Quantifying Alcohol-Related Mortality: Should Alcohol-Related Contributory Causes of Death be Included?

The aim of the study was to assess whether alcohol-related mortality data in the UK should be extended to include contributory as well as underlying cause of death.

A total of 101,320 deaths registered in Northern Ireland between 2001 and 2007 were analysed to determine the quantity and characteristics of those with an underlying or contributory alcohol-related cause of death.

Alcohol was found to be an underlying cause of death in 1690 cases (1.7% of deaths) and a contributory cause in a further 1105 cases. Analyses show that the addition of alcohol-related contributory causes of deaths would increase the male–female ratio, result in steeper socio-economic gradients and amplify the apparent rate of increase of alcohol-related deaths. The significant contribution of alcohol to external causes of death, such as accidents and suicide, is also more evident.

Using only underlying cause of death undoubtedly underestimates the burden of alcohol-related harm and may provide an inaccurate picture of those most likely to suffer from an alcohol-related death, especially among younger men.

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Request Reprint E -Mail: sheelah.connolly@qub.ac.uk

Matching motivation enhancement treatment to client motivation: re-examining the Project MATCH motivation matching hypothesis

The current study was designed to re-examine the motivation matching hypothesis from Project MATCH using growth mixture modeling, an analytical technique that models variation in individual drinking patterns.

The results provided support for the motivation matching hypothesis in the out-patient sample and among females in the aftercare sample: the majority of individuals with lower baseline motivation had better outcomes if assigned to motivation enhancement treatment (MET) compared to those assigned to cognitive behavioral treatment (CBT). In the aftercare sample there was a moderating effect of gender and alcohol dependence severity, whereby males with lower baseline motivation and greater alcohol dependence drank more frequently if assigned to MET compared to those assigned to CBT.

Results from the current study lend partial support to the motivation-matching hypothesis and also demonstrated the importance of moderating influences on treatment matching effectiveness. Based upon these findings, individuals with low baseline motivation in out-patient settings and males with low levels of alcohol dependence or females in aftercare settings may benefit more from motivational enhancement techniques than from cognitive–behavioral techniques.

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Request Reprint E-Mail: kate19@u.washington.edu

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Individuals receiving addiction treatment: are medical costs of their family members reduced?

To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members.

We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size.

AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2–5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls.

Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health.

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Request Reprint E-Mail: constance.weisner@kp.org

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Continuous, categorical and mixture models of DSM-IV alcohol and cannabis use disorders in the Australian community

To apply item response mixture modelling (IRMM) to investigate the viability of the dimensional and categorical approaches to conceptualizing alcohol and cannabis use disorders.

Of the 10 641 Australian adults interviewed, 7746 had drunk alcohol in the past 12 months and 722 had used cannabis. There was no improvement in fit for categorical latent class nor mixture models combining continuous and categorical parameters compared to continuous factor analysis models.

The results indicated that both alcohol and cannabis problems can be considered as dimensional, with those with the disorder arrayed along a dimension of severity.

A single factor accounts for more variance in the DSM-IV alcohol and cannabis use criteria than latent class or mixture models, so the disorders can be explained most effectively by a dimensional score.

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Request Reprint E-Mail: andrew.baillie@mq.edu.au

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Alcohol talks get under way

Key professionals were being brought together by BMA Cymru Wales this week to discuss how the UK can tackle alcohol abuse.

The seminar, to be held in Cardiff, comes amid increasing concern about the impact of alcohol use on health services. . . . . . .

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Sixty-third World Health Assembly

Date: 17–21 May 2010
Location: Geneva, Switzerland

The 63rd session of the World Health Assembly will take place in Geneva during 17–21 May 2010. At this session, the Health Assembly will discuss a number of public health issues, including:

• implementation of the International Health Regulations (2005);
• monitoring of the achievement of the health-related Millennium Development Goals;
• strategies to reduce the harmful use of alcohol; and
• counterfeit medical products.

The Health Assembly will also discuss the programme budget, administration and management matters of WHO.

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Changes in alcohol consumption and beverage preference among adolescents after the introduction of the alcopops tax in Germany

The aim of this study is to assess the contribution of the alcopops tax to changes in alcohol consumption and beverage preference among adolescents in Germany.

We hypothesize that the decrease of alcohol intake by alcopops is substituted by an increase of alcohol intake by other alcoholic beverages.

While alcopop consumption declined after the alcopops tax was implemented, consumption of spirits increased. Changes in beverage preference revealed a decrease in alcopop preference and an increase in the preference for beer and spirits.

Results indicate a partial substitution of alcopops by spirits and a switch in preference to beverages associated with riskier drinking patterns.

Effective alcohol policies to prevent alcohol-related problems should focus upon the reduction of total alcohol consumption instead of regulating singular beverages.

