The role of substance use and psychosocial characteristics in explaining unintentional injuries

The objective of this study was to examine the relationship between the use of various substances and selected psychosocial characteristics with unintentional injury.

For the univariate analyses, both frequency of cocaine and cannabis use, risk-taking/impulsivity, stress, and coping were significantly related to injuries.

For the multivariate analyses, only risk-taking/impulsivity, stress, age, and sex were significantly related to injuries.

The results provide important information regarding factors associated with reported injuries among individuals in addiction treatment.

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Request Reprint E-Mail: mcoghlan@uvic.ca

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Sweet preferences and analgesia during childhood: effects of family history of alcoholism and depression

To determine whether depression and family history of alcoholism are associated with heightened sweet preferences in children, before they have experienced alcohol or tobacco and at a time during the life-span when sweets are particularly salient.

The co-occurrence of having a family history of alcoholism and self-reports of depressive symptomatology was associated significantly with a preference for a more concentrated sucrose solution, while depressive symptomatology alone was associated with greater liking for sweet-tasting foods and candies and increased pain sensitivity. Depression antagonized the analgesic properties of sucrose.

While children as a group innately like sweets and feel better after eating them, the present study reveals significant contributions of family history of alcoholism and depression to this effect. Whether the heightened sweet preference and the use of sweets to alleviate depression are markers for developing alcohol-related problems or responses that are protective are important areas for future research.

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Request Reprint E-Mail: mennella@monell.org

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Internet-based prevention for alcohol and cannabis use: final results of the Climate Schools course

To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools.

This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools.

Internet-based prevention programs for school-age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.

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Request Rerprint E-Mail: nickien@unsw.edu.au

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How much alcohol do you buy? A comparison of self-reported alcohol purchases with actual sales

Unrecorded alcohol has increased in the Nordic countries during recent years, above all in terms of cross-border trade. This implies that trends and levels of per capita consumption would look different without estimates of this source of alcohol, estimates that in Sweden and other countries are made through surveys.

Of the recorded amount of purchases at Systembolaget, 87% was reported in the survey, compared with the 40–60% usually found for self-reported consumption. Significant differences across beverages were revealed, showing a lower coverage rate for beer and spirits and a higher coverage rate for wine and cider. Changes in purchases of all beverages were captured fairly well, at least changes taking place from one month to another.

Self-reported alcohol purchases achieve a higher coverage rate than found typically in studies based on self-reported use of alcohol. If adjustments are to be made to correct for underreporting in self-reported data on alcohol purchases, different weights should be applied to different beverages. Furthermore, at least major changes in how much alcohol is purchased in the population can be monitored using well-designed population surveys.

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Request Reprint E-Mail: mats.ramstedt@sorad.su.se

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How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?

To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up.

We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07–2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range.

Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.

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Request Reprint E-Mail: a.britton@ucl.ac.uk

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Consequences of eliminating federal disability benefits for substance abusers

Using annual, repeated cross-sections from national household surveys, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation.

We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity-score methods to address differences in observed characteristics between likely substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias.

In the short-run (1997–1998), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes.

In the later period after the policy change (1999–2002), the rate of SSI receipt rose, and short-run gains in labor market outcomes diminished.

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Request Reprint E-Mail: meara@hcp.med.harvard.edu

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Readiness to Change in Brief Motivational Interventions: A Requisite Condition for Drinking Reductions?

Brief motivational interventions (BMIs) have been found to be efficacious for reducing alcohol use and consequences among college student drinkers. Despite the putative emphasis on motivation, surprisingly little is known about the role of motivation in BMI-facilitated changes.

Using data from three published randomized trials implementing BMIs, we examined motivation or readiness to change (RTC) as a potential mechanism of behavior change. Two of the three studies indicated that BMI were associated with increases in motivation to change alcohol use that are apparent immediately after BMI sessions and persist up to 6-months post-intervention.

However, RTC does not appear to be a mechanism of behavior change, as it did not mediate reductions in alcohol use or problems in any of the studies.

Issues regarding the conceptualization and measurement of RTC are discussed, as well as promising directions for future research.

