The Ability of the Self-Rating of the Effects of Alcohol (SRE) Scale to Predict Alcohol-Related Outcomes Five Years Later
J. Stud. Alcohol Drugs 68: 371-378, 2007

A low level of response (LR) to alcohol as measured through alcohol challenges is an early-appearing, genetically influenced characteristic that predicts the risk of heavier drinking and alcohol problems.

A less expensive and more easily used measure of LR, the retrospective Self-Rating of the Effects of Alcohol (SRE) questionnaire, also relates to alcohol intake and problems but has not been evaluated for its ability to predict alcohol-related problems 5 years later.

These findings are consistent with the ability of SRE-based LR scores at Time 1 to predict alcohol-related outcomes over the subsequent 5 years.


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Reprint Request E-mail: mschuckit@ucsd.edu
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Monoamine oxidase-A polymorphisms might modify the association between thedopamine D2 receptor gene and alcohol dependence
J Psychiatry Neurosci 2007;32(3):185-92.

Low monoamine oxidase (MAO) activity and the neurotransmitter dopamine are two important factors in the development of alcohol dependence. MAO is an important enzyme associated with the metabolism of biogenic amines.

Therefore, the present study investigates whether the association between the dopamine D2 receptor (DRD2) gene and alcoholism is affected by different polymorphisms of the MAO type A (MAOA) gene.

The MAOA gene may modify the association between the DRD2 gene and ANX/DEP ALC phenotype.

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SAMHSA NEWS
March/April 2007
Vol 15, No 2

Inside This Issue

Social Security Benefits: Outreach, Access, and Recovery

Promising Practices

Resources on Homelessness

From the Administrator: Obtaining Benefits, Attaining Recovery

Funding Opportunities

Underage Drinking

Surgeon General Issues Call to Action

Ads, Billboards Highlight Younger Children

Reach Out Now Educates Teachers, Students

President's Budget Sustains Key Programs

National Outcome Measures: Update

Transforming Housing for People with Psychiatric Disabilities

Arab Americans & Muslims Assess Emotional Well-Being

Evidence-Based Practices: Online Registry

Screening, Referral Tools Available Online

Recovery Month Web Cast en Español

Treatment Update: Increasing Motivation

Inhalants Report

DAWN Report

Workforce Development Resources

SAMHSA News Information

Comparison of Extended-Release and Oral Naltrexone Assists Substance Abuse Treatment Providers
Date: 5/4/2007
Media Contact: SAMHSA Press Office
Telephone: 240-276-2130

Oral naltrexone and naltrexone for extended-release injectable suspension are the focus of a new comparative report recently released by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the Spring 2007 issue of Substance Abuse Treatment Advisory.

Read Full News Release

“Naltrexone for Extended-Release Injectable Suspension for Treatment of Alcohol Dependence” (Substance Abuse Treatment Advisory, Spring 2007, Volume 6, Issue 1) (PDF)

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Greater Access to Alcohol Treatment Goal of New NIAAA Guide

Psychiatr News May 4, 2007
Volume 42, Number 9, page 14

Greater Access to Alcohol Treatment Goal of New NIAAA GuideGeneral practitioners can take advantage of an updated tool that will help them treat alcohol-dependent patients.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, has issued an updated version of "Helping Patients Who Drink Too Much: A Clinician's Guide."

The guide is designed to help clinicians in general practice and nonspecialists in mental health settings treat patients for alcohol dependence, especially those who don't have access to or reject treatment from specialists.

The Substance Abuse and Mental Health Services Administration estimates that 15.8 million of the 18 million people who have alcohol problems do not seek treatment. Data collected by NIAAA's National Epidemiologic Survey on Alcohol and Related Conditions in 2001 and 2002 indicated that almost 40 percent of people who reported surviving a major depressive episode had also developed an alcohol use disorder (Psychiatric News, February 17, 2006).

The revised edition of the guide adds information about naltrexone extended-release injectable suspension, a once-monthly injectable medication for alcohol-dependence treatment the Food and Drug Administration approved in April 2006.

The guide includes a new medications management program that consists of brief, structured outpatient sessions designed for easy use in nonspecialty out-patient settings by physicians, nurses, and other health care professionals. According to NIAAA, applying the guide's medication management approach in nonspecialty settings will greatly expand access to effective treatment, since many patients with alcohol dependence either don't have access to specialty treatment or refuse referrals to specialists.

