Citalopram Neuropharmacological Challenge in Alcohol-Dependent Patients and Controls: Pharmacogenetic, Endocrine and Psychobehavioral Results
Pharmacopsychiatry 2008; 41: 72-78

Alcoholism has been associated with long-lasting alterations in LHPA (limbic-hypothalamus-pituitary-adrenal) axis function, related to a dysfunction of the serotonergic neurotransmission. Functional polymorphisms of the serotonin system were previously reported to have significant influence on serotonin-induced neuroendocrine response.

The aim of the study is to investigate in a double-blind, placebo-controlled approach, whether citalopram (a selective serotonin reuptake inhibitor, SSRI) would affect LHPA axis function as measured with ACTH (adrenocorticotrophic hormone) levels representing endocrine responsivity in 11 alcohol-dependent individuals compared to 12 controls.

Furthermore we wanted to know whether functional polymorphisms (5-HTTLPR and 5HT2C Ser23Cys), have any influence on this responsivity.

ACTH levels were higher for both groups in the verum compared to placebo administrations across timepoints. 5HT2C Ser23 alleles effected significantly higher ACTH responses under placebo administration but attenuated the responses under citalopram adminsitration. Considering both groups together, no influence of 5-HTTLPR alleles was found on ACTH levels in either group under either regimen. While citalopram adminsitration did not reduce craving in alcohol-dependent patients, it increased anxiety in patients and controls compared to placebo adminstration.

Despite the small differences in endocrine and subjective responses between alcoholic patients and controls, the effect of SSRI on endocrine response with respect to 5HT2C functional alleles deserves further investigation in larger samples to clarify whether this genetic variant constitutes a potential risk factor for changes in neuroendocrine functioning and subsequent psychiatric disorders.

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Request Reprint E-Mail: ulrich.preuss@medizin.uni-halle.de __________________________________________________________

"Culture of Drinking" and Individual Problems with Alcohol Use
American Journal of Epidemiology Advance Access published online on February 29, 2008



Binge drinking is a substantial and growing health problem. Community norms about drinking and drunkenness may influence individual drinking problems.

Using data from the New York Social Environment Study (n = 4,000) conducted in 2005, the authors examined the relation between aspects of the neighborhood drinking culture and individual alcohol use. They applied methods to address social stratification and social selection, both of which are challenges to interpreting neighborhood research.

In adjusted models, permissive neighborhood drinking norms were associated with moderate drinking (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.05, 1.55) but not binge drinking; however, social network and individual drinking norms accounted for this association.

By contrast, permissive neighborhood drunkenness norms were associated with more moderate drinking (OR = 1.20, 95% CI: 1.03, 1.39) and binge drinking (OR = 1.92, 95% CI: 1.44, 2.56); the binge drinking association remained after adjustment for social network and individual drunkenness norms (OR = 1.58, 95% CI: 1.20, 2.08).

Drunkenness norms were more strongly associated with binge drinking for women than for men (p_interaction = 0.006).

Propensity distributions and adjustment for drinking history suggested that social stratification and social selection, respectively, were not plausible explanations for the observed results.

Analyses that consider social and structural factors that shape harmful drinking may inform efforts targeting the problematic aspects of alcohol consumption.

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Genetic association of DRD2 polymorphisms with anxiety scores among alcohol-dependent patients
Biochemical and Biophysical Research Communications Article in Press, Uncorrected Proof 25 February 2008


The dopaminergic neurotransmission system is one of the major factors in development of alcoholism and also contributes to anxiety and depression.

In this study, the associations of the dopamine receptor type 2 (DRD2) polymorphisms with the symptoms of anxiety were analyzed.

A total of 573 alcoholics and 273 controls were enrolled in the study from the Korean population. Five DRD2 SNPs, including −32869 A>G, −32768 insdel C, +11890 C>G, +11915 C>T, and +32806 C>T, were genotyped using a TaqMan assay and analyzed with various alcoholic phenotypes.

Although no DRD2 polymorphisms were associated with the risk of alcoholism, +32806 C>T and Block2-ht1 showed associations (in dominant models) with both the state anxiety level scale (STAI-S) and the trait anxiety level scale (STAI-T) (P = 0.004 and P = 0.003, and P = 0.01 and P = 0.005, respectively).

In addition, the −32768 insdel C also showed positive association with both anxiety level scales in recessive models (P = 0.01 and P = 0.02, respectively).

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Alcohol preference in mice lacking the Avpr1a vasopressin receptor
Am J Physiol Regul Integr Comp Physiol (February 27, 2008)

Arg⁸]-Vasopressin (Avp), a nonapeptide hormone, is known to regulate blood pressure, water balance, and a variety of behaviors such as anxiety, aggression, and bonding. Although some evidence that Avp modifies ethanol consumption and some of the effects of ethanol on behavior have been reported, the role of Avp in alcohol consumption and preference is poorly understood. The Avp 1a receptor (Avpr1a) is ubiquitously expressed in the central nervous system.

