Critique 059: Association of quantity of alcohol and frequency of consumption with cancer mortality

A paper from the National Institutes of Health in the United States attempts to evaluate the separate and combined effects of the frequency of alcohol consumption and the average quantity of alcohol per occasion as they relate to the risk of mortality from all cancers, as well as cancer-specific mortality. It is based on repeated administrations of the National Health Interview Survey in the United States, with a total of more than 300,000 subjects and over 8,000 deaths from cancer, and reports on total cancer deaths and deaths from lung, colorectal, prostate, and breast cancers.

For total alcohol consumption (frequency x quantity), the data indicate a significant reduction in the risk of all-site cancers (RR=0.87, CI 0.80-0.94) which, interestingly, is not emphasized by the authors and is not included in their abstract. Moderate drinking consistently shows no effect, and only heavier drinking is associated with an increase in all-site cancer risk. For site-specific cancers, an increase in risk of lung cancer was seen only for heavier drinkers, with a tendency for less cancer among light drinkers. There was no evidence of an effect of total alcohol consumption on colorectal, prostate, or breast cancer. > > > > Read More

DR. MORRIS EDWARD CHAFETZ

Dr. Morris Edward Chafetz died October 14, 2011, at his home in Georgetown. Dr. Chafetz was born in Worcester, Massachusetts on April 20, 1924. He served in the Medical Corps during World War II and earned the M.D. in Psychiatry at Tufts Medical School in Boston in 1948. He served an internship in the U.S. Marine Hospital in Detroit, Michigan, 1948-49, and was named Resident Psychiatrist at the state hospital in Howard, Rhode Island, from 1949-1951. Following a stint at the Instituto Nacional de Cardiologia in Mexico City, 1951-52, Chafetz served two years as clinical and research fellow in Psychiatry at Massachusetts General Hospital as well as a research fellow in Psychiatry at Harvard Medical School, 1952-54. Chafetz was also a psychiatrist for the U.S. Coast Guard stationed in Cape May, New Jersey, in 1952. He was board certified by the American Board of Psychiatry and Neurology. During the 1970s and 1980s, Chafetz was involved with a number of national boards and conferences, among them a presidential appointment to the White House Conference for a Drug-Free America and as a member of the executive committee of the National Commission against Drunk Driving Board of Directors, as well as Chairman of its Committee on Education and Prevention. He was named Clinical Professor of Psychiatry and Behavioral Science, Medical University of South Carolina, and Adjunct Professor, Center for Metropolitan Affairs and Public Policy at the College of Charleston. He was also founding Director of the National Institute on Alcohol Abuse and Alcoholism, Alcohol, Drug Abuse, and Mental Health Administration. > > > > Read More

Mindfulness Is Associated With Fewer PTSD Symptoms, Depressive Symptoms, Physical Symptoms, and Alcohol Problems in Urban Firefighters

^{This study investigated the association between mindfulness, other resilience resources, and several measures of health in 124 urban firefighters.}

^{Participants completed health measures of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, physical symptoms, and alcohol problems and measures of resilience resources including mindfulness, optimism, personal mastery, and social support. The Mindful Awareness and Attention Scale (MAAS; Brown & Ryan, 2003) was used to assess mindfulness. Participants also completed measures of firefighter stress, number of calls, and years as a firefighter as control variables. Hierarchical multiple regressions were conducted with the health measures as the dependent variables with 3 levels of independent variables: (a) demographic characteristics, (b) firefighter variables, and (c) resilience resources.}

^{The results showed that mindfulness was associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems when controlling for the other study variables. Personal mastery and social support were also related to fewer depressive symptoms, firefighter stress was related to more PTSD symptoms and alcohol problems, and years as a firefighter were related to fewer alcohol problems.}

^{Mindfulness may be important to consider and include in models of stress, coping, and resilience in firefighters. Future studies should examine the prospective relationship between mindfulness and health in firefighters and others in high-stress occupations.}

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Request Reprint E-Mail: bwsmith@unm.edu

Effects of adverts from a drug and alcohol prevention campaign on willingness to engage in alcohol-related risky behaviors

Behavioral willingness is conceptualized as a pathway to behavior that is non-deliberative, yet traditional measures require thoughtful deliberation to complete.

