NATIONAL ADVISORY COUNCIL ON ALCOHOL ABUSE AND ALCOHOLISM

Summary of the 117th Meeting

February 6-7, 2008

The National Advisory Council on Alcohol Abuse and Alcoholism convened for its 117th meeting at 5:30 p.m. on February 6, 2008, at the Fishers Lane Conference Center in Rockville, Maryland, in a closed session, and again at 8:15 a.m. on February 7, also in closed session. The Council convened in open session at 9:00 a.m. on February 7. Dr. Tina Vanderveen presided over the closed review of grant applications on February 6. Dr. Ting-Kai Li, Director of the National Institute on Alcohol Abuse and Alcoholism, presided over the closed session on February 6; the closed session on February 7, at which the Board of Scientific Counselors’ June 2007 Report was presented; and the open session the same day.

Call to Order of the Open Session and Introductions, February 7, 2008

• NIH Peer Review

• Director’s Report/Special Announcements

• Extramural Advisory Board Report on Health Services Research

• Update on College Drinking Research

• Council Member Round Table
  

• Ex-Officio Member Report and Comment

Read Full Minutes

_____________________________________________________________________________________________

Working with Patients with Alcohol Problems: A Controlled Trial of the Impact of a Rich Media Web Module on Medical Student Performance
Journal of General Internal Medicine Volume 23, Number 7 / July, 2008

We designed an interactive web module to improve medical student competence in screening and interventions for hazardous drinking. We assessed its impact on performance with a standardized patient (SP) vs. traditional lecture.

First year medical students conveniently assigned to voluntarily complete a web module (N = 82) or lecture (N = 81) were rated by a SP in a later alcohol case. Participation trended higher (82% vs. 72%, p < .07) among web students, with an additional 4 lecture-assigned students crossing to the web module. The web group had higher mean scores on scales of individual components of brief intervention (assessment and decisional balance) and a brief intervention composite score (1–13 pt.; 9 vs. 7.8, p < .02) and self-reported as better prepared for the SP case.

A web module for alcohol use interview skills reached a greater proportion of voluntary learners and was associated with equivalent overall performance scores and higher brief intervention skills scores on a standardized patient encounter.

Read Full Abstract

Request Reprint E-Mail: joshua.lee@med.nyu.edu
________________________________________________________________

Cross-Cultural Patterns in College Student Drinking and its Consequences—A Comparison between the USA and Sweden
Alcohol and Alcoholism Advance Access published online on July 1, 2008



The aim of the study was to compare alcohol use, consequences and common risk factors between American and Swedish college students.

Swedish freshmen report higher alcohol use than US freshmen students. Swedish residence hall students report higher alcohol use than US residence hall students, but lower than American fraternity/sorority members. US students were less likely to be drinkers. Controlling for age, country moderated the relationship between family history and harmful drinking scores for women (stronger in the USA), and between expectancies and harmful drinking scores for men (stronger in Sweden), though in both cases this represented a small effect and patterns were similar overall.

Swedish students are at higher risk for alcohol use than US students, but similar patterns between aetiological predictors and outcomes in both countries suggest that research from the USA is generalizable to Swedish students and vice versa. More research is needed to better understand unique relationships associated with age and family history.

Read Full Abstract

Request Reprint E-Mail: henrietta.stahlbrandt@med.lu.se
______________________________________________________________

Successful Implementation of an Alcohol-Withdrawal Pathway in a General Hospital
Psychosomatics 49:292-299, July 2008


Although alcohol use and abuse are common among general-hospital inpatients, many patients are inadequately assessed and treated for alcohol withdrawal.

The purpose of this study was to determine whether the implementation of a clinical pathway for the treatment of alcohol withdrawal in medical inpatients would result in improvements in clinical practice and patient outcomes.

Assessment procedures and ordering patterns of physicians (medical house staff and staff physicians) shifted in a fashion consistent with the new treatment guidelines. Patient outcomes (e.g., length of stay and the incidence of delirium) improved for those patients who received benzodiazepines within the range of the pathway guidelines.

Timely assessment and staff education can shift prescription patterns, increase patient monitoring, and reduce costs associated with alcohol withdrawal.

Read Full Abstract

Request Reprint E-Mail: jrepperdelisi@partners.org
_________________________________________________________________

Swimming with Crocodiles: The Culture of Extreme Drinking




Swimming with Crocodiles examines the apparent increase in heavy drinking behavior by some young people in a number of countries, positioning it within its appropriate social, historical, and cultural contexts. The book argues in favor of a new term—“extreme drinking”—to fully encapsulate the many facets of this behavior, taking into account the underlying motivations for the heavy, excessive, and unrestrained drinking patterns among young people. The centerpiece of the book is a series of focus groups conducted with young people of legal drinking age in Brazil, China, Italy, Nigeria, Russia, South Africa, and the United Kingdom, which examine their views on extreme drinking, motivations behind it, and the cultural similarities and differences that exist, conferring at once risk and protective factors. The authors explore the developmental, cultural, and historical contexts that have surrounded this behavior, and offer a new approach to addressing it through prevention and policy. Swimming with Crocodiles: The Culture of Extreme Drinking is the ninth volume in the ICAP Book Series on Alcohol in Society.

