Examining Perceived Alcoholism Stigma Effect on Racial-Ethnic Disparities in Treatment and Quality of Life Among Alcoholics

The aim of this study was to examine racial-ethnic differences in perceived stigmatization of former alcoholics and their effect on associations of race-ethnicity with treatment history and psychological function among lifetime alcoholics.

Stigma scores were lowest for Whites and Native Americans, higher for Blacks, and highest for Asians and Hispanics, both in the total population and among lifetime alcoholics. Neither race-ethnicity nor stigma was associated with treatment utilization. Psychological function was negatively associated with stigma, but the impact of stigma on racial-ethnic differences in psychological function fell short of statistical significance.

Stigma may reduce quality of life among those with alcohol dependence, but there is no clear evidence that it affects racial-ethnic differences in quality of life.

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Transitioning Into and Out of Problem Drinking Across Seven Years

The extent to which problem drinkers transition into and out of problem drinking was examined using Markov modeling.

Although all possible patterns were observed, a latent Markov model with heterogeneous transitions and five patterns fit the data. The sampling frame and baseline alcohol severity related to pattern.

The data indicate that, although they do change over time, problem drinkers on the whole are more likely either to remain problem drinkers or to cease to be problem drinkers than they are to move into and out of problem-drinking status. Once they transition out of problem drinking, they are more likely to remain nonproblem drinkers.

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Request Reprint E-Mail: kdelucchi@lppi.ucsf.edu
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Effects of Alcohol- and Cigarette-Use Disorders on Global and Specific Measures of Cognition in Middle-Age Adults

This study examined the effects of alcohol- and tobacco-use disorders on global and specific cognitive abilities in middle age.

Lifetime alcohol- and tobacco-use disorders were not associated with cognition among men. Women having a diagnosis of tobacco dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) performed less well on measures of global cognition and executive functioning. A lifetime diagnosis of DSM-IV alcohol abuse or dependence was associated with higher working memory among women only.

These results demonstrate few negative effects of alcohol-use disorders on midlife cognition, especially if current consumption is light. Differential susceptibility to the effects of cigarette use on cognition was found with women showing greater deficits in visuospatial abilities, processing speed, and executive-functioning abilities.

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Request Reprint E-Mail: kristin-caspers@uiowa.edu

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An Ecological Analysis of Alcohol-Outlet Density and Campus-Reported Violence at 32 U.S. Colleges

The purpose of this study was to assess the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets in a multisite design.

Both on- and off-premise alcohol-outlet densities were associated with the campus rape-offense rate but not with the assault or robbery rates. Student drinking level was associated with both campus rape and assault rates but not with the campus robbery rate.

The apparent effect of on-premise outlet density on campus rape-offense rates was reduced when student drinking level was included in the model, suggesting that the effect of on-premise outlet density may be mediated by student drinking level.

Separate analyses revealed a similar mediational role for off-premise outlet density.

These findings demonstrate that there is a campus-level association between sexual violence and the campus-community alcohol environment.

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Anticipated Versus Actual Alcohol Consumption During 21st Birthday Celebrations

The 21st birthday celebration is often associated with excessive alcohol consumption.

The current study examined whether individuals consume more alcohol than anticipated during their celebration and whether situational factors contribute to prediction errors.

The majority of 21st birthday celebrants consumed more alcohol than they anticipated, with men showing greater prediction error than women. Situational factors were positively associated with the discrepancy between anticipated and actual alcohol consumption.

Drinking shots, drinking at a fast pace, celebrating with influential peers, and engaging in 21st birthday traditions were associated with drinking more alcohol than anticipated during 21st birthday celebrations.

Findings suggest future interventions that target situational factors could reduce excessive 21st birthday drinking.

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Alcohol-Consumption Trajectories and Associated Characteristics Among Adults Older Than Age 50

This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health.

A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

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Request Reprint E-Mail: alyssa.platt@duke.edu
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Retired Status and Older Adults' 10-Year Drinking Trajectories

Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees.

The purpose of this study was to determine the following: (a) the effect of retired status on older adults' 10-year within-person drinking trajectories and (b) whether age, gender, income, health, and problem-drinker status account for or moderate this effect.