This study explored non-deliberative measures of alcohol-related willingness to complement recent work on marijuana-related willingness. The study also examined whether adverts from a field-tested drug and alcohol prevention campaign may have operated by influencing alcohol-related willingness.

Participants viewed campaign adverts or consumer adverts (control). Outcomes were reaction times to make speeded judgments about whether one would engage in risky alcohol-related behaviors.

Results showed that campaign advertisements lowered willingness to play drinking games and (for males) to drive while intoxicated.

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comello@email.unc.edu

Preventing alcohol misuse in young people aged 9-11 years through promoting family communication: an exploratory evaluation of the Kids, Adults Togeth

Alcohol misuse by young people is an important public health issue, and has led to the development of a range of prevention interventions. Evidence concerning the most effective approaches to intervention design and implementation is limited. Parental involvement in school-based interventions is important, but many programmes fail to recruit large numbers of parents. This paper reports findings from an exploratory evaluation of a new alcohol misuse prevention programme - Kids, Adults Together (KAT), which comprised a classroom component, engagement with parents through a fun evening for families with children aged 9-11 years, and a DVD. The evaluation aimed to establish the programme's theoretical basis, explore implementation processes and acceptability, and identify plausible precursors of the intended long-term outcomes.

Documentary analysis and interviews with key personnel examined the programme's development. Classroom preparation and KAT family events in two schools were observed. Focus groups with children, and interviews with parents who attended KAT family events were held immediately after programme delivery, and again after three months. Interviews with head teachers and with teachers who delivered the classroom preparation were conducted. Follow-up interviews with programme personnel were undertaken. Questionnaires were sent to parents of all children involved in classroom preparation.

KAT achieved high levels of acceptability and involvement among both children and parents. Main perceived impacts of the programme were increased pro-social communication within families (including discussions about harmful parental alcohol consumption), heightened knowledge and awareness of the effects of alcohol consumption and key legal and health issues, and changes in parental drinking behaviours.

KAT demonstrated promise as a prevention intervention, primarily through its impact on knowledge and communication processes within families, and its ability to engage with large numbers of parents. A key programme mechanism was the classroom preparation's facilitation of parental involvement in the family fun evening. The programme also incorporated features identified in the literature as likely to increase effectiveness, including a focus on harm reduction, interactive delivery, and targeting primary-school-age children. Further research is needed to test and develop programme theory through implementation in different school contexts, and to examine potential longer-term impacts, and the feasibility of large scale delivery.

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A mathematical formula for prediction of gray and white matter volume recovery in abstinent alcohol dependent individuals

We propose a mathematical formula that predicts the trajectory of the recovery from lobar gray and white matter volume deficits in individuals with sustained abstinence from alcohol.

The formula was validated by using MRI-measured volumetric data from 16 alcohol dependent individuals who had brain scans at three time points during abstinence from alcohol.

Using the measured volumetric data of each individual from the first two time points, we estimated the individual's gray and white matter volume of the frontal, parietal and temporal lobes for the third time point using the formula. Similarly, using the measured data for the second and third time points, we estimated the first time point data for each individual.

The data predicted from the formula were very similar to the experimentally measured data for all lobes and for both gray and white matter. The intra-class correlation coefficients between the measured data and the data estimated from the formula were >0.95 for almost all the tissues.

The formula may also be applicable in other neuroimaging studies of tissue volume changes such as white matter myelination during brain development and white matter demyelination or brain volume loss in diseases, such as Alzheimer's disease.



