Alcohol Levels Do Not Accurately Predict Physical or Mental Impairment in Ethanol-Tolerant Subjects: Relevance to Emergency Medicine and Dram Shop

The human body and the central nervous system can develop tremendous tolerance to ethanol. Mental and physical dysfunctions from ethanol, in an alcohol-tolerant individual, do not consistently correlate with ethanol levels traditionally used to define intoxication, or even lethality, in a nontolerant subject.

Attempting to relate observed signs of alcohol intoxication or impairment, or to evaluate sobriety, by quantifying blood alcohol levels can be misleading, if not impossible.

We report a case demonstrating the disconnect between alcohol levels and generally assigned parameters of intoxication and impairment. In this case, an alcohol-tolerant man, with a serum ethanol level of 515 mg/dl, appeared neurologically intact and cognitively normal. This individual was without objective signs of impairment or intoxication by repeated evaluations by experienced emergency physicians.

In alcohol-tolerant individuals, blood alcohol levels cannot always be predicted by and do not necessarily correlate with outward appearance, overt signs of intoxication, or physical examination.

This phenomenon must be acknowledged when analyzing medical decision making in the emergency department or when evaluating the ability of bartenders and party hosts to identify intoxication in dram shop cases.

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Request Reprint E-Mail: JRoberts@mercyhealth.org
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Unnatural deaths in reindeer-herding Sami families in Sweden, 1961–2001

Unnatural deaths among Indigenous populations, including the Swedish Sami, occur more often than among the general population.

To find prevention strategies, we explored the circumstances of the unnatural deaths of members of reindeer-herding Sami families.

Transport-related deaths and suicides were the most common unnatural deaths among Swedish reindeer-herding Sami family members. Suicides contributed to 23% of all deaths, road traffic accidents to 16%, and snowmobile fatalities to 11%. The accidents generally reflected an “outdoor lifestyle” and the working conditions were characterized by the use of off-road vehicles such as snowmobiles.

Half of the number of victims tested positive for alcohol and alcohol abuse was documented in 15% of all victims. The results indicate that alcohol is an important factor in preventing unnatural deaths among reindeer-herding Sami, together with increased safety of both on-road and off-road transportation.

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Alcohol Intake and Risk of Coronary Heart Disease in Younger, Middle-Aged, and Older Adults

Light to moderate alcohol consumption is associated with a reduced risk of coronary heart disease. This protective effect of alcohol, however, may be confined to middle-aged or older individuals.

This study examined whether the beneficial effect of alcohol on coronary heart disease depends on age

In this pooled analysis of 8 prospective studies from North America and Europe including 192 067 women and 74 919 men free of cardiovascular diseases, diabetes, and cancers at baseline, average daily alcohol intake was assessed at baseline with a food frequency or diet history questionnaire.

An inverse association between alcohol and risk of coronary heart disease was observed in all age groups; hazard ratios among moderately drinking men (5.0 to 29.9 g/d) 39 to 50, 50 to 59, and 60 years of age were 0.58 (95% confidence interval [CI], 0.36 to 0.93), 0.72 (95% CI, 0.60 to 0.86), and 0.85 (95% CI, 0.75 to 0.97) compared with abstainers.

However, the analyses indicated a smaller incidence rate difference between abstainers and moderate consumers in younger adults (incidence rate difference, 45 per 100 000; 90% CI, 8 to 84) than in middle-aged (incidence rate difference, 64 per 100 000; 90% CI, 24 to 102) and older (incidence rate difference, 89 per 100 000; 90% CI, 44 to 140) adults. Similar results were observed in women.

Alcohol is also associated with a decreased risk of coronary heart disease in younger adults; however, the absolute risk was small compared with middle-aged and older adults.

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Request Reprint E-Mail: jst@niph.dk

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Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006.

Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct).

In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use.

Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population.

Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis.

Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals.

In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

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Request Reprint E-Mail: Jazorin@Ap-Hm.Fr
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Screening and Brief Intervention for Underage Drinkers

In a 2007 report, the US Surgeon General called for health care professionals to renew efforts to reduce underage drinking.

Focusing on the adolescent patient, this review provides health care professionals with recommendations for alcohol-related screening, brief intervention, and referral to treatment.

MEDLINE and published reviews were used to identify relevant literature.

Several brief screening methods have been shown to effectively identify underage drinkers likely to have alcohol use disorders.

After diagnostic assessment when germane, the initial intervention typically focuses on education, motivation for change, and consideration of treatment options. Internet-accessible resources providing effective brief interventions are available, along with supplemental suggestions for parents.

