Intervention for individuals with fetal alcohol spectrum disorders: Treatment approaches and case management

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 258 - 267

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs).

An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure.

This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs.

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Request Reprint E-Mail: bpaley@mednet.ucla.edu

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Fetal alcohol spectrum disorders and the criminal justice system

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 250 - 257

The life-long neurological impairments found in people with fetal alcohol spectrum disorders (FASDs), including learning disabilities, impulsivity, hyperactivity, social ineptness, and poor judgment, can increase susceptibility to victimization and involvement in the criminal justice system (CJS). Individuals with FASDs become involved in the CJS as complainants, witnesses, and accused. Their disabilities, resulting from the prenatal alcohol exposure, must be considered at all stages in the legal process.

Adverse experiences, such as having a dysfunctional family background, mental health problems, and substance use disorders, are compounding factors. Experiencing physical, sexual, and emotional abuse also increases the risk that these individuals will become involved in the CJS. It is critical that everyone involved in the CJS receives education and training to understand FASD and the implications for the individual offender.

A comprehensive medical-legal report, prepared by professionals experienced with FASD, can help judges and lawyers understand the complex interactions among brain damage, genetics and the environment. Corrections workers and probation officers need to comprehend the significance of FASD and how it affects the offender's abilities to understand and follow rules and probation orders. Caregivers and parents need to be involved whenever possible.

Early recognition of the disabilities associated with FASDs may help reduce the over-representation of this group in the CJS.

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Request Reprint E-Mail: dfast@cw.bc.ca

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Family matters: Fetal alcohol spectrum disorders and the family
Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 235 - 249

Information about family matters is vital to developing targeted interventions, reducing placement disruption, and enhancing outcome in fetal alcohol spectrum disorders (FASD). The quality of the caregiving environment and family function are associated with long-term outcome in natural history study of individuals with FASD.

This article integrates multiple information sources to better understand the role of family factors in the outcome of individuals with FASD, and how the family is affected by raising a child with this lifelong condition. A brief description of the useful informal literature is brought together with a review of the surprisingly limited body of systematic research findings on FASD and caregiver/family function, and new data describing children with FASD and characteristics of their caregivers.

Directions for future data-gathering and intervention development emerge from combining what is already known with an exploration of what can be learned from a highly targeted review of family-related data in the wide-ranging, general literature on developmental disabilities, and use of a proposed conceptual framework that joins a developmental systems perspective with a family systems approach.

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Request Reprint E-Mail: quiddity@u.washington.edu

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Psychiatric conditions associated with prenatal alcohol exposure

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 225 - 234

Since the identification of fetal alcohol syndrome (FAS) over 35 years ago, mounting evidence about the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities that are characterized by physical, cognitive, and behavioral impairments. These disabilities include a continuum of developmental disorders known as fetal alcohol spectrum disorders (FASDs). Longitudinal studies suggest that individuals with FASDs are at a greatly increased risk for adverse long-term outcomes, including mental health problems and poor social adjustment.

This review summarizes the existing literature on mental health outcomes for individuals with PAE across the lifespan, including findings in infancy and early childhood, middle childhood, and adolescence and early adulthood. Research on the psychiatric disabilities suffered by individuals with FASDs throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability since early identification and treatment have been demonstrated to be protective against more serious secondary disabilities.

It is hoped that with greater awareness of the mental health problems experienced by individuals with FASDs, these individuals can receive appropriate and early treatment resulting in more adaptive and rewarding lives.

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Request Reprint E-Mail: moconnor@mednet.ucla.edu

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Neurocognitive profile in children with fetal alcohol spectrum disorders

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 218 - 224

The question of whether children with fetal alcohol spectrum disorders (FASD) exhibit a unique neurocognitive profile has received considerable attention over the past three decades. The identification of a syndrome-specific neurocognitive profile would aid in diagnosing prenatally exposed children with cognitive deficits who do not exhibit clinically discernable physical anomalies.

The current review of the literature, therefore, focuses on the studies of higher-order cognitive skills in children with FASDs with a view towards delineating a pattern of cognitive functioning. Researchers have documented that children with FASDs show diminished intellectual functioning, with average IQ scores falling within the borderline to low average ranges. Slow information processing and disturbances of attention have been observed from infancy through adulthood in individuals with FASDs. Clinical and experimental reports on individuals with FASD have documented marked deficits in executive functioning, particularly in tasks that involve holding and manipulating information in working memory. Studies examining specific domains of cognitive functioning such as language, visual perception, memory and learning, social functioning, and number processing in individuals with FASDs have revealed performance decrements associated with increased task complexity.