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Request Reprint E-Mail: mueller@ift.de

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Sixth Meeting of the Science Group of the European Alcohol and Health Forum - Draft Agenda

EUROPEAN ALCOHOL AND HEALTH FORUM
SCIENCE GROUP
6th Meeting
Tuesday 18 May 2010, 11h00 – 17h00

Draft Agenda (PDF)


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EU citizens’ attitudes towards alcohol

Strong support of public policies is one of the key findings in the new Eurobarometer "EU citizens' attitudes towards alcohol".

The Special Eurobarometer survey on alcohol was carried out in October 2009 with 27 000 respondents.

Questions on drinking patterns and attitudes towards alcohol policies monitored trends from a similar survey in 2006. Awareness of alcohol-related risks was measured for the first time in this type of survey across the EU. . . . . .

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Govt 'drops ball on preventative health'

The federal government buried its response to the preventative health taskforce this week and is running scared of the alcohol industry in an election year, a leading health group says.

Labor released its final response to the National Preventative Health Taskforce's 136 recommendations on Tuesday in the budget lockup\

The government adopted half the 136 suggestions but ruled out banning alcohol advertisements during children's TV shows or sport broadcasts.

A crackdown on alcoho sponsorship of sporting codes was rejected, while a call for health warnings on alcohol packaging is being given "further consideration". . . . . . .

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Taking Preventative Action - the Government's response to the report of the National Preventative Health Taskforce

Addressing alcohol misuse , especially binge drinking

The Government signalled its strong commitment to changing the culture of binge drinking in Australia, particularly among young people, when in March 2008 the Prime Ministe announced $53.5 million over four years for the first stage of the National Binge Drinking Strategy. This included $20 million for hard-hitting social marketing campaigns highlighting the dangers of binge drinking; $14.4 million to harness the energy and initiative of community and sporting organisations to tackle the problem; and $19.1 million for early intervention pilot programs to confront young people with the consequences of excessive drinking.

The Government took further action in April 2008 to tackle the causes of binge drinking when it closed the tax loophole on ready-to-drink beverages or ‘alcopops’. The high sugar levels in alcopops mask their alcohol content and make them particularly appealing for young people, especially females. Since the closure of the tax loophole, in a typical week Australians are consuming approximately 3.45 million less standard drinks of all spirit-based products compared to before the tax increase. Revenue raised through the introduction of the alcopops tax has enabled the funding of the $872.1 million COAG National Partnership Agreement on Preventive Health. In 2009, the NHMRC released updated ‘Australian Guidelines to Reduce Health Risks from Drinking Alcohol’ based on the latest clinical and scientific evidence.

The Government is broadly distributing educational materials about the updated guidelines, with a particular focus on pregnant and breastfeeding women, young people and parents, and continues to make available promotional resources on the standard drinks concept.

The Government is investing a further $100,000 over two years to make the educational materials available in community languages for people from culturally and linguistically diverse backgrounds.

The Government is providing $50 million over four years through the 2010–11 Budget to extend the National Binge Drinking Strategy. This includes the establishment of a $25 million community sponsorship fund as an alternative to alcohol sponsorship for community sporting and cultural organisations. Community level initiatives to tackle binge drinking will be further supported with funding of $20 million over four years.

The Government is also providing $5 million over four years to enhance alcohol helplines and for the possible extension of the National Binge Drinking Strategy social marketing campaign.

Further action on alcohol will be informed by the Australian National Preventive Health Agency, evaluations of the National Binge Drinking Strategy measures, the results of the new Australian Health Survey and other existing data collection instruments.


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National Admissions to Substance Abuse Treatment Services

This report presents national-level data from the Treatment Episode Data Set (TEDS) for admissions in 2008, and trend data for 1998 to 2008. The report provides information on the demographic and substance abuse characteristics of admissions to treatment aged 12 and older for abuse of alcohol and/or drugs in facilities that report to individual State administrative data systems.

Alcohol admissions declined steadily from 49 percent of admissions aged 12 and older in 1998 to 39 percent in 2005, but then increased steadily to 41 percent in 2008. In 2008, 44 percent of primary alcohol admissions aged 12 and older reported secondary drug abuse as well [Table 1. .

■ Admissions for abuse of alcohol alone represented 23 percent of TEDS admissions aged 12 and older in 2008, while admissions for primary alcohol abuse with secondary drug abuse represented 18 percent [Table 1.1] .

■ Almost three-quarters of admissions for abuse of alcohol alone and for abuse of alcohol with secondary drug abuse were male (73 percent each) [Table 2.1]

■ The average age at admission among alcohol-only admissions was 40 years, compared with 36 years among admissions for primary alcohol with secondary drug abuse [Table 2.1].

