Three drinks and you're out

Michael Bachelard and Heath Gilmore
June 15, 2008

THREE glasses of wine during dinner is about to be redefined as a binge-drinking episode under the Federal Government's new official drinking guidelines to be released next month.

In what one health professional has slammed as a message that "makes no sense at all", the guidelines will say that having more than four standard drinks a day constitutes a binge. An average glass of wine is 1.5 standard drinks.
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Putting a price on alcohol abuse shows a simple first step

Friday, June 13, 2008

No one doubts that alcohol abuse is a major social problem. The evidence -- public disorder, drunk driving, failing health and broken homes -- confronts us every day.

Now, a pioneering study, The Avoidable Cost of Alcohol Abuse in Canada 2002, released this week, gives us a fresh perspective by putting a price on the problem.

In their 176-page report, researchers at the Centre for Addiction and Mental Health recommend six interventions they claim will, if implemented, save $1 billion a year and 800 lives.
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AHA defends low price of Alcopops

June 12, 2008


Alcopops' prices have been deliberately kept low to encourage responsible drinking, hoteliers have told a Senate inquiry.

The federal government raised the tax on the ready-to-drink (RTD) beverages in April, saying it would help curb binge drinking among young people.

But Australian Hotels Association (AHA) national affairs director Bill Healey says the government is wrong.

He told a Senate inquiry into the tax hike, the drinks have measured levels of alcohol and their lower price is an incentive for people to drink RTDs instead of buying bottles of spirits.
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Supermarket alcohol price cuts 'fuelling binge drinking'

By Kate Devlin, Medical Correspondent
13/06/08

Supermarkets are fuelling a culture of binge drinking by cutting the price of alcohol they sell, it has been claimed.

Some best-selling drinks now cost 20 per cent less than they did a year ago, new figures reveal.

A survey by mysupermarket.co.uk shows a dramatic fall in prices over the last 12 months.

The site looked at the cost of alcohol in four major supermarket chains - Asda, Tesco, Sainsbury's and Ocado, the online arm of Waitrose.
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Children With Heavy Prenatal Alcohol Exposure Demonstrate Deficits on Multiple Measures of Concept Formation
Alcoholism: Clinical and Experimental Research OnlineEarly Articles 13 June 2008

Children with heavy prenatal alcohol exposure have documented impairments in executive functioning (EF). One component of EF, concept formation, has not been well studied in this group.

Children with histories of heavy prenatal alcohol exposure showed impairment on both tests of concept formation compared to non-exposed controls. These deficits included difficulty generating and verbalizing concepts, increased error rates and perseverative responses, and poorer response to feedback. However, in comparison to controls, alcohol-exposed children performed better on measures of concept formation than predicted by their overall IQ scores. Exploratory analyses suggest that this may be due to differences in how the measures relate at different IQ levels and may not be specific to prenatal alcohol exposure.

Deficits in concept formation and conceptual set shifting were observed in alcohol-exposed children with or without the diagnosis of FAS and in the absence of mental retardation. These deficits likely impact problem solving skills and adaptive functioning and have implications for therapeutic interventions in this population.

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Social Recovery Model: An 8-Year Investigation of Adolescent 12-Step Group Involvement Following Inpatient Treatment
Alcoholism: Clinical and Experimental Research OnlineEarly Articles 13 June 2008

Despite widespread use of 12-step treatment approaches and referrals to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) by youth providers, little is known about the significance of these organizations in youth addiction recovery. Furthermore, existing evidence is based mostly on short-term follow-up and is limited methodologically.

The AA/NA attendance was common and intensive early posttreatment, but declined sharply and steadily over the 8-year period. Patients with greater addiction severity and those who believed that they could not use substances in moderation were more likely to attend. Despite declining attendance, the effects related to AA/NA remained significant and consistent. Greater early participation was associated with better long-term outcomes.

Even though many youth discontinue AA/NA over time, attendees appear to benefit, and more severely substance-involved youth attend most. Successful early posttreatment engagement of youth in abstinence-supportive social contexts, such as AA/NA, may have long-term implications for alcohol and drug involvement into young adulthood.

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The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) - A randomised control trial protocol.
BMC Health Services Research 2008, 8:129

There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers.

Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels.

There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.

The study design is a pragmatic prospective multi-centre two arm randomised controlled trial.

