Alcohol-use disorders: physical complications

The advice in the NICE guideline covers:

The care of adults and young people (aged 10 years and older) who have any of the following physical health problems that are completely or partly caused by alcohol use:

• acute alcohol withdrawal (which occurs if a ‘dependent’ drinker suddenly stops drinking)
• lack of thiamine (also called vitamin B1) in the body, which can cause a condition called Wernicke’s encephalopathy
• liver disease
• inflammation of the pancreas (called pancreatitis).

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NICE considers QOF indicator on alcohol consumption

The QOF may include an indicator on alcohol consumption from 2013/14, after NICE decided to undertake further development work in this area.

At its meeting on Thursday, NICE's QOF review committee decided that there was merit in alcohol consumption indicator. But it thought that more evidence was needed on who should be included in the target group for any indicator. . . . . .

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Gene—environment interactions in 7610 women with breast cancer: prospective evidence from the Million Women Study

Information is scarce about the combined effects on breast cancer incidence of low-penetrance genetic susceptibility polymorphisms and environmental factors (reproductive, behavioural, and anthropometric risk factors for breast cancer).

To test for evidence of gene—environment interactions, we compared genotypic relative risks for breast cancer across the other risk factors in a large UK prospective study.

We tested gene—environment interactions in 7610 women who developed breast cancer and 10 196 controls without the disease, studying the effects of 12 polymorphisms (FGFR2-rs2981582, TNRC9-rs3803662, 2q35-rs13387042, MAP3K1-rs889312, 8q24-rs13281615, 2p-rs4666451, 5p12-rs981782, CASP8-rs1045485, LSP1-rs3817198, 5q-rs30099, TGFB1-rs1982073, and ATM-rs1800054)

in relation to prospectively collected information about ten established environmental risk factors (age at menarche, parity, age at first birth, breastfeeding, menopausal status, age at menopause, use of hormone replacement therapy, body-mass index, height, and alcohol consumption).

After allowance for multiple testing none of the 120 comparisons yielded significant evidence of a gene—environment interaction. By contrast with previous suggestions, there was little evidence that the genotypic relative risks were affected by use of hormone replacement therapy, either overall or for oestrogen-receptor-positive disease. Only one of the 12 polymorphisms was correlated with any of the ten other risk factors: carriers of the high-risk C allele of MAP3K1-rs889312 were significantly shorter than non-carriers (mean height 162·4 cm [95% CI 162·1—162·7] vs 163·1 cm [162·9—163·2]; p=0·01 after allowance for multiple testing).

Risks of breast cancer associated with low-penetrance susceptibility polymorphisms do not vary significantly with these ten established environmental risk factors.

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Bid to cut drink-drive limit by almost half

The Daily Telegraph has learned that Coalition ministers are studying proposals to cut the drink-drive limit for the first time in a generation.

Under the plans, the limit would fall from 80mg of alcohol per 100ml of blood to 50mg. Anyone caught above the new limit would face an automatic 12-month driving ban, even if they were only marginally over the threshold. . . . . .

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PREVALENCE OF DEPRESSION SYMPTOMS AMONG ADOLESCENTS AGED 12–17 YEARS IN CALIFORNIA AND THE ROLE OF OVERWEIGHT AS A RISK FACTOR

Literature documentation of the health consequences of obesity among adolescents continues to grow and includes the psychosocial consequences of obesity on this population.

The specific aim of this study was to identify prevalence of depression in adolescents, aged 12 to 17 years, and to identify the role of overweight as a risk factor for depression.

Secondary data analysis of the adolescent version of the 2005 California Health Interview Survey. Symptoms of depression were measured with a reduced version of he Center for Epidemiologic Studies Depression Scale. Weight status was determined using the Centers for Disease Control definitions and those recommended by the American Academy of Pediatrics.

The sample was nearly half male (50.6%). The majority of the adolescents in the sample were White (47.2%) followed by Latino (33.5%). Approximately 10% of the adolescents reported more than 10 depression symptoms. Based on BMI, 16.5% of the sample were at-risk of being overweight, and 14.7% were overweight. However, 24.4% of sample thought they were ‘slightly overweight or very overweight.

We did not find any statistically significant association between weight statu and symptoms of depression, but at the bivariate level we did find a statistically significant association between perception of one’s weight and depression, P,.001.

We also found that sex (OR 3.10; CI 2.07–4.51), perceived health (OR 2.25; CI 1.53–3.31), smoking (OR 1.8; CI 1.30–2.69), and alcohol use (OR 2.06; CI 1.44–2.95) were independently associated with depression symptoms.

Even though we were unable to prove the proposed association, our findings are noteworthy given that the association between these variables are less clear in the literature. Future studies that attempt to examine the relationship between these two variables may benefit from longitudinal design, inclusion of multi-item risk and protective predictors, inclusion of social-context related variables, perceived weight, and family history of obesity.