Mental health clinicians who wish to provide specialized counseling will find new information about a state-of-the-art behavioral intervention developed for patients who received pharmacotherapy during a recent clinical trial.

"The clinician's guide is a brief, focused, and valuable tool," said Eric Strain, M.D., medical director of the Behavioral Pharmacology Research Unit at Johns Hopkins University School of Medicine and chair of APA's Council on Addiction Psychiatry. "This revision provides important new information about alcohol-use disorders and their treatment. Mental health care professionals and the general medical community should find it an extremely useful resource that is quick and easy to use. Psychiatrists, too, might also find it useful."

The updated version of "Helping Patients Who Drink Too Much" is posted at <http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm>.

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Alcohol: the solution
Jill Stark
May 5, 2007

There is a recurring problem in the attempt to reduce alcohol harm. "What's popular doesn't work and what works isn't popular," according to internationally renowned alcohol policy researcher Professor Robin Room, the president of the Alcohol and Other Drugs Council of Australia.

High-profile media campaigns urging the public to drink responsibly are far less effective than reducing density of alcohol outlets, restricting trading hours and increasing taxes, he argues.

But despite international evidence proving the success of such measures, the industry is not supportive.

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Alcohol: the problem
Jill Stark
May 5, 2007

Alcohol has become an intrinsic part of the national character but Australia's cultural love affair with booze is jeopardising the country's health and taking a large chunk out of its hip pocket.

There is growing concern about the long-term effects of alcohol abuse as the number of people drinking at levels likely to cause chronic or acute harm rises. While consumption rates are slightly lower than in the 1970s, they are steadily rising again - and the way the nation drinks is changing.

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Alcohol time bomb set to explode
Jill Stark
May 5, 2007

Australia's binge-drinking culture is a "ticking time bomb" threatening to overload the public health system within decades, health experts have warned.

A rise in dangerous drinking across all age groups, class boundaries and cultural lines has prompted calls for action.

Top researchers predict Australia will see a big rise in chronic diseases such as cirrhosis of the liver, cancers and brain disorders in the next 20 years.

Addiction doctors say they are seeing a growing trend of drinkers as young as 18 suffering tremors, sweats and even seizures. Many are drinking a bottle of spirits a day, with experts predicting a rise in brain-damage cases.

Those in the field have accused governments of failing to tackle the crisis, citing generous political donations from the alcohol industry and huge tax revenues as factors behind the complacency.

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Delay frustrates push for sobering-up centres
William Birnbauer
May 6, 2007

DELAYS in decriminalising public drunkenness in Victoria are frustrating health and welfare groups, but the move is opposed by the Opposition and Crown Casino.

Senior police said it would be fantastic to have 24-hour "sobering-up" centres as an alternative to police cells, but expressed reservations about how the centres would operate and whether they would have sufficient resources.

The reaction follows a report in The Sunday Age last week that Attorney-General Rob Hulls wants to bring the state's drunkenness laws into line with those of most other states.

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Introduction to Symposium
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S1-S2




Some physicians and public health officials, only too aware of the terrible personal and social problems associated with alcohol abuse, have been reluctant to acknowledge potential beneficial effects of moderate drinking, and others have questioned the methodology of the epidemiologic studies. These concerns will be important topics of discussion at this conference.

While positive effects of alcohol on high-density lipoprotein (HDL)-cholesterol have been known for years, an immense amount of recent research has identified many other potential mechanisms by which alcoholic beverages may relate to CHD. Demonstrated have been effects of alcohol and wine polyphenolic compounds on coagulation, fibrinolysis, endothelial function, lipid oxidation, glucose metabolism, inflammation, and ventricular function, many of which will be discussed at this conference. Also to be discussed will be the adverse effects of abusive drinking on the liver, the brain, and other organs, as well as potentially favorable effects of moderate drinking on other diseases of aging, including stroke, congestive heart failure, diabetes, metabolic syndrome, dementia, and even total mortality. Further topics will include the social and cultural aspects of alcohol consumption.

The goal of this symposium is to foster free communication among the participating scientists, many of whom have made important contributions to this field over many decades. It is a closed meeting, and the emphasis will be on uninhibited dialogue, whether it be ‘‘politically correct’’ or not. We are encouraging all of the participants to speak freely, asking each to indicate clearly whether he or she agrees, or does not agree, with what other speakers may saydand the reasons why.

