Press Release - A leap forward in addiction awareness and control

A study by a team of researchers at Bangor University has designed and tested two programmes that help problem drinkers curb their alcohol abuse. The study shows positive results after drinkers have followed either the Alcohol Attention-Control Training Programme (AACTP) or the Life Enhancement and Advancement Programme (LEAP).

Funded by the Economic and Social Research Council (ESRC) the study designed the two programmes and examined their effectiveness in helping excessive drinkers reduce their drinking. The AACTP and LEAP programmes address the challenges faced by excessive drinkers, including a preoccupation with drinking made worse by alcohol-related stimuli around them. The study also addressed excessive drinkers' difficulties with motivation which prevent them focusing on and achieving goals which provide alternative healthy activities to drinking alcohol. > > > >

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Effects of Attentional and Motivational Training on Reducing Excessive Drinking

Why do excessive drinkers carry on drinking too much, even when they are aware of doing so? Previous research has highlighted two main factors in the way excessive drinkers think: a preoccupation or ‘attentional bias’ towards alcohol; and a lack of motivation towards other, healthier goals as alternatives to drinking.

From this starting point, the researchers designed and tested two methods that could help problem drinkers.

The first, the Alcohol Attention-Control Training Programme (ACCTP), was designed to change the thinking process involved in the typical drink-wanting, drink-seeking, drink-taking chain of behaviour.

The second, a motivational counseling method called the Life Enhancement and Activity Programme (LEAP), was devised to help drinkers achieve their goals and lead a satisfying life without excessive use of alcohol.


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Integrating Project ASSERT: A Screening, Intervention, and Referral to Treatment Program for Unhealthy Alcohol and Drug Use Into an Urban Emergency De

The objective was to evaluate the effects of Project Alcohol and Substance Abuse Services Education and Referral to Treatment (ASSERT), an emergency department (ED)-based screening, brief intervention, and referral to treatment program for unhealthy alcohol and other drug use.

Health promotion advocates (HPAs) screened ED patients for alcohol and/or drug problems 7 days a week using questions embedded in a general health questionnaire. Patients with unhealthy drinking and/or drug use received a brief negotiation interview (BNI), with the goal of reducing alcohol/drug use and/or accepting a referral to a specialized treatment facility (STF), depending on severity of use. Patients referred to an STF were followed up at 1 month by phone or contact with the STF to determine referral completion and enrollment into the treatment program.

Over a 5-year period (December 1999 through December 2004), 22,534 adult ED patients were screened. A total of 10,246 (45.5%) reported alcohol consumption in the past 30 days, of whom 5,533 (54%) exceeded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Use of at least one illicit drug was reported by 3,530 patients (15.7%). Over one-fourth of screened patients received BNIs (6,266, or 27.8%). Of these, 3,968 (63%) were referred to an STF. Eighty-three percent of patients were followed at 1 month, and 2,159 (65%) had enrolled in a program. Patients who received a direct admission to an STF were 30 times more likely to enroll than those who were indirectly referred (odds ratio = 30.71; 95% confidence interval = 18.48 to 51.04). After 3 years, funding for Project ASSERT was fully incorporated into the ED budget.

Project ASSERT has been successfully integrated into an urban ED. A direct, facilitated referral for patients with alcohol and other drug problems results in a high rate of enrollment in treatment programs.

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Request Reprint E-Mail: gail.donofrio@yale.edu

A Brief Motivational Interview in a Pediatric Emergency Department, Plus 10-day Telephone Follow-up, Increases Attempts to Quit Drinking Among Youth

Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States; binge drinking peaks at age 21-25 years. Underage drinking is associated with many negative consequences, including academic problems and risk of intentional and unintentional injuries.

This study tested the effectiveness of pediatric emergency department (PED) screening and brief intervention to reduce alcohol consumption and associated risks.