Recent changes in federal and commercial insurance reimbursement policies provide some fiscal support for these services, although rate increases and expanded applicability may be required to prompt the participation of many practitioners.

Nevertheless, advances in clinical methods and progress on reimbursement policies have made screening and brief intervention for underage drinking more feasible in general health care practice.

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Request Reprint E-Mail: clarkdb@upmc.edu ___________________________________________

History of Antihypertensive Therapy Influences the Relationships of Alcohol With Blood Pressure and Pulse Pressure in Older Men

Blood pressure is known to be higher in heavy drinkers than in nondrinkers. The aim of this study was to determine whether the alcohol–blood pressure relationship is modified by therapy for hypertension in the elderly.

Systolic blood pressure and pulse pressure were significantly higher in subjects receiving antihypertensive therapy than in subjects not receiving antihypertensive therapy, whereas diastolic blood pressure was not different between the two groups.

In multivariate analysis with adjustment for age, smoking history, and body mass index (BMI), systolic and diastolic blood pressure and pulse pressure in the group not receiving antihypertensive therapy were significantly higher in heavy and very heavy drinkers than in nondrinkers, whereas in the group receiving antihypertensive therapy, systolic and diastolic blood pressure and pulse pressure were not different between each drinker group and the nondrinker group.

Alcohol intake was associated with blood pressure and pulse pressure in older men not receiving therapy for hypertension but not in those receiving antihypertensive therapy.

The indicated possibility that changes in drinking do not have a substantial impact on blood pressure among treated hypertensives should be examined in longitudinal studies and preferably in clinical trials.

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Request Reprint E-Mail: wakabaya@hyo-med.ac.jp

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When should clinicians switch treatments? An application of signal detection theory to two treatments for women with alcohol use disorders

Statistical application of signal detection theory has been used to study the clinical utility of early treatment response in a range of treatments and psychiatric disorders.

The current study sought to examine the predictive value of weekly within-treatment drinking using receiver operator curves (ROCs) and zero-inflated Poisson (ZIP) regression in 102 women with alcohol use disorders (AUDs) randomized to either alcohol behavioral individual treatment (ABIT; n = 52) or alcohol behavioral couples treatment (ABCT; n = 50).

ROC analyses indicated that failure to achieve or sustain abstinence by the end-of-treatment and one-year follow-up was predicted with reasonable accuracy by week 4 percent days abstinent (PDA) in ABIT.

ZIP models yielded similar results with evidence for within-treatment PDA with week 6 PDA predicting both the abstinence as well as percent days drinking at the end-of-treatment and one-year follow-up.

Within-treatment PDA was a significantly better predictor of outcomes for ABIT than ABCT, despite a better overall treatment response for ABCT.

Implications for stepped care models of alcohol treatment are discussed and recommendations for future research made.

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Request Reprint E-Mail: tom.hildebrandt@mssm.edu

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Association between alcohol consumption and bone strength in Korean adults: the Korean Genomic Rural Cohort Study

Previous studies have reported an inconsistent relationship between alcohol consumption and bone health.

A growing body of research has shown that chronic alcoholism leads to osteopenia and increased incidence of skeletal fractures, but some studies have concluded that alcohol consumption may be associated with higher bone mineral density in elderly populations.

However, most studies showing a significant relationship between alcohol consumption and bone status have been in Western countries; and subjects have usually been postmenopausal women.

The purpose of the present study was to investigate the association of alcohol consumption with bone strength in Korean adults. Data were from the Korean Genomic Rural Cohort Study, which is an ongoing population-based study of adults aged 40 to 70 years from 5 regions. A total of 7713 participants (3368 men, 4345 women) were surveyed about their annual consumption of alcohol such as soju, beer, makkolli, wine, and whisky. Bone strength was measured by stiffness index using the calcaneal quantitative ultrasound method.

Overall, the annual age-specific decrease rate in the stiffness index of women was 2.7 times higher than that of men (0.463% for women, 0.169% for men).

After adjustment for eligible covariates, the association between alcohol consumption and risk of reduced bone strength showed a J-shaped curve for both men and women.

Compared with nondrinkers, the relative risk of reduced bone strength was 0.52 (95% confidence interval, 0.33-0.83) in men who drank 4 to 5 cups of soju for an amount of 29.626 to 49.375 g of alcohol per day and 0.61 (95% confidence interval, 0.38-0.86) in men who drank 6 to 7 cups of soju for an amount of 49.376 to 69.125 g of alcohol per day.

