An Open Trial of Gabapentin in Acute Alcohol Withdrawal Using an Oral Loading Protocol

Anticonvulsants are increasingly being advocated for the treatment of acute alcohol withdrawal syndrome (AWS) to avoid the addictive properties of established medications.

Because earlier works showed that moderate gabapentin doses were too low to clearly ameliorate severe AWS, we tested a higher gabapentin entry dose.

Twenty-seven (73%) were early responders (baseline CIWA-AR improved from 17.3 ± 2.6 to 8.0 ± 3.6 points). In the remaining 10 patients, baseline CIWA-AR deteriorated within 2 h (from 20.1 ± 4.6 to 21.5 ± 4.65 points). These patients were switched to clomethiazole (n = 4) or clonazepam (n = 6), which is the usual treatment. Three of the ‘early responders’ worsened in the next 36 h and were then reclassified and treated as ‘non-responders’. Among them, two developed an epileptic seizure.

Oral 800 mg gabapentin (loaded up to 3200 mg in the first 24 h) is helpful only in reducing less severe and less complicated acute AWS.

Read Full Abstract

Request Reprint E-Mail: udo.bonnet@lvr.de
_______________________________________

Prevalence and Determinants of Binge Drinking in Middle Age in a Transitional Post-communist Country: A Population-based Study in Tirana, Albania

To assess the prevalence and determinants of binge drinking in the middle-age population of transitional post-communist Albania, for which data were previously unavailable.

Age-standardized to the 2005 census, 9.2% and 10.3% of men reported two to three or more annual episodes of drunkenness and hangovers, respectively. In women, the prevalence of both these markers of binging was 1.4% . Among men, 8.9% ( reported drinking 60 g alcohol per session. In multivariable-adjusted models in men, binge drinking was related to low educational level, financial loss in the pyramid collapse and religiosity (inversely) in both Muslims and Christians

Among men in this transitional Southeast European country, social disadvantage and financial stress appear to promote alcohol abuse (which is rare in women), and traditionalism may be protective.

Read Full Abstract

Request Reprint E-Mail: Genc.Burazeri@INTHEALTH.unimaas.nl
_______________________________________

Direct and Mediational Links Between Parental Bonds and Neglect, Antisocial Personality, Reasons for Drinking, Alcohol Use, and Alcohol Problems

The self-medication model suggests that some individuals may use alcohol as a means to cope with their negative experiences. Antisocial personality reflects a lack of concern for others and is often linked to alcohol use disorders.

The aim of this investigation was to examine potential parental influences to both pathological reasons for drinking and antisocial personality as pathways to alcohol use and problems.

In general, the overall patterns among male and female respondents were distinct. Among women, perceptions of having a caring mother lowered the likelihood of having antisocial tendencies, and perceptions of being rejected by one's father were directly linked to pathological reasons for drinking. Feeling neglected by one's mother was also directly linked to alcohol-related problems among women. Conversely, feeling neglected by one's father was directly linked to alcohol-related problems among males, suggesting a parent-offspring gender match. For men, antisocial personality mediated the impact of mother rejection and father overprotection on alcohol use.

These findings suggest that parental influences regarding vulnerabilities for alcohol use are very complex and that the genders of the respondent and the parent must be considered jointly.

Read Full Abstract

Request Reprint E-Mail: Julie_Patock@baylor.edu
______________________________________

Effects of Pretreatment and Posttreatment Depressive Symptoms on Alcohol Consumption Following Treatment in Project MATCH

This study examined the associations of pretreatment and posttreatment depressive symptoms with drinking outcomes in the year following treatment in Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity), a multisite clinical trial of behavioral treatments for alcohol-use disorders.

Pretreatment Beck Depression Inventory (BDI) scores predicted more frequent and intense drinking in the year following treatment, although not after accounting for posttreatment BDI scores, which were associated with the drinking outcomes as hypothesized. Patients who reported more depressive symptoms in the year following treatment reported less abstinence (PDA) and more intense drinking (DDD) than patients with fewer posttreatment depressive symptoms.

Our findings underscore the importance of obtaining repeated assessments of depression during the course of substance use treatment. Moreover, the data suggest the potential utility of augmenting standard chemical dependency care with depression-focused interventions for alcohol-dependent patients whose depressive symptoms do not subside during treatment.

