A regression model applied to gender-specific ethanol elimination rates from blood and breath measurements in non-alcoholics
International Journal of Legal Medicine Online First 7 October 2008

As elimination rates for alcohol are suggested to be gender specific, a novel regression model has been applied to estimate these rates for both men and women using experimentally measured data from 81 female and 96 male volunteers described in previous papers.

Breath alcohol measurements were done with the Alcotest 7110 Evidential device and were coupled with concomitant sampling of venous blood. Statistical analyses involved use of a mixed linear model for blood alcohol concentration (BAC) and breath alcohol concentration (BrAC), respectively.

The model takes regression lines for each test subject into account with an individual starting value (2 h after the end of drinking) and with an individual alcohol elimination rate per hour (coincidental effects). Further, the data was modeled so that an average alcohol elimination rate per hour could be estimated separately for both genders (constant effects). This enables us to methodically correctly estimate the back calculation.

The elimination rates β ₆₀, which can be used for minimum and maximum back calculations for the BAC, were 0.115 g/kg/h and 0.260 g/kg/h, respectively, for women and 0.096 g/kg/h and 0.241 g/kg/h, respectively, for men.

These figures widely deviate from gender-unspecific values commonly used in Germany (0.1 and 0.2 g/kg/h, respectively). The corresponding values for the BrAC were 0.061 mg/l/h and 0.124 mg/l/h for women and 0.049 mg/l/h and 0.112 mg/l/h for men. The probability of an over- or underestimation of the abovementioned extreme values is 0.3% in each case.


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Alcohol and Tobacco Use Among Rural Mexican Adolescents: Individual, Familial, and Community Level Factors
Journal of Adolescent Health Volume 43, Issue 5, November 2008, Pages 498-505

We investigated the contributions of individual, family, and community-level factors for explaining alcohol use and smoking among rural Mexican adolescents.

Generalized linear models adjusted for sampling design indicated that adolescents' use of alcohol was associated with being male, older, employment, and having a mother who used alcohol. Being from an indigenous family living in a majority-indigenous community was associated with less alcohol use. Family income, family size, and community standard of living were not directly associated with adolescents' alcohol use. Current smoking was associated with being male, older, and more anxious, having a mother who smoked, and having a mother with higher educational attainment. Further analyses indicated patterns in which adolescents' alcohol use was moderated by gender and ethnicity.

Beyond the contribution of male gender and age as risk factors, maternal substance use uniquely explained variability in alcohol and cigarette use among Mexican adolescents from rural communities. Indigenous ethnicity and living in majority-indigenous community settings appeared to confer protective benefits with respect to alcohol.

These findings extend prior research in Mexico and in other countries that identify the combined importance of developmental contexts and individual-level factors for adolescent health.

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Energy Drinks, Race, and Problem Behaviors Among College Students
Journal of Adolescent Health Volume 43, Issue 5, November 2008, Pages 490-497

This study examined relationships between energy drink consumption and problem behaviors among adolescents and emerging adults. It was hypothesized that frequent consumption of energy drinks would be positively associated with substance abuse and other risky behaviors, and that these relationships would be moderated by race.

Frequency of energy drink consumption was positively associated with marijuana use, sexual risk-taking, fighting, seatbelt omission, and taking risks on a dare for the sample as a whole, and associated with smoking, drinking, alcohol problems, and illicit prescription drug use for white students but not for black students.

These findings suggest that energy drink consumption is closely associated with a problem behavior syndrome, particularly among whites. Frequent consumption of energy drinks may serve as a useful screening indicator to identify students at risk for substance use and/or other health-compromising behavior.

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Alcohol, Helping Young Adults to Have Unprotected Sex with Casual Partners: Findings from a Daily Diary Study of Alcohol Use and Sexual Behavior
Journal of Adolescent Health Article in Press, 27 September 2008

To examine the event-level association between alcohol consumption and the likelihood of unprotected sex among college-age young adults considering contextual factors of partner type and amount of alcohol consumed.

Based on multilevel models, drinking proximal to events of sexual intercourse increased the likelihood of unprotected sex with casual but not steady partners. For women there was a positive association between number of drinks and a greater likelihood of unprotected sex with casual partners but a negative association with steady partners. Drinking during situations involving opportunities for sex with casual partners increased the likelihood of sex. For women especially, drinking more increased the likelihood of sex occurring regardless of partner type.

