To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, December 27, 2008

Integration of alcohol use disorders identification and management in the tuberculosis programme in Tomsk Oblast, Russia
The European Journal of Public Health Advance Access published online on December 26, 2008

Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes.

We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia.

First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care.

Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.

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Tuesday, December 23, 2008

ADD Bulletin 5/2008: Malawi and WHO

Invitation to an NGO Alliance for a Global Strategy

NGOs worldwide are now invited to join an information sharing network connected to the WHO process leading up to a Global Strategy on alcohol. More information on how your organization can be affiliated to the network can be found here.
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FORUT signs agreement with the Government of Malawi

The Government of Malawi and the Norwegian development NGO FORUT recently signed an agreement to cooperate on alcohol and drug prevention. The new Memorandum of Understanding is outlining the ambitions, intentions and motivation for the cooperation between the Government of the Republic of Malawi and FORUT. The parties have the common understanding that alcohol and drugs are obstacles to development and that it is important to develop evidence based alcohol policy and local prevention strategies to combat the harm of alcohol and drug.
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WHO Commission on Social Determinants of Health

Closing the gap in health inequities in a generation is the ambitious goal described in the report from the WHO Commission on Social Determinants on Health. The Commission calls on the WHO and all governments to lead global action on the social determinants of health with the aim of achieving health equity.
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Monday, December 22, 2008

Alcohol Primes the Airway for Increased Interleukin-13 Signaling
Alcoholism: Clinical and Experimental Research Published Online: 22 Dec 2008

Using an experimental model of airway fibrosis following lung transplantation, we recently showed that chronic alcohol ingestion by donor rats amplifies airway fibrosis in the recipient. Associated with alcohol-mediated amplification of airway fibrosis is increased transforming growth factor β-1(TGFβ1) and α-smooth muscle actin expression. Other studies have shown that interleukin-13 (IL-13) modulates TGFβ1 signaling during experimentally-induced airway fibrosis.

Therefore, we hypothesized that IL-13 is a component of alcohol-mediated amplification of pro-fibrotic mediators in the alcoholic lung.

Interleukin-13 expression was detected in type II alveolar epithelial cells and human bronchial epithelial cells, but not in lung fibroblasts. IL-13 expression was decreased in whole lung and type II cells in response to alcohol exposure. In all cell types analyzed, expression of IL-13 signaling receptor (IL-13Rα1) mRNA was markedly increased. In contrast, mRNA and protein expression of the IL-13 decoy receptor (IL-13Rα2) were decreased in all cells analyzed. Exposure to alcohol also increased STAT6 phosphorylation in response to IL-13 and lipopolysaccharide.

Data from multiple cell types in the pulmonary system suggest that IL-13 and its receptors play a role in alcohol-mediated activation of pro-fibrotic pathways. Taken together, these data suggest that alcohol primes the airway for increased IL-13 signaling and subsequent tissue remodeling upon injury such as transplantation.

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Alcohol Functionally Upregulates Toll-Like Receptor 2 in Airway Epithelial Cells
Alcoholism: Clinical and Experimental Research Published Online: 22 Dec 2008

Alcoholics are known to have more severe airway diseases of the lung, such as bronchitis. Little is known about why this phenomenon is observed. We hypothesized that alcohol may modulate Toll-like receptor 2 (TLR2), which regulates inflammation caused by gram-positive bacteria.

Alcohol, at biologically relevant concentrations (25 to 100 mM), caused a 2 to 3-fold time- and concentration-dependent increase in TLR2 mRNA in normal human bronchial epithelial cells and 16HBE 14o- cells. Western blots for TLR2 revealed a qualitative increase in TLR2 protein in cells exposed to 100 mM alcohol. FACS showed that TLR2 was quantitatively increased on the surface of airway epithelial cells that were exposed to alcohol. Airway cells that were primed with alcohol produced nearly twice as much IL-8 in response to 40 ng of peptidoglycan than naive cells.

