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, November 14, 2009

New report says Indiana binge drinking rate up

Indiana college students are binge drinking at a rate higher the national average, according to a new report.

A report released Friday by the Indiana Collegiate Action Network found that 48 percent of Hoosier students surveyed reported binge drinking in a two-week period, compared to 40 percent nationally. . . . . . .

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Indiana College Substance Use Survey

Key Findings

Eight in ten Indiana college students reported drinking alcohol in the past year, including three‐fourths of the students under 21 years of age. . . . . .

Three‐fourths (74.6%) of the Indiana students reported using alcohol in the past month, compared to 69% nationally (Johnston et al., 2009). . . . . .

In Indiana, almost half of the students surveyed reported binge drinking in the past two weeks, with male students reporting statistically higher rates than female students. . . . . .

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24-hour drinking 'leaves police dangerously stretched,' warns assistant chief constable

The introduction of 24-hour drinking has backfired as alcohol-fuelled disorder in cities now persists throughout the night leaving police dangerously stretched, an assistant chief constable has warned.

Garry Shewan, of Greater Manchester Police (GMP), called for the legislation to be reversed.

He also warned of the "real risks" associated with recession-busting all-you-can drink "Carnage" nights and cheap alcohol in supermarkets that people buy to get drunk before going out. . . . . . . .

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Increasing the involvement of family members in alcohol and drug treatment services: The results of an action research project in two specialist agenc

An evaluation of a two-year project that aimed to move the practice of two specialist substance misuse treatment teams towards greater involvement of family members.

The conclusion is drawn that the project was successful in changing team practice in the desired direction: by the end of the project both teams were capable of acting as demonstration sites for family-oriented alcohol and drug problems treatment.

The paper includes details of the family work conducted and its perceived benefits. Also discussed are the initial barriers to family involvement, a number of issues that remained unresolved, and the question of whether such changes are sustainable.

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Fancy a pint?: Alcohol use and smoking in soap operas

This study examined the frequency and portrayal of alcohol use and smoking in soap operas aired on British nonsatellite television.

Fifty-four hours of programing were analyzed, monitoring the type of alcohol act, who was carrying it out, and why, where, and what consequences of the acts were depicted.

Results supported previous findings that illustrate the prominent use of alcohol in popular soaps. More than 90% of the episodes viewed included some alcohol-related acts, with an average of 7.65 acts per episode, most of which were shown without any consequences. Female characters were drinking alcohol more often than expected and were also more likely to drink at home as a short-term means of coping. Alternatively, male characters were more often depicted as social drinkers, with more drinking inside pubs than expected.

The frequency of smoking was also investigated. This was rarely shown in the episodes viewed, with 82.41% of the episodes containing no smoking acts. Eastenders accounted for 78.57% of all smoking acts but even this soap only had, on average, 32 s per episode of smoking in the foreground.

Implications of the findings are discussed with regards to the possible influence on the socialization of younger viewers.

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The latent structure of alcohol dependence in female federal prisoners

Results obtained from a structured interview of substance abuse diagnoses were subjected to taxometric analysis in a group of 459 low and minimum security female federal prisoners applying for admission to a comprehensive drug treatment program.

Drawing indicators from a DSM-IV diagnosis of alcohol dependence (tolerance/withdrawal, loss of control, negative social/psychological consequences) the authors conducted a taxometric analysis using the following procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIG), and latent mode factor analysis (L-Mode).

Results were generally consistent with taxonic (categorical) latent structure for a DSM-IV diagnosis of alcohol dependence.

The implications and limitations of this study are examined and recommendations for future research are offered.

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Who receives confrontation in recovery houses and when is it experienced as supportive?

The Alcohol and Drug Confrontation Scale (ADCS) is a 72-item instrument that measures a construct of confrontation defined as warnings about potential harm associated with alcohol and drug use.

This analysis describes the characteristics of individuals entering residential recovery homes (N = 323) who received confrontation and when it was experienced as supportive.

A large proportion reported receiving at least one confrontational statement (80%), most commonly from family/friends (71%). Individuals who did and did not receive confrontation did not differ by demographics, but those receiving confrontation had more recent substance use, higher perceived costs of sobriety and more severe family and psychiatric problems. Differences were noted in confrontation from the criminal justice system versus family/friends.

Overall, residents experienced confrontation as supportive regardless of who confronted them. Residents who experienced confrontation the most helpful were those with higher levels of substance use and those who believed maintaining sobriety would be difficult.