We are hoping that the end result of the meeting will be up-to-date, scientifically sound, and balanced information on moderate drinking, data that should be useful to other scientists working in the field, to physicians and other health-care providers, and to those who develop guidelines for drinking and set policy related to alcohol use. We trust that the published proceedings of this conference will indeed be as close as possible to the ‘‘truth,’’ as we understand it now, about the health risk and benefits of the moderate consumption of alcoholic beverages.

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Contributor: Philippe Arvers
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Alcohol and Coronary Heart Disease: Drinking Patterns and Mediators of Effect
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S3-S7


An inverse association between alcohol consumption and coronary heart disease (CHD) has been shown in epidemiologic studies for more than 30 years; beneficial changes in high-density lipoprotein (HDL) cholesterol, clotting factors, insulin sensitivity, and inflammation provide biological plausibility. Recently, the importance of including drinking patterns in defining “moderate drinking” has been appreciated. A recent meta-analysis raised questions about systematic misclassification error in observational studies because of inclusion among “nondrinkers” of ex-drinkers and/or occasional drinkers. However, misclassification among a small percentage of nondrinkers cannot fully explain the inverse relation, and there is substantial evidence to refute the “sick quitter” hypothesis. Furthermore, it has been shown that moderate alcohol consumption reduces CHD and mortality in individuals with hypertension, diabetes, and existing CHD. To address the issue of residual confounding by healthy lifestyle in drinkers, in a large prospective study we restricted analysis to only “healthy” men (who did not smoke, exercised, ate a good diet, and were not obese). Within this group, men who drank moderately had a relative risk for CHD of 0.38 (95% CI, 0.16–0.89) compared with abstainers, providing further evidence to support the hypothesis that the inverse association of alcohol to CHD is causal, and not confounded by healthy lifestyle behaviors.

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Contributor: Philippe Arvers
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Alcohol Intake and Noncoronary Cardiovascular Diseases
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S8-S12

Moderate drinking has complex associations with cardiovascular diseases other than coronary heart disease. Recent cohort studies examining the relationship between alcohol use and ischemic stroke have shown a modest association, with risk ratios approximating 0.8 and the lowest risk among those who drink less than daily. In contrast, alcohol use is generally associated with an approximate dose-dependent risk for hemorrhagic stroke throughout the full range of intake.

Several prospective studies of alcohol intake and congestive heart failure have found lower risk with moderate drinking. This risk is also dose dependent through the moderate range, but its underlying mechanism remains uncertain. Accounting for the lower risk of myocardial infarction associated with moderate intake does not eliminate the observed association. Cohort studies have found no association of long-term alcohol intake with risk of atrial fibrillation below levels of at least 3 standard drinks per day. Finally, two prospective studies have found lower risks of claudication or clinically more severe peripheral arterial disease among moderate drinkers, an association also supported by cross-sectional studies of alcohol intake and ankle-brachial index.

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Contributor: Philippe Arvers

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Confounders of the Relation between Type of Alcohol and Cardiovascular Disease
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S13-S15


There have been numerous reports from epidemiologic studies showing that moderate drinkers have lower rates of cardiovascular disease (CVD) than do those who drink heavily or not at all. A number of scientific reports from scientists around the world suggest confounding may play a role in the reported beneficial health effects associated with moderate drinking. Among potentially confounding variables for these reported associations are the frequency of alcohol consumption, drinking pattern (steady or binge drinking), type of beverage, and differences in the pattern of drinking associated with different types of beverages. In some papers, individuals who report primarily wine consumption have been shown to be at lower risk of CVD and total mortality, and there is evidence for greater beneficial effects from more frequent, regular drinking. However, other potential confounders include better cognitive function, higher socioeconomic status, better subjective health, and a healthier diet, including food purchases, all of which are more common in regular drinkers and wine drinkers. Thus, the question of whether the beneficial effects of beverage types differ, with additional benefits for wine, remains unresolved.

