Vietnam Alcohol Policy Workshop

As input to its preparation for drafting a national alcohol policy, the Health Strategy and Policy Institute (HSPI) of the Ministry of Health of the Socialist Republic of Vietnam invited ICAP to co-organize a national workshop entitled, “Sharing Experiences for the Development of the National Policy on Alcohol-related Harm Prevention and Control.”

The workshop report, available in English and Vietnamese, records the main points of discussion and highlights areas of common interest among stakeholders.


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Alcohol use and mortality in older men and women

To compare the effect of alcohol intake on 10-year mortality for men and women over the age of 65 years.

Two prospective cohorts of community-dwelling men aged 65–79 years at baseline in 1996 (n = 11 727) and women aged 70–75 years in 1996 (n = 12 432).

Alcohol was assessed according to frequency of use (number of days alcohol was consumed per week) and quantity consumed per day. Cox proportional hazards models were compared for men and women for all-cause and cause-specific mortality.

Compared with older adults who did not consume alcohol every week, the risk of all-cause mortality was reduced in men reporting up to four standard drinks per day and in women who consumed one or two drinks per day. One or two alcohol-free days per week reduced this risk further in men, but not in women. Similar results were observed for deaths due to cardiovascular disease.

In people over the age of 65 years, alcohol intake of four standard drinks per day for men and two standard drinks per day for women was associated with lower mortality risk. For men, the risk was reduced further if accompanied with 1 or 2 alcohol-free days per week.

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Request Reprint E-Mail: kieran.mccaul@uwa.edu.au

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Computer-delivered interventions for alcohol and tobacco use: a meta-analysis

To quantify the overall effectiveness of computer-delivered interventions for alcohol and tobacco use.

Meta-analysis of 42 effect sizes from randomized controlled trials, based on the responses of 10 632 individuals.

The weighted average effect size (d) was 0.20, this may well reflect differences in the types of outcome measure used. Effect sizes did not vary significantly as a function of treatment location, inclusion of entertaining elements, provision of normative feedback, availability of a discussion feature, number of treatment sessions, emphasis on relapse prevention, level of therapist involvement or follow-up period.

Findings of the meta-analysis suggest that minimal contact computer-delivered treatments that can be accessed via the internet may represent a cost-effective means of treating uncomplicated substance use and related problems.

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Request Reprint E-Mail: s.rooke@unsw.edu.au

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The Temperament and Character Inventory in Addiction Treatment

This article provides an overview for assessing and working with personality variables in an abstinence-based addiction treatment program for professionals.

Included in this discussion are the ways in which one program uses the Temperament and Character Inventory-Revised (TCI-R) as a tool to explore the role of personality in addiction, to individualize treatment planning, and to monitor character growth in recovery.

There is also discussion regarding the importance of integrating spirituality and self-transcendence into the treatment of these patients and how the TCI-R can facilitate that process.


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Request Reprint E-Mail: dangres@reshealthcare.org .


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Acetaldehyde elicits ERK phosphorylation in the rat nucleus accumbens and extended amygdala

Recent advances suggest that acetaldehyde mediates some of the neurobiological properties of ethanol. In a recent study, we have shown that ethanol elicits the phosphorylation of extracellular signal-regulated kinase (pERK) in the nucleus accumbens and extended amygdala, via a dopamine D₁ receptor-mediated mechanism.

The aim of this study was to determine whether acetaldehyde and ethanol-derived acetaldehyde elicit the activation of ERK in the nucleus accumbens and extended amygdala.

The effects of acetaldehyde (10 and 20 mg/kg) and ethanol (1 g/kg), administered to rats intragastrically, were assessed by pERK peroxidase immunohistochemistry. To establish the role of ethanol-derived acetaldehyde, the alcohol dehydrogenase inhibitor, 4-methylpyrazole (90 mg/kg), and the acetaldehyde-sequestering agent, D-penicillamine (50 mg/kg), were administered before ethanol.

Acetaldehyde increased pERK immunoreactivity in the nucleus accumbens and extended amygdala. Inhibition of ethanol metabolism and sequestration of newly synthesized acetaldehyde completely prevented ERK activation by ethanol. In addition, to establish the role of D₁ receptors stimulation in acetaldehyde-elicited ERK phosphorylation, we studied the effect of the D₁ receptor antagonist, SCH 39166.

