National Survey of Substance Abuse Treatment Services (N-SSATS): 2008 Data on Substance Abuse Treatment Facilities (S-49)

This report presents tabular information and highlights from the 2007 National Survey of Substance Abuse Treatment Services (N-SSATS), conducted between March and October 2008, with a reference data of Marcy 30, 2008.

It is the 31st in a series of national surveys begun in the 1970s. The surveys were designed to collect data on the location, characteristics, and utilization of alcohol and drug treatment facilities and services throughout the 50 States, the District of Columbia, and other U.S. jurisdictions.

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4th national alcohol conference: presentations availablefrom Alcohol Policy UK

In November last year, the Home Office, Department of Health and Department of Children, Schools and Families in partnership with colleagues in the North West hosted the 4th National Alcohol Conference, “Safe Sensible Social: Supporting Delivery” in Liverpool. . . . . .

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Mechanisms of behavior change in alcoholics anonymous: does Alcoholics Anonymous lead to better alcohol use outcomes by reducing depression symptoms?

Indices of negative affect, such as depression, have been implicated in stress-induced pathways to alcohol relapse. Empirically supported continuing care resources, such as Alcoholics Anonymous (AA), emphasize reducing negative affect to reduce relapse risk, but little research has been conducted to examine putative affective mechanisms of AA's effects.

Findings revealed elevated levels of depression compared to the general population, which decreased during treatment and then remained stable over follow-up. Greater AA attendance was associated with better subsequent alcohol use outcomes and decreased depression. Greater depression was associated with heavier and more frequent drinking. Lagged mediation analyses revealed that the effects of AA on alcohol use was mediated partially by reductions in depression symptoms. However, this salutary effect on depression itself appeared to be explained by AA's proximal effect on reducing concurrent drinking.

AA attendance was associated both concurrently and predictively with improved alcohol outcomes. Although AA attendance was associated additionally with subsequent improvements in depression, it did not predict such improvements over and above concurrent alcohol use. AA appears to lead both to improvements in alcohol use and psychological and emotional wellbeing which, in turn, may reinforce further abstinence and recovery-related change.

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Failure of self regulation of UK alcohol advertising

Research has established that alcohol advertising,^{1 2 3} like that for tobacco⁴ and fast food,^{5 6 7} influences behaviour. It encourages young people to drink alcohol sooner and in greater quantities. From a public health perspective, advertising of alcohol should clearly be limited. The United Kingdom has opted for a system of self regulatory controls that focuses primarily on the content of advertisements, with some limitations on the channels that can be used. This is overseen by the Advertising Standards Authority, through the Committee of Advertising Practice, which represents the interests of advertisers, agencies, and media owners.

As part of its alcohol inquiry, the House of Commons health select committee wanted to explore the success of self regulation. It obtained a large number of internal marketing documents from alcohol producers and their communications agencies in order to examine the thinking and strategic planning that underpin alcohol advertising and hence show not just what advertisers are saying, but why they are saying it. Here we present the key insights to emerge. . . . .

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Preventing alcohol related harm to health

Alcohol misuse poses a huge public health problem, particularly in Europe. More than a fifth of European adults admit to binge drinking (five or more drinks on one occasion, or 50 g alcohol) at least once a week; of all World Health Organization regions Europe has the greatest proportion of alcohol related ill health and premature death; and the overall social cost of alcohol to the European Union is around 125bn (£110bn; $180bn) a year.¹ In Scotland alone, adults drink the equivalent of 46 bottles of vodka, or 537 pints of beer, or 130 bottles of wine each a year.² In England, more than a quarter of adults drink at hazardous levels, and the NHS spends £2.7bn a year on treating alcohol related conditions,³ while the overall cost to society of alcohol use each year amounts to around £20bn. ⁴ It is no wonder, however, that so many people drink so . . .

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Drinking at the last chance saloon

Distinguished voices are lining up behind England’s chief medical officer Liam Donaldson in support of a minimum price for alcohol The BMA and the Royal College of Physicians have made a good case and this week they are joined by the combined weight of the Faculty of Public Health and the Royal Society for Public Health. These two bodies list a minimum price for alcohol among 12 policy changes that will save many lives and relieve pressure on the NHS. As the faculty’s president Alan Maryon-Davies says, in lean times such action is all the more essential.

The BMJ supports calls for a minimum price on alcohol, as well as for a ban on alcohol advertising and sponsorship. In her editorial, deputy editor Trish Groves highlights evidence on the damage caused by the fall in price and increase in availability of alcohol over the past 20 years . She concludes that the serious health and societal costs of alcohol misuse are best prevented through legislation on pricing and marketing. . . . .

