Ramelteon and Improved Insomnia in Alcohol-Dependent Patients: A Case Series

In this case series of 5 alcohol-dependent patients with insomnia who had initiated abstinence, a 4-week course of ramelteon 8 mg nightly was associated with markedly improved insomnia scores, increased total sleep time, and decreased time to fall asleep.

Given its lack of abuse potential and evidence of low melatonin levels in alcoholism, ramelteon deserves further study as a treatment for insomnia in this group of patients. 

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Request Reprint E-Mail:  kbrower@umich.edu
 

NIAAA Spectrum Volume 3, Issue 2, June 2011

Features

•   NCIG: Making Drug Development More Efficient at NIAAA

News From the Field

•   Binge Drinking Pathway in the Rat Brain

•  A School’s Scholastic Success Can Keep Kids From Drugs, Alcohol

•  Study Helps Target Naltrexone Use

•  Stress Drinking Linked to Early Alcohol Use

Charticle 

•  Alcoholism Medication Prescriptions Are Modest But Growing

Photo Essay

•  The Brain: Receptive to the Ups and Downs of Alcohol

5 Questions With

•  Five Questions With Markus Heilig, M.D., Ph.D., NIAAA Clinical Director

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The Points Interview: James Nicholls

For the twelfth installment of the Points Interview we revisit alcohol (one of the psychoactive “Big Three”, to use David Courtwright’s term), and a marvelous account of England’s long public debate over the place of drinking in the social order. James Nicholls‘ The Politics of Alcohol: A History of the Drink Question in England (Manchester University Press, 2009) is a well-reviewed and ambitious study set to appear this August in a paperback edition, and we’re grateful to James for taking a moment to answer a few questions.
> > > >    Read More

Alcohol, Other Drugs, and Health: Current Evidence May–June 2011

Interventions and Assessments

• Brief Interventions Efficacious for Unhealthy Alcohol Use in Hospital Inpatients
• Screening for Alcohol Misuse Does Not Ensure Appropriate Intervention
• A Collaborative Care Model for Primary Care Delivery of Buprenorphine to Opioid-addicted Patients
• Interim Methadone versus Standard Methadone: No Differences in Treatment Outcomes at 4 Months
• Medication-specific Support May Reduce the Impact of Alcohol and Other Drug Use on Antiretroviral Adherence
• People with HIV and Injection Drug Use Who Initiate Antiretroviral Therapy Do Not Increase Needle Sharing

Health Outcomes

• Association between Daily Alcohol Use and Increased HIV Viral Load Independent of HAART Adherence
• Continued Cannabis Use Increases Incidence of Psychotic Symptoms
• The Association of Cannabis Use With Onset of Psychosis: Still Controversial
• Alcohol Use and Death from Pancreatic Cancer
• Preoperative Unhealthy Alcohol Use Increases Surgical Risk
• Alcohol and Cardiovascular Disease Risk and Outcomes: Compelling Evidence?
• Heavy Drinking Associated with Greater Risk for Myocardial Infarction in a Study that Measured Alcohol More than Once
• Association between Alcohol Consumption and Risk of Dementia in Patients Aged 75 and Older
• Prescription Drug Monitoring Programs Are Not Associated with Lower Rates of Overdose or Prescription Opioid Consumption

Slide Presentations

• Update on Alcohol, Other Drugs, and Health
• Journal Club 
  
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Coping Motives as a Mediator of the Relationship between Sexual Coercion and Problem Drinking in College Students

Sexually coercive experiences, heavy alcohol use, and alcohol-related problems occur at relatively high base rates in college populations. As suggested by the self-medication hypothesis, alcohol consumption may be a means by which one can reduce negative affect or stress related to experiences of sexual coercion. 

However, few studies have directly tested the hypothesis that coping motives for drinking mediate the relation between sexual assault and problem drinking behaviors, and no published studies have tested this in men.

The current study tested this hypothesis using structural equation modeling in a sample of 780 male and female undergraduates. 