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Denial in alcohol and other drug use disorders: A critique of theory

Despite the centrality of the construct in the field of alcohol and other drug (AOD) addiction, denial remains poorly conceptualized. One reason for this narrow conceptualization is the recent unilateral devotion to the Transtheoretical Model (TTM).

In an effort to demonstrate denial's theoretical complexity, the TTM and five additional intuitively appealing theories of denial will be summarized. The strengths and weaknesses of each theory and possible treatment implications based on each theory will also be presented.

The article concludes with a recommendation for future research to evaluate multiple theories of denial using consistent and rigorous research methodology in order to develop a comprehensive theory of denial. This will promote evolution of the deductive research process, and eventually lead to the development of empirically generated interventions which address the complex nature and etiology of denial.

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Industry Drug and Alcohol Testing Program

The Omnibus Transportation Employee Testing Act of 1991 requires drug and alcohol testing of safety-sensitive transportation employees in aviation.

The Drug Abatement Division develops and implements regulations for DOT/FAA drug and alcohol testing. These regulations cover employers, safety-sensitive employees and service agents. These rules are encompassed in 49 Code of Federal Regulations (CFR) Part 40 and 14 CFR Part 120.

The division also oversees the aviation industry’s compliance with drug and alcohol testing regulations. This oversight is accomplished with on-site inspections, guidance documents, and policies.

A Message from the Secretary: Why this Program is so
Important (PDF)

News Release - FDA To Look Into Safety of Caffeinated Alcoholic Beverages Agency Sends Letters to Nearly 30 Manufacturers

The Food and Drug Administration today notified nearly 30 manufacturers of caffeinated alcoholic beverages that it intends to look into the safety and legality of their products.

“The increasing popularity of consumption of caffeinated alcoholic beverages by college students and reports of potential health and safety issues necessitates that we look seriously at the scientific evidence as soon as possible,” said Dr. Joshua Sharfstein, principal deputy commissioner of food and drugs.

Of the combined use of caffeine and alcohol among U.S. college students in the few studies on this topic, the prevalence was as high as 26 percent.

Under the Federal Food, Drug, and Cosmetic Act, a substance added intentionally to food (such as caffeine in alcoholic beverages) is deemed “unsafe” and is unlawful unless its particular use has been approved by FDA regulation, the substance is subject to a prior sanction, or the substance is Generally Recognized As Safe (GRAS). FDA has not approved the use of caffeine in alcoholic beverages and thus such beverages can be lawfully marketed only if their use is subject to a prior sanction or is GRAS. For a substance to be GRAS, there must be evidence of its safety at the levels used and a basis to conclude that this evidence is generally known and accepted by qualified experts. . . . . .

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Friday, November 13, 2009

You can cut back on alcohol

Seventy years ago, Bill Wilson -- the co-founder of Alcoholics Anonymous -- declared his powerlessness over alcohol in a book by the same name. The failed businessman contended that, as an alcoholic, he had to "hit bottom" before changing his life and that sobriety could only be achieved through complete abstention.

For generations, Americans took these tenets to be true for everyone. Top addiction experts are no longer sure.

They now say that many drinkers can evaluate their habits and -- using new knowledge about genetic and behavioral risks of addiction -- change those habits if necessary. Even some people who have what are now termed alcohol-use disorders, they add, can cut back on consumption before it disrupts education, ruins careers and damages health.

In short, say some of the nation's leading scientists studying substance abuse, humans travel a long road before they become powerless over alcohol -- and most never reach that point.

"We're on the cusp of some major advances in how we conceptualize alcoholism," says Dr. Mark Willenbring, director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism. The institute is the nation's leading authority on alcoholism and the major provider of funds for alcohol research. "The focus now is on the large group of people who are not yet dependent. But they are at risk for developing dependence."
. . . . . .

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The Content of Substance Abuse and Mental Health Counseling Reported by Patients in a National Survey

This study examined counseling content reported by a national sample of persons receiving care for alcohol, drug or mental health (ADM) problems in a year.

The sample included 2,722 individuals over 18 who reported past year mental health or substance abuse care or assessments in a nationally representative survey conducted in 2000–2001.

Counseling domains approximating commonly practiced or evidence-based approaches for depression, anxiety, or substance abuse were assessed.

Patient self-report may be one useful way of tracking whether components of standard therapies are implemented in practice.

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Correlates of Past Homelessness in the National Epidemiological Survey on Alcohol and Related Conditions

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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Establishment of a Low Birth Weight Registry and Initial Outcomes

The study was conducted to evaluate a regional, prospective database of information on mothers of low birth weight (LBW) infants.

