Alcohol questions in A&E could cut £2.7bn NHS bill, say doctors

Leading doctors want patients arriving at hospital accident and emergency units to be questioned about their drinking habits in an attempt to cut the NHS's huge bill for treating people with alcohol problems.

The British Society of Gastroenterology is urging ministers to make casualty staff go through a one-minute questionnaire with any patient whose condition is likely to be drink-related. Alcohol is a factor in 35% of all A&E cases, and up to 70% of cases at the weekend. NHS spending on treating such people has risen to £2.7bn annually.

The BSG, which represents 2,700 doctors specialising in alcohol problems, is to call for every NHS hospital to undertake the Paddington alcohol test, which has been shown to identify heavy drinkers and cut their consumption by up to 43%.

In the few hospitals using the test, patients with any of the 10 conditions most commonly associated with alcohol, such as a fall, head injury or accident, are asked the test's three questions: if they drink alcohol; how much and what they drink per day; and how often they drink. The test should be deployed at all NHS casualty units, says the BSG. . . . . .

Read More

_____________________________________________

Person–environment interaction in the prediction of alcohol abuse and alcohol dependence in adulthood

Behavioral disinhibition (externalizing/impulsivity) and behavioral inhibition (internalizing/anxiety) may contribute to the development of alcohol abuse and dependence. But tests of person-by-environment interactions in predicting alcohol use disorders are needed.

This study examined the extent to which interactions between behavioral disinhibition, behavioral inhibition and family management during adolescence predict alcohol abuse and alcohol dependence at age 27.

Behavioral disinhibition and poor family management predicted increased likelihood of both alcohol abuse and alcohol dependence at age 27. Behavioral inhibition/anxiety was unrelated to both outcomes. Youths high in behavioral disinhibition were at increased risk for later alcohol abuse and dependence only in consistently poorly managed family environments. In consistently well-managed families, high levels of behavioral disinhibition did not increase risk for later alcohol abuse or dependence.

Behavioral disinhibition increases risk for alcohol abuse and dependence in early adulthood only for individuals who experience poor family management during adolescence. Interventions seeking to reduce environmental risks by strengthening consistent positive family management practices may prevent later alcohol abuse and dependence among individuals at risk due to behavioral disinhibition.

Read Full Abstract

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

_____________________________________________

Classification of Alcohol Abuse by Plasma Protein Biomarkers

Biochemical diagnostics of ethanol intake would improve alcohol abuse treatment and have applications in clinical trial and public safety settings. Self-reporting of alcohol use has clinical utility but lacks the desired reliability. Previously, proposed single-analyte biochemical tests of alcohol intake suffer from low sensitivity and specificity or examine only acute drinking and have therefore seen limited clinical use.

A 17-plasma protein panel was determined that correctly classifies abusive drinking with 100% sensitivity and also differentiates any level of drinking from alcohol abstinence with 88% accuracy.

The biomarker panel reflects changes in multiple organ systems and suggests robust changes in the plasma proteome with drinking that might serve as a sensitive and specific diagnostic test. The specific plasma proteins altered with alcohol self-administration might represent indicators of alcohol-induced stress on a variety of organ systems.

Read Full Abstract

Request Reprint E-Mail: kvrana@psu.edu

______________________________________

Disulfiram in severe alcoholism—an open controlled study

Disulfiram is used to a great extent in Denmark to treat alcoholism but the evidence is limited.

To study the effect of supervised disulfiram treatment in alcohol dependence. Subjects were recruited from a psychiatric emergency ward following alcohol withdrawal treatment.

The rate of abstinence was 20% and 26% in the control and disulfiram group, respectively. This difference was not statistically significant (NS). A trend towards increased mean time to first drink was found in the disulfiram group (96 vs. 76 days in the control group, NS), while fewer patients in this group completed CBT group therapy (41% vs. 67% in the control group, NS). Alcohol-free days were 100 days in both groups (NS).

Supervised disulfiram administration did not have any major impact on the treatment outcome.

Read Full Abstract

Request Reprint E-Mail: jakobulrichsen@mac.com

_________________________________________

Alcohol: No Ordinary Commodity – a summary of the second edition

This article summarizes the contents of Alcohol: No Ordinary Commodity (2nd edn).

The first part of the book describes why alcohol is not an ordinary commodity, and reviews epidemiological data that establish alcohol as a major contributor to the global burden of disease, disability and death in high-, middle- and low-income countries. This section also documents how international beer and spirits production has been consolidated recently by a small number of global corporations that are expanding their operations in Eastern Europe, Asia, Africa and Latin America.

In the second part of the book, the scientific evidence for strategies and interventions that can prevent or minimize alcohol-related harm is reviewed critically in seven key areas: pricing and taxation, regulating the physical availability of alcohol, modifying the drinking context, drink-driving countermeasures, restrictions on marketing, education and persuasion strategies, and treatment and early intervention services.

Finally, the book addresses the policy-making process at the local, national and international levels and provides ratings of the effectiveness of strategies and interventions from a public health perspective.

Overall, the strongest, most cost-effective strategies include taxation that increases prices, restrictions on the physical availability of alcohol, drink-driving countermeasures, brief interventions with at risk drinkers and treatment of drinkers with alcohol dependence.

Read Full Abstract

Request Reprint E-Mail: babor@nso.uchc.edu
_______________________________________

Changes in alcohol consumption and drinking patterns during 11 years of follow-up among ageing men: the FinDrink study

Alcohol consumption is often reported to decrease with ageing. We investigated alcohol consumption and drinking patterns in an ageing population-based male sample during an 11-year follow-up period.