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Partners in treatment: relational psychoanalysis and harm reduction therapy

A relational psychoanalytic harm reduction orientation to the treatment of substance misusers is presented and illustrated with a clinical example.

Both harm reduction therapy and relational psychoanalysis rely on a two-person model in which the therapist and client are collaborators in the treatment. In both, substance use is seen in the context of the user's internal psychodynamics and external environment, and there is an emphasis on treating the person as a whole individual whose substance use is one aspect of life, rather than focusing on the substance use itself as was often done in the past.

Historically, psychoanalysis and substance abuse treatment were so different from each other that their paths rarely crossed. The introduction of harm reduction therapy to substance abuse and the relational orientation in psychoanalysis have brought the fields closer together such that the valuable contributions that each can make to the other can now be appreciated.

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Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality

Harm reduction is a new paradigm that seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence.

This article discusses integrative harm reduction psychotherapy, one application of harm reduction principles to psychotherapy. Seven therapeutic tasks are described with attention to clinical process, skills, and strategies.

A case is presented that illustrates the application of this approach with life-threatening substance use that was related to multiple trauma and suicidal depression.

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Regulatory Accessibility and Social Influences on State Self-Control

The current work examined how social factors influence self-control. Current conceptions of state self-control treat it largely as a function of regulatory capacity.

The authors propose that state self-control might also be influenced by social factors because of regulatory accessibility.

Studies 1 through 4 provide evidence that individuals’ state self-control is influenced by the trait and state self-control of salient others such that thinking of others with good trait or state self-control leads to increases in state self-control and thinking of others with bad trait or state self-control leads to decreases in state self-control. Study 5 provides evidence that the salience of significant others influences both regulatory accessibility and state self-control.

Combined, these studies suggest that the effects of social influences on state self-control occur through multiple mechanisms.

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Maternal Ethanol Consumption Alters the Epigenotype and the Phenotype of Offspring in a Mouse Model

Recent studies have shown that exposure to some nutritional supplements and chemicals in utero can affect the epigenome of the developing mouse embryo, resulting in adult disease.

Our hypothesis is that epigenetics is also involved in the gestational programming of adult phenotype by alcohol.

We have developed a model of gestational ethanol exposure in the mouse based on maternal ad libitum ingestion of 10% (v/v) ethanol between gestational days 0.5–8.5 and observed changes in the expression of an epigenetically-sensitive allele, Agouti viable yellow (A^vy), in the offspring.

We found that exposure to ethanol increases the probability of transcriptional silencing at this locus, resulting in more mice with an agouti-colored coat. As expected, transcriptional silencing correlated with hypermethylation at A^vy.

This demonstrates, for the first time, that ethanol can affect adult phenotype by altering the epigenotype of the early embryo. Interestingly, we also detected postnatal growth restriction and craniofacial dysmorphology reminiscent of fetal alcohol syndrome, in congenic a/a siblings of the A^vy mice.

These findings suggest that moderate ethanol exposure in utero is capable of inducing changes in the expression of genes other than A^vy, a conclusion supported by our genome-wide analysis of gene expression in these mice. In addition, offspring of female mice given free access to 10% (v/v) ethanol for four days per week for ten weeks prior to conception also showed increased transcriptional silencing of the A^vy allele.

Our work raises the possibility of a role for epigenetics in the etiology of fetal alcohol spectrum disorders, and it provides a mouse model that will be a useful resource in the continued efforts to understand the consequences of gestational alcohol exposure at the molecular level.

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Neural Substrates of Alcohol-Induced Smoking Urge in Heavy Drinking Nondaily Smokers

A strong link exists between cigarette smoking and alcohol use, which may be explained by the experimental observation that alcohol ingestion promotes cigarette craving and precipitates smoking.

At the neuroanatomic level, it is unclear where and how alcohol exerts these effects, although the process likely involves the ventral striatum given its function in motivational salience and appetitive reinforcement.

In a double-blinded, placebo-controlled, crossover study, heavy drinking nondaily social smokers (ie, light smokers or ‘chippers’) were examined using functional magnetic resonance imaging after they ingested an acute dose of alcohol or placebo. We probed reactivity in the ventral striatum and other brain regions during exposure to visual smoking vs nonsmoking control cues.

We found that alcohol enhanced self-reported ratings of desire to smoke, and in this context, significantly increased ventral striatum responses to smoking compared with control cues.

In exploratory analyses, we observed that alcohol dampened orbitofrontal activity across both cue types, whereas dorsolateral prefrontal and anterior cingulate cortex activation to smoking cues was not affected by alcohol.