■ More than two-thirds (69 percent) of alcohol-only admissions were non-Hispanic White, followed by Hispanics (13 percent) and non-Hispanic Blacks (12 percent). Among admissions for alcohol with secondary drug abuse, 60 percent were non-Hispanic White, followed by 23 percent who were non-Hispanic Black and 11 percent who were Hispanic [Table 2.2].


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Translating Evidence into Policy: Lessons Learned from the Case of Lowering the Legal Blood Alcohol Limit for Drivers

This case study examines the translation of evidence on the effectiveness of laws to reduce the blood alcohol concentration (BAC) of drivers into policy.

It was reconstructed through discussions among individuals involved in the processes as well as a review of documentation and feedback on oral presentations. The Centers for Disease Control and Prevention collaborated extensively with federal and +non-federal partners and stakeholders in conducting a rigorous systematic review, using the processes of the Guide to Community Preventive Services to evaluate the body of empirical evidence on 0.08% BAC laws.

The timely dissemination of the findings and related policy recommendations—made by the independent Task Force on Community Preventive Services—to Congress very likely contributed to the inclusion of strong incentives to States to adopt 0.08 BAC laws by October 2003.

Subsequent dissemination to partners and stakeholders informed decision-making about support for state legislative and policy action.

This case study suggests the value of: clearly outlining the relationships between health problems, interventions and outcomes; systematically assessing and synthesizing the evidence; using a credible group and rigorous process to assess the evidence; having an impartial body make specific policy recommendations on the basis of the evidence; being ready to capitalize in briefly opening policy windows; engaging key partners and stakeholders throughout the production and dissemination of the evidence and recommendations; undertaking personalized, targeted and compelling dissemination of the evidence and recommendations; involving multiple stakeholders in encouraging uptake and adherence of policy recommendations; and addressing sustainability.

These lessons learned may help others working to translate evidence into policy.

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Request Reprint E-Mail: SMercer@cdc.gov

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Up-Regulation and Functional Effect of Cardiac β3-Adrenoreceptors in Alcoholic Monkeys

Recent studies link altered cardiac β-adrenergic receptor (AR) signaling to the pathology of alcoholic cardiomyopathy (ACM). However, the alteration and functional effect of β₃-AR activation in ACM are unknown.

We tested the hypothesis that chronic alcohol intake causes an up-regulation of cardiac β₃-AR, which exacerbates myocyte dysfunction and impairs calcium regulation, thereby directly contributing to the progression of ACM.

We compared myocyte β₃- and β₁-AR expression and myocyte contractile ([Ca²⁺]_i), transient ([Ca²⁺]_iT), and Ca²⁺ current (I_Ca,L) responses to β- and β₃-AR stimulation in myocytes obtained from left ventricle (LV) tissue samples obtained from 10 normal control (C) and 16 monkeys with self-administered alcohol for 12 months prior to necropsy: 6 moderate (M) and 10 heavy (H) drinkers with group average alcohol intakes of 1.5 ± 0.2 and 3.3 ± 0.2 g/kg/d, respectively.

Compared with control myocytes (C), in alcoholic cardiomyocytes, basal cell contraction (dL/dt_max, −39%, H: 69.8 vs. C: 114.6 μm/s), relaxation (dR/dt_max, −37%, 58.2 vs. 92.9 μm/s), [Ca²⁺]_iT (−34%, 0.23 vs. 0.35), and I_Ca,L (−25%, 4.8 vs. 6.4pA/pF) were all significantly reduced. Compared with controls, in moderate and heavy drinkers, β₁-AR protein levels decreased by 23% and 42%, but β₃-AR protein increased by 46% and 85%, respectively. These changes were associated with altered myocyte functional responses to β-AR agonist, isoproterenol (ISO), and β₃-AR agonist, BRL-37344 (BRL). Compared with controls, in alcoholic myocytes, ISO (10⁻⁸ M) produced significantly smaller increases in dL/dt_max (H: 40% vs. C: 71%), dR/dt_max (37% vs. 52%), [Ca²⁺]_iT (17% vs. 37%), and I_Ca,L (17% vs. 27%), but BRL (10⁻⁸ M) produced a significantly greater decrease in dL/dt_max (H: −23% vs. C: −11%), [Ca²⁺]_iT (−30% vs. −11%), and I_Ca,L (−28% vs. −17%).

Chronic alcohol consumption down-regulates cardiac β₁- and up-regulates β₃-ARs, contributing to the abnormal response to catecholamines in ACM. The up-regulation of cardiac β₃-AR signaling enhances inhibition of LV myocyte contraction and relaxation and exacerbates the dysfunctional [Ca²⁺]_i regulation and, thus, may precede the development of ACM.