Table of Contents:

Chapter 1: Extreme drinking (by Marjana Martinic and Fiona Measham)

Chapter 2: A history of intoxication: Changing attitudes to drunkenness and excess in the United Kingdom (by Fiona Measham)

Chapter 3: Beyond boundaries: Youth and the dream of the extreme (by Véronique Nahoum-Grappe, featuring Case Study: Young People’s Drinking in France by Marie Choquet)

Chapter 4: What motivates extreme drinking? (by Barbara Leigh and Christine Lee, featuring CASE STUDY: Drinking among young people in the United Kingdom by Fiona Measham)

Chapter 5: Focus Group Results (Brazil by Mônica Gorgulho and Vera Da Ros; CHINA by Ian Newman; ITALY by Enrico Tempesta; Nigeria by Olabisi Odejide, Olayinka Omigbodun, Ademola Ajuwon, Victor Makanjuola, Afolabi Bamgboye, and Frederick Oshiname; Russia by Eugenia A. Koshkina; South Africa by Chan Makan; Scotland, UK by Stephen March)

Chapter 6: Stakeholders and their roles (by Mark Leverton and Keith Evans)

Chapter 7: Extreme drinking, young people, and feasible policy (by Marjana Martinic and Barton Alexander, featuring Case Study: Botellón in Spain by Andrés Bascones Pérez-Fragero)

Chapter 8: Tackling extreme drinking in young people: Feasible interventions (by Mônica Gorgulho and Daniya Tamendarova, featuring Case Study: United States: Drinking among sorority and fraternity students by Jason Kilmer and Mary Larimer)

Afterword (by Marjana Martinic and Fiona Measham)

Annex 1: Procedures for focus groups on extreme drinking

Annex 2: Guiding questions for focus groups

Synopsis (in English, French, German, Italian, Mandarin,

Portuguese, Russian, Spanish)
_____________________________________________________________________________________________

Effects of CRF₁-Receptor and Opioid-Receptor Antagonists on Dependence-Induced Increases in Alcohol Drinking by Alcohol-Preferring (P) Rats
Alcoholism: Clinical and Experimental Research Published Online: 10 Jul 2008

Selective breeding of rats over generations and induction of alcohol dependence via chronic vapor inhalation both enhance alcohol consumption in animal models.

The purpose of this study was to determine whether dependence-induced increases in alcohol consumption by P rats is sensitive to naltrexone, a general opioid receptor antagonist (but with highest affinity at the μ-opioid receptor at low doses), and the recently characterized small molecule CRF₁-receptor antagonist MPZP (N,N-bis(2-methoxyethyl)-3-(4-methoxy-2-methylphenyl)-2,5-dimethyl-pyrazolo[1,5-a]pyrimidin-7-amine).

MPZP attenuated dependence-induced increases in alcohol intake by P rats while having no effect on alcohol consumption by nondependent controls. Conversely, operant alcohol responding was reduced similarly in dependent and nondependent P rats by naltrexone.

These results confirm a role for brain CRF₁-receptor systems in dependence-induced changes in the reinforcing properties of alcohol, and CRF₁-receptor blockade appears to suppress dependence-induced drinking at lower doses in P rats relative to other rat lines. Therefore, brain CRF₁-receptor systems are important in the regulation of dependence-induced alcohol consumption, whereas brain opioid systems are important in the regulation of basal alcohol consumption by rats.

Read Full Abstract

Request Reprint E-Mail: nickg@scripps.edu

_____________________________________________________________

Treatment-naive active alcoholics have greater psychiatric comorbidity than normal controls but less than treated abstinent alcoholics
Drug and Alcohol Dependence Article in Press 11 July 2008

Most alcoholism research in the U.S. uses convenience samples of treated alcoholics. The findings from treated samples have traditionally been applied to all alcoholics, including the 75% of alcoholics who are untreated. Improper generalization from select samples to an entire population is called ‘Berkson's fallacy’.

We compared untreated versus treated alcoholics, in order to ascertain whether both groups belonged to the same population with regard to psychiatric comorbidity.

We compared psychiatric comorbidity in 1)active treatment-naive alcoholics (TNA; n = 86) 2) treated long-term abstinent alcoholics (TAA; n = 52) and 3) non-alcoholic controls (NAC; n = 118) We examined lifetime and current diagnoses, lifetime symptom counts, and psychological measures in the anxiety, mood and externalizing disorder domains.

TNA did not differ from NAC in psychiatric diagnosis rates, were abnormal compared to NAC on all psychological measures, had more externalizing symptoms than NAC, and showed a strong trend for men to have more symptoms in the mood and anxiety domains. TAA compared to TNA had higher diagnosis rates (all domains), symptom counts (all domains), and psychological measures of deviance proneness, but were comparable to TNA on anxiety and mood psychological measures.

