Effects of Alcohol Use Initiation Patterns on High-Risk Behaviors among Urban, Low-Income, Young Adolescents

This study examined associations between patterns of alcohol use initiation and progression from age 12 to 14 years and recent cigarette and marijuana use, and violent and delinquent behavior at age 14.

The study sample (n = 2,193) was predominantly African American or Hispanic (43% and 37%, respectively) and low-income (68% receiving free, or reduced price, lunch). They completed classroom-based surveys when in 6th–8th grades. Multilevel latent class analyses were used to identify the heterogeneous alcohol use trajectories. Linear and logistic mixed-effects regression was then used to examine the association between these patterns and high-risk behaviors in 8th grade.

Five alcohol use trajectories were identified: (1) No Use (63.3%), (2) Onset of Consistently Infrequent Use at Age <12 (13.3%), (3) Onset of Monthly Use at Age 14 (9.9%), (4) Onset of Monthly Use at Age 13 to Heavy Use at Age 14 (6.6%), and (5) Onset of Consistently Heavy Use at Age 12 (6.9%).

Relative to non-users, membership in any of the alcohol use trajectory classes was significantly associated with greater past month cigarette and marijuana use, as well as violent behaviors in 8th grade.

Higher levels of delinquent behaviors were significantly associated with membership in all but one of the alcohol use trajectory classes relative to the “no use” class.

Results suggest that any use of alcohol in early adolescence is associated with other high-risk behaviors and support the critical need for efforts to prevent early initiation and progression of alcohol use among youth as a key component to prevent future high-risk behaviors.

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Request Reprint E-Mail: komro@ufl.edu
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R-rated Movie Viewing, Growth in Sensation Seeking and Alcohol Initiation: Reciprocal and Moderation Effects

The current study employed parallel process and discrete time hazard regressions to examine the interplay among exposure to R-rated movies, sensation seeking, and initiation of alcohol use in a national U.S. sample (N = 6255) of adolescents, ages 10–14, who were followed over four waves spanning 2 years.

There was a short-term reciprocal relation between watching R-rated movies and sensation seeking, but over the 2-year observation period, exposure to R-rated movies was associated with increases in sensation seeking and not vice versa.

Sensation seeking also moderated the effect of watching R-rated movies on initiation of alcohol consumption such that exposure was associated with greater increases in initiation of alcohol use among low sensation than among high sensation seeking adolescents.

The study provides empirical evidence of an environmental media effect on sensation seeking, and important new information about the relations among sensation seeking, media exposure, and adolescent alcohol use.

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Request Reprint E-Mail: james.d.sargent@dartmouth.edu
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Concurrent Alcohol Use or Heavier Use of Alcohol and Cigarette Smoking Among Women of Childbearing Age with Accessible Health Care

This study was conducted to provide nationally representative findings on the prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age with accessible health care.

For the years 2003–2005, a total of 20,912 women 18–44 years of age who participated in the National Health Interview Survey (NHIS) reported that during the study period, there was a place where they would usually go for health care when sick or in need of advice about their health.

The prevalence and distribution of concurrent alcohol use or heavier use of alcohol and cigarette smoking reported by such women was calculated. Logistic regression analysis was used to evaluate the “most often visited health care place” among concurrent users who reported having seen or talked to a health care provider during the previous 12 months.

Among surveyed women with accessible health care, 12.3% reported concurrent alcohol use and cigarette smoking, and 1.9% reported concurrent heavier use of alcohol and cigarette smoking during the study period.

Of women who reported either type of concurrent use, at least 84.4% also indicated having seen or talked to one or more health care providers during the previous 12 months. Such women were more likely than non-concurrent users to indicate that the “most often visited health care place” was a “hospital emergency room or outpatient department or some other place” or a “clinic or health center,” as opposed to an “HMO or doctor’s office.”

Concurrent alcohol use or heavier use of alcohol and cigarette smoking among women of childbearing age is an important public health concern in the United States.

The findings of this study highlight the importance of screening and behavioral counseling interventions for excessive drinking and cigarette smoking by health care providers in both primary care and emergency department settings.