Failure to assess the contextual determinants of the alcohol—unprotected sex association may result in underestimates of the magnitude of this association. These data highlight an important area for intervention with young adults: reducing alcohol-involved sexual risk behavior with casual partners, especially among women.

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Constructive imperialism and sobriety: Evidence of alcoholism among candidates for the British Colonial Service from 1898-1904
Drugs: education, prevention and policy, Volume 15, Issue 5 October 2008 pages 439 - 450


To study what was termed 'alcoholism' among candidates for the British Colonial Service from 1898-1904 and how it was identified by comparison with specialist literature of the time: and to analyse the results of such medical examinations for associations between evidence of alcoholism and other variables.

All 3846 medical examinations on candidates for the British Colonial Service from August 1898 to July 1904.

The term 'alcoholism' was used in the examination although 'inebriety' was the more usual specialist term at the time. Physical symptomology was used for the purposes of identification. There were 79 candidates (2%) who exhibited evidence of alcoholism, the predominant indicators being the smell of liquor on the breath (68%), facial congestion (27%), tremors (23%), a furred tongue (14%), and a tremulous tongue (8%). All of the candidates with evidence of alcoholism (CWA) were males, significantly older than non-CWAs and more likely to be rejected from the Colonial Service. Multiple logistic regression analyses found that a history of syphilis and a history of having lived in the tropics were associated with being a CWA.

The context of the examination and the terminology used showed little influence on colonial medicine from the specialist inebriety field.The use of the term 'alcoholism' predates its more general use in British medicine and psychiatry. The low prevalence of evidence of 'alcoholism' among candidates for the Colonial Service could be the result of one of more of the following: temperance movements, which made abstinence more respectable at the higher levels of English society; the overall labour skills needed for these colonial positions and the higher economic class of applicants; self-selection out of colonial work by heavy drinkers realizing that their condition would not be conducive to tropical life; or lack of motivation to pursue such careers.

The syphilis finding supports testimony in the Physical Deterioration Report of 1904 that linked alcoholism and syphilis. The association between having lived in the tropics and evidence of alcoholism supports contemporary concern over the effect of the tropical climate on the health of those who did not practice moderation in drink.


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Consultation responses published by Alcohol Concern and Transform

Transform Drug Policy Foundation and Alcohol Concern have published their responses to the recent consultation on further action on the alcohol industry, as part of the national alcohol strategy, Safe, Sensible, Social.

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A revised edition of the Readiness to Change Questionnaire [Treatment Version]

Addiction Research & Theory, Volume 16, Issue 5 October 2008 , pages 421 - 433


The UK Alcohol Treatment Trial provided an opportunity to examine the factor structure of the Readiness to Change Questionnaire-Treatment Version (RCQ[TV]) in a large sample (N = 742) of individuals in treatment for alcohol problems who were given the RCQ[TV] at baseline, 3-months and 12-months follow-up.

Confirmatory factor analysis of the previously reported factor structure (5 items for each of Precontemplation, Contemplation and Action scales) resulted in a relatively poor fit to the data.

Removal of one item from each of the scales resulted in a 12-item instrument for which goodness-of-fit indices were improved, without loss of internal consistency of the three scales, on all three measurement occasions.

Inspection of relationships between stage allocation by the new instrument and negative alcohol outcome expectancies provided evidence of improved construct validity for the revised edition of the RCQ[TV]. There was also a strong relationship between stage allocation at 3-months follow-up and outcome of treatment at 12 months.

The revised edition of the RCQ[TV] offers researchers and clinicians a shorter and improved measurement of stage of change in the alcohol treatment population.

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Request Reprint E-Mail: nick.heather@northumbria.ac.uk
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How much is too much?

Recycling. You feel good when you do it, don't you? You're doing your bit to save the planet after all. But do you ever look at the wine and beer bottles you're putting out and wonder 'just how did we manage to get through all that since last week...?'.

Then you're not alone. New research shows that one in six people are concerned by the amount of alcohol they're drinking at home, based on the number of bottles and cans they recycle.

And that's what the new Drinkaware campaign is all about.

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Media Release - Release of Disturbing New Research Regarding Alcohol


The Salvation Army today released new Australian research as part of its Alcohol Awareness campaign that shows 4.3 million people say alcohol has had a negative impact on them or their family and more than two million people have experienced children being embarrassed or scared as a result of alcohol consumption in the family.