Finnish men born in 1926–1946 do not seem to decrease drinking while ageing. In contrast those born in 1944–1946 increase drinking until their 60’s. This should be taken into consideration in planning health services for aged men in the near future.

Read Full Abstract

Request Reprint E-Mail: jenni.ilomaki@uku.fi
_______________________________________

A New Statistic to Evaluate Imputation Reliability

As the amount of data from genome wide association studies grows dramatically, many interesting scientific questions require imputation to combine or expand datasets. However, there are two situations for which imputation has been problematic: (1) polymorphisms with low minor allele frequency (MAF), and (2) datasets where subjects are genotyped on different platforms. Traditional measures of imputation cannot effectively address these problems.

We introduce a new statistic, the imputation quality score (IQS). In order to differentiate between well-imputed and poorly-imputed single nucleotide polymorphisms (SNPs), IQS adjusts the concordance between imputed and genotyped SNPs for chance. We first evaluated IQS in relation to minor allele frequency. Using a sample of subjects genotyped on the Illumina 1 M array, we extracted those SNPs that were also on the Illumina 550 K array and imputed them to the full set of the 1 M SNPs. As expected, the average IQS value drops dramatically with a decrease in minor allele frequency, indicating that IQS appropriately adjusts for minor allele frequency. We then evaluated whether IQS can filter poorly-imputed SNPs in situations where cases and controls are genotyped on different platforms. Randomly dividing the data into “cases” and “controls”, we extracted the Illumina 550 K SNPs from the cases and imputed the remaining Illumina 1 M SNPs. The initial Q-Q plot for the test of association between cases and controls was grossly distorted (λ = 1.15) and had 4016 false positives, reflecting imputation error. After filtering out SNPs with IQS<0.9,>0.99 demonstrating that a database of IQS values from common imputations could be used as an effective filter to combine data genotyped on different platforms

IQS effectively differentiates well-imputed and poorly-imputed SNPs. It is particularly useful for SNPs with low minor allele frequency and when datasets are genotyped on different platforms.

Read Full Article (PDF)

__________________________________________

Alcohol and young people

Alcohol is part of our national culture. The subject of alcohol use amongst children and young people particularly, is never far from the headlines and is a continuous topic for debate. From 'binge Britain' to 'mothers ruin' its impact on individuals and families is one on which everyone has an opinion.

From a parent's perspective it can be hard to know how to tackle the issue of alcohol with their children. The perception is that every teenager reaches a certain age and inevitably starts experimenting with alcohol, but what is the reality? As a parent you ask yourself, are all young people doing it? Is it the social norm? And where should the line be drawn?

Drinkaware and The Guardian are digging beneath the headlines to discover the truth about alcohol and young people in a series of polls and events, asking 'what's the attraction?' and challenging parents, professionals and young people themselves to define what makes alcohol so appealing and what can be done to ensure the UK alcohol culture is a healthy one.

The first official guidance on teen drinking was released by the Chief Medical Officer at the beginning of 2009. It advised parents that children under the age of 15 should not drink alcohol under any circumstances and that 15 to 17 year olds should only consume alcohol under the supervision of a parent or carer. But what are the issues that trigger a young person to drink? From stress to peer pressure, celebrity to advertising this comprehensive investigation will provide a snapshot of the UK today.

Drinkaware works to bring you the facts surrounding alcohol and young people, dispel myths and kick-start the debate.

Read More

____________________________________________

Alcoholic liver injury: Influence of gender and hormones

This article discusses several subjects pertinent to a consideration of the role of gender and hormones in alcoholic liver injury (ALI).

Beginning with an overview of factors involved in the pathogenesis of ALI, we review changes in sex hormone metabolism resulting from alcohol ingestion, summarize research that points to estrogen as a cofactor in ALI, consider evidence that gut injury is linked to liver injury in the setting of alcohol, and briefly review the limited evidence regarding sex hormones and gut barrier function.

In both women and female animals, most studies reveal a propensity toward greater alcohol-induced liver injury due to female gender, although exact hormonal influences are not yet understood.

Thus, women and their physicians should be alert to the dangers of excess alcohol consumption and the increased potential for liver injury in females.

Read Full Article (PDF)
______________________________________

Hepatoprotective effects of S-adenosyl-L-methionine against alcohol- and cytochrome P450 2E1-induced liver injury

S-adenosyl-L-methionine (SAM) acts as a methyl donor for methylation reactions and participates in the synthesis of glutathione.

SAM is also a key metabolite that regulates hepatocyte growth, differentiation and death. Hepatic SAM levels are decreased in animal models of alcohol liver injury and in patients with alcohol liver disease or viral cirrhosis.

This review describes the protection by SAM against alcohol and cytochrome P450 2E1-dependent cytotoxicity both in vitro and in vivo and evaluates mechanisms for this protection.

Read Full Article (PDF)
_______________________________________

Alcohol-induced alterations of the hepatocyte cytoskeleton

The hepatocyte cytoskeleton consists of three filamentous networks: microtubules, actin microfilaments and keratin intermediate filaments.

Because of the abundance of the proteins that comprise each system and the central role each network plays in a variety of cellular processes, the three filament systems have been the focus of a host of studies aimed at understanding the progression of alcohol-induced liver injury.

