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, November 3, 2007

Lifestyle- and diet-related factors in late-life depression - a 5-year follow-up of elderly European men: the FINE study
International Journal of Geriatric Psychiatry, Early View, 2 November 2007

Late-life depression is one of the main health problems among elderly populations and a key element of healthy ageing. Causal relationships of lifestyle- and diet-related factors in late-life depression are unclear.

This study investigates prospective associations of lifestyle- and diet-related factors with development of categorically defined late-life depression in a well-documented population of elderly European men.

Eleven percent (n = 59) of the men developed depression during follow-up. An independent association with development of depression was found for baseline depressive status , a decline in serum total cholesterol level between study years , physical activity and moderate alcohol intake but not for dietary factors.

This study of a well-documented population of elderly European men confirms that physical activity and moderate alcohol consumption may protect against depression in the old-old. Our results are the first to suggest that a decline in serum cholesterol level may predict development of late-life depression.

As the effects of age, medication and incipient cognitive decline could not be entirely ruled out; this finding must be interpreted with care.

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'Hazardous' alcohol abuse in Armed Forces
By Richard Gray

A culture of “hazardous” binge drinking is plaguing Britain’s Armed Forces with three times more men and nine times more women drinking dangerous amounts of alcohol than in the civilian population.

A report to be published next month lays bare the extent of alcohol abuse among the country’s military personnel, claiming that “ritualised drinking”, operational stress and the macho culture fuels excessive drinking.

Doctors behind the study, the largest of its kind in the British services, have criticised the military’s “ambivalent” view on alcohol abuse.
. . . . . . .

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Patterns of drinking in the UK Armed Forces
Addiction 102 (11), 1749–1759.

To examine patterns of drinking in the UK Armed Forces, how they vary according to gender and other demographics, and to make comparisons with the general population.

Sixty-seven per cent of men and 49% of women in the UK Armed Forces had an AUDIT score of 8+ (defined as hazardous drinking), compared to 38% of men and 16% of women in the general population. In both sexes, for all ages, the military have a higher prevalence of hazardous drinking. Binge drinking was associated with being younger, being in the Army, being single, being a smoker and being white. Among military men, heavy drinking (AUDIT score 16+) was associated with holding a lower rank, being younger, being single, being in the Naval Service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem.

Excessive alcohol consumption is more common in the UK Armed Forces than in the general population. There are certain socio-demographic characteristics associated with heavy drinking within the military; for example, young age, being single and being a smoker, which may allow the targeting of preventive interventions.

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Press release - Substance abuse practitioners ask 'what is recovery?'

More than just abstinence, according to proposed definition

Philadelphia, PA, November 1, 2007 – Abstinence from alcohol and drugs is just the starting point in defining "recovery" for people with substance abuse disorders, according to a paper in the October issue of the Journal of Substance Abuse Treatment (JSAT).

According to an initial definition developed by a panel of experts from the Betty Ford Institute, recovery is "a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship." The panel's report appears as part of a special section of JSAT devoted to Defining and Measuring Recovery.

Although "recovery" is widely recognized as the goal of treatment for substance abuse disorders, there has been no widely accepted definition of what the term actually means. "Recovery may be the best word to summarize all the positive benefits to physical, mental, and social health that can happen when alcohol- and other drug-dependent individuals get the help they need," the expert panel writes.

The panel's report outlines some of the thinking behind key components of the definition. Sobriety—meaning complete abstinence from alcohol and all other nonprescribed drugs—is regarded as necessary, but not in itself sufficient for recovery. The panel suggests a classification to define the duration of sobriety: "early" sobriety between one month and one year; "sustained" sobriety, between one and five years; and "stable" sobriety, five years or longer. People in "stable" recovery are thought to be at lower risk of relapse.

Personal health is included as a component of recovery that may be of special importance to substance abusers and their families, as well as to society. In this context, personal health refers not only to physical and mental health, but also to social health—ie, participation in social roles and supports. Citizenship refers to "giving back" to community and society. While acknowledging the need refine this part of the definition, the panel felt is was important to recognize the traditional place of citizenship as a key element of recovery.
. . . . . .

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“Recovery” means many things to many people.
Findings Betty Ford Institute Summer 2007

So many things to so many people, that the meaning of this word/concept/lifestyle has taken on a mysterious or even “fringe” quality that has prevented popular understanding and acceptance.