Pretreatment with the D₁ receptor antagonist (50 g/kg) fully prevented acetaldehyde-elicited ERK activation.

Overall, these results indicate that ethanol activates ERK by means of its metabolic conversion into acetaldehyde and strengthen the view that acetaldehyde is a centrally acting compound with a pharmacological profile similar to ethanol.


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Request Reprint E-Mail: acquas@unica.it


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NIAAA Director's Report on Institute Activities to the 123rd Meeting of the National Advisory Council on Alcohol Abuse and Alcoholism - February 4, 20

Contents

A. Legislation, Budget, and Policy	F. News Media Interactions
B. Director's Activities	G. What's Ahead
C. NIAAA Staff and Organization	H. NIAAA Program Annoucement and Request for Application Information
D. Multi-Media Products from NIAAA	I. NIAAA Research Programs
E. Outreach	J. Scientific Meetings

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Haplotypes of dopamine and serotonin transporter genes are associated with antisocial personality disorder in alcoholics

A different genetic background is postulated for alcoholics with early onset and with antisocial personality disorder (type 2 alcoholics) compared with those with late onset and without antisocial personality disorder (type 1 alcoholics). The dopamine transporter (DAT) and the serotonin transporter (SERT) are involved in endophenotypes that are associated with these subtypes.

Our study was aimed at investigating whether distinct haplotypes, defined by polymorphisms associated with the expressions of DAT and SERT, were associated with subgroups of alcohol dependence.

Intron 8 variable number of tandem repeats (VNTR), exon 15 rs27072 and VNTR (DAT), promoter VNTR and rs25531, and intron 2 VNTR (SERT) were genotyped in a case-control sample comprising 360 alcoholics and 368 controls, and in a family-based sample of 65 trios, all of German origin.

DAT: The haplogenotypes 6-A-10/6-G-10 and 5-G-9/5-G-9 were more often present in type 2 alcoholics as compared with type 1 alcoholics [odds ratio (OR): 2.8], and controls (OR: 5.8), respectively. The daily ethanol consumption was associated with haplogenotypes.

SERT: haplotypes SA-10 (OR: 2.3) and LG-12 (OR: 2.5) were more often present in type 2 alcoholics compared with controls. Haplotype LA-10 was less often present in type 2 alcoholics (OR: 0.5), and was more often transmitted, in families, to the affected offspring (transmission disequilibrium test: OR: 5.2; family-based association test: Z: 1.9).

The haplotype LA-12 was significantly undertransmitted to affected offspring in the whole group (transmission disequilibrium test: OR: 0.216; family-based association test: Z: -2.2).

A gene by environment interaction was observed with respect to the time course of the depression score after alcohol withdrawal and with respect to the positive family history of alcohol dependence.

Haplotype analysis, sub-grouping with respect to more homogeneous endophenotypes, and inclusion of quantifiable characteristics are sensible strategies to untangle the genetic background of such a complex disorder like alcohol dependence.

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Request Reprint E-Mail: adrian.kraschewski@charite.de

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Minister proposes policies on alcohol

East African Community partners should develop and implement policies on alcohol in order to reduce its harmful use, the minister for Health and Social Welfare, Prof David Mwakyusa, has proposed.

He was addressing the second East African conference on policies meant to reflect and share experience on issues relating to the development and implementation of alcohol policies in the region.

The conference held in Dar es Salaam late last week was also an opportunity for member countries to update each other on the progress made since the first conference held last year. . . . . .

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Genome-wide scan for self-rating of the effects of alcohol in American Indians

This study's aims were to map loci linked to self-rating of the effects of alcohol and to determine if there was overlap with loci mapped earlier for other substance dependence phenotypes in an American Indian community at high risk for substance dependence.

Each participant gave a blood sample and completed a structured diagnostic interview using the Semi Structured Assessment for the Genetics of Alcoholism. Retrospective report of responses to alcohol during the FIRST FIVE TIMES they had ever drank alcohol was estimated from the Self-Rating of the Effects of Alcohol (SRE) questionnaire for each participant. Genotypes were determined for a panel of 791 micro-satellite polymorphisms in 381 members of multiplex families using SOLAR.