The above findings converge on the conclusion that children with FASDs have a generalized deficit in the processing and integration of information. We recommend the study of developmental trajectories of both elementary and higher-order functions in future research on FASD to elucidate the development of this cognitive profile.

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Request Reprint E-Mail pkodituwakku@salud.unm.edu

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Neuroimaging and fetal alcohol spectrum disorders

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 209 - 217

The detrimental effects of prenatal alcohol exposure on the developing brain include structural brain anomalies as well as cognitive and behavioral deficits. Initial neuroimaging studies of fetal alcohol spectrum disorders (FASD) using magnetic resonance imaging (MRI) confirmed previous autopsy reports of overall reduction in brain volume and central nervous system (CNS) disorganization, with specific structural abnormalities of the corpus callosum, cerebellum, caudate, and hippocampus.

Advances in neuroimaging techniques have allowed detection of regional increases in cortical thickness and gray matter volume along with decreased volume and disorganization of white matter in individuals with FASD. In addition, functional imaging studies have found functional and neurochemical differences in those prenatally exposed to alcohol.

Behavioral alterations noted in individuals with FASD are consistent with the findings noted in the brain imaging studies.

Continued neuroimaging studies are needed to further advance understanding of the neuroteratogenic effects of alcohol.

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Request Reprint E-Mail: eriley@mail.sdsu.edu

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Animal models of fetal alcohol spectrum disorders: Impact of the social environment

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 200 - 208

Animal models of fetal alcohol spectrum disorder (FASD) have been used to demonstrate the specificity of alcohol's teratogenic effects and some of the underlying changes in the central nervous system (CNS) and, more recently, to explore ways to ameliorate the effects of alcohol.

The main point of this review is to highlight research findings from the animal literature which point to the impact of the social context or social behavior on the effect(s) of alcohol exposure during development, and also to point to research questions about the social environment and effects of prenatal alcohol exposure that remain to be answered. Alcohol exposure during early development alters maternal responding to the exposed pup in a variety of ways and the alteration in maternal responding could alter later stress responsivity and adult maternal and social behavior of the exposed offspring.

Environmental enrichment and voluntary exercise have been shown to ameliorate some of alcohol's impact during development, but the roles of enhanced social interactions in the case of enrichment and of social housing during voluntary exercise need to be more fully delineated. Similarly, the role of social context across the lifespan, such as social housing, social experiences, and contact with siblings, needs further study.

Because of findings that alcohol during development alters DNA methylation patterns and that there are alterations in the maternal care of the alcohol-exposed offspring, epigenetic effects and their relationship to social behavior in animal models of FASD are likely to become a fruitful area of research.

Because of the simpler social behavior and the short lifespan of rodents, animal models of FASD can be useful in determining how the social context impacts the effects of alcohol exposure during development.

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Request Reprint E-Mail: sandra-kelly@sc.edu)

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Prevention of fetal alcohol spectrum disorders

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 193 - 199

Alcohol use among women of childbearing age is a leading, preventable cause of birth defects and developmental disabilities in the United States. Although most women reduce their alcohol use upon pregnancy recognition, some women report drinking during pregnancy and others may continue to drink prior to realizing they are pregnant. These findings emphasize the need for effective prevention strategies for both pregnant and nonpregnant women who might be at risk for an alcohol-exposed pregnancy (AEP).

This report reviews evidence supporting alcohol screening and brief intervention as an effective approach to reducing problem drinking and AEPs that can lead to fetal alcohol spectrum disorders. In addition, this article highlights a recent report of the National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect that describes effective interventions to reduce alcohol use and AEPs, and outlines recommendations on promoting and improving these strategies.

Utilizing evidence-based alcohol screening tools and brief counseling for women at risk for an AEP and other effective population-based strategies can help achieve future alcohol-free pregnancies.

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Request Reprint E-Mail: rlf3@cdc.gov

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Prevalence and epidemiologic characteristics of FASD from various research methods with an emphasis on recent in-school studies

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 176 - 192

Researching the epidemiology and estimating the prevalence of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) for mainstream populations anywhere in the world has presented a challenge to researchers.