The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation.

Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility.

The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.

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Pharmacological activation of CB1 and D2 receptors in rats: predominant role of CB1 in the increase of alcohol relapse
European Journal of Neuroscience OnlineEarly Articles 12 June 2008

The classical dopamine D2 receptor has been widely studied in alcoholism. Recently, different studies have explored the role of the CB1 receptor in alcohol-related behavior. In alcohol addiction, relapse is one of the central features.

In light of this, we investigated the functional roles of and interactions between CB1 and D2 receptors in alcohol relapse. We used the learned task of alcohol operant self-administration in Wistar rats. In order to evaluate alcohol relapse, we set up a protocol essentially based on the alcohol deprivation effect.

We found that subchronic activation of CB1 (WIN 55,212–2, 2 mg/kg), but not D2 receptors (quinpirole, 1 mg/kg), during a period of alcohol deprivation increased long-lasting alcohol relapse.

The cannabinoid-induced potentiation of alcohol relapse was mediated by a motivational and appetitive component, and not merely by alcohol consumption. This potentiation was prevented by the pharmacological inactivation of D2 receptors (raclopride, 0.1–0.3 mg/kg).

Together, these results essentially demonstrate that activation of CB1 receptors plays a key role in the increase of alcohol relapse, whereas inactivation of D2 receptors modulates this aberrant behavior.

We suggest that there exists a functional and interactive relationship between both receptor systems, which controls alcohol relapse and alcohol-learned tasks.

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Socioeconomic Status and Alcohol Use Among Urban and Rural Residents in China
Substance Use & Misuse, Volume 43, Issue 7 June 2008 , pages 952 - 966

The association between socioeconomic status (SES) and current regular alcohol use was examined separately for urban and rural residents of Hubei, China, using the third Chinese National Health Service Survey conducted in 2003.

A probability sample of 15,609 respondents, ages 15 through 101 years, was selected from the study base. Alcohol use was a dichotomized variable (current regular users vs. others). Multivariate analyses incorporated four SES indicators: income, education, occupation, and house size.

Investigation of status discrepancy indicated that income was positively associated with the likelihood of current regular alcohol use, whereas education was negatively associated. For both urban and rural residents, likelihood of current regular alcohol use was smallest for those in the highest education and lowest income category.

Further research, which factors in quantity and frequency, is needed to understand how alcohol use among Chinese urban and rural populations impacts their health.

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SPRING 2008 SYMPOSIA SERIES ON MECHANISMS OF BEHAVIOR CHANGE

Considerations of Genetics and Psychosocial Theory in Health Behavior Change: Is It All In Your Head or In Your Genes?

View event:	You will be able to view the event at http://videocast.nih.gov when the event is live.
Air date:	Wednesday, June 18, 2008, 1:00:00 PM
Description:	SPRING 2008 SYMPOSIA SERIES ON MECHANISMS OF BEHAVIOR CHANGE Organizing Agencies: AHRQ, NCI, NIAAA, NIDA, OBSSR For more information, visit http://www.niaaa.nih.gov/NewsEvents/Conferences/changesymposia08.htm
Author:	Claude Bouchard, Alexander Rothman and Frank Perna
Runtime:	120 minutes ______________________________________________________

Wineglass figure is result of women's drinking

12/06/2008

British women are drinking so much they are developing a new type of figure - the wineglass - a dietitian has said.

The body shape is characterised by a larger upper body and thinner lower half.

Experts believe that health-conscious women are exercising more but failing to cut down on alcohol, which is high in calories and results in weight accumulating as fat around the middle.
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UK ad and TV industries join government for Olympics health push

Mark Sweney
Thursday June 12 2008

A coalition of advertisers, ad agencies and media companies is to work with the UK government on a multi-year health marketing campaign to raise awareness of issues such as obesity, alcohol and exercise in the run-up to the 2012 Olympics.

The initiative, spearheaded by the Advertising Association, marks the biggest effort to date by the UK ad industry to prove that it has a valuable role to play in contributing to a healthy lifestyle.
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Assessing spirituality/religiosity in the treatment environment: The Treatment Spirituality/Religiosity Scale
Journal of Substance Abuse Treatment Article in Press, Corrected Proof 17 April 2008


There has been much interest in measuring and evaluating the role of spirituality/religiosity (S/R) in substance use disorder (SUD) treatment.