Alcohol upregulates TLR2 message and protein in the airway epithelium. This leads to exaggerated inflammation in response to environmental stimuli that would normally be well tolerated in airway epithelial cells. This may be a partial explanation of why alcoholics have more severe airway disease than nonalcoholics.

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Characterization of White Matter Microstructure in Fetal Alcohol Spectrum Disorders
Alcoholism: Clinical and Experimental Research Published Online: 22 Dec 2008

Exposure to alcohol during gestation is associated with CNS alterations, cognitive deficits, and behavior problems. This study investigated microstructural aspects of putative white matter abnormalities following prenatal alcohol exposure.

Prenatal alcohol exposure was associated with low FA in multiple cerebral areas, including the body of the corpus callosum and white matter innervating bilateral medial frontal and occipital lobes. Fewer between-group differences in MD were observed.

These data provide an account of cerebral white matter microstructural integrity in fetal alcohol spectrum disorders and support extant literature showing that white matter is a target of alcohol teratogenesis. The white matter anomalies characterized in this study may relate to the neurobehavioral sequelae associated with gestational alcohol exposure, especially in areas of executive dysfunction and visual processing deficits.

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Associations of ADH and ALDH2 gene variation with self report alcohol reactions, consumption and dependence: an integrated analysis
Human Molecular Genetics Advance Access published online on November 7, 2008

Alcohol dependence (AD) is a complex disorder with environmental and genetic origins. The role of two genetic variants in ALDH2 and ADH1B in AD risk has been extensively investigated.
This study tested for associations between nine polymorphisms in ALDH2 and 41 in the seven ADH genes, and alcohol-related flushing, alcohol use, and dependence symptom scores in 4597 Australian twins. The vast majority (4296) had consumed alcohol in the previous year, with 547 meeting DSMIIIR criteria for AD.
There were study-wide significant associations (p<2.3x10–4) p="8.2x10–7)," p="2.7x10–6)," p="2.7x10–6)" p="8.9x10–8)">
After controlling for rs1229984, an independent association was observed between rs1042026 (ADH1B) and alcohol intake (p=4.7x10–5) and suggestive associations (p<0.001)>
These results bridge the gap between DNA sequence variation and alcohol-related behavior, confirming that the ADH1B-Arg48His polymorphism affects both alcohol-related flushing in Europeans and alcohol intake.
The absence of study-wide significant effects on alcohol dependence results from the low p-value required when testing multiple SNPs and phenotypes.
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NHS must take long term approach to tackling unhealthy lifestyles

A new report states the NHS needs to change its approach to health prevention in order to successfully impact on key health risks including alcohol misuse, obesity and smoking. 'Commissioning and behaviour change; Kicking Bad Habits', produced by the King's fund, says more work is needed to ensure NHS staff are suitably skilled to ensure people choose and maintain healthier lifestyles. A long term approach from the NHS must be delivered as the UK's unhealthy habits are deep-rooted within society and can not be addressed by short term measures. . . . . .
Editorial: Raise Wisconsin's alcohol tax to help address issue

December 22, 2008

We know that too many people in Wisconsin drive drunk. We read about repeat drunken driving offenders almost every day.

And, as The Post-Crescent revealed in its extensive State of Drinking series last summer, Wisconsinites have a litany of other alcohol-related problems that rank high among states in the nation.

We appreciate that the Wisconsin District Attorneys Association wants to raise the state's beer and liquor taxes. This is long overdue. The beer tax hasn't been raised in almost 40 years and the tax on alcohol hasn't gone up since 1981. . . . . .