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THE SECOND SOUTH AFRICAN NAT I O N A L Y O U T H R I S K B E H AVIOUR SURVEY 2 0 0 8

While the world is home to 1.2 billion young people, South Africa is home to 9 million 747 thousand young people. This generation, the world over, are said to be the most educated youth generation in history.

As there are regional differences, South Africa will do well to see where it is pitched or better still to embark on a plan that gels together all the skills, attitude and knowledge that young people need to facilitate change at a personal, political, social and economic level.

Young people undisputedly are our future and ideally situated to change the ‘fabric of society’ through their own self-improvement and determination. Children and adolescents aged 19 years and younger account for almost half of the South African population of 48.8 million.(1)

The transition to democracy has made schooling compulsory, which means large numbers of young people are now engaged in the process of education.(2) At secondary school level the gross enrolment rate is over 90% with 4.5 million enrolled learners.
. . . . . . . .
Alcohol use: Learners reported alcohol consumption was 50% for ever having drunk alcohol and 35% for having drunk alcohol in the past month, and 29% for having engaged in binge drinking in the past month.


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Alcohol Consumption and Expectations of Its Effects in the Border Region of Pomerania: Comparison of German and Polish Adolescents

The study focused on expectations of alcohol effects and patterns of consumption in German and Polish adolescents in the border region of Pomerania.

In 2005/2006 a cross-sectional study was conducted in various schools. Adolescents with an average age of 14 from one German town (Greifswald) and two Polish towns (Szczecin and Kolobrzeg) were assessed using the ESPAD (European School Project on Alcohol and Other Drugs) questionnaire. Altogether 757 (444 Polish and 313 German) students in their 7th and 8th grades were assessed.

Differences between alcohol consumption patterns and expectations between Germany and Poland, and relationships between alcohol consumption and anticipated alcohol effects were tested.

There is a difference in patterns of consumption between the two countries. Among all adolescents, expectations of positive alcohol effects dominated, and the negative effects were estimated to be less likely. In a country-specific comparison,

German students estimated the occurrence of positive as well as negative effects to be likely.

Adolescents who consumed a lot of alcohol in both countries estimated the positive effects to be stronger. Adolescents are more focused on short-term experiences than the long-term consequences of alcohol consumption.

The results show potential targets for prevention and intervention of future risky consumption and alcohol use disorders.


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Request Reprint E-Mail:: ulrich.preuss@medizin.uni-halle.de


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Alcohol Consumption in Southern Sweden after Major Decreases in Danish Spirits Taxes and Increases in Swedish Travellers’ Quotas

In 2003, Denmark lowered its tax on spirits, and in 2004, Sweden increased its traveller import quotas.

The aim of the study was to determine whether these two changes increased self-reported alcohol consumption in southern Sweden, which is located near Denmark.

Data were collected through telephone interviews with the general population between 2003 and 2006. Individuals aged 16–80 years were interviewed. Some lived in southern Sweden, others in the northern region, which was assumed to be unaffected by the policy changes and was thus used as a control site. Analyses were performed for the total population as well as by sex, age, socio-economic group and consumption pattern.

The expected results were not found: alcohol consumption in southern Sweden had not changed. The few statistically significant changes found in southern Sweden indicated decreases. In the north, however, consumption seemed to have increased.

In addition to the two policy changes mentioned above, other changes seem to have affected alcohol consumption in Sweden. It is possible, however, that the policy changes have affected population groups not reached by the survey, and thus other types of data need to be analysed before drawing any far-reaching conclusions.


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Request Reprint E-Mail: nina-katri.gustafsson@sorad.su.se


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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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An explanation for enhanced perceptions of attractiveness after alcohol consumption

Acute alcohol consumption increases ratings of attractiveness to faces. This may help to explain increased frequencies of sexual encounters during periods of alcohol intoxication. At least in part, such increased attraction may be the result of alcohol consumption decreasing ability to detect bilateral asymmetry, presumably because of the reductions in the levels of visual function.

We tested the hypotheses that acute alcohol consumption decreases ability to detect asymmetry in faces and reduces preference for symmetrical faces over asymmetrical faces.

Twenty images of a pair of faces and then 20 images of a single face were displayed on a computer, one at a time. Participants were instructed to state which face of each of the face pairs displayed was most attractive and then whether the single face being displayed was symmetrical or not. Data were collected near campus bars at Roehampton University. Sixty-four self-selecting students who undertook the study were classified as either sober (control) or intoxicated with alcohol. For each face pair or single face displayed, participant response was recorded and details of the alcohol consumption of participants that day were also obtained.

Sober participants had a greater preference for symmetrical faces and were better at detecting whether a face was symmetrical or otherwise, supporting the hypotheses. A further, unexpected finding was that males made fewer mistakes than did females when determining whether individual faces were asymmetrical.