Results revealed that coping motives partially mediated the relation between sexual coercion and drinking and alcohol-related negative consequences. In addition, direct and indirect paths between sexual coercion and drinking were found for men whereas only indirect paths were found for women.

Results provide support for self-medication models of drinking and suggest the importance of exploring gender differences in mechanisms for drinking.

 
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Request Reprint E-Mail:  nicole.fossos@gmail.com  

Alcohol use disorders contribute to hippocampal and subcortical shape differences in schizophrenia

Alcohol abuse and dependence have been reported to exacerbate the clinical course of schizophrenia. However, the neurobiological basis of this co-morbid interaction is unknown. 

The aim of this study was to determine the relationship of co-morbid alcohol use disorder (AUD) with brain structure abnormalities in schizophrenia patients.

T1-weighted magnetic resonance images were collected from schizophrenia patients without a history of any substance use disorder (SCZ_0, n = 35), schizophrenia patients with a history of AUD only (SCZ_AUD, n = 16), and a healthy comparison group without a history of any substance use disorder (CON, n = 56). Large-deformation, high-dimensional brain mapping was used to quantify the surface shapes of the hippocampus, thalamus, striatum, and globus pallidus in these subject groups. Analysis of variance was used to test for differences in surface shape measures among the groups.

SCZ_AUD demonstrated the greatest severity of shape abnormalities in the hippocampus, thalamus, striatum, and globus pallidus as compared to SCZ_0 and CON. SCZ_AUD demonstrated a combination of exaggerated shape differences in regions where SCZ_0 also showed shape differences, and unique shape differences that were not observed in SCZ_0 or CON.

Shape differences in schizophrenia were compounded by a history of co-morbid AUD.
 
Future research is needed to determine whether these differences are simply additive or whether they are due to an interaction between the underlying neurobiology of schizophrenia and alcoholism. The consequences of such shape differences for the clinical course of schizophrenia are not yet understood.

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Request Reprint E-Mail:   matthewsmith@northwestern.edu  

Nordic Studies on Alcohol and Drugs Volume 28, Number 1 / 2011

•   Alcohol policy is becoming a truly global issue    (PDF)

•   The rise of the total abstinence model. Recommendations regarding alcohol use during pregnancy in Finland and Denmark   (PDF)

•   The effects of missing data when surveying alcohol habits    (PDF)

•   Alcohol-related mishaps on weekends in Reykjavík    (PDF)

•   A window to alcohol problems and politics in Africa. Kettil Bruun Society Meeting in Uganda    (PDF)

Nordic Studies on Alcohol and Drugs Volume 28, Number 2 / 2011

•   In control and out of control. The discourse on intoxication among young Finnish women in the 1980s and 2000s     (PDF)

•   Risky drinking of alcohol in Sweden: A randomized population survey comparing web- and paper-based self-reports     (PDF)

•   The Drinking Habit Survey revival    (PDF)

News Release - Drinking, cannabis use and psychological distress increase, CAMH survey finds

The latest survey of Ontario adults from the Centre for Addiction and Mental Health (CAMH) shows increasing rates of daily drinking and cannabis use and high levels of psychological distress. The results of the 2009 CAMH Monitor survey, the longest running survey tracking mental health and addiction indicators among adults in Ontario, were published today. 

Alcohol

The proportion of adults reporting daily drinking increased from 5.3% in 2002 to over 9% in 2009. The average number of drinks  consumed weekly among drinkers has also increased from 3 drinks to 4.6 drinks, and the proportion of adults exceeding low-risk drinking guidelines remains at elevated levels (22%). However, there were also some encouraging findings: there was a significant decline in binge drinking from 12.6% in 2006 to 7.1% in 2009, and the decline was evident especially among young adults, from 24% to 11.5%.

Although driving within an hour of consuming two or more drinks has shown a steady decline in the past years, from 13.1% in 1996 to 6.9% in 2009, there is evidence that this trend has reversed among young adults. Driving after drinking posted a significant increase among 18 to 29 year olds, from 7.7% in 2005 to 12.8% in 2009. 