Read Full Abstract

Request Reperint E-Mail: Stephanie_Gamble@urmc.rochester.edu
_______________________________________

Combining Motivational Interviewing With Compliance Enhancement Therapy (MI-CET): Development and Preliminary Evaluation of a New, Manual-Guided Psych

Psychosocial interventions
that are practical, transportable, and effective in promoting treatment adherence and efficacy are greatly needed in both research and clinical settings involving alcohol-dependence pharmacotherapy.

In this article, we describe the development and preliminary evaluation of an integrative treatment blending motivational interviewing and compliance enhancement therapy (MI-CET) as a means of enhancing adherence and retention in an ongoing clinical trial.

High rates of medication adherence (79% of citalopram and 91% of placebo completers took ≥80% of doses), session attendance (average of 90% for citalopram and 93% for placebo groups), and study completion (81% for citalopram and 88% for placebo groups) were obtained in the present study using MI-CET. These rates were at least comparable to or were, in some cases, 20%-30% higher than rates obtained in the comparison trials.

These results suggest that MI-CET is feasible as a psychosocial adjunct to alcohol-dependence pharmacotherapy. Given its strengths as a clinical and research intervention (e.g., practicality, transportability), further evaluation of its efficacy is warranted.

Read Full Abstract

Request Reprint E-Mail: Jaimee.Heffner@psychiatry.uc.edu
_________________________________________

Alcohol Abuse in Pregnant Women: Effects on the Fetus and Newborn, Mode of Action and Maternal Treatment

Offspring of mothers using ethanol during pregnancy are known to suffer from developmental delays and/or a variety of behavioral changes.

Ethanol, may affect the developing fetus in a dose dependent manner. With very high repetitive doses there is a 6–10% chance of the fetus developing the fetal alcoholic syndrome manifested by prenatal and postnatal growth deficiency, specific craniofacial dysmorphic features, mental retardation, behavioral changes and a variety of major anomalies.

With lower repetitive doses there is a risk of "alcoholic effects" mainly manifested by slight intellectual impairment, growth disturbances and behavioral changes. Binge drinking may impose some danger of slight intellectual deficiency.

It is advised to offer maternal abstinence programs prior to pregnancy, but they may also be initiated during pregnancy with accompanying close medical care.

The long term intellectual outcome of children born to ethanol dependent mothers is influenced to a large extent by the environment in which the exposed child is raised.

Read Full Text (PDF)

_______________________________________

Gender Differences in Mutual-Help Attendance One Year After Treatment: Swedish and U.S. Samples

In the United States, many people turn to Alcoholics Anonymous (AA) and other mutual-help groups as a first source of help for an alcohol or drug problem, whereas others are introduced to AA while in treatment. Because AA and similar groups in the United States add to the treatment system and function without governmental funds, they represent an important element in ongoing care for individuals with substance-use disorders in the health care system. In countries with free (or more affordable) and more comprehensive systems of care, their role is less clearly defined.

In this study, we compared men and women from representative treatment samples from studies with parallel designs, one Swedish (n = 1,525) and the other American (n = 926), to explore whether rates and correlates of attendance at 1-year follow-up (63% and 78% followed) differ by gender. We explore individual characteristics (demographic, severity, motivational) and formal and informal influences (treatment, mutual help, coercive, social) as possible help-seeking correlates of attendance.

In both countries, similar proportions of men and women attended mutual-help groups. However, twice as many U.S. clients reported attendance. Moreover, twice as many U.S. clients set abstinence as a treatment goal. In multivariate models, having an abstinence goal, a perceived need for treatment, suggestions from one's employment environment, and prior mutual-help attendance predicted posttreatment attendance for men and women in both countries. Gender differences were also found.

Given the stages in which individuals seek care and the cyclical nature of relapse and recovery, mutual-help groups are an efficient resource in the continuum of services

Read Full Abstract

Request Reprint E-Mail: jwitbrodt@arg.org
_______________________________________

Reliability of Alcohol Recall After 15 Years and 23 Years of Follow-Up in the Johns Hopkins Precursors Study

Recall of past alcohol intake is used in many studies of chronic disease, but few studies have been able to examine its long-term reliability.

We sought to assess the reliability of recalled alcohol intake assessed at an average age of 70 years in 2001, after 15 and 23 years of follow-up, in a prospective study of medical students in classes 1948 to 1964.