This study presents the initial evaluation of a new measure of S/R in the treatment environment: the Treatment Spirituality/Religiosity Scale (TSRS). The TSRS has 10 items and can be completed by both patient and staff to measure the emphasis on S/R in a given treatment program, which may have important implications for patient–program fit.

Data on the TSRS were gathered from 3,018 patients and 329 staff members from 15 residential SUD treatment programs within the Department of Veterans Affairs Health Care System.

The TSRS showed good internal consistency ( = .77), a single-factor structure, close agreement between patients and staff members (r = .93), and good discriminant validity.

The TSRS appears to be a brief, easily administered, and potentially useful measure of the emphasis on S/R in residential SUD treatment programs.

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To what factors do clients attribute change? Content analysis of follow-up interviews with clients of the UK Alcohol Treatment Trial
Journal of Substance Abuse Treatment Article in Press, Corrected Proof 10 June 2008

The UK Alcohol Treatment Trial compared outcomes after a social treatment (Social Behavior and Network Therapy) and a motivational treatment (Motivational Enhancement Therapy).

As part of the process element of the trial, a subsample of clients were interviewed 3 months after treatment allocation and another subsample 12 months after allocation (N = 397) to explore the factors to which clients attributed positive changes that might have occurred in their drinking. Postinterview reports were content analyzed using three types of code: social, motivational, and general.

At 3 months, Social Behavior and Network Therapy clients made significantly more social attributions and Motivational Enhancement Therapy clients more motivational attributions, and the difference for motivational attributions was maintained at 12 months (with a trend for social attributions).

Overall, the factors to which change was most frequently attributed were involvement of others in supporting behavior change (a social factor), awareness of the consequences of drinking (a motivational factor), and three general factors—determination, commitment, and decision; detoxification or medication; and feeling comfortable talking.

Change was more frequently attributed to general factors than it was to either social or motivational ones. Some of the difficulties in eliciting and coding attribution material are referred to.

The results may help understand the absence of between-treatment type outcome differences in UK Alcohol Treatment Trial and other trials.

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Occupational Noise, Smoking, and a High Body Mass Index are Risk Factors for Age-related Hearing Impairment and Moderate Alcohol Consumption is Protective: A European Population-based Multicenter Study

A multicenter study was set up to elucidate the environmental and medical risk factors contributing to age-related hearing impairment (ARHI). Nine subsamples, collected by nine audiological centers across Europe, added up to a total of 4,083 subjects between 53 and 67 years.

Audiometric data (pure-tone average [PTA]) were collected and the participants filled out a questionnaire on environmental risk factors and medical history. People with a history of disease that could affect hearing were excluded. PTAs were adjusted for age and sex and tested for association with exposure to risk factors.

Noise exposure was associated with a significant loss of hearing at high sound frequencies (>1 kHz). Smoking significantly increased high-frequency hearing loss, and the effect was dose-dependent. The effect of smoking remained significant when accounting for cardiovascular disease events. Taller people had better hearing on average with a more pronounced effect at low sound frequencies (<2 kHz). A high body mass index (BMI) correlated with hearing loss across the frequency range tested.

Moderate alcohol consumption was inversely correlated with hearing loss. Significant associations were found in the high as well as in the low frequencies.

The results suggest that a healthy lifestyle can protect against age-related hearing impairment.


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EDITORIAL - The trouble with alcohol abuse: what are we trying to measure, diagnose, count and prevent?
Addiction 103 (7) , 1057–1059


Alcohol abuse was once defined facetiously as mixing good liquor with bad soda, implying that the real meaning of the term was the abuse of expensive alcohols, not the drinker. Despite this logical inconsistency, the term alcohol abuse has grown in popularity during the last 30 years, in part because it seems to fill a terminological gap between alcohol dependence and ‘moderate’ alcohol use, and in part because it was adopted into the formal nomenclature of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual in 1980.
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Alcohol measurement methodology in epidemiology: recent advances and opportunities
Addiction 103 (7) , 1082–1099


To review and discuss measurement issues in survey assessment of alcohol consumption for epidemiological studies.

The following areas are considered: implications of cognitive studies of question answering such as self-referenced schemata of drinking, reference period and retrospective recall, as well as the assets and liabilities of types of current (e.g. food frequency, quantity–frequency, graduated frequencies and heavy drinking indicators) and life-time drinking measures. Finally we consider units of measurement and improving measurement by detailing the ethanol content of drinks in natural settings.