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Cerebral white matter recovery in abstinent alcoholics—a multimodality magnetic resonance study

Most previous neuroimaging studies of alcohol-induced brain injury and recovery thereof during abstinence from alcohol used a single imaging modality. They have demonstrated widespread microstructural, macrostructural or metabolite abnormalities that were partially reversible with abstinence, with the cigarette smoking potentially modulating these processes.

The goals of this study were to evaluate white matter injury and recovery thereof, simultaneously with diffusion tensor imaging, magnetic resonance imaging and spectroscopy in the same cohort; and to evaluate the relationships between outcome measures of similar regions.

We scanned 16 non-smoking and 20 smoking alcohol-dependent individuals at 1 week of abstinence from alcohol and 22 non-smoking light drinkers using a 1.5 T magnetic resonance scanner. Ten non-smoking alcohol-dependent individuals and 11 smoking alcohol-dependent individuals were re-scanned at 1 month of abstinence.

All regional diffusion tensor imaging, magnetic resonance imaging and spectroscopic outcome measures were calculated over comparable volumes of frontal, temporal, parietal and occipital white matter.

At 1 week of abstinence and relative to non-smoking light drinkers, non-smoking alcohol-dependent individuals had higher mean diffusivity in frontal, temporal and parietal white matter (all P <> whereas smoking alcohol-dependent individuals had elevated mean diffusivity only in frontal white matter (P = 0.03).

Smoking alcohol-dependent individuals demonstrated lower concentrations of N-acetyl-aspartate (a marker of neuronal viability) in frontal white matter (P = 0.03), whereas non-smoking alcohol-dependent individuals had lower N-acetyl-aspartate in parietal white matter (P = 0.05).

These abnormalities were not accompanied by detectable white matter atrophy. However, the patterns of white matter recovery were different between non-smoking alcohol-dependent individuals and smoking alcohol-dependent individuals. In non-smoking alcohol-dependent individuals, the increase in fractional anisotropy of temporal white matter (P = 0.003) was accompanied by a pattern of decreases mean diffusivity in all regions over 1 month of abstinence; no corresponding changes were observed in smoking alcohol-dependent individuals.

In contrast, a pattern of white matter volume increase in frontal and temporal lobes was apparent in smoking alcohol-dependent individuals but not in non-smoking alcohol-dependent individuals. These results were not accompanied by significant changes in metabolite concentrations.

Finally, there were no consistent patterns of association between measures obtained with different imaging modalities, either cross-sectionally or longitudinally.

These data demonstrate significant white matter improvements with abstinence from alcohol, reflected either as microstructural recovery or volumetric increases that depend on the smoking status of the participants.

We believe our results to be important, as they demonstrate that use of a single imaging modality provides an incomplete picture of neurobiological processes associated with alcohol-induced brain injury and recovery thereof that may even lead to improper interpretation of results.

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Request Reprint E-Mail: stefan.gazdzinski@uj.edu.pl
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Silicon in beer and brewing

It has been claimed that beer is one of the richest sources of silicon in the diet; however, little is known of the relationship between silicon content and beer style and the manner in which beer is produced.

The purpose of this study was to measure silicon in a diversity of beers and ascertain the grist selection and brewing factors that impact the level of silicon obtained in beer.

Commercial beers ranged from 6.4 to 56.5 mg L^-1 in silicon. Products derived from a grist of barley tended to contain more silicon than did those from a wheat-based grist, likely because of the high levels of silica in the retained husk layer of barley. Hops contain substantially more silicon than does grain, but quantitatively hops make a much smaller contribution than malt to the production of beer and therefore relatively less silicon in beer derives from them. During brewing the vast majority of the silicon remains with the spent grains; however, aggressive treatment during wort production in the brewhouse leads to increased extraction of silicon into wort and much of this survives into beer.

It is confirmed that beer is a very rich source of silicon.

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Request Reprint E-Mail: cwbamforth@ucdavis.edu
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Alcohol levels in killed drivers and pedestrians on Irish roads 2003-2005: a national study.

No official data are provided in Ireland to indicate what proportion of the deaths on Irish roads have alcohol as a contributory factor.

The aim of this study was to identify the blood alcohol concentration (BAC) in fatally injured drivers and pedestrians in Ireland.