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Request Reprint E-Mail: ccheng@wfubmc.edu

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Surveillance for Violent Deaths — National Violent Death Reporting System, 16 States, 2007

An estimated 50,000 persons die annually in the United States as a result of violence-related injuries. This report summarizes data from CDC's National Violent Death Reporting System (NVDRS) regarding violent deaths from 16 states for 2007. Results are reported by sex, age group, race/ethnicity, marital status, location of injury, method of injury, circumstances of injury, and other selected characteristics.

For 2007, a total of 15,882 fatal incidents involving 16,319 deaths occurred in the 16 NVDRS states included in this report. The majority (56.6%) of deaths was suicides, followed by homicides and deaths involving legal intervention (i.e., deaths caused by police and other persons with legal authority to use deadly force, excluding legal executions) (28.0%), deaths of undetermined intent (14.7%), and unintentional firearm deaths (0.7%).

Suicides occurred at higher rates among males, American Indians/Alaska Natives, non-Hispanic whites, and persons aged 45--54 years. Suicides occurred most often in a house or apartment and involved the use of firearms. Suicides were precipitated primarily by mental-health, intimate-partner, or physical-health problems, or by a crisis during the preceding 2 weeks.

Homicides occurred at higher rates among males and persons aged 20--24 years; rates were highest among non-Hispanic black males. The majority of homicides involved the use of a firearm and occurred in a house or apartment or on a street/highway. Homicides were precipitated primarily by arguments and interpersonal conflicts or in conjunction with another crime.

Other manners of death and special situations or populations also are highlighted in this report.

Alcohol was a factor in approximately one third of the reported suicides, and 62% of these decedents had a BAC of >0.08 g/dL at the time of death. Alcohol and drug abuse are second only to depression and other mood disorders as the most frequent risk factors for suicidal behavior (8,12,13). However, the relation between these factors is complex. Previous research indicates that alcohol intoxication might act as an important proximal (i.e., an experience often occurs immediately prior to a suicide) risk factor for suicidal behavior (14). In cases where there is alcohol dependency, the alcohol abuse might lead directly to depression or indirectly through a sense of decline or failure that is experienced by many persons who are dependent on alcohol. Alcohol also might be a form of self-medication to alleviate depression. Both depression and alcohol abuse also might be the result of specific stresses in a person's life (15). The co-occurrence of mood disorders with substance abuse, including alcohol abuse, greatly increases the risk for suicidal behavior (16).

As with suicide decedents, alcohol was present in approximately one third of homicide decedents; more than half of these decedents (55.4%) had BACs of >0.08 g/dL. Alcohol is an important situational factor in interpersonal violence. In the case of interpersonal violence among youths, excessive alcohol consumption might increase impulsivity and make some drinkers more likely to resort to violence in a confrontation or argument (21,22). Reduced physical control and the ability to assess risks in potentially dangerous situations also can make some drinkers more vulnerable to victimization (21,22). In the case of intimate-partner violence, excessive alcohol consumption by one or both partners might exacerbate financial or child care problems or other stressors and increase tension and conflict in the relationship (23). Alcohol also can be a form of self-medication to cope with previous or current experiences of abuse (23).


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Differential Effects of Alcohol Intoxication on S100B Levels Following Traumatic Brain Injury

In an acute care setting, evaluation of traumatic brain injury (TBI) is often complicated by alcohol intoxication. The purpose of this study is to evaluate the clinical utility of the protein S100B as a biochemical marker for identifying brain injury in patients who are intoxicated at the time of injury.

The study participants were 160 patients who presented to a large urban Level I Trauma Centre in Vancouver, Canada. Patients were classified into four clinical groups (medical controls, trauma controls, mild TBI, and definite TBI) and two day-of-injury alcohol intoxication groups (i.e., sober and intoxicated). Blood samples were collected via venipuncture in heparinized tubes within 8 hours of injury. Measures of S100B concentration were obtained using a commercially available assay kit (Sangtec 100 Elisa).

For those patients who were sober at the time of injury, higher S100B levels were associated with TBI when compared with other physical injuries and general medical complaints. However, for patients who were intoxicated at the time of injury, there were uniformly low S100B levels across all clinical groups.

Although there seems to be a strong association between S100B levels and TBI, further research is required to establish the clinical role of S100B in patients with suspected TBI, particularly in patients whose clinical presentation is complicated by alcohol intoxication.

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Request Reprint E-Mail: rlange@bcmhs.bc.ca

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Effects of Ethanol Intoxication and Gender on Blood Coagulation

Ethanol intoxication is a common contributor to traumatic injury. It is unknown whether ethanol consumption contributes to the coagulation differences seen between men and women after trauma. Our aim was to examine the combined effect of ethanol intoxication and gender on coagulation.

