To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, September 22, 2007

Opinion - College Drinking

Published: September 20, 2007

To the Editor:

Re “Calling the Folks About Campus Drinking” (On Education column, Sept. 12):

Samuel G. Freedman notes that since the start of the University of Wisconsin’s parent notification program, student detox admissions have increased by 65 percent. Why? Because more than half of our 28,000 undergraduates engage in dangerous drinking at least once every two weeks, and they constitute a reservoir that continues to feed the pipeline to detox.
. . . . . .

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Gordon Brown's war on teen binge drinking

By Patrick Hennessy, Political Editor

Gordon Brown will unveil a crackdown on teenage alcohol abuse this week in an attempt to end the "excessive drinking culture" among young people.

The campaign, clearly designed to appeal to Middle Britain's voters, attempts to tackle overconsumption by under-18s both on the streets and in the home.

Mr Brown has vowed action on teenage drinking as he puts Labour on alert for a snap general election, which may be held at the end of October.

He will use Labour's annual conference, which begins in Bournemouth today, to unveil policies he believes will capture support from Conservative and Liberal Democrat voters.

Key among them is the scheme to fight the growing menace of teenage alcoholism, The Sunday Telegraph can disclose, only a year after Labour changed the law to allow pubs and clubs to open later. Mr Brown has told Ed Balls, his closest Cabinet confidant: "This is one of my top priorities."

Mr Balls, the Children, Schools and Families Secretary, and Jacqui Smith, the Home Secretary, will lead the drive to tackle teenagers drinking to excess at home.

The plans include the first ever set of guidelines on safe drinking for under-18s to be published — aimed at parents of teenagers.

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Contributor: Tom Colhurst


Lost Weekends: Alcoholism in the Movies

7:00-9:30 PM (Except as noted)
Ceremonial Hall - 4th floor

Host and discussion leader: Kurt Brokaw, MS, teaches at The New School and the 92nd Street Y

A 10-week fall film series featuring screenings/discussions of the rarest and classic feature films on drinking and drinkers.
The Films
Date Title
Oct. 2 Introduction. The Struggle
D.W. Griffth's final and only talking film (1931, 77 min.). The first feature about an alcoholic. Script by Anita Loos. Plus key scenes from Nightmare Alley; Bottom of the Bottle; Come Back Little Sheba; 8 Million Ways To Die; Leaving Las Vegas, and My Name Is Bill W.
Oct. 9 The Lost Weekend
From Charles Jackson's novel, the most harrowing portrait of a drunk in 20th century fiction, with Ray Milland and Jane Wyman, directed by Billy Wilder. 1945 Oscars: Best Picture, Actor, Director, Screenplay.
Oct. 16 Smash-up, The Story Of A Woman
Susan Hayward, a powerhouse actress, stars as a nightclub singer and failing parent in 1945 Manhattan who descends into alcoholism. Eddie Albert is a supportive songwriter.
Oct. 23 Something To Live For (1954)
Ray Milland returns as a recovering alcoholic who 12th-steps Joan Fontaine, losing his sobriety. With Teresa Wright, directed by George Stevens. Plus scenes from Milland's drunken "Night Into Morning" (1954).
Oct. 30 I'll Cry Tomorrow
Susan Hayward returns in 1955 as Follies beauty and Hollywood star Lillian Roth in this stirring, biographical drama. Eddie Albert co-stars again, this time as a recovering alcoholic.
Nov. 6 Come Fill The Cup
A great 1951 performance by James Cagney as a drunken Chicago news reporter. With Phyllis Thaxter, From Harlan Ware's boozy gangland novel. Cagney's one lost film, rarely seen.
Nov. 13 The Country Girl
Bing Crosby's astonishing 1954 role as an alcoholic actor trying for a last comeback, based on Clifford Odets' play. William Holden is his director, Oscar-winning Grace Kelly is his wife.
Nov. 20 Days Of Wine and Roses
PR exec and drunk (Jack Lemmon) plunges his wife (Lee Remick in her finest role) into alcoholism with him. Blake Edwards directs this 1962 classic from J.P. Miller's script with unflinching realism.
Nov. 27 Under The Volcano
Albert Finney is the alcoholic counsel. In John Huston's stark 1984 drama set in Mexico, based on the autobiographical 1947 novel by Malcolm Lowry. With Jacqueline Bisset, Katy Jurado. Quite rare.
Dec. 4
7:00-10:00 p.m. double feature!
Barfly and Drunks
First Charles Bukowski's 1987 LA bar scene with Faye Dunaway and Mickey Rourke. Then Peter Cohn's 1995 fictionalized Times Square AA meeting. Sharing are Faye Dunaway, Dianne Wiest, Richard Lewis, Amanda Plummer, Howard Rollins, Parker Posey and Spalding Gray.