We found no significant relationship between alcohol consumption and bone strength in any other group of men. For women, results suggested that the risk of reduced bone strength was lower in the moderate-consumption group; but no significant relationship was found between alcohol consumption at any level and bone strength.

Among Korean adults, alcohol consumption has a J-shaped relationship with risk of reduced bone strength.

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Request Reprint E-Mail: parkjk@yonsei.ac.kr
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The association of exon 3 VNTR polymorphism of the dopamine receptor D4 (DRD4) gene with alcoholism in Mexican Americans

In this study, the variable number tandem repeats (VNTR) polymorphism of a 48-bp sequence located in exon 3 of the dopamine receptor D4 (DRD4) gene was genotyped in 365 alcoholic and 337 non-alcoholic Mexican Americans.

Logistic regression showed that genotypes without the 7-repeat allele were risk factors for alcoholism.

However, linear regression did not find an association between DRD4 VNTR and MAXDRINKS, which was defined as the maximum number of drinks consumed within 24 h.

Our results indicate the presence of an association between DRD4 VNTR and alcoholism in Mexican Americans.

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Request Reprint E-Mail: ywan@kumc.edu


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Fourth National Conference on Women, Addiction and Recovery: Thriving in Changing Times

The Fourth National Conference on Women, Addiction and Recovery: Thriving in Changing Times is grounded in the principles of recovery and gender-responsive, trauma-informed care. The conference offers opportunities to explore a wide array of topics such as the following.

• family-centered treatment


• health policy affecting women’s treatment


• women and the criminal justice system


• co-occurring mental and health conditions


• comprehensive recovery support for women


• using technology in innovative ways


• culturally responsive approaches


• workforce development strategies

Read More
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News Release - Hospital trauma teams urged to help combat alcohol related injuries and deaths

The Royal College of Surgeons of England is today challenging nurses, doctors and surgeons working in NHS trauma services to help curb the epidemic of alcohol misuse by providing advice to patients during their course of treatment.

Clinical trials show that of hazardous drinkers who receive a ‘brief intervention’ at follow up appointments following a hospital admission for trauma, 24 per cent more reduce their drinking to safer levels a year later compared to those who don’t*.

The new standard affirms that this should be a routine and expected part of surgical care. . . . . .

Read Full Release
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Alcohol and endocannabinoids: Neuroendocrine interactions in the reproductive axis

Marihuana and alcohol consumption affect adversely reproduction by inhibiting the hypothalamic-pituitary-gonadal axis.

The endocannabinoid system, present in the central nervous system and in peripheral tissues, participates in the regulation of hormones involved in the reproductive physiology such as luteinizing hormone, prolactin and oxytocin. This system is activated in response to pathophysiological conditions such as stress and inflammatory/infectious states, as well as alcoholism and drug consumption acting as a negative modulator of reproductive function.

The secretion of luteinizing hormone from the adenohypophysis is reduced, mainly through hypothalamic inhibitory action of cannabinoids and alcohol on luteinizing hormone releasing hormone release from its nervous terminals in the median eminence.

This inhibitory effect is mediated, at least in part, by the activation of cannabinoid type 1 receptors. Cannabinoids also inhibit prolactin release from the lactotropes in the adenohypophysis acting locally and by increasing the release of hypothalamic dopamine mainly from tuberoinfundibular dopaminergic neurons in the external layer of the median eminence.

On the contrary, ethanol stimulates prolactin release from the adenohypophysis as well as oxytocin from the neurohypophysis. Besides, endocannabinoids modulate oxytocin synthesis and release from the hypothalamic magnocellular neurons and neurohypophysis.

In summary, all the results exposed in the present review suggest that there is interplay between the endocannabinoid system, hormones and neuropeptides in the control of reproduction and that this system mediates, at least in part, ethanol adverse effects on reproductive function.

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Request Reprint E-Mail: vrettori@yahoo.com

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The Influence of Drinking Pattern, at Individual and Aggregate Levels, on Alcohol-Related Negative Consequences

To determine the extent drinking patterns (at the individual and country level) are associated with alcohol-related consequences over and above the total alcohol the person consumes.

Hierarchical linear models were estimated based on general population surveys conducted in 18 countries participating in the GENACIS project

In general, the positive association between drinking pattern scores and alcohol-related consequences was found at both the individual and country levels, independent of volume of drinking. In addition, a significant interaction effect indicated that the more detrimental the country’s drinking pattern, the less steep the association between the volume of drinking and its consequences.

Drinking patterns have an independent impact on consequences over and above the relationship between volume and consequences.

