Weakening of one more alcohol control pillar: a review of the effects of the alcohol tax cuts in Finland in 2004

Addiction Volume 104 Issue 4, Pages 554 - 563

To review the consequences of the changes in Finnish alcohol policy in 2004, when quotas for travellers' tax-free imports of alcoholic beverages from other European Union (EU) countries were abolished, Estonia joined the EU and excise duties on alcoholic beverages were reduced in Finland by one-third, on average.

Alcohol consumption increased 10% in 2004, clearly more than in the early 2000s. With few exceptions, alcohol-related harms increased. Alcohol-induced liver disease deaths increased the most, by 46% in 2004–06 compared to 2001–03, which indicates a strong effect on pre-2004 heavy drinkers. Consumption and harms increased most among middle-aged and older segments of the population, and harms in the worst-off parts of the population in particular.

Alcohol taxation and alcohol prices affect consumption and related harms, and heavy drinkers are responsive to price. In Finland in 2004, the worst-off parts of the population paid the highest price in terms of health for cuts in alcohol prices. The removal of travellers' import quotas, which was an inherent part of creating the single European market, had serious public health consequences in Finland.

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Request Reprint E-Mail: pia.makela@thl.fi

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Concurrent Illicit Drug and Alcohol Use

Because of possible additive or interactive drug effects, data from SAMHSA's 2006 and 2007 National Surveys on Drug Use and Health were pooled to examine the likelihood of multiple concurrent substance use. The measure used to define concurrent substance use for this report was illicit drug use during or within 2 hours of last alcohol use.

About 6% (7.1 million) of persons age 12 or older who drank alcohol in the past month also reported using an illicit drug during or within 2 hours of their last alcohol drink.

Among past month alcohol drinkers, American Indian or Alaska Natives (11.7%) and Blacks (9.9%) were the most likely racial groups and Native Hawaiian or Other Pacific Islanders (4.2%) and Asians (2.1%) were the least likely racial groups to use an illicit drug concurrently with alcohol.

Youth aged 12 to 17 and young adults aged 18 to 25 were more likely than older persons among the past month alcohol drinkers to drink alcohol concurrently with an illicit drug.

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Alcohol Use and Risk of Pancreatic Cancer

American Journal of Epidemiology Advance Access published online on March 18, 2009

The epidemiologic evidence for the role of alcohol use in pancreatic cancer development is equivocal.

The authors prospectively examined the relation between alcohol use and risk of pancreatic cancer among 470,681 participants who were aged 50–71 years in 1995–1996 in the US National Institutes of Health-AARP Diet and Health Study. The authors identified 1,149 eligible exocrine pancreatic cancer cases through December 2003. Multivariate Cox proportional hazards regression models were used to calculate relative risks and 95% confidence intervals with the referent group being light drinkers

The relative risks of developing pancreatic cancer were 1.45 (95% confidence interval (CI): 1.17, 1.80; Ptrend = 0.002) for heavy total alcohol use (3 drinks/day, 40 g of alcohol/day) and 1.62 (95% CI: 1.24, 2.10; Ptrend = 0.001) for heavy liquor use, compared with the respective referent group. The increased risk with heavy total alcohol use was seen in never smokers (relative risk = 1.35, 95% CI: 0.79, 2.30) and participants who quit smoking 10 or more years ago before baseline (relative risk = 1.41, 95% CI: 1.01, 2.00).

These findings suggest a moderately increased pancreatic cancer risk with heavy alcohol use, particularly liquor; however, residual confounding by cigarette smoking cannot be completely excluded.

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Longitudinal Trends in Hazardous Alcohol Consumption Among Women With Human Immunodeficiency Virus Infection, 1995–2006

American Journal of Epidemiology Advance Access published online on March 6, 2009

Hazardous alcohol consumption among women with human immunodeficiency virus (HIV) infection is associated with several adverse health and behavioral outcomes, but the proportion of HIV-positive women who engage in hazardous drinking over time is unclear.

The authors sought to determine rates of hazardous alcohol consumption among these women over time and to identify factors associated with this behavior. Subjects were 2,770 HIV-positive women recruited from 6 US cities who participated in semiannual follow-up visits in the Women's Interagency HIV Study from 1995 to 2006. Hazardous alcohol consumption was defined as exceeding daily (4 drinks) or weekly (>7 drinks) consumption recommendations.