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News Release -
Restrictions proposed on alcohol advertising and sales (Finland)

The government has announced plans to reinforce current alcohol legislation by putting restrictions on pricing and price advertising, regulate advertising on TV and in movie theatres and give more information to customers on alcohol risks.

There will be restrictions on special offers on packs of drinks and happy hour notices. Packs of drinks will be labelled with health warnings in Finnish and Swedish.

The changes to the law will take effect at the beginning of next year. The aim is to cut and prevent alcohol problems, which have risen among the population as a result of EU-compliant tax cuts.

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Policy on reintegration of women with histories of substance abuse: A mixed methods study of predictors of relapse and facilitators of recovery
Substance Abuse Treatment, Prevention, and Policy 2007, 2:28

The predominant U.S. policy approach toward individuals with substance abuse problems has relied on stigma and punishment by withholding access to education, cash assistance, housing, social support, and normal social roles.

In contrast to this approach, the theory of reintegrative shaming asserts that providing individuals with the opportunity to reconnect with society is more effective in reducing potential to relapse to crime and drug abuse. Strategies that promote such reconnection include expanding access to basic needs and supportive relationships along with increasing opportunities to fully participate in mainstream social roles.

Results suggest that lower levels of instrumental support, affective support, and participation in normal roles (such as parent, employee, student, and citizen) are significant predictors of relapse to drug use and criminal behaviors. Qualitative findings support the quantitative results, revealing that participating women perceived the variables of support and role participation as critical in facilitating their recovery. They also noted the importance of individual characteristics such as optimism and strength and emphasized the significance of their relationship with their children in motivating them to avoid relapse. Findings suggest that punitive policies toward women with substance abuse histories may be ineffective.

The author concludes that current policies designed to withhold access to basic needs such as housing, education, cash assistance, and positive relationships may deprive women with histories of substance abuse of the means to reconnect with society. Policies that promote access to basic needs and offer avenues for women to participate in normal societal roles should be more fully explored.

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Pearson Family Chair to Support Forward-Looking Alcohol and Addiction Research

By Mika Ono Benedyk

Endowed chairs bring with them prestige and security, so when Professor Barbara Mason learned she would hold The Pearson Family Chair, a newly endowed position in alcohol and addiction research at The Scripps Research Institute, she was thrilled.

"The chair provides assurance that the team I assembled at The Scripps Research Institute can carry on our exciting work, which has great potential to help people in recovery," says Mason. "As part of the Pearson Center, the chair also gives me the freedom to conduct early proof-of-concept studies and quickly build on preclinical and clinical findings, work that could be delayed for years if we had to wait for National Institutes of Health funding, or never done at all."

The Pearson Family Chair was established with a gift from philanthropist and entrepreneur Mark Pearson, who also established the Pearson Center for Alcoholism and Addiction Research at Scripps Research in 2003. The center, co-directed by Mason and Professor George Koob, combines the latest biomedical research with new clinical treatments to fight the devastating, costly, and deadly disease of alcohol and drug addiction.
. . . . .

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Smaller feedback ERN amplitudes during the BART are associated with a greater family history density of alcohol problems in treatment-naïve alcoholics
Drug and Alcohol Dependence
Article in Press, Corrected Proof 14 September 2007

Alcoholism is characterized by impaired decision-making (i.e., choosing intoxication in the face of mounting negative consequences). This impairment may involve a reduced brain response to the negative consequences of behavior, which supports an inclination to engage in risky behaviors.

The feedback error-related negativity (F-ERN) is hypothesized to reflect the valence attached to the negative consequences of behavior. Performance on the Balloon Analogue Risk Task (BART) measures risk-taking propensity. We recorded F-ERNs during the BART and during a BART simulation, where individuals observed the rewards and consequences of (someone else's) BART performance.

F-ERNs over fronto-central electrode sites were observed to balloon pops in the BART and BART simulation. F-ERNs during the BART were more than twice the amplitude of F-ERNs during the BART simulation. Smaller F-ERN amplitudes from the BART (but not the BART simulation) were associated with a greater family history density of alcohol problems.