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Request Reprint E-Mail: mastudillo@sfa-ispa.ch
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Outcomes of occasional cannabis use in adolescence: 10-year follow-up study in Victoria, Australia

Regular adolescent cannabis use predicts a range of later drug use and psychosocial problems. Little is known about whether occasional cannabis use carries similar risks.

To examine associations between occasional cannabis use during adolescence and psychosocial and drug use outcomes in young adulthood; and modification of these associations according to the trajectory of cannabis use between adolescence and age 20 years, and other potential risk factors.

Occasional adolescent cannabis users who continued occasional use into early adulthood had higher risks of later alcohol and tobacco dependence and illicit drug use, as well as being less likely to complete a post-secondary qualification than non-users. Those using cannabis at least weekly either during adolescence or at age 20 were at highest risk of drug use problems in young adulthood. Adjustment for smoking in adolescence reduced the association with later educational achievement, but associations with drug use problems remained.

Occasional adolescent cannabis use predicts later drug use and educational problems. Partial mediation by tobacco use raises a possibility that differential peer affiliation may play a role.

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Request Reprint E-Mail: l.degenhardt@unsw.edu.au

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Revisiting the Cost-Effectiveness of the COMBINE Study for Alcohol Dependent Patients: The Patient Perspective

Most cost and cost-effectiveness studies of substance abuse treatments focus on the costs to the provider/payer. Although this perspective is important, the costs incurred by patients should also be considered when evaluating treatment.

This article presents estimates of patients' costs associated with the Combined Pharmacotherapies and Behavioral Interventions (COMBINE) alcohol treatments and evaluates the treatments' cost-effectiveness from the patient perspective.

The average total patient time devoted to treatment ranged from about 30 hours to 46 hours. Time spent traveling to and from treatment sessions and participation in self-help meetings accounted for the largest portion of patient time costs.

The cost-effectiveness results indicate that 6 of the 9 treatments were economically dominated and only 3 treatments are potentially cost-effective depending on patient's willingness to pay for the considered outcomes: medical management (MM) + placebo, MM + naltrexone, and MM + naltrexone + acamprosate.

Few studies consider the patient's perspective in estimating costs and cost-effectiveness even though these costs may have a substantial impact on a patient's treatment choice, ability to access treatment, or treatment adherence.

For this study, the choice of the most cost-effective treatment depends on the value placed on the outcomes by the patient, and the conclusions drawn by the patient may differ from that of the provider/payer.

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Request Reprint E-Mail: ljd@rti.org

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Health Profile of England 2009

The Health Profile of England (HPoE) provides national and regional data, which local areas can compare against their own Health Profiles. There is a section of international comparisons. The HPoE is intended for public service professionals and officials within the local community.

What the Health Profile of England 2009 shows – the general picture

An improvement in health outcomes

The report shows recent improvements in a number of critical areas, eg:

• declining mortality rates in targeted killers (cancers, all circulatory diseases and suicides)
• increasing life expectancy, now at its highest ever level
• further reductions in infant and perinatal mortality
• recent reductions in new diagnoses of gonorrhoea

However in some areas particular challenges remain to achieve and sustain progress, eg:

• rising rates of diabetes
• rising alcohol related hospital admissions and alcohol related deaths

Similarly for the determinants of health, we are making improvements in some important areas:

• the percentage of people who smoke
• quality of housing stock
• the proportion of school aged children completing at least two hours of PE and school sport a week.
  

However, even where we are seeing improvements, health inequalities are often present

• The report illustrates various geographical inequalities across England.

International comparisons give a wider context presenting national progress in comparison to countries of the European Union (EU), or to the 15 countries that were members of the EU prior to 2004 (EU-15), eg:

• Premature mortality rates from the two biggest killers, circulatory diseases and cancer are reducing faster in England than the average for the EU for both males and females
• The prevalence of adult obesity in England is amongst the highest in the EU
• Death rates for chronic liver disease and cirrhosis have risen markedly in a handful of countries, particularly in recent years. For both males and females latest data show that mortality rates in England have risen above the EU-15 average
• The percentage of all live births to mothers under age 20 in the United Kingdom remains the highest when compared to other EU-15 countries. Infant mortality rates are also higher in England than the EU-15 average.

Read Full Report (PDF)
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Accumbens Shell–Hypothalamus Interactions Mediate Extinction of Alcohol Seeking

The nucleus accumbens shell (AcbSh) is required to inhibit drug seeking after extinction training. Conversely, the lateral hypothalamus (LH), which receives projections from AcbSh, mediates reinstatement of previously extinguished drug seeking.