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Request Reprint E-Mail: jxt9@cdc.gov
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Profiles of Protection from Substance Use among Adolescents

The purpose of this study was to explore whether adolescents (N = 10,287) could be classified into homogeneous subgroups based on their protective factors and, if so, whether these constellations of protection differentially relate to adolescents’ lifetime and 30-day alcohol and tobacco use.

Latent class analysis with eight protective factors—four internal and four external—were used to identify the underlying latent class structure.

Five profiles of protection emerged: Adequate Protection (54%), Adequate External Protection (9%), Adequate Protection with Low Adult Communication (16%), Adequate Protection with Risky Friends (9%), and Inadequate Protection (12%).

Lifetime alcohol use was associated with only a modest increase in odds of belonging to the Adequate External or Low Adult Communication latent classes, but an enormous increase in odds of having Inadequate Protection or Risky Friends. Similar effects were found for past month alcohol use.

Unlike alcohol use, which was related most strongly with membership in the Risky Friends latent class (relative to Adequate Protection), cigarette use was most strongly related to membership in the Inadequate Protection latent class.

Findings can be used to inform prevention programs as they illustrate the relationships that exist between adolescents’ profiles of protection and substance use.

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Request Reprint E-Mail: syvertsen@psu.edu
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LateNight Penn State Alcohol-Free Programming: Students Drink Less on Days They Participate

Despite the public health importance of alcohol-free social programs for college students, the majority of existing campus strategies have not been empirically evaluated.

This study utilized repeated daily reports to examine the association between attendance at campus-led alcohol-free programming and alcohol use on specific days while controlling for individuals’ typical rates of use.

The current study assessed students’ participation in the LateNight Penn State (LNPS) alcohol-free programming and amount of alcohol use at a daily level, in order to determine whether students consumed less alcohol on days they attended LNPS compared to weekend days they did not attend. First-year college students reported their daily social activity involvement and alcohol use via 14 consecutive daily web-based surveys.

Multilevel regression analyses modeled variation in alcohol use on weekend days (N = 3,350) nested within people (N = 689 people, 51% women). Analyses focused on within-individual differences between nights attending and not attending LNPS, thereby controlling for stable individual differences, measured and unmeasured.

Results indicated that students drank less on days they attended LNPS and on days they stayed in (rather than going to bars/parties, other campus events, or entertainment), both especially among women.

These results suggest that alcohol-free social programs may be an effective strategy for decreasing alcohol use on days when students attend alcohol-free events rather than going to other events or gatherings.

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Request Reprint E-Mail: meganpat@isr.umich.edu
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Idiographically Determined Versus Standard Absorption Periods in Alcohol Administration Studies

Effects of alcohol vary depending on blood alcohol level and limb. Some researchers use standard absorption periods (SAPs) to determine when postdrinking experimental protocols should begin. Others use an idiographically determined absorption period (IDAP) based on criterion breath alcohol concentration (BrAC). We investigated and compared the characteristics of each method.

Mean time to reach 0.06% BrAC was 22.9 ± 14.6 minutes. Standard deviations in BrAC were 4 times greater using SAPs compared to IDAPs. Ten percent of participants' BrAC readings were on the descending limb 30 minutes postdrinking, and 25% were descending at 45 minutes postdrinking.

IDAPs result in less BrAC variability and may reduce experimental noise relative to SAPs. Experimental control in future alcohol administration studies may be enhanced by the use of IDAPs instead of SAPs.

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

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Differential Effects of Acute and Chronic Ethanol Exposure on Orexin Expression in the Perifornical Lateral Hypothalamus

Recent reports support the involvement of hypothalamic orexigenic peptides in stimulating ethanol intake. Our previous studies have examined the effects of ethanol on hypothalamic peptide systems of the paraventricular nucleus (PVN) and identified a positive feedback loop in which PVN peptides, such as enkephalin and galanin, stimulate ethanol intake and ethanol, in turn, stimulates the expression of these peptides. Recently, orexin (OX), a peptide produced mainly by cells in the perifornical lateral hypothalamus (PFLH), has been shown to play an important role in mediating the rewarding aspects of ethanol intake. However, there is little evidence showing the effects that ethanol itself may have on the OX peptide system.

In order to understand the feedback relationship between ethanol and the OX system, the current investigation was designed to measure OX gene expression in the PFLH following acute as well as chronic ethanol intake.

