Correlates of Past Homelessness in the National Epidemiological Survey on Alcohol and Related Conditions
Administration and Policy in Mental Health and Mental Health Services Research Online First September 17, 2009

This study sought to investigate correlates of past homelessness, especially mental illness and substance abuse, using data from the National epidemiological survey on alcohol and related conditions (NESARC), a large nationally representative survey conducted in 2001–2002.

Multivariate analyses showed that the factors most strongly related to past homelessness were diagnoses of behavioral health conditions which showed consistently stronger association than sociodemographic characteristics, measures of economic well being, or general health indicators.

The results presented here confirm in a nationally representative sample a number of single site studies that have also demonstrated the over representation of both mental illness and substance abuse disorders in homeless populations.

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Request Reprint E-Mail: greg.greenberg@yale.edu

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Integrated Employee Assistance Program/Managed Behavioral Health Care Benefits: Relationship with Access and Client Characteristics

Administration and Policy in Mental Health and Mental Health Services Research Online First 19 Aug 2009

This study examined service user characteristics and determinants of access for enrollees in integrated EAP/behavioral health versus standard managed behavioral health care plans.

Integrated plan service users were more likely to be employees rather than dependents, and to be diagnosed with adjustment disorder. Logistic regression analyses found greater likelihood in integrated plans of accessing behavioral health services , and substance abuse services specifically

Results are consistent with the concept that EAP benefits may increase access and address problems earlier.

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Request Reprint E-Mail: merrick@brandeis.edu

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Helping non-specialist professionals to detect and assist with co-existing mental health and drug and alcohol problems

Mental Health and Substance Use: dual diagnosis, Volume 2, Issue 3 October 2009 , pages 173 - 181

There is a high prevalence of co-existing mental health and drug and alcohol problems. Many people with these co-existing problems initially present in a range of contexts including the criminal justice system and social care settings relating to housing, relationships, family problems, etc., as opposed to mental health or substance misuse services. A complicating factor is that many people with these co-existing problems do not recognise that they have such problems and do not ask for help.

This paper seeks to help workers within such agencies to detect co-existing mental health and drug and alcohol problems, in order to offer help directly or to enable an onward referral.

In order to detect unrecognised co-existing mental health and drug and alcohol problems, it is suggested that non-specialist organisations need to develop methods of routine screening and risk assessment with a view to providing brief interventions for mental health symptoms and alcohol and other drug use, within the context of extensive liaison with a wide range of agencies.

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Request Reprint E-Mail: amanda.baker@newcastle.edu.au
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Predictors of completing treatment and achieving abstinence during inpatient dual diagnosis treatment

Mental Health and Substance Use: dual diagnosis, Volume 2, Issue 3 October 2009 , pages 182 - 190

Little is known about predictors of successful inpatient treatment of dual diagnosis patients.

No significant predictors were found of completing treatment. High thought disturbance, anxiety and severity of dependence were associated with drug or alcohol use during community linkage. A diagnosis of alcohol dependence was associated with abstinence during community linkage.

Dual diagnosis patients with severe substance dependence, as well as patients with elevated thought disturbance and anxiety, represent a challenge in a milieu therapeutic setting. Implications for treatment for patients with these complex problems will be addressed in the discussion.

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Request Reprint E-Mail: mh@crf.au.dk

Ethanol inhibits LPS-induced signaling and modulates cytokine production in peritoneal macrophages in vivo in a model for binge drinking

BMC Immunology (in press)

Previous reports indicate that ethanol, in a binge drinking model in mice, inhibits the production of pro-inflammatory cytokines in vivo. However, the inhibition of signaling through TLR4 has not been investigated in this experimental model in vivo. Considering evidence that signaling can be very different in vitro and in vivo, the present study was conducted to determine if effects of ethanol on TLR4 signaling reported for cells in culture or cells removed from ethanol treated mice and stimulated in culture also occur when ethanol treatment and TLR4 activation occur in vivo.

Overall, the effects of ethanol on signalling in vivo were similar to those reported for in vitro exposure to ethanol and/or lipopolysaccharide. However, inhibition of the activation of NF-κB was not detected as translocation of p65 to the nucleus but was detected using transgenic reporter mice. The observation that ethanol given 24 hr before dosing with LPS modulated production of some cytokines indicates a persistent effect which does not require continued presence of ethanol.