The challenge of the inaugural Betty Ford Institute Consensus Conference was to try to develop a definition of “recovery” that would have utility for clinicians and researchers alike.

In the Fall of 2006, a blue-ribbon panel of researchers, policy makers, clinicians and members of the recovering community, met in Rancho Mirage, California to discuss – and try to define – “recovery.” Erica Goode, a science editor at The New York Times, served as moderator.

The definition that emerged is this: Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship.

Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship:

1. Sobriety – abstinence from alcohol and all other non-prescribed drugs

This criterion is considered primary, and necessary for a recovery lifestyle. Evidence indicates that for formerly dependent individuals, sobriety is most reliably achieved through the practice of abstinance from alcohol and all other drugs of abuse.

Early sobriety = 1-11 months.
Sustained sobriety = 1-5 years.
Stable sobriety = 5 years or more

2. Personal Health – improved quality of personal life as defined and measured by validated instruments such as the physical health, psychological health independence and
spirituality scales of the World Health Organization Quality of Life instrument (WHO-QOL, 1998).

3. Citizenship – living with regard and respect for those around you as defined and measured by validated instruments such as the social function and environment scales of the WHO-QOL instrument. (WHO-QOL, 1998).

Criteria two and three extend sobriety into the broader concept of recovery. Personal healthand citezenship are often achieved and sustained through peer support groups such as AA and practices consistent with the 12 steps and 12 traditions.

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Traditions and alcohol use: A mixed-methods analysis.
Cultural Diversity and Ethnic Minority Psychology. 2007 Oct Vol 13(4) 269-284

An integrative mixed-methods analysis examined traditional beliefs as associated with beliefs about self-care during pregnancy and with alcohol abstinence among young adult women from two rural U.S.-Mexico border communities.

Quantitative (measured scale) variables and qualitative thematic variables generated from open-ended responses served as within-time predictors of these health-related outcomes.

A weaker belief that life is better in big cities was associated with stronger self-care beliefs during pregnancy. Also, a weaker belief that small towns offer tranquil environments was associated with total abstinence from alcohol.

Regarding the Hispanic Paradox, these results suggest that a critical appreciation of cultural traditions can be protective, as this avoids stereotypical or idyllic views of urban or rural lifeways, and promotes self-protective beliefs and behaviors.

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Neurophysiological Endophenotypes, CNS Disinhibition, and Risk for Alcohol Dependence and Related Disorders
The Scientific World, Vol 7, S2, pp.131-141, 2007

Biological endophenotypes are more proximal to gene function than psychiatric diagnosis, providing a powerful strategy in searching for genes in psychiatric disorders. These intermediate phenotypes identify both affected and unaffected members of an affected family, including offspring at risk, providing a more direct connection with underlying biological vulnerability.

The Collaborative Study on the Genetics of Alcoholism (COGA) has employed heritable neurophysiological features (i.e., brain oscillations) as endophenotypes, making it possible to identify susceptibility genes that may be difficult to detect with diagnosis alone. We found significant linkage and association between brain oscillations and genes involved with inhibitory neural networks (e.g., GABRA2, CHRM2), including frontal networks that are deficient in individuals with alcohol dependence, impulsivity, and related disinhibitory disorders.

We reported significant linkage and linkage disequilibrium for the beta frequency of the EEG and GABRA2, a GABAA receptor gene on chromosome 4, which we found is also associated with diagnosis of alcohol dependence and related disorders. More recently, we found significant linkage and association with GABRA2 and interhemispheric theta coherence. We also reported significant linkage and linkage disequilibrium between the theta and delta event-related oscillations underlying P3 to target stimuli and CHRM2, a cholinergic muscarinic receptor gene on chromosome 7, which we found is also associated with diagnosis of alcohol dependence and related disorders.

Thus, the identification of genes important for the expression of the endophenotypes (brain oscillations) helps when identifying genes that increase the susceptibility for risk of alcohol dependence and related disorders.

These findings underscore the utility of quantitative neurophysiological endophenotypes in the study of the genetics of complex disorders. We will present our recent genetic findings related to brain oscillations and Central Nervous System (CNS) disinhibition.

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Friday, November 2, 2007

The Costs of Alcohol, Illegal Drugs, and Tobacco in Canada, 2002
J. Stud. Alcohol Drugs 68: 886-895, 2007

The aim of this study was to estimate costs attributable to substance use and misuse in Canada in 2002.