Three major approaches have been used in the past: surveillance and record review systems, clinic-based studies, and active case ascertainment methods. The literature on each of these methods is reviewed citing the strengths, weaknesses, prevalence results, and other practical considerations for each method. Previous conclusions about the prevalence of FAS and total FASD in the United States (US) population are summarized.

Active approaches which provide clinical outreach, recruitment, and diagnostic services in specific populations have been demonstrated to produce the highest prevalence estimates. We then describe and review studies utilizing in-school screening and diagnosis, a special type of active case ascertainment. Selected results from a number of in-school studies in South Africa, Italy, and the US are highlighted.

The particular focus of the review is on the nature of the data produced from in-school methods and the specific prevalence rates of FAS and total FASD which have emanated from them. We conclude that FAS and other FASD are more prevalent in school populations, and therefore the general population, than previously estimated.

We believe that the prevalence of FAS in typical, mixed-racial, and mixed-socioeconomic populations of the US is at least 2 to 7 per 1,000. Regarding all levels of FASD, we estimate that the current prevalence of FASD in populations of younger school children may be as high as 2-5% in the US and some Western European countries.

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Request Reprint E-Mail; pmay@unm.edu

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Fetal alcohol spectrum disorders: When science, medicine, public policy, and laws collide

Developmental Disabilities Research Reviews Volume 15 Issue 3, Pages 170 - 175

Historically, alcohol has been used for different purposes including as a part of religious observances, as a food, at times as a medicine and its well-known use as a beverage. Until relatively recently these purposes have not changed and have at times been at odds with one another, resulting in collisions among policies and practices in science, medicine, public policy and the law.

One area in which this has been particularly true is that of fetal alcohol spectrum disorders (FASD) where the adverse consequences of consumed alcohol on children in the womb and after birth may have been observed since antiquity, but the actions taken based on such observations have been influenced as much by the socio/cultural/political context of the times in which they were made as by evidence of harm.

This article provides an overview of the inherent confusion when new scientific findings confront prevailing medical practice, the history involved in this confusion with respect to FASD, including public policy and legal issues that have arisen around alcohol and pregnancy, and the research and clinical challenges still being faced.

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Request Reprint E-Mail: bhewitt@mail.nih.gov

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Impulsivity and response inhibition in alcohol dependence and problem gambling

Psychopharmacology Online First 3 September 2009

Impulsivity is a central feature of drug addiction and may arise as a result of impaired inhibitory control. The extent to which inhibitory deficits arise as a consequence of drug exposure or relate to pre-existing addiction vulnerability is unknown.

Inhibitory control is impaired in alcohol dependence but occurs in the context of psychomotor slowing. In addition, alcohol-dependent individuals failed to show behavioral adjustment following failed stops. These deficits may represent direct effects of chronic alcohol administration on fronto-striatal circuitry.

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Solitary and social heavy drinking, suicidal ideation, and drinking motives in underage college drinkers

Addictive Behaviors Volume 34, Issue 12, December 2009, Pages 993-999

In college students, solitary heavy drinking (i.e., while alone) is associated with depression and with higher rates of drinking problems than heavy drinking in social contexts. This study explored the relationship among heavy episodic drinking context, suicidal ideation, and drinking motives among underage college drinkers (n = 91) with a history of passive suicidal ideation.

Multiple regression analyses revealed that suicidal ideation, but not depression, was significantly related to solitary heavy drinking. Neither was related to social heavy drinking. Enhancement motives for drinking, but not other drinking motives (i.e., social, conformity, drinking to cope), were significantly associated with social heavy drinking. In contrast, only drinking to cope was associated with solitary heavy drinking.

These findings suggest that greater suicidal ideation is associated with greater frequency of becoming intoxicated while alone, and that this drinking is motivated by attempts to cope. Solitary heavy drinking is a potentially dangerous coping strategy for an individual experiencing suicidal ideation.

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Request Reprint E-Mail; viviangonzalez@uaa.alaska.edu

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Alcohol use motives among traumatic event-exposed, treatment-seeking adolescents: Associations with posttraumatic stress

Addictive Behaviors Volume 34, Issue 12, December 2009, Pages 1065-1068

The current study evaluated the linkage between posttraumatic stress symptoms and alcohol use motives among 49 traumatic event-exposed adolescents (Mage = 16.39 years).

It was hypothesized that posttraumatic stress symptom levels would be positively associated with coping-related drinking motives specifically (cf., social, enhancement, or conformity motives) and that coping-related drinking motives would evidence associations with the hyperarousal and reexperiencing posttraumatic stress symptom types.