To determine the role of Avp signaling on the behavioral effects of alcohol, we examined voluntary ethanol consumption in mice with targeted disruptions of the Avpr1a (Avpr1a KO) gene. Avpr1a KO mice displayed both increased ethanol consumption and preference compared with the wild-type (WT) mice.

The enhanced ethanol consumption was dramatically and reversibly reduced by treatment with NMDA antagonists. Basal glutamate release was elevated around the striatum in Avpr1a KO mice. The elevation of extracellular glutamate was also produced in WT mice by local application of an Avpr1a antagonist though a dialysis probe, and this elevation was quickly reversed by stopping the perfusion.

These results suggest that Avp can inhibit the release of glutamate from the presynaptic terminal via the Avp 1a receptor and that elevation of glutamate levels owing to loss of the inhibitory effect via Avp-Avpr1a signaling may play an important role in the preference for ethanol.

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Ethnic Differences in Level of Response to Alcohol Between Chinese Americans and Korean Americans
J. Stud. Alcohol Drugs 69: 227-234,




Koreans have higher rates of alcohol-use disorders and family history of alcoholism, compared with Chinese. These differences likely reflect both environmental and genetic influences.

One genetically influenced characteristic that may contribute to these ethnic differences is level of response to alcohol. Variant alleles of aldehyde dehydrogenase (ALDH2) and alcohol dehydrogenase (ADH1B) genes are prevalent in individuals of Asian heritage and have been associated with an increased level of response to alcohol and a decreased risk for alcohol dependence.

Additionally, a low level of response to alcohol is more common in individuals with a first-degree family history of alcoholism and is predictive of increased risk for this disorder. It also is possible that sociocultural factors have an impact on an individual's response to alcohol.

The current study examined self-report level of response to alcohol, ALDH2 and ADH1B, country of origin, and family history of alcoholism in 154 Chinese- and 181 Korean-American college students.

Ethnicity was significantly related to level of response to alcohol, with Koreans having a lower self-reported level of response than Chinese. This relationship remained significant after considering the effects of gender, height, weight, quantity and frequency of alcohol consumption (over the previous 90 days), ALDH2 genotype, ADH1B genotype, country of origin, and first-degree family history of alcohol dependence.

The results suggest that a low level of response to alcohol may contribute to the increased risk for alcohol abuse and dependence found in Koreans, relative to Chinese.

More research is needed to determine additional factors that may be contributing to the low alcohol response and high rates of alcoholism in Koreans.

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Public Alcohol Policy: Current Directions and New Opportunities
Clinical Pharmacology & Therapeutics (2008) Advance Online 27 February 2008


Alcohol policy has been shown to have an impact on the incidence and prevalence of alcohol "addiction," or alcohol use disorders (AUDs), as currently defined by the International Classification of Diseases, volume 10, or by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition.

We will mainly use the term "addiction" to depict a state involving loss of control over intense urges to consume alcohol, even at the expense of adverse consequences. This definition goes beyond pure "physiological dependence."¹

We will use the term AUD when referring to statistics based on the above-described definitions.

In this overview we identify the pathways in the relationship between alcohol policy and addiction, present the empirical evidence, and draw conclusions. Special emphasis will be put on treatment policy.

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Chronic Alcohol Feeding Induces Biochemical, Histological, and Functional Alterations in Rat Retina Alcohol and Alcoholism Advance Access published online on February 27, 2008


Ethanol consumption originates a wide spectrum of disorders, including alteration of visual function. Oxidative stress is included among the mechanisms by which alcohol predisposes nervous tissue to injury. Retina, which is the neurosensorial eye tissue, is particularly sensitive to oxidative stress.

In this study we analyze the effect of long-term alcohol consumption on oxidative stress parameters of the rat retina, and its correlation to retinal function, as well as to the expression of the antiapoptotic protein Bcl-2. We also study the protective effect of ebselen, a synthetic selenoorganic antioxidant.

Herein we show that ethanol has a toxic effect on rat retina associated with oxidative stress. Decreases in retina glutathione concentration and increases in malondialdehyde content in whole eye homogenate significantly correlate with ERG b-wave decrease and Bcl-2 overexpression. We also show how ebselen is able to prevent all the alterations observed.

Chronic ethanol consumption induces oxidative stress in rat retina associated with an impairment of ERG and Bcl-2 overexpression, suggesting a role for glial cells. All these alterations in the rat allow the proposal of an alcoholic retinopathy in this species.


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Alcohol-related adverse consequences: cross-cultural variations in attribution process among young adults
The European Journal of Public Health Advance Access published online on February 19, 2008


Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution.

This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process.

Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences.

Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as ‘time-out’ behaviour. Respondents in countries with a stereotypical history of being ‘dry’ or with a stereotyped ‘binge’ drinking culture were more likely to attribute consequences to their alcohol consumption than people in ‘wet’ countries. This was particularly true for consequences that related to episodic ‘time-out’ heavy drinking.


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Age at Drinking Onset, Alcohol Dependence, and Their Relation to Drug Use and Dependence, Driving Under the Influence of Drugs, and Motor-Vehicle Crash Involvement Because of Drugs
J. Stud. Alcohol Drugs 69: 192-201, 2008


We explored among people who ever consumed alcohol whether early age at drinking onset and alcohol dependence predicted drug use and dependence. We also examined among drinkers who have used drugs whether they also predict driving under the influence of drugs and motor-vehicle crash involvement because of drugs.

Among ever drinkers, 22% used drugs, 10% had driven under the influence of drugs, and nearly 1% was in a motor-vehicle crash because of drug use, the equivalent of 1 million people. The younger the age of respondents when they first began drinking and whether they ever experienced alcohol dependence were independently associated with greater odds of ever using drugs and experiencing drug dependence.

Among persons who consumed alcohol and drugs, having ever experienced drug dependence was the strongest predictor of driving under the influence of drugs and motor-vehicle crash involvement because of drug use. After controlling for drug dependence and age at first drug use, having experienced alcohol dependence was also independently associated with both outcomes.

Efforts to prevent drug-related crashes should include drug use prevention and treatment, as well as prevention of early alcohol use and treatment of alcohol dependence.


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What Addicts Need

Addiction isn't a weakness; it's an illness. Now vaccines and other new drugs may change the way we treat it.

By Jeneen Interlandi | NEWSWEEK 12:43 PM ET February 23, 2008

Annie Fuller knew she was in trouble a year ago, when in the space of a few hours she managed to drink a male co-worker more than twice her size under the table. Of course, she'd been practicing for a quarter of her life by then; at 47, she was pouring a pint of bourbon, a 12-pack of beer and a couple of bottles of wine into her 115-pound body each day. She had come to prefer alcohol to food, sex or the company of friends and loved ones. Her marriage had ended; she had virtually stopped leaving the house, except to work and to drink. Fuller had tried and failed enough times over the years to know that she would not be able to sober up on her own.

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Alcohol Information Pack for Offenders under Probation Supervision

An alcohol information pack for offenders under Probation supervision has been developed by the Interventions and Substance Abuse Unit in conjunction with Alcohol Concern and MP Consultancy. The purpose of the pack is to provide offender managers with clear guidance and tools to:

• Identify offenders with alcohol related needs.
• Deliver ‘brief interventions’ to offenders with lower level alcohol problems
• Offer support and onward referral to those who may need more intensive intervention.

The pack includes sections on the probation service’s role in addressing offenders’ alcohol misuse needs; general alcohol information; specific offender groups and issues; and routes into treatment. There are also a number of exercises for offenders to work through either on their own or with their offender manager and a validated alcohol screening tool (AUDIT).

As is made clear in the accompanying guide for offender managers, the pack is not intended for use as a single document. Therefore, the five main sections are attached separately to make it easier for offender managers to extract and use whatever material is most appropriate in each specific case.

Date: Tue Feb 26 2008

• Alcohol Information Pack (382 K )
• Alcohol Information Pack - Guide for Offender Managers (88 K )
• Alcohol Information Pack, Section 1 - Probation Service's Role (47 K )
• Alcohol Information Pack, Section 2 - General Alcohol Information (196 K )
• Alcohol Information Pack, Section 3 - Specific Offender Groups and Issues (79 K )
• Alcohol Information Pack, Section 4 - Motivational Interventions (138 K )
• Alcohol Information Pack, Section 5 - Routes into Treatment (62 K )

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Alcohol-related deaths – latest UK figures for 2006
Health Statistics Quarterly 37 Spring 2008 p. 3




Latest figures on alcohol-related death rates in the UK in 2006 were released on 25 January 2008. Rates in the UK continued to increase, rising from 12.9 deaths per 100,000 population in 2005 to 13.4 in 2006. Rates almost doubled from 6.9 per 100,000 in 1991. The number of alcohol-related deaths more than doubled from 4,144 in 1991 to 8,758 in 2006.

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Adolescent problem behaviours predicting DSM-IV diagnoses of multiple substance use disorder
Social Psychiatry and Psychiatric Epidemiology, Online Early 27 Febrauary 2008

Whether there is an independent association between problem behaviours and substance use disorders (SUD) needs further investigation.

This study examined prospective associations of adolescent psychopathology and problem behaviours with SUD in early adulthood, and whether these associations are confounded by other factors.