The results suggest a possible link between the genetic vulnerability toward developing alcoholism and the brain's response to the negative consequences of behavior.

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Friday, September 21, 2007

Drinking by parents, siblings, and friends as predictors of regular alcohol use in adolescents and young adults: a longitudinal twin-family study
Alcohol and Alcoholism 2007 42(4):362-369;

The aim of this study was to examine whether the drinking habits of parents, siblings, and friends were related to regular drinking in adolescents and young adults, cross-sectionally as well as longitudinally.

Results show that age, sex, and one's own previous drinking habits were important predictors of later-life regular drinking. Drinking habits of parents showed small but persistent positive associations. Alcohol use of the co-twin was strongly related to alcohol use of the participants, especially in the cross-sectional analyses, while alcohol use of additional siblings other than the co-twin was relatively unimportant. Cross-sectionally, friends' alcohol use showed a high association with regular drinking, but this association decreased over time.

Cross-sectional analyses showed that a substantial part (29%) of the variance in regular drinking habits of adolescents and young adults was explained by the drinking habits of family members and friends, in particular, by drinking of co-twins and friends.

But, over time, drinking by family members and friends could only explain a relatively small part (4–5%) of the variance in adolescents' and young adults' alcohol use.

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Pharmacokinetic and pharmacodynamic basis for partial protection against alcoholism in Asians, heterozygous for the variant ALDH2*2 gene allele.
Pharmacogenetics and Genomics October 2007, 17:10

It has been well documented that although homozygosity of the variant aldehyde dehydrogenase-2 (ALDH2) gene allele, ALDH2*2, in Asians almost fully protects against alcoholism, the heterozygosity only affords a partial protection to varying degrees.

The full protection against alcoholism has been ascribed to the low-amount of alcohol hypersensitivity accompanied by a prolonged and large accumulation of acetaldehyde in blood (Peng et al. Pharmacogenetics 1999; 9:463-476). The physiological basis for the partial protection, however, remains unclear.

Heterozygotic ALDH2*1/*2 subjects were found to be strikingly responsive to the moderate amount of alcohol, as evidenced by the prominent cardiovascular effects as well as subjective perceptions of general discomfort for as long as 2 h following ingestion. The ADH1B polymorphisms did not appear to correlate with the pharmacokinetic and pharmacodynamic effects.

These results indicate that acetaldehyde, rather than ethanol or acetate, is primarily responsible for the observed alcohol sensitivity reactions and suggest that substantially lower accumulation of blood acetaldehyde in the heterozygotes significantly reduces the aversion reaction to low amounts of alcohol that permits other biological as well as environmental factors to facilitate drinking and the according risk for the disease.

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Moderate Level Fetal Alcohol Exposure and Serotonin Transporter Gene Promoter Polymorphism Affect Neonatal Temperament and Limbic-Hypothalamic-Pituitary-Adrenal Axis Regulation in Monkeys
Biological Psychiatry
Article in Press, Corrected Proof
Online 20 september 2007

A length polymorphism in the serotonin (5-HT) transporter gene promoter region in humans and rhesus monkeys affects functional characteristics of the brain 5-HT system. Prenatal alcohol exposure (FA-exposure) can have an impact on brain and psychosocial development that could interact with genetic endowment. This study determined whether moderate FA-exposure interacts with polymorphism in the 5-HT transporter gene to increase the incidence or severity of fetal alcohol effects in rhesus monkeys.

Prenatal alcohol exposed carriers of the s allele exhibited increased neonatal irritability and increased ACTH and CORT compared with FA-exposed monkeys homozygous for the l allele and monkeys that were not FA-exposed regardless of genotype.

The s allele of the 5-HT transporter increases the probability of neonatal irritability and increased stress responsiveness in FA-exposed monkeys, and this gene-environment interaction may affect psychosocial development. It is probable that FA-exposure contributes to 5-HT transporter gene-environment interactions in humans.

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Asian Americans in community-based substance abuse treatment: Service needs, utilization, and outcomes
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 313-319

The objectives of this study were to examine differences in substance abuse treatment needs, treatment utilization, and outcomes between Asian Americans/Pacific Islanders (AAPI) and others.