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Contributor: Philippe Arvers
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Moderate Alcohol Use and Reduced Mortality Risk: Systematic Error in Prospective Studies and New Hypotheses
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S16-S23


We have provided recent evidence suggesting that a systematic error may be operating in prospective epidemiological mortality studies that have reported “light” or “moderate” regular use of alcohol to be “protective” against coronary heart disease. Using meta-analysis as a research tool, a hypothesis first suggested by Shaper and colleagues was tested. Shaper et al suggested that people decrease their alcohol consumption as they age and become ill or frail or increase use of medications, some people abstaining from alcohol altogether. If these people are included in the abstainer category in prospective studies, it is reasoned that it is not the absence of alcohol elevating their risk for coronary heart disease (CHD) but, rather, their ill health. Our meta-analytic results indicate that the few studies without this error (i.e., those that did not contaminate the abstainer category with occasional or former drinkers) show abstainers and “light” or “moderate” drinkers to be at equal risk for all-cause and CHD mortality. We explore the history of this hypothesis, examine challenges to our meta-analysis, and discuss options for future research.

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Contributor: Philippe Arvers
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Mechanism by which Alcohol and Wine Polyphenols Affect Coronary Heart Disease Risk
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S24-S31



The reduction in coronary heart disease (CHD) from moderate alcohol intake may be mediated, in part, by increased fibrinolysis; endothelial cell (EC)–mediated fibrinolysis should decrease acute atherothrombotic consequences (eg, plaque rupture) of myocardial infarction (MI). We have shown that alcohol and individual polyphenols modulate EC fibrinolytic protein (t-PA, u-PA, PAI-1, u-PAR and Annexin-II) expression at the cellular, molecular, and gene levels to sustain increased fibrinolytic activity. Herein we describe the sequence of molecular events by which EC t-PA expression is increased through common activation of p38 MAPK signaling. Up-regulation of t-PA gene transcription, through specific alcohol and polyphenol transcription factor binding sites in the t-PA promoter, results in increased in vitro fibrinolysis and in vivo clot lytic activity (using real-time fluorescence [Fl] imaging of Cy5.5-labeled fibrin clot lysis in a mouse model). Fl-labeled fibrin clots injected into untreated C56Bl/6 wild-type control mice are lysed in approximately 2 hours and clot lytic rates significantly increased in mice treated with either alcohol, catechins, or quercetin (4–6 weeks). Fl-labeled clot lysis in ApoE knock-out mice (atherosclerosis model) showed impaired in vivo clot lysis that was “normalized” to wild-type control levels by treatment with alcohol, catechin, or quercetin for 6 to 8 weeks.

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Contributor: Philippe Arvers
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Changes in Cardiovascular Risk Factors Associated with Wine Consumption in Intervention Studies in Humans
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S32-S36

Evidence that links moderate wine consumption to cardiovascular health corresponds mostly to ecological observations. Intervention studies using moderate wine consumption with ischemic heart disease as the end point will probably not be available soon because they require long-term follow-up and adequately randomized experimental groups. In contrast, short-term studies focused on risk factors are feasible and should provide evidence suitable for a critical assessment of the apparent beneficial role of moderate drinking, as well as other lifestyle measures, on cardiovascular health.

Our intervention studies suggest an increase in HDL-cholesterol, decrease in the omega-6/omega-3 ratio, and in some cases a slight increase in triglyceride levels from moderate drinking. Observed changes in hemostasis include reduced coagulation and increased fibrinolysis; effects on blood pressure have been inconsistent. There is a reduction in inflammatory markers and an increase in endothelial function. Effects of wine are greater for subjects on a Mediterranean diet than those on an occidental diet. Several key biochemical or physiological processes related to atherogenesis are positively modified by wine consumption. From our observations, we conclude that wine in moderation and as part of the diet is directly responsible for changes that may help decrease the risk of cardiovascular disease.

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Contributor: Philippe Arvers

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Panel Discussion I: Does Alcohol Consumption Prevent Cardiovascular Disease?
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S37-S39


The panel on the relationship between alcohol consumption and cardiovascular disease was chaired by R. Curtis Ellison and the panelists were Goya Wannamethee, Eric B. Rimm, Kenneth J. Mukamal, Morten Grønbæk, Kaye M. Fillmore, Francois M. Booyse, Federico Leighton, and Murray A. Mittleman. This discussion was centered initially on whether the putative protection of moderate alcohol consumption against coronary heart disease (CHD) reported in epidemiological studies is due to methodologic “errors.”

