Commentary on Witkiewitz et al. (2010): Evidence for matching—at last

Witkiewitz and her colleagues confirm three things that clinicians know: motivation matters, matching treatment styles to motivational state matters and dependence complicates things.

The experienced clinician recognizes that people who are at different points in reaching a decision to change need different interventions; that discussion of behaviour change interventions with people who have not made a decision to change is likely to elicit resistance, and resistance to change is likely to result in treatment non-adherence.

The disciplined application of motivational interviewing has assisted the experienced clinician to prepare people for decisions about behaviour change which naturally leads on to behaviour change therapies. These clinical observations have been supported by empirical evidence.

Why is it that a rigorously controlled trial such as Project MATCH (Matching Alcoholism Treatment to Client Heterogeneity) has not, to date, supported these things we know? Why, some would ask, does it take the controlled trial approach to research so long to catch up with clinical observation and experience? > > > >

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Commentary on McCaul et al. (2010): Observational studies about average alcohol consumption and health - closing time for a limited evidence base

Positive attitudes about 'moderate' drinking may weaken efforts designed to reduce alcohol misuse and its terrible consequences. For many, it is dogma that alcohol is good for the heart, if not one's overall health.

The study by McCaul et al. about the relationship between alcohol consumption, mortality and coronary heart disease (CHD) death among older Australians will not change those convictions.

Although studies about drinking and mortality are mixed, this study's findings for CHD are generally consistent with those from other studies; and although it is rarely emphasized, this study is also consistent with others in demonstrating that, among drinkers, drinking less alcohol generally results in better health outcomes than drinking more.

However, this study suffers from the same limitations that afflict other observational studies about average alcohol consumption and chronic disease outcomes.

While these limitations are sometimes overlooked or dismissed, they are worth reviewing in depth and with a frequency matching the feverish publicity heralding new alcohol studies. > > > >

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Policies for Reducing Problems Associated With Alcohol Availability

The 15^th in a series of conferences on the avoidance of alcohol-related problems using public policy strategies

Sunday - Tuesday, December 5-7, 2010 Washington Marriott Wardman Park Washington, DC, USA Conference goals and objectives This 15th conference in the Alcohol Policy series will explore, develop, and advance public policy approaches to the prevention of alcohol problems in order to promote evidence-based strategies and to bring focus to the need for alcohol policy reform at all levels - local, regional, national, and international. Specific objectives are to: 1. Strengthen the understanding of sound, evidence-based public policy in preventing and reducing alcohol-related problems. 2. Illuminate policy-making processes at local, state, regional and national, and international levels. 3. Influence international, national, regional, state and local agendas to consider rational alcohol policy, with an emphasis on offsetting the public costs of alcohol use. 4. Expand the coalition of individuals, organizations and agencies committed to public policy approaches to the prevention of alcohol problems. 5. Promote public discussion on specific alcohol policy issues, including sales, service, products, marketing, and other conditions of availability.

Overview


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Risky alcohol use and age at onset of regular alcohol consumption in relation to frontal lobe indices, reward sensitivity, and rash impulsiveness

Excessive alcohol consumption has been linked to predisposing traits that may reflect frontal lobe functioning, an idea explored by this study.

The study recruited 132 adults of both genders aged 18–68 years who completed an online questionnaire battery.

Sensitivity to punishment was the primary variable associated with age of onset for weekly drinking. The relationship between disinhibition and drinking behavior, as assessed by the AUDIT, was partially mediated by sensitivity to reward.

The findings of this study suggest that several interrelated and heritable personality and neurobehavioral traits may promote earlier as well as riskier alcohol consumption.


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Request Reprint E-Mail: mlyvers@bond.edu.au


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Ethanol-Regulated Genes That Contribute to Ethanol Sensitivity and Rapid Tolerance in Drosophila

Increased ethanol intake, a major predictor for the development of alcohol use disorders, is facilitated by the development of tolerance to both the aversive and pleasurable effects of the drug. The molecular mechanisms underlying ethanol tolerance development are complex and are not yet well understood.

To identify genetic mechanisms that contribute to ethanol tolerance, we examined the time course of gene expression changes elicited by a single sedating dose of ethanol in Drosophila, and completed a behavioral survey of strains harboring mutations in ethanol-regulated genes.