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Sunday, December 21, 2008

Social anxiety disorder as a risk factor for alcohol use disorders: A prospective examination of parental and peer influences
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 128-137
Elucidation of mechanisms underlying the high rates of alcohol use disorder (AUD) remains a pressing clinical and research concern. Despite data indicating that social anxiety disorder (SAD) may be a psychological vulnerability that increases AUD risk, no known prospective research has examined underlying mechanisms. Given the nature of SAD, social support and peer alcohol use may be implicated.
The present study set out to clarify the SAD–AUD link in several ways using a prospective dataset comprised of 1803 (47% female) young adults at T1, 1431 of whom were assessed again approximately 3 years later. First, stringent criteria were used to directly test whether SAD was a risk for AUD. Second, we examined whether social support and peer alcohol use moderated the prospective SAD–AUD link. Structured diagnostic interviews were conducted to assess DSM-IV Axis I disorders, negative life events, social support, and peer alcohol use.
Among men, Time 1 (T1) SAD was not significantly related to Time 2 (T2) AUD. Yet, among women, T1 SAD was related to T2 AUD. Further, T1 SAD was the only internalizing disorder to significantly predict T2 AUD after controlling for relevant variables (e.g., T1 depression, other anxiety, alcohol and marijuana use disorders). The SAD–AUD relation demonstrated directional specificity. Family cohesion and adverse family relations significantly moderated this relation.
Findings highlight the important role of SAD and familial support in the onset of AUD among women.
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Change over time in alcohol consumption in control groups in brief intervention studies: systematic review and meta-regression study
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 107-114
Reactivity to assessment has attracted recent attention in the brief alcohol intervention literature. This systematic review sought to examine the nature of change in alcohol consumption over time in control groups in brief intervention studies.
Primary studies were identified from existing reviews published in English language, peer-reviewed journals between 1995 and 2005. Change in alcohol consumption and selected study-level characteristics for each primary study were extracted. Consumption change data were pooled in random effects models and meta-regression was used to explore predictors of change. Eleven review papers reported the results of 44 individual studies. Twenty-six of these studies provided data suitable for quantitative study.
Extreme heterogeneity was identified and the extent of observed reduction in consumption over time was greater in studies undertaken in Anglophone countries, with single gender study participants, and without special targeting by age. Heterogeneity was reduced but was still substantial in a sub-set of 15 general population studies undertaken in English language countries.
The actual content of the control group procedure itself was not predictive of reduction in drinking, nor were a range of other candidate variables including setting, the exclusion of dependent drinkers, the collection of a biological sample at follow-up, and duration of study.
Further investigations may yield novel insights into the nature of behaviour change with potential to inform brief interventions design.
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Acute effects of alcohol on inhibitory control and information processing in high and low sensation-seekers
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 91-99
Sensation-seeking is a personality characteristic that has been associated with drug abuse. Some evidence suggests that sensation-seekers might experience increased rewarding effects from drugs of abuse, possibly contributing to the association between sensation-seeking and risk for drug abuse.
The present study examined the effects of three doses of alcohol (0.0 g/kg, 0.45 g/kg, and 0.65 g/kg) on inhibitory control, information processing, and subjective ratings in a group of high sensation-seekers and a group of low sensation-seekers (N = 20). Inhibitory control was measured by a cued go/no-go task and speed of information processing was assessed by the Rapid Information Processing (RIP) task.
Alcohol impaired inhibitory control and information processing. Group differences were also observed. Compared with their low sensation-seeking counterparts, high sensation-seekers demonstrated increased sensitivity to the subjective rewarding effects of alcohol and a poorer degree of inhibitory control that was further impaired by alcohol.
The findings highlight reward- and cognitive-based mechanisms by which sensation-seeking could operate to increase risk for alcohol abuse.
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Induction of brain CYP2E1 changes the effects of ethanol on dopamine release in nucleus accumbens shell
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 83-90
CYP2E1 is an important enzyme involved in the brain metabolism of ethanol that can be induced by chronic consumption of alcohol. Recent works have highlighted the importance of this system in the context of the behavioural effects of ethanol. Unfortunately, the underlying neurochemical events for these behavioural changes, has not been yet explored.
In this work, we have started this exploration by analyzing the possible changes in the neurochemical response of the mesolimbic system to ethanol after pharmacological induction of brain CYP2E1. We have used the dopamine extracellular levels in nucleus accumbens (NAc) core and shell, measured by means of microdialysis in vivo, as an index of the effects of ethanol.
Acetone 1% in the tap water was used to induce brain CYP2E1. Efficacy of the induction protocol was assessed by immunoblotting. Intravenous administration of 1.5 g/kg of ethanol in control rats provoked a significant increase of the dopamine levels in both the core (up to 127% of baseline) and the shell (up to 122% of baseline) of the NAc. However, the same dose of ethanol in acetone-treated rats only increased the dopamine extracellular levels in the core (up to 142% of baseline) whereas dopamine levels in the shell subregion remain unaltered relative to baseline.
The results of this study indicate that induction of CYP2E1 changes the response of the mesolimbic system to ethanol in a region-dependent manner. Two hypotheses are postulated to explain the observed effects.
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The Alcohol Use Disorders Identification Test revisited: Establishing its structure using nonlinear factor analysis and identifying subgroups of respondents using latent class factor analysis
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 71-82
Previous research used principal components as well as exploratory and confirmatory factor analysis to establish continuous dimensions underlying answers to the 10-items of the Alcohol Use Disorders Identification Test (AUDIT). The majority of these studies conclude that one consumption dimension and an adverse consequences dimension explain the answers to the AUDIT sufficiently. However, most of the methods used presuppose normal answer distributions and linear relations between indicators and constructs, which are unrealistic assumptions for AUDIT answer.
First, to investigate the continuous factor analytic structure underlying the answers to all AUDIT items. Second and third, to assess the impact of consumption as well as age and gender on AUDIT consequences dimension. Fourth and fifth, to categorize respondents into subgroups based on the AUDIT consequences items and adjusting the subgroups for differences in consumption, age and gender. Sixth, to describe the subgroups with respect to further adverse consequences of drinking.