The results showed chronic consumption of ethanol versus water to dose-dependently reduce OX mRNA in the PFLH, with a larger effect observed in rats consuming 2.5 g/kg/d (−70%) or 1.0 g/kg/d (−50%) compared to animals consuming 0.75 g/kg/d (−40%). In contrast to chronic intake, acute oral ethanol compared to water significantly enhanced OX expression in the PFLH, and this effect occurred at the lower (0.75 g/kg) but not higher (2.5 g/kg) dose of ethanol. Additional analyses of the OX cells in the LH versus PF regions identified the former as the primary site of ethanol's stimulatory effect on the OX system. In the LH but not the PF, acute ethanol increased the density of OX-expressing and OX-immunoreactive neurons. The increase in gene expression was detected only at the lower dose of ethanol (0.75 g/kg), whereas the increase in OX peptide was seen only at the higher dose of ethanol (2.5 g/kg).

These results lead us to propose that OX neurons, while responsive to negative feedback signals from chronic ethanol consumption, are stimulated by acute ethanol administration, most potently in the LH where OX may trigger central reward mechanisms that promote further ethanol consumption.

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Request Reprint E-Mail: leibow@rockefeller.edu

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Adrenocortical and Pituitary Glucocorticoid Feedback in Abstinent Alcohol-Dependent Women

The long-term ingestion of alcohol diminishes hypothalamic–pituitary–adrenal (HPA) axis reactivity in alcohol-dependent men, potentially altering future relapse risk. Although sex differences in HPA axis functioning are apparent in healthy controls, disruptions in this system have received little attention in alcohol-dependent women.

In this study, we assessed the basal secretory profile of adrenocorticotropic hormone (ACTH) and cortisol, adrenocortical sensitivity in both the presence and absence of endogenous corticotropic pituitary activation, and feedback pituitary glucocorticoid sensitivity to dexamethasone.

Mean concentrations and pulsatile characteristics of ACTH and cortisol over 12 hours were not statistically different between the 2 groups. Healthy controls had a somewhat higher (p <>

Significant differences in pituitary–adrenal function were not apparent between alcohol-dependent women and matched controls. Despite the small n, it appears that alcohol-dependent women do not show the same disruptions in HPA activity as alcohol-dependent men. These findings may have relevance for gender-specific treatment effectiveness.

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Request Reprint E-Mail: bryon.adinoff@utsouthwestern.edu

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Trajectories of resilience over 25 years of individuals who as adolescents consulted for substance misuse and a matched comparison group

To examine trajectories of resilience over 25 years among individuals who as adolescents received treatment for substance misuse, the clinical sample (CS) and a matched general population sample (GP).

A total of 52.4% of the GP and 24.4% of the CS achieved resilience in all domains through 25 years. Among the CS, another one-third initially displayed moderate levels of resilience that rose to high levels over time, one-quarter displayed decreasing levels of resilience over time, while 9.3% showed little but improving resilience and 8.8% showed no resilience. Levels of resilience were associated with the severity of substance misuse and delinquency in adolescence.

Individuals who had presented substance misuse problems in adolescence were less likely to achieve resilience over the subsequent 25 years than was a matched general population sample, and among them, four distinct trajectories of resilience were identified. The severity and type of problems presented in adolescence distinguished the four trajectories.

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Request Reprint E-Mail: peter.larm@sll.se

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Estimating the number of alcohol-attributable deaths: methodological issues and illustration with French data for 2006

Computing the number of alcohol-attributable deaths requires a series of hypotheses. Using French data for 2006, the potential biases are reviewed and the sensitivity of estimates to various hypotheses evaluated.

When alcohol consumption distribution was adjusted for sales data, the estimated number of alcohol-attributable deaths, the sum of the cause-specific estimates, was 20 255. Without adjustment, the estimate fell to 7158. Using an all-cause mortality approach, the adjusted number of alcohol-attributable deaths was 15 950, while the non-adjusted estimate was a negative number. Other methodological issues, such as computation based on risk estimates for all causes for 'all countries' or only 'European countries', also influenced the results, but to a lesser extent.

The estimates of the number of alcohol-attributable deaths varied greatly, depending upon the hypothesis used. The most realistic and evidence-based estimate seems to be obtained by adjusting the consumption data for national alcohol sales, and by summing the cause-specific estimates. However, interpretation of the estimates must be cautious in view of their potentially large imprecision.

