Patterns and Predictors of Late-Life Drinking Trajectories: A 10-Year Longitudinal Study

This study examines the extent of group-level and intra-individual decline in alcohol consumption among adults as they traverse a 10-year interval spanning late-middle to early-old age.

Further, it identifies key baseline predictors of these adults' 10-year drinking trajectories.

Community residents (n = 1,291; age 55 to 65 years at baseline) were assessed at 4 points over a 10-year interval on demographic and health characteristics, coping responses, social context, and alcohol consumption.

Descriptive cross-wave statistics, and multilevel regression analyses, indicated that in the sample overall, participants' 10-year patterns of alcohol consumption were relatively stable.

However, men's patterns, and those of individuals drinking beyond recommended alcohol consumption guidelines at baseline, were more variable and showed steeper rates of decline, than did those of women and individuals drinking within recommended levels.

Contrary to expectation baseline use of substances to reduce tension and heavier reliance on avoidance coping predicted faster rate of decline in alcohol consumption.

Post hoc prospective mediation analyses suggested that this may have occurred because these and other baseline predictors heighten risk of developing new health problems which, in turn, motivate reduced alcohol consumption.

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

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A meta-analysis of the effectiveness of placebo manipulations in alcohol-challenge studies.

Our meta-analysis examined the impact of specific alcohol placebo procedures on two manipulation checks (participant reports of number of alcohol drinks consumed and subjective intoxication) to determine which procedures produced the smallest effect sizes in comparisons between alcohol and placebo conditions.

Databases for the years 1990–2007 yielded 44 studies that met inclusion criteria. These were subjected to detailed coding of procedures pertinent to placebo effectiveness.

Alcohol versus placebo condition comparisons generally produced large effect sizes for both manipulation checks, but they were moderated by double-blind procedures and by peak breath-alcohol concentration (BrAC) attained in the alcohol condition.

Other procedures moderated only the estimated number of alcohol drinks consumed.

Implications for selection and assessment of alcohol placebo manipulations and for interpretability of experiments using them are discussed.


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Request Reprint E-Mail: allang@psy.fsu.edu


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The social norms of alcohol-related negative consequences.

Social norms for alcohol use are important influences on individual college student drinking.

The present study extends social norms research by examining alcohol-related consequences and, in particular, whether similar misperceptions exist regarding the frequency and evaluation of these consequences over time.

College student drinkers (N = 624) participating in a longitudinal study completed Web-based surveys assessing alcohol use and related consequences, as well as their beliefs about frequency and evaluation of consequences for the typical college student.

Findings suggest that students overestimated how often typical college students experience negative consequences and underestimated how negatively other students evaluated those consequences.

Finally, results support a bidirectional model for alcohol-related consequences, possibly indicating a reciprocal, mutually influential feed-forward loop of norms and consequences that promotes maintenance of college student drinking and consequences.


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Request Reprint E-Mail: leecm@u.washington.edu


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Alcohol, Athletic Performance and Recovery

Alcohol consumption within elite sport has been continually reported both anecdotally within the media and quantitatively in the literature.

The detrimental effects of alcohol on human physiology have been well documented, adversely influencing neural function, metabolism, cardiovascular physiology, thermoregulation and skeletal muscle myopathy.

Remarkably, the downstream effects of alcohol consumption on exercise performance and recovery, has received less attention and as such is not well understood.

The focus of this review is to identify the acute effects of alcohol on exercise performance and give a brief insight into explanatory factors.


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Alcohol alters men's perceptual and decisional processing of women's sexual interest.

The current investigation examines the etiology of men's errors in sexual perception after moderate alcohol use.

Sensitivity and bias estimates, derived from multidimensional signal detection analysis, revealed that men's alcohol-influenced performance was associated with declining sensitivity to the distinction between women's friendliness and sexual interest.

However, sensitivity to the distinction between conservative and provocative clothing was unaffected.

Similarly, an alcohol dose led to an increased bias to respond that women's ambiguous cues were sexual interest (rather than friendliness) but did not influence response thresholds for clothing style.

Thus, there was specificity to the perceptual and decisional changes associated with alcohol use rather than a simple degradation of men's capacity to process all dating-relevant cues in the environment.