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Priming Deficiency in Male Subjects at Risk for Alcoholism: The N4 During a Lexical Decision Task

Alcoholism: Clinical and Experimental Research Early View 17 Sep 2009

While there is extensive literature on the relationship between the P3 component of event-related potentials (ERPs) and risk for alcoholism, there are few published studies regarding other potentially important ERP components. One important candidate is the N4(00) component in the context of semantic processing, as abnormalities in this component have been reported for adult alcoholics.

The lack of N4 attenuation to primed stimuli and/or inability to differentiate between primed and unprimed stimuli, without latency and reaction time being affected, suggest deficits in semantic priming, especially in semantic expectancy and/or postlexical semantic processing in HR male offspring. Further, it indicates that it might be an electrophysiological endophenotype that reflects genetic vulnerability to develop alcoholism.

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Request Reprint E-Mail: bp@cns.hscbklyn.edu

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Effects of Ethanol on Mouse Embryonic Stem Cells

Alcoholism: Clinical and Experimental Research Early View 17 Sep 2009

Fetal alcohol syndrome (FAS) reflects a constellation of congenital abnormalities caused by excess maternal consumption of alcohol. It is likely that interference with embryonic development plays a role in the pathogenesis of the disorder. Ethanol-induced apoptosis has been suggested as a causal factor in the genesis of FAS. Mouse embryonic stem (mES) cells are pluripotent cells that differentiate in vitro to cell aggregates termed embryoid bodies (EBs), wherein differentiation capacity and gene expression profile are similar to those of the early embryo.

Our findings suggest that ethanol may contribute to the pathogenesis of FAS by triggering apoptotic pathways during differentiation of embryonic stem cells and deregulating early stages of embryogenesis.

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Request Reprint E-Mail: emanuel.rubin@jefferson.edu

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Polymorphisms of the IL-1 Gene Complex Are Associated With Alcohol Dependence in Spanish Caucasians: Data From an Association Study

Alcoholism: Clinical and Experimental Research Early View 17 Sep 2009

There is growing evidence for involvement of pro-inflammatory cytokines in alcohol dependence. The aim of this study was to investigate whether 4 functionally relevant polymorphisms of the interleukin-1 (IL-1) and tumor necrosis factor-alpha genes were associated with alcohol dependence and with measures of clinical severity and treatment outcome.

Our findings provide further tentative evidence of the role of IL-1 in alcohol dependence as well as evidence that the nature of the associations may be direct, gender-specific, or involve haplotype effects. However, findings from single association studies constitute tentative knowledge and must be interpreted carefully and precise replication is required.

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Request Reprint E-Mail: frank@uniovi.es

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Effectiveness of Multicomponent Programs with Community Mobilization for Reducing Alcohol-Impaired Driving

American Journal of Preventive Medicine Volume 37, Issue 4, October 2009, Pages 360-371

A systematic review was conducted to determine the effectiveness and economic efficiency of multicomponent programs with community mobilization for reducing alcohol-impaired driving. The review was conducted for the Guide to Community Preventive Services (Community Guide). Six studies of programs qualified for the review. Programs addressed a wide range of alcohol-related concerns in addition to alcohol-impaired driving.

According to Community Guide rules of evidence, the studies reviewed here provided strong evidence that carefully planned, well-executed multicomponent programs, when implemented in conjunction with community mobilization efforts, are effective in reducing alcohol-related crashes. Three studies reported economic evidence that suggests that such programs produce cost savings. The multicomponent programs generally included a combination of efforts to limit access to alcohol (particularly among youth), responsible beverage service training, sobriety checkpoints or other well-defined enforcement efforts, public education, and media advocacy designed to gain the support of both policymakers and the general public for reducing alcohol-impaired driving.

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Request Reprint E-Mail: rshults@cdc.gov

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Chairman’s Mark
America’s Healthy Future Act of 2009

Washington, DC – Senate Finance Committee Chairman Max Baucus (D‐Mont.) today introduced the America’s Healthy Future Act, landmark health care reform legislation to lower costs and provide quality, affordable health care coverage. . . . . .

SUBTITLE C—MAKING COVERAGE AFFORDABLE
Benefit Options

Page 17 Chairman’s Mark

Definition of Four Benefit Categories. Four benefit categories would be available: bronze, silver, gold and platinum. No policies could be issued in the individual or small group market (other than grandfathered plans) that did not meet the actuarial standards described below. All health insurance plans in the individual and small group market would be required, at a minimum, to offer coverage in the silver and gold categories.