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Request Reprint E-Mail: gregoire.rey@inserm.fr

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Reduce safe drinking limits for overweight people, research suggests

Obese men who drink are 19 times more likely to develop the disease than average weight teetotallers and overweight women double the risk just by drinking two glasses of wine a day.

The two new studies show obesity and alcohol act together to increase the risk of liver disease in both men and women.

Rates of liver disease and obesity are increasing in the UK and it is now the country's fifth biggest killer.

While alcohol is a major cause of liver cirrhosis, recent evidence suggests that excess body weight may also play a role. . . . . .

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Perceived Norms Mediate Effects of a Brief Motivational Intervention for Sanctioned College Drinkers

The present study is a secondary analysis of a randomized trial of brief motivational interventions (BMIs) for 198 college students sanctioned for alcohol-related violations of school policy (Carey, Henson, Carey, & Maisto, 2009).

Using multivariate latent growth curve models, we evaluated theoretically derived mediators of the observed BMI effect: motivation to change (readiness-to-change, costs and benefits of drinking) and drinking norms (injunctive norms for peers, and descriptive norms for friends, local peers, and national peers).

Results provided partial support for mediation by changes in perceptions of descriptive but not injunctive norms, a pattern that varied by gender and norm type.

We found no evidence of a mediating role for any of the motivational variables.

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Request Reprint E-Mail: kbcarey@syr.edu

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Comorbidity between bipolar disorder and alcohol use disorder: Association of dopamine and serotonin gene polymorphisms

Bipolar disorder is a chronic mental illness with high prevalence of co-occurring alcohol use disorder. Linkage studies have revealed several candidate genes in the dopaminergic and serotonergic pathways which may be associated with both bipolar and alcohol use disorders.

We investigated the relationship between polymorphisms in candidate genes and alcohol use disorder comorbidity in bipolar patients.

We performed a retrospective study of a genomic database consisting of 278 bipolar disorder patients. Diagnosis of bipolar disorder was according to the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). RFLP analysis of single nucleotide polymorphisms were performed in dopamine (DRD1, DRD2 and DRD3) and serotonin receptor and transporter genes (5HTTLPR, 5HT1B, 5HT2A, 5HT2C).

There were 179 (64%) females in the database.

Seventy-one (25.5%) of the bipolar patients were diagnosed as comorbid alcohol use disorder.

Chi-square analysis indicated that in female bipolar patients, there was a significant difference in genotype frequency between the bipolar patients with comorbid alcohol use disorder and non-comorbid bipolar patients for the Ser23Cys (rs6318) polymorphism of the 5HT2C gene.

Overall, the results indicate a possible association between 5HT2C and alcohol use disorder comorbidity.

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Request Reprint E-Mail: usoa_busto@camh.net

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Body mass index and risk of liver cirrhosis in middle aged UK women: prospective study

To determine the relation between body mass index (BMI) and liver cirrhosis and the contribution that BMI and alcohol consumption make to the incidence of liver cirrhosis in middle aged women in the UK.

Excess body weight increases the incidence of liver cirrhosis. In middle aged women in the UK, an estimated 17% of incident or fatal liver cirrhosis is attributable to excess body weight. This compares with an estimated 42% attributable to alcohol.

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Analysis of extreme drinking in patients with alcohol dependence using Pareto regression

We developed a novel Pareto regression model with an unknown shape parameter to analyze extreme drinking in patients with Alcohol Dependence (AD).

We used the generalized linear model (GLM) framework and the log-link to include the covariate information through the scale parameter of the generalized Pareto distribution. We proposed a Bayesian method based on Ridge prior and Zellner's g-prior for the regression coefficients.

Simulation study indicated that the proposed Bayesian method performs better than the existing likelihood-based inference for the Pareto regression.