AAPI presented to treatment with lower alcohol and drug severity lower than the comparison group and similar problem severity in other domains. There were no group differences in treatment retention, but AAPI received a greater number of legal services and fewer medical and psychiatric services than the comparison group. AAPI also received fewer total services within their treatment program.

Treatment outcomes were similar between the two groups, with one exception: AAPI demonstrated better alcohol outcomes than those in the comparison group.

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Religiosity and participation in mutual-aid support groups for addiction
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 321-331

Mutual-aid support groups play a vital role in substance abuse treatment in the United States.

A national survey of mutual-aid support groups for addiction was conducted to identify key differences between participants in recovery groups.

Survey data indicate that active involvement in support groups significantly improves one's chances of remaining clean and sober, regardless of the group in which one participates. Respondents whose individual beliefs better matched those of their primary support groups showed greater levels of group participation, resulting in better outcomes as measured by increased number of days clean and sober.

Religious respondents were more likely to participate in 12-step groups and Women for Sobriety. Nonreligious respondents were significantly less likely to participate in 12-step groups. Religiosity had little impact on SMART Recovery participation but actually decreased participation in Secular Organizations for Sobriety.

These results have important implications for treatment planning and matching individuals to appropriate support groups.

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Spirituality and recovery in 12-step programs: An empirical model
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 265-272

Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal.

A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives.

The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts.

By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms.

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Assessment of spirituality and its relevance to addiction treatment
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 257-264

The prominence of Twelve-Step programs has led to increased attention on the putative role of spirituality in recovery from addictive disorders.

We developed a 6-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and we demonstrated here its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers.

This scale and the measures related to recovery from addiction and treatment response were applied in three diverse treatment settings: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs.

Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery.

Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities.

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What does recovery mean to you? Lessons from the recovery experience for research and practice
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 243-256

Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness.

This study examines recovery definitions and experiences among persons who self-identify as “in recovery.” Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289).

Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful “new life,” an ongoing process of growth, self-change, and reclaiming the self.

Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models.

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Addiction recovery: Its definition and conceptual boundaries
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 229-241

The addiction field's failure to achieve consensus on a definition of “recovery” from severe and persistent alcohol and other drug problems undermines clinical research, compromises clinical practice, and muddles the field's communications to service constituents, allied service professionals, the public, and policymakers.

This essay discusses 10 questions critical to the achievement of such a definition and offers a working definition of recovery that attempts to meet the criteria of precision, inclusiveness, exclusiveness, measurability, acceptability, and simplicity.

The key questions explore who has professional and cultural authority to define recovery, the defining ingredients of recovery, the boundaries (scope and depth) of recovery, and temporal benchmarks of recovery (when recovery begins and ends).

The process of defining recovery touches on some of the most controversial issues within the addictions field.

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Thursday, September 20, 2007

Trends in alcohol consumption in Singapore 1992–2004
Alcohol and Alcoholism 2007 42(4):354-361

To present trends in alcohol consumption between 1992 and 2004 in Singapore.

Prevalence of frequent, regular and binge drinking increased between 1992 and 2004. Prevalence increase in binge drinking was highest (from 5.1 to 10.0%), followed by frequent drinking (from 4.5 to 7.5%) and regular drinking (from 2.9 to 3.1%). Uptake in binge drinking increased in both genders and across all age groups but was most evident among adults aged 18–29.

Frequent drinking increase was observed for both genders but was most pronounced among women aged 18–29. The level of regular drinking declined in men but increased in women, especially those aged 18–29 and 30–49.

Being younger, male, separated, divorced or widowed, a current smoker, or having a monthly household income of S$6000 and above were attributes positively associated with binge drinking.

Alcohol consumption, especially binge drinking, has increased among Singaporeans between 1992 and 2004. There is gender convergence in alcohol consumption.

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Translational methods in biostatistics: linear mixed effect regression models of alcohol consumption and HIV disease progression over time
Epidemiologic Perspectives & Innovations 2007, 4:8

Longitudinal studies are helpful in understanding how subtle associations between factors of interest change over time. Our goal is to apply statistical methods which are appropriate for analyzing longitudinal data to a repeated measures epidemiological study as a tutorial in the appropriate use and interpretation of random effects models.

