Recognition and management of alcohol misuse in OEF/OIF and other veterans in the VA: A cross-sectional study

Mental health problems have been identified among soldiers serving in Operations Enduring Freedom and Iraqi Freedom (OEF/OIF), but little is known about the prevalence and management of alcohol misuse in OEF/OIF veterans seen in the Veterans Administration health care system (VA).

OEF/OIF men were more likely to screen positive for alcohol misuse than non-OEF/OIF men. Overall, approximately half of those with alcohol misuse had documented BI and/or referral to alcohol treatment suggesting a need for improvement in addressing alcohol misuse in OEF/OIF and other veterans.

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Request Reprint E-Mail: Eric.Hawkins@va.gov

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Genome Wide Association for Addiction: Replicated Results and Comparisons of Two Analytic Approaches

Vulnerabilities to dependence on addictive substances are substantially heritable complex disorders whose underlying genetic architecture is likely to be polygenic, with modest contributions from variants in many individual genes. “Nontemplate” genome wide association (GWA) approaches can identity groups of chromosomal regions and genes that, taken together, are much more likely to contain allelic variants that alter vulnerability to substance dependence than expected by chance.

We report pooled “nontemplate” genome-wide association studies of two independent samples of substance dependent vs control research volunteers (n=1620), one European-American and the other African-American using 1 million SNP (single nucleotide polymorphism) Affymetrix genotyping arrays. We assess convergence between results from these two samples using two related methods that seek clustering of nominally-positive results and assess significance levels with Monte Carlo and permutation approaches. Both “converge then cluster” and “cluster then converge” analyses document convergence between the results obtained from these two independent datasets in ways that are virtually never found by chance. The genes identified in this fashion are also identified by individually-genotyped dbGAP data that compare allele frequencies in cocaine dependent vs control individuals.

These overlapping results identify small chromosomal regions that are also identified by genome wide data from studies of other relevant samples to extents much greater than chance. These chromosomal regions contain more genes related to “cell adhesion” processes than expected by chance. They also contain a number of genes that encode potential targets for anti-addiction pharmacotherapeutics. “Nontemplate” GWA approaches that seek chromosomal regions in which nominally-positive associations are found in multiple independent samples are likely to complement classical, “template” GWA approaches in which “genome wide” levels of significance are sought for SNP data from single case vs control comparisons.

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News Release - Alaska’s fetal alcohol syndrome rate fell 32 percent between 1996-2002

Alaska Native babies were born with fetal alcohol syndrome (FAS) half as often around the year 2000 as they were five to seven years earlier, Department of Health and Social Services researchers found in an analysis of Alaska Birth Defects Registry data. That change brought the state’s overall rate from 1996 to 2002 down by a third, researchers reported in the State of Alaska Epidemiology Bulletin released yesterday.

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Decline in the Birth Prevalence of Fetal Alcohol Syndrome in Alaska

Population-based estimates of fetal alcohol syndrome (FAS) birth prevalence are higher for Alaska than other states using similar and consistent surveillance methodology. Trend analysis is critical to evaluating FAS prevention programs but is problematic because diagnostic and surveillance factors that affect FAS case determination are often inconsistent. The objective of this study was to evaluate overall and population specific FAS birth prevalence trends in Alaska.

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Recovery-Oriented System of Care: A Recovery Community Perspective

The Recovery Oriented Systems of Care (ROSC) Subcommittee was formed as part of the Drug and Alcohol Coalition with the specific charge to develop this White Paper.

The overarching goal of the subcommittee is to improve the system of care offered in Pennsylvania by expanding to a chronic care model of care. This attached White Paper was developed in order to inform the larger Coalition and future efforts in Pennsylvania on this historic endeavor to expand services using a Recovery Oriented System of Care model.

This paper then fits into a larger process to inform and influence service development through the Department of Health, the Department of Public Welfare and beyond.

