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Saturday, November 28, 2009
27th November 2009:
A new report released today by the Alcohol Education and Rehabilitation Foundation (AER), indicates one‐third of alcohol‐related admissions to public hospitals in a NSW Area Health Service (Sydney South West Area Health Service) were potentially lifethreatening, and a further 46.7% were considered potentially serious. 17% of the respondents stated they had been drinking in the six hours prior to their injury and 7.1% of these stated that their injury had been caused by another person. . . . . . .
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Translating the neuroscience of alcoholism into clinical treatments: From blocking the buzz to curing the blues
Understanding the pathophysiology of addictive disorders is critical for development of new treatments.
A major focus of addiction research has for a long time been on systems that mediate acute positively reinforcing effects of addictive drugs, most prominently the mesolimbic dopaminergic (DA) system and its connections. This research line has been successful in shedding light on the physiology of both natural and drug reward, but has not led to therapeutic breakthroughs. The role of classical reward systems is perhaps least clear in alcohol addiction.
Here, recent work is summarized that points to some clinically important conclusions. First, important pharmacogenetic differences exist with regard to positively reinforcing effects of alcohol and the ability of this drug to activate classical reward pathways. This offers an opportunity for personalized treatment approaches in alcoholism.
Second, brain stress and fear systems become pathologically activated in later stages of alcoholism and their activation is a major influence in escalation of alcohol intake, sensitization of stress responses, and susceptibility to relapse.
These findings offer a new category of treatment mechanisms. Corticotrophin-releasing hormone (CRH) signaling through CRH1 receptors is a major candidate target in this category, but recent data indicate that antagonists for substance P (SP) neurokinin 1 (NK1) receptors may have a similar potential.
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Women’s perceptions of their husband’s drinking behavior as a risk factor of their health-related quality of life in the postpartum period
The objective of this study is to investigate the association between women’s perceptions of their husband’s drinking behavior and their health-related quality of life (HRQOL) in the postpartum period.
Our study adds evidence supporting the negative association between of husbands’ alcohol drinking and their wives’ health as measured by the SF-36 HRQOL, especially for mental health.
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314 cases of combined cerebro-cranial trauma and posttraumatic intracranial hematomas were identified of which ethanol was detected in 114 hematomas. The other investigative group was 103 hospitalized patients who had hematomas evacuated during neurosurgical procedures. In 62 of these cases ethanol was detected. Blood and urine samples were also collected and the alcohol concentration was determined in all specimens by GC and ADH.
The ethanol elimination rate for autopsy and operative intracranial hematomas was approximately 0.07–0.08‰/h(±0.034‰/h). The elimination rate of ethanol from blood (β60) was about two or three times greater as that from hematomas. Because of the different water content of intracranial hematomas from blood, it was necessary to adjust the ethanol concentration for water content.
On the basis of the corrected ethanol concentrations and the elimination rates for both tissues it was possible to estimate the ethanol concentration at the time of injury. Intracranial hematomas are tissues of possible value in the determination of alcohol intoxication especially in alcoholism.
Ethanol can be found in hematomas even after 72h from head injury.
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Moderate alcohol consumption has been reported to be associated with lower risk for both cardiovascular disease and type 2 diabetes.
An explanation for these epidemiologic observations is not entirely clear. Alcohol raises high-density lipoprotein (HDL) cholesterol levels. Other potential beneficial mechanisms have been proposed including anti-inflammatory and anti-thrombotic effects.
The association between moderate alcohol consumption and insulin sensitivity is still under debate. Possible mechanisms include elevation of adiponectin level, reduction of C-reactive protein and suppression of free fatty acid release from adipose tissue.
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America is a country that worships personal tales of redemption. If public figures are caught out drunk or on drugs, cheating on their wives, then they quickly head off to Betty Ford or Hazelden, apologize to their families and constituents, and promise not to stray or drink again. And we forgive them. . . . . . .
Friday, November 27, 2009
Increased ethanol intake, a major predictor for the development of alcohol use disorders, is facilitated by the development of tolerance to both the aversive and pleasurable effects of the drug. The molecular mechanisms underlying ethanol tolerance development are complex and are not yet well understood.