Over the 11-year follow-up period, 14%–24% of the women reported past-year hazardous drinking, with a slight decrease in hazardous drinking over time. Women were significantly more likely to report hazardous drinking if they were unemployed, were not high school graduates, had been enrolled in the original cohort (1994–1995), had a CD4 cell count of 200–500 cells/mL, were hepatitis C-seropositive, or had symptoms of depression. Approximately 1 in 5 of the women met criteria for hazardous drinking.

Interventions to identify and address hazardous drinking among HIV-positive women are urgently needed.

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Request Reprint E-Mail: cookrl@phhp.ufl.edu

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Role of the HPA Axis and the A118G Polymorphism of the µ-Opioid Receptor in Stress-Induced Drinking Behavior
Alcohol and Alcoholism Advance Access published online on February 24, 2009

The present study sought to investigate the relationship between the HPA axis reactivity to stress, the endogenous opioid system and stress-induced drinking behavior.

In the present study, 74 non-treatment-seeking alcohol-dependent subjects were tested under two mood conditions, neutral and stress, in separate testing sessions. Salivary cortisol measurements were obtained following stress induction and during the neutral control condition. Multiple measurements of alcohol intake, latency to access the alcohol cue and craving for alcohol were obtained during cue-availability testing. In addition, 52 of the study subjects were genotyped for the µ-opioid receptor.

A blunted cortisol response to stress was significantly correlated with increased alcohol intake following stress exposure compared to alcohol intake during the neutral session. There was not a clear correlation between the change in cortisol in response to stress and the change in latency to access alcohol or alcohol craving in response to stress. Carriers of the Asp40 variant of the µ-opioid receptor exhibited a dampened cortisol response to stress, higher alcohol intake and greater craving in response to stress compared to Asn40 homozygotes, although these differences were not statistically significant.

The results of the present study indicate that a blunted biological stress response was correlated with increased drinking in response to stress. The Asp40 variant of the µ-opioid receptor may be associated with this HPA axis hyporeactivity although the small sample size used in the present study did not permit adequate evaluation of this association.

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Request Reprint E-Mail: wpratt@iupui.edu

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Television-supported self-help for problem drinkers: A randomized pragmatic trial
Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 451-457


To test the effectiveness of a television-supported self-help intervention for problem drinking.

Dutch television viewers (N = 181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking.

The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR = 9.4); the effects were maintained in the intervention group at 3-month follow-up.

The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.

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Request Reprint E-Mail: jkramer@trimbos.nl
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Alcohol criteria endorsement and psychiatric and drug use disorders among DUI offenders: Greater severity among women and multiple offenders
Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 432-439

Data from the Collaborative Study on the Genetics of Alcoholism (COGA), a high-risk family study of alcohol dependence, were used to examine differences in alcohol diagnostic criteria endorsement and psychiatric and drug use disorders by gender and by number of DUI offenses.

Individuals with two or more DUIs exhibited greater severity of alcohol dependence than those with none or one DUI. This severity was characterized in three ways: (1) higher endorsement of alcohol diagnostic criterion items, with evidence of greater severity among women, (2) higher prevalence of co-occurring lifetime psychiatric disorders, and (3) higher rates of drug use and of dependence on cocaine, stimulants, and, for women only, marijuana and opiates.

By examining gradations of disorder within a combination of two high-risk indicators, DUI and family vulnerability, this study provides useful information for clinical research about individuals with chronic and severe alcohol problems. In addition, the observed gender differences in this high-risk sample will contribute to the literature on alcohol dependence among women at the more severe end of the dependence spectrum.

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Request Reprint E-Mail: vmccutcheon@wustl.edu
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Family history of alcohol abuse moderates effectiveness of a group motivational enhancement intervention in college women

Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 415-420

This study examined whether a self-reported family history of alcohol abuse (FH+) moderated the effects of a female-specific group motivational enhancement intervention with first-year college women.