Enrichment for genes in metabolism, nucleic acid binding, olfaction, regulation of signal transduction, and stress suggests that these biological processes are coordinately affected by ethanol exposure. We also detected a coordinate up-regulation of genes in the Toll and Imd innate immunity signal transduction pathways. A multi-study comparison revealed a small set of genes showing similar regulation, including increased expression of 3 genes for serine biosynthesis. A survey of Drosophila strains harboring mutations in ethanol-regulated genes for ethanol sensitivity and tolerance phenotypes revealed roles for serine biosynthesis, olfaction, transcriptional regulation, immunity, and metabolism. Flies harboring deletions of the genes encoding the olfactory co-receptor Or83b or the sirtuin Sir2 showed marked changes in the development of ethanol tolerance.

Our findings implicate novel roles for these genes in regulating ethanol behavioral responses.


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•Thematic meeting, Kampala, Uganda 15-18th Nov 2010

You are welcome to the website of Kettil Brunn Society (KBS) thematic meeting on alcohol epidemiology and policy 2010. KBS is an international organization of scientists engaged in research on the social and health aspects of alcohol use and alcohol problems. The meeting will take place from 15th to 18th Nov 2010 at the Speke Resort Munyonyo in Kampala, Uganda (http://www.spekeresort.com/). The meeting will be the first ever KBS meeting in Africa.

The KBS thematic meeting is being organized by Makerere University school of Public Health (MUSPH) in conjunction with KBS management. The members of the local organizing committee have been drawn from different departments of the University, organizations dealing with alcohol related issues and relevant government ministries. There is also an international advisory group that comprises the KBS management and other eminent persons in the field of alcohol research. The websites for MUSPH and KBS are www.musph.ac.ug and www.kettilbruun.org respectively.


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The Validity of State Survey Estimates of Binge Drinking

State survey–based estimates of binge drinking may be useful for estimating the need for alcohol prevention and treatment services and for evaluating the effects of state alcohol control policies. However, as a result of declining survey response rates, there is growing concern about the validity of state survey estimates of binge drinking.

This study aims to examine the construct validity of state survey–based prevalence estimates of binge drinking.

State prevalence estimates of binge drinking in the past 30 days for 1999, 2001, 2003, 2005, and 2007 were obtained from published reports or public use data for the National Survey on Drug Use and Health, Behavioral Risk Factor Surveillance Survey, and Youth Risk Behavior Survey. Construct validity was assessed in 2009 by examining correlations between these survey estimates and, for corresponding years, state per capita alcohol consumption levels (based on sales data for beer, wine, and spirits) and the percentage of drivers in fatal motor-vehicle crashes with a blood alcohol concentration of at least 0.08.

Eighty-eight percent of the correlations between state survey–based binge drinking estimates and per capita alcohol sales data were significant and moderate to strong (r ≥0.30, range=0.16–0.60). Similarly, 86% of the state survey binge drinking estimates were moderately or strongly correlated with the percentage of drivers in fatal crashes with blood alcohol concentration ≥0.08 (range=0.11–0.60).

Results suggest that state survey–based estimates of binge drinking have construct validity and therefore can be used to investigate relationships between state alcohol policies and other state characteristics and the prevalence of this behavior.

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Request Reprint E-Mail: paschall@prev.org

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Police and licensing reform plans outlined by Home Office

The Home Office Structural Reform Plan [pdf] was released this week, outlining the Coalition's plans to reform policing, licensing, civil liberties, counter-terrorism and immigration laws. The plan details its alcohol and licensing plans as:

Overhaul alcohol licensing to give more power to police and local authorities to meet the concerns of local communities:

1. Consult and develop proposals to overhaul the Licensing Act 2003 to strengthen local authority and police powers to remove licenses from, or refuse to grant licenses to, any premises that are causing problems
2. Legislate through the Police Reform and Social Responsibility Bill
3. Develop options for alcohol taxation and pricing to ensure it tackles binge drinking, working with Department for Business, Innovation and Skills and HM Treasury
4. Develop options to ban below-cost sale of alcohol, working with other government departments
5. Introduce legislation if necessary

Read More > > > >


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Behavioral economic analysis of cue-elicited craving for alcohol

Craving as a motivational determinant of drug use remains controversial because of ambiguous empirical findings. A behavioral economic approach may clarify the nature of craving, theorizing that subjective craving functionally reflects an acute increase in a drug's value. The current study tested this hypothesis via a multidimensional assessment of alcohol demand over the course of an alcohol cue reactivity procedure.