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Alcohol/Drug/Substance “Abuse”: The History and (Hopeful) Demise of a Pernicious Label

The language used to label alcohol and other drug (AOD) problems exerts a significant influence on people experiencing such problems and on how professional helpers, policy makers, and the public view such people. Whether AOD-related problems are viewed primarily in terms of medicine (illnesses), psychology (habits), sociology (norms), morality (vices), religion (sins), or law (crimes) rests on a choice of concepts and words. America’s enduring and ambivalent relationship with psychoactive drugs is replete with cycles of stigmatization/de-stigmatization/re-stigmatization, criminalization/decriminalization/recriminalization, and medicalization/de-medicalization/re-medicalization. Put simply, we can’t seem to make up our collective minds about these substances and the people who use them to excess. As a result, we have not achieved any enduring consensus on the language that best depicts AOD-related problems (White, 2004).

This brief commentary is about two such word choices—abuse/abuser—whose origins and shortcomings we will explore. We join a growing list of addiction professionals who have advocated the immediate and permanent removal of abuse/abuser from the lexicon of the addictions field and discouragement of their use in broader cultural discussions of AOD problems. Five arguments support this recommendation. . . . . .

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Use of an Electronic Clinical Reminder for Brief Alcohol Counseling is Associated with Resolution of Unhealthy Alcohol Use at Follow-Up Screening

Brief alcohol counseling is a foremost US prevention priority, but no health-care system has implemented it into routine care.

This study evaluated the effectiveness of an electronic clinical reminder for brief alcohol counseling (“reminder”).

The specific aims were to (1) determine the prevalence of use of the reminder and (2) evaluate whether use of the reminder was associated with resolution of unhealthy alcohol use at follow-up screening.

Among 4,198 participants who screened positive for unhealthy alcohol use, 71% had use of the alcohol counseling clinical reminder documented in their medical records. Adjusted proportions of patients who resolved unhealthy alcohol use were 31% (95% CI 30–33%) and 28% (95% CI 25–30%), respectively, for patients with and without reminder use (p-value = 0.031).

The brief alcohol counseling clinical reminder was used for a majority of patients with unhealthy alcohol use and associated with a moderate decrease in drinking at follow-up.

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Request Reprint E-Mail: emily.williams3@va.gov

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The Effects of Current Subsyndromal Psychiatric Symptoms or Past Psychopathology on Alcohol Dependence Treatment Outcomes and Acamprosate Efficacy

This secondary analysis of the first U.S. acamprosate trial (N = 601) for alcohol dependence examines the effects of subsyndromal psychiatric symptoms or history of severe psychopathology on alcoholism treatment outcomes and any mitigating effects of acamprosate.

Psychiatric antecedents were documented using a protocol-specific interview. Current psychiatric symptoms were assessed using Hamilton Anxiety and Depression (HAM-A, HAM-D) rating scales. Predictors of good response, defined as abstinence for ≥90% of trial duration, were identified using logistic regression.

Subsyndromal anxiety (as determined by HAM-A "Anxious Mood" item) and the presence of ≥1 psychiatric antecedent were significant negative predictors of good response. Lower pretreatment drinking intensity, baseline motivation to have abstinence as a goal, and treatment with acamprosate were significant positive predictors of good response.

No significant interactions among predictors were detected, indicating that they are independent, additive factors.

Thus, the beneficial effects of acamprosate treatment in combination with motivational therapy may offset the liabilities for alcoholism recovery that are associated with current anxiety symptoms and/or a significant past psychiatric history.

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Request Reprint E-Mail: mason@scripps.edu
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Age at Regular Drinking, Clinical Course, and Heritability of Alcohol Dependence in the San Francisco Family Study: A Gender Analysis

We examined gender differences in age of onset, clinical course, and heritability of alcohol dependence in 2,524 adults participating in the University of California San Francisco (UCSF) family study of alcoholism.