The reduced ability of inebriated people to perceive asymmetry may be an important mechanism underlying the higher ratings of facial attractiveness they give for members of the opposite sex and hence their increased frequency of mate choice.

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Request Reprint E-Mail: l.halsey@roehampton.ac.uk


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The influence of the luteal and follicular phases on major pharmacokinetic parameters of blood and breath alcohol kinetics in women

Drink tests involving 14 women were carried out to determine the effects of the menstrual cycle phases on the pharmacokinetics of ethanol.

One experiment was carried out in the follicular phase of the cycle and another in the luteal phase, with the estradiol, progesterone, and testosterone levels being determined in both cases. The target concentration was a final blood alcohol concentration (BAC) of approximately 0.08g%. After drinking was completed, concurrent BAC and breath alcohol concentration (BrAC) measurements were carried out at intervals of 10–20min. The ethanol elimination rate was determined by calculating a linear function in the part of the slope that was clearly linear. In addition, the c0 and Widmark factors r were calculated.

In 10 of the volunteers, who had a normal increase in progesterone in the luteal phase, the average hourly elimination rate ß60 in the follicular phase amounted to 0.0194±0.0020g%/h (BAC) and 0.0975±0.0068mg/L/h (BrAC), and in the luteal phase to 0.0193±0.0031g%/h (BAC) and 0.1026±0.0101mg/L/h (BrAC).

There was no significant difference. Other pharmacokinetic parameters (c0 concentrations, Widmark factors r, distribution volumes, maximal BAC, mean absorption rate, time until the peak concentrations were reached) also revealed no significant differences between the blood and breath alcohol levels of the luteal and follicular phases.

In addition, no significant correlations were observed between the absolute progesterone level and the respective elimination rates ß60.

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Request Reprint E-Mail: andrea_dettling@med.uni-heidelberg.de

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The prevalence and correlates of alcohol use disorders in the United States and Korea—a cross-national comparative study

The purpose of this study was to compare the prevalence rates of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition 12-month diagnoses of alcohol use disorders between the United States and South Korea using two large nationally representative surveys.

Cross-tabulations were used to derive weighted prevalences of alcohol abuse and dependence, and odds ratio derived from linear logistic regression analyses were used to determine the relationships between alcohol abuse and dependence across sociodemographic characteristics of the general population samples.

The prevalence of 12-month alcohol abuse was greater in the United States (5.3%) than Korea (2.0%), whereas the rate of alcohol dependence was greater in Korea (5.1%) compared with the United States (4.4%).

The odds of abuse were significantly greater among men, and in the youngest age groups in both countries. There was increased odds of 12-month dependence among men, and those who were employed or never married in each country. Further, the rates of abuse and dependence in the United States and of abuse in Korea decreased as a function of age, a result that did not generalize to dependence among Koreans.

The implications of the results of this study are discussed in terms of national differences between the United States and Korea as the result of gender roles and drinking patterns, and the need to understand the potential influence of the cultural applicability and specificity of psychiatric assessment interviews across countries.

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


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Forum Syd Sweden addresses alcohol and development

Alcohol is now recognised as a strategic development issue in Forum Syd, Sweden, according to a decision taken in the general assembly of the Forum. – A decision of great importance, comments Per-Åke Andersson from IOGT-NTO in Sweden. . . . . .

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External Costs of Risky Health Behaviors Associated with Leading Actual Causes of Death in the U.S.: A Review of the Evidence and Implications for Fut

This paper reviews the evidence on external costs of risky behaviors in the U.S. and provides a framework for estimating them. External costs arise when a person does not bear all the costs of his or her behavior.

They provide one of the strongest rationales for government interventions. Although the earlier estimates of external costs no longer have policy relevance, they demonstrated that the existence of external costs was an empirical question.

We recommend that the estimates of external costs be updated as insurance structures, environments, and knowledge about these behaviors change.

The general aspects of external costs may apply to countries other than the U.S. after taking into account differences in institutional, policy and epidemiological characteristics.


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Youth Risk Behavior Surveillance — United States, 2009

The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health-risk behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition,

YRBSS monitors the prevalence of obesity and asthma. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and local school-based YRBSs conducted by state and local education and health agencies.

This report summarizes results from the 2009 national survey, 42 state surveys, and 20 local surveys conducted among students in grades 9--12.

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Long-lasting reduction in hippocampal neurogenesis by alcohol consumption in adolescent nonhuman primates

Binge alcohol consumption in adolescents is increasing, and studies in animal models show that adolescence is a period of high vulnerability to brain insults.

The purpose of the present study was to determine the deleterious effects of binge alcohol on hippocampal neurogenesis in adolescent nonhuman primates.

Heavy binge alcohol consumption over 11 mo dramatically and persistently decreased hippocampal proliferation and neurogenesis.