Alcohol versus neutral cues significantly increased craving and multiple behavioral economic measures of the relative value of alcohol, including alcohol consumption under conditions of zero cost (intensity), maximum expenditure on alcohol (O_max), persistence in drinking to higher prices (breakpoint) and proportionate price insensitivity (normalized P_max). Craving was significantly correlated with demand measures at levels ranging from 0.21–0.43.

These findings support the potential utility of a behavioral economic approach to understanding the role of environmental stimuli in alcohol-related decision making. Specifically, they suggest that the behavioral economic indices of demand may provide complementary motivational information that is related to though not entirely redundant with measures of subjective craving.

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Request Reprint E-Mail: jmackill@uga.edu

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The influence of cultural orientation, alcohol expectancies and self-efficacy on adolescent drinking behavior in Beijing

We hypothesized that the drinking behavior of adolescents in China is influenced by expectancies and self-efficacy and that adolescents' cultural orientation towards western versus traditional Chinese values influences expectancies, self-efficacy and drinking behavior, with western values leading to more dysfunctional patterns of beliefs and drinking, and that these beliefs are influenced by students' gender and school environment.

A total of 1020 high school students from Beijing completed the Chinese Adolescent Alcohol Expectancy, the Chinese Cultural Orientation and the Chinese Self-regulation Self-efficacy questionnaires.

Results generally confirmed our hypotheses. Higher negative expectancies and higher self-efficacy reduced the likelihood of drinking significantly. Higher positive expectancies increased the likelihood of regular drinking but not occasional drinking. Having western cultural orientation increased the likelihood of drinking. Higher levels of western cultural orientation also increased positive expectancies, lowered negative expectancies and lowered self-efficacy. Having more western (less traditional) views towards traditional Chinese values decreased positive and negative expectancies. Gender influenced beliefs, with males having higher positive and lower negative expectancies, lower self-efficacy and more traditional cultural orientation. Students in key and general schools had less traditional cultural orientation and key school students had higher self-efficacy.

Results indicate that cultural orientation influences adolescent drinking and this influence is mediated partially through cultural orientation influences on adolescent drinking expectancies and self-efficacy. Having more western and less traditional Chinese cultural orientation leads to more drinking, lower self-efficacy for regulating drinking and more risk-promoting alcohol expectancies.

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Request Reprint E-Mail: dshell2@unl.edu

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Community reinforcement and family training: an effective option to engage treatment-resistant substance-abusing individuals in treatment

Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSOs). This is disturbing, as untreated individuals are often associated with a variety of other addiction-related problems. Community Reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches.

The objective of this systematic review was to compare CRAFT with the Alcoholics Anonymous/Narcotics Anonymous (Al-Anon/Nar-Anon) model and the Johnson Institute intervention in terms of its ability to engage patients in treatment and improve the functioning of CSOs.

The electronic databases PubMed, PsycINFO, EMBASE, CINAHL and the Cochrane Library were consulted. Four high-quality randomized controlled trials were identified, with a total sample of 264 CSOs. Data were synthesized to quantify the effect with 95% confidence intervals, using the random effects model.

CRAFT produced three times more patient engagement than Al-Anon/Nar-Anon. Overall, CRAFT encouraged approximately two-thirds of treatment-resistant patients to attend treatment, typically for four to six CRAFT sessions. CSOs showed marked psychosocial and physical improvements whether they were assigned to CRAFT, Al-Anon/Nar-Anon or the Johnson Institute intervention within the 6-month treatment window.

CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with the traditional programmes.

Read Full Abstract.

Request Reprint E-Mail: h.roozen@erasmusmc.nl

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Alcohol and Acute Ischemic Stroke Onset. The Stroke Onset Study

Previous research suggests that regular heavy alcohol consumption increases the risk for ischemic stroke, whereas frequent light to moderate alcohol intake may decrease the risk. However, the risk of ischemic stroke associated with transient exposure to alcohol remains unclear.