All plans must provide preventive and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that at least meet minimum standards set by Federal and state laws.

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ABA CALLS ON SENATE COMMITTEE TO INCLUDE EQUAL COVERAGE FOR MENTAL HEALTH AND ADDICTION IN PROPOSED HEALTH CARE REFORM

To ensure that the millions of Americans suffering from addiction and mental health disorders are provided equitable health care coverage, the American Bar Association is calling on the Senate Committee on Finance to include in its health care bill the relevant provisions of P.L. 110-343, the “Paul Wellstone and Pete Domenici Mental Health and Addiction Equity Act of 2008.” The ABA is asking for parity for mental health and addiction in all health care plans covered by the new legislation. Currently, the provisions only apply to certain employer-sponsored plans.

In a letter sent yesterday to the Senate Finance Committee, the ABA noted that "it is estimated that 22.6 million Americans needed treatment for a substance use problem in the past year, and only 18 percent of those needing substance use treatment received it.

"Providing parity in benefits for the treatment of these disorders on a par with benefits provided for other medical and surgical problems would make an enormous difference in the treatment of millions of Americans who desperately need it,” continued the letter.

A full copy of the letter, signed by ABA Governmental Affairs Office Director Thomas M. Susman, is posted at

http://www.abanet.org/poladv/letters/healthlaw/2009sep14_paritys_l.pdf.

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Help Get SBI Standards for Hospitals Adopted

Last year, the Joint Commission on the Accreditation of Hospitals (JCAHO) called for comments on whether it should create standards for tobacco, alcohol and drug screening and referral for all hospitals. I asked Join Together subscribers then to write to the Joint Commission with your comments, and hundreds of you did. Your effort was successful. JCAHO has now published a set of proposed standards for tobacco, alcohol and drug screening, brief intervention, referral and treatment. . . . . .

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A selective ALDH-2 inhibitor reduces anxiety in Rats

Pharmacology Biochemistry and Behavior Article in Press 10 Sep 2009

CVT-10216 is a highly selective, reversible inhibitor of ALDH-2 that reduces excessive alcohol drinking. Anxiety plays a role in alcoholism. The present study asks whether CVT-10216 has anxiolytic properties, as reflected in social interaction behavior in four unrelated rodent models: endogenous anxiety-like behavior in naïve Fawn-Hooded rats, repeated alcohol withdrawal-induced anxiety, restraint stress-induced anxiety and drug-induced anxiety.

CVT-10216 counteracted anxiety in all models except that produced by the 5-HT2C agonist, mCPP. CVT-10216 exhibited both acute and prophylactic inhibition of repeated alcohol withdrawal-induced anxiety. Importantly, anxiogenic behavior induced by the benzodiazepine receptor inverse agonist, DMCM, was counteracted dose-dependently by CVT-10216.

Thus, a non-addictive selective inhibitor of ALDH-2 has both anxiolytic and antidipsotropic properties, which may be dependent, in part on the involvement of the GABA-benzodiazepine system.

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Request Reprint E-Mail: dhover@med.unc.edu

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Suppression of Alcohol Preference by Naltrexone in the Rhesus Macaque: A Critical Role of Genetic Variation at the μ-Opioid Receptor Gene Locus

Biological Psychiatry Article in Press, 12 Sep 2009

The role of a nonsynonymous A118G polymorphism of the human μ-opioid receptor gene (OPRM1) for alcohol reward and therapeutic efficacy of naltrexone remains controversial. A functionally equivalent OPRM1 C77G polymorphism in rhesus macaques allows this to be addressed under controlled experimental conditions.

Mixed-model analysis of variance controlling for baseline and sex showed a highly significant (p = .003) interaction between genotype and treatment. Post hoc analysis showed that vehicle-treated 77G carriers had markedly higher alcohol preference than 77C homozygous subjects (p = .001). Following naltrexone administration, 77G carriers decreased their preference (p = .002) and no longer differed from 77C homozygous subjects. In contrast, the latter group was unaffected by treatment and, in fact, showed a trend-level increase of preference following naltrexone.

These results support a critical pharmacogenetic role of OPRM1 variation for therapeutic efficacy of naltrexone.