We examined two issues of importance in the study of AD. First, we tested whether a single nucleotide polymorphism within GABRA2 gene, which encodes a subunit of the GABAA receptor, and that has been associated with AD, influences extreme alcohol intake and second, the efficacy of three psychotherapies for alcoholism in treating extreme drinking behavior. We found an association between extreme drinking behavior and GABRA2. We also found that, at baseline, men with a high-risk GABRA2 allele had a significantly higher probability of extreme drinking than men with no high-risk allele. However, men with a high-risk allele responded to the therapy better than those with two copies of the low-risk allele. Women with high-risk alleles also responded to the therapy better than those with two copies of the low-risk allele, while women who received the cognitive behavioral therapy had better outcomes than those receiving either of the other two therapies. Among men, motivational enhancement therapy was the best for the treatment of the extreme drinking behavior. Read Full Abstract Request Reprint E-Mail: oharel@stat.uconn.edu ____________________________________________

News MPs debate Health Committee report on alcohol

Kevin Barron MP, Chairman of the Health Select Committee opened a debate in the Commons on the Committee's recent report on alcohol. Gillian Merron, Minister of State, at the Health Department, responded to the debate.

• Video and Audio: Debate: Alcohol
• Commons Hansard: Debate: Alcohol
• Health Committee
• Report: Alcohol
• Topical Issues: Alcoholism

Alcohol report

The main areas covered in the report and the subsequent Commons debate were:

• history of alcohol consumption
• impact of alcohol on health, the NHS and society as a whole, including the costs of crime and loss of work
• analysis of the Government's alcohol strategy
• NHS policies on prevention and treatment
• education and information policies
• marketing of alcohol, pubs and licensing
• off-licence sales, particularly in supermarkets
• price of alcohol and arguments for minimum pricing and rises in alcohol duty
• proposals for a new alcohol strategy

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Maryland's strong alcohol lobby likely to quash tax increase

In recent years, Maryland has raised its sales tax, income tax, corporate tax and cigarette tax; added a surcharge called the "millionaires' tax"; and created taxes on electronic bingo, tip jars and even water and septic systems -- the "flush tax."

But lawmakers have not touched alcohol taxes. For 37 years, Maryland's levies on beer and wine have remained unchanged, and its pennies-per-drink charge on hard alcohol has not budged since 1955 -- a testament to the influence of the state's alcohol lobby.

. . . . . .

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Romanian street sign warns drivers of 'drunk pedestrians'

Officials in Pecica, a village town about 13 miles from the Hungarian border in the country’s west, ordered the bright red signs, complete with the phrase “Attention - Drunks”.

The 10 road signs, which also show a person crawling on their knees while clutching a glass in one hand, were erected in popular nightspot areas close to the city's bars and restaurants. . . . . .

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Impairment due to cannabis and ethanol: clinical signs and additive effects

Studies have shown that the impairing effects of Δ-9-tetrahydrocannabinol (THC) are dose-related. Cannabis intake increases the risk of traffic accidents.

The purpose of this study was to see how different clinical tests and observations were related to blood THC concentrations and to determine whether the combined influence of THC and ethanol was different from either drug alone.

This study demonstrates that cannabis impairs driving ability in a concentration-related manner. The effect is smaller than for ethanol. The effect of ethanol and cannabis taken simultaneously is additive. Conjunctival injection, dilated pupils and slow pupil reaction are among the few signs to reveal THC influence.

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Request Reprint E-Mail: j.g.bramness@medisin.uio.no
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Alcohol Social Marketing For England: Further tools, support and guidance released

The Department of Health this week launched a range of materials, tools and guidance to support the development and delivery of alcohol interventions and social marketing for England. Download the 'Alcohol Social Marketing For England. Further tools, support and guidance' toolkit or access it and other resources from the Alcohol Learning centre Social Marketing page. . . . . .

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Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries.

This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa.

Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i) improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii) strengthening clients’ abstinence-oriented social networks and, iii) strengthening the counselor-client therapeutic alliance.
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VA Faces Challenges in Providing Substance Use Disorder Services and Is Taking Steps to Improve These Services for Veterans

Introduction

•Substance use disorders (SUD), such as alcohol abuse and drug addiction, are serious health conditions that affect many Americans, including a substantial number of veterans who receive care from the Department of Veterans Affairs (VA). SUDs are a concern for both older veterans and veterans ofthe current operations in Iraq and Afghanistan. According to VA, about 420,000 of the over 5 million veterans receiving care at VA had SUD diagnoses in fiscal year 2009.*

•Identification and treatment of veterans with SUDs is important,as SUDs can have harmful effects on veterans’ physical, psychological, and social well-being. For example, substance use is a primary risk factor for both homelessness and suicide among veterans.