Average reported alcohol intake 15 years and 23 years prior were 6.3 and 7.4 drinks per week, respectively. Recall of alcohol intake overestimated the concurrently reported intake after 15 years by a mean of 0.47 (95% CI [0.10, 0.85]) drinks per week and underestimated intake after 23 years by a mean of 0.79 (95% CI [-1.27, -0.30]) drinks per week, mostly driven by differences between concurrently reported and recalled distilled spirits consumption. Characteristics associated with underestimation of alcohol recall were age of 71 years or older in 2001, self-report of memory difficulties, and self-report of difficulties in physical functioning. In multivariate regression analyses combining 15- and 23-year recall, subjects who reported consumption of more than 14 alcoholic drinks per week in 2001 marginally overestimated recall by slightly more than 1 drink per week (M = 1.18 drinks/week, 95% CI [-0.03, 2.40]).

Although significant differences were detected, recalled alcohol intake after 15 and 23 years of follow-up is remarkably reliable.

Read Full Abstract

Request Reprint E-Mail: achu@jhsph.edu
_____________________________________

A Principal Components Analysis of the Abbreviated Desires for Alcohol Questionnaire (DAQ

The aim of this study was to examine the abbreviated Desires for Alcohol Questionnaire (DAQ) with respect to component structure and concurrent validity.

The DAQ was administered to 2,960 adults participating in the Collaborative Studies on the Genetics of Alcohol. Rotated principal components analysis was conducted on 1,500 subjects with an alcohol-use disorder (AUD) and on 1,460 non-AUD subjects. Total DAQ scores were compared for these two subsamples. In addition, correlations were computed between DAQ scores and the following: (1) a sum of alcohol symptoms, and (2) endorsement of a single interview craving question.

Similar solutions emerged in the AUD and non-AUD subsamples, with dimensions characterized by (1) strong desires/intentions to drink, (2) negative reinforcement, and (3) positive reinforcement ability to control drinking. Each component was significantly correlated with the alcohol symptom scale in both subsamples (r_s = .25-.64 and .31-.40, respectively, p < .0001) and with the interview craving item in the AUD subsample (r_s = .22-.55, p < .0001). Total DAQ score was significantly higher for AUD subjects (40.5) than for non-AUD subjects (23.1, p < .0001) and exhibited significant correlations with the alcohol symptom scale in the AUD and non-AUD subsamples (r_s = .61 and .39, respectively, p < .0001) and with the interview craving item in the AUD subsample (r_s = .51, p < .0001).

The DAQ is an appropriate measure of alcohol craving, as demonstrated by similar component structures across two samples as well as its concurrent validity.

Read Full Abstract

Request Reprint E-Mail: john-kramer@uiowa.edu
_________________ ____________________

When Desire Collides with Reason: Functional Interactions between Anteroventral Prefrontal Cortex and Nucleus Accumbens Underlie the Human Ability to

Human decisions are guided by "desire" or "reason," which control actions oriented toward either proximal or long-term goals.

Here we used functional magnetic resonance imaging to assess how the human brain mediates the balance between proximal reward desiring and long-term goals, when actions promoting a superordinate goal preclude exploitation of an immediately available reward option.

Consistent with the view that the reward system interacts with prefrontal circuits during action control, we found that behavior favoring the long-term goal, but counteracting immediate reward desiring, relied on a negative functional interaction of anteroventral prefrontal cortex (avPFC) with nucleus accumbens (Nacc) and ventral tegmental area.

The degree of functional interaction between avPFC and Nacc further predicted behavioral success during pursuit of the distal goal, when confronted with a proximal reward option, and scaled with interindividual differences in trait impulsivity.

These findings reveal how the human brain accomplishes voluntary action control guided by "reason," suggesting that inhibitory avPFC influences Nacc activity during actions requiring a restraint of immediate "desires."

Read Full Abstract

Request Reprint E-Mail: e.diekhof@med.uni-goettingen.de
_____________________________________________

Alcohol-Expectancy Dimensions and Alcohol Consumption at Different Ages in the General Population

The purpose of this study was to investigate the cross-sectional relationship between alcohol-expectancy dimensions and alcohol consumption and to examine whether this relationship is modified by age.

Data from the 2003 German Epidemiological Survey on Substance Abuse were used (N = 6,099 subjects, ages 18-59 years). Alcohol expectancies were assessed using five dimensions of the Comprehensive Alcohol Expectancy Questionnaire: social assertiveness, tension reduction, sexual enhancement, cognitive impairment, and aggression. Alcohol consumption within the last 30 days was assessed by the number of drinking days and a beverage-specific quantity-frequency measure.