We hypothesized that reversible inactivation of AcbSh using GABA agonists (baclofen/muscimol) would reinstate extinguished alcohol seeking and increase neuronal activation in LH.

Rats underwent self-administration training for 4% (v/v) alcoholic beer followed by extinction. AcbSh inactivation reinstated extinguished alcohol seeking when infusions were made after, but not before, extinction training. We then used immunohistochemical detection of c-Fos as a marker of neuronal activity, combined with immunohistochemical detection of the orexin and cocaine- and amphetamine-related transcript (CART) peptides, to study the profile and phenotype of neural activation during reinstatement produced by AcbSh inactivation.

AcbSh inactivation increased c-Fos expression in hypothalamus, as well as in paraventricular thalamus and amygdala. Within hypothalamus, there was an increase in the number of orexin and CART cells expressing c-Fos.

Finally, we hypothesized that concurrent inactivation of LH would prevent reinstatement produced by inactivation of AcbSh alone.

Our results confirmed this. Together, these findings suggest that AcbSh mediates extinction of reward seeking by inhibiting hypothalamic neuropeptide neurons.

Reversible inactivation of the AcbSh removes this influence, thereby releasing hypothalamus from AcbSh inhibition and enabling reinstatement of reward seeking.

These ventral striatal–hypothalamic circuits for extinction overlap with those that mediate satiety, and we suggest that extinction training inhibits drug seeking because it co-opts neural circuits originally selected to produce satiety.

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Request Reprint E-Mail: g.mcnally@unsw.edu.au
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The influence of alcohol consumed with a meal on endothelial function in healthy individuals

Alcohol and polyphenols in wine and fruit juices have been strongly implicated in the favourable effects on of these beverages on vascular function. Despite a wealth of information on the metabolic and vascular effects of alcohol and polyphenols, the combined influences of these substances on vascular function, especially when consumed with food, is poorly understood.

A study was designed to determine the effects of a phenolic-rich grape juice, with or without alcohol, on vascular endothelial function in the postprandial state.

There was a significant effect of the three treatments (P = 0.0026) and time (P = 0.021) on percentage FMD. The meals with the grape juice and grape juice plus alcohol produced similar FMD responses but were both significantly greater than the meal with water. The concentration of plasma glucose, TAG and NEFA were similar after each treatment.

Alcohol had no effect on vascular function in the early postprandial phase. These findings provide new evidence to support the potential benefit of non-alcoholic components within alcoholic beverages on vascular function in the fed state.

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Request Reprint E-Mail: s.hampton@surrey.ac.uk

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Game Helps Parents and Children Talk about Alcohol

A new DVD game designed to be played on a computer brings parents and children together to talk about the dangers of underage drinking.

Ready, Set, Listen!, developed by SAMHSA’s Center for Substance Abuse Prevention (CSAP), offers a fun and interactive experience that introduces and reinforces the importance of family discussion on an important subject.

The game has two goals:

• To increase the number of conversations that parents and caregivers have with children age 9 to 13 about the harms of underage alcohol use.
• To increase the percentage of children, parents, and caregivers who see underage alcohol use as harmful

Read More
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The Social Cost of Alcohol: Passive drinking 02.02.2010

Over 120 people attended the Lunch Seminar organised by Eurocare in the European Parliament to discuss the harm to others as "The Cost of Alcohol: Passive drinking" on Tuesday 2nd February 2010.

The seminar was hosted by MEP Anna Hedh from the Group of the Progressive Alliance of Socialists and Democrats and 30 MEPs were present or represented at the event.

Click here to read the seminar's report.

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Seminar on Youth drinking and binge drinking, 25 February 2010

Summary report

Presentations

• Europe & Alcohol Health Harm - Mapping, understanding, and preventing a problem
  Witold Zatoñski
  Cancer Center Institute of Oncology, Warsaw

• Young binge drinkers in need of emergency care – the EU picture
  Walter Farke
  

• Youth drinking and binge drinking - the role of medical professions
  Ian Gilmore
  Royal College of Physicians of London

• “Prevention Intervention System” for children in The Netherlands
  N. van der Lely
  Paediatric alcohol policlinic Reinier de Graaf Gasthuis, Delft (The Netherlands)

• Youth drinking and binge drinking – drivers and protective factors
  Eileen Kaner & Stephanie O’Neil
  Newcastle University, Institute of Health & Society

• Alcohol, Children and Parents - Science not Seduction
  Liverpool John Moores University, Centre for Public Health

• Alcohol and Parenting 2006 - 2009
  Victor Everhardt
  Trimbos Institute, Utrecht (The Netherlands)