The research was conducted for The Salvation Army by Roy Morgan Research. The new research also shows more than 8.4 million people want alcohol advertising reduced and more than 3.6 million people want alcohol advertising banned altogether.
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Women 'unaware of alcohol threat'

Friday, 17 October 2008


Women do not know about one of the biggest health risks linked to drinking too much - a raised chance of breast cancer, says a survey.

While most knew that excessive alcohol intake could lead to liver disease or liver cancer, fewer than one in five linked it to breast cancer.

The YouGov survey of nearly 2,000 men and women was described as "shocking" by health minister Dawn Primarolo.

An estimated four million UK women drink more than recommended levels.
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Do Patients With Alcohol Dependence Respond to Placebo? Results From the COMBINE Study
J. Stud. Alcohol Drugs 69: 878-884, 2008


The purpose of this study was to examine the nature of the effect of placebo medication plus accompanying medical management in the treatment of alcohol dependence.

The National Institute on Alcohol Abuse and Alcoholism COMBINE (Combining Medications and Behavioral Interventions) study, a randomized controlled double-blind trial of 1,383 alcohol-dependent patients, compared combinations of medications (acamprosate [Campral] and naltrexone [ReVia]) and behavioral therapy (medical management and specialist-delivered behavioral therapy) for alcohol dependence.

This report focuses on a subset of that study population (n = 466) receiving (1) specialized behavioral therapy alone (without pills), (2) specialized behavioral therapy + placebo medication + medical management, or (3) placebo + medical management.

During 16 weeks of treatment, participants receiving behavioral therapy alone had a lower percentage of days abstinent (66.6%) than did the participants receiving placebo and medical management (73.1%) or those receiving specialized behavioral therapy + placebo + medical management (79.4%). The group receiving behavioral therapy alone relapsed to heavy drinking more often (79.0%) than those receiving behavioral therapy + placebo + medical management (71.2%).

This report focuses on potential explanations for this finding. The two groups of participants receiving placebo + medical management were more likely to attend Alcoholics Anonymous meetings during treatment (32.7% and 32.0% vs 20.4%) and were less likely to withdraw from treatment (14.1% and 22.9% vs 29.3%).

There appeared to be a significant "placebo effect" in the COMBINE Study, consisting of pill taking and seeing a health care professional. Contributing factors to the placebo response may have included pill taking itself, the benefits of meeting with a medical professional, repeated advice to attend Alcoholics Anonymous, and optimism about a medication effect.


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Three-year changes in adult risk drinking behavior in relation to the course of alcohol-use disorders.
J Stud Alcohol Drugs. 2008 Oct;69(6):866-77.



This study examines the associations between the course of alcohol-use disorder (AUD) and changes in average daily volume of ethanol intake, frequency of risk drinking, and maximum quantity of drinks consumed per day over a 3-year follow-up interval in a sample of U.S. adults.

There were positive changes in all consumption measures associated with developing an AUD and negative changes associated with remission of an AUD, even among individuals who continued to drink. Increases and decreases associated with onset and offset of dependence exceeded those associated with onset/ offset of abuse only, and the decreases associated with full remission from dependence exceeded those associated with partial remission.

There were few changes in consumption among individuals whose AUD status did not change. Interactions of AUD transitions with other factors indicate that development of an AUD is associated with a greater increase in consumption among men, possibly reflecting their greater total body water and lower blood alcohol concentration in response to a given dose of ethanol, and among individuals with high baseline levels of consumption.

Changes in consumption associated with onset and offset of AUD are substantial enough to have important implications for the risk of associated physical and psychological harm.


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Toward DSM-V: An Item Response Theory Analysis of the Diagnostic Process for DSM-IV Alcohol Abuse and Dependence in Adolescents
Journal of the American Academy of Child & Adolescent Psychiatry. 47(11):1329-1339, November 2008.

Item response theory analyses were used to examine alcohol abuse and dependence symptoms and diagnoses in adolescents. Previous research suggests that the DSM-IV alcohol use disorder (AUD) symptoms in adolescents may be characterized by a single dimension.

The present study extends prior research with a larger and more comprehensive sample and an examination of an alternative diagnostic algorithm for AUDs.

