Association of NFKB1, which encodes a subunit of the transcription factor NF-B, with Alcohol Dependence
Human Molecular Genetics Advance Access published online on December 12, 2007


A broad region on chromosome 4q has been linked to alcohol dependence (alcoholism). We hypothesized that such broad linkage regions represent the combined action of multiple genes.

Seeking to identify genes within that region that are associated with alcoholism, we have tested the association of NFKB1, located at 4q24, with alcoholism. NFKB1 encodes a 105 kDa transcription inhibitor that is cleaved to the 50 kDa DNA binding subunit of the ubiquitous transcription factor NF-B. NF-B regulates many genes relevant to brain function, and its actions can be potentiated by ethanol; thus NFKB1 is an excellent candidate gene for alcoholism.

Nineteen SNPs in and near NFKB1 were analyzed in a sample of 219 multiplex alcoholic families of European American descent.

Family based association analyses detected significant evidence of association with eight SNPs and marginal evidence for five more. The association was driven by the affected individuals with earlier onset of alcoholism (55% of the sample with onset 21 years). Further analysis of the age of onset as a quantitative variable provided evidence for the association of 12 SNPs in this gene.

Thus variations in NFKB1 appear to affect the risk for alcoholism, particularly contributing to an earlier onset of the disease.

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Baby risk labels proposed on alcohol

Sunday December 16, 2007

Alcohol bottles could be slapped with new labels warning pregnant women to steer clear under a new proposal floated by the trans-Tasman food regulator.

Food Standards Australia New Zealand (FSANZ) is inviting comment on the concept of putting baby risk warning labels on beers, wines and spirits.

The application has been proposed by the Alcohol Advisory Council of New Zealand (ALAC) but would also apply in Australia if ultimately approved.

Under the scheme "suppliers would be required to place a label on alcoholic beverage containers advising of the risks of consuming alcohol when planning to become pregnant and during pregnancy," the regulator said in a statement.
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Ingredient and nutrition information labelling of alcoholic beverages: do consumers want it? The World Today — Letters
Med J Aust 2007; 187 (11/12): 669.

To the Editor: In Australia, the packaging of alcoholic beverages, unlike that of non-alcoholic beverages, is not required to display a list of ingredients or nutritional information, such as the amount of sugar, calories, and any preservatives contained in the drink.1 It is possible that consumers, especially some population groups such as weight-conscious young women, might be less inclined to drink as much alcohol if they knew the calorie content of what they were consuming. There has been no published research on whether Australian consumers want this information.

In April 2007, we invited (by letter and email) a random sample of 13 000 students aged 17–25 years at an Australian university to complete a web survey on alcohol consumption, health effects, and attitudes toward nutrition/ingredient labelling. Of the students invited, 7237 responded (56% response rate), and 6497 of these (90%) had consumed alcohol in the preceding 12 months.

Results suggest that more than three-quarters of this population group want to see both ingredients and nutritional information displayed on alcoholic beverage packaging.
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Identifying Opinion Leaders to Promote Behavior Change
Health Education & Behavior, Vol. 34, No. 6, 881-896 (2007)

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health.

The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each.

Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

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Identifying Opinion Leaders to Promote Behavior Change
Health Education & Behavior, Vol. 34, No. 6, 881-896 (2007)

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health.

The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each.

Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

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A home for the homeless
The Times
Kit Malthouse

December 15, 2007

Rent a few flats, then let them free to those sleeping rough. It works in America, so why not here?

Every Christmas we see two warring camps loosing a volley of accusations at each other. The cause: what to do about rough sleepers. Make no mistake, this debate is a matter of life and death. Life expectancy on the street is as low as 42.

On one side stand some London boroughs and homeless charities who feel that the plentiful volunteer soup runs in the capital serve only to keep people on the streets. Opposing them are Ken Livingstone, the Mayor of London, and other charities, who argue that trying to make such soup runs illegal is cold-hearted and will lead to starvation. But both sides have missed the potential of one novel � some might say outrageous � solution tested in America.

Ten years ago the rough sleeping population in England was more than 2,000 a night. Since then a combination of government focus, lots of money and greater co-operation between boroughs and charities has caused these numbers to fall by two thirds. Most new arrivals today will spend fewer than four nights on the street, and it's vital to keep that number low. After living rough for more than a couple of weeks, habits are formed, addictions are acquired or exacerbated and rescue becomes even more difficult.
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Preconception and Interconception Health Status of Women Who Recently Gave Birth to a Live-Born Infant --- Pregnancy Risk Assessment Monitoring System (PRAMS), United States, 26 Reporting Areas, 2004

This report summarizes data from 26 PRAMS reporting areas that collected data during 2004 and that had achieved overall weighted response rates of >70% and had weighted data available by the time the analysis was conducted in January 2007. Data are reported on indicators regarding 18 behaviors and conditions that are relevant to preconception (i.e., prepregnancy) health and health care and 10 that are relevant to interconception (i.e., postpartum) health and health care. The number of questions that were administered varied by site; certain questions were not asked for all reporting areas.