Fifty-eight healthy subjects participated and chose to enter into a control group (CG; n = 20; 10 men and 10 women) or drinking group (DG; n = 38; 20 men and 18 women). Venous blood samples for thrombelastography, plasminogen activator inhibitor, thrombin-antithrombin complex, and tissue plasminogen activator were drawn at the beginning of the study. Subjects then interacted in a social atmosphere for at least 2 hours, eating and consuming alcoholic (DG) or nonalcoholic (CG) beverages. After 2 hours, blood alcohol level was determined and blood was drawn for a second set of coagulation studies.

Demographics were similar between groups except for age (36.7 years CG vs. 29.9 years DG; p = 0.009). All baseline thrombelastography measurements were similar between the CG and DG. Blood alcohol levels in the DG were similar between genders at the end of study. At the end of study, a decreased rate of fibrin formation, decreased clot strength, and a decreased rate of fibrin cross-linking was seen in men but not in women. Fibrinolysis was inhibited in drinkers compared with controls.

Consumption of commonly ingested quantities of alcohol correlated with the development of a hypocoagulable state in men but had no effect on coagulation status in women. This phenomenon may contribute to differences in post-trauma coagulation status previously noted between genders.

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Request Reprint E-Mail: spoerken@ohsu.edu

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Heavy drinking and health promotion activities

Empirical evidence suggests that individuals who consume relatively large amounts of alcohol are more likely to use expensive acute medical care and less likely to use preventive or ambulatory services than other individuals. The few studies that investigated the associations between heavy drinking and health promotion activities did not try to address omitted-variable biases that may confound the relationships.

To fill this void in the literature, we examined the effects of heavy alcohol use on three health promotion activities (routine physical exam, flu shot, regular seatbelt use) using the US 2006 Behavioral Risk Factor Surveillance Survey.

Although specification tests indicated that omitted variable bias was not present in the majority of the single-equation probit models, we cautiously interpret our findings as evidence of strong associations rather than causal effects. Among both men and women, heavy alcohol use is negatively and significantly associated with each of our three outcomes.

These findings suggest that heavy drinkers may be investing less in health promotion activities relative to abstainers and other drinkers. Policy options to address the associated externalities may be warranted.

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Request Reprint E-Mail: mfrench@miami.edu

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Urine tested positive for ethyl glucuronide and ethyl sulphate after the consumption of “non-alcoholic” beer

In abstinence maintenance programs, for reissuing the driving licence and in workplace monitoring programs abstinence from ethanol and its proof are demanded. Various monitoring programs that mainly use ethyl glucuronide (EtG) as alcohol consumption marker have been established.

To abstain from ethanol, but not from the taste of alcoholic beverages, in particular non-alcoholic beer has become more and more popular. In Germany, these “alcohol-free” beverages may still have an ethanol content of up to 0.5 vol.% without the duty of declaration.

Due to severe negative consequences resulting from positive EtG tests, a drinking experiment with 2.5 L of non-alcoholic beer per person was performed to address the question of measurable concentrations of the direct metabolites EtG and EtS (ethyl sulphate) in urine and blood.

Both alcohol consumption markers – determined by LC–MS/MS – were found in high concentrations: maximum concentrations in urine found in three volunteers were EtG 0.30–0.87 mg/L and EtS 0.04–0.07 mg/L, i.e., above the often applied cut-off value for the proof of abstinence of 0.1 mg EtG/L. In the urine samples of one further volunteer, EtG and EtS concentrations cumulated over-night and reached up to 14.1 mg/L EtG and 16.1 mg/L EtS in the next morning's urine.

Ethanol concentrations in blood and urine samples were negative (determined by HS-GC–FID and by an ADH-based method).

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Request Reprint E-Mail: annette.thierauf@uniklinik-freiburg.de

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Editorial - The mental health of UK military personnel revisited

Providing adequate support and health care for the UK's armed forces should be an important concern for the country's next government in whatever form it takes. In a study published online and in an upcoming issue of The Lancet, Nicola Fear and colleagues examine the effect of deployments to Iraq and Afghanistan on the mental health of military personnel from 2003 to 2009.

The study provides a follow-up to the group's 2006 Lancet papers, which assessed the health of armed forces deployed in Iraq from 2003 to 2005. The investigators show that the most common mental health problems reported by personnel continue to be alcohol misuse and common mental health disorders, rather than probable post-traumatic stress disorder. And, overall, the prevalence of mental health disorders in the UK armed forces remains stable.

There are several important messages arising from these results. First, contrary to reports in the mainstream media, there is not an epidemic of mental health problems in this group of service personnel.