Given the link between alcohol use, sexual misperception, and acquaintance-initiated sexual coercion, understanding the etiology of sexual misperception in the context of alcohol use may inform sexual coercion prevention efforts.


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Request Reprint E-Mail: cofaris@indiana.edu


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Determinants of parental support for governmental alcohol control policies

To explore determinants that predict parental support for governmental alcohol control policies in the Netherlands.

A questionnaire was administered among 1550 parents, containing six possible predictors to explain support for alcohol control policies.

Parental support can be explained by five partly normative predictors (R² = .503). Parents with lower drinking frequencies are stricter and more supportive than parents who consume more alcohol. Higher-educated parents are stricter than lower-educated parents.

In general, parents do support governmental alcohol control policies. Communication of the fact that youth alcohol consumption is problematic tends to increase parental support. Also, if policy makers are able to influence parents’ opinions on the consequences of alcohol consumption, as well as the norm of not consuming alcohol before 16 years of age, then parental support increases. Parents’ experiences with drunken youths also explain support. Factual knowledge does not influence support, so information campaigns alone do not increase parental support.

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Request Reprint E-Mail: j.j.vanhoof@utwente.nl

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Scotland progressing on brief interventions

A report indicates over 82,564 brief interventions [IBA] have been carried out in Scotland since 2008-09, with a target set by the Scottish Government of 149,449 to be completed by the end of 2010-11. According to the press release:

'In 2008-09 the Scottish Government introduced a three year NHS target for screening for alcohol problems and delivering brief interventions where appropriate. The target requires boards to deliver a cumulative number of screenings and brief interventions (149,449), over the period 2008-09 - 2010-11, in Primary Care, antenatal care and Emergency Departments. The aim is that brief interventions become part of the standard offer of the NHS.'

Reports on the number of brief interventions delivered are available here from the Alcohol Information Scotland website.

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Alcohol Concern 2010 Annual Conference: 'Generation alcohol: is drinking damaging childhood?'

Alcohol Concern's 2010 conference 'Generation alcohol: is drinking damaging childhood?' will take place in London on Tuesday 02 November 2010.

'The trend for drinking at home has risen sharply in recent years. What does this mean for parents and their children? Youth drinking and the generational impact of parental drinking are two ongoing issues of concern to treatment providers, politicians and the public. Alcohol Concern’s flagship event of the year will hear from academics, experts and politicians on what needs to be done to protect children from alcohol harm.'

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Latest HubCAPP projects: July 2010

The Hub of Commissioned Alcohol Projects and Policies (HubCAPP) is an online resource of local alcohol initiatives throughout England. The latest projects to be added include:

Lambeth | Pharmacy-based Identification and Brief Advice (IBA) Project

Birmingham | Total Place Pilot

Greater London Authority | Peer Outreach Team | Alcohol Awareness Project

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Acute Alcohol Intoxication Impairs the Hematopoietic Precursor Cell Response to Pneumococcal Pneumonia

Alcohol abuse is associated with an increased incidence and severity of pneumonia. In both the general population and individuals consuming excess alcohol, Streptococcus pneumoniae is the most frequent lung infection pathogen. Alcoholic patients with pneumonia frequently present with granulocytopenia, which is predictive of increased mortality. The mechanisms underlying this impaired granulopoietic response to pneumococcal pneumonia have yet to be elucidated.

Acute alcohol intoxication was induced in mice 30 minutes before intrapulmonary infection with S. pneumoniae. Bone marrow, lung, and blood samples were collected. Bone marrow cells were also isolated from naïve mice and treated in vitro with plasma from mice infected with S. pneumoniae.

Alcohol intoxication impaired the pneumococcal-induced increase in granulocyte recruitment into the alveolar space, decreased bacterial clearance from the lung, and increased mortality. Pneumococcal pneumonia significantly increased bone marrow lineage⁻c-Kit⁺Sca-1⁺ (LKS) cell number and colony-forming unit—granulocytes and monocyte (CFU-GM) activity of these cells. Both enhanced proliferation of LKS cells and re-expression of Sca-1 surface protein on downstream progenitor cells bearing lineage⁻c-Kit⁺Sca-1⁻ surface markers accounted for the expansion of marrow LSK cells during pneumonia. Alcohol intoxication impaired these 2 mechanisms of LKS cell population expansion and was associated with a relative granulocytopenia during pneumococcal lung infection.