With respect to preconception maternal behaviors and experiences, mean overall prevalence was 23.2% for tobacco use, 50.1% for alcohol use, 35.1% for multivitamin use at least four times a week, 53.1% for nonuse of contraception among women who were not trying to become pregnant, 77.8% for ever having a dental visit before pregnancy, 30.3% for receiving prepregnancy health counseling, 3.6% for experiencing physical abuse, and 18.5% for experiencing at least four stressors before pregnancy.

PRAMS results varied among reporting areas. The prevalence estimates in the majority of reporting areas and for the majority of indicators suggest that a substantial number of women would benefit from preconception interventions to ensure that they enter pregnancy in optimal health. The results also demonstrate disparities among age and racial/ethnic subpopulations, especially with respect to prepregnancy medical conditions and access to health care both before conception and postpartum. Differences also exist in health behaviors between women who reported intended and unintended pregnancies.
. . . . . .

"The results outlined in this report indicate that alcohol use in the 3 months before pregnancy is common." pg.12

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Evidence for a closing gender gap in alcohol use, abuse, and dependence in the United States population
Drug and Alcohol Dependence Volume 93, Issues 1-2, 11 January 2008, Pages 21-29


Descriptively, male–female differences in alcohol consumption and alcohol use disorders appear to have decreased in birth cohorts reaching adulthood since the 1970s compared to earlier birth cohorts.

However, such birth cohort effects on gender differences have never been statistically tested in nationally representative data. The aim of this study was to test the hypothesis that gender differences in alcohol consumption, abuse, and dependence are decreasing over time.

Face-to-face survey conducted in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions among those aged <90>N = 42,693). Birth cohort was divided into four categories: 1913–1932, 1933–1949, 1950–1967, 1968–1984. Outcomes included lifetime largest drinks, frequent binge drinking, DSM-IV defined alcohol abuse, and alcohol dependence, measured with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-IV).

Birth cohort and gender interacted significantly in predicting lifetime largest drinks, frequent binge drinking , alcohol abuse and alcohol dependence. Cohort-specific ORs indicated monotonic decreases in the gender ratio in more recent birth cohorts for all outcomes.

These results suggest that gender differences in the prevalence of all four outcomes are decreasing in younger age cohorts. While these changes are consistent with a cohort effect, the possibility of age and period effects cannot be ruled out but suggest important avenues for more specific hypothesis testing. Further, women in younger cohorts may be in need of new targeted prevention and intervention efforts.

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The 14-year course of alcoholism in a community sample: Do men and women differ�
Drug and Alcohol Dependence Volume 93, Issues 1-2, 11 January 2008, Pages 1-11

To investigate the course of alcoholism in males and females in a 14-year follow-up of persons with DSM-III alcoholism compared to very heavy drinkers and unaffected controls in a community sample.

Case–control study based on data from the 1997 Health Services Use and Cost study, a 14-year follow-up survey of 442 individuals who participated in two waves of the 1981–1983 St. Louis Epidemiologic Catchment Area study. Cases met criteria for DSM-III alcohol abuse (AA) or dependence (AD) at both waves of the ECA: “Two-times Alcohol Use Disorder Positives (ECA 2t-AUDPs).”

Two comparison groups were frequency matched to 2t-AUDPs: (1) ECA Very Heavy Drinkers/One-time Alcohol Use Disorder Positives (ECA VHD/1t-AUDPs) and (2) ECA alcohol-unaffecteds. Lifetime and past year alcohol use disorders, patterns of drinking and recovery among males and females are reported.

84.6% of 2t-AUDPs again met lifetime DSM-III criteria at 14-year follow-up. At follow-up, only 9.3% male 2t-AUDPs and 20.7% female 2t-AUDPs met past year DSM-IV AUD criteria. Past year drinking patterns, however, revealed higher rates of DSM-IV AA or AD, problem or risk drinking among 2t-AUDPs (61.7%) compared to both ECA VHD/1t-AUDPs (41.2%) and ECA alcohol-unaffecteds (22.1%).

In a community sample, the rate of past year DSM-IV alcohol dependence was lower among male 2t-AUDPs than females, though both groups showed past year rates substantially lower than lifetime rates.

However, less than half of ECA 2t-AUDPs exhibited low-risk or abstinent alcohol use behaviors, indicating that while remission from diagnosis is common, clinical relevance persists.

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Linkage scan for quantitative traits identifies new regions of interest for substance dependence in the Collaborative Study on the Genetics of Alcoholism (COGA) sample
Drug and Alcohol Dependence Volume 93, Issues 1-2, 11 January 2008, Pages 12-20


Dependence on alcohol and illicit drugs frequently co-occur. Results from a number of twin studies suggest that heritable influences on alcohol dependence and drug dependence may substantially overlap.