Findings were consistent with hypotheses, suggesting traumatic event-exposed adolescents may be using alcohol to manage posttraumatic stress symptoms.

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Request Reprint E-Mail: _mailto:eleenfe@uark.edu_

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News Release - SUPERMARKETS KEEPING SHOPPERS IN THE DARK OVER ALCOHOL INFORMATION CLAIMS CHARITY

'Message on a Bottle' a new report published by Alcohol Concern has found that the majority of alcohol sold by supermarkets is poorly labelled, leaving customers in the dark when it comes to vital health information. The report found that only 4% of products reviewed carried all five elements that make up the industry best practice label. Only 18% of products carried information about sensible drinking levels and 56% carried unit information.

In 1998 a voluntary agreement was reached between the drinks industry and the government to introduce unit labelling on all products. In 2008 the drinks industry made further promises to improve alcohol labelling but this research shows that many producers are falling short of their corporate social responsibility pledges. In the light of this poor progress Alcohol Concern is calling on government to take decisive action to introduce mandatory health labelling on alcohol products and for supermarkets to only promote products that are clearly labelled. . . . . .

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The TEDS Report - -School System Referrals to Substance Abuse Treatment

Adolescents and children referred to substance abuse treatment by the educational system were more likely than those referred by the criminal justice system to report primary alcohol abuse but less likely to report primary marijuana abuse.

Schools were more likely than the criminal justice system to refer children and adolescents to substance abuse treatment for the first time (88 vs. 68 percent). School-aged admissions referred through the educational system were less likely than those referred by the criminal justice system to have completed treatment or transferred to further care (52 vs. 58 percent).

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PKNOX2 gene is significantly associated with substance dependence in European-origin women

PNAS Online before preint August 31, 2009

Substance dependence is a complex environmental and genetic disorder that results in serious health and socioeconomic consequences. Many studies have reported and implicated genes associated with various substance dependence outcomes, including addiction to nicotine and addiction to alcohol.

Using data from several genome-wide case-control studies, we conducted a genome-wide association study of a composite substance dependence phenotype derived from six individual diagnoses: addiction to nicotine, alcohol, marijuana, cocaine, opiates, or other drugs as a whole.

We identified a strong (odds ratio = 1.77) and significant (P value = 7E-8) association signal with the PBX/knotted 1 homeobox 2 (PKNOX2) gene on chromosome 11 in European-origin women with the composite phenotype.

Our findings also indicate that the associations are not as significant when individual outcomes for addiction are considered, underscoring the importance of considering multiple addiction types.

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Request Reprint E-Mail: heping.zhang@yale.edu or singer@princeton.edu

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Avoidance of Alcohol-Related Stimuli Increases During the Early Stage of Abstinence in Alcohol-Dependent Patients

Alcohol and Alcoholism 2009 44(5):458-463

The aim of this study was to analyse initial orienting processes as well as maintenance of attention towards alcohol cues in recently detoxified alcoholics and light social drinkers. Furthermore, we investigated the influence of pre-treatment alcohol consumption and abstinence duration onto alcohol-related attentional bias. :

After initial visual orienting towards alcohol-related stimuli, light social drinkers as well as longer abstinent alcohol-dependent patients disengage their attention. In patients, this disengagement increased during the first 3 weeks after detoxification indicating assimilation to the attentional bias pattern of light social drinkers.

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Request Reprint E-Mail: s.vollstaedt-klein@zi-mannheim.de

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Hours and Days of Sale and Density of Alcohol Outlets: Impacts on Alcohol Consumption and Damage: A Systematic Review

Alcohol and Alcoholism 2009 44(5):500-516

The aim of this study was to examine recent research studies published from 2000 to 2008 focusing on availability of alcohol: hours and days of sale and density of alcohol outlets.

Forty-four studies on density of alcohol outlets and 15 studies on hours and days of sale were identified through a systematic literature search. The majority of studies reviewed found that alcohol outlet density and hours and days of sale had an impact on one or more of the three main outcome variables, such as overall alcohol consumption, drinking patterns and damage from alcohol.

Restricting availability of alcohol is an effective measure to prevent alcohol-attributable harm.

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Request Reprint E-Mail: Norman_Giesbrecht@camh.net

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How Will Alcohol Sales in the UK Be Affected If Drinkers Follow Government Guidelines?