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Request Reprint E-Mail: Anderson.Mon@ucsf.edu

Alcohol in fatal crashes involving Mexican and Canadian drivers in the USA

To determine the prevalence of alcohol involvement and impairment in fatal crashes in the USA involving Mexican and Canadian drivers.

Drivers in fatal crashes in the USA were identified during 1998 to 2008 from the Fatality Analysis Reporting System, and the prevalence of alcohol involvement and impairment (defined as blood alcohol concentrations ≥0.01 g/dl and ≥0.08 g/dl, respectively) was compared among drivers licensed in Mexico (n=687), Canada (n=598), and the USA (n=561 908).

The prevalence of alcohol involvement was 27% for US drivers, 27% for Mexican drivers, and 11% for Canadian drivers. Alcohol impairment was found in 23% of US drivers, 23% of Mexican drivers, and 8% of Canadian drivers. With adjustment for driver demographic characteristics and survival status and for crash circumstances, the prevalence of alcohol involvement was significantly lower for Canadian drivers (adjusted prevalence ratio (PR) 0.63, 95% CI 0.49 to 0.80) than for US drivers, and was similar between Mexican and US drivers (adjusted PR 0.91, 95% CI 0.81 to 1.02).

Alcohol involvement in fatal motor vehicle crashes in the USA is similarly prevalent in US and Mexican drivers, but is substantially less common in Canadian drivers

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Request Reprint E-Mail: gl2240@columbia.edu

Characteristics and behaviors of mothers who have a child with fetal alcohol syndrome

Fetal alcohol syndrome (FAS) is a leading cause of birth defects and developmental disabilities.

The objective of this study was to identify the characteristics and behaviors of mothers of children with FAS in the United States using population-based data from the FAS Surveillance Network (FASSNet). FASSNet used a multiple source methodology that identified FAS cases through passive reporting and active review of records from hospitals, specialty clinics, private physicians, early intervention programs, Medicaid, birth certificates and other vital records, birth defects surveillance programs, and hospital discharge data.

The surveillance included children born during January 1, 1995–December 31, 1997. In the four states included in our analysis – Arizona, New York, Alaska, and Colorado – there were 257 confirmed cases and 96 probable cases for a total of 353 FAS cases.

Compared to all mothers in the states where surveillance occurred, mothers of children with FAS were significantly more likely to be older, American Indians/Alaska Natives, Black, not Hispanic, unmarried, unemployed, and without prenatal care, to smoke during pregnancy, to have a lower educational level, and to have more live born children. A significant proportion of mothers (9–29%) had another child with suspected alcohol effects.

Compared to all US mothers, they were also significantly more likely to be on public assistance, to be on Medicaid at their child's birth, to have received treatment for alcohol abuse, to have confirmed alcoholism, to have used marijuana or cocaine during pregnancy, to have their baby screen positive for alcohol or drugs at birth, to have had an induced abortion, to have had a history of mental illness, to have been involved in binge drinking during pregnancy, and to have drunk heavily (7 days/week) during pregnancy.

These findings suggest that it is possible to identify women who are at high risk of having a child with FAS and target these women for interventions.



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Request Reprint E-Mail: mcannon@cdc.gov

A haplotype analysis is consistent with the role of functional HTR1B variants in alcohol dependence

Animal and human studies have suggested that the serotonergic system plays an important role in alcohol consumption and abuse, mainly due to the serotonin receptor 1B (5-HT_1B) function in the mesolimbic reward pathway. Association studies between the HTR1B gene variants and alcoholism have found significant results. There is also evidence for a complex balancing regulation of the gene by two functional variants in the promoter region (rs11568817 and rs130058), which are in linkage disequilibrium.

The aim of this study is to investigate the role of the most relevant variants (rs11568817, rs130058, rs6296 and rs13212041) of the HTR1B gene in the susceptibility to alcohol dependence. The sample comprised 136 Brazilian alcoholics of European descendent and 237 controls.