Enrichment for genes in metabolism, nucleic acid binding, olfaction, regulation of signal transduction, and stress suggests that these biological processes are coordinately affected by ethanol exposure. We also detected a coordinate up-regulation of genes in the Toll and Imd innate immunity signal transduction pathways. A multi-study comparison revealed a small set of genes showing similar regulation, including increased expression of 3 genes for serine biosynthesis. A survey of Drosophila strains harboring mutations in ethanol-regulated genes for ethanol sensitivity and tolerance phenotypes revealed roles for serine biosynthesis, olfaction, transcriptional regulation, immunity, and metabolism. Flies harboring deletions of the genes encoding the olfactory co-receptor Or83b or the sirtuin Sir2 showed marked changes in the development of ethanol tolerance.
Our findings implicate novel roles for these genes in regulating ethanol behavioral responses
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More than 3.8 million adults in England are misguidedly trying to burn off the booze with exercise, according to new research published today.
A YouGov survey, on behalf of the Know Your Limits campaign shows that 19 percent of adults in England who exercise regularly and drink alcohol admit to taking exercise or playing sport in order to 'make up' for having drunk a lot of alcohol in the previous few days. . . . . .
The purpose of this Overview is to compile and analyse the available data on the social consequences of harmful use of alcohol in Ireland. The methods used involved a combination of archival data, survey research results and research literature.
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Information on the economic impact of alcohol consumption can provide important evidence in supporting policies to reduce its associated harm. To date, several studies on the economic costs of alcohol consumption have been conducted worldwide. This study aims to review the economic impact of alcohol worldwide, summarizing the state of knowledge with regard to two elements: (1) cost components included in the estimation; (2) the methodologies employed in works conducted to date.
Discrepancies in the estimation method and cost components included in the analyses limit a direct comparison across studies. The findings, however, consistently confirmed that the economic burden of alcohol on society is substantial. Given the importance of this issue and the limitation in generalizing the findings across different settings, further well-designed research studies are warranted in specific countries to support the formulation of alcohol-related policies.
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The Effectiveness of Limiting Alcohol Outlet Density As a Means of Reducing Excessive Alcohol Consumption and Alcohol-Related Harms
The density of alcohol outlets in communities may be regulated to reduce excessive alcohol consumption and related harms. Studies directly assessing the control of outlet density as a means of controlling excessive alcohol consumption and related harms do not exist, but assessments of related phenomena are indicative.
To assess the effects of outlet density on alcohol-related harms, primary evidence was used from interrupted time–series studies of outlet density; studies of the privatization of alcohol sales, alcohol bans, and changes in license arrangements—all of which affected outlet density.
Most of the studies included in this review found that greater outlet density is associated with increased alcohol consumption and related harms, including medical harms, injury, crime, and violence. Primary evidence was supported by secondary evidence from correlational studies.
The regulation of alcohol outlet density may be a useful public health tool for the reduction of excessive alcohol consumption and related harms.
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Tuesday, November 24, 2009
Prevention research concerning alcohol, tobacco and other drugs faces a number of challenges as the scientific foundation is strengthened for the future.
Seven issues which the prevention research field should address are discussed: lack of transparency in analyses of prevention program outcomes, lack of disclosure of copyright and potential for profit/income during publication, post-hoc outcome variable selection and reporting only outcomes which show positive and statistical significance at any follow-up point, tendency to evaluate statistical significance only rather than practical significance as well, problem of selection bias in terms of selecting subjects and limited generalizability, the need for confirmation of outcomes in which only self-report data are used and selection of appropriate statistical distributions in conducting significance testing.
In order to establish a solid scientific base for alcohol, tobacco and drug prevention, this paper calls for discussions, disclosures and debates about the above issues (and others) as essential. In summary, the best approach is always transparency.
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Evidence of a complex association between dose, pattern and timing of prenatal alcohol exposure and child behaviour problems
There is a lack of evidence regarding the effect of dose, pattern and timing of prenatal alcohol exposure and behaviour problems in children aged 2 years and older.
Prenatal alcohol exposure at moderate and higher levels increased the odds of child behaviour problems with the dose, pattern and timing of exposure affecting the type of behaviour problems expressed. Larger studies with more power are needed to confirm these findings.