In multivariate analyses, attention problems, delinquency, and aggression were associated with both single and multiple SUD in early adulthood, with delinquent behaviour being the strongest predictor (OR = 2.0, 95% CI 1.4–2.9 for one SUD and OR = 3.6, 95% CI 2.4–5.0 for multiple SUDs).

Problem behaviours, in particular delinquency and aggression in early adolescence predict long-term SUD. The results suggest that substance use prevention programs should target adolescents with early symptoms of psychopathology and problem behaviour.

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Effectiveness of brief alcohol interventions for general practice patients with problematic drinking behavior and comorbid anxiety or depressive disorders
Drug and Alcohol Dependence Volume 94, Issues 1-3, 1 April 2008, Pages 214-220

Brief interventions (BIs) are effective methods to reduce problematic drinking. It is not known, if the effectiveness of BI differs between patients with or without comorbid depression or anxiety disorders.

BI were significantly related to reduction of drinking in the non-comorbid (−2.64 g/alcohol vs. −8.61 g/alcohol; p = .03) but not in the comorbid subsample (−22.06 g/alcohol vs. −22.09 g/alcohol; p = .76). Compared to non-comorbid participants, a significantly higher reduction of drinking was found for comorbid individuals (−6.55 g/alcohol vs. −22.08 g/alcohol; p = .01). An ordinal regression analysis revealed comorbidity to be a positive predictor for reduction of drinking (estimator = .594; CI = .175–1.013; p < .01). When entering the variables amount of drinking at baseline, intervention and classification of problematic drinking, these became significant predictors, whereas comorbidity showed only a tendency.

BI did not significantly effect a reduction of drinking in comorbid patients. As BI are known to be less effective for dependent drinkers, a larger proportion of dependents among the comorbid might have limited the effectiveness of BI.

Future studies with larger sample sizes of comorbid problem drinkers are necessary to confirm the results.

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Request Reprint E-Mail: Janina.Grothues@psychiatrie.uk-sh.de

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Reliability of a rating procedure to monitor industry self-regulation codes governing alcohol advertising content.
Stud. Alcohol Drugs 69:J. 235-242, 2008


The purposes of this study were to develop reliable procedures to monitor the content of alcohol advertisements broadcast on television and in other media, and to detect violations of the content guidelines of the alcohol industry's self-regulation codes.

A set of rating-scale items was developed to measure the content guidelines of the 1997 version of the U.S. Beer Institute Code. Six focus groups were conducted with 60 college students to evaluate the face validity of the items and the feasibility of the procedure. A test-retest reliability study was then conducted with 74 participants, who rated five alcohol advertisements on two occasions separated by 1 week.

Average correlations across all advertisements using three reliability statistics (r, rho, and kappa) were almost all statistically significant and the kappas were good for most items, which indicated high test-retest agreement. We also found high interrater reliabilities (intraclass correlations) among raters for item-level and guideline-level violations, indicating that regardless of the specific item, raters were consistent in their general evaluations of the advertisements.

Naïve (untrained) raters can provide consistent (reliable) ratings of the main content guidelines proposed in the U.S. Beer Institute Code. The rating procedure may have future applications for monitoring compliance with industry self-regulation codes and for conducting research on the ways in which alcohol advertisements are perceived by young adults and other vulnerable populations.

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Request Reprint E-Mail: babor@nso.uchc.edu
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Kinetics and Isoforms of Serum Glutamate Dehydrogenase in Alcoholics
Alcohol and Alcoholism Advance Access published online on February 27, 2008


The goal of this paper was to determine Glutamate dehydrogenase's (GLDH) increased activity and rapid decrease in alcoholics according to last consumption of alcohol as well as to confirm that quick normalisation cannot be a sign of hepatocyte necrosis and that GLDH from rough endoplasmic reticulum exists in the serum of alcoholics.

Alcoholics were ascertained to have statistically significantly higher mean GLDH serum activities (men 351.53 nkat/L, women 296.08 nkat/L); the higher the level, the less elapsed time there was after the latest alcohol intake. There was an increased GLDH activity in 65.5% of alcoholics; furthermore, the percentage rose sharply to 72.2% with those who had last consumed alcohol within 48 hours. In the serum of alcoholics, it was found that, on average, it was 32.4% thermo-stable and 67.6% thermo-labile GLDH, which means that almost one third of GLDH serum originates from rough endoplasmic reticulum and rest from mitochondria. This is a completely new finding.

A statistically significant fast decrease of GLDH serum activity after a break in alcohol consumption has been confirmed. It is estimated that increased GLDH activity in the sera of alcohol dependents and its fast decrease after total abstinence has been restored are specific for alcohol addiction.

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Distinct patterns of FosB induction in brain by drugs of abuse

Synapse 358-369, 2008.


The transcription factor FosB accumulates and persists in brain in response to chronic stimulation. This accumulation after chronic exposure to drugs of abuse has been demonstrated previously by Western blot most dramatically in striatal regions, including dorsal striatum (caudate/putamen) and nucleus accumbens.