All expectancy dimensions, except for sexual enhancement, were related to alcohol consumption. Results further revealed age differences between three expectancy dimensions and alcohol consumption.

The association of social assertiveness and sexual enhancement with drinking frequency, as well as with average daily intake, was stronger among younger respondents compared with respondents ages 30 years and older.

In addition, older respondents with high expectations of cognitive impairment drank lower amounts of alcohol compared with younger respondents at the same level of expectation.

Future research on alcohol expectancies should use multidimensional alcohol-expectancy instruments rather than measure only positive and negative alcohol expectancies.

Age modifies the relationship between alcohol-expectancy dimensions and drinking and needs to be taken into account.

Read Full Abstract

Request Reprint E-Mail: kraus@ift.de
__________________________________

Alcohol Use and Heavy Episodic Drinking Prevalence and Predictors Among National Samples of American Eighth- and Tenth-Grade Students

Given the public health impact of adolescent alcohol use and heavy episodic drinking, we sought to identify the prevalence of types of alcohol use among national samples of 8th- and 10th grade American students. In addition, a range of known risk factors was used to predict the most problematic type: heavy episodic use.

Monitoring the Future data on lifetime, past-year, and past-30-day alcohol use and on past-2-week heavy episodic drinking were available for 505,668 students from 1991 to 2007 (weighted N = 505,853; 51.5% girls; 65.3% White, 12.3% Black, 11.1% Hispanic). Logistic regression was then used in a representative subsample of 110,130 students to predict heavy episodic drinking in the previous 2 weeks.

In the most recent cohorts, about 1 in 10 8th graders and 1 in 5 10th graders had engaged in heavy episodic drinking in the past 2 weeks. Explanatory variables in logistic regression were largely invariant across cohort, grade level, gender, and race/ethnicity, accounting for 48% of the variance in heavy episodic drinking.

Heavy episodic drinking continues to be a prevalent behavior among the nation's youth, with consistent risk factors over time, highlighting the continued necessity of effective screening and prevention efforts.

Read Full Abstract

Request Reprint E-Mail: meganpat@isr.umich.edu
_____________________________________

Changes in Alcohol-Related Problems After Alcohol Policy Changes in Denmark, Finland, and Sweden

European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland.

Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes.

Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden.

Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found.

Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found.

Read Full Abstract

Request Reprint E-Mail: kbl@health.sdu.dk
______________________________________

Brief Physician Advice for Heavy Drinking College Students: A Randomized Controlled Trial in College Health Clinics

The aim of this study was to test the efficacy of brief physician advice in reducing alcohol use and related harm in college students.

The College Health Intervention Projects (CHIPs) is a randomized, controlled clinical trial with 12-month follow-up conducted in five college health clinics in Wisconsin; Washington state; and Vancouver, Canada. Of the 12,900 students screened for high-risk drinking, 484 men and 502 women met inclusion criteria and were randomized into a control (n = 493) or intervention (n = 493) group. Ninety-six percent of students participated in the follow-up procedures. The intervention consisted of two 15-minute counseling visits and two follow-up phone calls, and used motivational interviewing, contracting, diary cards, and take-home exercises.

No significant differences were found between groups at baseline on alcohol use, age, socioeconomic or smoking status, rates of depression, or measures of alcohol-related harm. At 12 months, the experimental subjects reduced their 28-day drinking totals by 27.2%, and the control group reduced their totals by 21%.

A mixed effects repeated measures model found a statistical difference in favor of the brief-intervention group (β = 4.7, SE = 2.0, p = .018) in 28-day drinking totals. The total Rutgers Alcohol Problem Index score was also significantly different during the 12-month follow-up period (β = 0.8, SE = 0.4, p = .033). There was no difference on the other outcome measures of interest, such as frequency of excessive heavy drinking, health care utilization, injuries, drunk driving, depression, or tobacco use.

The study supports resource allocation and implementation of alcohol screening and brief physician advice in primary care-based college health clinics.

Read Full Abstract

Request Reprint E-Mail: mfflemin@wisc.edu

_____________________________________

Alcohol Use After Forced Abstinence in Basic Training Among United States Navy and Air Force Trainees

The present study examined drinking rates of U.S. Navy and Air Force trainees during the month before attending basic training and after the ban on drinking alcohol was lifted during advanced training.

Findings showed a rate of 43.1% heavy episodic drinking during the month before basic training, 15.8% by infrequent heavy episodic drinkers (five or more drinks per occasion at least once, four or more for women), and 27.3% by frequent heavy episodic drinkers (five or more drinks per occasion, four or more for women, at least once a week).