• The role parents and families could and should play – An example from Germany
  Angelika Wiesgen-Pick
  Federal Association of the German Spirits Industry and Importers (BSI), Bonn

• The struggle against alcohol abuse for young children - Collaboration on three levels
  Ton Duif
  European School Headmasters Association (ESHA)

• Youth alcohol consumption and the role of parents
  Martin Schmalzried
  Confederation of Family Organisations in the European Union (COFACE)

• Parents Role in Youth Drinking and Binge Drinking – A Youth Perspective
  Nathalie A. Rodríguez McCullough
  Alcohol Policy Youth Network (APYN)

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Epidemiology of gout in women: Fifty-two-year followup of a prospective cohort

Despite the recent doubling of the incidence of gout among women and its substantial prevalence particularly in the aging female population, the risk factors for gout among women remain unknown.

We undertook this study to evaluate purported risk factors for incident gout among women and to compare them with those among men.

Multivariate relative risks conferred by increasing age (per 5 years), obesity (body mass index 30 kg/m2), alcohol intake (7 ounces of pure alcohol/week), hypertension, and diuretic use were 1.24, 2.74, 3.10, 1.82, and 2.39, respectively.

These prospective data with long-term followup provide evidence that higher levels of serum uric acid increase the risk of gout in a graded manner among women, but the rate of increase is lower than that among men. Increasing age, obesity, alcohol consumption, hypertension, and diuretic use were associated with the risk of incident gout among women. Read Full Abstract Request Reprint E-Mail: hchoius@bu.edu ____________________________________________

The effect of alcoholic beverage excise tax on alcohol-attributable injury mortalities

This study examines the effect of state excise taxes on different types of alcoholic beverages (spirits, wine, and beer) on alcohol-attributable injury mortalities—deaths caused by motor vehicle accidents, suicides, homicides, and falls—in the United States between 1995 and 2004, using state-level panel data. There is evidence that injury deaths attributable to alcohol respond differently to changes in state excise taxes on alcohol-specific beverages.

This study examines the direct relationship between injury deaths and excise taxes without testing the degree of the association between excise taxes and alcohol consumption.

The study finds that beer taxes are negatively related to motor vehicle accident mortality, while wine taxes are negatively associated with suicides and falls.

The positive coefficient of the spirit taxes on falls implies a substitution effect between spirits and wine, suggesting that an increase in spirit tax will cause spirit buyers to purchase more wine.

This study finds no evidence of a relationship between homicides and state excise taxes on alcohol.

Thus, the study concludes that injury deaths attributable to alcohol respond differently to the excise taxes on different types of alcoholic beverages.

Read Full Abstract

Request Reprint E-Mail: kudret.topyan@manhattan.edu
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Alcohol Related Disease: Meeting the Challenge of Improved Quality of care and Better Use of Resources

A joint paper produced by key health organisations has called for further action on improving care and treatment of those with alcohol-related problems. . . . . .

Read More
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What Are Peer Recovery Support Services?

In this paper on What Are Peer Recovery Support Services, you will be introduced to a new kind of social support services designed to fill the needs of people in or seeking recovery.

The services are called peer recovery support services and, as the word peer implies, they are designed and delivered by people who have experienced both substance use disorder and recovery.

Through the Recovery Community Services Program (RCSP), the Substance Abuse and Mental Health Services Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT) funds grant projects across the country to develop and deliver these services.

Read Full Report (PDF)
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Alcoholism and Alternative Splicing of Candidate Genes

Gene expression studies have shown that expression patterns of several genes have changed during the development of alcoholism. Gene expression is regulated not only at the level of transcription but also through alternative splicing of pre-mRNA.

In this review, we discuss some of the evidence suggesting that alternative splicing of candidate genes such as DRD2 (encoding dopamine D2 receptor) may form the basis of the mechanisms underlying the pathophysiology of alcoholism.

These reports suggest that aberrant expression of splice variants affects alcohol sensitivities, and alcohol consumption also regulates alternative splicing.

Thus, investigations of alternative splicing are essential for understanding the molecular events underlying the development of alcoholism.

Read Full Article (PDF)
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Alcohol policy in a Russian region: a stakeholder analysis

Male life expectancy in the Russian Federation, at 60 years, is the lowest in Europe. Several factors contribute to this situation, but hazardous consumption of alcohol is especially a key factor.

We undertook a stakeholder analysis in a typical Russian region located on the western side of the Urals. Organizations with a stake in alcohol policy in the region were identified by snowball sampling and information on their position and influence on alcohol policy was elicited from interviews with key informants. Their interests and influence were mapped and their relationships plotted.