Cognitive studies suggest inherent limitations in the measurement enterprise, yet diary studies show promise of broadly validating methods that assess a range of drinking amounts per occasion; improvements in survey measures of drinking in the life course are indicated; attending in detail to on- and off-premise drink pour sizes and ethanol concentrations of various beverages shows promise of narrowing the coverage gap plaguing survey alcohol measurement.\

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ALCOHOL AND VIOLENCE: EXPLORING PATTERNS AND RESPONSES

Commissioned by the
International Center for Alcohol Policies
2008

Increasing attention is being paid to the question of what exactly is the nature of the association between alcohol and violence. This is the case both in terms of scientific and research efforts and also in terms of public discourse. Although most commentators agree that there is no simple causative relationship, there is certainly a need to better understand how some patterns of drinking intersect with some patterns of violence. This collection of papers is an attempt to contribute to that understanding.

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Tax on alcopops sets off alcohol lobby war

Mark Metherell
June 12, 2008

THE huge tax increase on alcopops has unleashed a fresh lobbying war, with the alcohol industry raising obstacles for further tax changes being sought by community groups.

With most health and drugs groups arguing the Government should tax drinks uniformly by volume of alcohol, the drinks industry has turned out in force to protect its interests at the Senate inquiry into the new and controversial tax on alcopops.
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Alcohol Relapse Induced by Discrete Cues Activates Components of AP-1 Transcription Factor and ERK Pathway in the Rat Basolateral and Central Amygdala
Neuropsychopharmacology (2008) 33, 1835–1846


Alcohol-related cues may induce relapse to heavy alcohol drinking and promote molecular adaptations in discrete brain regions. An exact nature of these molecular alterations is still unknown.

In the present study, rats trained to self-administer ethanol were tested for cue-induced reinstatement of ethanol seeking after 30 days of abstinence. Next, a detailed immunocytochemical analysis of c-Fos activation was performed within seven nuclei of the amygdala. In the second experiment, c-Fos activation after reinstatement of ethanol seeking induced by discrete cues was compared with the activation pattern of its putative partner (c-Jun) and regulators (extracellular signal-regulated kinases and c-Jun N-terminal kinases).

Reexposure to ethanol-associated context cues (an extinction session) potentiated c-Fos expression within the basolateral and central amygdala. Repeated presentation of ethanol-associated discrete cues in an extinction/reinstatement session led to even stronger c-Fos activation in the latter nuclei.

In the second experiment, reexposure to the ethanol-associated context and discrete cues activated both c-Jun and extracellular signal-regulated kinases (ERK1/2) in the basolateral amygdala.

Our observations suggest that the basolateral and central amygdala may be specifically involved in alcohol-seeking behavior induced by discrete cues.

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Taxes, stricter alcohol limits could help cut cost of alcohol abuse: report

Alcohol abuse costs every Canadian $463 a year, a new study finds, but could be cut if Ottawa lowered consumption by increasing liquor taxes and lowering blood-alcohol limits, among other policy changes.

The Avoidable Cost of Alcohol Abuse in Canada 2002 report released Wednesday by the Centre for Addiction and Mental Health in Toronto finds that health-care costs related to alcohol abuse are actually higher than those for cancer.

It proposes six interventions that it says would save 800 lives and approximately $1 billion per year, almost 26,000 years of life lost to premature alcohol-related deaths and more than 88,000 days of acute care in hospital annually.
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News Release - Save $1 Billion and 800 Lives: CAMH’s"Avoidable Costs of Alcohol Abuse in Canada 2002" Study released

For Immediate Release – June 11, 2008 (TORONTO): The economic burden of alcohol abuse costs each Canadian $463 per year. In fact, the direct health care costs for alcohol abuse in Canada exceed those of cancer. Released today by the Centre for Addiction and Mental Health (CAMH), the Avoidable Cost of Alcohol Abuse in Canada 2002 report estimates that, even under very conservative assumptions,implementing six reviewed interventions would result in cost savings of about $1 billion per year and a savings of about 800 lives, close to 26,000 years of life lost to premature death and more than 88,000 acute care hospital days in Canada per year. This pioneering study is Canada’s first systematic estimate of the avoidable costs of alcohol abuse, and the first study of its kind worldwide.
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• Avoidable Costs of Alcohol Abuse 2002 - Full Report (1.1 MB)
• Avoidable Costs of Alcohol Abuse 2002 - Highlights (161 KB)

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Key future research questions on mediators and moderators of behaviour change processes for substance abuse
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S83 - S87

In summarizing the key themes and results of the second meeting of the German Addiction Research Network Understanding Addiction: Mediators and Moderators of Behaviour Change Process, the following concrete steps forward were laid out to improve knowledge.