Combinatorial analysis revealed distinct, actively dividing hippocampal neural progenitor cell types in the subgranular zone of the dentate gyrus that were in transition from stem-like radial glia-like cells (type 1) to immature transiently amplifying neuroblasts (type 2a, type 2b, and type 3), suggesting the evolutionary conservation of milestones of neuronal development in macaque monkeys.

Alcohol significantly decreased the number of actively dividing type 1, 2a, and 2b cell types without significantly altering the early neuronal type 3 cells, suggesting that alcohol interferes with the division and migration of hippocampal preneuronal progenitors.

Furthermore, the lasting alcohol-induced reduction in hippocampal neurogenesis paralleled an increase in neural degeneration mediated by nonapoptotic pathways.

Altogether, these results demonstrate that the hippocampal neurogenic niche during adolescence is highly vulnerable to alcohol and that alcohol decreases neuronal turnover in adolescent nonhuman primate hippocampus by altering the ongoing process of neuronal development.

This lasting effect, observed 2 mo after alcohol discontinuation, may underlie the deficits in hippocampus-associated cognitive tasks that are observed in alcoholics.

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Request Reprint E-Mail: cmandyam@scripps.edu.


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Predicting Women's Alcohol Risk-Taking While Abroad

Numerous studies have examined risk factors that are associated with heavy alcohol use; however, much of this research has not addressed factors that specifically relate to women's alcohol use.

The current study has extended the previous literature on women's alcohol-use behavior by examining factors associated with risky drinking in young women traveling abroad (n = 55). Using a pretest-posttest design, we examined the influence of disinhibition sensation-seeking and endorsement of social enhancement alcohol expectancies in relation to participation in risky alcohol use while abroad for three weeks.

Analyses confirmed that disinhibition sensation-seeking and social enhancement alcohol expectancies were associated with participation in risky alcohol-use behaviors while abroad (controlling for alcohol-use at the pretest).

Analysis of qualitative data reinforced the importance of social facilitation in women's alcohol risk-taking. Participants' qualitative data also emphasized characteristics of situational disinhibition relating to travel as well as culturally-specific motivations for alcohol-use behaviors.

Further research examining women's personal need for disinhibition and the role of situational disinhibition in motivating alcohol risk-taking is warranted.

In addition, the current findings suggest that interventions focusing on the connections between alcohol use and enhancement of social relationships and the potential isolating effects of non-use are necessary.


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Request Reprint E-Mail: gsmith@elon.edu


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Prefrontal Cortex Fails to Learn from Reward Prediction Errors in Alcohol Dependence

Patients suffering from addiction persist in consuming substances of abuse, despite negative consequences or absence of positive consequences.

One potential explanation is that these patients are impaired at flexibly adapting their behavior to changes in reward contingencies. A key aspect of adaptive decision-making involves updating the value of behavioral options. This is thought to be mediated via a teaching signal expressed as a reward prediction error (PE) in the striatum. However, to exert control over adaptive behavior, value signals need to be broadcast to higher executive regions, such as prefrontal cortex.

Here we used functional MRI and a reinforcement learning task to investigate the neural mechanisms underlying maladaptive behavior in human male alcohol-dependent patients.

We show that in alcohol-dependent patients the expression of striatal PEs is intact. However, abnormal functional connectivity between striatum and dorsolateral prefrontal cortex (dlPFC) predicted impairments in learning and the magnitude of alcohol craving.

These results are in line with reports of dlPFC structural abnormalities in substance dependence and highlight the importance of frontostriatal connectivity in addiction, and its pivotal role in adaptive updating of action values and behavioral regulation. Furthermore, they extend the scope of neurobiological deficits underlying addiction beyond the focus on the striatum.


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Request Reprint E-Mail: soyoung.q.park@gmail.com


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Sensitivity to Cigarette Prices Among Individuals With Alcohol, Drug, or Mental Disorders

Over 40% of all US smokers have comorbid alcohol, drug, or mental disorders.

Using data from the 2000–2001 Healthcare for Communities survey, we conducted multivariate logistic regressions to examine these individuals’ sensitivity to cigarette prices.

We found that a 10% increase in cigarette prices was associated with 18.2% less smoking participation among individuals with alcohol, drug, or mental disorders, except those with alcohol dependence. Increasing cigarette taxes could be effective in reducing smoking among individuals with alcohol, drug, or mental disorders.


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Request Reprint E-Mail: mong@mednet.ucla.edu .


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Alcohol Excites Cerebellar Golgi Cells by Inhibiting the Na+/K+ ATPase

Alcohol-induced alterations of cerebellar function cause motor coordination impairments that are responsible for millions of injuries and deaths worldwide.

Cognitive deficits associated with alcoholism are also a consequence of cerebellar dysfunction. The mechanisms responsible for these effects of ethanol are poorly understood. Recent studies have identified neurons in the input layer of the cerebellar cortex as important ethanol targets.