The results suggest an association between a functional variant of the gene (rs11568817) and alcohol dependence (p = 0.001). In addition, this association could also be confirmed in an independent sample using imputed data from a GWAS, where marginal significant association (p = 0.03, one-tailed) with the same allele was obtained. The pattern of distribution of haplotypes was significantly different between patients and controls (p < 0.0001), which is consistent with the role of the two functional variants of the promoter region.

In conclusion, our findings point to an association between functional variants in the promoter region of the HTR1B gene and alcohol dependence, supporting previous neurobiological evidences of the involvement of HTR1B variations in alcohol-related phenotypes.

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Request Reprint E-Mail: claiton.bau@ufrgs.br

Alcohol misuse and violent behavior: Findings from a 30-year longitudinal study

This study examined the associations between measures of alcohol abuse/dependence (AAD) and violent offending and intimate partner violence (IPV) to age 30 in a New Zealand birth cohort.

Outcomes included: measures of violent offending, violence victimization, and physical IPV perpetration and victimization. The study also used measures of AAD symptoms; and time-dynamic covariate factors including life stress, other substance use, mental health status, peer and partner substance use and offending, and unemployment. Data were analysed using conditional fixed effects regression modelling augmented by time-dynamic covariate factors to control for confounding.

Those with five or more AAD symptoms had unadjusted rates of violence outcomes that ranged from 4.10 to 11.85 times higher than those with no symptoms, but these associations did not differ by gender. Adjustment of the associations for both unobserved fixed effects and time-dynamic covariate factors reduced the magnitude of the associations for violent offending, violence victimization and IPV perpetration, with those with five or more AAD symptoms having rates of violence outcomes that were 1.91–3.58 times higher than those with no symptoms. However, control for both fixed effects and time-dynamic covariate factors reduced the associations between AAD symptoms and physical IPV victimization to statistical non-significance (IRR = 0.73, 95% CI: 0.51–1.06).

The results suggest a causal association between alcohol misuse and violent offending/victimization and IPV perpetration, with estimates suggesting that alcohol use disorder accounted for approximately 4.6–9.3% of the reported violent offending/victimization and IPV perpetration in the cohort.

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Request Reprint E-Mail: joseph.boden@otago.ac.nz

Determinants of Nurses' Attitudes toward the Care of Patients with Alcohol Problems

Nurses from an Australian metropolitan hospital completed the Marcus Alcoholism, Seaman Mannello Nurses' Attitudes toward Alcoholism, and the shortened Alcohol and Alcohol Problems Perception Questionnaires.

The majority had personal (73%) and/or professional (93%) experience with people with alcohol problems. Not one reported receiving drug and alcohol training.

On average, nurses held neutral to positive attitudes toward alcohol problems; however, 14.3% completely disagreed with the statement “I want to work with drinkers,” and 12.5% completely disagreed that they were likely to find working with people with alcohol problems rewarding.

Attitudes to care were significantly influenced by age, personal drinking habits, and beliefs about whether patients can be helped, whether alcoholism is a character defect, and the relationship between alcoholism and social status.

Negative attitudes towards patient care persist and are influenced by age, personal drinking habits, and beliefs about alcoholism. Specific training in this area may be beneficial.

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Economic Costs of Excessive Alcohol Consumption in the U.S., 2006

Excessive alcohol consumption causes premature death (average of 79,000 deaths annually); increased disease and injury; property damage from fire and motor vehicle crashes; alcohol-related crime; and lost productivity. However, its economic cost has not been assessed for the U.S. since 1998.

To update prior national estimates of the economic costs of excessive drinking.

This study (conducted 2009–2010) followed U.S. Public Health Service Guidelines to assess the economic cost of excessive alcohol consumption in 2006. Costs for health care, productivity losses, and other effects (e.g., property damage) in 2006 were obtained from national databases. Alcohol-attributable fractions were obtained from multiple sources and used to assess the proportion of costs that could be attributed to excessive alcohol consumption.