The database informs on unidentified or under-reported modifiable risk factors from which evidence-based, targeted community intervention strategies could be designed to lower the rate of low birth weight in the region. The LBW Registry is based on informed consent, a semi-structured face-to-face (FTF) interview with the mother of the newborn LBW infant, medical record review, and birth certificate worksheet data collection.

High rates of modifiable risk factors among mothers of low birth weight infants (October 2007–October 2008) include smoking (44%), alcohol consumption (16%), and drug abuse (14%). Preconception vitamin use was low (34%). The reported use of fertility drugs in FTF interviews was notably higher than information reported on the birth certificate worksheets by the same set of interviewed mothers (5.4 vs. 1.5%), as was alcohol use during pregnancy (16 vs. 1.3%).

More than half (52%) of the mothers of low birth weight infants reported a vaginal or urinary tract infection during pregnancy. Additionally there were higher than average rates of unmarried mothers (62%), unintended pregnancies (67%), and Medicaid beneficiaries (57%). Mothers repeatedly expressed excessive demands in their lives, straining their coping abilities and resources.

The LBW Registry provides expanded local data on potentially modifiable risk factors to aid in designing targeted prevention and intervention strategies.

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Empirically supported religious and spiritual therapies

This article evaluated the efficacy status of religious and spiritual (R/S) therapies for mental health problems, including treatments for depression, anxiety, unforgiveness, eating disorders, schizophrenia, alcoholism, anger, and marital issues.

Religions represented included Christianity, Islam, Taoism, and Buddhism. Some studies incorporated a generic spirituality.

Several R/S therapies were found to be helpful for clients, supporting the further use and research on these therapies. There was limited evidence that R/S therapies outperformed established secular therapies, thus the decision to use an R/S therapy may be an issue of client preference and therapist comfort.

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New Reports Highlight Important Gender Differences in Substance Use and Mental Health for Adolescents in Each State and the District of Columbia

The Substance Abuse and Mental Health Services Administration (SAMHSA) has developed 52 new short reports providing key information about the level of substance use and mental health problems and treatment among adolescents (age 12 to 17 years) in each state, the District of Columbia and for the country as a whole. The reports provide first-of-a-kind, state–by–state breakdowns by gender on substance abuse and mental health problems experienced by adolescents. In addition, the reports provide data on adolescent treatment facilities and admission factors for each state, the District of Columbia and for the country as a whole.

“These reports provide state and local authorities vital information about substance using behaviors and service needs of adolescents in their communities,” said SAMHSA Acting Administrator Eric Broderick, D.D.S., M.P.H. “The public health community can use these data to develop programs targeted to the specific needs of adolescent boys and girls.”

Entitled Adolescent Behavioral Health: States in Brief, the reports provide the following information for each individual state, the District of Columbia and the country as a whole through a variety of charts, graphs and accompanying text:

  • Adolescents’ risk perceptions associated with substance use
  • Prevalence of illicit substance and alcohol use
  • Number and type of substance abuse treatment facilities
  • Numbers and trends on those seeking treatment for substance abuse
  • Levels of those needing, but not receiving substance abuse treatment
  • Levels of underage smoking
  • Mental health indicators

The data included in these States in Brief reports are drawn from three large national surveys sponsored by SAMHSA - the National Survey on Drug Use and Health, the Treatment Episode Data Set and the National Survey on Substance Abuse Treatment Services.

These reports are available on the web at


Combined effects of alcohol and hepatitis C: A secondary analysis of alcohol use biomarkers and high-risk behaviors from two medication trials for al

The goal of this secondary analysis was to examine the combined effects of HCV infection and recent alcohol use on baseline biologic markers of alcohol consumption in two outpatient medication trials for alcohol dependence. In addition, the relationship between Hepatitis C virus (HCV) infection and behavioral risk factors for HCV infection in these clinical populations were examined.

Although groups had differing sociodemographic profiles (as indicated by race, marital status, level of education) subjects in Study I exhibited no statistically significant differences from the Study II cohort in HCV prevalence , lifetime history of injection drug use , lifetime history of needle sharing. As such, the data from both studies were analyzed together. Regardless of drinking status, HCV infection was significantly associated with an upward shift in the baseline level of ALT, AST, and GGT and a downward shift in baseline CDT . When using standard laboratory cutoff values to determine clinically significant elevations, HCV seropositivity was significantly associated with elevations in ALT, AST, GGT , and with decreases in CDT .