Using large, genetically informative pedigrees from the Collaborative Study on the Genetics of Alcoholism (COGA), we performed quantitative linkage analyses using a panel of 1717 SNPs.

Genome-wide linkage analyses were conducted for quantitative measures of DSM-IV alcohol dependence criteria, cannabis dependence criteria and dependence criteria across any illicit drug (including cannabis) individually and in combination as an average score across alcohol and illicit drug dependence criteria.

For alcohol dependence, LOD scores exceeding 2.0 were noted on chromosome 1 (2.0 at 213 cM), 2 (3.4 at 234 cM) and 10 (3.7 at 60 cM).

For cannabis dependence, a maximum LOD of 1.9 was noted at 95 cM on chromosome 14.

For any illicit drug dependence, LODs of 2.0 and 2.4 were observed on chromosome 10 (116 cM) and 13 (64 cM) respectively.

Finally, the combined alcohol and/or drug dependence symptoms yielded LODs >2.0 on chromosome 2 (3.2, 234 cM), 10 (2.4 and 2.6 at 60 cM and 116 cM) and 13 (2.1 at 64 cM).

These regions may harbor genes that contribute to the biological basis of alcohol and drug dependence.

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Public Health Campaigns to Change Industry Practices That Damage Health: An Analysis of 12 Case Studies
Health Education & Behavior 2007, Online 12 Dec 2997






Industry practices such as advertising, production of unsafe products, and efforts to defeat health legislation play a major role in current patterns of U.S. ill health. Changing these practices may be a promising strategy to promote health.

The authors analyze 12 campaigns designed to modify the health-related practices of U.S. corporations in the alcohol, automobile, food and beverage, firearms, pharmaceutical, and tobacco industries.

The objectives are to examine the interactions between advocacy campaigns and industry opponents; explore the roles of government, researchers, and media; and identify characteristics of campaigns that are effective in changing health-damaging practices. The authors compared campaigns that operate at different levels of organization and use different strategies.

Findings suggest that many campaigns achieve policy or mobilization outcomes that may contribute to improved health; local campaigns may be more effective than national ones; and advocates frequently frame their campaigns on the themes of children's health and social justice.

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Why there is more of stronger wine in Britain
By Nick Britten

14 Dec 2007

New World wines are largely to blame for the increase in the strength of the average glass of wine.

In the 1970s and 1980s, most wines being drunk in Britain were grown from cooler regions such as Germany, and had an average alcohol content of nine per cent.

However, the proliferation and increased popularity of wines from hotter regions brought with it much stronger wines of between 12 and 14 per cent alcohol by volume (ABV).
. . . . . . .

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Why there is more of stronger wine in Britain
By Nick Britten

14 Dec 2007

New World wines are largely to blame for the increase in the strength of the average glass of wine.

In the 1970s and 1980s, most wines being drunk in Britain were grown from cooler regions such as Germany, and had an average alcohol content of nine per cent.

However, the proliferation and increased popularity of wines from hotter regions brought with it much stronger wines of between 12 and 14 per cent alcohol by volume (ABV).
. . . . . . .

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The sense of coherence and risk of injuries: role of alcohol consumption and occupation
Journal of Epidemiology and Community Health 2008;62:35-41


To test the hypothesis that individuals with a strong sense of coherence (SOC) have a decreased incidence of external cause injuries and to study the role of alcohol consumption and occupational category in that association.

The SOC was inversely associated with the risk of injuries, with a significant 25% lower incidence in the highest tertile of SOC (7.6 per 1000 person-years) compared with the lowest (10.2 per 1000 person-years). The association remained significant if adjusted for age, but not if adjusted additionally for alcohol consumption or occupation. When considered jointly with occupational category, the injury risk showed a decreasing trend (p = 0.02) with increasing SOC among blue collar but not among white collar workers.

The use of alcohol had a great impact on injury risk among those with weak SOC, with incidences of 7.7, 10.2, and 14.9 per 1000 person-years in the non/light, medium, and heavy categories of consumption (p for trend 0.01). No such trend was seen in other SOC tertiles.

There was an effect of SOC on the incidence of injury especially among blue collar workers. A substantial part of the effect was mediated by alcohol consumption.

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Normal Acute Behavioral Responses to Moderate/High Dose Ethanol in GABA_A Receptor α4 Subunit Knockout Mice
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 12 Dec 2007

γ-Aminobutyric acid type A receptors (GABA_A-Rs) have been implicated in mediating some of the behavioral effects of ethanol (EtOH), but the contribution of specific GABA_A-R subunits is not yet fully understood. The GABA_A-R α4 subunit often partners with β2/3 and δ subunits to form extrasynaptic GABA_A-Rs that mediate tonic inhibition. Several in vitro studies have suggested that these extrasynaptic GABA_A-Rs may be particularly relevant to the intoxicating effects of low doses of EtOH. In α4 subunit knockout mice, tonic inhibition was greatly reduced, as were the potentiating effects of EtOH.