In this review, we will briefly discuss the hepatic organization of each cytoskeletal network and highlight some components of each system.

We will also describe what is known about ethanol-induced changes in the dynamics and distributions of each cytoskeletal system and discuss what is known about changes in protein expression levels and post-translational modifications.

Finally, we will describe the possible consequences of these cytoskeletal alterations on hepatocyte function and how they might contribute to the progression of liver disease.

Read Full Article (PDF)
_______________________________________

Effects of ethanol on the proteasome interacting proteins

Proteasome dysfunction has been repeatedly reported in alcoholic liver disease.

Ethanol metabolism end-products affect the structure of the proteasome, and, therefore, change the proteasome interaction with its regulatory complexes 19S and PA28, as well as its interacting proteins.

Chronic ethanol feeding alters the ubiquitin-proteasome activity by altering the interaction between the 19S and the 20S proteasome interaction. The degradation of oxidized and damaged proteins is thus decreased and leads to accumulation of insoluble protein aggregates, such as Mallory-Denk bodies.

Ethanol also affects the immunoproteasome formation. PA28a/b interactions with the 20S proteasome are decreased in the proteasome fraction isolated from the liver of rats fed ethanol chronically, thus affecting the cellular antigen presentation and defense against pathogenic agents.

Recently, it has been shown that ethanol also affects the proteasome interacting proteins (PIPs). Interaction of the proteasome with Ecm29 and with deubiquitinating enzymes Rpn11, UCH37, and Usp14 has been found to decrease. However, the two UBL-ubiquitin-associated domain (UBA) PIPs p62 and valosin-containing protein are upregulated when the proteasome is inhibited. The increase of these UBL-UBA proteins, as well as the increase in Hsp70 and Hsp25 levels, compensated for the proteasome failure and helped in the unfolding/docking of misfolded proteins.

Chronic alcohol feeding to rats causes a significant inhibition of the proteasome pathway and this inhibition results from a decreases of the interaction between the 20S proteasome and the regulatory complexes, PIPs, and the ubiquitin system components.

Read Full Article (PDF)
__________________________________________

Alcohol, nutrition and liver cancer: Role of Toll-like receptor signaling

This article reviews the evidence that ties the development of hepatocellular carcinoma (HCC) to the natural immune pro-inflammatory response to chronic liver disease, with a focus on the role of Toll-like receptor (TLR) signaling as the mechanism of liver stem cell/progenitor transformation to HCC.

Two exemplary models of this phenomenon are reviewed in detail. One model applies chronic ethanol/lipopolysaccharide feeding to the activated TLR4 signaling pathway. The other applies chronic feeding of a carcinogenic drug, in which TLR2 and 4 signaling pathways are activated.

In the drug-induced model, two major methyl donors, S-adenosylmethionine and betaine, prevent the upregulation of the TLR signaling pathways and abrogate the stem cell/progenitor proliferation response when fed with the carcinogenic drug.

This observation supports a nutritional approach to liver cancer prevention and treatment.

The observation that upregulation of the TLR signaling pathways leads to liver tumor formation gives evidence to the popular concept that the chronic pro-inflammatory response is an important mechanism of liver oncogenesis.

It provides a nutritional approach, which could prevent HCC from developing in many chronic liver diseases.

Read Full Article (PDF)
____________________________________________

Impact of alcohol on hepatitis C virus replication and interferon signaling

Hepatitis C virus (HCV) is one of the main etiological factors responsible for liver disease worldwide. It has been estimated that there are over 170 million people infected with HCV worldwide. Of these infected individuals, approximately 75% will go on to develop a life long necroinflammatory liver disease, which over decades, can result in serious complications, such as cirrhosis and hepatocellular carcinoma.

Currently there is no effective vaccine and whilst antiviral therapies have been improved, they are still only effective in approximately 50% of individuals.

HCV infection stands as a major cause of global morbidity and suffering, and places a significant burden on health systems. The second highest cause of liver disease in the western world is alcoholic liver disease.

Frequently, HCV infected individuals consume alcohol, and the combined effect of HCV and alcohol consumption is deleterious for both liver disease and response to treatment.

This review discusses the impact of alcohol metabolism on HCV replication and the negative impact on interferon (IFN)-α treatment, with a particular focus on how alcohol and HCV act synergistically to increase oxidative stress, ultimately leading to exacerbated liver disease and a reduction in the efficacy of IFN-α treatment.

A better understanding of the complicated mechanisms at play in hepatocytes infected with HCV and metabolizing alcohol will hopefully provide better treatment options for chronic hepatitis C individuals that consume alcohol.

Read Full Article (PDF)
________________________________________

Anti-inflammatory pathways and alcoholic liver disease: Role of an adiponectin/interleukin-10/heme oxygenase-1 pathway

The development of alcoholic liver disease (ALD) is a complex process involving both the parenchymal and non-parenchymal cells in the liver.

Enhanced inflammation in the liver during ethanol exposure is an important contributor to injury. Kupffer cells, the resident macrophages in liver, are particularly critical to the onset of ethanol-induced liver injury.

Chronic ethanol exposure sensitizes Kupffer cells to activation by lipopolysaccharide via Toll-like receptor 4. This sensitization enhances production of inflammatory mediators, such as tumor necrosis factor-α and reactive oxygen species, that contribute to hepatocyte dysfunction, necrosis, apoptosis, and fibrosis.

Impaired resolution of the inflammatory process probably also contributes to ALD. The resolution of inflammation is an active, highly coordinated response that can potentially be manipulated via therapeutic interventions to treat chronic inflammatory diseases.