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Request Reprint E-Mail: markus.heilig@mail.nih.gov

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The effect of alcohol and tobacco consumption, and apolipoprotein E genotype, on the age of onset in Alzheimer's disease

International Journal of Geriatric Psychiatry Early View 14 Sep 2009

This study examined the association between a history of heavy alcohol use and smoking, presence of the apolipoprotein-E epsilon 4 allele (APOE 4), and age of disease onset in a community dwelling sample of 685 Alzheimer's disease (AD) patients spanning three ethnic groups.

The results suggest that APOE 4 and heavy drinking and heavy smoking lower the age of onset for AD in an additive fashion. Copyright © 2009 John Wiley & Sons, Ltd.

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Request Reprint E-Mail: billy@msmc.com

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Proposed Accreditation Standards Could Compel U.S. Hospitals to Screen Patients for Addictions

September 11, 2009

By Bob Curley

A proposal to include screening and brief intervention for addictions in national quality and accreditation standards for hospitals could be one of the most important developments ever for addiction treatment -- or wind up being something far less significant, depending upon the outcome of ongoing discussions and feedback from the medical community.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently released for public comment a list of proposed new hospital performance measures for screening, brief intervention, referral and treatment (SBIRT) of alcohol, tobacco, and other drug use. JCAHO accredited nearly 16,000 U.S. healthcare facilities, accounting for 95 percent of the country's hospital beds. . . . . . .

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Candidate Measures for Assessing and Treating Tobacco, Alcohol, & Other Drug Use and Dependence

The Joint Commission has received funding from Partnership for Prevention and The Substance Abuse and Mental Health Services Administration (SAMHSA) and their Center for Substance Abuse Treatment (CSAT) in the Department of Health and Human Services to develop a set of performance measures to address assessing and treating tobacco, alcohol, and other drug use and dependence for all hospitalized patients.

The candidate measures address the following aspects of care: screening/assessment, treatment which includes brief interventions and if applicable, medication, and follow-up after hospital discharge and are listed below.

Measure ID#: Measure Name (TADD = Tobacco Alcohol & Drug Dependence)
TADD-1: Tobacco Use Assessment
TADD-2: Tobacco Use Treatment
TADD-3: Tobacco Use Treatment at Discharge
TADD-4: Tobacco Use Follow-up
TADD-5: Alcohol and Other Drug Use Screening
TADD-6: Alcohol and Other Drug Use and Dependence - Brief Intervention or Treatment
TADD-7: Alcohol and Other Drug Use and Dependence – Treatment Management at Discharge
TADD-8: Alcohol and Other Drug Use and Dependence – Follow-up for Unhealthy Use and/or Disorders

Click here to display (and print if needed) all 8 Candidate Measure Profiles

The Joint Commission is inviting public comment on a proposed set of 8 candidate measures that focus on assessing and treating tobacco, alcohol, and other drug use and dependence in the hospital setting.

Survey Web Site

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Driving Under the Influence of Our Fathers

This paper studies intergenerational correlations in drunk driving between fathers and their children using the Stockholm Birth Cohort. We find strong evidence of an intergenerational drunk driving relationship. Cohort members who have fathers with a drunk driving record have 2.59 times higher odds of having a drunk driving conviction themselves than cohort members with non-drunk driving fathers.

We then go on to investigate the underlying mechanisms that give rise to these correlations. The results provide compelling evidence that at least some of this relationship represents a behavior-specific transference from fathers to their children. Specifically, much of the raw father-child drunk driving relationship persists over and above controls for a number of potential explanations, including that the relationship is: (i) a by-product of parental alcoholism, (ii) symptomatic of a general pattern of non-law abiding behavior, (iii) attributable to inherited ability and physical characteristics, and (iv) accounted for by common background variables or social factors.

We then go on to show how this mechanism may change over time. As cohort members age into adulthood, the father-child drunk driving relationship appears to be driven by a more general behavioral transference mechanism and can be accountedfor by parental alcoholism and non-law abiding behavior.

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Screening, Brief Intervention, and Referral to Treatment SBIRT

What is SBIRT?

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur.

Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.

Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.

Referral to treatment provides those identified as needing more extensive treatment with access to speciality care.

A key aspect of SBIRT is the integration and coordination of screening and treatment components into a system of services. This system links a community's specialized treatment programs with a network of early intervention and referral activities that are conducted in medical and social service settings.