Costs of substance use and misuse totaled almost Can. $40 billion in 2002. The total cost per capita for substance use and misuse was about Can. $1,267: Can. $463 for alcohol, Can. $262 for illegal drugs, and Can. $541 for tobacco.

Legal substances accounted for the vast majority of these costs (tobacco: almost 43% of total costs; alcohol: 37%).

Indirect costs or productivity losses were the largest cost category (61%), followed by health care (22%) and law enforcement costs (14%). More than 40,000 people died in Canada in 2002 because of substance use and misuse: 37,209 deaths were attributable to tobacco, 4,258 were attributable to alcohol, and 1,695 were attributable to illegal drugs. A total of about 3.8 million hospital days were attributable to substance use and misuse, again mainly to tobacco.

Substance use and misuse imposes a considerable economic toll on Canadian society and requires more preventive efforts.

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Postpartum and Alcohol-Related Factors Associated With the Relapse of Risky Drinking
J. Stud. Alcohol Drugs 68: 879-885, 2007)

The purposes of this investigation were (1) to describe postpartum drinking patterns among women who were frequent drinkers before pregnancy and (2) to identify factors correlated with postpartum risky drinking among women who were frequent drinkers before pregnancy.

Overall, 37.8% (n = 144) of women reported postpartum risky drinking. Eighteen percent reported heavy episodic drinking only, 5% reported frequent drinking only, and 15% reported both behaviors.

Postpartum risky drinkers were more likely than other women to have had a partner who engaged in risky drinking , to have been unemployed , to have smoked following pregnancy , and to have consumed alcohol after the recognition of pregnancy . Women who breast-fed their child were less likely to report risky drinking .

In the postpartum period, health care providers may want to focus alcohol screening efforts on former frequent drinkers who are smokers, are unemployed, have a partner who is a risky drinker, or are not breast-feeding.

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Organizational-Level Predictors of Adoption Across Time: Naltrexone in Private Substance-Use Disorders Treatment Centers
J. Stud. Alcohol Drugs 68: 852-861, 2007

Prominent on the nation's research agenda on substance-use disorders treatment is the dissemination of effective pharmacotherapies. Thus, the purpose of this article is to use a diffusion of innovations theoretical framework to examine the organizational-level predictors of the adoption of a pharmacotherapy, naltrexone (Revia), in private substance use-disorders treatment centers (N = 165).

Data for these analyses were derived from the National Treatment Center Study, which contains four waves of data collected between 1994 and 2003. An event history model examined the impact of culture, leadership characteristics, internal structure, and external characteristics on the likelihood of adopting naltrexone between 1994 and 2003.

The results suggest that organizations embracing a 12-step model and those employing more experienced administrators were significantly less likely to adopt naltrexone. Moreover, treatment centers that used prescription drugs, possessed an employee handbook, were accredited, and operated on a for-profit basis were significantly more likely to adopt naltrexone over time.

Structural characteristics do affect the innovation adoption behaviors of private substance-use disorders treatment centers. Organizational-level research to practice implications to further the adoption of innovative evidence-based treatments are discussed.

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Alcohol Outlets and Problem Drinking Among Adults in California
J. Stud. Alcohol Drugs 68: 923-933, 2007

The purpose of the study was to examine the relationship between alcohol environments and problem drinking, including excessive alcohol consumption, heavy episodic drinking, driving after drinking, and riding with a drinking driver.

On-sale establishments, particularly minor-restricted establishments, were significantly associated with excessive alcohol consumption and heavy episodic drinking, after controlling for individual and neighborhood sociodemographics. The effect was limited to outlets located within proximity, roughly 1 mile from residential homes. Off-sale retails were not found to be related to problem drinking.

If the number of minor-restricted establishments increases from median to 90th percentile of their distribution, heavy episodic drinking would increase from 11.1% to 14.3% among women and from 19.6% to 22.0% among men.

Certain types of alcohol retailers in neighborhoods were associated with problem drinking. Moratorium of new licenses based on number of licenses per capita at county level is not effective because only a subgroup of licenses matters, and alcohol is more available in terms of distance, travel time, or search costs in densely populated cities.