Twenty-nine stakeholder organizations were identified and 43 interviews were conducted with their staff. The most influential actors were the Federal and regional governments, large beer producers and manufacturers of strong alcohols. However, the majority of organizations that might be expected to play a role in developing or implementing alcohol control policies were almost entirely disengaged and fragmented. No evidence was found of an existing or emerging multi-sectoral coalition for developing alcohol policy to improve health. Organizations that might be expected to contribute to tackling hazardous drinking had little understanding of what might be effective.

While stakeholders with an interest in maintaining or increasing alcohol consumption are engaged and influential, those who might seek to reduce it either take a very narrow perspective or are disengaged from the policy agenda. There is a need to mobilize actors who might contribute to effective policies while challenging those who can block them.

Read Full Abstract

Request Reprint E-Mail: artyom.gil@lshtm.ac.uk
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ICAP Periodic Review on Drinking and Culture

Issue 3 • December 2009

This issue of the Review features abstracts of journal articles published between 2008 and 2009 in nine central, southern, and eastern European countries.

• Alcohol and the Workplace

• Drinking and Violence

• Extreme/“Binge” Drinking

• Inequalities in Health

• Road Safety

• Young People

Read Full Review
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European Parliament plenary urged to protect the health of consumers through clear alcohol labelling

On Tuesday, 16th March the European Parliament Committee on the Environment, Public Health and Food Safety voted on the EC Proposed regulation on the provision on food information to consumers.

No nutritional declaration for alcoholic beverages

MEPs voted to exclude alcoholic beveragres from the mandatory nutritional declaration requirement (Article 29).

Eurocare is disappointed that the EU Parliament Committee rejected an obligation to tell consumers what ingredients or the amount of calories or carbohydrates that are in alcoholic beverages.

Eurocare hopes that the EP plenary will overturn this decision when it votes in May and calls on the European Parliament to prioritise the health needs of European citizens. . . . . .

Read More

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Underage Drinking Prevention Campaign

Real kids are curious about alcohol. 40% have tried it by the time they reach eighth grade.

Talking with your children early and often can make a difference. Get the facts, the tools, and the advice you need to start talking real.

Read Campaign Information

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Don't drink: message in a bottle for pregnant women

PREGNANT women would be warned of the dangers of drinking on every bottle of beer, wine and spirits in a plan to broaden food labelling laws.

First a government-appointed panel of legal, food and nutrition experts must determine if alcohol should be subjected to the same level of labelling scrutiny as other foods, a public hearing into the review heard yesterday.

Neal Blewett, chairman of the Food Labelling Review panel, said alcohol labelling presented the panel with several anomalies. ''At the moment alcohol is treated as a food but a distinct type of food,'' he said.

Labels must contain information on the alcoholic content and the number of standard drinks, but are exempt from nutritional information panels which include the amount of fat, sugar, protein and other nutrients in packaged foods. . . . . .

Read More

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The European Spirits Organisation - CEPS Fact Sheets

New Fact sheets on

Alcohol & Underage Drinking ,

Alcohol Taxation, Pricing & Alcohol Related Harm

Alcohol Advertising & Consumption

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Drinksinitiatives.eu database

Drinksinitiatives.eu database is the follow-up of the drinks industry initiatives brochure produced annually since 2005.

The database is the result of the combined work of the European Spirits Organisation – CEPS and the European Forum for Responsible Drinking (EFRD).

Its objective is to present programmes undertaken by the spirits industry across the EU to help reduce alcohol-related harm. The database provides not only a description of the campaigns (from partners to impact & evaluation) but also available visuals or supporting documents.

These initiatives are divided into
5 areas, as follows:

• Underage drinking
• Drink-driving
• Consumer information
• Responsible service/selling
• Workplace

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Peer substance use overestimation among French university students: a cross-sectional survey

Normative misperceptions have been widely documented for alcohol use among U.S. college students. There is less research on other substances or European cultural contexts. This study explores which factors are in association with alcohol, tobacco and cannabis use misperceptions among French college students, focusing on substance use.

Peer substance use overestimation frequency was 84% for tobacco, 55% for cannabis, 37% for alcohol and 56% for heavy episodic drinking. Cannabis users (p=0.006), alcohol (p=0.003) and heavy episodic drinkers (p=0.002), are more likely to overestimate the prevalence of use of these consumptions. Tobacco users are less likely to overestimate peer prevalence of smoking (p=0.044). Women are more likely to overestimate tobacco.