Alcohol inhibits the hematopoietic precursor cell response to pneumonia, which may serve as a mechanism underlying the granulocytopenia and impaired host defense in alcohol abusers with bacterial pneumonia.

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Request Reprint E-Mail: GBagby@lsuhsc.edu

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Familial Loading for Alcoholism and Offspring Behavior: Mediating and Moderating Influences

Familial loading for alcoholism is an important marker of risk for early-onset alcohol problems, but the early expression of this risk in community samples of children is understudied.

This study tested, for 452 8- and 10-year-old children, whether the density of alcohol problems in their biological relatives was associated with externalizing behaviors that are risk factors for later alcohol problems.

Density of alcohol problems in first- and second-degree biological relatives was associated with behavioral disinhibition (BD; e.g., poor inhibitory control, attentional shifting, β = 0.10, p = 0.04) and conduct problems (CP; i.e., defiance, aggression, delinquency, β = 0.18, p = 0.00). These relations were moderated by parenting practices (parental warmth, discipline consistency, and parental monitoring). The density-behavior association lost statistical significance when at least 2 of 3 parenting practices were rated above median levels for the sample (p = 0.67 to 0.36). The density-behavior association was mediated by current demographic advantage (p = 0.00 for BD, p = 0.00 for CP), current maternal mental health (p = 0.01 for BD, p = 0.00 for CP), and current maternal deviant behavior (for CP only, p = 0.01).

Findings support previously proposed but untested pathways in etiologic models of alcoholism and show the potentially important role of active parenting in reducing the expression of inherited vulnerability to alcoholism in childhood.

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Request Reprint E-Mail: molinab@upmc.edu

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Percentage of Subjects With No Heavy Drinking Days: Evaluation as an Efficacy Endpoint for AlcoholClinical Trials

Percent subjects with no heavy drinking days (PSNHDDs), an efficacy end point recommended by the Food and Drug Administration, considers abstinent individuals or those engaging in low-risk drinking behavior as successful responders to treatment.

As PSNHDD has been used infrequently in previous alcohol clinical trials, we evaluated the utility and validity of the PSNHDD outcome measure in 2 large alcohol clinical trials.

Data sets from 2 alcohol trials, COMBINE and a multisite topiramate trial, were used to analyze PSNHDDs and other traditional end points for the topiramate, naltrexone, acamprosate, and placebo groups. Effect sizes of PSNHDDs were determined for each month of active treatment and by varying grace periods—early periods in the trial where outcome is not considered in the analysis—and were compared with that of other traditional outcome measures. Long-term outcomes were compared for groups that had no heavy drinking days versus those that had heavy drinking days during active treatment.

PSNHDD effect sizes were significant for both topiramate (0.34 and 0.25 at months 2 and 3, respectively) and naltrexone (0.24 and 0.26 at months 3 and 4, respectively). Given a 2-month grace period for naltrexone, the effect size of PSNHDDs was comparable to the effect sizes using traditional outcome measures. With a 1-month grace period for topiramate, it was greater than the majority of traditional outcome measures. Little is gained by allowing up to 1, 2, or 3 heavy drinking days as an end point. Subjects with no HDDs during treatment fared better than those with some HDDs on drinking outcomes and alcohol-related consequences during a 1-year follow-up.

PSNHDD appears to be a clinically informative end point measure, especially when used with a grace period, and is as sensitive as most traditional outcome measures in detecting differences between the medication and placebo groups. Nonetheless, these findings should be replicated in other clinical data sets, particularly with medications that work via different mechanisms.

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Request Reprint E-Mail: falkde@mail.nih.gov

Individual Differences in Problem Drinking Among Tribal Members From One First Nation Community

Health disparities related to drinking in native communities are of concern. Although individuals living in native communities have high rates of problem drinking, there is also variability in their drinking levels.