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Serious Psychological Distress and Substance Use Disorder among Veterans


  • Combined data from SAMHSA's 2004 - 2006 National Surveys on Drug Use and Health indicate than an annual average of 7% of veterans aged 18 or older experienced past year serious psychological distress, 7.1% met the criteria for a past year substance use disorder, and 1.5% had co-occurring serious psychological distress and substance use disorder.
  • Veterans aged 18 to 25 were more likely than older veterans to have higher rates of serious psychological distress, substance use disorder, or co-occurring psychological distress and substance use disorder in the past year.
  • Veterans with family incomes of less than $20,000 per year were more likely than veterans with higher family incomes to have had serious psychological distress, substance use disorder, or co-occurring psychological distress and substance use disorder in the past year.
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Alcohol consumption and suicide mortality among Japanese men: the Ohsaki Study
Alcohol Volume 41, Issue 7, November 2007, Pages 503-510

The risk of suicide is well known to be increased among heavy alcohol drinkers. However, whether the risk is increased or decreased among light drinkers is still under debate.

We investigated this association in a population-based sample of men in Japan. The Ohsaki Study was a population-based, prospective cohort study among Japanese adults aged from 40 to 79 years.

Between October and December, 1994, 22,804 men in Miyagi Prefecture, Japan, completed a questionnaire on various health-related lifestyles, including alcohol drinking. During the subsequent 7 years follow-up, 73 participants committed suicide. We used the Cox proportional hazards regression model to estimate the hazard ratio (HR) for suicide mortality according to the quantity of alcohol consumed daily, with adjustment for potential confounders.

There was a statistically significant positive and linear association between the amount of alcohol consumed and the risk of suicide: the multivariate HRs in reference to nondrinkers were 1.2 , 1.5 , and 2.4 in current drinkers who consumed ≤22.7 g, 22.8 g–45.5 g, and ≥45.6 g of alcohol per day, respectively.

Even after the early death cases were excluded, a significant linear association was observed between alcohol consumption and the risk of suicide, with the risk of suicide also being nonsignificantly higher among the light drinkers than among nondrinkers .

This prospective cohort study indicated a positive linear association between alcohol consumption and the risk of suicide, and the suicide risk among the light drinkers was not decreased as compared with that in nondrinkers.

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Alcohol consumption, cardiovascular health, and endothelial function markers
Alcohol Volume 41, Issue 7, November 2007, Pages 479-488

Cardiovascular diseases are among the worldwide leading causes of shorter life expectancy and loss of quality of life. Thus, any influence of diet or life habits on the cardiovascular system may have important implications for public health.

Most world populations consume alcoholic beverages. Since alcohol may have both protective and harmful effects on cardiovascular health, the identification of biochemical mechanisms that could explain such paradoxical effects is warranted.

The vascular endothelium is the target of important mediating pathways of differential ethanol concentrations, such as oxidative stress, lipoproteins, and insulin resistance. Alcohol-induced endothelial damage or protection may be related to the synthesis or action of several markers, such as nitric oxide, cortisol, endothelin-1, adhesion molecules, tumor necrosis factor alpha, interleukin-6, C-reactive protein, and haemostatic factors.

The expression of these markers is consistent with the J-shaped curve between alcohol consumption and cardiovascular health. However, there is genetic and phenotypic heterogeneity in alcohol response, and despite the apparent beneficial biochemical effects of low doses of ethanol, there is not enough clinical and epidemiological evidence to allow the recommendation to consume alcoholic beverages for abstemious individuals.

Considering the potential for addiction of alcoholic beverage consumption and other negative consequences of alcohol, it would be worthwhile to identify substances able to mimic the beneficial effects of low doses of ethanol without its adverse effects.

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eNEWSLETTER 2 November 2007

Call for nominations

We wish Faces & Voices board member and New England regional representative Rev. Hugh-Tudor Foley best wishes on his new assignment to St. Paul's Episcopal Church in Yuma, Arizona. His move creates an opening on the Faces & Voices board of directors to serve out his term through July, 2009. The deadline for applications is December 5.

Recovery Voices Count

Our Recovery Voices Count campaign is underway.

Insurance Discrimination Update

Thanks to Faces & Voices board member William Moyers and David Wellstone, co-founder of Wellstone Action, for authoring, “Mental Illness and Addiction Don’t Discriminate, but Insurance Policies Do,” which appeared in The Hill, a publication widely read on Capitol Hill in Washington, DC. And thanks to Bill Johnson, President of the Central Illinois Recovery Coalition (CILRC) in Springfield, IL and other advocates for getting your letters published in your local newspaper. No date has yet been set for a vote in the U.S. House of Representatives on H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act of 2007.

Faces & Voices’ interns

Thanks to Holly Robertson who just completed her internship at Faces & Voices and welcome to Jennifer Taber, a senior at American University.