We therefore hypothesized that those behavioral responses to EtOH that are mediated by α4-containing GABA_A-Rs would be diminished in α4 knockout mice.

No differences were observed between α4 knockout mice and wild-type controls in terms of the baseline behavior in the absence of EtOH treatment or in the behavioral effects of EtOH in the assays tested. In contrast, α4 knockout mice were significantly more sensitive to pentylenetetrazol-induced seizures.

We conclude that GABA_A-Rs containing the α4 subunit are not absolutely required for the acute behavioral responses to moderate/high dose EtOH that were assessed with the elevated plus maze, screen test, hypothermia, fixed speed rotarod, open field, radiant tail flick, and loss of right reflex assays.

We further suggest that these findings are complicated by the demonstrated compensatory alterations in synaptic GABA_A-R EtOH sensitivity and function in α4 knockout mice.

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A cost-effectiveness analysis of alcohol prevention targeting licensed premises
The European Journal of Public Health 2007 17(6):618-623



A multi-component alcohol prevention programme targeting licenced premises has been ongoing in Stockholm since 1996. An earlier study has established that this led to a 29% reduction in police-reported violence.

The objective of the present study is to calculate the programme's cost-effectiveness from a societal perspective; the cost of implementation, the savings made as a result of fewer assaults, unlawful threats and violence towards officials, and the health gains in terms of quality-adjusted life-years (QALYs).

The cost of the programme was estimated at Euro 796 000. The average cost of a violent crime was estimated at Euro 19 049, which implies overall savings of Euro 31.314 million related to the judicial system (78%), production losses (15%), health care issues (5%) and other damages (2%). Accordingly, the base case cost-saving ratio was 1 : 39. The average loss of health state weighting among the victims at 0.09 translates into 236 gained QALYs for society as a whole, which should be compared with the modest proportion of savings in the health sector.

The most significant concern is the low response rate (35%), and caution needs to be exercised when interpreting our results. Yet, a reasonable conclusion is that the monetary and human benefits have been considerable.

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Community-Based Prevention of Alcohol Problems: Addressing the Challenges of Increasing Deregulation of Alcohol
Substance Use & Misuse, Volume 42, Issue 12 & 13 October 2007 , pages 1813 - 1834



This article focuses on the erosion of alcohol management policies and the implications for local prevention efforts.

It draws lessons from three large-scale multi-year multi-site programs in Canada, e.g., local addiction prevention projects, heart health programs, and tobacco control experiences.

It explores five themes: getting alcohol on the agenda and implementing effective local responses to alcohol problems; assessing conceptual frameworks in order to identify the essential components of an effective prevention strategy; developing a system of local prevention initiatives that give priority to long-lasting structural changes; generating accurate information on alcohol-related damage in order to set priorities; and developing a prevention action plan in order to support local initiatives.

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Press Release - ONS updates alcohol survey methodology
13 Dec 2007

The Office for National Statistics (ONS) is to update the methods it uses to estimate alcohol consumption in drinking surveys, reflecting increases in the alcoholic strength of some drinks and the measures in which they are served.

The changes, which are set out in a report published by ONS today, relate mainly to wine consumption but also update estimates of the alcoholic strengths of beers, lagers and ciders. Recent years have seen an increase in the availability of stronger wines, especially those from the New World, while wine glasses larger than the ‘traditional’ 125ml are increasingly popular in
licensed premises.

Reflecting this, ONS surveys will in future include a question relating to wine glass size, while at the same time the presumed alcoholic content of an ‘average’ glass of wine will be increased.

Improved estimates for beers, lagers and ciders will also be introduced.

While not reflecting a real change in individuals’ drinking habits, the updates produce higher alcohol consumption. Applied to General Household Survey data for 2005, the updated methodology shows average weekly alcohol consumption as approximately one-third higher, up from 10.8 units to 14.3 units.

The first full results using the updated methodology will be available with the publication of the annual reports from the 2006 General Household Survey and the 2007 ONS Omnibus survey on 22 January 2008. The methodology will also be applied to the 2006 Health Survey for Information Centre for health and social care in late January 2008.

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Download Report: GSS Methodology Series No 37 Estimating alcohol consumption from survey data: updated method of converting volumes to units
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Under diagnosis of alcohol misuse in the older adult population
British Journal of Nursing, Vol. 16, Iss. 20, 08 Nov 2007, pp 1254 - 1258

Alcohol abuse in older adults is common, yet it is often under detected and misdiagnosed, and as a result associated with considerable morbidity. There is growing concern that as the population ages, there will be a substantial increase in the number of older adults needing treatment for alcohol misuse and currently, little is done to identify and address this situation.

Factors contributing to under diagnosis include, but are not limited to, depression, dementia, physical changes associated with age, life events, late onset of alcoholism and lack of screening.

A case report is presented and existing research findings are discussed. The importance of assessment, the use of screening tools, treatment issues and identification of other comorbidities are presented.