The steps included pleas to (1) redefine substance abuse disorders, especially redefine the concept of abuse and harmful use; (2) increase the use of longitudinal and life-course studies with more adequate statistical methods such as latent growth modelling; (3) empirically test more specific and theoretically derived common factors and mechanisms of behavioural change processes; (4) better exploit cross-regional and cross-cultural differences.

Funding agencies are urged to support these developments by specifically supporting interdisciplinary research along the lines specified above. This may include improved forms of international funding of groups of researchers from different countries, where each national group conducts a specific part of an integrated proposal. Read Full Abstract Request Reprint E-Mail: jtrehm@aol.com ________________________________________________________________

Differences in help seeking rates after brief intervention for alcohol use disorders in general practice patients with and without comorbid anxiety or depressive disorders
International Journal of Methods in Psychiatric ResearchVolume 17 Issue S1, Pages S74 - S77



To examine, if the utilization of help for problematic drinking after brief intervention (BI) differs between general practice (GP) patients with and without comorbid depression or anxiety disorders.

BI were significantly related to an increase in utilization of formal help in non-comorbid patients (² = 4.54; df = 1; p < src="http://www3.interscience.wiley.com/giflibrary/12/khgr.gif" border="0">² = 0.40; df = 1; p = 0.60). In a logistic regression analysis, comorbidity [odds ratio (OR) = 1.81; 95% confidence interval (CI) = 1.14-2.88; p = 0.01) and previous help seeking (OR = 15.98; CI = 6.10-41.85; p < 0.001) were found to be positive predictors for utilization of formal help.

BIs do not seem to significantly support help-seeking in the comorbid. As comorbid anxiety and depression constitute a positive predictor for help-seeking, individuals with problematic drinking and comorbid anxiety or depressive disorders might benefit from more specialized support exceeding the low level of BI.

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Predicting utilization of formal and informal help among general hospital inpatients with alcohol use disorders
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S70 - S73


The aim of this prospective study was to identify predictors of utilizing formal and informal help among currently non-help-seeking individuals with alcohol use disorders.

Intention to seek help and prior help-seeking were identified as central predictors for formal and informal help-seeking.

The lack of utilization of formal help among persons with alcohol use disorders may be reduced by focusing professional interventions on enhancing help-seeking motivation.

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Request Reprint E-Mail: freyer@uni-greifswald.de
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Finding the ideal place for a psychotherapeutic intervention in a stepped care approach - a brief overview of the literature and preliminary results from the Project PREDICT
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S60 - S64

To provide an overview over empirical evidence regarding stepped care approaches that include psychotherapies. To present own preliminary study results in alcohol dependent patients.

Publications were searched in the databases Medline, PsycINFO and the internet search engine Google Scholar. Inclusion criteria were psychosocial treatment and psychiatric disorders. Our own study consists of two steps. In step 1 patients receive anti-craving medication or placebo and Medical Management (MM). After a relapse to heavy drinking patients can step up and after randomization they either continue with the same treatment or they receive additional alcoholism specific psychotherapy (ASP).

Evidence suggests that stepped care might be efficacious in patients with obsessive-compulsive behavior and depression. There is no evidence for efficacy in problem drinkers. Results of our own study show that the completer rate in MM alone is higher than in ASP with MM, but there are no significant differences concerning age, sex and disease severity between completer and non-completer in both study arms.

Further research with regard to stepped care in alcohol dependent patients is needed. An introduction of the psychotherapy at earlier stages might be sensible. Read Full Abstract Request Reprint E-Mail: michael.berner@uniklinik-freiburg.de __________________________________________________________________

Alcohol and drug treatment systems in public health perspective: mediators and moderators of population effects
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S50 - S59

This article describes a public health approach to the study of service systems for people with substance use disorders.