The authors conducted a test of a model of First Nation drinking risk that incorporates personality and psychosocial learning to examine its cross-cultural applicability. That model identifies a risk process thought to explain aspects of individual differences in both native problem drinking and non-native problem drinking. One implication of the theory is that positive alcohol expectancies mediate the influence of negative urgency (the tendency to act rashly when distressed) on problem drinking similarly for both cultures.

We administered questionnaires to a total of 211 First Nation people and 236 Caucasians.

A structural modeling analysis of 211 First Nation people and 236 Caucasian people found that (i) personality, alcohol expectancy, and problem drinking measures were invariant across the 2 cultures and (ii) results consistent with the hypothesis that positive alcohol expectancies mediated the influence of negative urgency on problem drinking were also invariant across culture.

The findings support the theory that personality traits and psychosocial learning are important determinants of problem drinking in First Nation people and Caucasians.

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Request Reprint E-Mail: Nichea_Spillane@Brown.edu

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Liver Disease and HPLC Quantification of Disialotransferrin for Heavy Alcohol Use: A Case Series

It had previously been suggested that individuals with cirrhosis may have a pattern of transferrin glycosylation that interferes with the interpretation of carbohydrate-deficient transferrin (CDT) testing for heavy alcohol use.

The goal of this case series was to evaluate the prevalence of liver disease among individuals with poor resolution of transferrin glycoforms by high performance liquid chromatography.

We reviewed the electronic medical records of 35 consecutive patients with poor chromatographic resolution of disialotransferrin from trisialotransferrin and recorded information on diagnosed liver disease, liver function testing, and other factors.

Thirty of the 35 subjects with poor chromatographic resolution of the transferrin glycoforms had sufficient data in the medical record for some estimation of liver function. Of these 30 subjects, 25 had previously diagnosed liver pathology. Of the remaining 5 subjects, 2 had liver imaging results suggestive of benign tumor; the remaining 3 had mildly elevated bilirubin and aminotransferase activity, and low albumin.

Liver abnormalities, but not necessarily cirrhosis, are common in individuals with poor chromatographic separation of transferrin glycoforms, which might lead to false-positive results on CDT testing. However, the chromatographic-based assay can detect this issue, minimizing the reporting of false positives, but not necessarily assisting in valid detection of heavy drinking.

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Request Reprint E-Mail: stewarsh@musc.edu

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Alcohol-Induced Exacerbation of Ischemic Brain Injury: Role of NAD(P)H Oxidase

Chronic alcohol consumption increases ischemic stroke and exacerbates ischemic brain injury.

We determined the role of NAD(P)H oxidase in exacerbated ischemic brain injury during chronic alcohol consumption.

Sprague Dawley rats were fed a liquid diet with or without alcohol (6.4% v/v) for 8 weeks. We measured the effect of apocynin on 2-hour middle cerebral artery occlusion (MCAO)/24-hour reperfusion-induced brain injury. In addition, superoxide production and expression of NAD(P)H oxidase subunit, gp91phox, in the peri-infarct area were assessed.

Chronic alcohol consumption produced a larger infarct volume, worse neurological score, and higher superoxide production. Acute (5 mg/kg, ip, 30 minutes before MCAO) and chronic treatment with apocynin (7.5 mg/kg/d in the diet, 4 weeks prior to MCAO) reduced infarct volume, improved neurological outcome, and attenuated superoxide production in alcohol-fed rats. Expression of gp91phox at basal conditions and following ischemia/reperfusion was greater in alcohol-fed rats compared to non-alcohol-fed rats. In addition, neurons are partially responsible for upregulated gp91phox during alcohol consumption.

Our findings suggest that NAD(P)H oxidase may play an important role in exacerbated ischemic brain injury during chronic alcohol consumption.

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Request Reprint E-Mail: hsu1@unmc.edu

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The Preventive Effect of Oral EGCG in a Fetal Alcohol Spectrum Disorder Mouse Model

Fetal alcohol spectrum disorder (FASD) is a challenging public health problem. Previous studies have found an association between FASD and oxidative stress.