To motivate their use, we study the association of alcohol consumption on markers of HIV disease progression in an observational cohort. To make valid inferences, the association among measurements correlated within a subject must be taken into account. We describe a linear mixed effects regression framework that accounts for the clustering of longitudinal data and that can be fit using standard statistical software. We apply the linear mixed effects model to a previously published dataset of HIV infected individuals with a history of alcohol problems who are receiving HAART (n=197).

The researchers were interested in determining the effect of alcohol use on HIV disease progression over time. Fitting a linear mixed effects multiple regression model with a random intercept and random slope for each subject accounts for the association of observations within subjects and yields parameters interpretable as in ordinary multiple regression.

A significant interaction between alcohol use and adherence to HAART is found: subjects who use alcohol and are not fully adherent to their HIV medications had higher log RNA (ribonucleic acid) viral load levels than fully adherent non-drinkers, fully adherent alcohol users, and non-drinkers who were not fully adherent.

Longitudinal studies are increasingly common in epidemiological research. Software routines that account for correlation between repeated measures using linear mixed effects methods are now generally available and straightforward to utilize. These models allow the relaxation of assumptions needed for approaches such as repeated measures ANOVA, and should be routinely incorporated into the analysis of cohort studies.

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A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months
Alcohol and Alcoholism 2007 42(4):328-332;

To examine the change in alcohol use parameters following a brief intervention (BI) based on the FRAMES protocol, compared to simple advice (SA), in a community setting in North India.

Of the 90 subjects, 87 (96.7%) were available for follow up in the first month and 86 (95.6%) in the third month. There was significant improvement across many drinking and QOL parameters in both the BI and SA groups, Significant differences were noticed across interventions, with a decrease in severity of dependence as measured by alcohol use in the last 30 days, composite ASI scores & improvement in physical and psychological quality of life, in those who received BI compared to those who received SA.

Changes in motivation toward action were documented at first follow up, but were not sustained in either of the interventions.

BI had a slight advantage over SA in excessive users of alcohol in this community setting in India. It is probable that booster sessions would be needed to achieve sustained effect.

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The acute effects of alcohol on auditory thresholds
BMC Ear, Nose and Throat Disorders 2007, 7:4

There is very little knowledge about alcohol-induced hearing loss. Alcohol consumption and tolerance to loud noise is a well observed phenomenon as seen in the Western world where parties get noisier by the hour as the evening matures. This leads to increase in the referrals to the "hearing aid clinic" and the diagnosis of "cocktail party deafness" which may not necessarily be only due to presbyacusis or noise-induced hearing loss.

Our results showed that there was a positive association between increasing breath alcohol concentration and the magnitude of the increase in hearing threshold for most hearing frequencies. This was calculated by using the Pearson Regression Coefficient Ratio which was up to 0.6 for hearing at 1000Hz. Over 90% of subjects had raised auditory thresholds in three or more frequencies; this was more marked in the lower frequencies.

Alcohol specifically blunts lower frequencies affecting the mostly 1000 Hz, which is the most crucial frequency for speech discrimination.

In conclusion alcohol does appear to affect auditory thresholds with some frequencies being more affected than others.

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Home Office tried to hide surge in drunken attacks

20th September 2007

Serious violence and murder near pubs and clubs in the early hours rose by almost 130 per cent in the year after licensing laws were relaxed.

But the Home Office omitted the figure from its report into the impact of 24-hour opening, claiming it was "not statistically significant".

Ministers have now been forced under Freedom of Information laws to reveal the missing data, which was simply replaced with a blank space when the research was published in July.

The rise of 127 per cent was recorded across 18 police regions in city centre locations or near pubs and clubs between 3am and 6am.

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Wednesday, September 19, 2007

Statistical Signal processing for an implantable ethanol biosensor
Engineering in Medicine and Biology Society, 2006. EMBS '06. 28th Annual International Conference of the IEEE Aug. 2006: 3704-3707

The understanding of drinking patterns leading to alcoholism has been hindered by an inability to unobtrusively measure ethanol consumption over periods of weeks to months in the community environment.

Signal processing for an implantable ethanol MEMS bio sensor under simultaneous development is described where the sensor-signal processing system will provide a novel approach to this need. For safety and user acceptability issues, the sensor will be implanted subcutaneously and therefore measure peripheral-tissue ethanol concentration.