These data emphasize the importance of evaluating HCV infection and HCV risk behaviors at intake in medication trials for alcohol dependence and also raise questions regarding the use of cutoff scores for ALT, AST, GGT and CDT levels as biologic markers of alcohol use in subjects when HCV status is unknown.

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Drinking motives, drinking restraint and drinking behaviour among young adults

Motives to drink alcohol are widely thought to be the proximal cognitive factors involved in the decision to consume alcohol beverages. However it has also been argued that the ability to restrain drinking may be a more proximal predictor of drinking behaviour.

The current study aimed to examine the relationships between drinking motives, drinking restraint and both alcohol consumption and alcohol-related problems in a sample of young adults. A sample of 221 young adults (aged 17–34 years) completed self-report measures assessing drinking behaviour, motives for drinking and drinking restraint.

Multiple regression analyses revealed that coping, enhancement and social motives were related to alcohol consumption and alcohol-related problems, while Cognitive and Emotional Preoccupation with drinking was related to all criterion variables. Further, the relationship between coping motives and drinking behaviour was mediated by preoccupation with drinking.

The results are discussed in light of the roles of drinking motives and drinking restraint in risky drinking among young people, and implications for prevention and early intervention are presented.

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Alcohol cue reactivity task development

The physiological and cognitive reactions provoked by alcohol cues, as compared to non-alcohol cues, can predict future drinking. Alcohol cue reactivity tasks have been developed; however, most were created for use with alcohol use disordered individuals and utilize limited or only partially standardized stimuli.

This project systematically created an alcohol cue reactivity task for studies with non-drinkers, using well-characterized stimuli.

The long-term objectives of this project are to utilize this task with non-drinking youth to investigate how reactivity to alcohol stimuli may predict alcohol use initiation and escalation, to help identify the role of exposure to alcohol stimuli on the subsequent development of alcohol-related problems.

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A cognitive model for the intergenerational transference of alcohol use behavior

A family history of alcoholism has shown to be one of the greatest consistent risk factors in the intergenerational transference of alcohol problems. Whereas a large number of studies have attempted to identify the processes responsible for this interfamilial transfer, the mechanisms remain unclear.

Family, twin and adoption studies, and environmental theories have resulted in a number of unanswered questions regarding the extent that these factors influence the transmission of alcohol behavior. Recently, cognitive theories have suggested that the observation of parental drinking habits contributes to the child's beliefs and expectations of alcohol's effects.

A hypothesised cognitive model will be proposed suggesting that the mechanism for the transference of particular drinking styles from parent to offspring may be further explained by the transference of alcohol cognitions, in particular, alcohol expectancies and drinking refusal self-efficacy.

This review focuses on research of bio/psycho/social factors that perpetuate alcohol misuse across generations, and will delineate the proposed cognitive mechanisms for the interfamilial transference of alcohol problems and discuss the implications of the proposed model.

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Deficits in amygdaloid cAMP-responsive element–binding protein signaling play a role in genetic predisposition to anxiety and alcoholism

We investigated the role of cAMP-responsive element–binding protein (CREB) in genetic predisposition to anxiety and alcohol-drinking behaviors using alcohol-preferring (P) and -nonpreferring (NP) rats.

The levels of CREB, phosphorylated CREB, and neuropeptide Y (NPY) were innately lower in the central amygdala (CeA) and medial amygdala (MeA), but not in the basolateral amygdala (BLA), of P rats compared with NP rats. P rats displayed higher baseline anxiety-like behaviors and consumed higher amounts of alcohol compared with NP rats.

Ethanol injection or voluntary intake reduced the higher anxiety levels in P rats. Ethanol also increased CREB function in the CeA and MeA, but not in the BLA, of P rats.

Infusion of the PKA activator Sp-cAMP or NPY into the CeA decreased the alcohol intake and anxiety-like behaviors of P rats. PKA activator infusion also increased CREB function in the CeA of P rats.

On the other hand, ethanol injection or voluntary intake did not produce any changes either in anxiety levels or on CREB function in the amygdaloid structures of NP rats. Interestingly, infusion of the PKA inhibitor Rp-cAMP into the CeA provoked anxiety-like behaviors and increased alcohol intake in NP rats. PKA inhibitor decreased CREB function in the CeA of NP rats.

These novel results provide the first evidence to our knowledge that decreased CREB function in the CeA may be operative in maintaining the high anxiety and excessive alcohol-drinking behaviors of P rats.

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Minimum pricing needed now, argues Lib Dem MP

Blaming pubs for the problems of “Binge Britain” is often wrong and minimum pricing is now the best way to tackle “pocket money” off-trade prices, according to a senior Liberal Democrat.