Approximately 5,587 adolescents between the ages of 12 and 18 years from adjudicated, clinical, and community samples were administered structured clinical interviews. Analyses were conducted to examine the severity of alcohol abuse and dependence symptoms and the severity of alcohol use problems (AUDs) within the diagnostic categories created by the DSM-IV.

Although the DSM-IV diagnostic categories differ in severity of AUDs, there is substantial overlap and inconsistency in AUD severity of persons across these categories. Item Response Theory-based AUD severity estimates suggest that many persons diagnosed with abuse have AUD severity greater than persons with dependence. Similarly, many persons who endorse some symptoms but do not qualify for a diagnosis (i.e., diagnostic orphans) have more severe AUDs than persons with an abuse diagnosis. Additionally, two dependence items, "tolerance" and "larger/longer," show differences in severity between samples.

The distinction between DSM-IV abuse and dependence based on severity can be improved using an alternative diagnostic algorithm that considers all of the alcohol abuse and dependence symptoms conjointly.

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Request Reprint E-Mail: Heather.Gelhorn@UCHSC.edu
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HIGH SPIRITS

Canadians spend $18 billion a year on beer and liquor, consuming about six times more beer than wine. A sampling of statistics on Canadians' drinking habits.

High Spirits: Main page

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SNP rank-and-file back alcohol crackdown


By Simon Johnson, Scottish Political Editor
17 Oct 2008

Grassroots SNP members have backed the party's controversial proposals for cracking down on alcohol abuse after coming under pressure from ministers not to "tie their hands".

Delegates overwhelmingly backed a Scottish Executive consultation on the measures, but were split over whether to support a plan to raise the minimum age for buying alcohol in supermarkets and off-licences from 18 to 21.

The SNP's youth wing, Young Scots For Independence, put forward an amendment arguing that the proposal will "do little to tackle the real problem with Scotland's relationship with the bottle" and demonise young people.

However, that was defeated by 131 votes to 190 at the party conference in Perth after Alex Salmond, the First Minister, pointedly appeared on the platform to cast his ballot.

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More congregations create addiction ministries

125 Unitarian Universalist congregations now offer ministries to people struggling with addiction.
By Donald E. Skinner
Fall 2008 8.18.08

The cover story of the summer 2004 issue of UU World profiled the Rev. Dr. Denis Meacham’s drive to help congregations develop ministries to those who struggle with addictions. When Meacham started his own addictions ministry at First Parish in Brewster, Massachusetts, in 2000, there were no others. Today around 125 congregations have such ministries and a move is underway to gain official recognition and support for addictions ministry from the Unitarian Universalist Association.
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Psychiatric comorbidity in older long-term abstinent alcoholics
Addictive Behaviors Volume 33, Issue 12, December 2008, Pages 1564-1571

We compared 89 older abstinent alcoholics (OAA, mean abstinence of 14.8 years), to 53 age and gender-comparable older non-alcoholic controls (ONC) with regard to lifetime and current psychiatric diagnoses, lifetime psychiatric symptom counts, and psychological measures in the mood, anxiety, and externalizing disorder domains. We compared these findings with our previously reported results in analogous middle-aged samples (MAA versus MNC).

OAA had more lifetime psychiatric and mood disorder diagnoses than ONC. They also had more lifetime symptoms and psychological test evidence of psychiatric disorder in all domains. However, OAA were less different from ONC than were MAA from MNC on most psychiatric and psychological measures. In both studies, differences between alcoholics and controls were dramatically larger in the externalizing compared with the mood and anxiety domains, and there was little evidence that psychiatric comorbidity measures impacted abstinence duration.

The finding that OAA had less psychiatric illness than MAA may involve a combination of selective survivorship, selection bias, and cohort differences. Although selection bias may be present in clinical studies of samples of any age, it is a more potent problem in older samples.

However, given these potential biases, our results underestimate psychiatric comorbidity in OAA, strengthening our finding of increased psychiatric disorder in OAA versus ONC.

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Alcohol and other drug treatment services in Australia 2006-07: findings from the National Minimum Data Set

AIHW bulletin no. 65

Alcohol and other drug treatment services in Australia 2006-07: findings from the National Minimum Data Set presents data on publicly funded alcohol and other drug treatment services and their clients, including information about the types of drugs for which treatment is sought and the types of treatment provided. The data contained in this bulletin are derived from the comprehensive AODTS-NMDS 2006-07 annual report.