Alcohol and Alcoholism 2009 44(5):523-528

The proportion of alcohol consumption that is above government guidelines (‘risky drinking’) has been estimated in several countries, suggesting that reductions in risky drinking would lead to significant declines in total alcohol consumption. However, this has not previously been conducted transparently in the UK. Furthermore, existing studies have under-explored the importance of several methodological decisions, as well as not closely examining the meaning of these figures for debates on ‘corporate social responsibility’ (CSR).

Methodologically, the study shows that at least two decisions have considerable importance: the definition of risky drinking used and whether we count all drinking (as in most previous studies) or only drinking above guidelines. Substantively, these studies do not directly show that drink companies’ profitability would be affected by declines in risky drinking. Nevertheless, they are valuable for present debate in themselves and form the basis of a more complex analysis of alcohol CSR

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Request Reprint E-Mail: b.p.baumberg@lse.ac.uk

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Media Release - ALCOHOL ABUSE IS A FACTOR IN 1 IN 15 SURGICAL DEATHS

Alcohol abuse was a factor in 1 in 15 reported deaths that occurred during 2008 while patients were under the care of a surgeon. This is the key finding in the first interim report produced by the Scottish Audit of Surgical Mortality (SASM) and the first time that SASM has included data on the involvement of alcohol in surgical deaths. . . . . . .

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SASM Summary Report 2009 (2008 data) (PDF)

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Impact and risk factors of craniofacial malformations in a Colombian population

International Journal of Pediatric Otorhinolaryngology Volume 73, Issue 10, Pages 1434-1437

Craniofacial malformations comprise diverse diagnoses, implying a wide range of morbidity and disability among populations. Our aim was to study them as a group and describe their epidemiological factors inside a population as well as finding common risk factors for their presentation in Colombia.

Craniofacial malformations are frequently encountered among the group of congenital defects. When they present in an isolated fashion, familial history is an important risk factor, although some prenatal factors such as alcohol and some medications may have influence over their prevalence.

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Request Reprint E-Mail: izarante@javeriana.edu.co

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Do Canadian prenatal record forms integrate evidence-based guidelines for the diagnosis of a FASD?

Canadian Journal of Public Health, July/August 2009, Vol. 100, No. 4

Prenatal alcohol exposure is a significant public health issue with lifelong psychological, emotional and financial costs associated with caring for an affected individual. In 2005, the Public Health Agency of Canada and Health Canada's First Nations and Inuit Health Branch developed evidence-based guidelines for the diagnosis of a Fetal Alcohol Spectrum Disorder (FASD). We examined the extent to which prenatal records across Canadian provinces and territories currently integrate key recommendations from these guidelines.

Integration of the Canadian recommendations into Canadian prenatal record forms may be an effective public health strategy for helping identify pregnancies at high risk for alcohol exposure, reducing the incidence of a FASD through appropriate prenatal intervention and referral, and facilitating early diagnosis of a FASD.

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Request Reprint E-Mail: premjis@ucalgary.ca

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Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach

Journal of Substance Abuse Treatment Volume 37, Issue 3, October 2009, Pages 228-239

Most treatment programs recommend clients attend 12-step groups, but many drop out posttreatment. The effectiveness of Making Alcoholics Anonymous [AA] Easier (MAAEZ ), a manual-guided intervention designed to help clients connect with individuals encountered in AA, was tested using an “OFF/ON” design (n = 508).

MAAEZ effectiveness was determined by comparing abstinence rates of participants recruited during ON and OFF conditions and by studying the effect of the number of MAAEZ sessions attended. At 12 months, more clients in the ON condition (vs. OFF) reported past 30-day abstinence from alcohol (p = .012), drugs (p = .009), and both alcohol and drugs (p = .045). In multivariate analyses, ON condition participants had significantly increased odds of abstinence from alcohol (odds ratio [OR] = 1.85) and from drugs (OR = 2.21); abstinence odds also increased significantly for each additional MAAEZ session received.

MAAEZ appeared especially effective for those with more prior AA exposure, severe psychiatric problems, and atheists/agnostics. MAAEZ represents an evidence-based intervention that is easily implemented in existing treatment programs.