The abnormal thinking (psychological measures) in TNA (versus NAC) does not extend to behavior (symptoms) to the degree that it does in TAA.

These results underline the importance of the use of subdiagnostic measures of psychiatric comorbidity in studies of alcoholics. The finding of lesser comorbidity in TNA versus TAA confirms the presence of Berkson's fallacy in generalizing from treated samples to all alcoholics.

Read Full Abstract

Request Reprint E-Mail: victoria@nbresearch.com

___________________________________________________________________

The prognostic implications of DSM-IV abuse criteria in drinking adolescents
Drug and Alcohol Dependence Volume 97, Issues 1-2, 1 September 2008, Pages 94-104

The validity of the DSM-IV diagnostic criteria for alcohol abuse has been questioned, and additional issues have been raised regarding the performance of this label in adolescents. While future diagnostic manuals might alter the approach to abuse, it is worthwhile to evaluate the implications of the current definition that has been in place since 1994.

Six hundred and sixteen 12–19-year-old subjects (mean 16.5 years) were offspring identified in the Collaborative Study on the Genetics of Alcoholism (COGA) protocol who had ever consumed a full drink and who were followed up 5 years later using age-appropriate semi-structured interviews. Following the guidelines for evaluating the utility of the diagnostic labels of Robins and Guze [Robins, E., Guze, S.B., 1970. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am. J. Psychiat. 126, 983–987], the subjects with alcohol abuse were compared with other groups regarding clinical validators and clinical course.

At initial interview, the pattern of most alcohol use and problem variables were least severe for teenagers with no diagnosis, intermediate for those with abuse, and the highest for individuals with alcohol dependence. At follow-up, 50% of those with initial abuse maintained that diagnosis, 19% developed dependence, and 31% had no DSM-IV diagnosis. Baseline alcohol abuse predicted follow-up diagnosis even when evaluated along with initial demographic and substance use characteristics.

These results support some assets for the DSM-IV alcohol abuse criteria in these adolescents, including indications of both cross-sectional and predictive validities. Additional studies will need to compare the current abuse label with other possible approaches.

Read Full Abstract

Request Reprint E-Mail: mschuckit@ucsd.edu

_______________________________________________________________

Alcoholic Anony-mouse
Behind the headlines
Your guide to the science that makes the news

Thursday July 10 2008

“Carry on boozing!” is the headline in the Daily Star today. This and other newspapers describe a piece of animal research which suggests quitting even moderate levels of booze could be bad for your mental health. “It’s the news we’ve all been waiting for”, the Daily Express says.

The basis for this somewhat surprising conclusion is also described by the newspaper. Mice were tested for depression-like behaviour using the Porsolt Swim Test, in which they were placed inside a beaker filled with water and allowed to swim for six minutes. Mice usually manage this easily, however some stop swimming, and the longer a mouse spends floating, the more “depressed” it is thought to be.

The relevance of this research to humans is not yet clear, and in view of the significant harms that alcohol can do to the lives of individuals and to society, a more cautious and serious interpretation of this animal study is advisable.

. . . . . .

Read Full Article

___________________________________________________________

Structure of Daidzin, a Naturally Occurring Anti-Alcohol-Addiction Agent, in Complex with Human Mitochondrial Aldehyde Dehydrogenase
J. Med. Chem., ASAP Article, Web Release Date: July 10, 2008


The ALDH2*2 gene encoding the inactive variant form of mitochondrial aldehyde dehydrogenase (ALDH2) protects nearly all carriers of this gene from alcoholism. Inhibition of ALDH2 has hence become a possible strategy to treat alcoholism.

The natural product 7-O-glucosyl-4′-hydroxyisoflavone (daidzin), isolated from the kudzu vine (Peruraria lobata), is a specific inhibitor of ALDH2 and suppresses ethanol consumption. Daidzin is the active principle in a herbal remedy for “alcohol addiction” and provides a lead for the design of improved ALDH2.

The structure of daidzin/ALDH2 in complex at 2.4 Å resolution shows the isoflavone moiety of daidzin binding close to the aldehyde substrate-binding site in a hydrophobic cleft and the glucosyl function binding to a hydrophobic patch immediately outside the isoflavone-binding pocket.

These observations provide an explanation for both the specificity and affinity of daidzin (IC₅₀ = 80 nM) and the affinity of analogues with different substituents at the glucosyl position.