In the present study, we assessed the role of oxidative stress in ethanol-induced embryonic damage and the effect of (-)-epigallocatechin-3-gallate (EGCG), a powerful antioxidant extracted from green tea, on the development of FASD in a murine model.

Pregnant female mice were given intraperitoneal ethanol (25%, 0.005 to 0.02 ml/g) on gestational day 8 (G8) to establish the FASD model. On G10.25, mice were sacrificed and embryos were collected and photographed to determine head length (HL), head width (HW), and crown rump length (CRL). For mice given EGCG, administration was through a feeding tube on G7 and G8 (dose: 200, 300, or 400 mg/kg/d, the total amount for a day was divided into 2 equal portions). G10.25 embryos were evaluated morphologically. Brain tissues of G9.25 embryos were used for RT-PCR and western blotting of neural marker genes and proteins and detection of oxidative stress indicators.

Administration of ethanol to pregnant mice on G8 led to the retardation of embryonic growth and down-regulation of neural marker genes. In addition, administration of ethanol (0.02 ml/g) led to the elevation of oxidative stress indicators [hydrogen peroxide (H₂O₂) and malondialdehyde (MDA)]. Administration of EGCG on G7 and G8 along with ethanol on G8 ameliorated the ethanol-induced growth retardation. Mice given EGCG (400 mg/kg/d) along with ethanol had embryo sizes and neural marker genes expression similar to the normal controls. Furthermore, EGCG (400 mg/kg on G7 and G8) inhibited the increase in H₂O₂ and MDA.

In a murine model, oxidative stress appears to play an important role in ethanol-induced embryonic growth retardation. EGCG can prevent some of the embryonic injuries caused by ethanol.

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Request Reprint E-Mail: docpengy@yahoo.com.cn

Reduced Resource Optimization in Male Alcoholics: N400 in a Lexical Decision Paradigm

Event Related Potential (ERP) studies have highlighted some measures, notably P3 amplitude, that are associated with both state and trait deficits in alcoholism, while studies examining N400 amplitude in alcoholism are few.

The present study aims to examine differences in the N400 component, an electrophysiological correlate of semantic priming, in event-related potentials from a lexical decision task in 87 alcohol dependent subjects and 57 community controls.

Each subject was presented with 300 stimuli sequentially in a quasi-randomized design, where 150 stimuli were words and 150 were non-words. The subjects made a lexical decision indicating the word/non-word status with a button press. Among the words, 50 words (primed) were always preceded by their antonyms (prime, n = 50), whereas the remaining 50 words were unrelated. N400 amplitude and latency measures were compiled from ERPs to the primed and unprimed words. Corresponding reaction time (RT) and response characteristics were also analyzed.

Control subjects revealed a significant attenuation of the N400 response to the primed word when compared to the unprimed word. Significantly less attenuation was observed in alcohol dependent subjects. No significant group differences were seen for latency and behavioral measures. All subjects had slower RT for unprimed words compared to primed words; however significantly less RT savings between the unprimed and primed condition was noted for alcoholics.

These results suggest a reduced flexibility in the cognitive networks and a lack of resource optimization in alcoholics. The reduced attenuation of N400 during the primed condition in the alcohol dependent subjects may reflect an inability to engage similar neuronal substrates associated with semantic relatedness as seen in the controls.

As diminished N400 attenuation during priming is observed in both alcoholics and high risk subjects, it may be a marker of risk and a good endophenotype for alcoholism.

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Request Reprint E-Mail: madhavi.rangaswamy@downstate.edu

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Screening, Brief Intervention, and Referral to Treatment (SBIRT): 12-Month Outcomes of a Randomized Controlled Clinical Trial in a Polish Emergency De

A randomized controlled trial of screening, brief intervention, and referral to treatment (SBIRT) among at-risk (based on average number of drinks per week and drinks per drinking day) and dependent drinkers was conducted in an emergency department (ED) among 446 patients 18 and older in Sosnowiec, Poland.

Patients were recruited over a 23-week period (4:00 pm to 12:00 midnight) and randomized to 1 of 3 conditions: screened-only (n = 147), assessed (n = 152), and intervention (n = 147). Patients in the assessed and intervention conditions were blindly reassessed via a telephone interview at 3 months, and all 3 groups were assessed at 12 months (screened-only = 92, assessed = 99, and intervention = 87).