The focus on increased awareness among clinicians as well as their role in identifying and addressing alcohol abuse issues in the older adult population is explored.

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Alcohol, marijuana, and tobacco use patterns among youth in Canada
Cancer Causes and Control Onlie First 6 Dec 2007


The authors characterized changes in the prevalence of alcohol, tobacco, and marijuana use over time, and examined age of onset, co-morbid use and sociodemographic factors associated with ever using alcohol, tobacco, or marijuana in a nationally representative sample of Canadian youth.

Data were collected from students in grades 7–9 as part of the Canadian Youth Smoking Survey (n = 19,018 in 2002; n = 29,243 in 2004). Descriptive analyses examined age of onset, co-morbid substance use and changes over time. Logistic regression models were used to examine factors associated with ever trying alcohol, tobacco, or marijuana with the 2004 data.

Alcohol was the most prevalent substance used by youth and it was also the only substance which exhibited increased rates of use between 2002 and 2004. Co-morbid substance use was common, and it was rare to find youth who had used marijuana or tobacco without also having tried alcohol.

As expected, youth who had poorer school performance were more likely to drink and smoke marijuana or tobacco, as were youth with more disposable income.

Such timely and relevant data are important for guiding future policy, programing, and surveillance activities.

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The Efficacy of a Multicultural Prevention Intervention among Urban American Indian Youth in the Southwest U.S.
The Journal of Primary Prevention Online First 6 Dec 2007


This study explored how a non-targeted group of ethnic minority youth might or might not benefit from a prevention intervention focused on other cultural groups.

The study specifically evaluated the effects of an evidence-based drug prevention curriculum with a sample of urban American Indian youth in the southwest U.S., most of whom self-reported multi-ethnic heritages.

Using growth curve modeling, this research examined the developmental trajectory of drug use for these youth, and compared it with the trajectory of youth from other racial/ethnic groups at pre-intervention, post-intervention, and two follow up time periods.

Results indicate that alcohol and marijuana use increased from pre-intervention across subsequent time periods for all youth. The drug use of the American Indian youth in the treatment group increased on some measures. Specifically, they reported a steeper trajectory in the amount and frequency of alcohol and marijuana use compared to the youths in the treatment groups with other racial/ethnic identifications.

The implications of these findings for the development of culturally grounded prevention programs for multi-ethnic, urban American Indian youth are discussed.

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Press Release - A drink to healthy ageing
Thursday 13 December 2007

Researchers at the University of Newcastle say a glass of wine a day may be of benefit to the health of older women.

A study by the University's Priority Research Centre for Gender, Health and Ageing, in collaboration with the Hunter Medical Research Institute's (HMRI) Public Health Program, indicates that moderate consumption of alcohol in older women, in line with Australian alcohol guidelines*, is associated with better survival and quality of life.

Researchers conducted a national survey of 12,432 older women using data from the Australian Longitudinal Study on Women's Health. The women, who were aged 70 to 75 years when the study began, provided information on alcohol consumption and their health over six years by completing questionnaires.

Results of the study, published in the Journal of the American Geriatrics Society in 2006, indicate that survival rates were lower in women who did not consume alcohol.

"The study was undertaken to determine whether women who drank alcohol according to Australian recommendations could continue doing so from age 70 years and beyond. Our data indicates that these guidelines can safely apply to these women at older ages. Indeed non drinkers and women who rarely drink had a significantly higher risk of dying than women who consumed a low intake of alcohol," Centre Director, Professor Julie Byles, said.
. . . . . . .

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Responding to the challenge of co-occurring disorders: Suggestions for future research
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 139-146


This special issue consolidates some recent research findings and scientific thought on co-occurring disorders from both the substance abuse and mental health fields.

This summary article recaps and synthesizes the main findings and themes, then considers additional issues in the field today to arrive at an agenda for future co-occurring disorders research.

Plans must: (1) encourage and assist further development of treatment programs that respond to an array of types and severities of co-occurring disorders while taking into account the limited resources typically available; (2) continue the development and testing of continuing care models by exploring strategies that will sustain the recovery of treated individuals who remain vulnerable to relapse; and (3) contribute to our understanding of the mechanisms and processes that enable new interventions and practices to be adopted, implemented, and sustained.

“Co-occurring disorders” is a relatively new area of research; this special issue illustrates the productivity of work to date and indicates the potential for advances to come.

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Enhanced outpatient treatment for co-occurring disorders: Main outcomes
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 48-60


This study, which was conducted in an outpatient substance abuse treatment program, randomly assigned clients with mental health symptoms to either a control group, which received basic program services, or an experimental group, which was configured as a modified therapeutic community (TC) track, with the addition of modified TC features and three specific elements—psychoeducational seminar, trauma-informed addictions treatment, and case management.

The experimental group had significantly better outcomes as compared with the control group on measures of psychiatric severity and on the key measure of housing stability; no difference was observed for substance use, crime, and employment.