Job Opening at the Legal Action Center for a Policy Associate for its Washington, DC office whose responsibilities will include advocacy and federal relations. Learn more…

A 2005 national survey
of participants in mutual-aid support groups by The Walsh Group found that active involvement in these groups improved individuals’ chances of sustaining their recovery.
Learn more…

White Bison's Wellbriety! Online Magazine for 2007 is now available.

Voices for Recovery
is a popular feature on the Recovery Month web site, where people can post their recovery stories so that others can learn about what recovery means to individuals in long-term recovery and their families. To post Learn more…

Rally for Recovery! photographs are still coming in, check out what we’ve received so far!


What is recovery? A working definition from the Betty Ford Institute
Journal of Substance Abuse Treatment
Volume 33, Issue 3, October 2007, Pages 221-228

There is an unknown but very large number of individuals who have experienced and successfully resolved dependence on alcohol or other drugs. These individuals refer to their new sober and productive lifestyle as “recovery.”

Although widely used, the lack of a standard definition for this term has hindered public understanding and research on the topic that might foster more and better recovery-oriented interventions.

To this end, a group of interested researchers, treatment providers, recovery advocates, and policymakers was convened by the Betty Ford Institute to develop an initial definition of recovery as a starting point for better communication, research, and public understanding.

Recovery is defined in this article as a voluntarily maintained lifestyle composed characterized by sobriety, personal health, and citizenship.

This article presents the operational definitions, rationales, and research implications for each of the three elements of this definition.

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NIAAA Expert Explains Impact of Alcohol Abuse on Justice System

Research shows that alcohol abuse costs the United States an estimated $184.6 billion a year, due to crime, medical consequences, lost earnings, lost productivity, motor vehicle crashes, and other social consequences. A large part of that can be attributed to the costs incurred by the criminal justice system—estimated at 6.2 billion. Here, Linda Chezem, a trial court judge by profession and former special assistant to Dr. Ting-Kai (T. K.) Li, M.D., Director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA), explores the impact that alcohol abuse has on the court system and how community coalitions can help lessen that impact.
. . . . . .

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Evidence Note 20 - Screening tools, detoxification and vitamin supplementation for alcohol dependence


Alcohol misuse in Scotland is a significant problem and evidence shows that 27% of men and 14% of women are drinking more than the weekly recommended levels. The overall estimated cost to society is £1 billion per year. Alcohol dependence is defined as a cluster of physiological, behavioural and cognitive phenomena in which the use of alcohol assumes higher priority for an individual than other behaviours. The level of dependence can either be moderate or severe. The first step in helping people overcome their alcohol dependence is detoxification. Detoxification is deliberate alcohol withdrawal managed clinically in an inpatient or outpatient setting. This evidence note focuses on screening tools, detoxification, drugs and adjunctive vitamin supplementation for alcohol dependence. It provides the best available evidence from published secondary literature to inform planners and practitioners.

Key points

  • Appropriate screening tools for detecting people with alcohol dependence that may need detoxification are Fast Alcohol Screening Test (FAST) in A&E settings and Cut down Annoyed Guilty Eye-opener (CAGE) plus or FAST in community settings.
  • People with moderate alcohol dependence can be effectively and safely detoxified in community/home/outpatient settings. However, people with severe alcohol dependence will require care in an inpatient setting with close monitoring by specialists. Outpatient and home detoxification settings are clinically effective and less costly than inpatient settings.
  • Benzodiazepines are the best choice of drugs and chlordiazepoxide is preferred for treating uncomplicated detoxification due to its reduced potential for dependency.
  • High dose parenteral thiamine is an effective treatment for Wernicke’s encephalopathy.Vitamin supplements should be prescribed where nutritional deficiencies are likely.

Link opens in new windowEvidence Note 20 (PDF, 202KB, 29secs)


Thursday, November 1, 2007

How do college students view alcohol prevention policies?
Journal of Substance Use, Volume 12, Issue 6 December 2007 , pages 447 - 460

Despite research supporting comprehensive community prevention strategies, there has been relatively less done in the way of policy-orientated approaches to prevention on college campuses, in the face of powerful appeals to do so.

Among the likely reasons for this state of affairs is that college administrations are cautious about adopting new alcohol policies because of a general belief that such policies are held in very low favor among the students themselves. The sense that most alcohol policies will be met with universal opposition is largely unexamined, however, and it is entirely possible that student attitudes regarding alcohol polices are worthy of investigation in themselves.