Participants' drinking frequency declined moderately over the 10-year interval, and retired status hastened the decline. However, this effect disappeared once covariates were added to the model: Baseline poorer health, lower income, and current problem-drinker status predicted steeper decline in drinking frequency, whereas former problem-drinker status predicted slower decline. Lower income and current drinking problems also predicted steeper declines in amount of alcohol consumed.

There were no statistically significant or uniquely contributive interactions between retired status and age, gender, health, income, or drinking problems for predicting late-life drinking trajectories

Baseline health, income, and problem-drinking history are more important than retired status for predicting older adults' long-term within-person drinking trajectories. These factors--and recency of drinking problems--should be considered in future studies of retirement and late-life drinking patterns.

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Request Reprint E-Mail: penny.brennan@med.va.gov ________________________________________

Drinking patterns, gender and health III: Avoiding versus seeking health care

Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care.

Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.

Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher body mass index, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care.

Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.

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Request Reprint E-Mail: carla.a.green@kpchr.org

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Drinking patterns, gender and health II: Predictors of preventive service use

Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers.

Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until they become ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.

Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol-use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher body mass index (BMI) (negative).

When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.

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Request Reprint E-Mail: carla.a.green@kpchr.org

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Drinking patterns, gender and health I: Attitudes and health practices

Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking.

We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.

Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.

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Request Reprint E-Mail: Carla.A.Green@kpchr.org

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Kerala's love affair with alcohol

People in the southern state of Kerala are the heaviest drinkers in India, and sales of alcohol are rising fast. The BBC's Soutik Biswas examines why. . . . . .

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Move to 0.02 alcohol limit 'inevitable'

Reducing Australia's blood alcohol limit for drivers to 0.02 is probably inevitable, a public health expert says as other prominent academics also voice their support for the move.

Professor Mike Daube, from Western Australia's Curtin University, said the move would send an important and, in many cases, life-saving signal to motorists amid the "national crisis" that was Australia's road toll.

"This is an important proposal that deserves very careful consideration and is probably inevitable over time," said Prof Daube, who is Professor of Health Policy and Director of Curtin's Public Health Advocacy Institute. . . . . .

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A Double-Blind, Placebo-Controlled Trial Combining Sertraline and Naltrexone for Treating Co-Occurring Depression and Alcohol Dependence

Empirical evidence has only weakly supported antidepressant treatment for patients with co-occurring depression and alcohol dependence. While some studies have demonstrated that antidepressants reduce depressive symptoms in individuals with depression and alcohol dependence, most studies have not found antidepressant treatment helpful in reducing excessive drinking in these patients.

The authors provide results from a double-blind, placebo-controlled trial that evaluated the efficacy of combining approved medications for depression (sertraline) and alcohol dependence (naltrexone) in treating patients with both disorders.

The sertraline plus naltrexone combination produced a higher alcohol abstinence rate (53.7%) and demonstrated a longer delay before relapse to heavy drinking (median delay=98 days) than the naltrexone (abstinence rate: 21.3%; delay=29 days), sertraline (abstinence rate: 27.5%; delay=23 days), and placebo (abstinence rate: 23.1%; delay=26 days) groups.

The number of patients in the medication combination group not depressed by the end of treatment (83.3%) approached significance when compared with patients in the other treatment groups.

The serious adverse event rate was 25.9%, with fewer reported with the medication combination (11.9%) than the other treatments.

More depressed alcohol-dependent patients receiving the sertraline plus naltrexone combination achieved abstinence from alcohol, had delayed relapse to heavy drinking, reported fewer serious adverse events, and tended to not be depressed by the end of treatment.

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Request Reprint E-Mail: PETTINATI_H@MAIL.TRC.UPENN.EDU
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TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women

The primary goal of TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women, is to assist substance abuse treatment providers in offering effective, up-to-date treatment to adult women with substance use disorders.

The TIP reviews gender-specific research and best practices beginning with the common patterns of initiation of substance use among women and extending to specific treatment issues and strategies across substance abuse treatment services.