Second, hazardous drinking, both before and after deployment, continues to be a serious problem for regular service men and women. This group is at increased risk of the social complications of excessive drinking such as violence and relationship breakdowns. Although having introduced some alcohol-control policies, the armed forces need to reassess whether these are rigorous enough. . . . . . .
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What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK armed forces? A cohort study

Concerns have been raised about the psychological effect of continued combat exposure and of repeated deployments. We examined the consequences of deployment to Iraq and Afghanistan on the mental health of UK armed forces from 2003 to 2009, the effect of multiple deployments, and time since return from deployment.

We reassessed the prevalence of probable mental disorders in participants of our previous study (2003—05). We also studied two new randomly chosen samples: those with recent deployment to Afghanistan, and those who had joined the UK armed forces since April, 2003, to ensure that the final sample continued to be representative of the UK armed forces. Between November, 2007, and September, 2009, participants completed a questionnaire about their deployment experiences and health outcomes.

9990 (56%) participants completed the study questionnaire (8278 regulars, 1712 reservists). The prevalence of probable post-traumatic stress disorder was 4·0% (95% CI 3·5—4·5; n=376), 19·7% (18·7—20·6; n=1908) for symptoms of common mental disorders, and 13·0% (12·2—13·8; n=1323) for alcohol misuse.

Deployment to Iraq or Afghanistan was significantly associated with alcohol misuse for regulars (odds ratio 1·22, 95% CI 1·02—1·46) and with probable post-traumatic stress disorder for reservists (2·83, 1·23—6·51). Regular personnel in combat roles were more likely than were those in support roles to report probable post-traumatic stress disorder (1·87, 1·26—2·78).

There was no association with number of deployments for any outcome. There was some evidence for a small increase in the reporting of probable post-traumatic stress disorder with time since return from deployment in regulars (1·13, 1·03—1·24).

Symptoms of common mental disorders and alcohol misuse remain the most frequently reported mental disorders in UK armed forces personnel, whereas the prevalence of probable post-traumatic stress disorder was low. These findings show the importance of continued health surveillance of UK military personnel.

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Request Reprint E-Mail: nicola.t.fear@kcl.ac.uk


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Low Concentrations of Alcohol Inhibit BDNF-Dependent GABAergic Plasticity via L-type Ca2+ Channel Inhibition in Developing CA3 Hippocampal Pyramidal N

Fetal alcohol spectrum disorder (FASD) is associated with learning and memory alterations that could be, in part, a consequence of hippocampal damage. The CA3 hippocampal subfield is one of the regions affected by ethanol (EtOH), including exposure during the third trimester-equivalent (i.e., neonatal period in rats).

However, the mechanism of action of EtOH is poorly understood. In CA3 pyramidal neurons from neonatal rats, dendritic BDNF release causes long-term potentiation of the frequency of GABA_A receptor-mediated spontaneous postsynaptic currents (LTP-GABA_A) and this mechanism is thought to play a role in GABAergic synapse maturation.

Here, we show that short- and long-term exposure of neonatal male rats to low EtOH concentrations abolishes LTP-GABA_A by inhibiting L-type voltage-gated Ca²⁺ channels.

These findings support the recommendation that even light drinking should be avoided during pregnancy.

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Request Reprint E-Mail: fvalenzuela@salud.unm.edu


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The Endocannabinoid System Tonically Regulates Inhibitory Transmission and Depresses the Effect of Ethanol in Central Amygdala

The central amygdala (CeA) has a major role in alcohol dependence and reinforcement, and behavioral and neurochemical evidence suggests a role for the endocannabinoid (eCB) system in ethanol binging and dependence.

We used a slice preparation to investigate the physiological role of cannabinoids and their interaction with ethanol on inhibitory synaptic transmission in CeA.

Superfusion of the cannabinoid receptor (CB1) agonist WIN55212-2 (WIN2) onto CeA neurons decreased evoked GABA_A receptor-mediated inhibitory postsynaptic potentials (IPSPs) in a concentration-dependent manner, an effect prevented by the CB1 antagonists Rimonabant (SR141716, SR1) and AM251. SR1 or AM251 applied alone augmented IPSPs, revealing a tonic eCB activity that decreased inhibitory transmission in CeA.

Paired-pulse analysis suggested a presynaptic CB1 mechanism. Intracellular BAPTA abolished the ability of AM251 to augment IPSPs, demonstrating the eCB-driven nature and postsynaptic origin of the tonic CB1-dependent control of GABA release.

Superfusion of ethanol increased IPSPs and addition of WIN2 reversed the ethanol effect. Similarly, previous superfusion of WIN2 prevented subsequent ethanol effects on GABAergic transmission. The ethanol-induced augmentation of IPSPs was additive to CB1 blockade, ruling out a participation of CB1 in the action of acute ethanol.

Our study points to an important role of CB1 in CeA in which the eCBs tonically regulate neuronal activity, and suggests a potent mechanism for modulating CeA tone during challenge with ethanol.