A three-group randomized assignment trial was structured to test differences between intervention (I) and standard assessed control (AC) groups in alcohol consumption and alcohol-related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control (MAC) group to adjust for the effect of assessment reactivity on control group behavior. Patients aged 14–21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test (AUDIT) or for binge drinking or high-risk behaviors. The MAC group received a resource handout, written advice about alcohol-related risks, and a 12-month follow-up appointment. Patients in the AC group were assessed using standardized instruments in addition to the MAC protocol. The I group received a peer-conducted motivational intervention, referral to community resources and treatment if indicated, and a 10-day booster in addition to assessment. Measurements included 30-day self-report of alcohol consumption and alcohol-related behaviors, screens for depression and posttraumatic stress disorder, and self-report of attempts to quit, cut back, or change conditions of use, all repeated at follow-up. Motor vehicle records and medical records were also analyzed for changes from baseline to 1-year follow-up.

Among 7,807 PED patients screened, 1,202 were eligible; 853 enrolled (I, n = 283; AC, n = 284; MAC, n = 286), with a 12-month follow-up rate of 72%. At 12 months, more than half of enrollees in Reaching Adolescents for Prevention (RAP) attempted to cut back on drinking, and over a third tried to quit. A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees, and there was a numerically but not significantly greater likelihood (p = 0.065) among the I group for efforts to cut back on drinking. At 3 months, the likelihood of the I group making attempts to cut back was almost triple that of ACs. For efforts to quit, it was double, and for trying to be careful about situations when drinking, there was a 72% increase in the odds ratio (OR) for the I group. Three-month results for attempts were sustained at 12 months for quit attempts and efforts to be careful. Consumption declined in both groups from baseline to 3 months to 12 months, but there were no significant between-group differences in alcohol-related consequences at 12 months or in alcohol-related risk behaviors. We found a pattern suggestive of assessment reactivity in only one variable at 12 months: the attempt to cut back (73.3% for the I group vs. 64.9% among the AC group and 54.8% among the MAC group).

Brief motivational intervention resulted in significant efforts to change behavior (quit drinking and be careful about situations while drinking) but did not alter between-group consumption or consequences.

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Request Reprint E-Mail: ebernste@bu.edu.

“Daimon Drink”: Ancient Greek and Roman Explanations for Drunkenness

What did ancient Greek and Roman wine drinkers believe was the mechanism, force, or process which caused their drunkenness?

Three primary answers to this question emerge from the extensive ancient Greek and Roman literary references to wine and drinking.

The first is that drunkenness is caused by some property resident in the drinker, the result of a bodily response to wine. This will be designated below as the “human cause.”

The second is that drunkenness is caused by a property resident in the wine itself. This will be designated below as the “wine cause.”

The third of these answers, the one most widely encountered, was that drunkenness was the work of the god of wine, known to Greeks as Dionysus and Bacchus. This will be designated as the “divine cause.”

The purpose of this paper is to describe and document these three explanations of drunkenness within the setting of Greco-Roman culture. Relevant original sources will be cited and translated.

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Licensing act reform consultation launched

The Home Office have opened consultation on government plans to overhaul the current licensing regime, following the Home Secretary's announcement earlier this week:

'Rebalancing the Licensing Act - a consultation on empowering individuals, families and local communities to shape and determine local licensing' [pdf]

> > > >

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.).

A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 (n = 3 944 778), followed from the beginning of FY02 through the end of FY06.

Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.

Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.

In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.

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Requerst Reprint E-Mail: marki@umich.edu

Initial, habitual and compulsive alcohol use is characterized by a shift of cue processing from ventral to dorsal striatum

During the development of drug addiction, initial hedonic effects decrease when substance use becomes habitual and ultimately compulsive. Animal research suggests that these changes are represented by a transition from prefrontal cortical control to subcortical striatal control and within the striatum from ventral to dorsal domains of the striatum, but only limited evidence exists in humans.

In this study we address this hypothesis in the context of alcohol dependence.

Non-abstinent heavy social drinkers (n = 21, 5.0 ± 1.5 drinks/day, 13 of them were alcohol-dependent according to DSM-IV) and light social drinkers (n = 10, 0.4 ± 0.4 drinks/day) were examined.

We used a cue-reactivity functional magnetic resonance imaging (fMRI) design during which pictures of alcoholic beverages and neutral control stimuli were presented.

In the dorsal striatum heavy drinkers showed significant higher activations compared to light drinkers, whereas light social drinkers showed higher cue-induced fMRI activations in the ventral striatum and in prefrontal areas compared to heavy social drinkers. Correspondingly, ventral striatal activation in heavy drinkers correlated negatively with obsessive-compulsive craving, and furthermore we found a positive association between cue-induced activation in the dorsal striatum and obsessive-compulsive craving in all participants.