Such an approach is broadly conceived to include the consideration not only of specialized services for alcohol and drug dependence, but also of medical care and social welfare services that interact with and complement specialized drug and alcohol services.

After describing a conceptual model of the substance abuse service system, we discuss how systems of care may contribute to population health and social welfare by reducing the societal burden of substance use disorders.

The article then summarizes key systems issues pertaining to mediators and moderators of effective treatment systems. The potential benefits of systems thinking in relation to the management of substance use disorders are described.

It is suggested that systems concepts and research may help to improve access, efficiency, economy, continuity of care, and effectiveness, thereby improving the population impact of treatment services.

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Treatment for persons with substance use disorders: mediators, moderators, and the need for a new research approach
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S45 - S49

This article describes two major studies (i.e. Project MATCH and the US Department of Veterans Affair Effectiveness Study) of mediators and moderators of drinking behavior change following treatment, and considers alternatives to the dominant paradigm that has guided treatment research for more than two decades. Both studies were designed to test the Technology Model of therapeutic change, which postulates that patient attributes and treatment process elements, respectively, constitute mediators and moderators of change in drinking and drug use following treatment.

The studies show that matching to therapeutic orientation is not an essential ingredient to substantially enhanced outcomes, as previously believed. They also indicate that the mediational mechanisms underlying several of the most popular therapies are different than what is suggested by their proponents.

The inability of the Technology Model to explain, much less improve, the effectiveness of addiction treatment suggests the need for a new paradigm. It may be more fruitful to look for matching in larger populations at the level of communities or treatment systems, where a wider range of settings and therapeutic interventions can be evaluated.

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The adolescent origins of substance use disorders
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S30 - S38

Although early use of alcohol during adolescence has been consistently associated with increased risk of alcoholism in adulthood, the specific mechanisms that underlie this association remain unclear.

We describe a program of epidemiological twin-family research that shows that early use of alcohol is best conceptualized as an indicator of a more general propensity to engage in adolescent problem behavior. Adolescent problem behavior, in turn, is a risk factor for a broad range of adult externalizing disorders, of which alcoholism is but one manifestation.

These findings are shown to be consistent with a dual-process model whereby early adolescent problem behavior is associated with increased risk of adult psychopathology because both are indicators of a common inherited liability and because early adolescent problem behavior increases the likelihood an adolescent is exposed to high-risk environments.

We conclude with a discussion of the importance of cross-cultural research, which may be especially informative for identifying the consequences of early adolescent drinking.


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What are the high risk periods for incident substance use and transitions to abuse and dependence? Implications for early intervention and prevention
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S16 - S29

For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females.

A sample of (N = 3021) community subjects aged 14-24 at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results: Ages 10-16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition.

Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence. Read Full Abstract Request Reprint E-Mail: silke.behrendt@psychologie.tu-dresden.de ___________________________________________________________________

Why people change? The role of cognitive-control processes in the onset and cessation of substance abuse disorders
International Journal of Methods in Psychiatric Research Volume 17 Issue S1, Pages S4 - S15

The current effectiveness of preventative and therapeutic interventions for substance use disorders (SUDs) is less than satisfying. Progress in understanding the processes related to the onset, course, and cessation of SUDs merits top priority, given the high prevalence and the severe negative consequences.

This position paper, after summarizing major factors related to onset and cessation processes, discusses the possible role of cognitive-control dysfunctions in the complex interaction between mechanisms of change (mediators) and risk factors (moderators).

In past decades, research has expanded our knowledge about the impact of SUDs on human behaviour. Formal interventions are effective, but there is limited information about the mechanisms responsible for change during the onset and cessation of SUDs and for individual differences related to them. Preliminary results suggest that impairments in higher order control functions play a role in SUDs.

Deficiencies in our understanding of behaviour-change processes during the onset and cessation of SUDs require that research have a different focus. A better understanding of the relevance of impairments in executive-control functions might help to improve formal preventative and therapeutic interventions and social conditions. Such interventions might reduce the chances that a SUD will develop or increase the likelihood of recovery from it.