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Request Reprint E-Mail: pschweitzer@scripps.edu


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Confirmation and Generalization of an Alcohol-Dependence Locus on Chromosome 10q

Several genome scans on alcohol dependence (AD) and AD-related traits have been published.

In this article, we present the results of a genome-wide linkage scan on AD and several related traits in 322 European-American (EA) families, and results of additional analysis in 335 African-American (AA) families that were the subject of a previous report.
All families were initially ascertained for cocaine and/or opioid dependence.

Non-parametric linkage analysis in the EA sample revealed suggestive linkages on chromosomes 7 (LOD=2.1 at 82.8 cM, p=0.0009) and 10 (LOD=3.0 at 137.7 cM, p=0.0001). The chromosome 10 linkage peak is 20 cM distal from a genome-wide significant linkage peak we observed previously in the AA sample.

Parametric linkage analysis on chromosome 10 (assuming a recessive model, 80 penetrance, disease allele frequency%=0.3) resulted in LOD scores of 2.7 at 136.7 cM and 1.9 at 121.7 cM in the EA and AA samples, respectively, with a combined sample genome-wide significant LOD score of 4.1 at 131.7 cM.

To reduce heterogeneity of the AD phenotype, we also assessed linkage of chromosome 10 markers with the presence of alcohol withdrawal symptoms, one of the seven components of the DSM-IV diagnosis of AD. Suggestive evidence for linkage was observed in both populations with only 5 cM separating the location of the peak LOD scores despite a loss of power due to a smaller number of families informative for this trait.

Results of our study confirm a chromosome 10 risk locus for AD in two genetically distinct populations and suggest that this locus may correspond more precisely to a specific component of the disorder.


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Press Release - GREEN LIGHT FOR TEST-TUBE DRINKS

Alcohol can still be sold in test-tubes following an inquiry under the Portman Group Code into whether this packaging causes people to drink rapidly.

The Portman Group’s Code prevents drinks companies from urging consumers to drink rapidly or ‘down-in-one’.

Alcohol Focus Scotland brought complaints against four brands: Quivers; Shot in a Tube; Shoeyz Shots and Shootaz, all of which contain 20ml of liquid and less than 0.3 units of alcohol.

Research commissioned by the Portman Group found that although most consumers drink test-tubes ‘down-in-one’, this tended to be because of the small volume of liquid in the test-tube rather than because of the packaging itself. . . . . .

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Women's Perspectives on Screening for Alcohol and Drug Use in Prenatal Care

Screening for alcohol and drug use in prenatal care is widely promoted in the United States as a public health strategy for reducing alcohol and drug use during pregnancy. However, the published literature does not consider women's perspectives or the potential negative ramifications of screening.

Twenty semistructured interviews and two focus groups (n = 38) were conducted with a racially/ethnically diverse sample of low-income pregnant and parenting women using alcohol and/or drugs in a northern California county.

Most women were averse to having drug but not alcohol use identified and were mistrustful of providers' often inconspicuous efforts to discover drug use. Women expected psychological, social, and legal consequences from being identified, including feelings of maternal failure, judgment by providers, and reports to Child Protective Services. Women did not trust providers to protect them from these consequences. Rather, they took steps to protect themselves. They avoided and emotionally disengaged from prenatal care, attempted to stop using substances that could be detected by urine tests before prenatal care visits, and shared strategies within social networks for gaining the benefits of prenatal care while avoiding its negative consequences.

Considerations of the public health impact of screening for drug use in prenatal care should account for the implications of women's physical avoidance of and emotional disengagement from prenatal care, specifically the direct effects of late, limited, and no prenatal care on pregnancy outcomes and missed opportunities for health promoting interventions.

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Request Reprint E-Mail: sroberts@arg.org

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Alcohol Use Accelerates HIV Disease Progression

The effects of alcohol abuse on HIV disease progression have not been definitively established.

A prospective, 30-month, longitudinal study of 231 HIV⁺ adults included history of alcohol and illicit drug use, adherence to antiretroviral therapy (ART), CD4⁺ cell count, and HIV viral load every 6 months.

Frequent alcohol users (two or more drinks daily) were 2.91 times (95% CI: 1.23–6.85, p=0.015) more likely to present a decline of CD4 to ≤200 cells/μl, independent of baseline CD4⁺ cell count and HIV viral load, antiretroviral use over time, time since HIV diagnosis, age, and gender.

Frequent alcohol users who were not on ART also increased their risk for CD4 cell decline to ≤200 cells/mm³ (HR=7.76: 95% CI: 1.2–49.2, p=0.03).

Combined frequent alcohol use with crack-cocaine showed a significant risk of CD4⁺ cell decline (HR=3.57: 95% CI: 1.24–10.31, p=0.018).