This study bridges a pharmacological challenge approach to the study of brain reactivity to smoking cues, extends prior cigarette cue imaging studies to nondependent smokers, and elucidates a potential neurobiological mechanism to explain the co-consumption of alcohol and cigarettes in nondependent users.

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Separable Roles of the Nucleus Accumbens Core and Shell in Context- and Cue-Induced Alcohol-Seeking

Conditioned responding to drug-predictive discrete cues can be strongly modulated by drug-associated contexts.

We tested the hypothesis that differential recruitment of the nucleus accumbens (NAc) core and shell mediates responding to drug cues in a drug vs non-drug context.

Rats were trained to discriminate between two 10-s auditory stimuli: one stimulus (CS+) was paired with ethanol (10% v/v; 0.2 ml; oral) whereas the other (CS−) was not. Training occurred in operant conditioning chambers distinguished by contextual stimuli, and resulted in increased entries into the ethanol delivery port during the CS+ when compared with the CS−. In experiment 1, port entries were then extinguished in a second context by withholding ethanol, after which context-induced renewal of ethanol-seeking was tested by presenting both stimuli without ethanol in the previous training context. This manipulation stimulated strong responding to the CS+ in rats pretreated with saline in the core (n=9) or shell (n=10), which was attenuated by pharmacologically inactivating (muscimol/baclofen; 0.1/1.0 mM; 0.3 μl/side) either subregion pretest. In experiment 2, after discrimination, training rats were habituated to a different context in which ethanol and both stimuli were withheld. Cue-induced ethanol-seeking was then elicited by presenting the CS+ and CS− without ethanol in the different context. Saline-pretreated rats responded more to the CS+ than the CS− (core n=8; shell n=9), and inactivating the core but not shell attenuated this effect.

These data highlight an important role for the core in cue-induced ethanol-seeking, and suggest that the shell is required to mediate the influence of contexts on conditioned ethanol-seeking.

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ICAP Periodic Review on Drinking and Culture

Alcohol consumption is an integral part of the social fabric in many countries. Yet the role occupied by drinking is quite different across countries and cultures, and is reflected in local customs, patterns, and attitudes. Despite this wide diversity, the lingua franca of the alcohol field is English, as are the publications that provide the evidence base most commonly used in international policy discussions. As a result, much of the research published in other languages and reflecting different cultural contexts and approaches escapes broader notice.

The ICAP Periodic Review on Drinking and Culture is an electronic publication that seeks to help remedy this disparity. Its key objectives are to:

1. give greater exposure to research not currently published or widely available in English;
2. broaden the range of cultural perspectives and the evidence base used in the crafting of policy and prevention.

Each issue of the Periodic Review presents English translations of abstracts of publications appearing in language areas currently underrepresented in major English-language research databases. Coverage of the Periodic Review is limited to psychosocial and socio-cultural research, to focus on drinking culture, behavior, patterns, and psychosocial outcomes.

Identification and selection of key research to be featured and all editorial decisions are carried out by an Editorial Group, consisting of experts from diverse geographic, linguistic, and disciplinary areas

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A grandparent-influenced locus for alcohol preference on mouse chromosome 2.

Loci on mouse chromosome 2 have previously been associated with ethanol consumption. Here, we used a limited access choice paradigm in which mice consume large quantities of ethanol (2–3 g/kg/2 h) with a high preference (>80%). In addition, mouse chromosome substitution strains were used to further evaluate the contribution of chromosome 2 to ethanol consumption.

Using a limited access choice paradigm, we found that mouse chromosome 2 carries an allelic variant of a locus for ethanol intake and a distinct locus selective for ethanol preference. The heritability of alcoholism has been suggested to be parent-specific, perhaps resulting from genetic imprinting. Our findings suggest that grandparent-influenced vulnerability for ethanol consumption is conferred by genes on chromosome 2, providing important new leads to enhance our understanding of the heritability of alcoholism.

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The association between time perspective and alcohol consumption in university students: cross-sectional study

Heavy alcohol consumption is associated with significant morbidity and mortality. Levels of alcohol consumption among students and young people are particularly high. Time perspective describes the varying value individuals place on outcomes in the present and future. In general, it has been found that individuals prefer to receive a gain today rather than in the future. There is evidence that time perspective is associated with addictive health behaviours, including alcoholism and cigarette smoking, but less evidence of its association with non-addictive, but hazardous, levels of alcohol consumption.

The objective was to determine if there is an association between time perspective and hazardous alcohol consumption. Hazardous alcohol consumption was reported by 264 (82%) respondents. After controlling for potential confounding by socio-demographic variables, greater consideration of future consequences was associated with lower odds of reporting hazardous drinking ,

Interventions aimed at increasing future orientated time perspective may be effective in decreasing hazardous alcohol consumption in students.