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Contributor: Philippe Arvers
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Moderate Alcohol Consumption and Risk of Developing Dementia in the Elderly: The Contribution of Prospective Studies
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S43-S45


Moderate alcohol consumption, after controlling for potential confounding factors, has been found to be associated with a lower risk of developing dementia in several prospective epidemiological studies from Europe, the United States, and China. When the type of alcoholic beverage consumed is analyzed, moderate wine intake has been systematically associated with lower risk. However, moderate consumption has very different definitions across studies, ranging from monthly or weekly drinking to 3 to 4 drinks per day. In addition, different results have been observed according to sex; some studies found the same effect in men and women, while others found either no association or a stronger association in women. All of these results lead to the conclusion that the observed association is fragile and needs further confirmation.

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Contributor: Philippe Arvers
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Moderate Alcohol Consumption and Cancer
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S46-S48

Alcohol consumption may increase the risk for at least six types of cancer, although the evidence is not uniformly strong. Alcohol is not a carcinogen in standard tests but is likely a cocarcinogen, at least in the digestive tract. The strongest association is with cancer of the oral cavity and pharynx (seven-fold increase for heavy consumption). For moderate consumption (2–3 drinks/day for men and 1–2 drinks/day for women), the risks never increase above twofold and are mostly less than 25% above baseline. The evidence from the epidemiological literature suggests that 25g/d of alcohol is associated with a relative risk of 1.9 for cancers of the oral cavity and pharynx, 1.4 for cancers of the esophagus and larynx, about 10% for colorectal cancer (mechanisms unclear), and 20% for liver cancer (mechanisms well described). The association between alcohol and breast cancer is not strong and not necessarily causative, at least for moderate consumption.

In the United Kingdom, cancer deaths attributable to alcohol consumption above the recommended limits (caused mostly by colorectal cancer) are maximal for men aged 65 to 74 years and for women at ages 75 to 84 years. It is postulated that if everyone in the United Kingdom drank “sensibly,” there would be a marked increase in cancer deaths.

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Contributor: Philippe Arvers
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Moderate Drinking, Inflammation, and Liver Disease
Volume 17, Issue 5, Supplement 1, May 2007, Pages S49-S54



It is well known that heavy drinking increases the risk of alcohol-related liver disease (ALD). Female gender, hepatitis C or B, obesity, and other cofactors increase susceptibility to ALD, so “safe” levels of alcohol consumption in regard to ALD vary among individuals. Inflammation is one mechanism by which alcohol causes liver damage. Increasing evidence suggests that in contrast to the proinflammatory activation by chronic excessive alcohol consumption, acute moderate alcohol administration has anti-inflammatory effects. Long-term alcohol administration results in increased baseline nuclear regulatory factor κB (NF-κB) activation in the livers of mice; in contrast, acute alcohol administration in mice attenuates lipopolysaccharide (LPS)-induced NF-κB activation in the liver and serum tumor necrosis factor alpha (TNFα) induction. Consistent with this notion, peripheral blood monocytes from patients with alcoholic hepatitis spontaneously produce increased amounts of TNFα and respond to ex vivo LPS stimulation with increased TNFα levels, while acute moderate alcohol consumption in normal volunteers results in the attenuation of TNFα production by various stimulants and attenuates monocyte production of other proinflammatory cytokines. To date, no evidence for a beneficial role of the anti-inflammatory effect of acute moderate alcohol consumption on the liver has been demonstrated, but this may contribute to the effect of alcohol on other organ systems.


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Contributor: Philippe Arvers
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Investigating the Association Between Moderate Drinking and Mental Health
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S55-S62

In an attempt to relate “moderate drinking” to “mental health,” inadequacies of definition for both terms become apparent. Moderate drinking can be variously defined by a certain number of drinks to “nonintoxicating” to “noninjurious” to “optimal,” whereas mental health definitions range from “the absence of psychopathology” to “positive psychology” to “subjective well-being.” Nevertheless, we evaluated the relation by conducting an electronic search of the literature from 1980 onwards using the terms “moderate drinking,” “moderate alcohol consumption,” “mental health,” and “quality of life.”

Most studies report a “J-shaped curve,” with positive self-reports of subjective mental health associated with moderate drinking but not with heavier drinking. The relevance of expectancies has been unevenly acknowledged, and studies on the cultural differences among expectancies are largely lacking. The potential role of moderate drinking in stress reduction and studies of social integration have yielded inconsistent results as previous levels of drinking, age, social isolation, and other factors have often not been adequately controlled. Future anthropological, epidemiological, and pharmacological interactions preferably must be studied through a prospective design and with better definitions of moderate drinking and mental health.