A statistical signal processing system based on detailed models of the physiology and using extended Kalman filtering and dynamic programming tools is described which determines ethanol consumption and kinetics in other compartments from the time course of peripheral-tissue ethanol concentration

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SAMHSA's Road to Recovery Update

The Road to Recovery Update keeps you informed about activities leading up to National Alcohol & Drug Addiction Recovery Month (Recovery Month) in September. Feel free to forward this information to friends and colleagues, include it in newsletters or listservs, or link to it from your Web site.

Recovery Month Continues....

Recovery Month is off to a great start with over 550 community events listed on the Web site! Please keep those events coming in and help us continue to spread the word of recovery. Have a successful event? Please send us your pictures, videos and comments and encourage other event planners to follow. Click here to post an event and send us your event results today!

Recovery Month Live-Read Radio Scripts Available

It's not too late to help publicize Recovery Month. Here are some tips to help you distribute live-read scripts to local radio stations:
  • Call local radio stations to have them read live-read radio scripts.
  • Fax, e-mail, or mail copies of the PSA scripts to the contact person for their consideration, after calling to introduce them to Recovery Month. When you send the scripts, remember to include a cover letter. This letter should reference your previous conversation and list your contact name, organization, and phone number. The letter also should summarize the main points that are discussed in the PSA, and be clear about your appreciation for the station's support in disseminating the message of Recovery Month to the community. Click here to view the scripts.

Next Webcast

Wednesday, September 19: "Improving Addiction Treatment Services: Taking Action Now"

Improving Addiction Treatment Services: Taking Action Now View the Trailer

As leaders who can influence and shape policy, civic and elected officials play a crucial role in reducing the toll addiction takes on their communities. Implementing policies that effectively treat substance abuse and dependence leads to increased productivity and profitability in the workplace, as well as decreased costs throughout the criminal justice system and social services system. Therefore, policy implementation lessens the financial burden on taxpayers. This program will look at the role of civic and elected officials in fighting substance abuse and dependence, as well as steps they can take to improve their communities' well-being.

Ask the Expert

Get answers to your questions about the topics covered in the latest Road to Recovery Webcast: "Investing in Treatment: Policymakers' Positive Impact on Their Community."

Submit your questions using our anonymous online form, and answers from our expert will be posted in early October.

Visit Ask the Expert before September 28 to submit questions for this month's expert, Todd Molfenter, Ph.D, Deputy Director, NIATx.

As Deputy Director, Todd Molfenter's role includes managing the technical assistance provided to NIATx members and process improvement coaches. He also oversees the Advancing Recovery project, serves as coach to selected NIATx members, and is a key faculty member in Learning Sessions.

For more information about Todd Molfenter, Ph.D, visit:

About Recovery Month

National Alcohol and Drug Addiction Recovery Month, celebrating 18 years of observance in 2007, is an initiative of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Substance Abuse Treatment (CSAT). For more information about Recovery Month, visit

The Search for Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: A Commentary
Alcoholism: Clinical and Experimental Research 31 (s3), 21s–32s.

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple.

This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested.

It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders.

Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

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12-Step Approaches for the Dually Diagnosed: Mechanisms of Change
Alcoholism: Clinical and Experimental Research 31 (s3), 64s–66s.

Existing data indicate that 12-step program involvement is associated with improved outcomes in the dually diagnosed, but there are questions concerning the magnitude and mechanisms of this effect in various dually diagnosed populations.

Dually diagnosed individuals attend 12-step programs at rates comparable to the nondually diagnosed, although specific diagnoses may have some effect on attendance. The benefits of 12-step attendance do not appear to be markedly different for those with psychiatric disorders. Specialized 12-step programs could have benefits for the dually diagnosed over and above those of traditional 12-step programs. Existing data suggest that nonspecific change mechanisms (self-efficacy, social support) are similar to those found in the general AA literature.

Based on existing data, the change mechanisms are broadly similar to those found in the general 12-step literature, but additional factors related to mental illness may also play a significant role. Further work is necessary to test the components of this model and to achieve a firm empirical foundation for understanding the processes of 12-step recovery in the dually diagnosed.

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A Broader View of Change in Drinking Behavior
Alcoholism: Clinical and Experimental Research 31 (s3), 84s–86s.

Most research concerning change in drinking behavior has taken place within the context of specialized treatment for a help-seeking population. However, treatment approaches with different purported mechanisms of action yield very similar results, suggesting that common elements, rather than specific mechanisms, may be responsible for the bulk of the individual change process.