The estimated economic cost of excessive drinking was $223.5 billion in 2006 (72.2% from lost productivity, 11.0% from healthcare costs, 9.4% from criminal justice costs, and 7.5% from other effects) or approximately $1.90 per alcoholic drink. Binge drinking resulted in costs of $170.7 billion (76.4% of the total); underage drinking $27.0 billion; and drinking during pregnancy $5.2 billion. The cost of alcohol-attributable crime was $73.3 billion. The cost to government was $94.2 billion (42.1% of the total cost), which corresponds to about $0.80 per alcoholic drink consumed in 2006 (categories are not mutually exclusive and may overlap).

On a per capita basis, the economic impact of excessive alcohol consumption in the U.S. is approximately $746 per person, most of which is attributable to binge drinking. Evidence-based strategies for reducing excessive drinking should be widely implemented.

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Request Reprint E-Mail: sacksj@bellsouth.net

Personality Traits and Coping Compensate for Disadvantageous Decision-making in Long-term Alcohol Abstinence

High relapse rate and extreme difficulty to maintain abstinence are core characteristics of alcohol dependence (AD). Previous studies have demonstrated a persistent decision-making (DM) deficit in AD. We aimed to reveal specific personality features and stress-coping mechanisms presumed to compensate for ineffective DM skills.

Eighty-eight unmedicated patients with AD were enrolled. Intact general cognitive status was assured by IQ above 90. Forty-three patients had an average abstinence period of 12 weeks and were currently in an inpatient treatment program (short-term abstinence group, STA) and 45 patients were abstinent for at least 3 years (long-term abstinence group, LTA). The two groups were assessed using an integrative approach combining domains of DM, temperament and character dimensions and stress-coping measures.

Both groups performed at chance level wth no linear improvement tendency on the gambling task assessing DM adequacy. The LTA group scored significantly higher on scales of self-directedness and cooperativeness. In contrast, levels of harm avoidance, emotion-oriented coping and perceived stress were significantly higher in the STA group

Our findings provide new evidence for a persistent DM deficit with no learning effect in AD. Despite the deficit, alcohol-dependent patients can achieve LTA. STA patients perceive higher levels of stress and use non-adaptive coping strategies. We propose that the more adaptive personality profile of LTA patients contributes to the compensation of the trait-like DM deficit in alcoholism. These compensatory features represent promising new targets for preventive measures and therapeutic interventions in AD.



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Request Reprint E-Mail: must.anita@med.u-szeged.hu

Individual psychomotor impairment in relation to zopiclone and ethanol concentrations in blood – a randomized controlled double-blinded trial

To investigate individual traffic-relevant impairment related to measured blood zopiclone and ethanol concentrations. Also, we aimed to study possible development of acute tolerance.

A randomized controlled 4-way crossover double blinded trial. Study drugs were zopiclone 5 or 10 mg, 50 g ethanol or placebo.

Laboratory study with computerized tests: Connors Continuous Performance test, Choice reaction time, and Stockings of Cambridge. Altogether, the tests consisted of 15 test components, representing 3 levels of behavior (automotive, control, executive planning), relevant to traffic safety.

16 healthy male volunteers.

Each study day, 10 blood samples were collected from each volunteer. 15 psychomotor test components were registered at baseline and a further 3 times after intake. Impairment was defined as any individual deterioration in performance compared to individual baseline performance.

Blood drug concentrations up to 74 µg/l zopiclone and 0.100 % ethanol were measured. We found a clear positive concentration-effect relationship for zopiclone and ethanol for both automotive and control behaviors, and a modest relationship for executive planning behavior. Significant impairment started to be observed at concentrations above 16 µg/l zopiclone (automotive and control behavior) and above 0.026 % ethanol (automotive behavior). Acute tolerance was found for both drugs.