In this layer, granule cells (GrCs) receive the majority of sensory inputs to the cerebellum through the mossy fibers. Information flow at these neurons is gated by a specialized pacemaker interneuron known as the Golgi cell, which provides divergent GABAergic input to thousands of GrCs.

In vivo electrophysiological experiments have previously shown that acute ethanol exposure abolishes GrC responsiveness to sensory inputs carried by mossy fibers. Slice electrophysiological studies suggest that ethanol causes this effect by potentiating GABAergic transmission at Golgi cell-to-GrC synapses through an increase in Golgi cell excitability.

Using patch-clamp electrophysiological techniques in cerebellar slices and computer modeling, we show here that ethanol excites Golgi cells by inhibiting the Na⁺/K⁺ ATPase. Voltage-clamp recordings of Na⁺/K⁺ ATPase currents indicated that ethanol partially inhibits this pump and this effect could be mimicked by low concentrations of ouabain. Partial inhibition of Na⁺/K⁺ ATPase function in a computer model of the Golgi cell reproduced these experimental findings.

These results establish a novel mechanism of action of ethanol on neuronal excitability, which likely has a role in ethanol-induced cerebellar dysfunction and may also contribute to neuronal functional alterations in other brain regions.


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


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Developmental Trajectories of Impulsivity and Their Association With Alcohol Use and Related Outcomes During Emerging and Young Adulthood

Research has documented normative patterns of personality change during emerging and young adulthood that reflect decreases in traits associated with substance use, such as impulsivity. However, evidence suggests variability in these developmental changes.

This study examined trajectories of impulsivity and their association with substance use and related problems from ages 18 to 35. Analyses were based on data collected from a cohort of college students (N = 489), at high and low risk for AUDs, first assessed as freshmen at a large, public university.

Mixture modeling identified five trajectory groups that differed in baseline levels of impulsivity and developmental patterns of change. Notably, the trajectory group that exhibited the sharpest declines in impulsivity tended to display accelerated decreases in alcohol involvement from ages 18 to 25 compared to the other impulsivity groups.

Findings highlight the developmental nature of impulsivity across emerging and young adulthood and provide an empirical framework to identify key covariates of individual changes of impulsivity.

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Request Reprint E-Mail: littlefielda@missouri.edu

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The Burden of Disease and the Cost of Illness Attributable to Alcohol Drinking—Results of a National Study

The World Health Organization estimated that 3.2% of the burden of disease around the world is attributable to the consumption of alcohol. The aim of this study is to estimate the burden of disease attributable to alcohol consumption in Portugal.

Burden and costs of diseases attributable to alcohol drinking were estimated based on demographic and health statistics available for 2005, using the Disability-Adjusted Life Years (DALY) lost generated by death or disability.

In Portugal, 3.8% of deaths are attributable to alcohol (4,059 of 107,839). After measuring the DALY generated by mortality data, the proportion of disease attributable to alcohol was 5.0%, with men having 5.6% of deaths and 6.2% of disease burden, while female figures were, respectively, 1.8 and 2.4%. Considering the sum of death and disability DALYs, liver diseases represented the main source of the burden attributable to alcohol with 31.5% of total DALYs, followed by traffic accidents (28.2%) and several types of cancer (19.2%).

As for the cost of illness incurred by the health system, our results indicate that €95.1 millions are attributable to alcohol-related disease admissions (liver diseases, cancer, traffic accidents, and external causes) while the ambulatory costs of alcohol-related diseases were estimated in €95.9 million, totaling €191.0 million direct costs, representing 0.13% of Gross Domestic Product and 1.25% of total national health expenditures. An alternative analysis was carried out using higher consumption levels so as to replicate aggregate alcohol consumption statistics. In this case, DALYs lost increased by 11.7% and health costs by 23%.

Our results confirm that alcohol is an important health risk factor in Portugal and a heavy economic burden for the health system, with hepatic diseases ranking first as a source of burden of disease attributable to alcohol.

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Request Reprint E-Mail: hlcortezpinto@netcabo.pt

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Binge Drinking and Suboptimal Self-Rated Health Among Adult Drinkers

Binge drinking accounts for more than half of the 79,000 annual deaths in the United States that are owing to excessive drinking. The overall objective of our study was to examine the prevalence of binge drinking and consumption levels associated with suboptimal self-rated health among the general population of adult drinkers in all 50 states and territories in the United States.

The study included a total of 200,587 current drinkers who participated in the 2008 Behavioral Risk Factor Surveillance System (BRFSS) survey. We estimated the prevalence of binge drinking (i.e., ≥5 drinks on 1 occasion for men or ≥4 drinks on 1 occasion for women) and heavy drinking (i.e., an average of >14 drinks per week for men or >7 drinks per week for women), as well as the average number of binge episodes per person during a 30-day period. Odds ratios were produced with multivariate logistic regression models using binge-drinking levels as a predictor; status of suboptimal self-rated health was used as an outcome variable while controlling for sociodemographic, health, and behavioral risk factors.