It provides clinical and administrative information to assist counselors, clinical supervisors, program administrators, and others working with female clients with substance use disorders on how they can best respond to the specific treatment needs of women.

Contents

Consensus Panel

Editorial Board

KAP Expert Panel and Federal Government Participants

Foreword

Executive Summary

Chapter 1: Creating the Context

Chapter 2: Patterns of Use: From Initiation to Treatment

Chapter 3: Physiological Effects of Alcohol, Drugs, and Tobacco on Women

Chapter 4: Screening and Assessment

Chapter 5: Treatment Engagement, Placement, and Planning

Chapter 6: Substance Abuse Among Specific Population Groups and Settings

Chapter 7: Substance Abuse Treatment for Women

Chapter 8: Recovery Management and Administrative Considerations

Appendix A: Bibliography

Appendix B: CSAT’s Comprehensive Substance Abuse Treatment Model for Women and Their Children

Appendix C: Screening and Assessment Instruments

Appendix D: Allen Barriers to Treatment Instrument

Appendix E: DSM-IV-TR Criteria for Posttraumatic Stress Disorder

Appendix F: Integration Self-Assessment for Providers

Appendix G: Resource Panel Members

Appendix H: Cultural Competency and Diversity Network Participants

Appendix I: Field Reviewers

Appendix J: Acknowledgments

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Beer and its Non-Alcoholic Compounds: Role in Pancreatic Exocrine Secretion, Alcoholic Pancreatitis and Pancreatic Carcinoma

In this article we provide an overview of the newest data concerning the effect of non-alcoholic constituents of alcoholic beverages, especially of beer, on pancreatic secretion, and their possible role in alcoholic pancreatitis and pancreatic carcinoma.

The data indicate that non-alcoholic constituents of beer stimulate pancreatic enzyme secretion in humans and rats, at least in part, by direct action on pancreatic acinar cells.

Some non-alcoholic compounds of beer, such as quercetin, resveratrol, ellagic acid or catechins, have been shown to be protective against experimentally induced pancreatitis by inhibiting pancreatic secretion, stellate cell activation or by reducing oxidative stress. Quercetin, ellagic acid and resveratrol also show anti-carcinogenic potential in vitro and in vivo.

However, beer contains many more non-alcoholic ingredients. Their relevance in beer-induced functional alterations of pancreatic cells leading to pancreatitis and pancreatic cancer in humans needs to be further evaluated.

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A New View of Alcohol Metabolism and Alcoholism—Role of the High-Km Class Ⅲ Alcohol Dehydrogenase (ADH3)

The conventional view is that alcohol metabolism is carried out by ADH1 (Class I) in the liver. However, it has been suggested that another pathway plays an important role in alcohol metabolism, especially when the level of blood ethanol is high or when drinking is chronic.

Over the past three decades, vigorous attempts to identify the enzyme responsible for the non-ADH1 pathway have focused on the microsomal ethanol oxidizing system (MEOS) and catalase, but have failed to clarify their roles in systemic alcohol metabolism.

Recently, using ADH3-null mutant mice, we demonstrated that ADH3 (Class III), which has a high K_m and is a ubiquitous enzyme of ancient origin, contributes to systemic alcohol metabolism in a dose-dependent manner, thereby diminishing acute alcohol intoxication.

Although the activity of ADH3 toward ethanol is usually low in vitro due to its very high K_m, the catalytic efficiency (k_cat/K_m) is markedly enhanced when the solution hydrophobicity of the reaction medium increases.

Activation of ADH3 by increasing hydrophobicity should also occur in liver cells; a cytoplasmic solution of mouse liver cells was shown to be much more hydrophobic than a buffer solution when using Nile red as a hydrophobicity probe.

When various doses of ethanol are administered to mice, liver ADH3 activity is dynamically regulated through induction or kinetic activation, while ADH1 activity is markedly lower at high doses (3–5 g/kg).

These data suggest that ADH3 plays a dynamic role in alcohol metabolism, either collaborating with ADH1 or compensating for the reduced role of ADH1. A complex two-ADH model that ascribes total liver ADH activity to both ADH1 and ADH3 explains the dose-dependent changes in the pharmacokinetic parameters (b, CL_T, AUC) of blood ethanol very well, suggesting that alcohol metabolism in mice is primarily governed by these two ADHs.