Recent studies have identified an adiponectin/interleukin-10/heme oxygenase-1 (HO-1) pathway that is profoundly effective in dampening the enhanced activation of innate immune responses in primary cultures of Kupffer cells, as well as in an in vivo mouse model of chronic ethanol feeding. Importantly, induction of HO-1 also reduces ethanol-induced hepatocellular apoptosis in this in vivo model.

Based on these data, we hypothesize that the development of therapeutic agents to regulate HO-1 and its downstream targets could be useful in enhancing the resolution of inflammation during ALD and preventing progression of early stages of liver injury.

Read Full Article (PDF)
_____________________________________________

Alcoholic liver disease and the gut-liver axis

Alcoholic liver disease (ALD) is one of the leading causes of liver diseases and liver-related death worldwide.

Of the many factors that contribute to the pathogenesis of ALD, gut-derived lipopolysaccharide (LPS) plays a central role in induction of steatosis, inflammation, and fibrosis in the liver.

In this review, we discuss the mechanisms by which alcohol contributes to increased gut permeability, the activation of Kupffer cells, and the inflammatory cascade by LPS.

The role of the Toll-like receptor 4 (TLR4) complex in LPS recognition and the importance of the TLR4-induced signaling pathways are evaluated in ALD.

Read Full Article (PDF)
__________________________________________

Alcoholic pancreatitis: Lessons from the liver

The association between alcohol consumption and pancreatitis has been recognized for over 100 years. Despite the fact that this association is well recognized, the mechanisms by which alcohol abuse leads to pancreatic tissue damage are not entirely clear.

Alcohol abuse is the major factor associated with pancreatitis in the Western world. Interestingly, although most cases of chronic pancreatitis and many cases of acute pancreatitis are associated with alcohol abuse, only a small percentage of individuals who abuse alcohol develop this disease.

This situation is reminiscent of the association between alcohol abuse and the incidence of alcoholic liver disease. The liver and the pancreas are developmentally very closely related. Even though these two organs are quite different, they exhibit a number of general structural and functional similarities. Furthermore, the diseases mediated by alcohol abuse in these organs exhibit some striking similarities. The diseases in both organs are characterized by parenchymal cell damage, activation of stellate cells, aberrant wound healing, and fibrosis.

Because of the similarities between the liver and the pancreas, and the alcohol-associated diseases of these organs, we may be able to apply much of the knowledge that we have gained regarding the effects of alcohol on the liver to the pancreas.

Read Full Article (PDF)
_______________________________________

Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development

Chronic inflammation is often associated with alcohol-related medical conditions.

The key inducer of such inflammation, and also the best understood, is gut microflora-derived lipopolysaccharide (LPS). Alcohol can significantly increase the translocation of LPS from the gut. In healthy individuals, the adverse effects of LPS are kept in check by the actions and interactions of multiple organs.

The liver plays a central role in detoxifying LPS and producing a balanced cytokine milieu. The central nervous system contributes to anti-inflammatory regulation through neuroimmunoendocrine actions.

Chronic alcohol use impairs not only gut and liver functions, but also multi-organ interactions, leading to persistent systemic inflammation and ultimately, to organ damage.

The study of these interactions may provide potential new targets for therapeutic intervention.

Read Full Article (PDF)


_______________________________________

9th Annual Association of Recovery Schools Conference

The 9^th Annual Association of Recovery Schools Conference, “On the Trail to Freedom”, will provide a wide array of opportunities for those who work with adolescents in the area of substance abuse. This conference will allow participants to share best practices, learn from experts in the field, and connect with colleagues from all over the country. The Association of Recovery Schools is committed to ensuring that every student with a substance abuse issue has the opportunity to access a safe and supportive educational opportunity in a recovery high school environment.

The Pre-Conference will focus on sharing of best practices. This morning session is a tremendous opportunity for those currently operating recovery schools or in the process of starting a recovery school to learn from others in the field. The main conference consists of workshops, both interactive and didactic, presented by experts in their fields. The conference tracks this year include: Education, Evaluation, Medical and Therapeutic/Clinical. These workshops will be greatly beneficial to high school and college recovery programs as well as health care providers and substance abuse treatment providers from community care settings.

Conference Information

________________________________________

Alcohol intoxication at a university hospital acute medicine unit—with special consideration of young adults: an 8-year observational study from Switz

Many media reports suggest an increase in alcohol intoxication, particularly among young people. Indeed, several surveys on young people have confirmed this fact. These were based on self-declaration of alcohol consumption. However, there are few clinical data that show an increase in alcohol intoxication in hospitals.

The aim of this study was to evaluate the number of alcohol intoxications in relation to the total number of patients and to look for a statistical trend.

The authors found a significant increase in alcohol intoxication in all age groups and also in young people aged below 25 years. There were more intoxicated males than females (male to female ratio 1.5:1). The age distribution of our intoxicated patients showed a peak at 35–45 years of age and repeated admissions were frequent in this age class. Drugs consumed together with alcohol in the age group 16–25 were mostly cannabis and cocaine.

Episodic drinking is not only a problem in the 16–25 age group, it also concerns men of 35–45 years. This is a major public health problem in industrialised countries. Intoxicated patients are at acute risk of injuries and violence following alcohol abuse. Preventive measures should not only be limited to younger adults

Read Full Abstract

Request Reprint E-Mail: hans.marty@insel.ch

_____________________________________________

Alcohol use in georgian students; pilot study rigorously following criteria of European school project on alcohol and other drug.