Local interventions that focus on creating realistic perceptions of substance use prevalence could be considered for cannabis and alcohol prevention in French campuses.

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Spirituality and the twelve steps

This paper relates to the Spirituality of Twelve Step Programs. The Twelve Steps are normally thought of as a spiritual and not a religious program.

A brief history of the Twelve Steps as related to Alcoholics Anonymous with specific reference to Carl Jung is given.

The author then relates the application of Twelve Steps to his own life.

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The Jack Mendelson Honorary Lecture Series - Glutamate, Dopamine, and Alcoholism: From Vulnerability to Treatment

Event:	Glutamate, Dopamine, and Alcoholism: From Vulnerability to Treatment
Location:	Lipsett Amphitherater, Building 10, National Institutes of Health, Bethesda, MD.
Start Date:	4/29/2010 1:30 PM
End Date:	4/29/2010 3:30 PM
Event Details:	NIAAA Jack Mendelson Honarary Lecuture Series: As a tribute to Dr. Mendelson's remarkable scientific contributions to the field of alcohol research, NIAAA has established this honorary lecture series to highlight clinical/human research in the alcohol field by featuring an outstanding investigator who has made significant and long-term contributions to our understanding of alcoholism susceptibility, alcohol's effects on the brain and other organs, and the prevention and treatment of alcohol use disorders. NIAAA is please to present this series of scientific lectures both to acknowledge continuing advances in alcohol-related areas of clinical research and to honor the memory of an individual whose pioneering research in alcoholism remains relevant today. More Information on Lecture _________________________________

Alcohol and HCV Chronic Infection Are Risk Cofactors of Type 2 Diabetes Mellitus for Hepatocellular Carcinoma in Italy

Type 2 diabetes mellitus (DM2) has been associated with hepatocellular carcinoma (HCC) development.

To study this relationship, we enrolled 465 HCC patients compared with 618 Cirrhotic cases and 490 Controls.

The prevalence of DM2 is significantly higher in HCC patients with an Odds Ratio of 3.12 versus Controls. In HCC cases with alcohol abuse, the frequency of DM2 is the highest. In our HCC patients, when HCV infection is associated with alcohol abuse, the liver cancer develops earlier.

In addition, multivariate analysis shows that alcohol consumption is an independent risk factor for HCC more relevant than HCV infection.

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Suicidal Behavior and Alcohol Abuse

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide.

We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases.

Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns.

Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence.

People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality.

Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

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ACMD: Pathways to Problems - a follow-up report on the implementation of recommendations from Pathways to Problems

Pathways to Problems focused on the patterns, trends, influences and determinants observed in the use of psychoactive drugs by young people aged 24 and under in the UK. The report reflected the fact that the use of substances such as tobacco, alcohol and cannabis typically starts in adolescence.

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Cohort Profile: Risk patterns and processes for psychopathology emerging during adolescence: the ROOTS project

Mental illness makes a major contribution to the global burden of disease. The impact of disorders such as depression and anxiety has been heightened by the increasing success of public health measures in controlling physical diseases. Mental health disorders are severely impairing in their own right but may also exacerbate the disability resulting from physical disease. The situation will be worse globally as the pattern of morbidity seen in the developed world sweeps over low- and middle-income countries. Mental illness is commonly understood to result from complex interactions between vulnerability and stress, though such a model is uniquely difficult to study, particularly in longitudinal or life course designs. A considerable proportion of individuals who experience mental illness during their lives report the emergence of symptoms and impairment during the adolescent years.

Adolescence is a critical period of accelerated maturation. Individuals differ widely in their rate of physical, social, psychological and sexual development. Physiological changes occurring over the second decade of life include alterations in gonadal hormone levels as well as significant elevations in glucocortioids resulting in physical maturation. There are also changes in psychological functions associated with brain development such as cognitive control of emotions, greater reasoning skills and problem solving ability. These changes occur within the contexts of peer groups, school and family settings, each of which has been shown to have an important impact on individual development.

A striking feature of this period is the emergence of major mental illness, such as depressive, anxiety, eating and behaviour disorders and psychoses, some of which have their genesis earlier in childhood. Early onset carries considerable risk for continuity and recurrence into adult life. In particular, rates of depression and suicide rise alarmingly over the adolescent period. The co-occurrence of two or more diagnoses is the rule rather than the exception. Likewise, gender is of considerable importance as there are markedly emerging sex differences in the incidence of emotional disorders (females males) in the adolescent period. In contrast, the known ratio of three males for every female in childhood conduct disorder contrasts with an almost equal sex ratio for cases beginning in the adolescent years.

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