The findings must be qualified because (a) only 3 of 34 representative measures (<10%) showed significant differential treatment effects and (b) analysis revealed partial implementation of the enhancements.

The study provides modest support for the effectiveness, on specific outcomes, of outpatient substance abuse treatment programs that add modified TC features and targeted interventions to strengthen their capacity to treat co-occurring disorders.

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Co-occurring disorders in substance abuse treatment: Issues and prospects
Journal of Substance Abuse Treatment
Volume 34, Issue 1, January 2008, Pages 36-47


This article explores the epidemiology of co-occurring disorders (CODs) with an emphasis on the implications of study findings for the functioning and potential of substance abuse treatment.

Severity of disorder is discussed as an issue that may have particular significance for the selection of specialized as opposed to traditional substance abuse treatment forms.

Exploration is made, as well, of the resources currently available to substance abuse treatment, especially the human resources available, and the implications of resource availability for undertaking initiatives specific to COD.

Findings from standard and enhanced treatment for comorbid individuals are examined in an effort to clarify areas of need for specialized and typical treatment personnel.

Issues are raised for consideration by the clinical research and treatment provider communities in terms of assessment and diagnosis, manpower and training, and response to the challenge of relapse in this population.


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Prevalence and comorbidity of major internalizing and externalizing problems among adolescents and adults presenting to substance abuse treatment
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 14-24


As the field follows recommendations to introduce standardized assessments on substance, mental, and behavioral problems, a consistent picture has emerged that co-occurring disorders are common, that there is heterogeneity in the type of disorder, and that the pattern varies by age.

This study examines the prevalence of self-reported substance use and mental health problems, the pattern of comorbidity, and how both vary by age among people presenting to substance abuse treatment.

Data are from 4,930 adolescents and 1,956 adults admitted to substance abuse treatment in multisite studies who were assessed with the Global Appraisal of Individual Needs and categorized into five age groups: <15, 15–17, 18–25, 26–39, and 40+ years.

Two thirds of clients had a co-occurring mental health problem in the year prior to treatment admission. Across all ages, clients self-reporting criteria for past-year substance dependence were more likely than those who did not to have other co-occurring mental health problems (odds ratios of 2.9 to 8.8).

The prevalence and patterns of co-occurring mental health problems, however, varied by age. Young adults (ages 18–25) were found to be most vulnerable to co-occurring problems.

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Male Admissions with Co-occurring Psychiatric and Substance Use Disorders, 2005

Highlights:

• "Psychiatric problem in addition to alcohol or drug problem" is a supplemental data set item collected by States for SAMHSA's Treatment Episode Data Set (TEDS). Data from the 26 States that had a response rate of 75% or higher on this item in 2005 were used to examine substance abuse treatment admissions of males with co-occurring psychiatric and substance use disorders.

• Male admissions to substance abuse treatment with co-occurring psychiatric and substance use disorders were more likely than those without these co-occurring disorders to have started using alcohol and/or illicit drugs before age 13 (18% vs. 13%). The largest differences between first use before age 13 for the co-occurring vs. non co-occurring groups of male substance abuse treatment admissions were for alcohol (24% vs. 16%) and marijuana (32% vs. 23%).

• Among male substance abuse treatment admissions reporting alcohol, cocaine, marijuana, or stimulants as the primary substance of abuse, those with co-occurring psychiatric and substance use disorders were more likely than those without co-occurring disorders to report daily use of these substances.

• Male substance abuse treatment admissions with co-occurring disorders were more likely than those without co-occurring disorders to report five or more prior substance abuse treatment episodes (17% vs. 10%).

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Alcohol and Aggression: Perspectives on Controlled and Uncontrolled Social Information Processing
Social and Personality Psychology Compass (OnlineEarly Articles) 28 Nov 2007

This paper reviews the main current social cognitive explanations of the effects of acute alcohol consumption on aggression: the cognitive disruption model, the attributional model, and model of automaticity.

The cognitive disruption model posits that intoxication affects controlled processing arising from the impairment of executive cognitive functions by alcohol's pharmacological properties. The individual consequently focuses on the most salient and proximal situational factors, thereby spoiling self-regulatory processes.

According to the attributional model, drinkers expect alcohol to mitigate social sanctions following aggression by shifting blame to alcohol. These explicit expectations represent an extrapharmacological cause of the alcohol–aggression link.

Finally, the model of automaticity implies that alcohol meanings stored in long-term memory and activated in drinking contexts automatically trigger aggressive thoughts and behavior without the individual's awareness.

The explanation of intoxicated aggression should integrate these co-etiological social cognitive models that take into account pharmacological as well as extrapharmacological consequences of alcohol consumption.