Read Full Abstract

Request Reprint E-Mail: edward.lowe@biop.ox.ac.uk
____________________________________________________________
_____________________________________________________________

Association of single nucleotide polymorphisms in a glutamate receptor gene (GRM8) with theta power of event-related oscillations and alcohol dependence
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published Online 10 July 2008

Evidence suggests the P3 amplitude of the event-related potential and its underlying superimposed event-related oscillations (EROs), primarily in the theta (4-5 Hz) and delta (1-3 Hz) frequencies, as endophenotypes for the risk of alcoholism and other disinhibitory disorders. Major neurochemical substrates contributing to theta and delta rhythms and P3 involve strong GABAergic, cholinergic and glutamatergic system interactions. The aim of this study was to test the potential associations between single nucleotide polymorphisms (SNPs) in glutamate receptor genes and ERO quantitative traits. GRM8 was selected because it maps at chromosome 7q31.3-q32.1 under the peak region where we previously identified significant linkage (peak LOD = 3.5) using a genome-wide linkage scan of the same phenotype (event-related theta band for the target visual stimuli). Neural activities recorded from scalp electrodes during a visual oddball task in which rare target elicited P3s were analyzed in a subset of the Collaborative Study on the Genetics of Alcoholism (COGA) sample comprising 1,049 Caucasian subjects from 209 families (with 472 DSM-IV alcohol dependent individuals). The family-based association test (FBAT) detected significant association (P <>GRM8 gene and event-related theta power to target visual stimuli, and also with alcohol dependence, even after correction for multiple comparisons by false discovery rate (FDR). Our results suggest that variation in GRM8 may be involved in modulating event-related theta oscillations during information processing and also in vulnerability to alcoholism. These findings underscore the utility of electrophysiology and the endophenotype approach in the genetic study of psychiatric disorders. Read Full Abstract Request Reprint E-Mail: bernice.porjesz@downstate.edu ___________________________________________________________________

Testing the level of response to alcohol-based model of heavy drinking and alcohol problems in offspring from the san diego prospective study.
J Stud Alcohol Drugs. 2008 Jul; 69(4):571-9



The low level of response (LR) to alcohol, an endophenotype related to heavy drinking and alcohol problems, influences the risk for alcoholism in the context of additional life domains.

This article evaluates an LR-based model of drinking patterns in 113 drinking offspring, ages 12 to 24 years, from the San Diego Prospective Study.

Correlations and structural equation models (SEMs) were evaluated using LR as measured from the Self-Report of the Effects of Alcohol questionnaire in the offspring. The expectations of the effects of alcohol (EXPECT), the perception of drinking in peers (PEER), the use of alcohol to cope with stress (COPE), and the drinking quantities and alcohol-related problems (ALCOUT) were evaluated in the SEM.

The LR-based model worked well, with good fit characteristics and 78% of the variance of outcome explained. LR related directly to ALCOUT, with additional mediation of that relationship through EXPECT and COPE.

The LR-based model performed well in adolescents from the San Diego Prospective Study. Knowledge of which domains mediate how LR impacts alcohol-related outcomes may be useful in developing more focused and potentially more effective prevention approaches.

Read Full Abstract


Request Reprint E-Mail: mschuckit@ucsd.edu
__________________________________________________________________

DEATHS OF PERSONS AGED 13 to 25 YEARS IN AUSTRALIA (EXCLUDING QLD & SA) WHICH INVOLVED ALCOHOL


The National Coroners’ Information System (NCIS) was used to identify deaths reported to a coroner of those aged 13 to 25 years of age where alcohol was involved in the death. For the purposes of this report, alcohol was considered to have been involved in a death where the deceased’s alcohol level was detected at equal to or greater than 0.05g/100ml.

Data reported to a coroner between 2003 and 2006 inclusive were examined.
. . . . . .
Read Full Report (PDF)
_______________________________________________________________

Lapses following Alcohol Treatment: Modeling the Falls From the Wagon.
J Stud Alcohol Drugs. 2008 Jul;69(4):594-604



This study investigated transitions between drinking and nondrinking during the first 12 months following treatment and whether transitions in posttreatment drinking are related to alcohol-dependence symptoms.

Across both aftercare and outpatient samples, three drinking classes were identified at each time point: frequent heavy drinking with high consequences, moderate infrequent drinking with low consequences, and nondrinking with low consequences. Many participants maintained nondrinking, and, of those who drank, there was a trend toward transitioning to less drinking over time. Transition probabilities were noninvariant across treatment arms: The probability of transitioning from moderate drinking to frequent drinking was more than six times more likely in the aftercare arm, as compared with the outpatient arm. In both samples the transition to heavy drinking and membership in the heavy-drinking class were significantly positively related to alcohol dependence symptoms. There were no differences across MATCH treatment groups.

This study examined transitions in post treatment drinking and the role of alcohol dependence in predicting posttreatment drinking. The results suggest a low probability of moderate drinking among individuals with greater alcohol dependence.


Read Full Abstract


Request Reprint E-Mail: kate19@u.washington.edu
_________________________________________________________________

Sex Differences in the Heritability of Alcohol Problems
American Journal on Addictions, Volume 17, Issue 4 July 2008 , pages 319 - 327


Genetic factors may have a role in defining more coherent clinical phenotypes and subtypes in the DSM-V. Research has demonstrated that there are gender differences in the patterns of alcohol consumption, specific symptom endorsement, withdrawal effects, and rates of alcohol use disorders (AUD).

We examined the sex-specific heritability of diagnostic symptoms for alcohol-related problems in a community-based sample of twin pairs (males: n = 519; females: n = 613) using a biometrical analytic strategy to estimate the genetic and environmental components of AUD symptoms.