“The data tell us that while the number of people who drink alcohol has not changed, the way they are drinking has -- people are drinking more often and may be consuming more alcohol when they do drink, although there may be fewer binge occasions,” said Dr. Robert Mann, CAMH Senior Scientist and lead investigator on the study. “We know that the more access people have to alcohol, the more people will drink, leading to more instances of drinking and driving. Measures such as Random Breath Testing and lowering legal limits to .05% can reduce drunk driving deaths. The implementation of .05% legislation in British Columbia appears to have resulted in a 50% decrease in drinking and driving deaths in that province.” 

> > > >    Read Full News Release

Quality of illegally and informally produced alcohol in Europe: Results from the AMPHORA project

In the WHO region Europe, the average unrecorded adult per capita alcohol consumption was 2.67 L pure ethanol in 2005, which is 22% of the total consumption of 12.20 L. Despite concerns about potential health harms from the chemical composition of unrecorded alcohol, there are surprisingly few data on the problem in the European Region. 

This study reports the results from the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, which assessed the quality of unrecorded alcohol in a Europe-wide study.

Samples of unrecorded alcohol were collected in 16 European
countries and chemically analyzed for potentially health-relevant
parameters. Thresholds for parameters were defined based on potential health hazards of daily drinking.
 
The average alcoholic strength of unrecorded wine products was 14.9% vol, and 47.8% vol in unrecorded spirits. One half of the
samples (n=57) showed acceptable alcohol quality. The other half
(n=58) showed one or several deficits with the most prevalent problem being ethyl carbamate contamination (n=29). Other problems included copper (n=20), manganese (n=16) and acetaldehyde (n=12). All other parameters (including methanol, higher alcohols, phthalates) were onlyseldom problematic (limit exceedance in less than 10 samples). The price of unrecorded alcohol was approximately 45% of the price of recorded alcohol.

 The major problem regarding unrecorded alcohol appears
to be ethanol itself, as it is often higher in strength and its lower price
may further contribute to higher drinking amounts. Compared to the
health effects of ethanol, the contamination problems detected may be of minor importance as exposure will only in worst-case scenarios reach tolerable daily intakes of these substances.




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The effects of alcohol and dosage-set on risk-seeking behavior in groups and individuals.

A great deal of risky activity occurs in social contexts, yet only recently have studies begun to examine the impact of drinking on risk-seeking behavior in groups. 

The present study sought to extend this work by examining both pharmacological and expectancy (dosage-set) effects of drinking. In addition, by using a much larger sample than in prior studies we aimed to increase the power to examine how drinking affects the decision-making process (i.e., Does the initial proposed decision stand, or does it shift during discussion to a safer or riskier final decision?). 

Seven hundred twenty unacquainted social drinkers (half female) were randomly assigned to three-person groups that consumed alcohol (0.82 g/kg males; 0.74 g/kg females), a placebo, or a no-alcohol control beverage. After drinking, participants decided whether to complete a 30-min questionnaire battery (the less risky choice) or toss a coin and, pending the outcome of that toss, complete either no questionnaires or a 60-min battery (the riskier choice).

Neither drinking nor believing one had been drinking affected the decision to toss the coin when participants deliberated in isolation.

In contrast, when the decision occurred in a group context, groups led to believe they were drinking alcohol (i.e., groups administered alcohol or placebo beverages) were significantly more likely than groups knowing they had consumed a nonalcoholic beverage (i.e., groups administered a no-alcohol control beverage) to choose the coin toss. 

Results extend prior findings highlighting the effects of alcohol dosage-set in social contexts.

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Request Reprint E-Mail:  sayette@pitt.edu
  

If substance use disorder treatment more than offsets its costs, why don't more medical centers want to provide it?: A budget impact analysis in the Veterans Health Administration

Given that many studies have reported that the costs of substance use disorder (SUD) treatment are more than offset by other savings (e.g., in health care, in criminal justice, in foster care), why haven't health care system managers rushed to expand treatment? 