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News Release - Pre-natal Alcohol Exposure Shapes Sensory Preference, Upping the Odds of Later Alcohol Use and Abuse
12 December 2007

Young people whose mothers drank when pregnant may be more likely to abuse alcohol because, in the womb, their developing senses came to prefer its taste and smell. Researchers with the State University of New York Developmental Ethanol Research Center have found that because the developing nervous system adapts to whatever mothers eat and drink, young rats exposed to alcohol (ethanol) in the womb drank significantly more alcohol than non-exposed rats.

These findings, covered in two related studies, appear in the December issue of Behavioral Neuroscience, published by the American Psychological Association (APA). The studies contribute a critical biological piece to the complex puzzle of why teens with a family history of drinking may themselves drink more. Lead author Steven Youngentob, PhD, observes that a biologically instilled preference for alcohol’s taste and smell can make young people much more likely to abuse alcohol, especially in light of social pressures, risk-taking tendencies and alcohol’s addicting qualities.

These more subtle consequences of fetal alcohol exposure come on top of the potential for Fetal Alcohol Syndrome, which leads to profound neurodevelopmental problems including mental retardation.
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Experience-Induced Fetal Plasticity: The Effect of Gestational Ethanol Exposure on the Behavioral and Neurophysiologic Olfactory Response to Ethanol Odor in Early Postnatal and Adult Rats
Behavioral Neuroscience 2007, Vol. 121, No. 6, 1293–1305

Human fetal ethanol exposure is strongly associated with ethanol avidity during adolescence. Evidence that intrauterine olfactory experience influences chemosensory-guided postnatal behaviors suggests that an altered response to ethanol odor resulting from fetal exposure may contribute to later abuse risk.

Using behavioral and neurophysiological methods, the authors tested whether ethanol exposure via the dam’s diet resulted in an altered responsiveness to ethanol odor in infant and adult rats.

Compared with controls, (a) fetal exposure tuned the neurophysiologic response of the olfactory epithelium to ethanol odor at some expense to its responsiveness to other odorants in infantile rats—this effect was absent in adults; (b) the neural effect in infantile rats was paralleled by an altered behavioral response to ethanol odor that was specific to this odorant—this effect was also absent in adults; and (c) a significant component of the infantile behavioral effect was attributable to ethanol’s effect on the olfactory neural modality.

These data provide evidence for an important relationship between prenatal ethanol experience and postnatal behavioral responsiveness to the drug that is modulated or determined by olfactory function


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The Effect of Gestational Ethanol Exposure on Voluntary Ethanol Intake in Early Postnatal and Adult Rats
Behavioral Neuroscience 2007, Vol. 121, No. 6, 1306–1315


Clinical and epidemiological studies provide strong data for a relationship between prenatal ethanol exposure and the risk for abuse in adolescent and young adult humans. However, drug-acceptance results in response to fetal exposure have differed by study, age at evaluation, and experimental animal.

In the present study, the authors tested whether voluntary ethanol intake was enhanced in both the infantile and adult rat (15 and 90 days of age, respectively), as a consequence of chronic fetal drug experience.

Experimental rats were exposed in utero by administering ethanol to a pregnant dam in a liquid diet during gestational Days 6–20. Compared with those for isocaloric pair-fed and ad lib chow control animals, the results for experimental animals demonstrated that fetal exposure significantly increased infantile affinity for ethanol ingestion without affecting intake patterns of an alternative fluid (water).

Heightened affinity for ethanol was absent in adulthood. Moreover, the results argue against malnutrition as a principal factor underlying the infantile phenomenon. These data add to a growing literature indicative of heightened early postnatal acceptance patterns resulting from maternal use or abuse of ethanol during pregnancy.

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Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 25-35



A complicating factor affecting the treatment of individuals with coexisting substance use problems and serious mental illness is their motivation for change and how these interacting, chronic conditions affect the entire process of intentional behavior change.

This selective review explores conceptual and assessment issues related to readiness to modify substance use and readiness to initiate behaviors helpful for managing mental illness in the search for a better understanding of patient motivation for change.

The recent but limited research on motivation and stages of change among dually diagnosed patients indicates that these individuals appear to access and use an intentional behavior change process. However, it is not completely clear how this process works and what precise adaptations are needed to assess and to access motivation to change to encourage sustained behavior change in this population.

Nevertheless, motivation and readiness to change are important dimensions that need to be addressed in treatment and research with dually diagnosed populations.

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Policy and practice implications of epidemiological surveys on co-occurring mental and substance use disorders
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 3-13

This article describes factors that influence national policy and practice, with particular focus on the implications of epidemiological survey research.

Examples of areas of concern to policymakers include treatment-seeking patterns, access to care at points of service in public health and social service systems, evidence-based practices, workforce development, and the complexities of reimbursement.

In responding to data on systemic barriers to care, the Substance Abuse and Mental Health Services Administration (SAMHSA) has sought to promote a no wrong door strategy to address the needs of persons with co-occurring disorders (CODs) involving their mental health and substance use.