The main purpose of the European School Survey Project on Alcohol and Other Drugs (ESPAD) is to collect comparable data on substance use among 15-16 year-old European students in order to monitor trends within as well as between countries.

In the article the results of the pilot study of Alcohol Use among Georgian Students, rigorously following Criteria of European School Project on Alcohol and Other Drug (ESPAD) are presented. The survey was conducted according to a standardized methodology and with a standardized questionnaire. Data were collected during February 2009 and the target population was Tbilisi students in the 10-th grade (93% born in 1992), with a mean age of 16.1 years at the time of data collection. Data were collected by group-administered questionnaires. The students answered the questionnaires anonymously in the classroom with researchers.

The survey revealed that alcoholic beverages, especially beer and wine are considered easily available; 73% found beer and 70% wine easy to obtain. 90% of the surveyed students have tried alcohol at least once during their lifetime. 80% have done so in the last 12months and 40% in the past 30 days. Gender differences become apparent when frequency of use is considered: boys have used alcohol more often than girls. 7.5% of the students state that, they never drink alcohol at all.

Wine and beer are the two most important types of beverage for the students. On average, 40% of students on the latest drinking day consumed wine and 38% - beer. Champagne and spirits consumed 29% and 22% of students, respectively.

On average, half of the students have been intoxicated, at least once during their lifetime, to the point of staggering when walking, having slurred speech or throwing up. 40% reported intoxication in the last 12 months and 12% in the past 30 days. Another way to measure drunkenness is to ask about a specific amount of alcohol consumed within a certain period of time. The students were asked if they had had five drinks or more on one occasion during the past month; this is referred to here as "heavy episodic drinking", 40% reported this; more boys than girls did so (45% versus 33%).

More than half of the questioned students had consumed at least one glass of alcohol at the age of 13 or younger, and 25% had been drunk at that age.

Having been intoxicated during the past 30 days, in turn, co-varies both with anticipating more positive consequences from drinking and with having experienced more negative personal consequences when drinking.

Alcohol remains the number one problem. The fact that more than 90% of respondents have had drunk alcohol at least once and that more than 43% have had their last drink at home and more than 27% at friend's home, indicates the great reflection of the cultural acceptance of alcohol within Georgian society and within Georgian families.

The consumption level among adults and their attitudes towards the substance in question can be one factor that affects use among teenagers. So may the magnitude of information and preventive efforts.

Availability, not only in physical terms but also in financial terms, is another factor.

Other, less substance-related, factors include the general level of health awareness in a population and the social and economic structures and conditions of individual communities.

The study showed the importance of knowledge of alcohol use and the necessity including the healthy lifestyle subject in school curricula.

Read Full Article pg 52-59 (PDF)
____________________________________________
__________________________________________

Age Differences in the Correlates of Problematic Alcohol Use Among Southern Lesbians

Research has demonstrated a high frequency and intensity of alcohol use among lesbian women.

This work explores age differences in risk factors for problematic alcohol use among self-identified Southern lesbians.

Risk factors of interest include depression, general stress, and three measures of sexual minority stress (i.e., experiences of discrimination, lesbian/gay-related stigma, and internalized homophobia).

Frequent and intense alcohol use was most common among lesbian women ages 19-29. Depression and stress were the most consistent psychosocial correlates of problematic alcohol use, although these patterns varied by age. Each of the minority stress measures was associated with problematic alcohol use, although no clear age-related pattern appeared.

Our findings suggest that depression and stress are strong predictors of problematic alcohol use among lesbians, which is comparable to previous findings in heterosexual populations.

Additional research is needed to understand how the association between sexual minority stress and problematic alcohol use changes across the life course.

Read Full Abstract

Request Reprint E-Mail: elaustin@uab.edu
________________________________________

Metabolite Levels in the Brain Reward Pathway Discriminate Those Who Remain Abstinent From Those Who Resume Hazardous Alcohol Consumption After Treatm

This study compared baseline metabolite levels in components of the brain reward system among individuals who remained abstinent and those who resumed hazardous alcohol consumption after treatment for alcohol dependence.

Fifty-one treatment-seeking alcohol-dependent individuals (abstinent for approximately 7 days [SD = 3]) and 26 light-drinking nonsmoking controls completed 1.5-T proton magnetic resonance spectroscopic imaging, yielding regional concentrations of N-acetylaspartate, choline-containing compounds, creatine-containing compounds, and myoinositol. Metabolite levels were obtained in the following component of the brain reward system: dorsolateral prefrontal cortex, anterior cingulate cortex, insula, superior corona radiata, and cerebellar vermis. Alcohol-dependent participants were followed over a 12-month period after baseline study (i.e., at 7 days of abstinence [SD = 3]) and were classified as abstainers (no alcohol consumption; n = 18) and resumers (any alcohol consumption; n = 33) at follow-up. Baseline metabolite levels in abstainers and resumers and light-drinking nonsmoking controls were compared in the above regions of interest.

Resumers demonstrated significantly lower baseline N-acetylaspartate concentrations than light-drinking nonsmoking controls and abstainers in all regions of interest. Resumers also exhibited lower creatine-containing-compound concentrations than abstainers in the dorsolateral prefrontal cortex, superior corona radiata, and cerebellar vermis. Abstainers did not differ from light-drinking nonsmoking controls on baseline metabolite concentrations in any region of interest.