In the present study, we used immunohistochemistry to define with greater anatomical precision the induction of FosB throughout the rodent brain after chronic drug treatment. We also extended previous research involving cocaine, morphine, and nicotine to two additional drugs of abuse, ethanol and ⁹-tetrahydrocannabinol (⁹-THC, the active ingredient in marijuana).

We show here that chronic, but not acute, administration of each of four drugs of abuse, cocaine, morphine, ethanol, and ⁹-THC, robustly induces FosB in nucleus accumbens, although different patterns in the core vs. shell subregions of this nucleus were apparent for the different drugs.

The drugs also differed in their degree of FosB induction in dorsal striatum. In addition, all four drugs induced FosB in prefrontal cortex, with the greatest effects observed with cocaine and ethanol, and all of the drugs induced FosB to a small extent in amygdala.

Furthermore, all drugs induced FosB in the hippocampus, and, with the exception of ethanol, most of this induction was seen in the dentate. Lower levels of FosB induction were seen in other brain areas in response to a particular drug treatment.

These findings provide further evidence that induction of FosB in nucleus accumbens is a common action of virtually all drugs of abuse and that, beyond nucleus accumbens, each drug induces FosB in a region-specific manner in brain.

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Request Reprint E-Mail: eric.nestler@utsouthwestern.edu
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Memory patterns of acquisition and retention of verbal and nonverbal information in children with fetal alcohol spectrum disorders
Can J Clin Pharmacol Vol 15(1) Winter 2008:e44-e56; January 9, 2008

Previous research indicates that children with FASD have both memory and learning deficits. However, there is no consensus about whether the deficits identified from a pattern of impairment, and whether this pattern is consistent with the current theories regarding the organization of memory. Thus, the goal of this study was to further explore memory functions and expose possible patterns that may exist in children with FASD.

A significant difference between types of verbal memory in the FASD sample was identified. Specifically, recall of word pairs was found to be more impaired than that for stories. In addition to this, recall of immediate word pairs was significantly more impaired than that for delayed word pairs, implying the presence of encoding deficits in this area.

Children and adolescents with FASD displayed specific types of verbal memory deficits and these deficits were greater for immediate rather than delayed memory. These data are consistent with previous studies that describe deficits in immediate memory, and suggest that deficits in delayed memory are better accounted for by encoding deficits. Furthermore, their greatest difficulty arose with those items in which the phonological loop was required, which would have facilitated learning though internal recitation and adequate phonological storage.

Further research into these distinctions in memory is warranted, as is exploration into educational techniques that could account for delayed encoding in children with FASD.

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Fetal alcohol syndrome related knowledge assessment and comparison in New Jersey health professional groups
Can J Clin Pharmacol Vol 15(1) Winter 2008:e57-e65; January 9, 2008

There is a need to educate health professionals in regard to Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders across many health and allied health fields.

Conduct evaluations of educational programs designed to assess knowledge, attitudes and beliefs in relation to Fetal Alcohol Spectrum Disorders (FASD) among health and allied health professionals in the northeastern United States.


Results showed that a majority of health care professionals in New Jersey possess basic knowledge related to FASD and the effects of alcohol on a child in utero. They also had significant awareness of the importance of early diagnosis and the importance of reducing secondary disabilities. The study did however reveal areas for improvement in some professional groups.

FASD is the most important preventable cause of mental retardation. Health professionals attending workshops typically had a good basic understanding of FASD, though with some weaknesses specific to their discipline. Educational efforts in regard to FASD should be sensitive to the various health professionals engaged in preventing, diagnosing and treating FASD.

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Perspectives of mothers with substance use problems on father involvement
Can J Clin Pharmacol Vol 15(1) Winter 2008:e99-e107; February 1, 2008

A number of complex factors contribute to pregnant and parenting women’s alcohol and substance use. To date, little research has focused on the implications, meaning and experiences of father involvement on mothers with substance use problems.

The current study explores the experiences of mothers with substance use problems with respect to the role, impact and meaning of father involvement.

The meaning of father involvement among this group of women centered on four dimensions: emotional support, financial contributions to the family, amount and quality of time spent with the children and the family, and was dependent upon the particular expectations of the mother involved. Barriers and influences of father involvement were identified. The nature of father involvement had negative and positive impacts on participants.

Maternal use of alcohol is a complex issue, one factor often ignored in father involvement. For mothers with substance use problems father involvement has a number of implications, both positive and negative.

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Fetal alcohol syndrome disorder pilot media intervention in New Jersey
Can J Clin Pharmacol Vol 15(1) Winter 2008:e124-e131;February 26, 2008

The New Jersey Fetal Alcohol Spectrum Disorders Task Force launched the “Be in the kNOw” multimedia public education campaign in July 2006. The campaign continued until December 2006.