Examples of SAMHSA programs and policies addressing CODs discussed in this article include targeted partnerships with the states, mechanisms to enhance system infrastructure, technical assistance, and initiatives with special populations.

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Activation of protein tyrosine kinases and matrix metalloproteinases causes blood-brain barrier injury: Novel mechanism for neurodegeneration associated with alcohol abuse
Glia Volume 56, Issue 1 , Pages 78 - 88

Blood-brain barrier (BBB) formed by brain microvascular endothelial cells (BMVEC) regulates the passage of molecules and leukocytes in and out of the brain. Activation of matrix metalloproteinases (MMPs) and alteration of basement membrane (BM) associated with BBB injury was documented in stroke patients. While chronic alcoholism is a risk factor for developing stroke, underlying mechanisms are not well understood.

We hypothesized that ethanol (EtOH)-induced protein tyrosine kinase (PTK) signaling resulted a loss of BBB integrity via MMPs activation and degradation of BM component, collagen IV.

Treatment of BMVEC with EtOH or acetaldehyde (AA) for 2-48 h increased MMP-1, -2 and -9 activities or decreased the levels of tissue inhibitors of MMPs (TIMP-1, -2) in a PTK-dependent manner without affecting protein tyrosine phosphatase activity. Enhanced PTK activity after EtOH exposure correlated with increased phosphorylated proteins of selective receptor and nonreceptor PTKs. Up-regulation of MMPs activities and protein contents paralleled a decrease in collagen IV content, and inhibitors of EtOH metabolism, MMP-2 and -9, or PTK reversed all these effects.

Using human BMVEC assembled into BBB models, we found that EtOH/AA diminished barrier tightness, augmented permeability, and monocyte migration across the BBB via activation of PTKs and MMPs.

These findings suggest that alcohol associated BBB injury could be mediated by MMPs via BM protein degradation and could serve as a comorbidity factor for neurological disorders like stroke or neuroinflammation.

Furthermore, our preliminary experiments indicated that human astrocytes secreted high levels of MMP-1 and -9 following exposure to EtOH, suggesting the role of BM protein degradation and BBB compromise as a result of glial activation by ethanol.

These results provide better understanding of multifaceted effects of alcohol on the brain and could help develop new therapeutic interventions.

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Co-Occurring Mental Illness, Alcohol and/or Drug Abuse & Medical Conditions (R01)


Executive Summary

• Purpose. The NIDA, NIAAA, and the NIMH invite research grant applications to services research on co-occurring mental illness, alcohol and/or drug abuse, and commonly co-occurring medical conditions.
• Mechanism of Support. This FOA will utilize the NIH Research Project Grant (R01) award mechanism, but applications under the NIH Small Research Grant Program (R03) and the NIH Exploratory/Developmental Research Grant Program (R21) are also sought. Applicants for the R03 should respond to PA-06-180 and applicants for the R21 should respond to PA-06-181.
• Funds Available and Anticipated Number of Awards. Awards issued under this FOA are contingent upon the availability of funds and the submission of a sufficient number of meritorious applications.
• Eligible Institutions/Organizations. Public/State Controlled Institution of Higher Education; Private Institution of Higher Education; Nonprofit with 501(c)(3) IRS Status (Other than Institution of Higher Education); Nonprofit without 501(c)(3) IRS Status (Other than Institution of Higher Education); Small Business; For-Profit Organization (Other than Small Business); State Government; U.S. Territory or Possession; Indian/Native American Tribal Government (Federally Recognized); Indian/Native American Tribal Government (Other than Federally Recognized); Indian/Native American Tribally Designated Organization; Non-domestic (non-U.S.) Entity (Foreign Organization); Hispanic-serving Institution; Historically Black Colleges and Universities (HBCUs); Tribally Controlled Colleges and Universities (TCCUs); Alaska Native and Native Hawaiian Serving Institutions; Regional Organization; Other(s): Eligible agencies of the Federal government; Faith-based or community based organizations.
• Eligible Project Directors/Principal Investigators (PDs/PIs). Individuals with the skills, knowledge, and resources necessary to carry out the proposed research are invited to work with their institution/organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.
• Number of Applications. Applicants may submit more than one application, provided each application is scientifically distinct.
• Renewals and Resubmissions. Applications can be renewed by competing for additional project periods. Applicants may submit a “resubmission” application, but such application must include an “Introduction” addressing the previous peer review critique (Summary Statement).
• Number of PDs/PIs. More than one PD/PI, or multiple PDs/PIs, may be designated on the application.
• Application Materials. See Section IV.1 for application materials.
• General Information. For general information on SF424 (R&R) Application and Electronic Submission, see these Web sites:
  • SF424 (R&R) Application and Electronic Submission Information: http://grants.nih.gov/grants/funding/424/index.htm
  • General information on Electronic Submission of Grant Applications: http://era.nih.gov/ElectronicReceipt/
• Hearing Impaired. Telecommunications for the hearing impaired is available at: TTY 301-451-0088.

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