Analyses of multipoint variance component Log of Odds (LOD) scores, for the FIRST FIVE TIMES phenotype, revealed two loci that had a LOD score greater than 3.0 on chromosomes 6 and 9. In addition, three locations were identified with LOD scores above 2.0 on chromosomes 10, 12, 17.

These results corroborate the importance of regions on chromosome 6 and 9 highlighted in earlier segregation studies in this and other populations for substance dependence-related phenotypes, as well as an area on chromosome 10 earlier identified for the FIRST FIVE TIMES phenotype in the collaborative study on the genetics of alcoholism. These studies additionally lend further support the construct that the SRE may represent an important endophenotype associated with alcohol and other substance dependence.

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Request Reprint E-Mail: cindye@scripps.edu

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Modelling lifetime QALYs and health care costs from different drinking patterns over time: a Markov model

The negative health consequences of alcohol use and its treatment account for significant health care expenditure worldwide.

Long-term modelling techniques are developed in this paper to establish a link between drinking patterns, health consequences and alcohol treatment effectiveness and cost-effectiveness.

The overall change in health related quality and quantity of life which results from changes in health-related behaviour is estimated.

Specifically, a probabilistic lifetime Markov model is presented where alcohol consumption in grams of alcohol per day and drinking history are used for the categorization of patients into four Markov states. Utility weights are assigned to each drinking state using EQ-5D scores. Mortality and morbidity estimates are state, gender and age specific, and are alcohol-related and non-alcohol-related.

The methodology is tested in a case study. This represents a major development in the techniques traditionally used in alcohol economic models, in which short-term costs and outcomes are assessed, omitting potential longer term cost savings and improvements in health related quality of life.

Assumptions and implications of the approach are discussed.


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Request Reprint E-Mail: cppb500@york.ac.uk


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Media Release - Ready to drink alcohol drops by one third: ABS

Apparent consumption of alcohol through ready to drink, pre-mixed beverages fell by 30% in 2008-09, according to figures released today by the Australian Bureau of Statistics. This reversed the upward trend over the last 4 years. . . . . .

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Substance Use among Hispanic Adults

Rates of past month alcohol and illicit drug use were lower among Hispanic adults than the national averages for adults (46.1 vs. 55.2 percent and 6.6 vs. 7.9 percent, respectively); however, past month binge alcohol use was higher among Hispanics than the national average (26.3 vs. 24.5 percent).

Among Hispanic adults, substance use varied greatly by subgroup; past month illicit drug use, for example, ranged from a high of 13.1 percent among adults of Spanish origin (from Spain) to a low of 3.9 percent among those of Dominican origin.

Hispanic adults who were born in the United States had higher rates of past month substance use than Hispanic adults who were not born in the United States, regardless of age.

Among Hispanics who needed treatment for an alcohol or illicit drug problem, the percentage who received such treatment did not differ significantly from the national average.

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News Release - COMMITTEE GIVES QUALIFIED SUPPORT TO ALCOHOL BILL TO ALLOW IT TO PROCEED TO NEXT STAGE

The Scottish Parliament’s Health and Sport Committee agrees that the scale of the country’s alcohol problem is such that it must be addressed, according to a report published today.

In its Stage 1 report, the committee recognises the Scottish Government’s public health purpose behind the Alcohol etc (Scotland) Bill.

However, some members had fundamental reservations about key elements of the Bill. Nonetheless, the committee concluded that, in the interests of more detailed debate, the Bill should proceed to Stage 2 when further evidence can be considered.

Committee Convener Christine Grahame MSP said: “The committee conducted detailed scrutiny of all elements of the Bill.

"Although we could not reach a consensus on the proposal for minimum unit pricing and other aspects of the Bill, all members agreed that the scale of the alcohol problem in Scotland is such that it must be addressed.” . . . . .