In this study, we used a case–crossover approach to test the hypothesis that alcohol consumption affects the acute risk of ischemic stroke, to determine the length of time between alcohol intake and the onset of symptoms (induction time), and to examine whether the risk varies by the type of alcohol.

In this multicenter study, we interviewed 390 patients (209 men, 181 women) between January 2001 and November 2006 (median 3 days after stroke). Alcohol consumption in the hour before stroke symptoms was compared with its expected frequency based on the usual frequency of alcohol consumption over the prior year.

Of the 390 patients, 248 (64%) reported alcohol consumption in the prior year, 104 within 24 hours and 14 within 1 hour of stroke onset. The relative risk of stroke in the hour after consuming alcohol was 2.3 (95% CI, 1.4 to 4.0; P=0.002). The relative risks were similar for different types of alcoholic beverages and when the sample was restricted to those who were not simultaneously exposed to other potential triggers.

The risk of stroke onset is transiently elevated in the hour after alcohol ingestion

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Request Reprint E-Mail: mmittlem@bidmc.harvard.edu .

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Effects of a Novel Cognition-Enhancing Agent on Fetal Ethanol-Induced Learning Deficits

Drinking during pregnancy has been associated with learning disabilities in affected offspring. At present, there are no clinically effective pharmacotherapeutic interventions for these learning deficits.

Here, we examined the effects of ABT-239, a histamine H₃ receptor antagonist, on fetal ethanol-induced fear conditioning and spatial memory.

Long-Evans rat dams stably consumed a mean of 2.82 g ethanol/kg during a 4-hour period each day during pregnancy. This voluntary drinking pattern produced a mean peak serum ethanol level of 84 mg/dl. Maternal weight gain, litter size and birth weights were not different between the ethanol-consuming and control groups. Female adult offspring from the control and fetal alcohol-exposed (FAE) groups received saline or 1 mg ABT-239/kg 30 minutes prior to fear conditioning training. Three days later, freezing time to the context was significantly reduced in saline-treated FAE rats compared to control. Freezing time in ABT-239-treated FAE rats was not different than that in controls. In the spatial navigation study, adult male offspring received a single injection of saline or ABT-239 30 minutes prior to 12 training trials on a fixed platform version of the Morris Water Task.

All rats reached the same performance asymptote on Trials 9 to 12 on Day 1. However, 4 days later, first-trial retention of platform location was significantly worse in the saline-treated FAE rats compared control offspring. Retention by ABT-239-treated FAE rats was similar to that by controls. ABT-239's effect on spatial memory retention in FAE rats was dose dependent.

These results suggest that ABT-239 administered prior to training can improve retention of acquired information by FAE offspring on more challenging versions of hippocampal-sensitive learning tasks.

Further, the differential effects of ABT-239 in FAE offspring compared to controls raises questions about the impact of fetal ethanol exposure on histaminergic neurotransmission in affected offspring.

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

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A Double-Blind, Placebo-Controlled Study With Quetiapine as Adjunct Therapy With Lithium or Divalproex in Bipolar I Patients With Coexisting Alcohol D

This study evaluated the efficacy of quetiapine versus placebo as an adjunct to lithium or divalproex in reducing alcohol consumption in patients with bipolar I disorder and coexisting alcohol dependence.

Male and female outpatients (21 to 60 years) with a history of bipolar I disorder and alcohol dependence were included in this 12-week, placebo-controlled study. Patients treated with lithium or divalproex (ongoing or assigned at screening) were randomized to receive quetiapine (dosed up to 400 mg/d over 7 days, followed by 300 to 800 mg/d flexible dosing until study end) or placebo. The primary outcome measure was the change in the proportion of heavy drinking days from baseline to Week 12 (as derived from the Timeline Followback method). Secondary outcome measures included time to the first consecutive 2 weeks of abstinence, changes from baseline to Week 12 in the proportion of nondrinking days, mean number of standardized drinks per day, and Clinical Global Impressions-Severity of Illness score.

Of 362 enrolled patients (mean 38.6 years), 176 were randomized to receive quetiapine and 186 to placebo. The mean proportion of heavy drinking days at baseline was 0.66 in the quetiapine group and 0.67 in the placebo group. At Week 12, the mean change in the proportion of heavy drinking days was −0.36 with quetiapine and −0.36 with placebo (p = 0.93). No statistically significant differences in any of the secondary outcome measures were noted between the quetiapine and placebo groups. The incidence of adverse events was consistent with the previously known tolerability profile of quetiapine.