This article attempts to explain this puzzling discrepancy by analyzing 1998–2006 data from the national Veterans Affairs (VA) health care system. 

The main outcome measures were annual cost and utilization for VA SUD-diagnosed patients. The key independent variable was the medical centers' annual spending for SUD treatment. 

There was no evidence that SUD spending was associated with lower medical center costs over time within the medical center that paid for the treatment. 

Health care system managers may not be influenced by research suggesting that the costs of SUD treatment are more than fully offset because they bear the cost of providing treatment while the savings largely accrue to other systems.

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Request Reprint E-Mail:   knh@stanford.edu 

Alcohol News - 24/2011

YLE News (Finland) - Police keeping a close eye on drunk drivers

Police are enhancing efforts to keep intoxicated drivers in check this week. Law enforcement officials across Europe are stepping up their surveillance of drivers under the influence during the week-long campaign.

Read more

ERR News (Estonia) - Cabinet Throws Out Alcohol Ban Bill

The Cabinet did not support an absolute ban on alcohol advertising in a June 9 meeting. The bill, which was proposed by the opposition Centre Party, would affect TV, radio and outdoor advertising.

Read more

European Journalism Center (Lithuania) - Russian broadcasters to benefit from Lithuanian round-the-clock ban on alcohol advertising

Although Lithuanian TV and radio stations do not disclose their alcohol advertising revenues, it is estimated that these make up for a considerable bulk of broadcasters’ income. According to some experts, the figure may reach up to 20 percent.

Read more

The Independent (UK) - Critics line up as alcohol giant funds health campaign

The drinks giant Diageo is to bankroll a scheme to alert midwives and expectant mothers to the dangers of drinking alcohol during pregnancy.

Read more

PR Newswire (USA) - Victory on Stopping Bus Bench Alcohol Ads in Los Angeles

The Coalition to Ban Alcohol Ads from Public Property organized a lively grassroots rally in Los Angeles City Hall Plaza this morning to send a message to the L.A. Board of Public Works that promoting alcohol on city-owned bus benches was a really bad idea.

Read more

TVNZ (New Zealand) - Emergency staff demand hard line on alcohol

Frontline emergency staff are calling on the government to take a hard line on people who sell and consume alcohol, following new research which shows staff at Wellington Hospital are under increasing attack from drunk patients.

Read more

EurekAlert - The association of alcohol drinking with migraine headache

Migraine is a neurovascular disease that affects about 15% of the western population. Compounds in foods and beverages (chocolate, wine, citrus, etc) considered as migraine triggers include tyramine, phenylethylamine and possibly histamine and phenolic compounds. Avoiding those triggers may significantly reduce the frequency of migraines in some patients.

Read more

The Hindu - Even small amounts of alcohol impact the brain

Just the one drink can sometimes prove one too many when it comes to alcohol, according to Chinese researchers who have discovered that even minimal alcohol intake can cause immediate damage to the brain.

Read more

Irish Examiner (Ireland) - Supermarkets and off-licences now account for 33% of all alcohol sales

CONSUMERS are buying more alcohol in supermarkets and off-licences, both of which now account for a third of all alcohol sales.

Read more

Herald Scotland (Scotland) - Why Scotland needs to put the demon back into drink

SCOTLAND has much to be proud of but when it comes to alcohol, you should be ashamed of yourselves. In fact, restoring the stigma that used to be associated with drunkenness would help create a healthier nation, and prevent a generation of young people from being harmed by the substance their parents adore.

Read more

SunHerald.com (USA) - Local authorities battle teen drinking

South Mississippi law enforcement officials say they are working day and night to curb the trend among teens to buy alcohol and liquor. A growing number of minors are now mixing alcohol with high-energy drinks to prolong their buzz.