An Garda Síochána (The Irish police) gather data on all fatal road crashes and individual paper files are kept on each crash. The authors examined all such files for deaths in 2003-2005.

Of the 611 drivers fatally injured, 184 (30.1%) were over the BAC legal limit (80 mg/100 ml). BACs were available for only 397 (64.9%) of drivers. Of the 397 drivers who had their BACs recorded, 184 (46.3%) had a BAC over the legal limit of 80 mg/100 ml and 220 (55.4%) had BACs 20 mg/100 ml or higher. Fatally injured drivers with BACs 20 mg/100 ml or greater were more likely to be male (88.6%/o, p<0.01).

Alcohol-related crashes were more likely to occur on week end nights. Pedestrian alcohol consumption was considered to be a contributory factor in 50 (24.4%) of the pedestrian deaths with 22 (10.7%) of the pedestrians having alcohol levels exceeding 240 mgl/100 ml.

This study confirms that alcohol is a significant factor in road deaths. Further targeted action including a reduction in the legal limit is required.

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The relationship of comorbidity of mental and substance use disorders with suicidal behaviors in the Nigerian Survey of Mental Health and Wellbeing

Mental and substance use disorders are often associated with an elevated risk for suicidal behaviors. The role of the co-occurrence of multiple disorders in this association is still unclear.

Persons with lifetime suicide attempt were more likely than those without attempt to have experienced lifetime DSM-IV disorders. Lifetime attempters were also more likely to have comorbid conditions. Compared with only 0.4% of persons with no history of lifetime attempts, over 11% of persons with lifetime attempt had three or more co-occurring disorders.

Multivariate analysis controlling for the effects of comorbid conditions suggests that while mood disorder is independently associated with suicidal outcomes, comorbidity partly explains the association of anxiety disorders and almost fully accounts for the association of substance use disorders with suicidal outcomes.

Comorbidity is an important factor in the association of mental and substance use disorders with suicidal behavior.

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Request Reprint E-Mail: ogureje@comui.edu.ng
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Ethanol alters endosomal recycling of human dopamine transporters

Dynamic membrane trafficking of the monoamine dopamine transporter (DAT) regulates dopaminergic signaling. Various intrinsic and pharmacological modulators can alter this trafficking. Previously we have shown ethanol potentiates in vitro DAT function and increases surface expression. However, the mechanism underlying these changes is unclear.

In the present study, we found ethanol directly regulates DAT function by altering endosomal recycling of the transporter.

We defined ethanol's action on transporter regulation by [3H]DA uptake functional analysis combined with biochemical and immunological assays in stably expressing DAT HEK-293 cells.

Short-term ethanol exposure potentiated DAT function in a concentration-, but not time-dependent manner. This potentiation was accompanied by a parallel increase in DAT surface expression.

Ethanol had no effect on function or surface localization of the ethanol-insensitive mutant (G130T DAT), suggesting a trafficking-dependent mechanism in mediating the ethanol sensitivity of the transporter.

The ethanol-induced increase in DAT surface expression occurred without altering the overall size of DAT endosomal recycling pools.

We found ethanol increased the DAT membrane insertion rate while having no effect on internalization of the transporter.

Ethanol had no effect on the surface expression or trafficking of the endogenously expressing transferrin receptor, suggesting ethanol does not have a non-specific effect on endosomal recycling.

These results define a novel trafficking mechanism by which ethanol regulates DAT function.

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Request Reprint E-Mail: dayne.mayfield@mail.utexas.edu
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Prevention of cardiovascular risk by moderate alcohol consumption: epidemiologic evidence and plausible mechanisms

An inverse association between moderate alcohol intake and cardiovascular risk, in particular coronary disease and ischemic stroke, has been shown in many epidemiologic studies.

In addition, several other diseases are also known to occur less frequently in moderate drinkers than in non-drinkers, whereas excess of drinking is invariably harmful.

However, some concern has been recently raised about the possibility that at all dosages the harm of alcohol could overcome its beneficial effects.

We present here the epidemiologic and mechanistic evidence to support the protective effect of moderate alcohol intake against cardiovascular disease and all-cause mortality.