First-year college women (N = 287) completed an initial questionnaire and attended an intervention (n = 161) or control (n = 126) group session, of which 118 reported FH+. Repeated measures ANCOVA models were estimated to investigate whether the effectiveness of the intervention varied as a function of one's reported family history of alcohol abuse.

Results revealed that family history of alcohol abuse moderated intervention efficacy. Although the intervention was effective in producing less risky drinking relative to controls, among those participants who received the intervention, FH+ women drank less across five weeks of follow-up than FH− women.

The current findings provide preliminary support for the differential effectiveness of motivational enhancement interventions with FH+ women.

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Request Reprint E-Mail: jlabrie@lmu.edu

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Validation of the Dutch version of the brief young adult alcohol consequences questionnaire (B-YAACQ)

Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 411-414

The purpose of this study was to validate the Dutch version of the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ).

Data from 667 undergraduate and graduate students (184 men and 483 women) who reported alcohol use during the past year was used in the analysis. On average, students in this study report 4.7 alcohol-related consequences. The Dutch B-YAACQ was shown to have a high reliability and validity: Cronbach's Alpha was 0.816, and B-YAACQ scores correlated significantly with AUDIT-PC scores (r = 0.747). B-YAACQ scores correlated significantly

The Dutch B-YAACQ is a useful new tool for screening of alcohol-related consequences.

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Request Reprint E-Mail: j.c.verster@uu.nl

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New insights into the genetics of addiction

Nature Reviews Genetics, advance online publication, 24 February 2009

Drug addiction is a common brain disorder that is extremely costly to the individual and to society. Genetics contributes significantly to vulnerability to this disorder, but identification of susceptibility genes has been slow. Recent genome-wide linkage and association studies have implicated several regions and genes in addiction to various substances, including alcohol and, more recently, tobacco. Current efforts aim not only to replicate these findings in independent samples but also to determine the functional mechanisms of these genes and variants.

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Request Reprint E-Mail: Ming_Li@virginia.edu

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Interaction between dopamine D2 receptor genotype and parental rule-setting in adolescent alcohol use: evidence for a gene-parenting interaction

Molecular Psychiatry advance online publication 24 February 2009

Association studies investigating the link between the dopamine D2 receptor gene (DRD2) and alcohol (mis)use have shown inconsistent results. This may be due to lack of attention for environmental factors. High levels of parental rule-setting are associated with lower levels of adolescent alcohol use and delay of initiation of drinking.

We tested whether DRD2 TaqI A (rs1800497) genotype interacts with alcohol-specific parenting practices in predicting the uptake of regular adolescent alcohol use.

Parental rule-setting was directly and inversely related to adolescent alcohol use over time.

For DRD2 genotype no significant main effect was found. DRD2 genotype interacted with parental rule-setting on adolescent alcohol use over time: adolescents, with parents highly permissive toward alcohol consumption and carrying a genotype with the DRD2 A1 (rs1800497T) allele, used significantly more alcohol over time than adolescents without these characteristics.

The DRD2 genotype may pose an increased risk for alcohol use and abuse, depending on the presence of environmental risk factors, such as alcohol-specific parenting.

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Request Reprint E-Mail: C.vanderZwaluw@bsi.ru.nl_

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Finland's u-turn on alcohol tax



Health ministers are describing drinking as the new smoking amid rising concern about the price of alcohol in the UK.

The Scottish government has suggested a range of radical measures, including a minimum price per unit of alcohol.

After a public consultation they are due to respond with more detailed proposals for legislation later this month.

The idea of minimum pricing is supported by medical organisations and charities, but opposed by retailers who say moderate drinkers would be unfairly penalised.

The Scottish government says the connection between price and consumption is backed by international evidence, including the recent experience of Finland.

Tax cut
In 2004 tax on alcohol in Finland was dramatically reduced, leading to price reductions of up to a third, depending on the type of alcohol.

Health campaigners say alcohol related harm visibly increased within the space of two or three years.
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Moderate Alcohol Intake and Cancer Incidence in Women

Journal of the National Cancer Institute Advance Access published online on February 24, 2009

With the exception of breast cancer, little is known about the effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk in women.