In line with our hypothesis we found higher cue-induced activation of the ventral striatum in social compared to heavy drinkers, and higher dorsal striatal activation in heavy drinkers. Increased prefrontal activation may indicate that social drinkers activate cortical control when viewing alcohol cues, which may prevent the development of heavy drinking or alcohol dependence. Our results suggest differentiating treatment research depending on whether alcohol use is hedonic or compulsive.

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Request Reprint E-Mail: s.vollstaedt-klein@zi-mannheim.de

The importance of family management, closeness with father and family structure in early adolescent alcohol use

To examine the importance of family management, family structure and father–adolescent relationships on early adolescent alcohol use.

Cross-sectional data was collected across 30 randomly selected Australian communities stratified to represent a range of socio-economic and regional variation.

Setting Data were collected during school time from adolescents attending a broad range of schools.

The sample consisted of a combined 8256 students (aged 10–14 years).

Students completed a web-based survey as part of the Healthy Neighbourhoods project.

Family management—which included practices such as parental monitoring and family rules about alcohol use—had the strongest and most consistent relationship with alcohol use in early adolescence. Adolescents reporting higher family management were less likely to have drunk alcohol in their life-time, less likely to drink alcohol in the preceding 30 days and less likely to have had an alcohol binge. Adolescents reporting emotionally close relationships with their fathers were less likely to have drunk alcohol in their life-time and less likely to have had an alcohol binge in the preceding fortnight.

Findings indicate that family management practices may contribute to alcohol abstinence in adolescents. Furthermore, emotionally close father–adolescent relationships may also foster abstinence; however, fathers' drinking behaviours need to be considered.

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Request Reprint E-Mail: habibche@deakin.edu.au

Drug and Alcohol Strategy Annual Report 2009-2010

SUCCESSFUL initiatives are highlighted in the Annual Report of the Chief Minister's Drugs and Alcohol Strategy.

The report, published on the Department of Home Affairs website, gives details of the work in progress on drugs and alcohol, with emerging drugs of concern – legal highs – one of the biggest ongoing challenges. The report refers to the Island's swift action in managing the emergence of drugs of concern – moves which received praise from other administrations.

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Understanding college students’ alcoholrelated social norms in Sefton: Drink It’s Not What You Think

Alcohol-related harms in the North West are higher than the England average and Sefton reports high levels of alcohol-specific admission among those aged under 18 (149 per 100,000; 2005-2007), well above the regional average (122 per 100,000). Alcohol abuse by those under 18 has numerous associated harms (violence, injury, sexual abuse, impaired intellectual development and under-achievement at schools) and clearly this situation requires swift attention. Reframing social norms is one such approach. Social norms refer to what is perceived to be normal, accepted and negotiated behaviour and reframing of these norms offers the chance to, in the case of alcohol, revise maladaptive drinking perceptions and consequently behaviours. In light of this Sefton PCT commissioned the Centre for Public Health to investigate prevailing attitudes and norms in young people and to evaluate a social norms based intervention.

The campaign and accompanying evaluation were divided into two phases. The first phase was delivered in schools in 2009 amongst 14-16 year olds. The results showed that participants tended to overestimate the consumption of their peers and that the intervention may have helped, in part, to dissolve the link between own drinking and perceptions of peers’ consumption. Phase two was delivered in a further education college with 18-24 year olds. Interim findings showed an inconsistency between own and estimates of peers’ drinking, detailed drinking harms (unprotected sex), safety precautions (leaving drinks unattended) and acceptable drinking behaviours.

This is the final report in the series examining changes in consumption and perceptions since the campaign. The evaluation employed online questionnaires at two time points. The pre-intervention survey included topics such as: quantities; frequencies of own and peer consumption; harms; perceptions of acceptable behaviours; sources of alcohol information; alcohol advertisements seen; and parental attitudes/awareness. Based on the interim findings, a social norms campaign was designed (called “Drink it’s not what you think”) and delivered through posters, fliers, health days and tutorials. The post-intervention campaign followed the same format as the pre-intervention, with an additional section evaluating the awareness of the campaign materials. From a potential sample of 3,000, 484 completed the pre-intervention (16%), 275 (9%) completed the post; 85 completed both the pre-and postsurvey and could be matched. Statistical analysis was conducted on the pre and post survey sample and the matched pair sample.