Men were significantly more likely than women to have initiated regular drinking during adolescence. Onset of regular drinking was not found to be heritable but was found to be significantly associated with a shorter time to onset of alcohol dependence.

A high degree of similarity in the sequence of alcohol-related life events was found between men and women, however, men experienced alcohol dependence symptoms at a younger age and women had a more rapid clinical course. Women were found to have a higher heritability estimate for alcohol dependence (h²= .46) than men (h²= .32).

These findings suggest that environmental factors influencing the initiation of regular drinking rather than genetic factors associated with dependence may in part underlie some of the gender differences seen in the prevalence of alcohol dependence in this population.

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Request Reprint E-Mail: cindye@scripps.edu
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Studentship Grant Scheme 2010

Taught Course Prospectus

The purpose of the scheme is to encourage research in the alcohol field and to improve the quality of service provided for those with drinking problems. These objectives are very much within the aims of the Council.

A small number of Studentships are available for people working in the alcohol field, who wish to acquire appropriate professional qualifications by following a taught course. The Council will make a one-off payment of £1,200 towards the fees for 2010/11 for successful students.

Applications should normally be for studies or courses beginning in the academic year 2010/11. In exceptional circumstances the Council will accept applications to finance existing courses. In such cases the applicant will need to provide a satisfactory progress report from the course tutor or supervisor. The AERC will not fund retrospectively. . . . . .

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Gamma-hydroxybutyrate (GHB) for treatment of alcohol withdrawal and prevention of relapses

Excessive long term alcohol consumption can lead to dependence on alcohol. This means that when a person stops drinking suddenly he or she experiences withdrawal symptoms. The main goals for clinical management of alcohol withdrawal are to minimize the severity of symptoms and facilitate entry into a treatment program so that the person can achieve and maintain abstinence from alcohol.

Symptoms of withdrawal range from tremor, nausea, anxiety, restlessness and insomnia to a more severe form with seizures, hallucinations, agitation and delirium. Progression to coma and cardiac arrest is possible.

Medications include benzodiazepines, anticonvulsants and gamma-hydroxybutyrate, which was first available as a health food and body-building supplement. Reports of adverse events led to its withdrawal for that purpose.

Thirteen randomised controlled trials involving 648 participants were included in this review. Eleven were conducted in Italy. Six trials with a total of 286 participants evaluated the effectiveness of gamma-hydroxybutyric acid (GHB) in reducing withdrawal syndrome. Single studies showed that GHB could reduce withdrawal symptoms when compared to a placebo and Chlormethiazole but with more side effects. No strong differences were observed between GHB and benzodiazepines. In the other comparisons the differences were not statistically significant.

Seven trials involving 362 participants tested the use of GHB to treat alcohol dependence or prevent relapses if a person was already detoxified (mid-term outcomes). GHB was better than naltrexone and Disulfiram in maintaining abstinence and had a better effect on craving than placebo and Disulfiram. Sample sizes in individual trials were generally small (range 17 to 98 participants). The most consistently reported side effect of GHB was dizziness and vertigo, which was clearly dose dependent.

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The NSDUH Report - -Substance Use among Black Adults

Among black adults aged 18 or older, rates of past month alcohol use and binge alcohol use were lower than the national average for adults (44.3 vs. 55.2 percent and 21.7 vs. 24.5 percent, respectively); the rate of past month illicit drug use, however, was higher than the national average (9.5 vs. 7.9 percent).

The rate of need for treatment for an alcohol use problem in the past year among black adults was similar to that of the national average among adults (7.7 and 8.1 percent); however, the rate of need for treatment for an illicit drug use problem was higher among blacks than the national average (4.4 vs. 2.9 percent).

One in seven (14.2 percent) black adults in need of alcohol treatment in the past year and 24.2 percent of those in need of illicit drug treatment received treatment at a specialty facility; both of these rates were higher than the national averages for adults.