Frequent alcohol intake was associated with higher viral load over time (β=0.259, p=0.038). This significance was maintained in those receiving ART (β=0.384, p=0.0457), but not in those without ART.

Frequent alcohol intake and the combination of frequent alcohol and crack-cocaine accelerate HIV disease progression.

The effect of alcohol on CD4⁺ cell decline appears to be independent of ART, through a direct action on CD4 cells, although alcohol and substance abuse may lead to unmeasured behaviors that promote HIV disease progression.

The effect of alcohol abuse on viral load, however, appears to be through reduced adherence to ART.

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Request Reprint E-Mail: baumm@fiu.edu


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Cross-sectional measures and modelled estimates of blood alcohol levels in UK nightlife and their relationships with drinking behaviours and observed

Management of nightlife in UK cities focuses on creating safe places for individuals to drink. Little is known about intoxication levels as measuring total alcohol consumption on nights out is complicated by early evening interviews missing subsequent consumption and later interviews risking individuals being too drunk to recall consumption or participate at all.

Here we assess mixed survey and modelling techniques as a methodological approach to examining these issues.

Interviews with a cross sectional sample of nightlife patrons (n=214) recruited at different locations in three cities established alcohol consumption patterns up to the point of interview, self-assessed drunkenness and intended drinking patterns throughout the remaining night out. Researchers observed individuals' behaviours to independently assess drunkenness. Breath alcohol tests and general linear modelling were used to model blood alcohol levels at participants' expected time of leaving nightlife settings.

At interview 49.53% of individuals regarded themselves as drunk and 79.43% intended to consume more alcohol before returning home, with around one in ten individuals (15.38% males; 4.35% females) intending to consume >40 units (equal to 400mls of pure alcohol). Self-assessed drunkenness, researcher observed measures of sobriety and blood alcohol levels all correlated well.

Modelled estimates for blood alcohol at time of going home suggested that 71.68% of males would be over 0.15%BAC (gms alcohol/100mls blood). Higher blood alcohol levels were related to drinking later into the night.

UK nightlife has used substantive health and judicial resources with the aim of creating safer and later drinking environments. Survey and modelling techniques together can help characterise the condition of drinkers when using and leaving these settings. Here such methods identified patrons as routinely getting drunk, with risks of drunkenness increasing over later nights. Without preventing drunkenness and sales to intoxicated individuals, extended drinking hours can simply act as havens for drunks.

A public health approach to nightlife is needed to better understand and take into account the chronic effects of drunkenness, the damages arising after drunk individuals leave city centres and the costs of people avoiding drunken city centres at night.

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IAS Alcohol Alert: Issue 1 2010

The latest free 'Alcohol Alert' magazine produced by the Institure of Alcohol Studies (IAS) is available to download. . . . . . .

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Binge Drinking Effects on EEG in Young Adult Humans

Young adult (N = 96) university students who varied in their binge drinking history were assessed by electroencephalography (EEG) recording during passive viewing.

Groups consisted of male and female non-binge drinkers (>1 to 5/4 drinks/ounces in under two hours), low-binge drinkers (5/4–7/6 drinks/ounces in under two hours), and high-binge drinkers (≥ 10 drinks/ounces in under two hours), who had been drinking alcohol at their respective levels for an average of 3 years.

The non- and low-binge drinkers exhibited less spectral power than the high-binge drinkers in the delta (0–4 Hz) and fast-beta (20–35 Hz) bands.

Binge drinking appears to be associated with a specific pattern of brain electrical activity in young adults that may reflect the future development of alcoholism.

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Patterns of alcohol use among Brazilian adolescents.

To describe patterns of alcohol consumption by adolescents in Brazil.

From November 2005 to April 2006, a sample composed of 661 subjects aged between 14 to 17 years was rigorously selected in Brazil using a multistage probabilistic method to represent the profile of the adolescent Brazilian population.

34% of Brazilian adolescents drink alcoholic beverages. The mean age of drinking initiation was 14 years of age. Older adolescents, as well as those living in the southern part of Brazil, those who are not attending school and those who are working, and black individuals and those with personal income reported a higher frequency of drinking. Socio-demographic factors such as gender, income bracket, family income and student status do increase the amount of alcohol consumed. Males report a higher frequency of binge drinking than females. Moreover, more than half of the males that had drunk in the previous year reported having engaged in binge drinking on at least one occasion. Beer represents approximately half of all the drinks consumed by adolescents. There was no significant difference between genders in the kind of alcohol consumed.

Among adolescents who drink, the consumption of several drinks is frequent. Alcohol consumption varies from region to region, social economic status (including self-generated income) and age. These findings are discussed in light of their importance for the development of alcohol prevention policies in Brazil.


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