Don Foster, Lib Dem shadow culture secretary, slammed the supermarkets’ policy on alcohol and pledged his support for pubs, during the Business In Sport and Leisure conference today in London.

“There is no doubt that Booze Britain is causing real problems… but far too often the problems are laid at the door of hard pushed pub landlords and club owners,” he said. . . . . . .

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Alcohol use and related harms in school students in the USA and Australia

Recognizing there have been few methodologically rigorous cross-national studies of youth alcohol and drug behaviour, state student samples were compared in Australia and the USA.

Sampling methods were
matched to recruit two independent, state-representative, cross-sectional samples of students in Grades 5, 7 and 9 in Washington State, USA, (n = 2866) and Victoria, Australia (n = 2864) in 2002.

Of Washington students in Grade 5 (age 11), 10.3% (95% CI 7.2–14.7) of boys and 5.2% (95% CI 3.4–7.9) of girls reported alcohol use in the past year. Prevalence rates were markedly higher in Victoria (34.2%, 95% CI 28.8–40.1 boys; 21.0%, 95% CI 17.1–25.5 girls).

Relative to Washington, the students
in Victoria demonstrated a two to three times increased likelihood of reporting substance use (either alcohol, tobacco or illicit drug use), and by Grade 9, experiences of loss-of-control of alcohol use, binge drinking (frequent episodes of five or more alcoholic drinks), and injuries related to alcohol were two to four times higher. The high rates of early age alcohol use in Victoria were associated with frequent, heavy and harmful alcohol use and higher overall exposure to alcohol or other drug use.

These findings reveal considerable variation in international
rates of both adolescent alcohol misuse and co-occurring drug use and suggest the need for cross-national research to identify policies and practices that contribute to the lower rate of adolescent alcohol and drug use observed in the USA in this study.

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Cluster-randomized Controlled Trial of Dissemination Strategies of an Online Quality Improvement Programme for Alcohol-related Disorders

This project investigated different dissemination strategies of an online quality improvement programme for alcohol-related disorders into routine care in South Baden and South Württemberg in Germany.

Two thousand six hundred and forty-seven practitioners were asked to take part in the study, and it was possible to randomize 112 (4%) practices. There were no significant differences concerning the use of the system between the groups: 41.9% of the GPs in the first group, 42.9% in the second group and 44.4% in the control group used the system. In terms of only the system users, 55.6% of the GPs in the first group, 33.3% in the second group and 8.3% in the control group used the system six times or more (P = 0.019). Diagnostic assessments made by the GPs in the groups differed substantially: 72.2% of diagnoses in the first group were correct, while this figure lay at 69.7% in the second group and 36.4% in the control group (P = 0.034)

No effect of the additional training on the primary outcome (acceptance) was identified, but on two of the secondary outcomes. Further cost-effectiveness studies should investigate whether the effort involved in providing training additionally to the system is justifiable.

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Planned and Unplanned Discharge from Alcohol Services in Scotland, 2004–2008

Available data suggests that the rate of unplanned discharge from alcohol treatment services is an international problem reflective, perhaps, of ambivalence surrounding treatment in general. Given Scotland's escalating prevalence of alcohol misuse, a preliminary study of Scottish dropout rates would make a useful contribution to the international scene.

Of 48,299 cases, 52.23% (n = 25,231) were unplanned discharges. Data showed a general increasing trend in the rate of planned discharges across the examined 4-year period, from 41.66% in 2004–2005 to 51.94% in 2007–2008. Inspection of the data revealed marked regional variations in ratios of planned to unplanned discharge, with only four of the 10 regions examined reporting a planned discharge rate >50%.

More than one of every two entries to alcohol misuse services between 2004 and 2008 resulted in an unplanned discharge. The trend of improvement over the examined 4-year period was not consistent for all regions. A comparison of this figure with available US and Welsh data is made. The importance of these data in assessing the cost-effectiveness of alcohol treatment services and implications for policy making is discussed.

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Thursday, November 12, 2009


The European Sponsorship Association (ESA) has seen the promotional release from the journal 'Addiction' and wishes to clarify a number of points.

ESA is the trade body representing the sponsorship industry in Europe. The Association's 240 members include sports governing bodies, arts companies, sports clubs, sponsorship consultancies, suppliers to the sector and also sponsors. Sponsor members include brands such as Visa, Coca-Cola, McDonald’s, National Express, Guardian Newspapers, Aviva and Castrol.

ESA has a number of drinks industry members which account for three percent of its membership. The Association's agenda is independent as it looks after the benefits of sponsorship in general and its views are not set by the drinks sector.