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Editorial - Understanding addiction - mediators and moderators of behaviour change processes: an introduction
International Journal of Methods in Psychiatric Research

Volume 17 Issue S1, Pages S1 - S3

We provide an introduction into a highly important research area for the improvement of preventive and therapeutic measures in the field of substance use disorders: a better understanding of core mediators and moderators of change processes, especially during critical phases like onset, progression, cessation and relapse. Based on a brief description of 12 papers on related projects we detail relevant research issues like the role of impaired cognitive control functions or the narrow window of opportunity for early interventions during adolescence.

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Needs Assessment and Current Practice of Alcohol Risk Assessment of Pregnant Women and Women of Childbearing Age by Primary Health Care Professionals
Can J Clin Pharmacol Vol 15(2) Summer 2008:e214-e222; June 1, 2008

Assessing the current practices and learning and resource needs of primary health care professionals in regards to their alcohol risk assessment practices is an important step in providing optimal training and educational methods. Needs and current practices in alcohol risk assessment of pregnant women and women of child bearing years may vary according to practitioner demographics.

To appraise alcohol risk assessment current practices and learning and resource needs among Saskatchewan primary health care professionals, a mail and online survey was distributed in the spring of 2006 to family physicians/general practitioners and nurse practitioners.

In total, 876 surveys were distributed and 386 were returned for an overall response rate of 44.1%. The majority of survey respondents reported either rarely or never using a standardized screening tool in assessing alcohol risk in women or reported using a standardized screening tool that is less sensitive. Current practices varied according to gender, length of time in practice and practice location, while learning and resource needs were more likely to be identified by nurse practitioners, female physicians, and physicians from rural areas. Physicians who had practiced for less than 5 years were more likely to want an online course.

Knowing the needs and practices of health care professionals may assist learning and resource training and could assist in teaching best practices in alcohol risk assessment. Assessing alcohol risk in pregnant women and women of childbearing age is critical for prevention of FASD.

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Building Clinical Capacity for Fetal Alcohol Spectrum Disorder Diagnoses in Western and Northern Canada
Can J Clin Pharmacol Vol 15 (2) Summer 2008:e223-e237; June 10, 2008

Fetal alcohol syndrome and fetal alcohol spectrum disorder are common problems. In response to this problem the Canada Northwest FASD Research Network was established in 2005 by the Canada Northwest FASD Ministerial Partnership. This study was conducted to determine the FASD clinical activity in Canada Northwest.

Of the 27 programs identified to receive the questionnaire 15 programs responded. These programs were determined to have evaluated about 85% of the patients evaluated by all the programs. The total 7 jurisdictional capacity for FASD diagnosis was 816 evaluations in 2005 and projected to be 975 in 2006. Selection methods for appointing patients for assessment seemed excellent as 23% of those assessed were found to have FAS or pFAS and another 44% had other forms of FASD. The most common professionals to participate in the team evaluations were Paediatricians, Clinical Psychologists, Speech and Language Pathologists and Occupational Therapists.

Clinics are developing in western and northern Canada to diagnose patients with FASD. Comparing the experiences of these clinics can help to determine the continued need to increase diagnostic capacity, standardize diagnostic approaches to assure consistency of approach and diagnosis across the sites and appropriately staff and fund the programs.

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Fetal Alcohol Spectrum Disorder: New Zealand Birth Mothers' Experiences
Can J Clin Pharmacol Vol 15 (2) Summer 2008:e191-e213; June 1, 2008

The aim of this study was to describe the ‘lived’ experiences of New Zealand birth mothers, from pregnancy onwards, of a child/ren diagnosed with Fetal Alcohol Spectrum Disorder (FASD).

The mothers described a range of issues of concern for their disabled offspring and themselves (as advocates) relating to health, social, educational, judicial systems, lack of knowledge by professionals and problems in diagnosis, to being oppressed and stigmatized. Cognitive concerns for the offspring included attention-deficit, absence of fear, diminished memory and comprehension and inability to acknowledge and understand consequences. Behavioural issues included excessive crying or no crying as a baby, lying, stealing, hyper-activity, aggressiveness, destructiveness, sexual promiscuity and few friends. Other issues of concern were delayed milestones and numerous health problems. All mothers stated that the pregnancy, labour and delivery of their child with FASD were different from their other non-compromised pregnancies/labours/deliveries. Most mothers said that the doctors used medical language which they did not understand, thus giving power to the former. Seven mothers were either married to or partners of alcoholics when they conceived their offspring with FASD. All mothers had been drinking alcohol before becoming pregnant. Six mothers came from drinking families. Most mothers continued to consume alcohol because they did not know that they had conceived. All mothers were unaware of FASD and its effects on the unborn child. Eight babies had low Apgar scores with an average of 6 (out of 10) and low birth weight (average 6lb 2oz). An Apgar score is a numerical expression of an infant’s condition, usually determined at 60 seconds after birth, based on heart rate, respiratory efforts, muscle tone, reflex irritability and colour. All women were of middle to high socio-economic status. Seven mothers experienced family breakdown as a result of alcohol consumption by the biological father of the child with FASD. All women feared for their child’s future.