SBIRT Web Site

Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort
Am J Psychiatry 2009; 166:1031-1040

Genetic variation influences differential vulnerability to addiction within populations. However, it remains unclear whether differences in frequencies of vulnerability alleles contribute to disparities between populations and to what extent ancestry correlates with differential exposure to environmental risk factors, including poverty and trauma.



These results suggest that African genetic heritage does not increase the likelihood of genetic risk for addictions. They highlight the complex interrelation between genetic ancestry and social, economic, and environmental conditions and the strong relation of those factors to addiction. Studies of epidemiological samples characterized for genetic ancestry and social, psychological, demographic, economic, cultural, and historical factors are needed to better disentangle the effects of genetic and environmental factors underlying interpopulation differences in vulnerability to addiction and other health disparities.


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Request Reprint E-Mail: francesca.ducci@iop.kcl.ac.uk

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Toward National Estimates of Alcohol Use Disorders among Drivers: Results from the National Roadside Survey Pilot Program

Traffic Injury Prevention, Volume 10, Issue 5 October 2009 , pages 403 - 409

To determine whether drivers contacted at the roadside can be screened for alcohol use disorders (AUDs). Secondarily, to produce preliminary estimates of AUDs among drivers and estimate the relationship between AUD status and BAC measured at the roadside.

AUD status can be effectively measured at the roadside. The poor reliability for alcohol abuse is related to underreporting of drinking and driving during roadside assessments, compared to telephone follow-up. Other measures of hazardous alcohol use should be used in the roadside context to measure alcohol abuse.

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Request Reprint E-Mail: dholden@jhsph.edu

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Geographic clustering of underage drinking and the influence of community characteristics

Drug and Alcohol Dependence Article in Press, 8 September 2009

The aim of this paper was to examine the extent to which underage drinking clusters geographically in a sample of communities, and to investigate the manner in which community-level contexts are related to this process.

Clustering of drunkenness and experiencing non-violent consequences as a result of drinking was greatest in the least economically disadvantaged and least disordered communities with the greatest percentage of married-couple families. The clustering of making a purchase attempt, however, was greatest in more disordered communities, specifically the largest communities with the highest degree of residential mobility and housing density.

These findings that clustering of underage drinking behaviors varies by community context has the potential for identifying the types of communities to target for underage drinking behavior-specific preventive interventions.

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Request Reprint E-Mail: brebouss@wfubmc.edu

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Predictors of Error in Estimates of Blood Alcohol Concentration: A Replication

J. Stud. Alcohol Drugs 70: 683-688, 2009

To identify predictors of error in estimated blood alcohol concentration (eBAC) in a sample of bar patrons.

The accuracy of eBAC is poor at best. In an earlier study of parties, eBACs were often underestimated; in the bar setting, eBACs were often overestimated. More research is needed to understand the role of setting on eBAC calculations.

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

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Persistence of Heavy Drinking and Ensuing Consequences at Heavy Drinking Colleges

J. Stud. Alcohol Drugs 70: 726-734, 2009

Purpose of this study was to examine drinking levels, related harms, and secondhand effects of alcohol use at heavy drinking colleges between 1993 and 2005 at colleges with high levels of drinking in 1993.

Heavy drinking and associated problems continue unabated, with few exceptions, at colleges that are most in need of intervention: those with high levels of heavy episodic drinking. Addressing student alcohol use at heavy drinking colleges may require stronger, more consistent, and more comprehensive approaches, with increased emphasis on the alcohol environment.

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Request Reprint E-Mail: tfnelson@umn.edu

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Longitudinal associations among depression, obesity and alcohol use disorders in young adulthood

General Hospital Psychiatry Volume 31, Issue 5, September-October 2009, Pages 442-450

This study examined concurrent and prospective relations between clinical depression, obesity and alcohol use disorders during young adulthood to better understand common etiology and the progression of co-occurrence.

Results show that depression, obesity and alcohol use disorders are interrelated conditions for women. A greater understanding of reasons underlying the co-occurrence of these conditions would benefit prevention and intervention efforts.

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

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Fetal alcohol spectrum disorders are 100% preventable

CDC Features September 8, 2009

FASDs are 100% preventable if a woman doesn't drink alcohol while she is pregnant. Learn more about the cause, signs, and treatments and what you can do if you think your child might have an FASD.

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.

Read more about FASDs:

• 
  Cause and Prevention
  
• Signs and Symptoms
• 
  Treatment for Children with FASDs
• 
  Get Help!
• 
  International FASD Awareness Day
  
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