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Request Reprint E-Mail: dicastel@ngi.it
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Alcohol-Induced Neurodegeneration, Suppression of Transforming Growth Factor-β, and Cognitive Impairment in Rats: Prevention by Group II Metabotropic

Glutamatergic neurotransmission has been implicated in mechanisms of alcohol-induced neurodegeneration and cognitive impairment, but the underlying mechanism remains unknown.

Here, we examined whether the group II metabotropic glutamate receptor agonist LY379268 prevents neuronal death and learning deficits in a rat model of binge-like exposure to alcohol.

Our data support a neuroprotective role for group II metabotropic glutamate receptor agonists and TGF-β in alcohol-induced neurodegeneration.

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Request Reprint E-Mail: markus.heilig@mail.nih.gov

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Community Norms, Enforcement of Minimum Legal Drinking Age Laws, Personal Beliefs and Underage Drinking: An Explanatory Model

Strategies to enforce underage drinking laws are aimed at reducing youth access to alcohol from commercial and social sources and deterring its possession and use. However, little is known about the processes through which enforcement strategies may affect underage drinking.

The purpose of the current study is to present and test a conceptual model that specifies possible direct and indirect relationships among adolescents’ perception of community alcohol norms, enforcement of underage drinking laws, personal beliefs (perceived parental disapproval of alcohol use, perceived alcohol availability, perceived drinking by peers, perceived harm and personal disapproval of alcohol use), and their past-30-day alcohol use.

This study used data from 17,830 middle and high school students who participated in the 2007 Oregon Health Teens Survey.

Structural equations modeling indicated that perceived community disapproval of adolescents’ alcohol use was directly and positively related to perceived local police enforcement of underage drinking laws. In addition, adolescents’ personal beliefs appeared to mediate the relationship between perceived enforcement of underage drinking laws and past-30-day alcohol use.

Enforcement of underage drinking laws appeared to partially mediate the relationship between perceived community disapproval and personal beliefs related to alcohol use.

Results of this study suggests that environmental prevention efforts to reduce underage drinking should target adults’ attitudes and community norms about underage drinking as well as the beliefs of youth themselves.

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Request Reprint E-Mail: skreda@prev.org
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Empirically defined subtypes of alcohol dependence in an Irish family sample

Alcohol dependence (AD) is clinically and etiologically heterogeneous.

The goal of this study was to explore AD subtypes among a sample of 1221 participants in the Irish Affected Sib Pair Study of Alcohol Dependence, all of whom met DSM-IV criteria for AD.

Variables used to identify the subtypes included major depressive disorder, antisocial personality disorder, illicit drug dependence (cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens), nicotine dependence, the personality traits of neuroticism and novelty seeking, and early alcohol use.

Using latent class analysis, a 3-class solution was identified as the most parsimonious description of the data. Individuals in a Mild class were least likely to have comorbid psychopathology, whereas a severe class had highest probabilities of all comorbid psychopathology. The third class was characterized by high probabilities of major depression and higher neuroticism scores, but lower likelihood of other comorbid disorders than seen in the severe class.

Overall, sibling pair resemblance for class was stronger within than between classes, and was greatest for siblings within the severe class, suggesting a stronger familial etiology for this class.

These findings are consistent with the affective regulation and behavioral disinhibition subtypes of alcoholism, and are in line with prior work suggesting familial influences on subtype etiology.

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Request Reprint E-Mail: cprescot@usc.edu
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Naltrexone and combined behavioral intervention effects on trajectories of drinking in the COMBINE study

COMBINE is the largest study of pharmacotherapy for alcoholism in the United States to date, designed to answer questions about the benefits of combining behavioral and pharmacological interventions.

Trajectory-based analyses of daily drinking data allowed identification of distinct drinking trajectories in smaller studies and demonstrated significant naltrexone effects even when primary analyses on summary drinking measures were unsuccessful.

The objective of this study was to replicate and refine trajectory estimation and to assess effects of naltrexone, acamprosate and therapy on the probabilities of following particular trajectories in COMBINE.

It was hypothesized that different treatments may affect different trajectories of drinking.

We replicated the trajectories (“abstainer”, “sporadic drinker”, “consistent drinker”) established previously in smaller studies. However, greater numbers of trajectories better described the heterogeneity of drinking over time.