The data reported here were collected via a mailed survey of a random sample of undergraduate students from the University of California. The questionnaire included a set of twenty alcohol problem prevention policies that were described as among those some college campuses have adopted or are thinking of adopting. Data were collected from 1648 students, with the sample comprising 33% Asians, 30% Whites, 14% multi-ethnic, 11% Hispanics, 5% African-Americans, and 6% other.

In all cases, the students' approval is higher than their perception of their peers' level of approval, particularly for "enforcement" policies. What we found was a universal tendency to underestimate support for prevention policies, particularly those with some "teeth" to them.

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P300 amplitude, externalizing psychopathology, and earlier- versus later-onset substance-use disorder.
Journal of Abnormal Psychology. 2007 Aug Vol 116(3) 565-577

P300 amplitude predicts substance use or disorder by age 21. Earlier- versus later-onset substance disorders may reflect different levels of an externalizing psychopathology dimension. P300 in adolescence may not be as strongly related to later-onset substance problems as it is to earlier-onset ones.

In the present study, visual P300 amplitude was measured at age 17 in a community-representative sample of young men. Substance and externalizing disorders were assessed at approximately ages 17, 20, and 24.

Earlier-onset (by age 20) substance disorder was associated with higher rates of externalizing disorders than were later-onset problems.

P300 amplitude was reduced in subjects with earlier-onset substance disorders, relative to later-onset and disorder-free subjects. Amplitude was also reduced in subjects with an externalizing disorder but no substance disorder. Earlier-onset subjects had reduced P300, even in the absence of an externalizing disorder. The results could not be attributed to a concurrent disorder or to recent substance use at the time of the P300 recording.

The findings are consistent with P300 indexing an externalizing spectrum. Earlier-onset substance disorders are more strongly related to P300 and externalizing than are later-onset problems.

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Declining Estimated Prevalence of Alcohol Drinking and Smoking among Young Adults Nationally: Artifacts of Sample Undercoverage?
American Journal of Epidemiology Advance Access published online on October 31, 2007

A growing concern in public health surveillance surveys that rely on random digit dialing for sampling is the exclusion of adults in cell-phone-only households. The purpose of this study was to examine whether recent increases in wireless substitution have affected estimates of tobacco and alcohol use in the Behavioral Risk Factor Surveillance System (BRFSS) in a subpopulation with notable cell-phone usage (i.e., young adults).

BRFSS data from 2001–2005 were examined. Analyses were limited to participants aged 18–24 years, and the sample contained approximately 18,500 persons in each year.

Prevalence estimates were generated with SUDAAN software for three health behaviors: cigarette smoking, binge drinking, and heavy alcohol consumption. In addition, the authors examined sample completeness for young adults relative to US Census estimates.

Overall, prevalences of all three health behaviors among young adults were fairly stable between 2001 and 2003 but significantly decreased between 2003 and 2005. These trends are not replicated in national surveys that use area probability samples. The authors found a declining trend in the sample completeness ratio for young adults; it declined from 0.32 in 2001 to 0.15 in 2005.

Given the high prevalence of wireless substitution among young adults and the declining sample completeness ratio, the authors suspect that the observed decreases in prevalence are artifacts of undercoverage.

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National Summit on Recovery Conference Report

On September 28-29, 2005, the Center for Substance Abuse Treatment (CSAT)
convened over 100 stakeholders to discuss transformative ideas and concrete
recommendations for moving the substance use disorders services field more
toward a recovery-oriented approach. At the Summit, leaders in the field
identified 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

The Report from the CSAT National Summit on Recovery is being provided as a
reference document to assist individuals and organizations submitting
applications under the CSAT Request for Applicants (RFA) for the Addiction
Technology Transfer Centers (ATTC) Program. The ATTC RFA requires
applicants to discuss how they will help prepare the addictions workforce to
function in recovery-oriented systems of care. By providing background
information on the process and key findings of the CSAT National Summit on
Recovery, the Conference Report may be helpful to applicants.

National Summit on Recovery Report
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Contributor: Don Phillips
Efficacy and Tolerability of Naltrexone in the Treatment of Alcohol Dependence: Oral versus Injectable Delivery
Eur Addict Res 2007;13:201-206

Oral naltrexone, an opioid antagonist, reduces relapse and heavy drinking in alcohol-dependent patients. However, oral delivery is associated with poor compliance and adverse events. To enhance treatment outcome and reduce side effects, injectable extended-release naltrexone formulations have been developed. Currently, there are no studies available directly comparing oral and injectable formulations of naltrexone in alcohol-dependent patients.