The efficacy of quetiapine in the treatment of bipolar disorder is already well established. In this study, however, quetiapine added to lithium or divalproex did not result in significantly greater improvement compared with placebo in measures of alcohol use and dependence in patients with bipolar I disorder and alcohol dependence.

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Request Reprint E-Mail: marystedman@tampabay.rr.com

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Sobriety, Science, and AA’s Legacy

Alcoholics Anonymous – AA – got its start 75 years ago this summer.

Every AA member knows the story. Of how alcoholic Bill Wilson saw God in his detox room, and went on to lay out the twelve steps of the AA path.

It’s been a godsend for many. Doesn’t work for all.

And 75 years on, scientists are still trying to figure out exactly what it is that does work about AA. “Higher power” is not exactly a scientific term.

This Hour, On Point: AA at 75, and what science – and alcoholics – understand about the twelve-step way.

-Tom Ashbrook

Guests:

Brendan Koerner, contributing editor at WIRED magazine. His latest article is “Secret of AA: After 75 Years, We Don’t Know How It Works.” He also writes Wired’s “Mr. Know-it-All” column.

Bill N.,twenty-year member of Alcoholics Anonymous.

Lee Ann Kaskutas, senior scientist at the Public Health Institute’s Alcohol Research Group.

Scott Tonigan, research professor in the Department of Psychology at the University of New Mexico.

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Recovery Association Project (RAP), Portland, Oregon

The Recovery Association Project (RAP) is a nonprofit organization dedicated to creating a vehicle for people in recovery in the Portland, Oregon, metropolitan area to speak out and challenge the stigma on substance abuse-related issues.

RAP's goals are to develop leadership among people in recovery and to support individual recovery through a range of peer-to-peer recovery support services.

Core values and principles of RAP include the following beliefs: (1) active citizenship is a stage of recovery—it helps to end the social marginalization that is often involved with a history of addiction; (2) collectively in recovery, we can do together what we could not do alone; and (3) attainment of self-respect, integrity, and development of one's personal gifts is critical to one's recovery.

From 2003 to 2007, RAP's Recovery Community Services Program (RCSP)-funded peer recovery services included a recovery center with a drop-in resource center, a wide range of clean-and-sober social and recreational activities, and numerous self-help meetings; a cafe located in the recovery center that served as a job training program for peers; and leadership training for civic engagement of people in recovery.

The feedback RAP gathered from the Government Performance Reporting Act survey of participants during its RCSP grant, and from additional satisfaction questions RAP added to the survey, showed that RAP's services are meeting the needs of participants and helping sustain recovery. At the 6-month follow-up point, more than 85% of participants in RAP services indicated that they had not used alcohol or drugs in the past 30 days.


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Request Reprint E-Mail: evarmitage@centralcityconcern.org


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Peers Reach Out Supporting Peers to Embrace Recovery (PROSPER): A Center for Substance Abuse Treatment Recovery Community Services Program

Peers Reach Out Supporting Peers to Embrace Recovery (PROSPER), a Center for Substance Abuse Treatment (CSAT) Recovery Community Services Program (RCSP) grantee, is based in Los Angeles, California, under the umbrella of its facilitating agency, Walden House, Inc. (WH) that is headquartered in San Francisco, California.

There are more than 100,000 men and women in Los Angeles who are on parole, probation, or are being released from state prison and county jails on any given day. Most of those individuals and their families are concentrated in Central and South Central Los Angeles. Peers in the program include people in recovery who have been incarcerated, and their families and significant others.

The combined effects of substance abuse and incarceration can be overwhelming for individuals and families, as relapse and recidivism rates indicate. WH believes that social support through a peer-community approach can have a significant impact on this specific population.

PROSPER is a unique, strength-based recovery maintenance program based on holistic peer-to-peer social support that complements existing services with a responsive program design that addresses the dual challenge of recovery and reentry.

The strategic mix of includes an array of peer-run groups, coaching, workshop/seminars, social and recreational activities, and community events.

Establishing a culturally appropriate peer-to-peer recovery community for the target population is timely for WH, given the agency's current work with the population in prisons and in the community; its basic peer-driven approach as a modified therapeutic community; and its experience, expertise, and expansive network serving the criminal justice population in Los Angeles.