We estimate that 34.7 million adult drinkers in the United States engaged in binge drinking in 2008, including an estimated 42.2% who reported either heavy drinking or at least 4 binge-drinking episodes in a 30-day period. Binge drinking with such levels was associated with a 13–23% increased likelihood of reporting suboptimal self-rated health, when compared to the nonbinge drinkers.

Binge drinking continues to be a serious public health concern. Frequent binge drinkers or binge drinkers who consume alcohol heavily are especially at risk of suboptimal self-rated health. Our findings underscore the importance of broad-based implementation in health care settings of screening for and brief interventions to address alcohol misuse, as well as the continuing need to implement effective population-based prevention strategies to reduce alcohol-related morbidity and mortality.

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Request Reprint E-Mail: jxt9@cdc.gov

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Trends in Alcohol-Related Traffic Risk Behaviors Among College Students

Alcohol-impaired driving is a major public health problem. National studies indicate that about 25% of college students have driven while intoxicated in the past month and an even greater percentage drive after drinking any alcohol and/or ride with an intoxicated driver. The purpose of this investigation was to examine the change in these various alcohol-related traffic risk behaviors as students progressed through their college experience.

A cohort of 1,253 first-time first-year students attending a large, mid-Atlantic university were interviewed annually for 4 years. Repeated measures analyses were performed using generalized estimating equations to evaluate age-related changes in prevalence and frequency of each behavior (i.e., ages 19 to 22).

At age 19, 17%_wt of students drove while intoxicated, 42%_wt drove after drinking any alcohol, and 38%_wt rode with an intoxicated driver. For all 3 driving behaviors, prevalence and frequency increased significantly at age 21. Males were more likely to engage in these behaviors than females. To understand the possible relationship of these behaviors to changes in drinking patterns, a post hoc analysis was conducted and revealed that while drinking frequency increased every year, frequency of drunkenness was stable for females, but increased for males.

Alcohol-related traffic risk behaviors are quite common among college students and take a significant upturn when students reach the age of 21. Prevention strategies targeted to the college population are needed to prevent serious consequences of these alcohol-related traffic risk behaviors.

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Request Reprint E-Mail: aarria@umd.edu

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Premiering Today! The June Road to Recovery Program: Recovery at Any Age: Young People Can and Do Recover

Join host Ivette Torres for a program that examines factors that can lead to addiction in young people, and options for receiving treatment and recovery services.

This episode will examine environmental and/or biological factors that can lead to addiction; how drugs and alcohol can affect a youth's development; and the role of modern technology options (e.g., social networking, texting) available to adolescents and young people receiving treatment and recovery services. Some of these are in-person services; others use new technologies and social networking.

This episode will highlight available supports, such as recovery high schools and colleges and other educational supports for young people in recovery; it will also discuss other support networks available to youth, such as family, faith, and community, to help them live healthy and productive lives in long-term recovery.

Panelists include: Frances M. Harding, Director, Center for Substance Abuse Prevention, SAMHSA; Monique Bourgeois, LADC, Executive Director, Association of Recovery Schools; Greg Williams, Co-Director, Connecticut Turning to Youth and Families; Mark Godley, Ph.D., Director of Research and Development for Chestnut Health Systems.



View the TV Program | Listen to the Radio Program


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Alcohol podcast

Professor Eileen Kaner and Professor Anne Ludbrook discuss the NICE public health guidance that aims to tackle the worrying rise in levels of alcohol consumption, binge drinking and alcohol-related deaths across the UK.

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Alcohol-use disorders: preventing the development of hazardous and harmful drinking

This guidance is for government, industry and commerce, the NHS and all those whose actions affect the population’s attitude to – and use of – alcohol. This includes commissioners, managers and practitioners working in:

• local authorities
• education
• the wider public, private, voluntary and community sectors.

It may also be of interest to members of the public.

This is one of three pieces of NICE guidance addressing alcohol-related problems among people aged 10 years and older. (See also: Alcohol-use disorders in adults and young people: clinical management; and Alcohol dependence and harmful use: diagnosis and management in young people and adults.)

Alcohol-related harm is a major health problem. The guidance identifies how government policies on alcohol pricing, its availability and how it is marketed could be used to combat such harm (see recommendation 1 to 3). Changes in policy in these areas is likely to be more effective in reducing alcohol-related harm among the population as a whole than actions undertaken by local health professionals.

The recommendations for practice (recommendations 4 to 12) support, complement – and are reinforced by – these policy options. They cover:

• Licensing.
• Resources for identifying and helping people with alcohol-related problems.
• Children and young people aged 10 to 15 years – assessing their ability to consent, judging their alcohol use, discussion and referral to specialist services.
• Young people aged 16 and 17 years – identification, offering motivational support or referral to specialist services.
• Adults – screening, brief advice, motivational support or referral.