This paper reviews the efficacy and adverse events of oral versus injectable extended-release naltrexone. Therefore, data were extracted from two recently published reviews about oral naltrexone in the treatment of alcohol dependence. Pooled outcomes were compared with reported outcomes of recent studies on injectable extended-release naltrexone.

Injectable naltrexone seems to be effective in the management of alcohol dependence. Although inconclusive, the available results indicate that the expected advantages of injectable naltrexone over oral naltrexone still have to be proven.

Randomized studies with direct comparisons of oral and injectable naltrexone are urgently

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Health-related consequences of problem alcohol use
Overview 6

The purpose of this Overview is to compile and analyse the available data on problem alcohol use in Ireland and its health-related consequences. This will help determine what approaches are likely to be effective in reducing alcohol-related harm in Ireland, and identify gaps in current knowledge so as to inform future research needs in this area.

Alcohol use in the general population in Ireland and among specific sub groups is described using published literature. Alcohol-related morbidity and mortality between 1995 and 2004 is analysed using previously unpublished data from the Economic and Social Research Institute and the Central Statistics Office. Alcohol treatment in Ireland from 2004 to 2005 is also described, using data from the Health Research Board.

Alcohol consumption among Irish people has increased by 17% over the past 11 years, from 11.5 litres per adult in 1995 to 13.4 litres in 2006. This rise in consumption has led to increases in alcohol-related harm and disease, and has resulted in more than 1,775 deaths. This, in turn, has created escalating pressures on our health and hospital services.

A comprehensive new overview, just published by the HRB, looks at the health-related consequences of problem alcohol use. A full copy of the report can be found in the publications section of the HRB website at
Effects of training community staff in interventions for substance misuse in dual diagnosis patients with psychosis (COMO study)
The British Journal of Psychiatry (2007) 191: 451-452

A cluster randomised controlled trial was used to investigate the effectiveness of training staff in 13 London community mental health teams (CMHTs) to deliver substance misuse interventions to patients with psychosis and comorbid substance misuse (‘dual diagnosis’).

The primary hypotheses, which were that experimental group patients would spend fewer days in hospital over 18 months of follow-up and show reduced alcohol and drug consumption, were not confirmed, although confidence intervals were wide for some outcomes.

Current UK policy guidance advocates training CMHT professionals to deliver dual diagnosis interventions, but the effectiveness of this strategy has not so far been demonstrated.

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Red meat and alcohol are major cancer causes
By Rebecca Smith, Medical Editor


Millions of people are at risk of getting cancer unless they slash levels of alcohol and red meat in their diets, medical experts have warned in a landmark study.

The most comprehensive review of the evidence linking obesity, diet and physical activity to the chances of developing cancer recommends sweeping changes to our lifestyles if we are to combat rising cancer rates.

Current guidelines on the intake of alcohol and red meat should be nearly halved while people should try to be at the slimmer end of the recommended weight limits in order to lower their risk of developing the disease.

People must be leaner, take more exercise, eat more whole foods, virtually cut out alcohol, consume less red meat and eat no bacon or ham at all.
. . . . . . .

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Wednesday, October 31, 2007

WCRF/AICR Expert Report, Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective.

The production of the second expert report has been a huge undertaking for the WCRF global network, involving over 100 scientists from 30 different countries. WCRF/AICR commissioned and funded the report, but the content has been driven by an independent panel of 21 world renowned scientists. The Expert Panel worked for five years to assess the research and their conclusions and recommendations are firmly based on the scientific evidence.

The second expert report by chapter:

Introductory Pages

Part 1 Intro
Chapter 1: International variations and trends
Chapter 2: The cancer process
Chapter 3: Judging the evidence

Part 2 Intro
Chapter 4: Foods and drinks
Chapter 5: Physical activity
Chapter 6: Body composition, growth, and development
Chapter 7: Cancers
Chapter 8: Determinants of weight gain, overweight and obesity
Chapter 9: Cancer survivors
Chapter 10: Findings of other reports
Chapter 11: Research issues

Part 3 Intro
Chapter 12: Public health goals and personal recommendations


Fold Outs:
The Panel's judgements
The cancer process and summary recommendations

The Effect of Restricting Opening Hours on Alcohol-Related Violence
AJPH First Look, published online ahead of print Oct 30, 2007

We investigated whether limiting the hours of alcoholic beverage sales in bars had an effect on homicides and violence against women in the Brazilian city of Diadema. The policy to restrict alcohol sales was introduced in July 2002 and prohibited on-premises alcohol sales after 11 PM.