Karen Earl, ESA Chairman, acknowledges that the alcohol sector is an important source of sponsorship revenue and says that ESA is highly mindful of the way that alcohol sponsorship has become linked in the press and in some people's minds with problem drinking. . . . . .

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Press Release - Athletes on performance enhancers more likely to abuse alcohol, other drugs

PISCATAWAY, NJ – College athletes who use performance-enhancing substances may be at heightened risk of misusing alcohol and using recreational drugs as well, according to new research in the Journal of Studies on Alcohol and Drugs.

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Rethinking “community”: addiction, recovery, and globalisation

The notion of “community” is central to the thought, philosophy, and practice of the emerging recovery movement.

This presentation explores how the processes of globalisation engender reconfigured conceptions of “community” and how this reconfiguration impacts on the recovery movement.

To do this, I will argue that the capitalisation of the addict in the treatment economy (a corollary of the first-cause of globalisation, the free market) has resulted in the subjugation of “recovery knowledge” and that grassroots communities of recovery represent key sites of resistance against this totalising, reductive trend.

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Role of the GABAB receptor system in alcoholism and stress: focus on clinical studies and treatment perspectives

Alcoholism and stress share some common neurobiological circuits, including the GABAergic system. In particular, the GABAB receptor seems to play an important role.

The GABAB receptor agonist baclofen has been studied as a treatment for alcohol-dependent subjects. Baclofen administration in alcohol-dependent patients was able to promote abstinence, inducing the remission of withdrawal symptoms, reducing alcohol craving, and reducing alcohol intake.

Baclofen also reduced anxiety in alcohol-dependent subjects, probably acting on brain stress circuitry and/or on other neuroendocrine systems. Baclofen also showed excellent safety and tolerability, even in alcohol-dependent patients with advanced liver disease (i.e., cirrhosis).

Future studies should investigate which alcoholic subtype may better benefit of the administration of baclofen in the treatment of alcohol dependence.

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Role of the GABAB receptor in alcohol-seeking and drinking behavior

The present paper summarizes experimental data demonstrating the reducing effect of direct agonists and positive allosteric modulators (PAMs) of the γ-aminobutyric acidB (GABAB) receptor on different alcohol-related behaviors.

Different lines of evidence indicate that direct agonists, including baclofen, effectively suppress acquisition and maintenance of alcohol drinking behavior, relapse-like drinking, and alcohol's reinforcing, rewarding, stimulating, and motivational properties in rats and mice.

More recently, the discovery of a positive allosteric modulatory binding site, together with the synthesis of in vivo effective ligands, opened a new avenue of research in GABA
B pharmacology.

Accumulating lines of evidence suggest that PAMs retain baclofen's capcity to suppress alcohol consumption and alcohol's reinforcing and motivational properties in rats; these effects occur at doses far from those producing behavioral toxicity.

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Contribution of early environmental stress to alcoholism vulnerability

The most problematic aspects of alcohol abuse disorder are excessive alcohol consumption and the inability to refrain from alcohol consumption during attempted abstinence. The root causes that predispose certain individuals to these problems are poorly understood but are believed to be produced by a combination of genetic and environmental factors.

Early environmental trauma alters neurodevelopmental trajectories that can predispose an individual to a number of neuropsychiatric disorders, including substance abuse. Prenatal stress (PNS) is a well-established protocol that produces perturbations in nervous system development, resulting in behavioral alterations that include hyperresponsiveness to stress, novelty, and psychomotor stimulant drugs (e.g., cocaine, amphetamine).

Moreover, PNS animals exhibit enduring alterations in basal and cocaine-induced changes in dopamine and glutamate transmission within limbic structures, which exhibit pathology in drug addiction and alcoholism, suggesting that these alterations may contribute to an increased propensity to self-administer large amounts of drugs of abuse or to relapse after periods of drug withdrawal.

Given that cocaine and alcohol have actions on common limbic neural substrates (albeit by different mechanisms), we hypothesized that PNS would elevate the motivation for, and consumption of, alcohol. Accordingly, we have found that male C57BL/6J mice subject to PNS exhibit higher operant responding and consume more alcohol during alcohol reinforcement as adults.

Alterations in glutamate and dopamine neurotransmission within the forebrain structures appear to contribute to the PNS-induced predisposition to high alcohol intake and are induced by excessive alcohol intake.

Accordingly, we are exploring the interactions between neurochemical changes produced by PNS and changes induced by consumption of alcohol in adulthood to model the biological bases of high vulnerability to alcohol abuse.