Mechanisms of change have not been explicitly examined. Other factors such as social pressure may be more important mediators of change, which may occur prior to treatment entry. Also, most change occurs outside the context of specific treatment. A broader perspective focusing on mechanisms of change will need to account for change occurring both with and without professional treatment.

Future research must be interdisciplinary in nature, seeking to relate social, behavioral, and neurophysiologic correlates of behavior change.

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Glycemic effects of moderate alcohol intake among patients with type 2 diabetes: A Multi-center, randomized clinical intervention trial
Diabetes Care Publish Ahead of Print
published online ahead of print September 11, 2007

In a randomized controlled trial, we assessed the effect of daily moderate alcohol intake on glycemic control in the fasting and postprandial states in patients with type 2 diabetes who previously had abstained from alcohol.

During the intervention, 17% of participants (12% from the alcohol group) dropped out, leaving 91 who completed the trial. Within the alcohol group, fasting plasma glucose (FPG) decreased from 139.6+/-41 to 118.0+/-32.5mg/dL after 3 months compared to 136.7+/-15.4 to 138.6+/-27.8mg/dL in the controls (Pv=0.015). However, alcohol consumption had no effect on 2-hour postprandial glucose levels (difference=18.5 in the control vs. 17.7mg/dL in the alcohol groups, Pv=0.97). Patients in the alcohol group with higher baseline HbA1c levels had greater reductions in FPG (age-adjusted correlation=-0.57, Pv<0.001).> observed in the levels of bilirubin, alkaline phosphatase, ALT, or AST, and no notable adverse effects were reported. Participants in the alcohol group reported an improvement in the ability to fall asleep (Pv<0.001).

Among previous alcohol abstainers with type 2 diabetes, initiation of moderate daily alcohol consumption reduced FPG but not postprandial glucose. Patients with higher HbA1c may benefit more from the favorable glycemic effect of alcohol.

Further intervention studies are needed to confirm the long-term effect of moderate alcohol intake.

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News Release - Family history of alcoholism affects response to drug used to treat heavy drinking

New study in Biological Psychiatry

Philadelphia, PA, September 19, 2007 – Naltrexone is one of four oral medications approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcoholism. A recent large multicenter research study of alcohol dependence supported by the National Institute of Alcoholism and Alcohol Abuse (NIAAA), the COMBINE Study, suggested that naltrexone produced a modest but significant benefit but another FDA-approved medication, acamprosate, was ineffective.

Perhaps consistent with its modest effects in COMBINE, naltrexone is not widely prescribed in the treatment of alcoholism. Yet, clinicians report that naltrexone may have significant benefits for individual patients.

To make naltrexone a more useful medication, it would be important to begin to identify groups of patients who might be more or less likely to show a significant clinical benefit from naltrexone prescription and to understand the causes of differential naltrexone efficacy. A new study that will appear in the September 15th issue of Biological Psychiatry suggests that alcohol dependent individuals with a family history of alcohol dependence may be more likely than alcohol dependent individuals without a family history of alcohol dependence to reduce their drinking in the laboratory when prescribed naltrexone.
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AMPA Receptor Potentiation can Prevent Ethanol-Induced Intoxication

Neuropsychopharmacology advance online publication 12 September 2007;

We present a substantial series of behavioral and imaging experiments, which demonstrate, for the first time, that increasing AMPA receptor-mediated neurotransmission via administration of potent and selective biarylsulfonamide AMPA potentiators LY404187 and LY451395 reverses the central effects of an acutely intoxicating dose of ethanol in the rat.

Using pharmacological magnetic resonance imaging (phMRI), we observed that LY404187 attenuated ethanol-induced reductions in blood oxygenation level dependent (BOLD) in the anesthetized rat brain. A similar attenuation was apparent when measuring local cerebral glucose utilization (LCGU) via C14-2-deoxyglucose autoradiography in freely moving conscious rats.

Both LY404187 and LY451395 significantly and dose-dependently reversed ethanol-induced deficits in both motor coordination and disruptions in an operant task where animals were trained to press a lever for food reward. Both prophylactic and acute intervention treatment with LY404187 reversed ethanol-induced deficits in motor coordination.

Given that LY451395 and related AMPA receptor potentiators/ampakines are tolerated in both healthy volunteers and elderly patients, these data suggest that such compounds may form a potential management strategy for acute alcohol intoxication.