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Request Reprint E-Mail: lkaskutas@arg.org

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Binge drinking in undergraduates: relationships with sex, drinking behaviors, impulsivity, and the perceived effects of alcohol

Behavioural Pharmacology: POST AUTHOR CORRECTIONS, 28 August 2009

Binge drinking on university campuses is associated with social and health-related problems. To determine the factors that may predict this behavior, we collected information on alcohol use, alcohol expectations, and impulsivity from 428 undergraduate students attending a Canadian university.

Compared with men, women reported different expectations of alcohol, specifically related to sociability and sexuality. Self-reported impulsivity scores were related, albeit weakly, to drinking behaviors and to expectations in both the sexes. Finally, intoxicated binge drinkers reported feeling less intoxicated, liking the effects more, and wanting more alcohol than did non-binge drinkers receiving an equivalent dose of alcohol.

These results have implications for sex-specific prevention strategies for binge drinking on university campuses.

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Request Reprint E-Mail: olmstead@queensu.ca

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A web application for moderation training: Initial results of a randomized clinical trial

Journal of Substance Abuse Treatment Volume 37, Issue 3, October 2009, Pages 266-276

Eighty-four heavy drinkers who responded to a newspaper recruitment advertisement were randomly assigned to receive either (a) training in a Moderate Drinking protocol via an Internet-based program and use of the online resources of Moderation Management or (b) use of the online resources of MM alone. Follow-ups are being conducted at 3, 6, and 12 months.

Results of the recently completed 3-month follow-up (86% follow-up) indicated both groups significantly reduced their drinking based on these variables: standard drinks per week, percent days abstinent, and mean estimated blood alcohol concentration (BAC) per drinking day. Both groups also significantly reduced their alcohol-related problems. Relative to the control group, the experimental group had better outcomes on percent days abstinent and log drinks per drinking day.

These short-term outcome data provide evidence for the effectiveness of both the Moderate Drinking Web application and of the resources available online at MM in helping heavy drinkers reduce their drinking and alcohol-related problems.

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Request Reprint E-Mail: reidhester@lobo.net

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White matter integrity in adolescents with histories of marijuana use and binge drinking

Neurotoxicology and Teratology Article in Press 23 July 2009

Structural brain abnormalities have been observed in adolescents with alcohol use disorders but less is known about neuropathological brain characteristics of teens with sub-diagnostic binge drinking or the common pattern of binge drinking combined with marijuana use. The goal of this study was to examine white matter integrity in adolescents with histories of binge drinking and marijuana use.

Findings are largely consistent with research suggesting less neuropathology in adolescents without histories of substance use. However, binge drinkers who also use marijuana did not show as consistent a divergence from non-users as did the binge drink-only group. Detection of white matter alterations may have implications in identifying early cognitive dysfunction in substance using adolescents.

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Request Reprint E-Mail: stapert@ucsd.edu

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Alcohol, tobacco and illicit drug use amongst same-sex attracted women: results from the Western Australian Lesbian and Bisexual Women's Health and Well-Being Survey

BMC Public Health 2009, 9:317

The prevalence of alcohol, tobacco and illicit drug use has been reported to be higher amongst lesbian and bisexual women (LBW) than their heterosexual counterparts. However, few studies have been conducted with this population in Australia and rates that have been reported vary considerably.

LBW appear to use alcohol, tobacco and illicit drugs at higher rates than women generally, indicating that mainstream health promotion messages are not reaching this group or are not perceived as relevant. There is an urgent need for public health practitioners working in the area of substance use to recognise that LBW drug consumption and use patterns are likely to be different to the wider population and that special considerations and strategies are required to address the unique and complex needs of this population.

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News Release - September is the new January

English drinkers vow to cut back after holiday boozing

Drinkers in England drank an average eight alcoholic drinks every day during their summer holiday this year, a new survey from the Know Your Limits campaign revealed today. . . . . . .

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Objections to suicide among depressed patients with alcohol use disorders

Journal of Affective Disorders Volume 117, Issue 3, Pages 197-201

Understanding how alcohol misuse interacts with beliefs that protect individuals against suicide can help to enhance suicide prevention strategies.

Patients with AUDs had fewer objections to suicide, even though their level of current suicidal ideation was similar to those without AUD, suggesting that attitudes about the acceptability of suicide may be conceptually distinguished from suicidal ideation, and may be differentially associated with risk for suicidal behavior.

These findings suggest that alcohol use and suicidal behavior predict current attitudes toward suicide, however causal mechanisms are not clearly understood.