Five of the seven symptoms of alcohol problems demonstrated sex-differences in heritability. Three of the seven symptoms examined had significant heritability in female twins only: “increased risk of injury or harm,” “emotional problems related to drinking,” and “the desire to drink.” In males, a different pattern was observed, with four of the seven examined symptoms demonstrating heritability: “Increased chance of injury or harm,” “spending more time using alcohol or getting over its effects,” “using larger amounts for longer periods of time than intended,” and “the need to use more alcohol to get the same effect.”

These data suggest that alcohol problems in females and males may be etiologically distinct, and that diagnostic criteria and therapeutics might be enhanced if these sex differences were taken into consideration.

Read Full Abstract

Request Reprint E-Mail: thardie@udel.edu
___________________________________________________________________

Harm reduction among at-risk elderly drinkers: a site-specific analysis from the multi-site Primary Care Research in Substance Abuse and Mental Health for Elderly (PRISM-E) study
International Journal of Geriatric Psychiatry Published Online: 9 Jul 2008

To assess the efficacy of a harm-reduction based intervention to enhance access to treatment and clinical outcomes among elderly at-risk drinkers. At-risk drinkers in the integrated care condition were more likely to access treatment than at-risk drinkers assigned to the enhanced referral condition (93% vs 35%; 2 = 11.38, df = 1, p = 0.001). Among those who received treatment, there were no differences in the total amount of treatment visits or in the number of brief alcohol interventions received among at-risk drinkers in the two conditions. However, those in integrated care condition received services sooner than those in the referral condition. Those in the integrated care condition showed a significant decrease in the number of drinks in the past week and in the number of binge drinking episodes in the past 3 months while there were no significant changes in these outcomes among the at-risk drinkers in the enhanced referral condition. At-risk drinkers in the integrated care condition were more likely to access treatment and decrease harmful drinking behaviors than those in the enhanced referral condition. Implications for future research and treatment are discussed. Read Full Abstract Request Reprint E-Mail: hlee@lppi.ucsf.edu _______________________________________________________________

Alcohol Consumption and Mortality From Stroke and Coronary Heart Disease Among Japanese Men and Women. The Japan Collaborative Cohort Study
Stroke. 2008 Published online before print July 10, 2008


Previous studies have demonstrated the association between alcohol consumption and cardiovascular mortality. However, the sex-specific association between alcohol consumption and mortality from stroke and coronary heart disease remains unclear.

Between 1988 and 1990, 34 776 men and 48 906 women aged 40 to 79 years completed a self-administered questionnaire including information about alcohol consumption. They were followed-up for a median duration of 14.2 years.

Of the 83 682 respondents, 1628 died from stroke and 736 died from coronary heart disease. For men, heavy drinking (46.0 g ethanol/day) was associated with increased mortality from total, hemorrhagic, and ischemic strokes, whereas light-to-moderate drinking was associated with reduced mortality from total cardiovascular disease, compared with not drinking. The respective multivariable hazard ratios (95% CI) were 1.48 (1.22 to 1.80) for total stoke, 1.67 (1.17 to 2.38) for hemorrhagic stroke, 1.35 (1.04 to 1.75) for ischemic stroke, and 0.88 (0.78 to 1.00) for total cardiovascular disease. Women who were heavy drinkers (46.0 g ethanol/day) showed increased mortality from coronary heart disease, and there was reduced mortality from total cardiovascular disease for drinkers of 0.1 to 22.9 g ethanol per day compared with mortality for nondrinkers. The respective multivariable hazard ratios (95% CI) for the 2 categories of drinkers were 4.10 (1.63 to 10.3) and 0.75 (0.62 to 0.91).

Heavy alcohol consumption is associated with increased mortality from total stroke, particularly hemorrhagic stroke, and total cardiovascular disease for men, and from coronary heart disease for women, whereas light-to-moderate drinking may be associated with reduced mortality from cardiovascular disease for both sexes.

Read Full Abstract

Request Reprint E-Mail: iso@pbhel.med.osaka-u.ac.jp

______________________________________________________________

Epidemiology for Researchers Performing Genetic/Genomic Studies

Air date:	Friday, July 18, 2008, 8:00:00 AM

This is a short course targeted at investigators and trainees doing research in human genetics, particularly studies employing genomic analyses of samples from human population. It aims to familiarize researchers studying the human genome with basic principles and potential pitfalls of epidemiology as applied to human genome research. It will draw from traditional genetic epidemiology and statistical genetics, but will emphasize the application of genomic technologies to unrelated subjects in human populations. Focus will be on the design, conduct, analysis, and interpretation of the epidemiologic studies most feasible and appropriate to address the genomic questions of interest.


More Information

You will be able to view the event at http://videocast.nih.gov when the event is live.

________________________________________________________

Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study
Alcoholism: Clinical and Experimental Research Published Online: 9 Jul 2008

Within the alcoholism field, there is mounting evidence supporting an important relationship between medication adherence and drinking outcomes. Little is known however, about the complex relationships between medication and treatment variables and drinking outcomes.