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A survey of general practitioners’ knowledge, attitudes and practices regarding the prevention and management of alcohol-related problems: an update o

Alcohol related problems are one of the leading causes of morbidity and premature death. Primary care is ideal for early detection and secondary prevention of alcohol-related problems and brief interventions have been shown to reduce excessive consumption in primary care patients.

However, General Practitioners (GPs) exhibit low levels of formal identification, treatment and referral of patients with alcohol related problems. In a survey carried out in 1999, GPs reported receiving more alcohol-related education than in previous studies, that they were prepared to counsel patients about reducing consumption and that a perceived lack of effectiveness in helping patients change alcohol consumption could be ameliorated by more information, training and support.

However, GPs were little involved in, and poorly motivated to work with, alcohol issues and identification of alcohol problems was hampered by a focus on physical symptoms. Compared to other areas of lifestyle counselling (e.g. smoking cessation, diet and physical activity), GPs reported that the largest gap between their preparedness to intervene and their sense of being a success at changing behaviour was for alcohol issues.

Given that alcohol has risen higher up the public policy agenda, it is timely to assess if personal, organisational and structural factors have altered over time to promote alcohol intervention work.

The aim of this study was therefore to assess the current knowledge, attitudes and practices of GPs concerning brief alcohol intervention and to examine whether these had changed over the last ten years and in light of recent health policy initiatives.

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DRAFT GLOBAL STRATEGY TO REDUCE THE HARMFUL USE OF ALCOHOL

The harmful use of alcohol has a serious effect on public health and is considered to be one of the main risk factors for poor health globally.

In the context of this draft strategy, the concept of the harmful use of alcohol is broad and encompasses the drinking that causes detrimental health and social consequences for the drinker, the people around the drinker and society at large, as well as the patterns of drinking that are associated with increased risk of adverse health outcomes.

The harmful use of alcohol compromises both individual and social development. It can ruin the lives of individuals, devastate families, and damage the fabric of communities.

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The impact of relative residence times on the distribution of heavy drinkers in highly distinct environments

Alcohol consumption is a function of social dynamics, environmental contexts, individuals' preferences and family history.

Empirical surveys have focused primarily on identification of risk factors for high-level drinking but have done little to clarify the underlying mechanisms at work. Also, there have been few attempts to apply nonlinear dynamics to the study of these mechanisms and processes at the population level.

A simple framework where drinking is modeled as a socially contagious process in low- and high-risk connected environments is introduced. Individuals are classified as light, moderate (assumed mobile), and heavy drinkers. Moderate drinkers provide the link between both environments, that is, they are assumed to be the only individuals drinking in both settings.

The focus here is on the effect of moderate drinkers, measured by the proportion of their time spent in “low-” versus “high-” risk drinking environments, on the distribution of drinkers.

A simple model within our contact framework predicts that if the relative residence times of moderate drinkers are distributed randomly between low- and high-risk environments then the proportion of heavy drinkers is likely to be higher than expected.

However, the full story even in a highly simplified setting is not so simple because “strong” local social mixing tends to increase high-risk drinking on its own.

High levels of social interaction between light and moderate drinkers in low-risk environments can diminish the importance of the distribution of relative drinking times on the prevalence of heavy drinking.

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How intelligence and education contribute to substance use: Hints from the Minnesota Twin family study

In old and even middle age, there are associations between physical health and both intelligence and education. This may occur because intelligence and/or education exert effects on lifestyle choices that, in turn, affect later health.

Substance use is one aspect of lifestyle choice in young adulthood that could play such a role. The effects of intelligence and/or education on substance use could be direct and environmental, or indirect due to the presence of confounding genetic and shared family influences.

We used the Minnesota Twin Family Study to distinguish these effects in males and females at age 24.

In contrast to prevailing expectations, there were moderately negative direct nonshared environmental effects of both IQ and education on both smoking and drinking in both males and females.