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Stress, alcohol craving, and relapse risk: mechanisms and viable treatment targets

Article Outline
Stress and relapse to drug seeking: an update (Y. Shaham)

Role and treatment target potential of groups I and II metabotropic glutamate receptors in stress-induced drug seeking (F. Weiss)

Stress-induced reinstatement of alcohol seeking: studies with the α2 noradrenergic receptor antagonist yohimbine (A.D. Le)

A human laboratory model of risk factors for relapse in alcohol dependence and for predicting medication efficacy (B.J. Mason)

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Ethanol and acetaldehyde action on central dopamine systems: mechanisms, modulation, and relationship to stress

There has been a great deal of activity in recent years in the study of the direct effects of ethanol on the dopamine reward system originating in the ventral tegmental area (VTA). In addition, recent evidence suggests that acetaldehyde formed from ethanol in the brain or periphery may be a crucial factor in the central effects of ethanol.

This critical review examines the actions of ethanol and acetaldehyde on neurons of the VTA and the possible interactions with stress, with a focus on electrophysiological studies in vivo and in vitro.

Ethanol has specific effects on dopamine neurons and there is recent evidence that some of the in vivo and in vitro effects of ethanol are mediated by acetaldehyde. Stress has some analogous actions on neuronal activity in the VTA, and the interactions between the effects of stress and alcohol on VTA neurons may be a factor in ethanol-seeking behavior.

Taken together, the evidence suggests that stress may contribute to the activating effects of ethanol on dopamine VTA neurons, that at least some actions of ethanol on dopamine VTA neurons are mediated by acetaldehyde, and that the interaction between stress and alcohol could play a role in susceptibility to alcoholism.

The link between acetaldehyde and ethanol actions on brain reward pathways may provide a new avenue for the development of agents to reduce alcohol craving.

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The role of neuroactive steroids in ethanol/stress interactions: proceedings of symposium VII at the Volterra conference on alcohol and stress, May 20

This report summarizes the proceedings of the symposium VII on the role of neuroactive steroids in stress/alcohol interactions.

The production of GABAergic neuroactive steroids, including (3α,5α)-3-hydroxypregnan-20-one and (3α,5α)-3,21-dihydroxypregnan-20-one is a consequence of both acute stress and acute ethanol exposure. Acute, but not chronic ethanol administration elevates brain levels of these steroids and enhances GABAA receptor activity. Neuroactive steroids modulate acute anticonvulsant effects, sedation, spatial memory impairment, anxiolytic-like, antidepressant-like, and reinforcing properties of ethanol in rodents.

Furthermore, these steroids participate in the homeostatic regulation of the hypothalamic–pituitary–adrenal axis. Therefore, it is not surprising that neuroactive steroids are involved in ethanol/stress interactions. Nevertheless, the interactions are complex and not well understood.

This symposium addressed the role of neuroactive steroids in both stress and alcohol responses and their interactions. Professor Giovanni Biggio of the University of Cagliari, Italy presented the effects of juvenile isolation stress on neuroactive steroids, GABAA receptor expression, and ethanol sensitivity.

Professor Howard Becker of the Medical University of South Carolina, USA presented evidence for neuroactive steroid involvement in ethanol dependence and drinking behavior.

Professor Patrizia Porcu of the University of North Carolina, USA described a potential neuroactive steroid biomarker that may predict heavy drinking in monkeys and mice.

These presentations provide a framework for new theories on the nature of ethanol/stress interactions that may be amenable to therapeutic interventions.

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Neurobiological mechanisms contributing to alcohol–stress–anxiety interactions

This article summarizes the proceedings of a symposium that was presented at a conference entitled “Alcoholism and Stress: A Framework for Future Treatment Strategies.” The conference was held in Volterra, Italy on May 6–9, 2008 and this symposium was chaired by Jeff L. Weiner.

The overall goal of this session was to review recent findings that may shed new light on the neurobiological mechanisms that underlie the complex relationships between stress, anxiety, and alcoholism.

Dr. Danny Winder described a novel interaction between D1 receptor activation and the corticotrophin-releasing factor (CRF) system that leads to an increase in glutamatergic synaptic transmission in the bed nucleus of the stria terminalis.

Dr. Marisa Roberto presented recent data describing how protein kinase C epsilon, ethanol, and CRF interact to alter GABAergic inhibition in the central nucleus of the amygdala.

Dr. Jeff Weiner presented recent advances in our understanding of inhibitory circuitry within the basolateral amygdala (BLA) and how acute ethanol exposure enhances GABAergic inhibition in these pathways.