A quarter of the cohort reported drinking no alcohol; 98% of drinkers consumed fewer than 21 drinks per week, with drinkers consuming an average of 10 g alcohol (1 drink) per day. During an average 7.2 years of follow-up per woman 68 775 invasive cancers occurred. Increasing alcohol consumption was associated with increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, Ptrend < .001), esophagus (22%, 95% CI = 8% to 38%, Ptrend = .002), larynx (44%, 95% CI = 10% to 88%, Ptrend = .008), rectum (10%, 95% CI = 2% to 18%, Ptrend = .02), liver (24%, 95% CI = 2% to 51%, Ptrend = .03), breast (12%, 95% CI = 9% to 14%, Ptrend < .001), and total cancer (6%, 95% CI = 4% to 7%, Ptrend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers (Pheterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer (Ptrend = .005), non–Hodgkin lymphoma (Ptrend = .001), and renal cell carcinoma (Ptrend = .03).

Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75.

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Request Reprint E-Mail: naomi.allen@ceu.ox.ac.uk

Alcohol Intake and Cigarette Smoking and Risk of a Contralateral Breast Cancer

American Journal of Epidemiology Advance Access published online on February 11, 2009

Women with primary breast cancer are at increased risk of developing second primary breast cancer. Few studies have evaluated risk factors for the development of asynchronous contralateral breast cancer in women with breast cancer.

In the Women's Environmental Cancer and Radiation Epidemiology Study (1985–2001), the roles of alcohol and smoking were examined in 708 women with asynchronous contralateral breast cancer (cases) compared with 1,399 women with unilateral breast cancer (controls).

Ever regular drinking was associated with an increased risk of asynchronous contralateral breast cancer (rate ratio = 1.3, 95% confidence interval: 1.0, 1.6), and the risk increased with increasing duration (P = 0.03). Smoking was not related to asynchronous contralateral breast cancer.

In this, the largest study of asynchronous contralateral breast cancer to date, alcohol is a risk factor for the disease, as it is for a first primary breast cancer.

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Request Reprint E-Mail: knight@lunenfeld.ca

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Sequence Variations of the Human MPDZ Gene and Association With Alcoholism in Subjects With European Ancestry

Alcoholism: Clinical and Experimental Research Published Online: 28 Jan 2009

Mpdz gene variations are known contributors of acute alcohol withdrawal severity and seizures in mice.

Sixty-seven new, mostly rare variants were discovered in the human MPDZ gene. Sequence comparison revealed that the human gene does not have variations identical to those comprising Mpdz gene haplotype associated with AWS in mice. We also found no significant association between MPDZ haplotypes and AWS in humans. However, a global test of haplotype association revealed a significant difference in haplotype frequencies between alcohol-dependent subjects without AWS and Coriell controls (p = 0.015), suggesting a potential role of MPDZ in alcoholism and/or related phenotypes other than AWS. Haplotype-specific tests for the most common haplotypes (frequency > 0.05), revealed a specific high-risk haplotype (p = 0.006, maximum statistic p = 0.051), containing rs13297480G allele also found to be significantly more prevalent in alcoholics without AWS compared with nonalcoholic Coriell subjects (p = 0.019).

Sequencing of MPDZ gene in individuals with EA ancestry revealed no variations in the sites identical to those associated with AWS in mice. Exploratory haplotype and single SNP association analyses suggest a possible association between the MPDZ gene and alcohol dependence but not AWS.

Further functional genomic analysis of MPDZ variants and investigation of their association with a broader array of alcoholism-related phenotypes could reveal additional genetic markers of alcoholism.

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Request Reprint E-Mail: karpyak.victor@mayo.edu

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Media coverage of celebrity DUIs: teachable moments or problematic social modeling?
Alcohol and Alcoholism Advance Access published online on0 on February 16, 2009

Alcohol in the media influences norms around use, particularly for young people. A recent spate of celebrity arrests for drinking and driving (DUI) has received considerable media attention. We asked whether these newsworthy events serve as teachable moments or problematic social modeling for young women. .

Stories were brief, episodic and focused around glamorous celebrity images. They included routine discussion of the consequences of the DUI for the individual celebrities without much evidence of a consideration of the public health dimensions of drinking and driving or possible prevention measures.