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Contributor: Philippe Arvers
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Comprehensive Social Model Service Delivery System


This paper has been developed and recently approved by the full Board of CAARR and reflects the best thinking on what we now call the Comprehensive Social Model.


Conclusion

It has been the purpose of this text to describe the evolution of Social Model into that of a more comprehensive service delivery system “Comprehensive Social Model”. The commitment to the recovery of alcoholics and addicts has always been the focus of Social Model practitioners. In order to protect the environment and ensure its safety, and to promote spiritual growth conducive to, we have had to modify certain aspects of our service delivery system. These modifications have been dictated by both the changing needs of our clientele (listen to them and they will tell you what they need) and compliance with program licensing, certification (both program and individual), accreditation, SB 198, ADA, CFR 42 Part II, and HIPAA.

We realize that we are not alone in our commitment and dedication to those who need recovery, nor are we so arrogant as to believe that our chosen way of providing services is the only model that works. We do hold true at the core of our belief that authority tends to promote dependency; over function produces dysfunction; and a parent may keep a child a child forever. After all, the one true goal of recovery is to produce an independent, functioning adult.

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Contributor: Susan Blacksher CAARR
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eNewsletter: May 4, 2007

Faces & Voices Message and Media Training

Save the dates of June 22-23, 2007 for our next message and media training in Denver, CO. Details to follow. Almost 1000 recovery advocates have participated in this exciting training. Click here for more details.

National “Parity Day” success!

Thanks to everyone who got in touch with their members of Congress on May 2nd, when Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) were joined by House Speaker Nancy Pelosi, House Leaders and over a dozen House colleagues on Capitol Hill rally support for H.R. 1424, the "The Paul Wellstone Mental Health and Addiction Equity Act.” Learn More…

Rally for Recovery! September 15th

Saturday, September 15, 2007 is Rally for Recovery! day across the country as part of National Alcohol and Drug Addiction Recovery Month. To join our organizing network to strategize with other recovery community organizations who are using this event to raise the national profile of recovery and recovery advocacy, email National Field Director Tom Coderre.

Missouri Recovery Advocates Letters to the Editor Success

When Missouri Recovery Network (Jefferson City chapter) advocates decided to do a letter writing campaign, they made it the activity for a meeting and provided background materials and information right there. Faces & Voices of Recovery board member Judie Didricksen reports that they had examples of past letters on hand as well as background information on poster board with bullet points so that people could pick and choose what they wanted to include in their letters. They offered to send in letters that were written at the meeting and encouraged people who couldn’t make the meeting to write their letters from home and send them in. Some of the individuals who wrote letters did not wish to break their anonymity so they wrote their letters as parents of concerned teen-agers.

The result: seven letters to the editor were published in the Jefferson City News Tribune during the month of April and on the last Sunday of the month, the newspaper editor wrote an opinion piece in the local section of the paper, applauding the letters and their commitment to recovery. Click here to read the letters. Faces & Voices’ sample letters to the editor has how-to information for writing and sending in letters to the editor.

Maryland restores voting rights for many

On July 1, 2007 a Maryland law will go into effect that reverses the state’s lifetime voting ban for people with drug convictions. The new law will make more than 50,000 Marylanders eligible to vote. Listen to Faces & Voices’ webinar on the restoration of voting rights.

Resources

• Report from CSAT National Summit on Recovery is a follow-up to a September 2005 conference sponsored by the federal government’s the Center for Substance Abuse Treatment (CSAT). The agency convened over 100 stakeholders to discuss and identify guiding principles of recovery and elements of recovery-oriented systems for care for people with substance use disorders. This was the first time a broad-based consensus on guiding principles of recovery and elements of recovery-oriented systems of care was achieved on a national level.

• Check out Stopandstartover.org, a new recovery-oriented web site that grew out of a thesis project. The site is oriented toward younger people. “Recovery is a way of life. You don’t just check into rehab with a drug or alcohol problem and get better by the time your stay is over. You don’t just go to a few twelve-step meetings and get sober. Recovery is about learning to live your life in a new way, without a crutch. It’s about developing a network of sober friends, people who you can talk with and relate to. It’s about creating a new life.”