The present paper reports on the differential impact of medication adherence and treatment factors on drinking outcomes. Data derived from the COMBINE Study was used to investigate the interrelationships between medication adherence, combination treatments and drinking outcomes.

Concerning time to first heavy drinking day, a significant three-way interaction was found between medication adherence, CBI and naltrexone (p = 0.0160). Within the MM only plus placebo group (no CBI), significant differences were found in "recovery" (i.e., no heavy drinking days) rates between adherers and nonadherers (40% vs. 10%, p < class="i">p = 0.12) when CBI was introduced into the relationship. CBI did not add any such advantage to naltrexone-treated patients.

CBI might serve a protective function for nonadherers in the placebo group; the median relapse time was reduced when these nonadherers were exposed to the alcohol specialty intervention. CBI offered little additional benefit to nonadherers in the naltrexone group. Among nonadherers in the naltrexone group, relapse rates appear to be more a function of inadequate exposure to the active medication and less influenced by CBI.

Read Full Abstract

Request Reprint E-Mail: az173@columbia.edu

____________________________________________________________________

The Role of Behavioral Impulsivity in the Development of Alcohol Dependence: A 4-Year Follow-Up Study
Alcoholism: Clinical and Experimental Research Published Online: 9 Jul 2008

Although many studies have established a close relation between impulsivity and alcohol use disorders, little is known about the role of behavioral impulsivity in the development of these disorders.

To determine the role of 2 laboratory paradigms of impulsivity in the development of alcohol use disorders.

Follow-up study carried out with 471 participants diagnosed as heavy drinkers (HD) and followed-up for 4 years. Initially, they were compared with a healthy control group. Assessment of behavioral impulsivity was carried out with the Continuous Performance Test (CPT), and the Stop-Signal Task (SST) assessed behavioral inhibitory control. Differential reinforcement for low-rate responding (DRLR) was used to evaluate the delay reward dimension. The Structured Clinical Interview (SCID-DSM-IV) was used to diagnose alcohol dependence.

The HD performed worse than the control group in all the behavioral tests of impulsivity. Performance in DRLR was the only behavioral impulsivity test that classified the HD correctly compared to controls. Logistic regression analysis indicated that performance on SST was a significant predictor [odds = 1.52(CI = 1.08–2.31)] of developing alcohol dependence.

Our results support the relation between behavioral impulsivity and alcohol use disorders. The paradigm related to delay of reward may be a factor associated with the use of alcohol and the incapacity to control inhibition as dependence develops.

Read Full Abstract

Request Reprint E-Mail: garuva@inicia.es

_________________________________________________________________

News Release - Action on alcohol

09/07/2008

The Scottish Government's consultation on tackling the country's problem with alcohol misuse is attracting international interest.

Justice Secretary Kenny MacAskill today met with his counterpart from New Zealand, Lianne Dalziel, to bring her up to speed with the proposals, including minimum pricing, banning irresponsible promotions and introducing a social responsibility fee.
. . . . . .

Read Full Release
_____________________________________________________________

Are Social Norms the Best Predictor of Outcomes Among Heavy-Drinking College Students?

J Stud Alcohol Drugs. 2007 July; 68(4): 556–565.



This research was designed to evaluate the relative contribution of social norms, demographics, drinking motives, and alcohol expectancies in predicting alcohol consumption and related problems among heavy-drinking college students.

Regression results indicated that descriptive and injunctive norms were among the best predictors of college student drinking. With respect to alcohol problems, results indicated that coping motives accounted for the largest proportion of unique variance. Finally, results revealed that alcohol consumption mediated the relationships between predictors and problems for social norms, whereas coping motives, negative expectancies, and evaluation of negative effects were directly associated with alcohol problems despite having relatively weak or null unique associations with consumption.

The results of this study substantiate social norms as being among the best predictors of alcohol consumption in this population and suggest that drinking to cope is a better predictor of problems. The findings are discussed in terms of practical prevention and treatment implications.

Read Full Article (PDF)
________________________________________________________________

Hazardous Drinking: Prevalence and Associations in the Finnish General Population
Alcoholism: Clinical and Experimental Research Published Online: 8 Jul 2008

Hazardous drinking, defined as consuming alcohol on a risky level and not meeting the diagnostic criteria of alcohol use disorders (AUDs), has been suggested for a new complementary nondependence diagnosis. This study aimed to investigate the prevalence and associations of hazardous drinking in comparison to AUDs, moderate drinking, and abstinence.

A national representative sample of Finns was examined in the Health 2000 Survey. For 4477 subjects aged 30 to 64 years (76%, 2341 females), both the quantity frequency data about alcohol consumption and Composite International Diagnostic Interview (CIDI) data concerning AUD diagnoses were available. The nationally recommended limits for hazardous drinking were used (males: 24 drinks, females: 16 drinks/wk). Logistic regression models were used to analyze associations.