Finally, Dr. Brian McCool discussed recent findings on complementary glutamatergic and GABAergic adaptations to chronic ethanol exposure and withdrawal in the BLA.

Collectively, these investigators have identified novel mechanisms through which neurotransmitter and neuropeptide systems interact to modulate synaptic activity in stress and anxiety circuits. Their studies have also begun to describe how acute and chronic ethanol exposure influence excitatory and inhibitory synaptic communication in these pathways.

These findings point toward a number of novel neurobiological targets that may prove useful for the development of more effective treatment strategies for alcohol use disorders.

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Young Investigator Award Symposium

This article highlights the research presented at the inaugural meeting of Alcoholism and Stress: A Framework for future Treatment Strategies. This meeting was held on May 6–8, 2008 in Volterra, Italy. It is an international meeting dedicated to developing preventive strategies and pharmacotherapeutic remedies for stress- and alcohol-related disorders.

For the first time, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conferred a Young Investigator Award to promote the work of young researchers and highlight their outstanding achievements in the fields of addiction medicine and stress disorders.

The awardees were Dr. Katie Witkiewitz (University of Washington), Dr. Andrew Holmes (NIAAA), Dr. Lara A. Ray (Brown University), Dr. James Murphy (University of Memphis), and Dr. Heather Richardson (The Scripps Research Institute).

The symposium was chaired by Drs. Fulton Crews and Antonio Noronha.

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Stress-related neuropeptides and alcoholism: CRH, NPY, and beyond

This article summarizes the proceedings of a symposium held at the conference on “Alcoholism and Stress: A Framework for Future Treatment Strategies” in Volterra, Italy, May 6–9, 2008.

Chaired by Markus Heilig and Roberto Ciccocioppo, this symposium offered a forum for the presentation of recent data linking neuropetidergic neurotransmission to the regulation of different alcohol-related behaviors in animals and in humans.

Dr. Donald Gehlert described the development of a new corticotrophin-releasing factor receptor 1 antagonist and showed its efficacy in reducing alcohol consumption and stress-induced relapse in different animal models of alcohol abuse.

Dr. Andrey Ryabinin reviewed recent findings in his laboratory, indicating a role of the urocortin 1 receptor system in the regulation of alcohol intake.

Dr. Annika Thorsell showed data supporting the significance of the neuropeptide Y receptor system in the modulation of behaviors associated with a history of ethanol intoxication.

Dr. Roberto Ciccocioppo focused his presentation on the nociceptin/orphanin FQ (N/OFQ) receptors as treatment targets for alcoholism.

Finally, Dr. Markus Heilig showed recent preclinical and clinical evidence suggesting that neurokinin 1 antagonism may represent a promising new treatment for alcoholism.

Collectively, these investigators highlighted the significance of neuropeptidergic neurotransmission in the regulation of neurobiological mechanisms of alcohol addiction. Data also revealed the importance of these systems as treatment targets for the development of new medication for alcoholism.

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Relationship Between Potentially Modifiable Lifestyle Factors and Risk of Second Primary Contralateral Breast Cancer Among Women Diagnosed With Estrog

An outcome of considerable concern among breast cancer survivors is the development of second primary breast cancer. However, evidence regarding how potentially modifiable lifestyle factors modulate second breast cancer risk is limited.

We evaluated
the relationships between obesity, alcohol consumption, and smoking on risk of second primary invasive contralateral breast cancer among breast cancer survivors.

Our population-based study adds to the limited available literature and suggests that obesity, smoking, and alcohol consumption influence contralateral breast cancer risk, affording breast cancer survivors three means of potentially reducing this risk.

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Wednesday, November 11, 2009

Alcohol-Induced Psychotic Disorder: A Comparative Study on the Clinical Characteristics of Patients With Alcohol Dependence and Schizophrenia

Alcohol-induced psychotic disorder (AIPD) is a rare complication of excessive alcohol use for which limited comparative studies are available. The aim of this study was to prospectively investigate demographic and psychopathological characteristics in patients with AIPD, schizophrenia, and uncomplicated alcohol dependence.

We postulated that AIPD is a discrete clinical entity that can be differentiated from schizophrenia and uncomplicated alcohol dependence by means of standardized clinical assessments.

Patients with AIPD had a significantly lower educational level, later onset of psychosis, higher levels of depressive and anxiety symptoms, fewer negative and disorganized symptoms, better insight and judgment, and less functional impairment compared with patients with schizophrenia.

The study provides further supportive evidence that AIPD can be clinically distinguished from schizophrenia.

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