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Request Reprint E-Mail: richran@pi.cpmc.columbia.edu

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Oxcarbazepine in Combination with Tiaprid in Inpatient Alcohol-withdrawal - a RCT

Pharmacopsychiatry 2009; 42: 175-181

Oxcarbazepine (OXC), a derivative of Carbamazepine (CBZ), may represent a solution to metabolic and side effects of CBZ treatment due to the fact that renal excretion is its major route of elimination. The goal of the study is to compare the efficacy and tolerability of OXC/Tiaprid (TIA) combination therapy to the well established Clomethiazole (CLO) therapy in an inpatient setting.

OXC/TIA inpatient therapy proved to be as effective and participants demonstrated the same tolerance as with CLO. In medication-based alcohol withdrawal, OXC/TIA could have the potential to become a promising alternative for alcohol dependent patients unable to undergo inpatient withdrawal therapy with CLO.

Our findings further indicate that it could be worthwhile testing OXC/TIA in alcohol withdrawal in daily care units and outpatient settings. This is an important question for national health care services, since outpatient therapy is more and more asked for as alternative to inpatient settings.

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Request Reprint E-Mail: b.croissant@klksig.de

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Selective Boosting of Transcriptional and Behavioral Responses to Drugs of Abuse by Histone Deacetylase Inhibition

Neuropsychopharmacology advance online publication 2 September 2009

Histone acetylation and other modifications of the chromatin are important regulators of gene expression and, consequently, may contribute to drug-induced behaviors and neuroplasticity. Earlier studies have shown that a reduction in histone deacetylase (HDAC) activity results in the enhancement of some psychostimulant-induced behaviors.

In this study, we extend those seminal findings by showing that the administration of the HDAC inhibitor sodium butyrate enhances morphine-induced locomotor sensitization and conditioned place preference. In contrast, this compound has no effects on the development of morphine tolerance and dependence. Similar effects were observed for cocaine and ethanol-induced behaviors. These behavioral changes were accompanied by a selective boosting of a component of the transcriptional program activated by chronic morphine administration that included circadian clock genes and other genes relevant to addictive behavior.

Our results support a specific function for histone acetylation and the epigenetic modulation of transcription at a reduced number of biologically relevant loci on non-homeostatic, long-lasting, drug-induced behavioral plasticity.

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Request Reprint E-Mail: abarco@umh.es

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Addiction Genetics and Pleiotropic Effects of Common Haplotypes that Make Polygenic Contributions to Vulnerability to Substance Dependence

Journal of Neurogenetics, Volume 23, Issue 3 September 2009 , pages 272 - 282

Abundant evidence from family, adoption, and twin studies point to large genetic contributions to individual differences in vulnerability to develop dependence on one or more addictive substances. Twin data suggest that most of this genetic vulnerability is shared by individuals who are dependent on a variety of addictive substances. Molecular genetic studies, especially genomewide and candidate gene association studies, have elucidated common haplotypes in dozens of genes that appear to make polygenic contributions to vulnerability to developing dependence. Most genes that harbor currently identified addiction-associated haplotypes are expressed in the brain. Haplotypes in many of the same genes are identified in genomewide association studies that compare allele frequencies in substance dependent vs. control individuals from European, African, and Asian racial/ethnic backgrounds. Many of these addiction-associated haplotypes display pleiotropic influences on a variety of related brain-based phenotypes that display 1) substantial heritability and 2) clinical cooccurence with substance dependence.

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Request Reprfint E-Mail: guhl@intra.nida.nih.gov

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New alcohol strategy document from the World Health Organization

The 2008 World Health Assembly adopted a resolution that calls for the development of a global strategy to reduce harmful consumption of alcohol. Since then the WHO secretariat has been working to develop a draft Global Strategy to present to the World Health Assembly in May 2010, with prior discussion at the Excecutive Board meeting in Januar.

The WHO Secretariat has now produced and sent out to Member States for their feedback a working document for developing a draft global strategy to reduce harmful use of alcohol. The working document is public and may be downloaded from the WHO website in six languages. It is based on the outcomes of the regional consultations with Member States and consultative process with other stakeholders and contains relevant background information, as well as a proposed vision, objectives and target areas for action by Member States. . . . . .

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From Pubs to Scrubs: Alcohol Misuse and Health Care Use

Health Services Research Volume 44 Issue 5p1, Pages 1480 - 1503

To analyze the relationships between alcohol misuse and two types of acute health care use—hospital admissions and emergency room (ER) episodes.