Nonlinear factor analyses suggested two continuous correlated factors reflecting the adverse consequences of alcohol use: (1) harmful alcohol use, (2) alcohol dependence (aim 1). Consumption items did not prove to be reasonable construct indicators, but adverse consequences were predicted by consumption (aim 2), and also by age and gender (aim 3). Latent class factor analysis identified four subgroups based on the AUDIT consequences items (aim 4): one not affected (66%), and three subgroups defined by either harmful (15%) or dependent (9%), or combined harmful and dependent use (10%). These groups differed also with respect to further alcohol use consequences. Adjusting the subgroups for differences in consumption, age and gender (aim 5) reduced the non-affected subgroup and increased the subgroup with harmful and dependent use.

The AUDIT items cover three separable domains, i.e. consumption, harmful and dependent use, as originally intended. Hence, assessment of alcohol use does not substitute for assessing adverse consequences, as assumed in short versions of the AUDIT comprising only the AUDIT consumption items. Further, the dimensional as well as the LCFA subgroup solution imply that the respondents cannot be ordered along a single severity dimension without loss of information.
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Alcohol use disorders in patients with obsessive–compulsive disorder: The importance of appropriate dual-diagnosis
Drug and Alcohol DependenceVolume 100, Issues 1-2, 1 February 2009, Pages 173-177

To evaluate the prevalence and clinical associated factors of alcohol use disorders (AUD) comorbidity in a large clinical sample of patients with obsessive–compulsive disorder (OCD).

Forty-seven patients (7.5%) presented AUD comorbidity. Compared to OCD patients without this comorbidity they were more likely to be men, to have received previous psychiatric treatment, to present lifetime suicidal thoughts and attempts and to have higher scores in the hoarding dimension. They also presented higher comorbidity with generalized anxiety and somatization disorders, and compulsive sexual behavior. Substance use was related to the appearance of the first O.C. symptoms and symptom amelioration.

Although uncommon among OCD treatment seeking samples, AUD comorbidity has specific clinical features, such as increased risk for suicidality, which deserve special attention from mental health professionals. Future studies focused on the development of specific interventions for these patients are warranted.

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