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Detrimental drinking patterns: Empirical validation of the pattern values score of the Global Burden of Disease 2000 study in 13 countries
Journal of Substance Use, Volume 12, Issue 5 October 2007 , pages 337 - 358

In addition to volume, patterns of drinking have an effect on disease and injury. Depending on the prevailing way alcohol is coghnsumed (i.e. on drinking patterns), mortality and morbidity should vary across cultures even if per capita consumption is about the same.

In a Comparative Risk Analysis (CRA), the WHO estimated for the year 2000 the Global Burden of Disease stemming from alcohol consumption by including both dimensions of intake (volume and patterns). For this purpose, a detrimental drinking pattern scale was developed. This scale used expert ratings of six dimensions of the prevailing drinking patterns in each country.

The present study attempts first to replicate the expert ratings based on survey data from 13 countries. Secondly, it compares the scaling of individual level data with the scaling of aggregate level data. For the latter, such survey measures as percentage usually drinking with meals and percentage usually getting drunk when drinking to approximate the pattern scoring system used in CRA were constructed.

Aggregate and individual level analyses resulted in similar orderings of countries on a one-dimensional scale. There was a good correspondence between the orderings and country's values on the CRA detrimental drinking pattern scale. The ordering of countries varied if men and women were scaled separately.

The results indicated a bias of expert ratings towards focusing on male drinking patterns. From analysis of the survey data, the patterns in Nigeria appeared relatively more detrimental than the CRA score based on expert ratings, while the patterns in Finland appeared less detrimental.

Future attempts to include drinking patterns in addition to volume should take gender differences into account.

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Intelligent Data Analysis for Diagnostics of Alcohol Dependency
Twentieth IEEE International Symposium on Computer-Based Medical Systems (CBMS'07) pp. 445-450

The alcohol dependency is hard to diagnose since none of the existing laboratory markers has sufficient specificity and sensitivity. Therefore the goal of our study was to find better laboratory markers and / or their combinations. For that purpose the intelligent data analysis using the decision tree induction method was used.

The results show that the combination of three or even two markers can prove alcohol dependency with almost 85% accuracy.

However the remark has to be made that the induced decision tree offers a qualitatively different access to diagnostic evaluation of laboratory findings and varies from common practice, because it sets up its new and own borders and criteria what is the unlike from generally accepted or set up reference values. All selected markers are widely accessible, inexpensive and part of a routine laboratory tests.

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Tuesday, September 18, 2007

The Search for Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: A Commentary
Alcoholism: Clinical and Experimental Research 31 (s3), 21s–32s.

Definitive results from efforts to identify mechanisms of change in behavioral treatments for alcohol use disorders have been elusive. The working hypothesis guiding this paper is that one of the reasons for this elusiveness is that the models we hypothesize to account for treatments effectiveness are unnecessarily restricted and too simple.

This paper aims to accomplish 3 things. First, a typography for locating potential mediators of change will be presented. In the course of doing so, a nomenclature will be proposed with the hope that this will facilitate communications among alcohol treatment researchers studying mechanisms of change. Second, alternatives to the classic test of mediation of alcohol treatment effects will be considered and one such alternative described. Third, alternative ways of conceptualizing, constructing and analyzing variables to measure mediators will be suggested.

It is hoped that this commentary will facilitate research on mechanisms of change in behavioral treatments for alcohol use disorders.

Behavioral change is a complex process, and the models that we develop to account for this process need to reflect this complexity. Advances in statistical approaches for testing mediation, along with a better understanding as to how to use these tools should help in moving toward this goal.

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Mechanisms, Determinants and Processes of Change in the Modification of Drinking Behavior
Alcoholism: Clinical and Experimental Research 31 (s3), 13s–20s.

This article explores the conceptual foundations of the search for mechanisms of change in psychotherapy and behavior change approaches.

A series of key questions is addressed. The first critical question is, Where are the appropriate places to look for mechanisms of change in the modification of drinking behavior: person, provider, intervention, or environment? The second questions what we know about change mechanisms from recent research. The third addresses the appropriate methods and designs to isolate and understand these mechanisms. The final question is, How should we proceed to advance our understanding of the critical mechanisms that drive the process of the modifying drinking and recovery from alcoholism?

We propose a dynamic, life course and an interactive, multidimensional perspective that focuses on personal mechanisms of change and how they interact with interventions, providers, policies, and other life context factors that facilitate or act as barriers to engaging these mechanisms of change.

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