Pre-basic frequent heavy episodic drinkers averaged 7.9 drinks per occasion and nearly 15 heavy episodic drinking days during the month.

In contrast, heavy episodic drinking following basic training was substantially lower: 12.0% for infrequent heavy episodic drinkers and 9.0% for frequent heavy episodic drinkers.

Comparisons with the U.S. Department of Defense Health Related Behaviors Survey suggest that post-basic frequent heavy episodic drinking rates are likely to increase over time but not to pre-basic levels. Pre-basic infrequent and frequent heavy episodic drinkers were more likely than nondrinkers or non-heavy episodic drinkers to initiate or re-initiate frequent heavy episodic drinking.

Frequent heavy episodic drinking after basic tended to occur 1-6 weeks after the ban on alcohol use was lifted.

Selection and socialization help explain heavy episodic drinking of U.S Navy and U.S. Air Force trainees.

Read Full Abstract

Request Reprint E-Mail: rmb rti.org
______________________________________

WHO Executive Board recommends alcohol strategy to Assembly

On Friday 22 January the WHO Executive Board Session passed a resolution which recommends to the World Health Assembly (WHA) to endorse the Global Strategy to Reduce the Harmful Use of Alcohol.

Read more...

Changes in ambivalence mediate the relation between entering treatment and change in alcohol use and problems

The present study examined the role of ambivalence about change as (1) a predictor of subsequent heavy alcohol use and drinking problems and (2) a mediator of change between entering treatment and heavy alcohol use and drinking problems among individuals self-referring for treatment with an alcohol use disorder.

A sample of 439 individuals (49.9% female) who initiated help-seeking was surveyed at baseline, and at 1 year and 3 year follow-ups on domains of alcohol-related and personal functioning.

A series of regression analyses indicated that a measure reflecting ambivalence significantly predicted subsequent heavy alcohol use and related problems and mediated changes between entering treatment and heavy alcohol use and related problems.

The findings highlight one mechanism associated with treatment seeking, initiation of and engagement in treatment, and reduction in heavy alcohol use and related problems.

Read Full Abstract

Request Reprint E-Mail: Megan.Oser@va.gov

_____________________________________

Social network effects in alcohol consumption among adolescents

In this paper we seek to empirically quantify the role of peer social networks in explaining drinking behavior among adolescents.

Using data from a nationally representative sample of adolescents we utilize a multivariate structural model with school-level fixed effects to account for the problems of contextual effects, correlated effects and peer selection to purge the potential biases from the estimates of peer influence. Our peer group measures are drawn not only from the nomination of close friends, but also from classmates. Drinking behavior among the peer groups was constructed using the peers' own report of their alcohol consumption.

Controlling for parent level characteristics, and other demographic parameters, we find that a 10% increase in the proportion of classmates who drink will increase the likelihood of drinking participation and frequency by approximately four percentage points.

We also find evidence to show that the influence of close friends, while still significant, diminishes in magnitude after accounting for unobserved environmental confounders.

Our findings support the literature that peer effects are important determinants of drinking behavior even after controlling for potential biases. Effective policy aimed at reducing alcohol consumption among adolescents would consider these significant peer effects.

Read Full Abstract

Request Reprint E-Mail: mir.ali3@utoledo.edu

______________________________________

Event-level analyses of energy drink consumption and alcohol intoxication in bar patrons

To assess event-level associations between energy drink consumption, alcohol intoxication, and intention to drive a motor vehicle in patrons exiting bars at night

These event-level associations provide additional evidence that energy drink consumption by young adults at bars is a marker for elevated involvement in nighttime risk-taking behavior.

Further field research is needed to develop sound regulatory policy on alcohol/energy drink sales practices of on-premise establishments.

Read Full Abstract

Request Reprint E-Mail: dthombs@phhp.ufl.edu
_______________________________________

Social desirability biases in self-reported alcohol consumption and harms

Self-reports remain the most common means of assessing alcohol consumption despite concern for their validity. The objective of this research is to assess the extent to which social desirability biases relate to self-reported consumption, hazardous use, and harms.

Impression management bias represents a significant threat to the validity of self-reported alcohol use and harms. Such bias may lead to misspecification of models and under-estimates of harmful or hazardous use.

Read Full Abstract

Request Reprint E-Mail: Chris_Davis@Carleton.ca:

__________________________________________