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5th Report, 2010 (Session 3) Stage 1 Report on the Alcohol etc. (Scotland) Bill

The Alcohol etc. (Scotland) Bill (“the Bill”) was introduced by Nicola Sturgeon MSP, Deputy First Minister and Cabinet Secretary for Health and Wellbeing (“the Cabinet Secretary”), on 25 November 2009. The Bill is accompanied by Explanatory Notes (SP Bill 34–EN), which include a Financial Memorandum, and a Policy Memorandum (SP Bill 34-PM), as required by the Parliament’s Standing Orders. The Health and Sport Committee was subsequently designated lead committee on the Bill. Under Rule 9.6 of the Parliament’s Standing Orders, it is for the lead committee to report to the Parliament on the general principles of the Bill.

Purpose of the Bill

2. The Bill, if passed, would reform the law in furtherance of the Scottish Government’s strategy on tackling alcohol misuse, Changing Scotland’s Relationship with Alcohol: A Framework for Action.The measures in the Bill¹ are as follows—

• minimum pricing, in the pursuance of reducing alcohol consumption;

• further restrictions on off-sales promotions and promotional activity;

• a requirement for an age verification policy;

• provisions concerning the modification of licence conditions;

• provisions in respect of assessing the impact of off-sales to people under 21;

• provisions in respect of a social responsibility levy.

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4th European Alcohol Policy Conference 21 – 22 June 2010, Brussels

Under the heading “From Capacity to Action”, the conference will seek to stimulate action in alcohol policy. To that end, it will bring together highly reputed experts in the alcohol field and policy makers from the national, EU and global levels to analyse why Europe has not got to grips with alcohol and the consequences this is having in third countries.

The conference is organized by Eurocare (European Alcohol Policy Alliance) under the patronage of Her Royal Highness Princess Astrid of Belgium and it is co-financed by the European Commission and co-sponsored by the WHO (World Health Organization). . . . . .

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Moderate alcohol disrupts a mechanism for detection of rare events in human visual cortex

Moderate doses of alcohol (blood alcohol concentration [BAC] of about 0.05%) may result in acute impairments at various levels of information processing. A number of reports have documented detrimental effects of moderate alcohol on the mismatch negativity (MMN), the electrocortical manifestation of a rapid (100 ms poststimulus) mechanism dedicated to the detection of unexpected auditory change (e.g., Jääskeläinen, et al., 1995).

Recently, we and others identified a partial visual counterpart of the MMN, sometimes called the rareness-related negativitity (RRN). Analogous to the MMN, the RRN evolves at about 100 ms after the unexpected change and was localized in visual cortex (Kenemans, et al., 2003).

Rapid detection of unexpected events is important for everyday-life conditions like driving, prompting the question whether the visual RRN shows sensitivity to moderate alcohol similar to the MMN.

In all, 16 subjects were tested either under moderate alcohol or under placebo. Unexpected visual change was implemented by presenting 2.4 versus 0.6 c/d gratings in pseudorandom sequences according to a deviant (10%)/standard (90%) schedule. The alcohol effects on MMN reported before were replicated. Furthermore, the RRN, defined as the difference between deviant and standard event-related potentials between 120 and 170 ms at Oz, was present under placebo but not under alcohol.

It is concluded that moderate alcohol does indeed impair the rapid detection in visual cortex of unexpected changes. In contrast, electrocortical correlates of lower level sensory processing were still significantly present under alcohol.


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Request Reprint E-Mail: j.l.kenemans@uu.nl

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Delineation of the Role of Nicotinic Acetylcholine Receptor Genes in Alcohol Preference in Mice

The genetic factors that increase risk for alcohol and nicotine addiction have been elusive, although the frequent co-abuse of these drugs suggests they may act on a common biological pathway. A site of action for both nicotine and alcohol effects in the brain are neuronal nicotinic acetylcholine receptors (nAChR).

This report explores the association between six nAChR subunit genes (Chrna3, Chrna4, Chrnb4, Chrnb2, Chrna5, and Chrna7) with alcohol preference (AP) using co-segregation of AP with nAChR subunit genotypes in a F₂ population produced from reciprocal crosses of alcohol-preferring C57BL/6J (B6) and alcohol-avoiding DBA/2J (D2) strains of mice.

Polymorphisms located within the Chrna5-Chrna3-Chrnb4 cluster on mouse chromosome 9 were found to co-segregate with AP, with high-drinking F₂ mice carrying B6 alleles and low-drinking F₂ mice carrying D2 alleles.