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New ICAP Report on Lower Alcohol Beverages

We are pleased to announce the publication of the new, nineteenth issue of the ICAP Reports, entitled, Lower Alcohol Beverages. Drinks with “lower” alcohol content are produced in each of the major beverage alcohol categories (beer, wine, and spirits). The existence of such drinks points toward an interest on the part of the beverage alcohol producers to provide an expanded range of choices reflecting consumers’ lifestyles, health-consciousness, price sensitivities, as well as tastes. This report examines lower alcohol beverage (LABs) from the perspectives of the beverage alcohol producers, governments, and consumers. It provides an overview of the types of LABs available, identifies trends, and reviews relevant research.

The full text of this report is available on the ICAP Web site,

Contributor: Tinisha Carroll

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Early Adolescent Exposure to Alcohol Advertising and its Relationship to Underage Drinking

To determine whether early adolescents who are exposed to alcohol marketing are subsequently more likely to drink. Recent studies suggest that exposure to alcohol ads has a limited influence on drinking in mid-adolescence. Early adolescents may be more vulnerable to alcohol advertising effects.

After adjusting for covariates, the joint effect of exposure to advertising from all six sources at grade 6 was strongly predictive of grade 7 drinking and grade 7 intentions to drink. Youth in the 75th percentile of alcohol marketing exposure had a predicted probability of drinking that was 50% greater than that of youth in the 25th percentile.

Although causal effects are uncertain, policy makers should consider limiting a variety of marketing practices that could contribute to drinking in early adolescence.

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Reprint Request E-mail: Rebecca_Collins@rand.org
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News Release: RAND STUDY FINDS ALCOHOL ADVERTISING AND MARKETING ARE ASSOCIATED WITH ADOLESCENT DRINKING

FOR RELEASE
Thursday
May 3, 2007

Children's exposure to alcohol advertising during early adolescence appears to influence both beer drinking and their intentions to drink a year later, according to a RAND Corporation study issued today.

The study of children in the sixth and seventh grades found that those exposed to alcohol advertising at high levels – from television, magazines, in-store displays and promotional items like T-shirts and posters – were 50 percent more likely to drink and 36 percent more likely to intend to drink than children whose exposure to alcohol advertising was very low.

Previous studies have found that adolescents on average see at least 245 television ads for alcoholic beverages every year, and that these ads may promote drinking. But the RAND study is unique because it also asked adolescents about advertising in magazines, radio and elsewhere, along with whether they owned any promotional items from alcoholic beverage companies.

. . . . . Read Full News Release

Read the Abstract at jahonline.org

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Alcohol Drinking and Total Mortality Risk

Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S63-S67



To evaluate further the relation between alcohol consumption and total mortality, we have carried out new Cox proportional hazards model analyses of 21,535 deaths through 2002 in the Kaiser Permanente study. This follow-up includes 2,618,523 person-years of observation, with a mean follow-up of 20.6 years. We adjusted for age, sex, ethnicity, body mass index, marital status, education, and smoking. New methodology was used to stratify light-moderate drinkers into groups felt more or less likely to include under-reporters. The analysis reconfirms that the relation of alcohol drinking to total mortality is J-shaped, with reduced risk (mainly because of less cardiovascular disease) for lighter drinkers and increased risk for persons reporting more than 3 drinks per day. Infrequent (occasional) drinkers have risk similar to that of lifelong abstainers, while former drinkers are at increased risk, especially for noncardiac death. The general shape of the relation of alcohol to mortality is similar for men and women. Age differences are substantial, with the apparent benefit from light-moderate drinking not seen before middle life. Our data indicate further that the apparent magnitude of benefit of lighter drinking is probably reduced by systematic underreporting.

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Contributor: Philippe Arvers
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Panel Discussion II: Net Effects of Moderate Alcohol Consumption on Health

Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S68-S70



This discussion focused on the effects of moderate alcohol consumption on conditions other than cardiovascular diseases and on total mortality. The panel was chaired by Richard Smallwood, and the panelists were Henk F.J. Hendriks, Luc Letenneur, Klim McPherson, Gyongyi Szabo, Nady el-Guebaly, and Arthur Klatsky.