The hypnotic, zopiclone, can impair psychomotor performance at blood concentrations as low as 16ug/ml.

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Request Reprint E-Mail: ingebjorg.g.gustavsen@fhi.no

Changes in sobriety in the Swedish population over three decades: Age, period, or cohort effects?

This study aimed to examine age, cohort, and period trends in alcohol abstinence.

Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the SWEOLD collected in 1992 and 2002 were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves, and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

The samples were representative of the Swedish population.

Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

Alcohol abstinence was determined by asking “Do you ever drink wine, beer, or spirits?”, where a “no” response indicated abstinence.

Decreases in abstinence rates were observed from 1968 to 2000/2002. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (p > .05) predictors of abstinence when cohort (p < .001) was included.

Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be primarily attributable to decreases in successive cohorts rather than drinkers becoming abstainers.

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Request Reprint E-Mail: Kozma.Ahacic@ki.se

Alcohol and aggressive behavior in men – moderating effects of oxytocin receptor gene (OXTR) polymorphisms

We explored if the disposition to react with aggression while alcohol intoxicated was moderated by polymorphic variants of the oxytocin receptor gene (OXTR).

Twelve OXTR polymorphisms were genotyped in 116 Finnish men (aged 18-30, M = 22.7, SD = 2.4) who were randomly assigned to an alcohol condition in which they received an alcohol dose of 0.7g pure ethanol / kg body weight or a placebo condition. Aggressive behavior was measured using a laboratory paradigm in which aggressive behavior was operationalized as the level of aversive noise administered to a fictive opponent.

No main effects of the polymorphisms on aggressive behavior were found after controlling for multiple testing.

The interactive effect between alcohol and two of the OXTR polymorphisms (rs4564970 and rs1488467) on aggressive behavior was nominally significant and remained significant for the rs4564970 when controlled for multiple tests.

To the best of our knowledge, this is the first experimental study suggesting interactive effects of specific genetic variants and alcohol on aggressive behavior in humans.

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Request Reprint E-Mail: ada.johansson@abo.fi

Genome-wide significant association between alcohol dependence and a variant in the ADH gene cluster

Alcohol dependence (AD) is an important contributory factor to the global burden of disease. The etiology of AD involves both environmental and genetic factors, and the disorder has a heritability of around 50%.

The aim of the present study was to identify susceptibility genes for AD by performing a genome-wide association study (GWAS).

The sample comprised 1333 male in-patients with severe AD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and 2168 controls. These included 487 patients and 1358 controls from a previous GWAS study by our group. All individuals were of German descent. Single-marker tests and a polygenic score-based analysis to assess the combined contribution of multiple markers with small effects were performed.

The single nucleotide polymorphism (SNP) rs1789891, which is located between the ADH1B and ADH1C genes, achieved genome-wide significance [P = 1.27E–8, odds ratio (OR) = 1.46].

Other markers from this region were also associated with AD, and conditional analyses indicated that these made a partially independent contribution.

The SNP rs1789891 is in complete linkage disequilibrium with the functional Arg272Gln variant (P = 1.24E–7, OR = 1.31) of the ADH1C gene, which has been reported to modify the rate of ethanol oxidation to acetaldehyde in vitro. A polygenic score-based approach produced a significant result (P = 9.66E–9).

This is the first GWAS of AD to provide genome-wide significant support for the role of the ADH gene cluster and to suggest a polygenic component to the etiology of AD. The latter result may indicate that many more AD susceptibility genes still await identification.

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Request Reprint E-Mail: marcella.rietschel@zi-mannheim.de

Chronic disease and recent addiction treatment utilization among alcohol and drug dependent adults

Chronic medical diseases require regular and longitudinal care and self-management for effective treatment. When chronic diseases include substance use disorders, care and treatment of both the medical and addiction disorders may affect access to care and the ability to focus on both conditions. The objective of this paper is to evaluate the association between the presence of chronic medical disease and recent addiction treatment utilization among adults with substance dependence.