Further, the Chrnb4 and Chrna5 genes showed expression differences between B6 and D2 mice, which is compatible with their involvement in AP in mice and, potentially, alcohol abuse in humans.


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Request Reprint E-Mail: ssingh@uwo.ca


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Children, Young People and Alcohol: Pan-London Guidance

Guidance on children and young people's alcohol issues has been released this month by the London Joint Action Group (JAG) on alcohol. The guidance is aimed at all commissioners, service managers and front-line staff who work with children and young people.
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Evaluation of a New Core Curriculum on Alcohol Use Disorders for Undergraduate Medical Students

This study was aimed to review and rewrite the undergraduate curriculum on alcohol use disorders, implement the changes and assess for any early evidence of an improvement in knowledge.

A three-stage process was used to review the old curriculum and a new one was designed around the five undergraduate years. Students' opinions were sought about the acceptability of the new curriculum using a questionnaire, to which 93 responded and 70 volunteers were objectively assessed using an examination based on questions from the text of the Medical Students' Handbook on Alcohol and Health.

There was no evidence of any improvement in the students' knowledge using the old curriculum. After teaching with the new curriculum, examination scores significantly increased (P <> sexes. The new curriculum was assessed as acceptable to the students.

This new curriculum reflects the need for a new teaching method and not only offers improved teaching, but also produces a generation of doctors equipped to identify alcohol-related problems and to deliver brief interventions, helping to reduce the projected consequences of alcohol abuse and the associated burden on the health service.

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Request Reprint E-Mail: m.groome@nhs.net

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Body Mass Index, Cigarette Smoking, and Alcohol Consumption and Cancers of the Oral Cavity, Pharynx, and Larynx: Modeling Odds Ratios in Pooled Case-C

Odds ratios for head and neck cancer increase with greater cigarette and alcohol use and lower body mass index (BMI; weight (kg)/height² (m²)).

Using data from the International Head and Neck Cancer Epidemiology Consortium, the authors conducted a formal analysis of BMI as a modifier of smoking- and alcohol-related effects. Analysis of never and current smokers included 6,333 cases, while analysis of never drinkers and consumers of 10 drinks/day included 8,452 cases. There were 8,000 or more controls, depending on the analysis.

Odds ratios for all sites increased with lower BMI, greater smoking, and greater drinking. In polytomous regression, odds ratios for BMI (P = 0.65), smoking (P = 0.52), and drinking (P = 0.73) were homogeneous for oral cavity and pharyngeal cancers.

Odds ratios for BMI and drinking were greater for oral cavity/pharyngeal cancer, while smoking odds ratios were greater for laryngeal cancer . Lower BMI enhanced smoking- and drinking-related odds ratios for oral cavity/pharyngeal cancer while BMI did not modify smoking and drinking odds ratios for laryngeal cancer.

The increased odds ratios for all sites with low BMI may suggest related carcinogenic mechanisms; however, BMI modification of smoking and drinking odds ratios for cancer of the oral cavity/pharynx but not larynx cancer suggests additional factors specific to oral cavity/pharynx cancer.

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Request Reprint E-Mail: lubinj@mail.nih.gov


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Substance Abuse Treatment: Addressing the Specific Needs of Women

SAMHSA's Treatment Improvement Protocol (TIP) 51, Substance Abuse Treatment: Addressing the Specific Needs of Women, will help professionals provide effective, up-to-date treatment to women with substance use disorders by taking into account their unique treatment needs.

The information in TIP 51 is based on women's experiences, as well as best or promising practices and research-based approaches. This eight-chapter TIP presents treatment approaches for women that consider a woman's social and economic environments; her relationships with family members, significant others, and support systems; and the impact of gender and culture on treatment.

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Nicotine: Alcohol Reward Interactions

It is well established that the continued intake of drugs of abuse is reinforcing—that is repeated consumption increases preference. This has been shown in some studies to extend to other drugs of abuse; use of one increases preference for another.

In particular, the present review deals with the interaction of nicotine and alcohol as it has been shown that smoking is a risk factor for alcoholism and alcohol use is a risk factor to become a smoker.

The review discusses changes in the brain caused by chronic nicotine and chronic alcohol intake to approach the possible mechanisms by which one drug increases the preference for another.