To report on the pilot media intervention campaign in Essex and Atlantic Counties, New Jersey, with the goal of identifying strategies to help prevent Fetal Alcohol Syndrome Disorder (FASD).

A total of 49 Fetal Alcohol Syndrome (FAS) related telephone calls were received through the Family Health Line over the six-month period. An increase from the 5-6 FAS calls typically received in a six-month period. Callers were located throughout New Jersey with 24.5% from Essex County, 12.2% from Mercer County, and 12.2% from Bergen County. 69% of callers identified themselves as white, 25% black, and 6% other. 76% of callers were female. Ages ranged from 8 to 50.

The media intervention reached a wide geographic audience, provoking interest beyond the initial target area and expected age ranges. The results, however, point to the difficulty of raising awareness of FASD.

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What human service professionals know and want to know about fetal alcohol syndrome.
Can J Clin Pharmacol Vol 15(1) Winter 2008:e117-e123; February 26, 2008

Although human service professionals are critical to prevention of primary and secondary disabilities among those who are or could be affected by prenatal exposure to alcohol surprisingly little information is available on their knowledge, attitudes, or beliefs about this problem.

This article presents the results from a statewide survey (2005) undertaken in the United States to gain such information.

The purpose of the study was to : a) measure the knowledge, attitudes, and beliefs about Fetal Alcohol Syndrome (FAS) of professionals working in the fields of child welfare/child protective services, foster care, and Medicaid enrollment, and b) use that knowledge to inform educational and training resources to help them with their work.

A purposive sample of human service professionals in 42 counties completed a self-administered survey patterned after similar FAS surveys for other professionals.

The results were based on answers from 1,168 human service professional respondents that showed that they were knowledgeable about primary prevention. However, it also revealed that they had lesser knowledge of epidemiology, how to recognize children with FAS, and methods to work with them. The fact that 90% of the respondents reported they did not care for children with FAS - is an important finding.

Although these findings suggest that human service professionals are knowledgeable about primary prevention, they lack additional education and assertive assessment protocols. These resources are needed to help them work with families and children who are already affected by exposure to alcohol in utero.

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Escalated Aggression after Alcohol Drinking in Male Mice: Dorsal Raphé and Prefrontal Cortex Serotonin and 5-HT_1B Receptors
Neuropsychopharmacology advance online publication 27 February 2008;

A significant minority of individuals engages in escalated levels of aggression after consuming moderate doses of alcohol (Alc). Neural modulation of escalated aggression involves altered levels of serotonin (5-HT) and the activity of 5-HT_1B receptors.

The aim of these studies was to determine whether 5-HT_1B receptors in the dorsal raphé (DRN), orbitofrontal (OFC), and medial prefrontal (mPFC) cortex attenuate heightened aggression and regulate extracellular levels of 5-HT.

Male mice were trained to self-administer Alc by performing an operant response that was reinforced with a delivery of 6% Alc. To identify Alc-heightened aggressors, each mouse was repeatedly tested for aggression after consuming either 1.0 g/kg Alc or H₂O. Next, a cannula was implanted into either the DRN, OFC, or mPFC, and subsets of mice were tested for aggression after drinking either Alc or H₂O prior to a microinjection of the 5-HT_1B agonist, CP-94,253. Additional mice were implanted with a microdialysis probe into the mPFC, through which CP-94,253 was perfused and samples were collected for 5-HT measurement.

Approximately 60% of the mice were more aggressive after drinking Alc, confirming the aggression-heightening effects of 1.0 g/kg Alc. Infusion of 1 g CP-94,253 into the DRN reduced both aggressive and motor behaviors.

However, infusion of 1 g CP-94,253 into the mPFC, but not the OFC, after Alc drinking, increased aggressive behavior. In the mPFC, reverse microdialysis of CP-94,253 increased extracellular levels of 5-HT; levels decreased immediately after the perfusion. This 5-HT increase was attenuated in self-administering mice.

These results suggest that 5-HT_1B receptors in the mPFC may serve to selectively disinhibit aggressive behavior in mice with a history of Alc self-administration.

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Training in dual diagnosis interventions (the COMO study): a randomised controlled trial
BMC Psychiatry 2008, 8: 27 February 2008

Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group.

In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score and team for that outcome) was performed.

At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was not significantly different between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p=0.0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p=0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p=0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22],, p=0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p=0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant.

A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance.

Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care.

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Sixth Grade Students Who Use Alcohol: Do We Need Primary Prevention Programs for "Tweens"?
Health Education & Behavior 2008, Online Early 26 February 2008



Young adolescent alcohol users drink at higher rates than their peers throughout adolescence and appear to be less amenable to intervention.