Cross-sectional secondary data analysis of self-reported baseline data from alcohol and/or drug-dependent adults enrolled in a randomized clinical trial of a disease management program for substance dependence in primary care. The main independent variable was chronic medical disease status, categorized using the Katz Comorbidity Score as none, single condition of lower severity, or higher severity (multiple conditions or single higher severity condition), based on comorbidity scores determined from self-report. Asthma was also examined in secondary analyses. The primary outcome was any self-reported addiction treatment utilization (excluding detoxification) in the 3 months prior to study entry, including receipt of any addiction-focused counseling or addiction medication from any healthcare provider. Logistic regression models were adjusted for sociodemographics, type of substance dependence, recruitment site, current smoking, and recent anxiety severity.

Of 563 subjects, 184 (33%) reported any chronic disease (20% low severity; 13% higher severity) and 111 (20%) reported asthma; 157 (28%) reported any addiction treatment utilization in the past 3 months. In multivariate regression analyses, no significant effect was detected for chronic disease on addiction treatment utilization (adjusted odds ratio [AOR] 0.88 lower severity vs. none, 95% confidence interval (CI): 0.60, 1.28; AOR 1.29 higher severity vs. none, 95% CI: 0.89, 1.88) nor for asthma.

In this cohort of alcohol and drug dependent persons, there was no significant effect of chronic medical disease on recent addiction treatment utilization. Chronic disease may not hinder or facilitate connection to addiction treatment.

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Development and Applications of Biomarkers of Alcohol Abuse and Tissue Damage, Cancer and Neurodegeneration

NIAAA Satellite Symposium at the Annual Meeting and Exposition of the
American Association of Pharmaceutical Scientists
Walter E. Washington Convention Center
October 23, 2011, Washington, DC

Biomarkers have considerable potential as indicators of disease states and processes as well as aids in assessing responses to therapeutics.

Biomarkers of alcohol consumption, alcohol dependence and alcohol-induced tissue and organ damage are necessary for detection and diagnosis of alcohol use disorders and for evaluations of the efficacy of treatments for these disorders.

As alcohol use disorders are prevalent in the general population and have broad and long-term effects, improved alcohol biomarkers could provide significant public health benefits.

This session will feature examples of alcohol-related biomarker signatures that reflect both alcohol consumption and alcohol-mediated tissue damage.

Additional presentations will describe novel biomarkers in the fields of cancer and neurodegenerative disorders, with the goal of gaining insights that may be broadly applicable. Challenges and prospects for development and application of biomarkers in the pharmaceutical industry will be also be addressed.

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Decision Memo for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse (CAG-00427N)

The Centers for Medicare and Medicaid Services (CMS) has determined that the evidence is adequate to conclude that screening and behavioral counseling to reduce alcohol misuse, which is recommended with a grade of B by the U.S. Preventive Services Task Force (USPSTF) for adults, including pregnant women, in primary care settings, is reasonable and necessary for the prevention or early detection of illness or disability, and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore CMS will cover annual alcohol screening and for those that screen positive, up to four brief, face-to-face, behavioral counseling interventions per year for Medicare beneficiaries, including pregnant women:

• Who misuse alcohol, but whose levels or patterns of alcohol consumption do not meet criteria for alcohol dependence (defined as at least three of the following: tolerance; withdrawal symptoms; impaired control; preoccupation with acquisition and/or use; persistent desire or unsuccessful efforts to quit; sustains social, occupational, or recreational disability; use continues despite adverse consequences); and
• Who are competent and alert at the time that counseling is provided; and
• Whose counseling is furnished by qualified primary care physicians or other primary care practitioners in a primary care setting.

Each of the behavioral counseling interventions should be consistent with the 5A’s approach that has been adopted by the USPSTF to describe such services:

1. Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
2. Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
4. Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
5. Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment. > > > > Read More