In 2006–07:

• 633 government-funded alcohol and other drug treatment agencies provided 147,325 closed treatment episodes.

• Most treatment episodes (95%) were for people seeking assistance about their own drug use. The remaining episodes were provided to people who were concerned about someone else’s drug use.

• The median age of persons receiving treatment for their own drug use was 31 years.

• Around one-third of all closed treatment episodes were for clients aged 20–29 years, while more than one-quarter were for clients aged 30–39 years.

• Male clients accounted for two-thirds of all closed treatment episodes.

• In 10% of treatment episodes, the clients were of Aboriginal and/or Torres Strait Islander origin.

• Overall, alcohol was the most common principal drug of concern reported (42%), followed by cannabis (23%), opioids (14%, with heroin accounting for 11%) and amphetamines (12%). These proportions are very similar to those seen in previous years.

• Indigenous clients reported the same leading principal drugs of concern as the whole treatment population.

• Clients are able to nominate more than one drug of concern. When all reported drugs of concern are considered, more than half (57%) of all episodes included alcohol as a drug of concern, while 44% of episodes included cannabis as a drug of concern.

• Nationally, counselling was the most common form of main treatment provided (38% of treatment episodes), followed by withdrawal management (17%) and assessment only (15%).

• The length of treatment episodes was highly varied and influenced by the type of treatment received. For example, where counselling was the main treatment type provided, the median duration of treatment was 43 days.

• Most treatment episodes ended either because treatment was completed (54%) or because the client ceased to participate without notice to the treatment provider (17%).

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Ethanol Enhances Reactivated Fear Memories
Neuropsychopharmacology (2008) 33, 2912–2921



Although ethanol has been shown to impair acquisition of memory, its effect on consolidated memories is not clear. Recent reports revealed that memory retrieval converted consolidated memory into a labile state and initiated the reconsolidation process.

In the present study, we have demonstrated the effect of ethanol on reactivated fear memory. We used contextual fear conditioning where rats were conditioned with mild footshock, re-exposed to the training context for 2 min, immediately injected with ethanol or saline, and finally tested 48 h after re-exposure.

Ethanol-treated groups demonstrated longer freezing and the effect lasted for 2 weeks. Reactivation is necessary for this effect. Injection of ethanol itself did not induce a fearful response. Reactivated and ethanol-treated rats exhibited longer freezing than non-reactivated controls, suggesting that ethanol does not inhibit the memory decline but facilitates the fear memory. Two minute re-exposures induced no or little extinction. The effect of ethanol was specific for 2-min reactivation, which induces reconsolidation. Moreover, we found that picrotoxin inhibited the memory enhancement that was produced by ethanol administered just after the reactivation.

These studies demonstrate that ethanol enhances reactivated contextual fear memories via activation of GABA_A receptors.

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Request Reprint E-Mail: hiro.nomu@f-h.nir.jp
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Escalated Aggression after Alcohol Drinking in Male Mice: Dorsal Raphé and Prefrontal Cortex Serotonin and 5-HT_1BReceptors
Neuropsychopharmacology (2008) 33, 2888–2899



A significant minority of individuals engages in escalated levels of aggression after consuming moderate doses of alcohol (Alc). Neural modulation of escalated aggression involves altered levels of serotonin (5-HT) and the activity of 5-HT_1B receptors.

The aim of these studies was to determine whether 5-HT_1B receptors in the dorsal raphé (DRN), orbitofrontal (OFC), and medial prefrontal (mPFC) cortex attenuate heightened aggression and regulate extracellular levels of 5-HT.

Approximately 60% of the mice were more aggressive after drinking Alc, confirming the aggression-heightening effects of 1.0 g/kg Alc. Infusion of 1 g CP-94,253 into the DRN reduced both aggressive and motor behaviors. However, infusion of 1 g CP-94,253 into the mPFC, but not the OFC, after Alc drinking, increased aggressive behavior. In the mPFC, reverse microdialysis of CP-94,253 increased extracellular levels of 5-HT; levels decreased immediately after the perfusion. This 5-HT increase was attenuated in self-administering mice.

These results suggest that 5-HT_1B receptors in the mPFC may serve to selectively disinhibit aggressive behavior in mice with a history of Alc self-administration.

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Request Reprint E-Mail: sara_faccidomo@med.unc.edu
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