In patients with alcoholic liver disease, liver ADH3 activity increases, while ADH1 activity decreases, as alcohol intake increases. Furthermore, ADH3 is induced in damaged cells that have greater hydrophobicity, whereas ADH1 activity is lower when there is severe liver disease.

These data suggest that chronic binge drinking and the resulting liver disease shifts the key enzyme in alcohol metabolism from low-K_m ADH1 to high-K_m ADH3, thereby reducing the rate of alcohol metabolism.

The interdependent increase in the ADH3/ADH1 activity ratio and AUC may be a factor in the development of alcoholic liver disease. However, the adaptive increase in ADH3 sustains alcohol metabolism, even in patients with alcoholic liver cirrhosis, which makes it possible for them to drink themselves to death.

Thus, the regulation of ADH3 activity may be important in preventing alcoholism development.

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From floated to conventional confidence intervals for the relative risks based on published dose–response data

A dose–response meta-analysis of epidemiological studies can encounter different types of confidence intervals (floated vs. conventional).

This paper illustrates how to back calculate conventional confidence intervals from a set of relative risks reported with floated confidence intervals or floated standard errors.

Furthermore, we provide an implementation of the formulas in a user-friendly program developed for Stata software.

I exemplify the point using published data about alcohol intake and endometrial cancer incidence from the Million Women Study.

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Request Reprint E-Mail: nicola.orsini@ki.se

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Treatment Admissions Reporting Abuse of Both Alcohol and Drugs: 1997-2007

● Between 1997 and 2007, the proportion of substance abuse treatment admissions reporting co-abuse of alcohol and drugs declined from 45.3 to 39.4 percent

● Regardless of which substance was the primary substance of abuse, the most common combinations reported by co-abuse admissions in both 1997 and 2007 were alcohol and marijuana and alcohol and cocaine; however, the proportion of co-abuse admissions reporting alcohol and cocaine decreased between 1997 and 2007, from 51.1 percent to 44.8 percent

● Nearly two thirds of co-abuse admissions had been in treatment at least once before (61.3 in 1997 and 59.6 percent in 2007).

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The relation between different dimensions of alcohol consumption and burden of disease: an overview

As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease.

Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome.

Dose–response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases.

Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries.

For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day).

For several disease and injury categories, the effects were stronger on mortality compared to morbidity.

There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden.

Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes.

Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol–disease relationships.

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Request Reprint E-Mail: jtrehm@aol.com

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Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: molecular mechanisms of carcinogenesis

Esophageal cancer is the eighth most common incident cancer in the world and ranks sixth among all cancers in mortality. Esophageal cancers are classified into two histological types; esophageal squamous cell carcinoma (ESCC), and adenocarcinoma, and the incidences of these types show a striking variety of geographic distribution, possibly reflecting differences in exposure to specific environmental factors.

Both alcohol consumption and cigarette smoking are major risk factors for the development of ESCC. Acetaldehyde is the most toxic ethanol metabolite in alcohol-associated carcinogenesis, while ethanol itself stimulates carcinogenesis by inhibiting DNA methylation and by interacting with retinoid metabolism.

Cigarette smoke contains more than 60 carcinogens and there are strong links between some of these carcinogens and various smoking-induced cancers; these mechanisms are well established.

Synergistic effects of cigarette smoking and alcohol consumption are also observed in carcinogenesis of the upper aerodigestive tract.

Of note, intensive molecular biological studies have revealed the molecular mechanisms involved in the development of ESCC, including genetic and epigenetic alterations. However, a wide range of molecular changes is associated with ESCC, possibly because the esophagus is exposed to many kinds of carcinogens including alcohol and cigarette smoke, and it remains unclear which alterations are the most critical for esophageal carcinogenesis.

This brief review summarizes the general mechanisms of alcohol- and smoking-induced carcinogenesis and then discusses the mechanisms of the development of ESCC, with special attention to alcohol consumption and cigarette smoking.

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Request Reprint E-Mail: ytoh@nk-cc.go.jp
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