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Alcohol Consumption and Lung Cancer Risk in the Environment and Genetics in Lung Cancer Etiology (EAGLE) Study
The authors investigated the relation between alcohol consumption and lung cancer risk in the Environment and Genetics in Lung Cancer Etiology (EAGLE) Study, a population-based case-control study.
Overall, both nondrinkers and very heavy drinkers (60 g/day) were at significantly greater risk than very light drinkers (0.1–4.9 g/day). The alcohol effect was modified by smoking behavior, with no excess risk being observed in never smokers.
In summary, heavy alcohol consumption was a risk factor for lung cancer among smokers in this study. Although residual confounding by tobacco smoking cannot be ruled out, this finding may reflect interplay between alcohol and smoking, emphasizing the need for preventive measures.
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Developmental toxicity of ethanol in chick heart in ovo and in micromass culture can be prevented by addition of vitamin C and folic acid.
The teratogenic effects of ethanol include malformations of the cardiovascular system, which may be abrogated by multivitamin therapy.
Chick cardiomyocytes in micromass culture were treated with ethanol alone or with supplementation with folate or vitamin C. Ethanol alone caused a loss of cell viability and differentiation (beating) whereas those cells treated in addition with vitamins were comparable to the control. Chick embryos were injected on day 3 of incubation with PBS, ethanol alone or with additional vitamin C or folic acid. On day 9 embryos were examined for viability, growth retardation and gross malformation and the hearts were processed for histology.
Results showed that ethanol significantly decreased survival of embryos or caused growth retardation and gross malformation (p<0.05). class="bioentity" bioid="drg_pubchem_cid235_none_1|true" biotype="drug|None">vitamin C or folic acid were comparable to the control.
Data obtained in this study suggest that supplementation with vitamin C or folic acid during pregnancy may prevent defects in heart development brought about by ethanol.
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MSPs at Holyrood are to be told at what level the Scottish Government intends to set the minimum price for alcohol but only during the Parliamentary passage of the legislation.
The Scottish Government has made clear that it will not set the minimum price when it publishes its Bill on Alcohol Misuse on Thursday. However, sources have emphasised that MSPs will be told as the legislation makes its way through Parliament.
The reason for the change of mind by ministers is a technical one. The sources say that if the minimum price level was on the face of this week’s Bill, any future change to the level would have to be subject to further primary legislation. In effect, this means that minimum pricing will be established in the Bill as a principle but the specific level will be covered in future by “enabling” or secondary legislation. . . . . .
Binge drinking is a matter of current social, political and media concern. It has a long-term, but also a recent, history.
This paper discusses the contemporary history of the concept of binge drinking. In recent years there have been significant changes in how binge drinking is defined and conceptualised. Going on a ‘binge’ used to mean an extended period (days) of heavy drinking, while now it generally refers to a single drinking session leading to intoxication.
We argue that the definitional change is related to the shifts in the focus of alcohol policy and alcohol science, in particular in the last two decades, and also in the role of the dominant interest groups.
The paper is a case study in the relationship between science and policy. We explore key themes, raise questions and point to a possible agenda for future research.
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Monday, November 23, 2009
Ethanol is one of the most widely used drugs in western society and worsens obstructive sleep apnea in humans. There are no studies, however, that distinguish between two primary mechanisms that could mediate suppression of genioglossus activity with ethanol.
We test the hypothesis that ethanol suppresses genioglossus activity by effects at the hypoglossal motor pool and/or by state-dependent regulation of motor activity via independent influences on sleep/arousal processes.
These data show that ethanol can suppress genioglossus by primary influences on state-dependent aspects of central nervous system function independent of effects on the respiratory network per se, a distinction not previously identified experimentally.
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Variance-components methods for linkage and association analysis of ordinal traits in general pedigrees.
Many complex human diseases such as alcoholism and cancer are rated on ordinal scales. Well-developed statistical methods for the genetic mapping of quantitative traits may not be appropriate for ordinal traits.
We propose a class of variance-component models for the joint linkage and association analysis of ordinal traits. The proposed models accommodate arbitrary pedigrees and allow covariates and gene-environment interactions. We develop efficient likelihood-based inference procedures under the proposed models. The maximum likelihood estimators are approximately unbiased, normally distributed, and statistically efficient.