Chronic nicotine administration was shown to affect nicotine receptors in the brain, affecting not only receptor levels and distribution, but also receptor subunit composition, thus affecting affinity to nicotine. Other receptor systems are also affected among others catecholamine, glutamate, GABA levels and opiate and cannabinoid receptors. In addition to receptor systems and transmitters, there are endocrine, metabolic and neuropeptide changes as well induced by nicotine.

Similarly chronic alcohol intake results in changes in the brain, in multiple receptors, transmitters and peptides as discussed in this overview and also illustrated in the tables. The changes are sex and age-dependent—some changes in males are different from those in females and in general adolescents are more sensitive to drug effects than adults.

Although nicotine and alcohol interact—not all the changes induced by the combined intake of both are additive—some are opposing. These opposing effects include those on locomotion, acetylcholine metabolism, nicotine binding, opiate peptides, glutamate transporters and endocannabinoid content among others. The two compounds lower the negative withdrawal symptoms of each other which may contribute to the increase in preference, but the mechanism by which preference increases—most likely consists of multiple components that are not clear at the present time.

As the details of induced changes of nicotine and alcohol differ, it is likely that the mechanisms of increasing nicotine preference may not be identical to that of increasing alcohol preference. Stimulation of preference of yet other drugs may again be different –representing one aspect of drug specificity of reward mechanisms.


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Request Reprint E-Mail: Sershen@nki.rfmh.org


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Combined effect of alcohol consumption and lifestyle behaviors on risk of type 2 diabetes

It has been suggested that the inverse association between alcohol and type 2 diabetes could be explained by moderate drinkers’ healthier lifestyles.

We studied whether moderate alcohol consumption is associated with a lower risk of type 2 diabetes in adults with combined low-risk lifestyle behaviors.

We prospectively examined 35,625 adults of the Dutch European Prospective Investigation into Cancer and Nutrition (EPIC-NL) cohort aged 20–70 y, who were free of diabetes, cardiovascular disease, and cancer at baseline (1993–1997).

In addition to moderate alcohol consumption (women: 5.0–14.9 g/d; men: 5.0–29.9 g/d), we defined low-risk categories of 4 lifestyle behaviors: optimal weight [body mass index (in kg/m²) >30 min of physical activity/d), current nonsmoker, and a healthy diet [upper 2 quintiles of the Dietary Approaches to Stop Hypertension (DASH) diet].

During a median of 10.3 y, we identified 796 incident cases of type 2 diabetes. Compared with teetotalers, hazard ratios of moderate alcohol consumers for risk of type 2 diabetes in low-risk lifestyle strata after multivariable adjustments were 0.35 (95% CI: 0.17, 0.72) when of a normal weight, 0.65 (95% CI: 0.46, 0.91) when physically active, 0.54 (95% CI: 0.41, 0.71) when nonsmoking, and 0.57 (95% CI: 0.39, 0.84) when consuming a healthy diet. When 3 low-risk lifestyle behaviors were combined, the hazard ratio for incidence of type 2 diabetes in moderate alcohol consumers after multivariable adjustments was 0.56 (95% CI: 0.32, 1.00).

In subjects already at lower risk of type 2 diabetes on the basis of multiple low-risk lifestyle behaviors, moderate alcohol consumption was associated with an 40% lower risk compared with abstention.

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Request Reprint E-Mail: j.beulens@umcutrecht.nl .

Press Release - Moderate alcohol consumption reduces the chances of diabetes type 2

Adults that drink 1 to 2 glasses of alcohol daily are less likely to develop diabetes type 2 than teetotallers, also when they adhere to more habits that reduce the risk of diabetes. This is the outcome of the long-term study carried out for the National Institute for Public Health and the Environment (RIVM) and the Julius Centre (UMCU) among 35,000 adults. TNO and Wageningen University performed the analysis in cooperation with RIVM and UMCU . . . . .


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Statistics on Alcohol , England 2010

This statistical report presents a range of information on alcohol use and misuse which are drawn together from a variety of published sources and includes additional analysis undertaken by the NHS Information Centre for health and social care.