Read more

BBC News (UK) - Alcohol-related problems: Survey checks nurse training

Nottingham researchers have launched a national survey to find out if nurses need extra training to deal with patients who have drink problems.

Read more

The Australian (Australia) - Alcohol floor 'a hit on elderly and poor'

PENSIONERS, those earning less than $40,000 a year and rural Australians would be the hardest hit by a floor price on alcohol, which would increase the cost of cask wine by up to 400 per cent.

Read more

BBC News (UK) - Alcohol admissions 'stretch' NHS

A huge rise in people suffering alcohol-related injuries and illness is putting an increasing strain on the NHS in Brighton and Hove, and is said to be costing millions of pounds a year.

Read more

Medscape - Screening Tools May Detect Youth Alcohol and Cannabis Misuse

Emergency department clinicians should use a 2-question instrument to detect youth alcohol misuse and a 1-question instrument to detect cannabis misuse, according to the results of a systematic review reported online June 6 in Pediatrics.

Read more

News of the World (UK) - Boozed-up teens are heading for lifetime of bad health, says doc

BRITAIN is in the grip of an under-age booze epidemic even worse than we thought - with millions of kids heading for a lifetime of huge health problems...

Read more

Irish Times (Ireland) - State could save €80m a year in health costs if alcohol consumption halved

IF IRISH people halved their current alcohol consumption to the upper limit of recommended drinking levels, the health costs to the exchequer for hospital beds would drop by €80 million a year, according to newly-published research.

Read more

 

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Analyzing performance in addiction treatment: An application of data envelopment analysis to the state of Maryland system

The pressure is on to measure performance and to increase accountability in health care in general and in addiction treatment in particular. 

The pressure in the world of addiction treatment comes in large measure from the limited resources that are available in relation to the very large numbers of potential patients.

Using data on 161 clinics in the state of Maryland, this article illustrates how data envelopment analysis (DEA), a methodology used widely in other settings, can be used to measure the performance of addiction treatment clinics and can help to identify appropriate benchmarks for clinics wishing to improve their performance. 

The potential utility of DEA is not only limited to the analysis of state networks but extends to analyses of organizations that have a number of treatment locations. However, its full potential at the national and state levels will only be realized when state-level uniform data sets become available.


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Request Reprint E-Mail:     rcorredo@rhsmith.umd.edu

News Release - WV STUDENTS CREATE PUBLIC SERVICE ANNOUNCEMENTS TO PREVENT UNDERAGE DRINKING

More than two dozen West Virginia youth from Cabell, Greenbrier and Kanawha counties will star in new public service announcements (PSAs) designed to raise awareness of and prevent underage drinking.

 
Earlier this year, the teams of youth from Cabell County’s Substance Abuse Prevention Coalition, the Marshall University Ad Club, Greenbrier East High School and the South Charleston Housing Authority submitted draft scripts for
this year’s 2011 PSA Challenge. This month, the youth will fine-tune their scripts and work with the Tri-State CW and WV Radio Corporation to produce the television and radio spots.

> > > >    Read Full News Release  (PDF)

Instruments to Detect Alcohol and Other Drug Misuse in the Emergency Department: A Systematic Review

Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important. 

To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients. 

Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR⁺) and negative (LR⁻) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity. 

Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR⁺: 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR⁺: 6.83). 

On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED. 

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Request Reprint E-Mail:  mandi.newton@ualberta.ca   

Parents’ plans to supply their adolescents with alcohol

The aim was to determine the extent to which parent and adolescent characteristics and patterns of alcohol use influence parents’ plans to supply their adolescent aged 14–16 years with full serves of alcohol (i.e. not necessarily initiation) in the next 6 months.

A cross-sectional sample of parents from Victoria, Australia, completed an online survey. 

Parents’ plans to supply alcohol in the next 6 months was significantly associated with their reports of supplying alcohol in the previous 3 months (β = 0.51, P < 0.01), perceptions that their adolescent drinks (β = 0.34, P < 0.01), reports of not practising religion (β = 0.13, P < 0.01), and Alcohol Use Disorders Identification Test scores (β = 0.09, P = 0.04). The total variance explained by the model was 57.4% F (9, 242) = 36.2, P < 0.01. 