This study compares those who reported alcohol use in the past year to those who reported no use in a multiethnic, urban sample of sixth graders in 61 schools in Chicago in 2002 (N = 4,150). Demographic, behavioral, intrapersonal, and socioenvironmental factors were identified based on behavioral theories and potential mediators of the Project Northland Chicago intervention.

Single and multiple regression models were created for users and nonusers to determine associations between these factors and alcohol use behavior and intentions. The multiple regression models explained 35% and 56% of the variance in alcohol use behavior and intentions between students for nonusers and users, respectively.

Results suggest that primary prevention programs for alcohol use should occur prior to sixth grade, particularly for the substantial group at high risk for early use.

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Estimation from PET data of transient changes in dopamine concentration induced by alcohol: support for a non-parametric signal estimation method
Phys. Med. Biol. 53 1353-1367

We previously developed a model-independent technique (non-parametric ntPET) for extracting the transient changes in neurotransmitter concentration from paired (rest & activation) PET studies with a receptor ligand.

To provide support for our method, we introduced three hypotheses of validation based on work by Endres and Carson (1998 J. Cereb. Blood Flow Metab. 18 1196–210) and Yoder et al (2004 J. Nucl. Med. 45 903–11), and tested them on experimental data.

All three hypotheses describe relationships between the estimated free (synaptic) dopamine curves (F^DA(t)) and the change in binding potential (ΔBP). The veracity of the F^DA(t) curves recovered by nonparametric ntPET is supported when the data adhere to the following hypothesized behaviors: (1) ΔBP should decline with increasing DA peak time, (2) ΔBP should increase as the strength of the temporal correlation between F^DA(t) and the free raclopride (F^RAC(t)) curve increases, (3) ΔBP should decline linearly with the effective weighted availability of the receptor sites.

We analyzed regional brain data from 8 healthy subjects who received two [¹¹C]raclopride scans: one at rest, and one during which unanticipated IV alcohol was administered to stimulate dopamine release. For several striatal regions, nonparametric ntPET was applied to recover F^DA(t), and binding potential values were determined.

Kendall rank-correlation analysis confirmed that the F^DA(t) data followed the expected trends for all three validation hypotheses.

Our findings lend credence to our model-independent estimates of F^DA(t). Application of nonparametric ntPET may yield important insights into how alterations in timing of dopaminergic neurotransmission are involved in the pathologies of addiction and other psychiatric disorders.

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Editorials - Tackling alcohol misuse in the UK
BMJ, doi:10.1136/bmj.39496.556435.80 (published 22 February 2008)

Higher alcohol taxes and restricting availability are more likely to succeed than partnerships with industry

Nations, like people, can develop a pathological pattern of alcohol misuse. Ever since the Blair government consolidated its alcohol control policy around a "partnership" with the alcohol drinks industry,¹ the United Kingdom has been anything but united about how to deal with the nation’s alcohol problems.^{2 3} While some people have seen collaboration with industry as a way of "disabling the public interest,"² the ostensible rationale was to involve alcohol producers and retailers in new initiatives—such as voluntary limits on advertising, safer packaging, and codes of good conduct—to make town centres safer at night. In response to mounting evidence that this approach is not working,³ this week the BMA voices its opinion on how the problem should be tackled through the release of a report on alcohol misuse.⁴

According to the report the long wave of increasing alcohol consumption—which has moved the UK into eighth position in the hard drinking nations of Europe—did not occur by chance. It was facilitated by the progressive dismantling of previously effective alcohol control policies through deregulation and trade liberalisation, exemplified by 24 hour a day opening.

Although the connection between deregulation, consumption, and alcohol related problems is admittedly complex, the BMA report makes a good case for a combination of new regulatory measures, controls on consumption, and approaches to minimise harm. The evidence base for effective alcohol policy reviewed in the report is impressive. Universal strategies like increased alcohol taxes can drive down per capita consumption, especially in younger drinkers, and targeted approaches such as early intervention and specialised treatment are effective ways to deal with hazardous and harmful drinkers.⁵ The BMA’s recommendations are organised into six areas: controlling access to alcohol, promoting responsible industry practices, introducing measures to reduce drink driving, promoting health education and healthy living, encouraging early intervention and treatment, and supporting international cooperation on alcohol control .
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Men with serious injuries: Relations among masculinity, age, and alcohol use.
Rehabilitation Psychology. 2008 Feb Vol 53(1) 39-45



To increase understanding of masculine role attitudes and conflicts associated with alcohol use among men with serious injuries.

Fifty-two Midwestern adult men with spinal cord injury or traumatic brain injury completed masculine role attitudes and conflicts and alcohol consumption instruments. Age and blood alcohol content at injury were obtained from records.

Younger men reported greater pursuit of status, drive for dominance, and risk taking but less self-reliance and overall masculine role conflict. Earlier age of injury was associated with greater pursuit of status and drive for dominance but less self-reliance, restrictive emotionality, and overall masculine role conflict.

