [TBC]), motor impairment (loss of righting reflex, [LORR], locomotor activity) and ethanol clearance (blood ethanol level [BEL]).

As compared with WT mice, KO mice displayed (1) significantly greater preference for and consumption of ethanol in a TBC paradigm (3%–11% vol/vol escalating over 10 weeks), with no significant difference observed in TBC with sucrose (1%–3%); (2) significantly greater sedative-like effects of acute ethanol (2.0 or 2.5 g/kg, intraperitoneal [i.p.]) manifested as LORR observed at a lower dose and for longer time, with similar BELs and rates of ethanol clearance; and (3) lower cumulative locomotor activity over 60 minutes in response to an acute ethanol challenge (1.0–2.5 g/kg, i.p.).

The present findings are the first to implicate TAAR1 in the behavioral and reinforcement-related effects of ethanol and raise the question of whether specific drugs that target TAAR1 could potentially reduce alcohol consumption in humans with AUDs.



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Characterization of Suicidal Behaviour with Self-Organizing Maps




The study of the variables involved in suicidal behavior is important from a social, medical, and economical point of view. Given the high number of potential variables of interest, a large population of subjects must be analysed in order to get conclusive results.

In this paper, we describe a method based on self-organizing maps (SOMs) for finding the most relevant variables even when their relation to suicidal behavior is strongly nonlinear. We have applied the method to a cohort with more than 8,000 subjects and 600 variables and discovered four groups of variables involved in suicidal behavior.

According to the results, there are four main groups of risk factors that characterize the population of suicide attempters: mental disorders, alcoholism, impulsivity, and childhood abuse.

The identification of specific subpopulations of suicide attempters is consistent with current medical knowledge and may provide a new avenue of research to improve the management of suicidal cases.


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Sunday, July 21, 2013

FASD News - 28/2013

 
 
 
 
 
 
 
NEWS and ARTICLES
Scotsman (Scotland) - Pregnant women quizzed on alcohol intake
Thousands of pregnant women have been quizzed about their drinking habits amid concerns about the effects of alcohol on their health and their babies, figures reveal.
Science World Report - Maternal Alcohol Consumption During Pregnancy Affects Learning and Memory Function in Offspring
A latest study highlights the association between maternal alcohol consumption during pregnancy and its effect on the learning and memory function of the infant.
HealthCanal.com - Pre-pregnancy alcohol consumption affects alcohol use among pregnant women, suggests new study
Most women who consume alcohol pre-pregnancy will continue to consume alcohol throughout their pregnancy even when healthcare guidelines promote abstinence, suggests a new study published today in BJOG: An International Journal of Obstetrics and Gynaecology.
WebMD.Boots.com - Regular drinkers 'more likely to continue when pregnant'
Women who drink alcohol each week before conceiving are 50% more likely to carry on drinking when pregnant, according to a study.
Stroud News and Journal (UK) - No change in advice to avoid alcohol in pregnancy say midwives
RESPONDING to research to be published tomorrow, in BJOG on pre-pregnancy alcohol consumption among pregnant women, Janet Fyle, professional policy advisor at the Royal College of Midwives, said: “This is very useful research that supports our advice to women about alcohol and pregnancy.
Medical Xpress - Study explores fetal alcohol impact at molecular level
While some physicians tell women a small amount of alcohol is OK during pregnancy, Ben Laufer vehemently disputes any such advice – and he has the research to back it up.
American Academy of Pediatrics - Joint Call to Action on Alcohol and Pregnancy
Through its cooperative agreement with the Centers for Disease Control and Prevention (CDC) National Center on Birth Defects and Developmental Disabilities (NCBDDD) the AAP Division of Children with Special Needs Fetal Alcohol Spectrum Disorders (FASD) program staff convened an FASD Risk Communication Workshop from July 30–31, 2012.
Chicago Tribune (USA) - Raising a child with profound birth defect
Sometimes, the best expert isn't someone with a long list of credentials, but a parent, especially when the child has a disability. The relentless demands of caring for a child with profound birth defects is its own graduate school and can rarely be described to someone who hasn't "been there."