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Request Rerprint E-Mail: dandreas@waldenhouse.org


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Supporting Peer Recovery in Rural New England: The RECOVER Project, Franklin County, MA

Alcoholism and other drug abuse in rural communities conjure a particular picture. In small towns and sparsely populated areas people are isolated, have few things to do with their spare time, and tend to share attitudes and beliefs that sometimes support the use of alcohol and other substances.

The concepts of recovery may not be accepted at face value in these areas. Further, providing recovery supports in rural communities is challenged by physical, emotional, and social isolation; the need to respond to the multiple vulnerabilities that coexist with addiction (e.g., trauma, health, problems, homelessness); and the lack of opportunities for individual self-sufficiency.

The RECOVER Project was created to bring recovery supports and resources to all individuals in rural Franklin County through peer-to-peer interactions.

This article describes the organization of the resources, services and supports to overcome these barriers.


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Request Reprint E-Mail:

veysey@andromeda.rutgers.edu

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Developing Peer Leaders and Reducing Recidivism Through Long-Term Participation in a Faith-Based Program: The Story of Welcome Home Ministries

Welcome Home Ministries is a faith-based community reentry organization serving women being released from jail and/or prison. Welcome Home's mission is to create a faith-based support system for women from incarceration to productive citizenship.

Welcome Home's goal is to reduce recidivism of women ex-offenders who suffer from substance abuse and mental health issues by creating a healthy life focus. Founded by Warner-Robbins in 1996,

Welcome Home (WHM) has provided service to more than 300 women per year who have been released from jail or prison into San Diego County communities. The women served usually have few resources and need support to address the lifestyle values and changes that must be confronted to make a successful transition back into the community. The combination of recovery programs, peer services, and early intervention have proven to be effective in assisting the women through the change process.

To date, more than 80% of the women we have served have been able to sustain their recovery and avoid additional offenses requiring a return to jail or prison. Welcome Home has helped women go to college, embark on careers in drug and alcohol counseling or nursing, and reunite with their families.

Welcome Home provides a healthy supportive environment, within which women who had never made healthy choices for themselves, now assist other women getting out of jail or prison in making healthier decisions for their lives.


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Request Reprint E-Mail: jhnhrbbns@sbcglobal.net

The Multicultural Wellbriety Peer Recovery Support Program: Two Decades of Community-Based Recovery

White Bison has been effective in training 388 peer recovery support persons, known as Firestarters, to implement standardized, Native-focused, peer recovery programs based on the traditional knowledge of tribal elders.

Following the elders' Four Laws of Change, White Bison has demonstrated the program capacity to build indigenous support communities of Wellbriety, which are facilitated by these healthy and sober spiritual leaders. Using the Native paradigm of evidence-based model programs, effectiveness has been measured and validated through success at generating this human capital of civic leadership.

In turn, using a clan model of Wellbriety, community coalitions have begun to emerge to sustain the work of the Firestarters through local Healing Forests that correct for multigenerational family problems that have grown up in the wake of high rates of addiction.


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Request Reprint E-Mail: ddmoore@argosy.edu


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Nonclinical Addiction Recovery Support Services: History, Rationale, Models, Potentials, and Pitfalls

For more than 150 years, the transition from intractable addiction to stable recovery has often involved two quite different worlds: (1) professionally directed addiction treatment aimed at bio-psycho-social stabilization and recovery initiation, and (2) recovery mutual aid that has served as a medium of recovery initiation/stabilization and long-term recovery maintenance. A third sphere, nonclinical recovery support services, is rapidly emerging as a portal of entry into and a bridge between these two worlds. This article identifies factors related to the rapid growth of peer-based recovery support services, describes the organizational contexts in which they are being imbedded, outlines the variations in how the roles of recovery support specialists are being defined, and discusses the potentials and possible pitfalls of such services.


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Request Reprint E-Mail: bwhite@chestnut.org


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Introduction: The Recovery Community Services Program

This article traces the history of the Recovery Community Services Program (RCSP) from its inception in the Substance Abuse Mental Health Services Administration/Center for Substance Abuse Treatment (SAMHSA/CSAT) 1998 vision of communities of recovery engaged in the public dialogue about addiction, treatment, and recovery through the 2002 programmatic refocus onto the provision of social supports for recovery, designed and delivered by people who share the experience of addiction and recovery, that is, peers.