Endorsement of dominance correlated positively with number of alcoholic drinks per drinking episode (r-sub(s) = .43) and binge drinking (r-sub(s) = .47). Masculine role conflict associated with success, power, and competition correlated with number of drinks per drinking episode (r-sub(s) = .46).

Greater awareness and sensitivity to masculinity-related attitudes and conflicts may (a) reduce psychological barriers to accepting assistance, (b) promote active engagement in rehabilitation activities, (c) avoid counterproductive ambivalence and resistance, and (d) improve the therapeutic working alliance associated with favorable outcomes among men with serious injuries


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Research on the transmission of drinking cultures: the family and multiple influences

Project summary. We wish to fund further research on the transmission of drinking cultures. The two areas of interest for this year are how children learn about alcohol in the family context and the multiple influences acting on young drinkers.

Deadline:	2pm on Tuesday 8 April 2008
JRF Committee:	Alcohol Research Committee
Timescale:	18 months
Budget:	£300,000
Key contacts:	Charlie Lloyd (Principal Research Manager), charlie.lloyd@jrf.org.uk Christine Appleton, 01904 615911, christine.appleton@jrf.org.uk

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News Release - Rules on alcopops ads don't effectively protect teens
26/02/2008

In a CHOICE test of alcopops, 25% of the teenage participants couldn't taste the alcohol.

Teenagers find it hard to tell the difference between soft drinks and so-called alcopops, which are part spirit and part soft drink or milk, according to a CHOICE taste test.

Almost half of the teenage male taste test participants could not tell that Vodka Mudshake Original Chocolate, which is 4% alcohol by volume, contained alcohol.

Overall, one quarter of the participants, who for legal reasons were over 18, couldn’t taste the alcohol in alcopops, also known as ready-to-drink or RTD beverages.
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Alcohol slows interhemispheric transmission, increases the flash-lag effect, and prolongs masking: Evidence for a slowing of neural processing and transmission
Vision Research Volume 47, Issue 13, June 2007, Pages 1821-1832


While the alcohol literature is extensive, relatively little addresses the relationship between physiological effects and behavioural changes.

Using the visual system as a model, we examined alcohol’s influence on neural temporal processing as a potential means for alcohol’s effects. We did this by using tasks that provided a measure of processing speed: Poffenberger paradigm, flash-lag, and backward masking.

After moderate alcohol, participants showed longer interhemispheric transmission times, larger flash-lags, and prolonged masking.

Our data are consistent with the view that alcohol slows neural processing, and provide support for a reduction in processing efficiency underlying alcohol-induced changes in temporal visual processing.

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Doctors' body applies for late drinking licence
By Andy Bloxham

25/02/2008

Doctors have been accused of hypocrisy after applying to extend the licensing hours at their headquarters.

Just days after warning the population of the dangers of alcohol, it emerged the British Medical Association has asked for permission to open the bar at its central London headquarters earlier and close later. The bar is used for functions and weddings.

It has been criticised for the move following last week's high profile campaign to oppose 24-hour drinking.
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News Release - The BBPA comments on British Medical Association report

21.02.2008

Commenting on Today’s report from the British Medical Association on alcohol misuse, Rob Hayward, Chief Executive of the British Beer & Pub Association, said:

“The evidence offered by the BMA for many of their assertions is both flawed and flimsy. Contrary to what they say, since the introduction of the Licensing Act two years ago, alcohol consumption has fallen.

“Equally, high taxes are not the answer. The fact is we already have some of the highest taxes and prices in Europe. Yet our alcohol problems and those of all the high tax and high price countries are significantly greater than the low tax and low price countries of Europe.
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Outpatient Long-term Intensive Therapy for Alcoholics (OLITA): a successful biopsychosocial approach to the treatment of alcoholism
Dialogues Clin Neurosci. 2007;9:399-412.


Alcohol dependence is a frequent, chronic, relapsing, and incurable disease with enormous societal costs. Thus, alcoholism therapy and research into its outcome are of major importance for public health.

The present article will: (i) give a brief overview of the epidemiology, pathogenesis, and treatment outcomes of alcohol dependence; (ii) introduce the basic principles of outpatient long-term therapy of alcohol-dependent patients; and (iii) discuss in detail process-outcome research on Outpatient Long-term Intensive Therapy for Alcoholics (OLITA).

This successful biopsychosocial approach to the treatment of alcoholism shows a 9-year abstinence rate of over 50%, a re-employment rate of 60%, and a dramatic recovery from comorbid depression, anxiety disorders, and physical sequelae. The outcome data are empirically based on treatment processes that have proven high predictive validity and give concrete information about where to focus the therapeutic efforts.

Thus, process-outcome research on OLITA can serve for the development of new therapeutic guidelines on adapting individual relapse prevention strategies.


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