MATERIALS and VIDEOS
The Knowledge Network (Scotland) - NHS' first on-line course/resource on fetal alcohol harm
The resource has been developed to support a range of activity led by the Scottish Government to substantially reduce the harm caused by alcohol consumption in pregnancy across Scotland.
Atlantic Intergovernmental Fetal Alcohol Spectrum Disorder (FASD) Partnership Update
Women and Alcohol in the EU
The European Institute of Women’s Health has published a new policy brief called “Women and Alcohol in the EU.”
THE CULTURAL POLITICS OF FETAL ALCOHOL SPECTRUM DISORDERS AND THE DIAGNOSIS OF DIFFERENCE
This dissertation is based on an ethnographic study of Fetal Alcohol Spectrum Disorders (FASD) and the racial, cultural and political considerations that shape the meaning of diagnosis for Alaska Native individuals and families in Anchorage, Alaska.
Variety Charity - Variety - the Children's Charity & Kimberley Diamond Company - supporting the Marulu Strategy

RESEARCH
Pediatrics - Prenatal Alcohol Exposure and Educational Achievement in Children Aged 8–9 Years
This study examines the relationships between the dose, pattern, and timing of prenatal alcohol exposure and achievement in reading, writing, spelling, and numeracy in children aged 8 to 9 years.

IN OTHER LANGUAGES
Luxemburger Wort (Luxembourg) - Null Prozent Alkohol während der Schwangerschaft oder der Stillzeit
Ständig warnen Mediziner und Wissenschaftler vor den Gefahren von Alkoholkonsum während der Schwangerschaft oder nach der Geburt. Der Genuss kann zu fetalen Alkoholspektrumstörungen (FASD) mit körperlichen Missbildungen, Gehirnschäden oder geistigen Behinderungen führen.
 
 
 
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Committee on National Alcohol Policy and Action

 
 
 
 
11th meeting of the Committee on National Alcohol Policy and Action
Luxembourg, 22 May 2013
 
Presentations
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The Change Questionnaire predicts change in hazardous tobacco and alcohol use

Assessing motivation for change is deemed an important step in the treatment process that allows further refinement of the intervention in motivational interviewing (MI) and brief MI adaptations (BMI). During MI (and BMI) sessions, motivation for change is expressed by the client as “change talk”, i.e. all statements inclined toward or away from change. We tested the predictive validity of the Change Questionnaire, a 12-item instrument assessing motivation to change, on hazardous tobacco and alcohol use.

As part of the baseline measurements for a randomized controlled trial on multi-substance BMI at Lausanne recruitment center (army conscription is mandatory in Switzerland for males at age 20, and thus provides a unique opportunity to address a non-clinical and largely representative sample of young men), 213 participants completed the questionnaire on tobacco and 95 on alcohol and were followed-up six months later. The overall Change Questionnaire score and its six sub-scales (Desire, Ability, Reasons, Need, Commitment, and Taking steps) were used as predictors of hazardous tobacco use (defined as daily smoking) and hazardous alcohol use (defined as more than one occasion with six standard drinks or more per month, and/or more than 21 standard drinks per week) in bivariate logistic regression models at follow-up.

 

Higher overall change scores were significant predictors of decreased risk for hazardous tobacco (odds ratio [OR]=0.83, p=0.046) and alcohol (OR=0.76, p=0.03) use. Several sub-dimensions were associated with the outcomes in bivariate analyses. Using a principal components analysis to reduce the number of predictors for multivariate models, we obtained two components. ‘Ability to change’ was strongly related to change in hazardous tobacco use, the second we interpreted as ‘Other change language dimensions’ and which was significantly related to change in hazardous alcohol use .

 

The present findings lend initial support for the predictive validity of the Change Questionnaire on hazardous tobacco and alcohol use, making it an interesting and potentially useful tool for assessing motivation to change among young males.



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