•It is also important to identify and counsel veterans who may not meet the diagnostic criteria for an SUD—that is, they may not abuse or be dependent on alcohol or drugs—but use substances to a degree that puts them at risk for developing an SUD or other health problems.

•VA’s SUD treatment services have been evolving in recent years. VA’s 2004 mental health strategic plan** noted that its system of SUD services had been in decline since the mid-1990s and that VA needed to improve access to care for veterans with SUDs. Since then, VA has taken steps to enhance its SUD services.

Objectives

You asked us to review VA’s provision of SUD services. This briefing provides an overview of:

•The challenges that VA officials and providers reported facing in their efforts to provide SUD services to veterans who have or are at risk for SUDs.

•The national efforts VA has recently undertaken to improve its SUD services for veterans who have or are at risk for SUDs.

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Sensitivity to ethanol and other hedonic stimuli in an animal model of adolescence: Implications for prevention science?

Age-related patterns of sensitivity to appetitive and aversive stimuli seemingly have deep evolutionary roots, with marked developmental transformations seen during adolescence in a number of relatively ancient brain systems critical for motivating and directing reward-related behaviors.

Using a simple animal model of adolescence in the rat, adolescents have been shown to be more sensitive than their adult counterparts to positive rewarding effects of alcohol, other drugs, and certain natural stimuli, while being less sensitive to the aversive properties of such stimuli.

Adolescent-typical alcohol sensitivities may be exacerbated further by a history of prior stress or alcohol exposure as well as by genetic vulnerabilities, permitting relatively high levels of adolescent alcohol use and perhaps an increased probability for the emergence of abuse disorders.

A number of potential (albeit tentative) implications of these basic research findings for prevention science are considered.

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Request Reprint E-Mail: lspear@binghamton.edu
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Reduced Nucleus Accumbens SK Channel Activity Enhances Alcohol Seeking during Abstinence

The cellular mechanisms underlying pathological alcohol seeking remain poorly understood. Here, we show an enhancement of nucleus accumbens (NAcb) core action potential firing ex vivo after protracted abstinence from alcohol but not sucrose self-administration.

Increased firing is associated with reduced small-conductance calcium-activated potassium channel (SK) currents and decreased SK3 but not SK2 subunit protein expression.

Furthermore, SK activation ex vivo produces greater firing suppression in NAcb core neurons from alcohol- versus sucrose-abstinent rats.

Accordingly, SK activation in the NAcb core significantly reduces alcohol but not sucrose seeking after abstinence.

In contrast, NAcb shell and lateral dorsal striatal firing ex vivo are not altered after abstinence from alcohol, and SK activation in these regions has little effect on alcohol seeking.

Thus, decreased NAcb core SK currents and increased excitability represents a critical mechanism that facilitates motivation to seek alcohol after abstinence.

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Request Reprint E-Mail: woody@gallo.ucsf.edu
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News Release - Three Named for Honorary Doctorates at Commencement

The University of Kentucky Board of Trustees today approved honorary degrees to be presented at UK's 143rd Commencement to newspaper editor Judith G. Clabes, architect Daniel Libeskind and alcoholism researcher Robert Straus.

Straus, who was a professor at UK from 1956 to 1987, established the field of Medical Behavioral Science in the UK College of Medicine in 1959. He established the pioneering protocols for evaluating alcoholism.

Straus served as a special consultant to the director of the National Institute of Mental Health. He was elected a member of the Institute of Medicine at the National Academy of Sciences in 1975 and received the Lifetime Achievement Award from the American Public Health Association in 1993 and the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology from the American Sociological Association in 1998.

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Associations Between Alcohol Drinking and Multiple Risk Factors for Atherosclerosis in Smokers and Nonsmokers

This study investigated relationships between alcohol intake and multiple risk factors for atherosclerosis in smokers and nonsmokers.

Men aged 35 to 54 years (n = 27 005) were divided into 6 groups by ethanol intake. The prevalence of multiple (3 or 4) risk factors, including obesity, high blood pressure, high total cholesterol, triglyceride and fasting blood glucose, and low high-density lipoprotein (HDL) cholesterol, was compared among the groups in smokers and nonsmokers.