It focuses on the role of peer-to-peer recovery support services in an evolving recovery-oriented system of care, lessons learned as the grant program has matured, and continuing challenges in this latest chapter of the ongoing history of the relationship between communities of recovery and formal systems of care.

Following articles represent how these principles are embodied in RCSP communities across the nation.

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Request Reprint E-Mail: linda.kaplan@samhsa.hhs.gov


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Epidemiology of alcohol-related burden of disease among Indigenous Australians

To compare the burden of alcohol-related harm and underlying factors of this harm, by age and sex, for Indigenous and general population Australians.

Population attributable fractions are used to estimate the disability adjusted life years (DALYs) for alcohol-related disease and injury. The DALYs were converted to rates per 1,000 by age and sex for the Indigenous and general populations.

Homicide and violence rates were much higher for Indigenous males: greatest population difference was for 30–44 years, Indigenous rate 8.9 times higher. Rates of suicide were also greater: the largest population difference was for 15–29 years, Indigenous rate 3.9 times higher. Similarly, for Indigenous females, homicide and violence rates were much higher: greatest population difference was for 30–44 years, Indigenous rate 18.1 times higher. Rates of suicide were also greater: the largest population difference was for 15–29 years, Indigenous rate 5.0 times higher.

Alcohol consumption and associated harms are of great concern for Indigenous Australians across all ages. Violent alcohol-related harms have been highlighted as a major concern.

To reduce the disproportionate burden of alcohol-related harm experienced by Indigenous Australians, targeted interventions should include the impact on families and communities and not just the individual.

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Request Reprint E-Mail: b.calabria@unsw.edu.au

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Reducing alcohol related harm experienced by Indigenous Australians: identifying opportunities for Indigenous primary health care services

Identify key issues and opportunities relating to the dissemination of cost-effective interventions for alcohol in Indigenous-specific settings.

Update previous reviews of the Indigenous alcohol literature, particularly in relation to intervention and dissemination studies aimed at identifying and integrating into routine clinical care those strategies that are most cost-effective in reducing alcohol-related harm.

The harmful use of alcohol has been identified as a major public health issue, which has a disproportionately high negative impact on Indigenous Australians. While the disproportionately high burden of harm borne by Indigenous Australian communities is well documented in descriptive studies, attempts to redress this imbalance through well controlled intervention and dissemination studies appear to have been inadequate to date. There is compelling evidence from the non-Indigenous community that brief intervention is an effective treatment for harmful alcohol use, compared to the relatively lower levels of evidence for primary and tertiary level interventions. The effectiveness of brief intervention for alcohol in Indigenous Australian communities should, therefore, be examined.

An opportunity exists to implement brief intervention into Indigenous primary health care settings, as an evidence-based strategy using established resources. There is the possibility that such Indigenous-specific health services research will lead the dissemination field in demonstrating how the implementation process can be successfully tailored to specific and defined clinical settings.

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Request Reprint E-Mail: a.shakeshaft@unsw.edu.au

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Managing alcohol-related problems among Indigenous Australians: what the literature tells us

To contextualise and provide an overview of two review papers – prepared as part of a larger research program – dealing with different aspects of the treatment of Indigenous Australians with alcohol-related problems.

The papers were reviewed thematically and compared to identify key issues raised in them.

Together, the papers highlight the paucity of the evidence base for the provision of treatment for Indigenous Australians with alcohol-related problems. Among the key issues identified are: the need to engage with clients in culturally safe ways; practitioner, organisational and client barriers to engagement; the contexts in which Indigenous drinking and treatment take place; the need to develop rigorous methods of evaluation more appropriate to Indigenous cultural and service provision settings; and the importance of effective partnerships in the provision of services.

For those working in the field, the reviews direct attention to the need to review and interrogate our current practice. They also provide clear directions for future research.

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Request Reprint E-Mail: d.gray@curtin.edu.au


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News Release - Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases

Nearly 12 million visits made to U.S. hospital emergency departments in 2007 involved people with a mental disorder, substance abuse problem, or both, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). This accounts for one in eight of the 95 million visits to emergency departments by adults that year.