The significantly decreased N-acetylaspartate and creatine-containing-compound concentrations in resumers suggest compromised neuronal integrity and abnormalities in cellular bioenergetics in major neocortical components and white-matter interconnectivity of the brain reward pathway. The lack of metabolite differences between abstainers and light-drinking nonsmoking controls suggests premorbid factors potentially contributed to the baseline brain metabolite abnormalities observed in resumers.

Read Full Abstract

Request Reprint E-Mail: timothy.durazzo@ucsf.edu
_______________________________________

Seminar intensive consumption of alcohol in youth: knowledge, options and feasibility

• Information and Accommodation

• Schedule

• Registration

_______________________________________

Government rejects MPs' call for alcohol ad crackdown

The government has today rejected a call from MPs on the Commons health select committee to crack down on alcohol advertising, including a pre-9pm watershed ban, instead backing a policy of education and self-regulation.

There was "some way to go" before the restrictions proposed by the health select committee should be considered, the Department of Health said.

"While the committee has drawn attention to an important issue from some emerging evidence on the potential harm to young people, there is some way to go before there is a strong enough case for the specific restrictions and controls the committee has recommended," said the DoH in its response today.

The DoH rejected the call for a pre-9pm alcohol ad ban as disproportionate and said that "given the current economic climate extensive regulatory interventions … would most likely have a significant impact on the creative industries. It is not clear that this impact would be a proportionate or effective response." . . . . .

Read More

____________________________________________

Health Characteristics of the American Indian and Alaska Native Adult Population: United States, 2004-2008

This report compares national estimates for selected health status indicators, health behaviors, health care utilization, health conditions, immunizations, and human immunodeficiency virus (HIV) testing status for American Indian or Alaska Native (AIAN) adults with those for white, black, Asian, and Hispanic adults aged 18 years and over.

In general, compared with other groups, non-Hispanic AIAN adults are more likely to have poorer health, unmet medical needs due to cost, diabetes, trouble hearing, activity limitations, and to have experienced feelings of psychological distress in the past 30 days.

Non-Hispanic AIAN adults are more likely to be current smokers and current drinkers compared with other adults.

The non-Hispanic AIAN community faces many health challenges as reflected in their higher rates of risky health behaviors, poorer health status and health conditions, and lower utilization of health services.

Read Full Report (PDF)
_______________________________________

Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis .

Policymakers and other stakeholders can use cost-benefit analysis as an informative tool for decision making for substance abuse prevention. This report reveals the importance of supporting effective prevention programs as part of a comprehensive substance abuse prevention strategy.

The following patterns of use, their attendant costs, and the potential cost savings are analyzed:

 Extent of substance abuse among youth;

 Costs of substance abuse to the Nation and to States;

 Cost savings that could be gained if effective prevention policies, programs, and services were implemented nationwide;

 Programs and policies that are most cost beneficial.

Read Full Report (PDF)
_____________________________________

EEG alpha phenotypes: linkage analysis and relation to alcohol dependence in an American Indian community study

Evidence for a high degree of heritability of EEG alpha phenotypes has been demonstrated in twin and family studies in a number of populations. However, information on linkage of this phenotype to specific chromosome locations is still limited.

This study's aims were to map loci linked to EEG alpha phenotypes and to determine if there was overlap with loci previously mapped for alcohol dependence in an American Indian community at high risk for substance dependence.

Sixty percent of this study population had a lifetime diagnosis of alcohol dependence. Analyses of multipoint variance component LOD scores, for the EEG alpha power phenotype, revealed two loci that had a LOD score of 3.0 or above for the fronto-central scalp region on chromosomes 1 and 6. Additionally, 4 locations were identified with LOD scores above 2.0 on chromosomes 4, 11, 14, 16 for the fronto-central location and one on chromosome 2 for the centro-parietal-occipital location.

These results corroborate the importance of regions on chromosome 4 and 6 highlighted in prior segregation studies in this and other populations for alcohol dependence-related phenotypes, as well as other areas that overlap with other substance dependence phenotypes identified in previous linkage studies in other populations. These studies additionally support the construct that EEG alpha recorded from fronto-central scalp areas may represent an important endophenotype associated with alcohol and other substance dependence.

Read Full Article (PDF)

________________________________________

News Release - Strong public support for action on drink and drug-driving

Road safety charity Brake and Direct Line today reveal an overwhelming cry from the British public for Government action to curb the menace of drink and drug driving.

The call comes in the same month as the findings from an inquiry on drink and drug driving by Sir Peter North for the Department for Transport are due to be published.

More than 9 out of 10 drivers (92%) surveyed by the charity and motor insurer support the introduction of a new anti drug drive law to enable prosecution of anyone driving on impairing drugs, similar to the law on drink driving. At the moment, a prosecution can only be brought against a drug driver if the police also have evidence the driver was driving badly.

Drivers are also overwhelmingly in favour of a lower drink-drive limit, with more than 7 out of 10 (71%) agreeing that the current limit of 80mg alcohol per 100ml blood should be cut. Research indicates that someone driving with this much alcohol in their blood is five times more likely to crash than if they were driving without any alcohol in their system.

More than half of drivers (55%) support Brake and Direct Line’s calls for a low limit of 20mg alcohol per 100ml blood. . . . . .

Read Full Release
____________________________________________

Can the Blood Alcohol Concentration Be a Predictor for Increased Hospital Complications in Trauma Patients Involved in Motor Vehicle Crashes?