Smokers and nonsmokers showed U- and J-shaped relationships, respectively, between alcohol intake and prevalence of multiple risk factors.

Odds ratios of drinkers versus nondrinkers for multiple risk factors were significantly low in very light, light, moderate, and heavy drinkers in smokers and were significantly low in light and moderate drinkers but not in very low and heavy drinkers in nonsmokers.

There is a U- or J-shaped relationship between alcohol consumption and multiple risk factors for atherosclerosis, and this relationship is modified by smoking.

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Request Reprint E-Mail: wakabaya@hyo-med.ac.jp
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Predictors of motivation for abstinence at the end of outpatient substance abuse treatment

Commitment to abstinence, a motivational construct, is a strong predictor of reductions in drug and alcohol use. Level of commitment to abstinence at treatment end predicts sustained abstinence, a requirement for recovery.

This study sought to identify predictors of commitment to abstinence at treatment end to guide clinical practice and to inform the conceptualization of motivational constructs.

Polysubstance users (N = 250) recruited at the start of outpatient treatment were reinterviewed at the end of services. Based on the extant literature, potential predictors were during treatment measures of substance use and related cognitions, psychological functioning, recovery supports, stress, quality of life satisfaction, and treatment experiences.

In multivariate analyses, perceived harm of future drug use, abstinence self-efficacy, quality of life satisfaction, and number of network members in 12-step recovery contributed 26.6% of the variance explained in the dependent variable, a total of 49.6% when combined with the control variables (demographics and baseline level of the outcome).

Gender subgroup analyses yielded largely similar results.

Clinical implications of findings for maximizing commitment to abstinence when clients leave treatment are discussed as are future research directions.

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Request Reprint E-Mail: alexandrelaudet@gmail.com

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The effect of alcohol on radiographic progression in rheumatoid arthritis

Alcohol consumption reduces the risk of development of Rheumatoid Arthritis (RA) and significantly attenuates the development of erosive arthritis in animal models. It remains unknown whether alcohol consumption influences joint damage progression in RA.

2908 RA patients with a mean of 4 sequential radiographs and 3.9 years of follow-up were included. A trend towards reduced radiographic progression existed in D compared to ND, with ERO of 0.99% (0.89-1.09) and 1.13% (1.00-1.26) at one year respectively. Alcohol consumption displayed a J-shaped dose response effect, with a more favorable evolution in occasional consumers (p=0.01) and daily consumers (p=0.001), compared to non-drinkers, while heavy-drinkers demonstrated worse radiographic evolution (p=0.0001). We found significant effect modification by sex, with male D displaying significantly less ERO compared to male ND (0.86% (0.70-1.03) versus 1.35% (1.02-1.67), p=0.007).
A trend towards reduced radiographic progression was observed in alcohol drinkers compared to non-drinkers, specifically in occasional and daily alcohol consumers, and in particular, male RA patients who consume alcohol demonstrate less radiographic progression than male non-drinkers. Read Full Abstract Request Reprint E-Mail: Michael.J.Nissen@hcuge.ch ______________________________________

Rumination as a predictor of drinking behaviour in alcohol abusers: a prospective study

To investigate the role of depression and rumination in predicting drinking status (absence or presence of alcohol use) and level of alcohol use at 3, 6 and 12 months following a brief course of cognitive–behavioural therapy for alcohol abuse.

These indicated that rumination predicted drinking status and level of alcohol use at 3-, 6- and 12-month follow-up. The contribution of rumination was independent of depression and initial level of alcohol use.

The results confirm that rumination is an important prospective predictor of drinking status and level of alcohol use in alcohol abusers and highlight the potential relevance of targeting rumination in the treatment of alcohol abuse.

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Request Reprint E-Mail: gabriele.caselli@gmail.com

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What are the policy lessons of National Alcohol Prohibition in the United States, 1920–1933?

National alcohol prohibition in the United States between 1920 and 1933 is believed widely to have been a misguided and failed social experiment that made alcohol problems worse by encouraging drinkers to switch to spirits and created a large black market for alcohol supplied by organized crime.

The standard view of alcohol prohibition provides policy lessons that are invoked routinely in policy debates about alcohol and other drugs. The alcohol industry invokes it routinely when resisting proposals to reduce the availability of alcohol, increase its price or regulate alcohol advertising and promotion. Advocates of cannabis law reform invoke it frequently in support of their cause.