The new restriction on drinking hours led to a decrease of almost 9 murders a month. Assaults against women also decreased, but this effect was not significant in models in which we controlled for underlying trends.

Introducing restrictions on opening hours resulted in a significant decrease in murders, which confirmed what we know from the literature: restricting access to alcohol can reduce alcohol-related problems. Our results give no support to the converse view, that increasing availability will somehow reduce problems

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Alcohol Consumption and Posttraumatic Stress After Exposure to Terrorism: Effects of Proximity, Loss, and Psychiatric History
AJPH First Look, published online ahead of print Oct 30, 2007

We examined the effects of exposure to or interpersonal loss resulting from a terrorist attack on posttraumatic stress and alcohol consumption after we controlled for psychiatric history assessed before the attack.

In regression models, interpersonal loss and past major depression, but not proximity to the World Trade Center, predicted posttraumatic stress symptoms. Proximity and past alcohol dependence, but not interpersonal loss, predicted high levels of post–September 11 alcohol consumption. Past alcohol dependence did not modify the proximity–drinking relationship, and past major depression did not modify the loss–posttraumatic stress relationship.

Participants’ responses to September 11 were specific to their type of exposure and not predetermined by their psychiatric history. A better understanding of responses to traumatic events should assist more-effective prevention and intervention efforts.

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A Longitudinal Study of Alcohol Use and Antisocial Behaviour in Young People
Alcohol and Alcoholism Advance Access published online on October 30, 2007

To examine the direction of causation between young people's antisocial behaviour and alcohol (mis)use in the longer and shorter term, together with their joint effects on alcohol-related trouble.

Overall, the results support the susceptibility hypothesis, particularly in the longer-term models. There is no support for ‘pure’ disinhibition. However, in the shorter-term and joint-effects models (i.e. as the time lag becomes shorter), there is evidence that in some gender, social class, or drinking contexts, in addition to antisocial behaviour causing alcohol (mis)use, the reverse also applies.

Antisocial behaviour is the main predictor of alcohol (mis)use and alcohol-related trouble, with alcohol (mis)use impacting only modestly on antisocial behaviour and alcohol-related trouble in the shorter term.

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News Release - Antisocial behaviour in kids key to alcohol trouble in teens
30 October 2007

It is not levels of underage drinking, but early signs of antisocial behaviour that best predict future alcohol-related trouble and continued alcohol use by young people. This conclusion is drawn from a study led by Robert Young of the Medical Research Council Social and Public Health Sciences Unit in Glasgow.

Published in the Journal Alcohol and Alcoholism, the study reveals that the strongest predictor of alcohol-related trouble among 15 year-olds is a history of antisocial behaviour rather than their actual drinking habits.
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CYP2E1 Rsa I polymorphism impacts on risk of colorectal cancer association with smoking and alcohol drinking.
World J Gastroenterol 2007 November;13(43):5725-5730

To investigate associations between the Rsa I polymorphism of CYP2E1 and risk of colorectal cancer.

The proportional distribution of the CYP2E1 Rsa I c1/c1, c1/c2 and c2/c2 genotypes were 61.4%, 35.6% and 3.0% in controls, 60.6%, 33.7% and 5.8% in colon cancer cases, and 58.4%, 34.0% and 7.7% in rectal cancer cases, respectively.

A significant difference was noted between controls and rectal cancer cases , the c2/c2 genotype being associated with elevated OR (adjusted age, sex and status of the smoking and alcohol drinking) for rectal cancer , but not for colon cancer.

In interaction analysis between the CYP2E1 Rsa I genotype and smoking and drinking habits, we found a significant cooperative action between the c2/c2 genotype and alcohol drinking in the sex-, age-adjusted ORs for both colon and rectal cancers. Among non-smokers, the CYP2E1 Rsa I c2/c2 genotype was also associated with elevated ORs in the two sites .

The results of the present study suggest that the CYP2E1 c2/c2 genotype increases susceptibility to rectal cancer and the gene-environmental interactions between the CYP2E1 polymorphism and smoking or alcohol drinking exist for colorectal neoplasia in general.

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