Of these visits, about two-thirds involved patients with a mental disorder, one quarter was for patients with a substance abuse problem, and the rest involved patients dealing with both a mental disorder and substance abuse.

The Federal agency's analysis also found that for the 12 million emergency department visits involving mental health and/or substance abuse problems:

• Depression and other mood disorders accounted for 43 percent of the visits, while 26 percent were for anxiety disorders, and 23 percent involved alcohol-related problems.

• Mental health and/or substance abuse-related visits were 2½ times more likely to result in hospital admission than visits not involving mental disorders and/or substance abuse. Nearly 41 percent of mental disorder and/or substance abuse-related visits resulted in hospitalization.

• Medicare was billed for 30 percent of all mental health and/or substance abuse emergency department visits; private insurance was billed for 26 percent; the uninsured for 21 percent; and Medicaid for 20 percent

This AHRQ News and Numbers is based on data in Mental Health and Substance Abuse-Related Emergency Department Visits among Adults, 2007 (PDF file, 279 KB; PDF Help). The report uses statistics from the 2007 Nationwide Emergency Department Sample, an AHRQ database that is nationally representative of emergency department visits in all non-Federal hospitals. The Nationwide Emergency Department Sample contains 26 million records from emergency department visits from approximately 1,000 community hospitals nationwide. This represents 20 percent of all U.S. hospital emergency departments.


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How Australia decided there is no good to drinking

In 2009, Australia issued new guidelines (see the FAQs section here (PDF 454KB)) - replacing those from 2001 - for the consumption of alcohol through the government’s National Health and Medical Research Council. The 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol (keep this title in mind) halved the acceptable levels of consumption for men from four to two glasses of alcohol daily (the level for women remained at two glasses).

In 2010, the United States issued a draft - through its Department of Agriculture - of Dietary Guidelines for Americans, which is reissued every five years. The group responsible for the alcohol section (PDF 323KB) was headed by epidemiologist Eric Rimm of Harvard Medical School, where he is a co-director of the Health Professionals Follow-Up Study. This “prospective” research project has tracked groups of doctors’ and nurses’ health outcomes and drinking for decades.

The two sets of guidelines differed rather substantially. The American guidelines assert: “the lowest mortality risk for men and women [occurs] at the average level of one to two drinks per day, [and] is likely due to the protective effects of moderate alcohol consumption on CHD [coronary heart disease], diabetes and ischemic stroke as summarized in this chapter.” . . . . .

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Structural models of the comorbidity of internalizing disorders and substance use disorders in a longitudinal birth cohort

The present study examined the associations between internalizing disorders and substance use disorders using structural equation models to examine the relative contributions of common fixed confounding factors and direct causal pathways, and to determine the direction of causality.

Data were gathered during the course of the Christchurch Health and Development Study, a 25-year longitudinal study of a birth cohort of New Zealand children (n = 953). Measures included DSM-IV symptom criteria for major depression, anxiety disorders, alcohol abuse/dependence, nicotine dependence, and illicit drug abuse/dependence, ages 18, 21, and 25.

Structural equation modeling showed that for depression and substance use disorder, the best-fitting model was the one in which the associations were explained by a combination of common fixed factors and direct causal pathways from substance use to depression. A similar pattern emerged for anxiety disorders and (1) nicotine dependence, and (2) illicit drug abuse/dependence.

The comorbidity of anxiety disorder and alcohol abuse/dependence was best explained by a model that included common fixed factors and a reciprocal pathway between these disorders.

Decomposition of the correlations between internalizing disorders and substance use disorders showed that most of the correlation arose from direct causal pathways between disorders.

The findings suggest that the comorbidity between internalizing disorders and substance use disorders can be attributed to both common fixed factors and direct causal pathways between substance use disorder and internalizing disorder.

The evidence suggests that, in most cases, the most plausible explanation of causality is the one in which substance use disorder increases the risk of internalizing disorder.


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Review of alcohol taxation and pricing

The Budget announced that the Government would review alcohol taxation and pricing and report in the autumn.

It also announced that secondary legislation will be introduced to increase the tax on cheap, strong ciders. This legislation will change the definition of cider by introducing a minimum juice content to qualify to pay duty at the cider rates. Products with low juice content will be taxed at the more appropriate made-wine rate from September 2010. . . . . .

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