The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes.

Data for the study was collected by a retrospective review of the University of Wisconsin Hospital trauma registry between 1999 and 2007 using the National Trauma Registry of the American College of Surgeons (NTRACS). Of 3729 patients, 2210 (59%) had a negative BAC, 338 (9%) <100>200 mg/dL.

Forty-six percent of patients had one or more hospital related complications. The odds ratio (OR) for the occurrence of alcohol withdrawal in the three alcohol groups compared to the no alcohol group was 12.02 (CI 7.0–20.7), 16.81 (CI 10.4–27.2), and 30.96 (CI 19.5–49.2) as BAC increased with a clear dose response effect.

While there were no significant differences in the frequency of the total hospital events following trauma across the four groups, rates of infections, coagulopathies, central nervous system events and renal complications were lower in the high BAC group.

Prospective studies are needed to more precisely estimate the frequency of hospital complications in patients with alcohol use disorders and in persons intoxicated at the time of the motor vehicle accident.

The study supports the use of routine BAC to predict patients at high risk for alcohol withdrawal and the early initiation of alcohol detoxification.

Read Full Article (PDF)
_______________________________________

A case–control analysis of socio-economic and marital status differentials in alcohol- and non-alcohol-related mortality among working-age Russian mal

We examined the role of socio-economic status (SES) and marital status in premature mortality among working-age Russian males. Life expectancy among this group dropped sharply following the collapse of the Soviet Union and has yet to recover despite the relative economic and political stability of the last decade.

Results revealed clear protective effects of SES and marital status against premature mortality. Although the effects for marital status were significant across alcohol- and non-alcohol-related causes of death, the effects of SES were largely limited to non-alcohol-related causes of death. When heavy drinkers were excluded from the analysis, however, SES was found to protect against premature mortality for alcohol-related causes.

While hazardous drinking is known to be a leading cause of premature mortality among working-age Russian males, it is unwise to ignore other factors. Given the substantial social and economic impacts in Russia of the dissolution of the Soviet Union, it is important to examine the health effects of SES and marital status and other social forces in the nation.

Our results reveal that while Russia has a very different past in terms of medicine, public health and economic institutions, it currently faces public health threats that follow similar patterns to those found in Western nations.

Read Full Abstract

Request Reprint E-Mail: wpridemo@indiana.edu

_____________________________________________

RCT of Effectiveness of Motivational Enhancement Therapy Delivered by Nurses for Hazardous Drinkers in Primary Care Units in Thailand

To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand.

Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group after both 3 and 6 months. The groups did not generally differ at 6 weeks.

However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study.

MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.

Read Full Abstract

Request Reprint E-Mail: beelittlebird@yahoo.com
____________________________________________

Differentiating Prenatal Exposure to Methamphetamine and Alcohol versus Alcohol and Not Methamphetamine using Tensor-Based Brain Morphometry and Discr

Here we investigate the effects of prenatal exposure to methamphetamine (MA) on local brain volume using magnetic resonance imaging.

Because many who use MA during pregnancy also use alcohol, a known teratogen, we examined whether local brain volumes differed among 61 children (ages 5–15 years), 21 with prenatal MA exposure, 18 with concomitant prenatal alcohol exposure (the MAA group), 13 with heavy prenatal alcohol but not MA exposure (ALC group), and 27 unexposed controls.

Volume reductions were observed in both exposure groups relative to controls in striatal and thalamic regions bilaterally and in right prefrontal and left occipitoparietal cortices.

Striatal volume reductions were more severe in the MAA group than in the ALC group, and, within the MAA group, a negative correlation between full-scale intelligence quotient (FSIQ) scores and caudate volume was observed.

Limbic structures, including the anterior and posterior cingulate, the inferior frontal gyrus (IFG), and ventral and lateral temporal lobes bilaterally, were increased in volume in both exposure groups. Furthermore, cingulate and right IFG volume increases were more pronounced in the MAA than ALC group.

Discriminant function analyses using local volume measurements and FSIQ were used to predict group membership, yielding factor scores that correctly classified 72% of participants in jackknife analyses.

These findings suggest that striatal and limbic structures, known to be sites of neurotoxicity in adult MA abusers, may be more vulnerable to prenatal MA exposure than alcohol exposure and that more severe striatal damage is associated with more severe cognitive deficit.

Read Full Abstract

Request Reprint E-Mail: esowell@ucla.edu
_____________________________________

News Release - Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-2009

A major new report commissioned by the Australian National Council on Drugs (ANCD) will be launched on Thursday 18^th of March at Parliament House by Parliamentary Secretary for International Development Assistance, Bob McMullan MP. The report has highlighted that whilst illicit drugs are becoming an increasing concern in the Pacific region alcohol is still the main issue.

This report, Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-09, was commissioned in order to provide detailed country profiles relating to alcohol and other drug issues. In addition, a regional overview has been prepared to highlight where existing regional mechanisms may be, and already have been, employed to address these issues. The report provides a much needed picture of the Pacific Region and the drug and alcohol issues they are experiencing.

The report Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-09 prepared by the Burnet Institute is based on a review of published and grey literature, key informant interviews and broad consultations on detailed country profiles.

Read Full Release

ANCD research paper 21- Situational analysis of drug and alcohol issues and responses in the Pacific 2008-09 (PDF)

____________________________________________

________________________________________

YOUTH COMMISSION ON ALCOHOL ANNOUNCES FINDINGS AND RECOMMENDATIONS!