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A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health

We provide estimates of several leading US adult health indicators by sexual orientation identity and gender to fill gaps in the current literature.

We aggregated data from the 2001–2008 Massachusetts Behavioral Risk Factor Surveillance surveys (N=67359) to examine patterns in self-reported identity and gender, using multivariable logistic regression.

Compared with heterosexuals, sexual minorities (i.e., gays/lesbians, 2% of sample; bisexuals, 1%) were more likely to report activity limitation, tension or worry, smoking, drug use, asthma, lifetime sexual victimization, and HIV testing, but did not differ on 3-year Papanicolaou tests, lifetime mammography, diabetes, or heart disease.

Compared with heterosexuals, bisexuals reported more barriers to health care, current sadness, past-year suicidal ideation, and cardiovascular disease risk.

Gay men were less likely to be overweight or obese and to obtain prostate-specific antigen tests, and lesbians were more likely to be obese and to report multiple risks for cardiovascular disease.

Binge drinking and lifetime physical intimate partner victimization were more common among bisexual women.

Sexual orientation disparities in chronic disease risk, victimization, health care access, mental health, and smoking merit increased attention. More research on heterogeneity in health and health determinants among sexual minorities is needed.

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Request Reprint E-Mail: kconron@hsph.harvard.edu .

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Anti-alcohol Posters in Poland, 1945-1989: Diverse Meanings, Uncertain Effects

We provide a historical study of the anti-alcohol public health poster in Poland between 1948 and 1990.

Our case study illuminates public health policies under communism, with the state as the dominant force in health communication. Poland has a distinctive history of poster art, moving from a Stalinist phase of socialist realism to the diverse styles of the later Polish School.

Quantitative and qualitative analysis of 213 posters establishes the major themes and differentiates community approaches, which depict the drinker as a social or political deviant, from those emphasizing individual risk. Medical issues were a minor theme, reflecting public policies geared more toward confinement than treatment.

However, Polish School artists used metaphor and ambiguity, and references to the contested cultural symbolism of drink, to complicate and subvert the narrow propaganda intent.

Thus, although apparently unsuccessful in restraining overall consumption, these posters offer valuable lessons for policymakers on the use of visual media in health campaigns.

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Request Reprint E-Mail: martin.gorsky@lshtm.ac.uk .

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'Clarifying brief interventions': Academy briefing paper released

A briefing paper 'Clarifying brief interventions' [pdf] has been released by the AERC Alcohol Academy. The paper aims to clarify key issues relating to the delivery of brief interventions and related practice, particularly distinctions in the types of interventions and their key characteristics. . . . . . .

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Medication Treatment of Different Types of Alcoholism

Alcoholism remains a serious cause of morbidity and mortality despite progress through neurobiological research in identifying new pharmacological strategies for its treatment.

Drugs that affect neural pathways that modulate the activity of the cortico-mesolimbic dopamine system have been shown to alter drinking behavior, presumably because this dopaminergic system is closely associated with rewarding behavior. Ondansetron, naltrexone, topiramate, and baclofen are examples.

Subtyping alcoholism in adults into an early-onset type, with chronic symptoms and a strong biological predisposition to the disease, and a late-onset type, typically brought on by psychosocial triggers and associated with mood symptoms, may help in the selection of optimal therapy.

Emerging adults with binge drinking patterns also might be aided by selective treatments.

Although preliminary work on the pharmacogenetics of alcoholism and its treatment has been promising, the assignment to treatment still depends on clinical assessment.

Brief behavioral interventions that encourage the patient to set goals for a reduction in heavy drinking or abstinence also are part of optimal therapy.

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Request Reprint E-Mail: bankolejohnson@virginia.edu.

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A Double-Blind, Placebo-Controlled Trial Combining Sertraline and Naltrexone for Treating Co-Occurring Depression and Alcohol Dependence

Empirical evidence has only weakly supported antidepressant treatment for patients with co-occurring depression and alcohol dependence. While some studies have demonstrated that antidepressants reduce depressive symptoms in individuals with depression and alcohol dependence, most studies have not found antidepressant treatment helpful in reducing excessive drinking in these patients.

The authors provide results from a double-blind, placebo-controlled trial that evaluated the efficacy of combining approved medications for depression (sertraline) and alcohol dependence (naltrexone) in treating patients with both disorders.

A total of 170 depressed alcohol-dependent patients were randomly assigned to receive 14 weeks of treatment with sertraline (200 mg/day [N=40]), naltrexone (100 mg/day [N=49]), the combination of sertraline plus naltrexone (N=42), or double placebo (N=39) while receiving weekly cognitive-behavioral therapy.