The report aims to present a broad picture of health issues relating to alcohol in England and covers topics such as drinking habits and behaviours among adults (aged 16 and over) and school children (aged 11 to 15), drinking-related mortality, affordability of alcohol and alcohol-related costs.

Key facts

• In England in 2008, 71 per cent of men and 56 per cent of women (aged 16 and over) reported drinking an alcoholic drink on at least one day in the week prior to interview. Eleven per cent of men and 6 per cent of women reported drinking on every day in the previous week.

• In England in 2008, 38 per cent of men drank over 4 units on at least one day in the week prior to interview and 29 per cent of women drank more than 3 units on at least one day in the week prior to interview. Twenty two per cent of men reported drinking over 8 units and 15 per cent of women reported drinking over 6 units on at least one day in the week prior to interview.

• The average weekly alcohol consumption in England in 2008, was 16.8 units for men and 8.6 units for women. There has been an increase from 54 per cent in 1997 to 75 per cent in 2009 in the proportion of people in Great Britain who had heard of daily drinking limits. Throughout the period, differences between men and women have been slight.

• In England in 2009, there were 150,445 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings or NHS hospitals and dispensed in the community. This is an increase of 12 per cent since 2008 when there were 134,423 prescription items and 46 per cent since 2003 when there were 102,741 prescription items.

• In England in 2008, there were 6,769 deaths directly related to alcohol. An increase of 24 per cent from 2001. Of these alcohol related deaths, the majority (4,400) died from alcoholic liver disease.

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Hydration Status and the Diuretic Action of a Small Dose of Alcohol

This study was conducted to examine the effect of consuming a dilute alcohol solution (weak beer) on urine production in euhydrated and hypohydrated individuals.

No difference existed in the volume of urine produced between the alcohol (261 ± 138 ml; mean ± SD) and non-alcohol (174 ± 61 ml) beer when hypohydrated (P = 0.057), but there was a difference when euhydrated (1279 ± 256 vs 1121 ± 148 ml alcohol and non-alcohol, respectively; P < 0.001).

Unsurprisingly, more urine was produced on both euhydrated trials than either of the hypohydrated trials (P < 0.001).

Blood alcohol concentration was elevated (P <> 1.8 and 6.0 ± 2.7 mmol/l (hypohydrated and euhydrated, respectively) on the alcohol trials. Serum osmolality was higher 1 h after drinking on both the alcohol trials (303 ± 5 and 298 ± 5 mosmol/l) than on their non-alcohol, equivalent hydration trials (290 ± 8 and 284 ± 5 mosmol/l hypohydrated and euhydrated, respectively..

These results suggest that the diuretic action of alcohol is blunted when the body is hypohydrated.

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Request Reprint E-Mail: R.J.Maughan@lboro.ac.uk

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The effects of the 2004 reduction in the price of alcohol on alcohol-related harm in Finland : A natural experiment based on register data

Changes in alcohol pricing have been documented as inversely associated with changes in consumption and alcohol-related problems. Evidence of the association between price changes and health problems is nevertheless patchy and is based to a large extent on cross-sectional state-level data, or time series of such cross-sectional analyses. Natural experimental studies have been called for. There was a substantial reduction in the price of alcohol in Finland in 2004 due to a reduction in alcohol taxes of one third, on average, and the abolition of duty-free allowances for travellers from the EU. These changes in the Finnish alcohol policy could be considered a natural experiment, which offered a good opportunity to study what happens with regard to alcohol-related problems when prices go down.

The present study investigated the effects of this reduction in alcohol prices on (1) alcohol-related and all-cause mortality, and mortality due to cardiovascular diseases, (2) alcohol-related morbidity in terms of hospitalisation, (3) socioeconomic differentials in alcohol-related mortality, and (4) small-area differences in interpersonal violence in the Helsinki Metropolitan area. Differential trends in alcohol-related mortality prior to the price reduction were also analysed.


The findings of the present study suggest that that a reduction in alcohol prices may lead to a substantial increase in alcohol-related mortality and morbidity. However, large population group differences were observed regarding responsiveness to the price changes. In particular, the less privileged, such as the unemployed, were most sensitive. In contrast, at least in the Finnish context, the younger generations and the employed do not appear to be adversely affected, and those in the older age groups may even bene it from cheaper alcohol in terms of decreased
rates of CVD mortality. The results also suggest that reductions in alcohol prices do not necessarily affect interpersonal violence. The population group differences in the effects of the price changes on alcohol-related harm should be acknowledged, and therefore the policy actions should focus on the population subgroups that are primarily responsive to the price reduction.