No difference was found across the 3 conditions in at-risk drinking at 12 months, as the primary outcome variable, or in decrease in the number of drinks per drinking day, with all 3 groups showing a significant reduction in both. Significant declines between baseline and 12 months in secondary outcomes of the RAPS4, number of drinking days per week, and the maximum number of drinks on an occasion were seen only for the intervention condition, and in negative consequences for both the assessment and intervention conditions.

Data suggest that improvements in drinking outcomes found in the assessment condition were not because of assessment reactivity, with both the screened and intervention conditions demonstrating greater (although nonsignificant) improvement than the assessed condition. Only those in the intervention condition showed significant improvement in all outcome variables from baseline to 12-month follow-up. Although group by time interaction effects were not found to be significant, these findings suggest that declines in drinking measures for those receiving a brief intervention can be maintained at long-term follow-up.

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Request Reprint E-Mail: ccherpitel@arg.org

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Effects of Alcohol Taxes on Alcohol-Related Mortality in Florida: Time-Series Analyses From 1969 to 2004

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Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol-related mortality.

We evaluated effects of multiple changes in alcohol tax rates in the state of Florida from 1969 to 2004 on disease (not injury) mortality

A time-series quasi-experimental research design was used, including nonalcohol deaths within Florida and other states' rates of alcohol-related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36-year period. Analyses included ARIMA, fixed-effects, and random-effects models, including a noise model, tax independent variables, and structural covariates.

We found significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida. The frequency of deaths (t = −2.73, p = 0.007) and the rate per population (t = −2.06, p = 0.04) declined significantly. The elasticity effect estimate is −0.22 (t = −1.88, p = 0.06), indicating a 10% increase in tax is associated with a 2.2% decline in deaths.

Increased alcohol taxes are associated with significant and sizable reductions in alcohol-attributable mortality in Florida. Results indicate that 600 to 800 lives per year could be saved if real tax rates were returned to 1983 levels (when the last tax increase occurred). Findings highlight the role of tax policy as an effective means for reducing deaths associated with chronic heavy alcohol use.

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Request Reprint E-Mail: maldonado@ichp.ufl.edu

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Fetal Alcohol Exposure Increases Mammary Tumor Susceptibility and Alters Tumor Phenotype in Rats

Altered fetal programming because of a suboptimal in utero environment has been shown to increase susceptibility to many diseases later in life.

This study examined the effect of alcohol exposure in utero on N-nitroso-N-methylurea (NMU)-induced mammary cancer risk during adulthood.

Study 1: Pregnant Sprague Dawley rats were fed a liquid diet containing 6.7% ethanol (alcohol-fed), an isocaloric liquid diet (pair-fed), or rat chow ad libitum (ad lib-fed) from day 11 to 21 of gestation. At birth, female pups were cross-fostered to ad lib-fed control dams. Adult offspring were given an I.P. injection of NMU at a dose of 50 mg/kg body weight. Mammary glands were palpated for tumors twice a week, and rats were euthanized at 23 weeks postinjection. Study 2: To investigate the role of estradiol (E2), animals were exposed to the same in utero treatments but were not given NMU. Serum was collected during the preovulatory phase of the estrous cycle.

At 16 weeks postinjection, overall tumor multiplicity was greater in the offspring from the alcohol-fed group compared to the control groups, indicating a decrease in tumor latency. At study termination, 70% of all animals possessed tumors. Alcohol-exposed animals developed more malignant tumors and more estrogen receptor-α–negative tumors relative to the control groups. In addition, IGF-binding protein-5 (IGFBP-5) mRNA and protein were decreased in tumors of alcohol-exposed animals. Study 2 showed that alcohol-fed animals had significantly increased circulating E2 when compared to either control group.

These data indicate that alcohol exposure in utero increases susceptibility to mammary tumorigenesis in adulthood and suggest that alterations in the IGF and E2 systems may play a role in the underlying mechanism.

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Request Reprint E-Mail: cohick@aesop.rutgers.edu

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