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The Effectiveness of Tax Policy Interventions for Reducing Excessive Alcohol Consumption and Related Harms

A systematic review of the literature to assess the effectiveness of alcohol tax policy interventions for reducing excessive alcohol consumption and related harms was conducted for the Guide to Community Preventive Services (Community Guide).

Seventy-two papers or technical reports, which were published prior to July 2005, met specified quality criteria, and included evaluation outcomes relevant to public health (e.g., binge drinking, alcohol-related crash fatalities), were included in the final review.

Nearly all studies, including those with different study designs, found that there was an inverse relationship between the tax or price of alcohol and indices of excessive drinking or alcohol-related health outcomes.

Among studies restricted to underage populations, most found that increased taxes were also significantly associated with reduced consumption and alcohol-related harms.

According to Community Guide rules of evidence, these results constitute strong evidence that raising alcohol excise taxes is an effective strategy for reducing excessive alcohol consumption and related harms.

The impact of a potential tax increase is expected to be proportional to its magnitude and to be modified by such factors as disposable income and the demand elasticity for alcohol among various population groups.

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The Intensity of Binge Alcohol Consumption Among U.S. Adults

Binge drinking (consuming five or more drinks during a drinking occasion) is responsible for more than half of the 79,000 annual deaths due to excessive drinking in the U.S. Although studies show a strong dose–response relationship between the intensity of binge drinking (i.e., the number of drinks consumed per binge episode) and adverse outcomes, there are no population-based studies assessing this measure,

Binge drinkers consumed an average of 8.0 drinks (median 6) during their most recent binge drinking episode; 70.0% of binge drinkers consumed six or more drinks, and 38.4% consumed eight or more drinks. Men consumed more drinks during their last binge episode than women (M=8.3 vs 7.0, median=7 vs 6), and those aged 18–34 years consumed more drinks than those aged >34 years for both men and women. Independent risk factors for consuming eight or more drinks included being male; being aged <35>

Most adult binge drinkers drink in excess of the five-drink threshold defining this risky behavior. The intensity of binge drinking should be monitored regularly by health agencies to improve surveillance and to better assess the impact of interventions designed to reduce binge drinking and its consequences.

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Excerpts from Transcript of Meeting on Measures to Reduce Alcohol Consumption in Russia

PRESIDENT OF RUSSIA DMITRY MEDVEDEV: Colleagues,

As was agreed a while ago, we are meeting today in expanded format to discuss measures for fighting alcoholism. At the State Council meeting on youth policy we agreed to address this subject separately, in detail, and make the necessary decisions.

You know just how serious a problem alcoholism has become for our country. Frankly speaking, it has taken on the proportions of a national disaster. According to the Healthcare and Social Development Ministry’s statistics, per capita alcohol consumption in Russia – taking the whole population, including babies – now stands at 18 litres of pure alcohol a year. You can calculate for yourselves how many bottles of vodka this means – quite simply alarming. This is more than twice the level that the World Health Organisation defines as dangerous for people’s health and lives. Such a high level is quite simply a real threat to our country’s and people’s normal life.

We have taken various measures over these last years of course. Tighter rules on production and sale of alcoholic beverages were introduced, and significant restrictions were imposed on their advertising. Tougher penalties were introduced for drunk driving. But so far, we have not seen any real change in the situation. To be really honest, all of these efforts have had no real effect at all. Let’s be up front about this. All they have done is brought some order to the situation. . . . . .

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Substance Use Disorders and Risk for Completed Suicide

Substance use disorders are among the most frequent psychiatric disorders found in suicides. In psychological autopsy studies between 19% and 63% of all suicides suffered from substance use disorders, mostly from alcohol use disorders.

Suicide risk is highly increased in substance use disorders, particularly in alcohol use disorders, and in co-morbid alcoholism and depression. So far, some risk factors for suicide have been identified in alcoholism. Nevertheless, various questions about the relationship between substance use disorders and suicide remain open, which indicate directions for future research.

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SCIENCE AND INDUSTRY: COMMENTS ON THE COMMENTARIES

We appreciate the thoughtful, diverse and engaging comments on our paper [1] by these distinguished alcohol academicians. We are even more grateful for the opportunity to respond.

First, we agree with Professor Heath's comments [2] that alcohol is known to have social as well as medical benefits, and that we could learn much by studying its benefits. However, given the increasing involvement of industry in alcohol science, studies of positive effects of drinking would be more trustworthy if they are not funded by the industry. We absolutely agree with Tanya Chikritzhs [3] and others that addiction journals have a crucial role to play as gatekeepers and that there is need for more research on conflict of interest declarations, as well as on all kinds of bias in alcohol research. . . . . .

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