Frequent drinking to intoxication was positively associated with hospital admissions for both men and women and increased the likelihood of using ER services for women. Alcohol dependence and/or abuse was related to higher use of ER services for both genders and increased hospitalizations for men.

These findings provide updated and nationally representative estimates of the relationships between alcohol misuse and health care use, and they underscore the potential implications of alcohol misuse on health care expenditures.

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Request Reprint E-Mail: mfrench@miami.edu.

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A cotwin-control analysis of drug use and abuse/dependence risk associated with early-onset cannabis use

Addictive Behaviors Article in Press 14 August 2009

We assessed whether, after controlling for genetic and shared environmental influences, early cannabis use remains a significant predictor of other drug use, abuse, and dependence, and whether the risk for early-users is greater than that for later cannabis users.

After familial influences on early cannabis use were controlled for, cannabis use—regardless of the age of initiation—still conferred increased risk of other illegal drug use, drug abuse/dependence, and alcohol dependence. In contrast to previous research, there is limited evidence for increased risk associated with early-onset use in this sample of Vietnam-era veterans.

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Request Reprint E-Mail: grantj@psychiatry.wustl.edu

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Alcohol Consumption as a Risk Factor for Dementia and Cognitive Decline: Meta-Analysis of Prospective Studies

American Journal of Geriatric Psychiatry: July 2009 - Volume 17 - Issue 7 - pp 542-555

The relationships between alcohol consumption and dementia and cognitive decline were investigated in a systematic review including meta-analyses of 15 prospective studies.

Our results suggest that alcohol drinkers in late life have reduced risk of dementia. It is unclear whether this reflects selection effects in cohort studies commencing in late life, a protective effect of alcohol consumption throughout adulthood, or a specific benefit of alcohol in late life.

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Request Reprint E-Mail: kaarin.anstey@anu.edu.au

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Australia: The Healthiest Country by 2020 National Preventative Health Strategy

This Strategy sets out a vision for Australia to be the healthiest country by 2020. To realise this vision, the Strategy provides the roadmap for a series of strategic and practical actions, to be mplemented across all sectors and by all Australians between now and 2020. This is a major hallenge for the nation, but the rewards will be immense in terms of lives saved, and improved health and wellbeing.

3.1 THE BURDEN OF DISEASE – A FOCUS ON OBESITY, TOBACCO AND ALCOHOL

Obesity, tobacco and alcohol feature in the top seven preventable risk factors that influence the burden of disease, with over 7% of the total burden being attributed to each of obesity and smoking, and more than 3% attributed to the harmful effects of alcohol. Along with a range of other risk factors, and accounting for their interactions, approximately 32% of Australia’s total burden of disease can be attributed to modifiable risk factors.

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Editorial - Britain and alcohol: Drink problem

The Guardian, Wednesday 2 September 2009

Tucked away in yesterday's OECD report on childhood was a dismal if unsurprising figure: British children get drunk, or claim to get drunk, far more often than their counterparts anywhere else in the developed world. A third of 13- to 15-year-olds in this country said they had been drunk at least twice; in France the proportion is well under a fifth. The report made other important observations – Britain spends above the OECD average on children, while not always achieving better results – but it is the drinking that caught the attention, an often-told story of damaged hopes that begins with cheap cider and ends in a lifelong addiction. . . . . .

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World Health Statistics Report

World Health Statistics 2009 contains WHO’s annual compilation of data from its 193 Member States, and includes a summary of progress towards the health-related Millennium Development Goals (MDGs) and targets. This edition also contains a new section on reported cases of selected infectious diseases.

The contents of this book have been collated from publications and databases produced and maintained by WHO’s technical programmes and regional offices. Indicators have been included on the basis of their relevance to global health, the availability and quality of the data and the reliability and comparability of estimates. This set of indicators provides a omprehensive summary of the current status of national health and health systems, including: mortality and burden of disease, causes of death, reported infectious diseases, health service overage, risk factors, health systems resources, health expenditures, inequities and mographic and socioeconomic statistics.

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Risk Factors Table 5

Harmful use of alcohol can cause chronic alcohol dependence, hepatic cirrhosis, cancer and cute injuries. Of the 20 countries with the highest alcohol consumption per capita, 18 are European. Factors that influence the reliability of this indicator include: unmeasured informal production, tourist consumption, stockpiling, waste and spillage, smuggling, duty-free sales and variations in beverage strength.

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