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Our Thinking About Drinking

A touchstone of working at Brown-Forman is the belief that our company has thrived because of our long-term perspective. The Issues Forum is an extension of that point of view.

The Issues Forum shares our perspectives on critical alcohol-related issues and invites the comments, opinions, and ideas that you or others may have.

It is our view that, enjoyed responsibly, beverage alcohol enriches the experience of life for many. Hence we promote our brands responsibly and encourage responsible consumption, knowing that beverage alcohol plays a part in enhancing the lives of the vast majority of those who choose to drink in moderation. . . . . .

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Upated resources: IBA e-learning; Ready Reckoner; LAPE profiles

An updated version of the Alcohol Identification and Brief Advice (IBA) e-learning course has been produced. The course helps professionals to identify individuals whose drinking might be impacting on their health and how to respond by delivering simple, structured advice.

A new version of the Ready Reckoner (V5 updated April 2010) data tool for commissioners is now available. The ready reckoner aims to assist PCTs to assess interventions' effectiveness in reducing alcohol related admissions. Tools to help commissioners apply the RUSH model, 'a systems approach to estimating the required capacity of alcohol treatment services' are available here.

The Local Alcohol Profiles for England (LAPE) have also continued to develop their resources, now also offering regional profiles.

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How much is enough?

Parents in the UK are increasingly aware of problems associated with teenagers and alcohol – but is their experience unusual, or is it mirrored in other countries around the world? The statistics suggest youngsters here are more likely than those elsewhere to get into difficulties over drink.

Last year a survey of 15- and 16-yearolds in the UK, carried out as part of the European School Survey Project, found increasing numbers of them are suffering serious mental and physical health problems because of alcohol. More than one in four said they had suffered an accident or injury because of drinking, and one in 10 said they had had sex while intoxicated and later regretted it. Overall 54% of the teenagers admitted to binge drinking, which is a much higher percentage than the European average of 43%. Britain was fifth out of 35 European countries, coming behind the Isle of Man, Denmark, Portugal and Malta. . . . . . .

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California - Senate Democrats to propose $4.9 billion in tax hikes

Senate Democrats today plan to roll out a $4.9 billion package of tax hikes on cars, alcohol, income and corporate profits.

According to a budget committee analysis, the Democratic 2010-11 plan includes:

-- Suspending corporate tax breaks scheduled to begin Jan. 1 (worth $2.05 billion)

-- Extending a 0.25 percent income tax surcharge that is scheduled to end Dec. 31. (worth $1 billion)

-- Extending a $217 per dependent reduction in the state's dependent income tax credit, also scheduled to end Dec. 31 (worth $430 million)

-- Raising the vehicle-license fee from 1.15 percent to 1.50 percent of estimated value starting July 1 of this year (worth $1.2 billion)

-- Increasing the state's alcohol tax by an inflation-adjusted amount; these rates currently remain at 1991 levels (worth $210 million) . . . .

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Comparing the Effectiveness of TWEAK and T-ACE in Determining Problem Drinkers in Pregnancy

The TWEAK and T-ACE screening tools are validated methods of identifying problem drinking in a pregnant population.

The objective of this study was to compare the effectiveness of the TWEAK and T-ACE screening tools in identifying problem drinking using traditional cut-points (CP).

The study consisted of 75 problem and 100 non-problem drinkers. Using traditional CP, the TWEAK and T-ACE tools both performed similarly at identifying potential at-risk women (positive predictive value = 0.54), with very high sensitivity rates (100–99% and 100–93%, respectively) but poor specificity rates (36–43% and 19–34%, respectively). Upon comparison, there was no statistical difference in the effectiveness for one test performing better than next using either CP of 2 (P = 0.66) or CP of 3 (P = 0.38).

Despite the lack of difference in performance, improved specificity associated with TWEAK suggests that it may be better suited to screen at-risk populations seeking advice from a helpline.

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