The prevalence of hazardous drinking was 5.8%. Hazardous drinking was more prevalent among males than females (8.5% vs. 3.1%). It was most prevalent among the subjects aged 40 to 49 years (7.3%), divorced or separated (8.3%), unemployed (8.2%) and subjects living in the southern (Helsinki) region (7.5%). AUDs versus hazardous drinking were more likely to be in males versus females and in the unemployed versus employed. Subjects aged 40 and over had higher odds for hazardous drinking versus AUDs. The odds for hazardous versus moderate drinking were higher for males versus females (adjusted odds ratio = 3.24), for subjects aged over 40 years, unemployed versus employed and cohabiting, divorced/separated or unmarried subjects versus married subjects.

The high prevalence of hazardous drinking makes it an important public health concern. Hazardous drinkers have different sociodemographic characteristics as compared to people in other alcohol use categories.

Read Full Abstract

Request Reprint E-Mail: mauri.aalto@ktl.fi

___________________________________________________________

The Integration of Genetic Propensities into Social-Control Models of Delinquency and Violence among Male Youths
American Sociological Review, Volume 73, Number 4, August 2008 , pp. 543-568(26)


This study, drawing on approximately 1,100 males from the National Longitudinal Study of Adolescent Health, demonstrates the importance of genetics, and genetic-environmental interactions, for understanding adolescent delinquency and violence.

Our analyses show that three genetic polymorphisms—specifically, the 30-bp promoter-region variable number tandem repeat (VNTR) in MAOA, the 40-bp VNTR in DAT1, and the Taq1 polymorphism in DRD2—are significant predictors of serious and violent delinquency when added to a social-control model of delinquency.

Importantly, findings also show that the genetic effects of DRD2 and MAOA are conditional and interact with family processes, school processes, and friendship networks.

These results, which are among the first that link molecular genetic variants to delinquency, significantly expand our understanding of delinquent and violent behavior, and they highlight the need to simultaneously consider their social and genetic origins.

Read Full Abstract

Request Reprint E-Mail: guang_guo@unc.edu

The U.S. Military as a Natural Experiment - Changes in Drinking Age, Military Environment, and Later Alcohol Treatment Episodes among Veterans
Military Medicine, Volume 173, Number 7, July 2008 , pp. 619-625(7)


Before 1982, soldiers consumed alcohol legally on U.S. bases, regardless of age. By 1988, the military established policies to discourage underage and problem drinking and, along with the civilian population, fully transitioned to a 21-year minimum legal drinking age.

We explored whether these changes were associated with changes in later alcohol treatment episodes among male veterans and civilians from years 1992 to 2003. Treatment rates for veterans and civilians were calculated using administrative databases for four age cohorts.

Alcohol treatment rates were similar and odds ratios were ≥1.0 for veterans compared with same-aged civilians in 1992; however, by 2003, veterans' treatment rates fell by 60% for ages 25 to 34 compared with a 20 to 25% reduction for civilians, and odds ratios fell to between 0.80 and 0.60 those of civilians.

The military's concerted efforts to enforce the 21-year minimum legal drinking age were associated with greater reductions in later alcohol treatment episodes among veterans compared with civilians.

Read Full Abstract

Request Reprint E-Mail: wbw@dartmouth.edu
________________________________________________________________

New report links homelessness to early relationships

Wednesday, July 09, 2008

The Salvation Army in the UK has produced its fourth report , The Seeds of Exclusion, that works to understand the indicators in early life which can lead to future problems of social exclusion, including mental health, addictions and relationship breakdown. The report aims to understand the nature, complexity and severity of problems for those suffering from social exclusion. Findings show early relationships to be at the heart these issues.

. . . . . .

Read Full Article

________________________________________________________________

Diffusion Tensor Tractography in Mesencephalic Bundles: Relation to Mental Flexibility in Detoxified Alcohol-Dependent Subjects
Neuropsychopharmacology advance online publication 9 July 2008;

Components of the corticocerebellar circuit and the midbrain individually play a central role in addictive processes and have been associated with altered volumes and impairment of cognitive flexibility in alcohol-dependent subjects.

The microstructure of white matter bundles composing the corticocerebellar network and passing through the midbrain was studied using diffusion tensor imaging in a group of detoxified alcohol-dependent men (n=20) and a group of healthy men (n=24).

The relationship between properties of these white matter bundles and cognitive flexibility performance was investigated in alcohol-dependent subjects. Bundles connecting two regions of interest were analyzed using a fiber-tracking quantitative approach, which provided estimates of the fractional anisotropy and the apparent diffusion coefficient, as well as the number of tracked fibers normalized by the volume of regions of interest. Within the bundles running between the midbrain and pons, a mean of 18% fewer fibers per unit volume were tracked in alcohol-dependent men than in healthy controls. In addition, the normalized number of these fibers correlated with the performance in the Trail-Making Test part-B.

Even though the alcohol-dependent subjects were detoxified and apparently neurologically intact, their earlier excessive use of alcohol seems to be associated with altered neural microstructure of mesencephalic white matter bundles, which may contribute to their cognitive flexibility impairment.