After a range of meetings with high profile industry experts, five intense residentials and two international study visits, the ground-breaking Youth Commission on Alcohol has come to an end.

The young Commissioners have attended their final residential meeting where they finalised the recommendations which they have came up with during the year long project which examined Scotland's relationship with alcohol.

They have identified eight key recommendations focussed around education, social marketing, advertising and availability to name a few. The young people have today presented their final recommendations to the Scottish Government.

Click on this link, http://www.youngscot.net/projects/index.asp?id=1441&SR=29&ssnb=5 to view the final evidence and recommendations document.

_______________________________________

Health Behaviors of Adults: United States, 2005–2007

This report presents selected prevalence estimates for key indicators of alcohol use, cigarette smoking, leisure-time physical activity, body weight status, and sleep among U.S. adults, using data from the 2005–2007 National Health Interview Survey (NHIS).

The NHIS is conducted annually by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. The subgroups are compared in terms of their prevalence of ‘‘healthy’’ and ‘‘unhealthy’’ behaviors.

Read Full Report (PDF)
_______________________________________

Concordance of Adolescent Reports of Friend Alcohol Use, Smoking, and Deviant Behavior as Predicted by Quality of Relationship and Demographic Variabl

The strongest predictor of adolescent alcohol use is affiliation with friends who drink, use other drugs, or engage in deviant behavior. Most studies measure this variable using adolescent perceptions of friend problem behavior, but some research suggests these perceptions may be inaccurate.

The current study's objective was to determine the concordance between adolescent perceptions of their friend's drinking, smoking, and deviant behavior and the friend's self-report. Relationship characteristics and demographic variables were explored as predictors of report concordance.

The relations between target perceptions of friend and friend self-reports of drinking and smoking were statistically significant (p < .001), but concordance was driven largely by agreement regarding the absence of behavior. Although 22% of friends drank and 8.6% smoked, fewer than 60% of targets perceived these behaviors. Deviant behavior reports correlated moderately (r .45), with 51% of adolescents underreporting friend deviance. There were few predictors of report concordance.

Adolescents and their friends generally provided concordant reports of one another's drinking and smoking behaviors, but most agreement concerned the absence of behavior; most targets provided underreports of their friend's engagement in deviant behaviors.

These findings suggest that adolescent perceptions of friends' problem behavior do not exaggerate the involvement of their friends in these behaviors.

Read Full Abstract

Request Reprint E-Mail: donovanje@upmc.edu
_______________________________________

Relationship Between Alcohol Drinking and Aspartate Aminotransferase:Alanine Aminotransferase (AST:ALT) Ratio, Mean Corpuscular Volume (MCV), Gamma-Gl

The misuse of alcohol, even at levels just above two drinks per day, is a public health problem, but identifying patients with this potentially unhealthy drinking is hindered by the lack of tests. Several blood tests, such as those testing for gamma-glutamyl transpeptidase (GGT) or mean corpuscular volume (MCV), are among the commonly used markers to identify very heavy drinking, but combinations of these markers have rarely been tested in lighter drinkers.

We examined the relationship between alcohol drinking and the levels of these markers in a national population-based study composed primarily of lighter drinkers.

Data were analyzed from 8,708 adult participants in the third U.S. National Health and Nutrition Examination Survey after excluding subjects with iron overload; with hepatitis B and C; who were pregnant; and who were taking prescription drugs such as phenytoin (Dilantin), barbiturates, and hydroxyurea (Droxia and Hydrea). The relationship between the amount of alcohol drinking and GGT, aspartate aminotransferase:alanine aminotransferase ratio, MCV of erythrocytes, and apolipoprotein A1 and B were analyzed and adjusted for potential liver injury risk factors.

The prevalence of unhealthy alcohol drinking (defined as consumption of more than two standard drinks per day) was 6.7%. Heavier drinkers tended to be younger and reported an average of 4.2 drinks per day. When tested alone or in combination, the sensitivity and positive predictive values for these blood tests were too low to be clinically useful in identifying the subjects in the heavier drinking category.

In this large, national, population-based study, the markers of heavy drinking studied here, either alone or in combination, did not appear to be useful in identifying unhealthy drinking. More work is needed to find the novel marker(s) associated with risky alcohol drinking.

Read Full Abstract

Request Reprint E-Mail: sliangpu@iupui.edu
______________________________________

Drinking, Driving, and Crashing: A Traffic-Flow Model of Alcohol-Related Motor Vehicle Accidents

This study examined the influence of on-premise alcohol-outlet densities and of drinking-driver densities on rates of alcohol-related motor vehicle crashes.

A traffic-flow model is developed to represent geographic relationships between residential locations of drinking drivers, alcohol outlets, and alcohol-related motor vehicle crashes.

Cross-sectional analyses showed that effects relating on-premise densities to alcohol-related crashes were moderated by highway traffic flow. Depending on levels of highway traffic flow, 10% greater densities were related to 0% to 150% greater rates of SVN crashes. Time-series cross-sectional analyses showed that changes in the population pool of drinking drivers and on-premise densities interacted to increase SVN crash rates.

A simple traffic-flow model can assess the effects of on-premise alcohol-outlet densities and of drinking-driver densities as they vary across communities to produce alcohol-related crashes. Analyses based on these models can usefully guide policy decisions on the siting of on-premise alcohol outlets.

Read Full Abstract

Request Reprint E-Mail: paul@prev.org
_______________________________________