The sertraline plus naltrexone combination produced a higher alcohol abstinence rate (53.7%) and demonstrated a longer delay before relapse to heavy drinking (median delay=98 days) than the naltrexone (abstinence rate: 21.3%; delay=29 days), sertraline (abstinence rate: 27.5%; delay=23 days), and placebo (abstinence rate: 23.1%; delay=26 days) groups. The number of patients in the medication combination group not depressed by the end of treatment (83.3%) approached significance when compared with patients in the other treatment groups. The serious adverse event rate was 25.9%, with fewer reported with the medication combination (11.9%) than the other treatments.

More depressed alcohol-dependent patients receiving the sertraline plus naltrexone combination achieved abstinence from alcohol, had delayed relapse to heavy drinking, reported fewer serious adverse events, and tended to not be depressed by the end of treatment.

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Request Reprint E-Mail: PETTINATI_H@MAIL.TRC.UPENN.EDU

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Editorial - Treatments for Alcohol Dependence: Rethinking the Role of Comorbidity and Clinical Subtypes

This issue of the Journal includes two articles that address treatment of alcohol dependence.

Pettinati et al. (1) report a 14-week, randomized controlled trial comparing naltrexone alone, sertraline alone, combination of naltrexone and sertraline, and placebo as adjunct to weekly cognitive-behavioral therapy (CBT) for depressed alcohol-dependent patients.

Johnson (2) presents a look to the future on medication-assisted treatment strategies for three different clinical phenotypes of alcohol-dependent patients. This excellent review reminds us that alcoholism is a complex heterogeneous disorder with identified genetic and environmental risk factors.

Alcohol-related disorders affect male and female patients alike, both young and old. Family history, early exposure to alcohol, and comorbidity are important contributors to the future risk of developing alcoholism, severity of the disorder, and response to treatment. . . . ..

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Facilitators and barriers to intervening for problem alcohol use

This article is a report of a study exploring nurses' perceived facilitators and barriers to conducting brief interventions for problem alcohol use.

Excessive alcohol use has been associated with health, social and legal problems. Healthcare providers worldwide need help to detect and intervene with hazardous/harmful drinkers.

For this cross-sectional study, ten hospitals were randomly selected throughout Taiwan during 2007. Nurses (N = 741) were selected from the emergency department, and psychiatric and gastrointestinal medical-surgical units where most patients with alcohol problems are seen. Data collected using facilitator and barrier scales and a demographic information form were analysed by descriptive statistics and stepwise, multiple linear regression analysis.

Nurses identified the top facilitator to intervening for problem alcohol use as 'patients' drinking problems are related to their illness'. Top barriers were 'patients lack motivation to change' and 'patients express no interest in receiving intervention'. Perceived facilitators were associated with nurses' work unit, intention to intervene for problem alcohol use, and age. Perceived barriers were associated with work unit, experience in intervening for problem alcohol use, and having attended a training course.

Source of perceived barriers reflected cultural influences. Taiwanese nurse education needs to be strengthened in terms of brief interventions for problem alcohol use. Emergency department nurses need to become more aware of their important role in alcohol intervention. Alcohol-related education is needed for the general population and hospital policymakers to enhance facilitators and reduce barriers to intervening for problem alcohol use.

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Request Rerprint E-Mail: yftsai@mail.cgu.edu.tw

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Healthcare system use by risky alcohol drinkers: A secondary data analysis

To examine the effects of at-risk alcohol use on patterns of healthcare use and health outcomes.

Using the National Health Interview Survey and the Medical Expenditures Panel Survey, a total sample of 4449 adults, mean age 45 (SD 15), were grouped according to responses to the question: "In the past year, on how many days did you have 5 or more drinks of any alcoholic beverage?"

Three categories of respondents were grouped as follows: not at-risk group = 0 days of 5+ drinks/day (n = 2991, 67%); the low at-risk group = 1–11 days of 5+ drinks/day (n = 796, 18%); and the high at-risk group = 12–365 days of 5+ drinks/day (n = 662, 15%).

The level of risky alcohol use did not predict healthcare use or healthcare outcomes; high at-risk alcohol drinkers were less likely to use the healthcare system than other drinkers. When divided by rural versus urban living, rural high at-risk alcohol drinkers reported more emergency department visits and all rural living groups reported poorer physical and mental health than their urban counterparts.

Risky alcohol use, defined as drinking above low-risk guidelines, affects 3 out of 10 adults, and risky drinking plays a role in over 60 chronic health conditions. Nurse practitioners encounter risky alcohol users in multiple practice settings. It may be difficult to identify the underlying alcohol issues, particularly in those living in rural settings; however, identification of at-risk drinkers is essential for prompt intervention in the potential progression from risky alcohol use to an alcohol use disorder

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Request Reprint E-Mail: barbara-heise@byu.edu


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