Read Full Abstract

Request Reprint E-Mail: jean-luc.martinot@cea.fr

________________________________________________________________

Pathways to Change: The Effect of a Web Application on Treatment Interest
American Journal on Addictions, Volume 17, Issue 4 July 2008 , pages 265 - 270


Most individuals with drinking problems do not receive treatment, generally because they do not perceive the need for it. It is difficult to access this population of problem drinkers in order to encourage treatment-seeking.

A Web-based program was written, designed to increase motivation for change. The program guided non-treatment-seekers through a multi-stage assessment and provided them with feedback. The level of interest in treatment was measured pre-and post-intervention.

Compared to baseline, after the intervention, significantly more individuals rated themselves “very interested” in participating in some form of traditional treatment (19% vs. 28%), and their focus on a specific modality increased.

Read Full Abstract


Request Reprint E-Mail: dlieber-man@mfa.gwu.edu
_______________________________________________________________

Effects of Naltrexone During the Descending Limb of the Blood Alcohol Curve
American Journal on Addictions, Volume 17, Issue 4 July 2008 , pages 257 - 264



The neuropharmacological effects of alcohol are known to vary by limb of the blood alcohol curve, yet human laboratory studies of alcoholism pharmacotherapies have largely failed to consider limb of intoxication when examining medication effects on subjective responses to alcohol.

This study examined the effects of naltrexone compared to placebo on subjective responses to alcohol at the descending limb of the blood alcohol curve following a controlled intravenous (IV) alcohol administration. Non-treatment-seeking hazardous drinkers (n = 38) completed two double-blind counterbalanced IV alcohol challenge sessions, one after taking naltrexone (50 mg) for three days and one after taking a placebo for three days. During each session, participants reported on subjective responses to alcohol during the descending limb of the blood alcohol curve.

Analyses revealed significant main effects of naltrexone, reflecting significantly decreased alcohol-induced stimulation, craving, vigor, positive mood, and alcohol “high” and increased tension as compared to placebo.

These findings suggest that naltrexone may exert some of its therapeutic effects via alterations to experiential aspects of intoxication during the descending limb of alcohol intoxication.

Additionally, these results highlight the potential utility of considering limb of blood alcohol curve when examining the mechanisms of action of pharmacotherapies thought to alter subjective responses to alcohol.

Read Full Abstract

Request Reprint E-Mail: lara@psych.colorado.edu
_______________________________________________________________

Association of Recovery Schools




The 7th Annual Conference of the Association of Recovery Schools will be hosted by Vanderbilt University, in Nashville, Tennessee, July 25-27, 2008. The theme for this year's conference is "Joining Our Voices". The conference will begin at 1pm Friday afternoon.


Conference Home Page
______________________________________________________________

The Government and alcohol watchdog that can’t handle its super-strength drink

8 July: 2008:

Homelessness charity Thames Reach has slammed both the Government and the Portman Group for letting the drinks industry off the hook over the availability of dangerous nine per cent super-strength beers.

This follows the Portman Group’s Complaints Panel decision to reject a complaint from Thames Reach, concerning the production of super-strength lager containing four and a half units of alcohol in 500ml cans.

. . . . . . .

Read Full Article

______________________________________________________________

Public consultation on proposed revision to ISD's list of ICD10 codes used for reporting alcohol-related hospital discharges.


ISD generated National Statistics on alcohol-related discharges from acute and psychiatric hospitals are based on a cluster of diagnostic codes from the The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD10), a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organisation (WHO).

Alcohol-related hospital discharges are the basis of a national indicator/target: to reduce alcohol-related hospital admissions by 2011.

For the purpose of producing statistics on alcohol-related discharges ISD uses a list of ICD10 codes (for a full description of these codes see WHO) to extract records from relevant databases. This list has been undergoing an internal ISD review over the past year. Some changes to the list have been suggested, and are being assessed by a team of substance misuse professionals across Scotland. All briefing notes and background documents will be made available here for a period of 12 weeks. This is in accordance with the Public Consultation protocols described in the National Statistics Code of Practice [PDF 400KB]. All comments will be welcome.
. . . . . . .

Read Full Notice
____________________________________________________________________

Safety: Laws Reduce Drunken-Driving Deaths

By NICHOLAS BAKALAR

Published: July 8, 2008

Two federal policies meant to make it harder for young people to acquire alcohol have significantly reduced drunken-driving deaths, a new study finds.

The policies — banning purchase or possession of alcohol by people under 21 and making it illegal to use false identification to buy alcohol — have been in effect in all 50 states since at least 1988, when Congress made them a condition for federal highway money.

Reporting in the July issue of Accident Analysis and Prevention, the scientists calculate that the possession and purchase laws reduced the ratio of drinking to nondrinking drivers involved in fatal crashes by about 11 percent. Laws requiring an automatic license sanction for the use of fake IDs resulted in a 7 percent decrease.

. . . . . . .

Read Full Article

______________________________________________________________