Our analysis found little material in the media coverage that dealt with preventing injury or promoting individual and collective responsibility for ensuring such protection. Media attention to such newsworthy events is a missed opportunity that can and should be addressed through media advocacy efforts.

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Request Reprint E-Mail: kasmith@jhsph.edu
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Alcohol, Gestation and Breastfeeding: Selenium as an Antioxidant Therapy
Alcohol and Alcoholism Advance Access published online on February 12, 2009

The aim of this paper is to study the relationship between alcohol, selenium and oxidative stress in breastfeeding rat pups exposed to ethanol during gestation and lactation. We have also studied how a Se-supplemented diet among mothers could prevent different oxidative liver disorders in the pups.

In the liver of pups, exposure to ethanol provoked a decrease in selenium and GPx activity and an increase in GR and CAT activity, as well as in carbonyl groups in protein. A pups had higher Se levels and GPx activity in serum than C pups. Administering Se with alcohol balances the activities of scavenging enzymes and reduces peroxidation protein products.

These results suggest that selenium could be effective in neutralizing the damage of ethanol consumption during gestation and lactation in pups since it repairs selenium levels in liver as well as the activity of scavenging enzymes and peroxidation protein products. In serum, Se also recovers GPx activity and increases the levels of Se that are available to other organs.

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Request Reprint E-Mail: olimpia@us.es
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The TEDS Report: Treatment Outcomes among Clients Discharged from Residential Substance Abuse Treatment:

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  SAMHSA's annual Treatment Episode Data Set (TEDS) provides data on completion rates by race, gender, primary substance of abuse, and type of residential treatment for those with discharge information provided by the States for their specialty substance abuse treatment facilities.


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  In 2005, clients discharged from short-term residential treatment (30 days or less) were more likely to complete treatment than those discharged from long-term residential treatment (57% vs. 38%).


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  Among short-term residential treatment discharges, a higher proportion of American Indian/Alaska Natives (63%) and Asian/Pacific Islanders (60%) completed treatment than Whites (57%), Blacks (55%), or Hispanics (52%).


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  Clients who reported alcohol as their primary drug of abuse were more likely to complete treatment among residential short-term discharges (66%) and long-term discharges (46%) than those with other primary drugs of abuse.


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  Discharged clients who reported stimulants as their primary drug of abuse were the least likely to complete short-term residential treatment (46%) and were almost as likely (19%) as those reporting opiates (21%) as their primary drug to drop out of short-term residential treatment.


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  Treatment completion among clients discharged from long-term residential treatment was lowest among those reporting cocaine abuse (33%) or opiate abuse (35%) as their primary drug of abuse.

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Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans

American Journal of Public Health March 2009, Vol 99, No. 3, 540-548

We compared the health of older US, English, and other European adults, stratified by wealth.

American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

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Request Reprint E-Mail: m.avendanopabon@erasmusmc.nl

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Curbing Problem Drinking with Personalized-Feedback Interventions: A Meta-Analysis

American Journal of Preventive MedicineVolume 36, Issue 3, March 2009, Pages 247-255

The effectiveness of personalized-feedback interventions to reduce problem drinking has been evaluated in several RCTs and systematic reviews.

A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalized-feedback interventions without therapeutic guidance.

The selection and analyses of studies were conducted in 2008. Fourteen RCTs of single-session personalized-feedback interventions without therapeutic guidance were identified, and their combined effectiveness on the reduction of problematic alcohol consumption was evaluated in a meta-analysis. Alcohol consumption was the primary outcome measure.

The use of single-session personalized-feedback interventions without therapeutic guidance appears to be a viable and probably cost-effective option for reducing problem drinking in student and general populations. The Internet offers ample opportunities to deliver personalized-feedback interventions on a broad scale, and problem drinkers are known to be amenable to Internet-based interventions. More research is needed on the long-term effectiveness of personalized-feedback interventions for problem drinking, on its potential as a first step in a stepped-care approach, and on its effectiveness with other groups (such as youth obliged to use judicial service programs because of violations of minimum-age drinking laws) and in other settings (such as primary care).

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Request Reprint E-Mail: hriper@trimbos.nl

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