This paper aims: (i) to provide an account of alcohol prohibition that is more accurate than the standard account because it is informed by historical and econometric analyses; (ii) to describe the policy debates in the 1920s and 1930s about the effectiveness of national prohibition; and (iii) to reflect on any relevance that the US experience with alcohol prohibition has for contemporary policies towards alcohol.

It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure.

Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.

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Request Reprint E-Mail: w.hall@sph.uq.edu.au

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A review of computer-based alcohol problem services designedfor the general public

This review summarizes the literature on computer-based drinking assessment and intervention programs evaluated using members of the general public.

The primary aim was to summarize the demand, usage, and effectiveness of these services.

A systematic search of the literature identified seven online drinking assessments and eight computerized interventions that were evaluated using members of the general public.

Internet assessment users tend to be in their early 30s, are more often male, tend to be at risk for or are experiencing alcohol-related problems, more fully explore assessment sites, and are more likely to enroll in interventions linked to these sites when their drinking problem is more severe.

Although dropout from computer-based interventions is often very high and treatment models vary widely, program completers appear to show improvements.

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Request Reprint E-Mail: mvernon@arg.org

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The adoption of alcohol pharmacotherapies in the Clinical Trials Network: The influence of research network participation

Organizational participation in clinical research may lead to adoption of the intervention by treatment agencies, but it is not known whether research involvement enhances innovativeness beyond the specific interventions that are tested.

The National Institute on Drug Abuse's Clinical Trials Network (CTN) is a platform for considering this research question. To date, the CTN has not conducted research on medications for alcohol use disorders (AUDs), so greater adoption of innovative AUD pharmacotherapies by CTN-affiliated programs would suggest an added value of research network participation.

Using longitudinal data from a pooled sample of CTN and non-CTN publicly funded treatment programs, we investigate adoption of tablet naltrexone and acamprosate over a 2-year period.

CTN-affiliated programs were more likely to have adopted tablet naltrexone and acamprosate at 24-month follow-up, net of the effects of a range of organizational characteristics.

Research network participation may thus enhance organizational innovativeness to include interventions beyond the scope of the network.

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US expert says positive thinking is the smart way to recover from alcoholism

Alcoholism is a disease that leaves victims powerless and needing to stay in permanent recovery if they are serious about stopping the demon drink from inflicting further damage, conventional wisdom holds. Given that most people can't afford to pay for a stay in a Priory clinic, then the best way for chronic drinkers to tackle their addiction, so the theory goes, is to turn to Alcoholics Anonymous, seek the help of a higher power with their struggle, begin using the 12-step programme, and be ready to attend meetings for the rest of their lives.

Not so, says Joe Gerstein, a retired clinical professor of medicine in the US. "A myth has grown up that you can't get over a substance addiction without AA," he says. "It's a widely-held belief, but it's a myth." . . . . .

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Providing Alcohol-Related Screening and Brief Interventions to Adolescents through Health Care Systems: Obstacles and Solutions

Adolescent binge drinking and related disorders are worldwide public health problems.

The European School Survey Project on Alcohol and Other Drugs surveyed 16-year-old adolescents in 35 countries. Defined as the consumption of five or more drinks per episode, binge drinking had occurred in 43% of these adolescents in the prior 30 days.

Eleven countries were noted to have rates of over 50% (e.g., United Kingdom 54%; Portugal 56%) and all but two countries had rates over 30%. In the US, about one-third of high school seniors reported binge drinking in the prior two weeks. Comparable adolescent alcohol involvement has been noted for some Western Pacific countries, including Australia and New Zealand.

For over a decade, governmental and professional organizations such as the World Health Organization (WHO), the US Surgeon General, the American Medical Association, and the American Academy of Pediatrics have called on health care practitioners to become more involved in providing screening, brief intervention, and referral for treatment (SBIRT) for adolescent drinkers.

While often somewhat general, SBIRT guidance has been offered by some organizations ( see also Box 1) and in review articles. Moreover, although there is a consensus that the health care system is an appropriate SBIRT venue, most adolescents visiting health care providers do not receive these services .

This Policy Forum identifies the problems impeding SBIRT for adolescents and proposes some solutions.

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