Health, social, educational, judicial professionals, policy-makers and agencies, need to understand and be educated in the daily realities and complex problems that children with FASD and their families face. Only then will the correct diagnosis be made so that these individuals can receive the nurturing, needs, education, funding and support they require in order to live full and meaningful lives and have the quality of life they deserve.

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Stroke Incidence in Women under 60 Years of Age Related to Alcohol Intake and Smoking Habit
Cerebrovasc Dis 2008;25:517-525


The association between alcohol intake, cigarette smoking and risk of stroke amongst women remains unclear, especially in young women.

During an average of 11 years of follow-up, 170 incident stroke cases, of which 111 ischemic and 47 hemorrhagic, were identified. Compared to abstainers, risk of stroke was reduced among women consuming less than 20 g (RR = 0.7, 95% CI 0.5-1.0) or 20-69.9 g (RR = 0.5, 95% CI 0.3-0.7) of alcohol per week, whilst women who consumed 70 g of alcohol per week had a nonsignificant reduced relative risk (RR = 0.7, 95% CI 0.4-1.3).

We found no difference in stroke risk according to the types of alcoholic beverage consumed.

Compared with never smokers, there was an increased risk of all strokes among current smokers of 1-9 cigarettes/day (RR = 2.3, 95% CI 1.5-3.7) or 10 cigarettes/day (RR = 2.6, 95% CI 1.7-4.1). The observed smoking-related excess risks were confined mainly to ischemic stroke. Former smokers had a 50-60% increase in RRs of both ischemic and hemorrhagic stroke.

In stratified analyses, current smokers had a 4-fold excess risk if they were nondrinkers (RR = 4.2; 95% CI 2.2-7.8) but a lower risk (RR = 1.5; 95% CI 0.8-2.4) if they drank in moderation. Compared to never drinkers and never smokers, women who drank in moderation were also at reduced risk (RR = 0.6; 95% CI 0.3-1.1). These interactions were statistically significant (p = 0.001).

Light to moderate alcohol intake, regardless of type of alcoholic beverage, reduces risk of stroke among women under 60 years of age, in particular those women who were never smokers. Smoking increases the risk of stroke, especially ischemic stroke.

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Alcohol hospital admissions hit squad announced
Wednesday, June 11, 2008

A specialist squad is to be set up to help towns with the most drink-related hospital admissions fight their alcohol problems. Health Secretary Alan Johnson announced the formation of the National Alcohol Support Team during a speech on tackling health inequalities.

The 10 worst-affected towns or local authority areas across England will get targeted support by March next year. The Alcohol Support Team will be made up of civil servants who will advise primary care trusts about how they can tackle alcohol misuse in their areas.
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Using the Temperament and Character Inventory (TCI) to Predict Outcome after Inpatient Detoxification during 100 Days of Outpatient Treatment
Alcohol and Alcoholism Advance Access published online on June 10, 2008

The aim was to evaluate TCI (Temperament and Character Inventory) scales in identifying personality traits for predicting adherence to outpatient treatments and the relapse of alcohol consumption by alcoholic patients.

Of the patients, 34.8% abandoned the treatment and 31.5% relapsed. The patients who abandoned treatment had lower scores on the Cooperativeness scale. The length of time until the abandonment of the treatment was greater for those with scores >50 for the Self-directedness or Cooperativeness scales. Patients with scores >50 on the Persistence scale were more often abstinent; however, they took the same time to relapse.

Higher scores on the TCI personality scales of Persistence, Self-directedness and Cooperativeness predict a better therapeutic evolution, especially with regard to adherence during outpatient treatment after detoxification.

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Request Reprint E-Mail: mmonras@clinic.ub.es

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