Extensive simulation studies demonstrate that the proposed methods perform well in practical situations. An application to data from the Collaborative Study on the Genetics of Alcoholism is provided.
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A new study from Perth's Telethon Institute for Child Health Research has found evidence that the amount and timing of alcohol consumption in pregnancy affects child behaviour in different ways.
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Acute ethanol administration increases striatal dopamine release and decreases cerebral glucose metabolism. The A1 allele of the ANKK1 TaqIa polymorphism is associated with lower dopaminergic tone and greater risk for alcoholism, but the mechanisms are unclear.
We hypothesized that ethanol would be more reinforcing in men with the A1 allele (A1+) than in men without it (A1−), as indicated by decreased anxiety and fatigue and altered activity in associated brain regions.
In a pilot study, A1+ and A1− men (6/group) drank ethanol (0.75 ml/kg) or placebo beverages on each of 2 days. Positron emission tomography with [F-18]fluorodeoxyglucose (FDG) was used to assess regional cerebral glucose metabolism as a measure of relative brain activity while participants performed a vigilance task.
Significant findings were as follows: Ethanol decreased anxiety and fatigue in A1+ men but increased them in A1– men. Ethanol increased activity in the striatum and insula of A1+ men, but reduced activity in the anterior cingulate of A1– men. Reduced anxiety and fatigue in A1+ men were significantly associated with greater activity within a right orbitofrontal region previously implicated in cognitive control, and less activity in structures associated with anxiety (amygdala), fatigue (thalamus), and craving/reinforcement (striatum). In contrast, anxiety and fatigue changes were unrelated to brain activity in A1− men.
Although these results require replication in a larger sample, alcohol-induced negative reinforcement may explain the greater risk for alcoholism associated with the A1 allele.
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Sunday, November 22, 2009
Integrated Management of Physician-delivered Alcohol Care for Tuberculosis Patients: Design and Implementation
While the integration of alcohol screening, treatment, and referral in primary care and other medical settings in the U.S. and worldwide has been recognized as a key health care priority, it is not routinely done. In spite of the high co-occurrence and excess mortality associated with alcohol use disorders (AUDs) among individuals with tuberculosis (TB), there are no studies evaluating effectiveness of integrating alcohol care into routine treatment for this disorder.
Utilizing an iterative, collaborative approach, a multi-disciplinary U.S. and Russian team has implemented a model of alcohol management that is culturally appropriate to the patient and TB physician community in Russia. Implementation to date has achieved the integration of routine alcohol screening into TB care in Tomsk; an ethnographic assessment of knowledge, attitudes, and practices of AUD management among TB physicians in Tomsk; translation and cultural adaptation of the BCI to Russia and the TB setting; and training and certification of TB physicians to deliver oral naltrexone and brief counseling interventions for alcohol abuse and dependence as part of routine TB care. The study is successfully enrolling eligible subjects in the RCT to evaluate the relationship of integrating effective pharmacotherapy and brief behavioral intervention on TB and alcohol outcomes, as well as reduction in HIV risk behaviors.
The IMPACT study utilizes an innovative approach to adapt 2 effective therapies for treatment of alcohol use disorders to the TB clinical services setting in the Tomsk Oblast, Siberia, Russia, and to train TB physicians to deliver state of the art alcohol pharmacotherapy and behavioral treatments as an integrated part of routine TB care. The proposed treatment strategy could be applied elsewhere in Russia and in other settings where TB control is jeopardized by AUDs. If demonstrated to be effective, this model of integrating alcohol interventions into routine TB care has the potential for expanded applicability to other chronic co-occurring infectious and other medical conditions seen in medical care settRead Full Abstract
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We therefore propose a wider-ranging framework for understanding and explaining trends in alcohol consumption, illustrating the operation of the factors with historical or contemporary examples.
In the framework, we include not only taxes and other alcohol controls, but also situational and other norms on drinking and intoxication, competing responsibilities and attractions that demand or favour sobriety, structural changes, external influences and the range of societal or cultural responses to alcohol problems.
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