Naltrexone reduced the chance to follow a “nearly daily” trajectory and Combined Behavioral Intervention (CBI) reduced the chance to be in an “increasing to nearly daily” trajectory of any drinking. The combination of naltrexone and CBI increased the probability of membership in a trajectory in which the frequency of any drinking declined over time. Trajectory membership was associated with different patterns of treatment compliance.

The trajectory-analyses identified specific patterns of drinking that were differentially influenced by each treatment and provided support for hypotheses about the mechanisms by which these treatments work.

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Request Reprint E-Mail: ralitza.gueorguieva@yale.edu

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Predicting drinking onset with discrete-time survival analysis in offspring from the San Diego prospective study

Previous research has shown that an early onset of drinking is associated with a range of problematic drinking outcomes in adulthood.

However, earlier drinking is also linked to additional characteristics that themselves predict alcohol problems including male gender, a family history (FH) of alcoholism, age, race, parental alcoholism, depression symptoms, prior drug use, and conduct problems.

This study tested the relationship between the age of first drink (AFD) and a range of risk factors that predict the onset of alcohol use. Participants were offspring from the San Diego Prospective Study (SDPS) who were at least 15 years old at the time of their most recent interview (n=147). Discrete-time survival analysis (DTSA) was used to relate multiple characteristics to the hazard function of alcohol onset across a relevant age range.

The results demonstrated the predicted relationships to AFD for conduct problems, male gender, prior marijuana use, and a FH of alcoholism, even when these characteristics were estimated together.

Furthermore, an interaction occurred such that offspring with both conduct problems and marijuana use were at substantially higher risk for alcohol use onset during this time period than would be predicted from the effect of these two risk factors alone.

However, age at interview, ethnicity, parent education, and depressive symptoms did not predict the pattern of onset of drinking.

Implications for future research and prevention efforts are discussed.

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Request Reprint E-Mail: mschuckit@ucsd.edu
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Alcohol and drug involvement after adolescent treatment and functioning during emerging adulthood

This study identified patterns of alcohol and other drug (AOD) involvement during the decade following adolescent AOD treatment and developmental outcomes in emerging adulthood.

AOD and psychosocial variables were assessed at eight time points from adolescence into adulthood (n=153; 41.2% women) in an inpatient treatment sample of alcohol and other drug dependent teens.

Latent class growth analysis identified six trajectories based on alcohol and substance use frequency which were consistent with developmental transitions and validated by measures of dependency symptoms.

While few differences were evident at intake, the educational, occupational and interpersonal attainments were differentially associated with the alcohol/drug trajectories as youth transitioned into adulthood.

High rates of high school graduation (71.1%), professional occupations (45.2%), marriage/cohabitation (48.5%), and financial responsibility for children (F[5,27]=2.75, p=.02) were evident for those with the least alcohol and drug involvement.

More severe drug use trajectories were associated with higher rates of dependence, incarceration and more treatment at the final period of assessment.

Outcomes of the trajectory of frequent alcohol involvement were distinct from combined alcohol and drug use.

These findings highlight the long-term diversity of substance use outcomes following adolescent treatment and suggest that identification of these patterns of use following treatment can help clarify the developmental impact of youth alcohol and drug use on outcomes in young adulthood.

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Request Reprint E-Mail: sanbrown@ucsd.edu
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Beliefs about the empirical support of drug abuse treatment interventions: A survey of outpatient treatment providers

This study assessed substance abuse treatment providers’ beliefs about empirically supported treatments (ESTs) to determine if providing information about empirical support for interventions would change beliefs.

Treatment providers (N=136) completed an interview regarding five interventions with varied empirical support: contingency management (CM), motivational interviewing (MI), relapse prevention (RP), 12-step approaches (TSA), and verbal confrontation (VC). Participants then read primers describing empirical support for each intervention prior to completing a repeat interview.

Overall, providers reported positive beliefs about ESTs. Baseline beliefs about empirical support for each intervention were inflated relative to that of expert raters except for CM. After reading the primers, beliefs about efficacy changed in the direction of the experts for all interventions except MI, but continued to be inflated except for CM.

Willingness to utilize interventions increased for RP, MI, and CM and decreased for TSA and VC, but remained higher than warranted by empirical support.

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Request Reprint E-Mail: lbenishek@tresearch.org

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