That is, controlling for family background effects in the form of both genetic and shared environmental influences, both higher IQ and greater education were associated with greater alcohol and nicotine use. These effects were accounted for by alcohol and nicotine use at age 17.

Our results suggest that genetic and family-culture variables confound the associations between intelligence and education and substance use in young adults, rendering them indirect.

Further research is needed to understand the roles of IQ and education in alcohol and nicotine use and their relative impacts on physical health throughout the lifespan.

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Request Reprint E-Mail: wendy.Johnson@ed.ac.uk
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In vivo wireless ethanol vapor detection in the Wistar rat

Traditional alcohol studies measure blood alcohol concentration to elucidate the biomedical factors that contribute to alcohol abuse and alcoholism. These measurements require large and expensive equipment, are labor intensive, and are disruptive to the subject.

To alleviate these problems, we have developed an implantable, wireless biosensor that is capable of measuring alcohol levels for up to 6 weeks.

Ethanol levels were measured in vivo in the interstitial fluid of a Wistar rat after administering 1 and 2 g/kg ethanol by intraperitoneal (IP) injection. The data were transmitted wirelessly using a biosensor selective for alcohol detection. A low-power piezoresistive microcantilever sensor array was used with a polymer coating suitable for measuring ethanol concentrations at 100 % humidity over several hours.

A hydrophobic, vapor permeable nanopore membrane was used to screen liquid and ions while allowing vapor to pass to the sensor from the subcutaneous interstitial fluid.

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Request Reprint E-Mail: ccheney@utk.edu

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A randomised controlled feasibility trial of alcohol consumption and the ability to appropriately use a firearm

To show the feasibility of using a controlled trial to investigate the effect of alcohol on firearm use.

12 subjects enrolled in the trial, completing 160 training scenarios. All subjects in the alcohol arm reached target alcohol level. 33% of placebo subjects reported alcohol consumption. Mechanical malfunction of the simulator occurred in 9 of 160 (5.6%) scenarios. Intoxicated subjects were less accurate, slower to fire in reaction time scenarios, and quicker to fire in scenarios requiring judgement relative to controls.

The feasibility of a randomised, controlled trial exploring the relationship between alcohol consumption and firearm use was shown. The hypothesis that alcohol consumption worsens accuracy and retards judgement about when to use a gun should be tested. Larger trials could inform policies regarding firearm use while intoxicated.

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Request Reprint E-Mail: carrb@upenn.edu

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Don’t lose your snooze - cut back on the booze

Drinkers across England are losing valuable sleep and disrupting vital brain functions without knowing that their boozing is the cause, new research for the Government’s Know Your Limits campaign has today revealed.

More than half (58%) of nearly 2,000 drinkers surveyed by YouGov did not realise that drinking above the recommended daily limits can cause sleep problems, with more men (63%) than women (53%) unaware of the link.

Almost half (45%) of those surveyed admit to experiencing tiredness the day after drinking over the recommended daily limits, but it seems many people don’t realise this could be due to alcohol interfering with their normal, restful sleep. . . . .

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Alcohol Consumption before and after a Significant Reduction of Alcohol Prices in 2004 in Finland: Were the Effects Different across Population Subgro

To examine trends in adult alcohol consumption by age, gender and education from 1982 to 2008 and evaluate the effects that a significant reduction in alcohol prices in 2004 had on alcohol consumption in different population subgroups.

Following the reduction of alcohol prices in 2004, drinking increased among men and women aged 45–64. Among men, both moderate to heavy drinking and heavy episodic drinking increased in the lowest educational group. Among women, moderate to heavy drinking increased mostly in the lowest and intermediate educational groups, while the highest increases for heavy episodic drinking were in the intermediate and highest female educational groups.

Alcohol consumption increased especially among those aged 45–64 and among lower educated people following the reduction in alcohol prices in 2004 in Finland.

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Request Reprint E-Mail: satu.helakorpi@thl.fi
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