Parents’ plans to supply their adolescent with alcohol might be a reflection of the normalisation of alcohol use in Australia. 

There is a need to support Australian parents to review their own alcohol use, clarify their views on alcohol use by their adolescent and confidently restrict their child’s access to alcohol, irrespective of their own drinking patterns.

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Request Reprint E-Mail:   B.Ward@latrobe.edu.au  

Alcohol and Migraine: What Should We Tell Patients?

Alcoholic drinks are a migraine trigger in about one third of patients with migraine in retrospective studies on trigger factors. 

 

Many population studies show that patients with migraine consume alcohol in a smaller percentage than the general population. 

 

Moreover, research has shown a decreased prevalence of headache with increasing number of alcohol units consumed. 

 

The classification criteria of alcohol-related headaches remain problematic. 

 

We discuss the role and mechanism of action of alcohol or other components of alcoholic drinks in relation to alcohol-induced headache. 

 

In accordance with data from a recent prospective study, we believe that reports overestimate the role of alcohol, as well as other foods, in the triggering of migraine. 

 

If a relationship between the intake of alcohol and the migraine attack is not clear, a small dose of alcohol is not contraindicated either for enjoyment or its protective effect on cardiovascular disease. 

 

 

 

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Request Reprint E-Mail:  a.panconesi@usl11.tos.it. 

EFFECTIVENESS BANK ABSTRACT BULLETIN 10 June 2011

Prevention and early intervention from school to college to work

In this new bag of studies are mixed but always instructive results from substance use prevention and early intervention attempts across the life stages from school to college and work. The negative school studies raise questions about relying on developer-led evaluations and about whether promising programmes really will work in the real world. Can colleges get away with sitting new students in front of a computer to learn how to drink safely, and will brief alcohol counselling really leave companies more than a thousand dollars better off? It takes more ' a new family ' to help the most severely problematic Norwegian teenagers. 

Leading US school-based prevention programme fails independent test ...

No success for school counselling/education for troubled US teens ...

US college uses internet to start new students drinking more safely...

Prison alternative turns round lives of child substance users with multiple problems ...

Productivity savings for US firms which counsel risky drinking staff ...

Cyanidin-3-glucoside ameliorates ethanol neurotoxicity in the developing brain

Ethanol exposure induces neurodegeneration in the developing central nervous system (CNS). Fetal alcohol spectrum disorders (FASD) are caused by ethanol exposure during pregnancy and are the most common nonhereditary cause of mental retardation. 

It is important to identify agents that provide neuroprotection against ethanol neurotoxicity. Multiple mechanisms have been proposed for ethanol-induced neurodegeneration, and oxidative stress is one of the most important mechanisms. 

Recent evidence indicates that glycogen synthase kinase 3β (GSK3β) is a potential mediator of ethanol-mediated neuronal death. Cyanidin-3-glucoside (C3G), a member of the anthocyanin family, is a potent natural antioxidant. Our previous study suggested that C3G inhibited GSK3β activity in neurons. 

Using a third trimester equivalent mouse model of ethanol exposure, we tested the hypothesis that C3G can ameliorate ethanol-induced neuronal death in the developing brain. Intraperitoneal injection of C3G reduced ethanol-meditated caspase-3 activation, neurodegeneration, and microglial activation in the cerebral cortex of 7-day-old mice. 

C3G blocked ethanol-mediated GSK3β activation by inducing phosphorylation at serine 9 while reducing the phosphorylation at tyrosine 216. C3G also inhibited ethanol-stimulated expression of malondialdehyde (MDA) and p47phox, indicating that C3G alleviated ethanol-induced oxidative stress. 

These results provide important insight into the therapeutic potential of C3G.

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Request Reprint E-Mail:  jialuo888@uky.edu