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Contributor: Philippe Arvers
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Why We Don't Know More about the Social Benefits of Moderate Drinking

Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S71-S74



The scientific literature about drinking shows that a preoccupation with the harms that occasionally befall those who drink too much or too fast is coupled with a virtual ignorance (in both senses of that term) about the benefits that more often accrue to the vast majority who are moderate drinkers. It is ironic that reviews of the subject that appear under the World Health Organization (WHO) imprint have paid almost no attention to two thirds of WHO's definition of health: “…mental and social well-being…,” while focusing overwhelmingly on the physical aspects. This imbalance is so striking that in a recent WHO-affiliated publication the authors suggested that social consequences may be “the forgotten dimension.” This, despite the fact that drinking plays very important roles in many societies with respect to such widely recognized and appreciated benefits as celebration, relaxation, sociability, enhancement of food, concretization of the social order, and time out, in addition to medical and therapeutic benefits. The time is ripe for increasing collaboration to investigate such social benefits in ways that would be of greater interest and of use to those who heretofore have neglected them.

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Contributor: Philippe Arvers
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Patterns of Alcohol Consumption and Cardiovascular Risk in Northern Ireland and France

Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S75-S80


The PRIME Study was begun in 1991 and recruited 10,600 men aged 50 to 59 years in the WHO MONICA Project centers of Belfast, Lille, Strasbourg and Toulouse. Although drinkers in France and Northern Ireland consumed almost identical amounts, the pattern of consumption was different. In Northern Ireland beer and spirits were the staple beverages, whereas in France it was predominantly red wine; in France, 90% of men drank at least one unit per week versus 61% in Northern Ireland. Frenchmen drank evenly throughout the week, whereas in Northern Ireland two thirds of the consumption took place on Friday and Saturday nights. In the 5-year follow up of PRIME in France, the usual cardiovascular protective effect of increasing consumption (up to 45 units per week) was shown and the level of significance for trend in consumption was highly significant (p = 0.006); in Northern Ireland, this pattern was less consistent and did not attain significance. It remains a matter of conjecture whether in Northern Ireland the beneficial effects of alcohol consumption were annulled by a pattern of drinking that increases blood pressure, a well-established risk factor for heart disease, or whether the protection in France resulted from the consumption of wine along with food.

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Contributor: Philippe Arvers
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Harm, Benefits, and Net Effects on Mortality of Moderate Drinking of Alcohol Among Adults in Canada in 2002
Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S81-S86


Alcohol is an important risk factor contributing to the burden of chronic diseases and injuries, but is also associated with some health benefits. This study estimates risks and benefits associated with moderate consumption of alcohol in terms of mortality for Canada in 2002 by age and sex. Distribution of exposure was taken from a Canadian survey and corrected for per capita consumption from production and sales data; risk relationships were taken from published literature to calculate alcohol-attributable fractions for moderate consumption. If moderate consumption is based on average volume alone, 866 net deaths in 2002 among those younger than 70 years of age were due to moderate consumption of alcohol (1.3% of all the deaths in this age group, consisting of 1653 deaths caused and 787 deaths prevented). When heavy drinking episodes were excluded, the net effect was beneficial (55 prevented deaths, 0.09% of all deaths); the net burden was higher for younger ages and the net benefits for older ages.

The net impact of average moderate alcohol consumption on mortality depends on patterns of drinking. Beneficial net effects are seen only when heavy drinking occasions are excluded. Policies should strive to reduce the burden of moderate alcohol consumption while preserving the beneficial impacts.

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Contributor: Philippe Arvers

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Alcohol Use and Mental Health in Developing Countries

Annals of Epidemiology
Volume 17, Issue 5, Supplement 1, May 2007, Pages S87-S92






This paper provides an overview of mental health and alcohol use in developing countries. The review shows that mental disorders are common and pose a significant burden on the health of developing nations. There are close associations between poor mental health and other public health and social development priorities.

Although the overall use of alcohol at the population level is relatively low, with high abstention rate, drinking patterns among those who do drink are often hazardous. The consumption of alcohol is heavily gendered and is characterized by a high proportion of hazardous drinking among men. Hazardous drinkers do not only consume large amounts of alcohol, but also do so in high-risk patterns, such as drinking alone and bingeing. Hazardous drinking is associated with depressive and anxiety disorders as well as suicide and domestic violence.

The limited evidence base suggests that moderate or casual drinking is not associated with social or health hazards; any likely benefits of moderate drinking for mental health have not been studied in developing countries. The implications of this evidence base for future research and policy are discussed.

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Contributor: Philippe Arvers
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