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Alcoholics Anonymous doesn't work for everyone -- and that's OK

As I read Dr. Drew Pinsky's comments on Lindsay Lohan's problems and prognosis — that the actress should be framed so a judge could order her to a long-term treatment program, remarks for which he has since apologized — I felt worried and even scared for all the people who are suffering with addiction today.

Why? Because what Dr. Drew was saying expressed the attitude that so many people have regarding addiction and recovery, which, in my experience, is ineffective and even damaging for some of us. I suspect Lohan is one such person. She has not told us why rehab has not helped her to quit her substance-abusing behavior, but it seems to me she is in an informed position to do so given that she's been in rehab before. The Times recently published two pieces related to alcohol and addiction recovery, most recently with Stanton Peele's July 21 Times Op-Ed article on alcohol and health, and a July 4 piece by a man named calling himself "Chas" who achieved sobriety with Alcoholics Anonymous. > > > >

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Alcohol use and implications for public health: Patterns of use in four communities

Alcohol is one of the leading causes of death and disability globally and in India. Information on quantum and pattern of consumption is crucial to formulate intervention programs.

To identify the extent and pattern of alcohol use in urban, rural, town and slum populations using a uniform methodology.

Door-to-door survey was undertaken and simple random sampling methodology was adopted; households were the primary sampling unit. One respondent in each alcohol-user household was randomly chosen for detailed interview.

Overall, 13% of males and females consumed alcohol. Proportion of users was greater in town (15.7%) and among 26-45 years (67.4%). Whisky (49%) and arrack (35%) were the preferred types and the preferences differed between rural (arrack) and urban (beer) areas. Nearly half (45%) of rural population were very frequent users (consuming daily or every alternate-days) as against users in town (23%) or slum (20%). Two-thirds were long-term users and the proportions were greater in the rural and town areas. While, overall 17% of the users were heavy-users, frequent-heavy-drinking was more in slum and rural areas. Nearly two-thirds consumed alcohol in liquor-shops, restaurants, bars and pubs. Habituation and peer-pressure were the key reasons for alcohol use.

The study documented alcohol use and patterns of use in four different communities particularly in transitional areas using similar methodology. Many of the patterns identified are detrimental to health both immediate and over the long period of time.

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Using theories of behaviour change to inform interventions for addictive behaviours

This paper reviews a set of theories of behaviour change that are used outside the field of addiction and considers their relevance for this field.

Ten theories are reviewed in terms of (i) the main tenets of each theory, (ii) the implications of the theory for promoting change in addictive behaviours and (iii) studies in the field of addiction that have used the theory. An augmented feedback loop model based on Control Theory is used to organize the theories and to show how different interventions might achieve behaviour change.

Briefly, each theory provided the following recommendations for intervention:

Control Theory: prompt behavioural monitoring,

Goal-Setting Theory: set specific and challenging goals,

Model of Action Phases: form 'implementation intentions',

Strength Model of Self-Control: bolster self-control resources,

Social Cognition Models (Protection Motivation Theory,

Theory of Planned Behaviour,

Health Belief Model): modify relevant cognitions,

Elaboration Likelihood Model: consider targets' motivation and ability to process information,

Prototype Willingness Model: change perceptions of the prototypical person who engages in behaviour and

Social Cognitive Theory: modify self-efficacy.

There are a range of theories in the field of behaviour change that can be applied usefully to addiction, each one pointing to a different set of modifiable determinants and/or behaviour change techniques. Studies reporting interventions should describe theoretical basis, behaviour change techniques and mode of delivery accurately so that effective interventions can be understood and replicated.

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Request Reprint E-Mail: t.webb@sheffield.ac.uk

Brief integrative multiple behavior intervention effects and mediators for adolescents

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents.

A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up.

A total of 479 students attending two public high schools participated.

Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P’s = .01.

No effects were found on cigarette and marijuana use, exercise and sleep.

Effect sizes were small with alcohol use cessation effects reaching medium size.

Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors.

Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.


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Request Reprint E-Mail: cwerch@hhp.ufl.edu

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil

The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil.

This cross-sectional study selected 1586 subjects (719M/867F, age: 14–104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design.

Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1–39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1–3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5–3.2 and OR = 1.7, 95% CI = 1.0–2.8), older age (OR = 22, 95% CI = 8.0–60.8 and OR = 8.9, 95% CI = 3.4–23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0–3.5 and OR = 3.0, 95% CI = 1.2–7.2).

This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic-demographic disparities in this and similar populations.

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Request Reprint E-Mail: csusin@mcg.edu

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The alcohol use disorders identification test (AUDIT) and its derivatives in screening for heavy drinking among the elderly

The performance of the Alcohol Use Disorders Identification Test (AUDIT) in screening for heavy drinking among the elderly has been unsatisfactory. The aim of the present study was to determine whether tailoring the cut point improves the performance of the AUDIT and its derivatives in this age group.

Methods

From a stratified random sample of 804 Finns aged 65-74 years, 517 subjects (64.3%) completed the AUDIT and the Timeline Follow-back (TLFB) interview regarding alcohol consumption. A subject was defined as a heavy drinker if consumption of 8 drinks (approx. 12 g) on average in a week or 4 drinks at least in 1 day during the prior 28 days was reported. Combinations in which both sensitivity and specificity are 0.8 were defined as optimal. The elderly specific AUDIT-3 is a modification in which the binge drinking threshold is 4 drinks.

Based on the TLFB, 118 subjects (22.8%) were heavy drinkers. The areas under receiving operating characteristics curves (AUROCs) were equivalent (0.898) for all questionnaires. When using the standard cut point of 8 for the AUDIT, the sensitivity was 0.48. Lowering the cut point to 5 led to both a sensitivity and specificity over 0.85. The optimal cut point of the AUDIT-C was 4. The AUDIT-QF, AUDIT-3 and elderly specific AUDIT-3 did not provide optimal combinations of sensitivity and specificity with any cut point.

The AUDIT and AUDIT-C are accurate in screening for heavy drinking among the elderly if the cut points are tailored to this age group. Read Full Abstract Request Reprint E-Mail: mauri.aalto@thl.fi _______________________________________

The Changes of Sialic Acid Concentration and Content in Apolipoprotein B-Containing Lipoproteins in the Sera of Alcoholics

The aim of this study was to investigate the changes associated with alcohol abuse in the structure and metabolism of lipoproteins, in particular, the content of sialic acid (SA).

The level of SA in apolipoprotein B (apoB)-containing lipoproteins was determined by using enzymatic assay followed by the precipitation step in 126 alcohol-dependent men.

Increased level and content of SA in apoB-containing lipoproteins was found not only in the hyperlipidemic alcoholic subjects but also in normolipidemic subjects. The highest value was observed in alcoholics with type IIb of hyperlipidemia followed by type IV, IIa and normolipidemia. The increase of SA level in apoB-containing lipoproteins in type IIb hyperlipidemia is accompanied by an increase of serum apoB concentration. Increased level and content of SA in apoB-containing lipoproteins did not correlate with any markers of alcohol abuse and lipid status.

There are changes in the structure of atherogenic lipoproteins in alcoholics, which consist of increasing SA concentration in apoB-containing lipoproteins. These changes are independent of serum apoB level and may precede the development of hyperlipidemia.


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Request Reprint E-Mail: cylwikb@umwb.edu.pl
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Sweet Liking and High Novelty Seeking: Independent Phenotypes Associated with Alcohol-related Problems

We tested the hypothesis that high novelty seeking (NS; a trait that promotes experimentation) and hedonic response to sweet taste (a trait that may reflect processing of hedonic stimuli) act independently to increase the risk for having alcohol-related problems in young adults.

The study was conducted in 158 healthy subjects (age 20–25 years) with no lifetime history of alcohol and/or drug abuse/dependence. NS was evaluated using the Tridimensional Personality Questionnaire. Pleasurable response to sweet taste was tested, using a sweet taste test to identify sweet likers (SL; those preferring the strongest offered sucrose solution) and sweet dislikers (SDL; those preferring weaker sucrose solutions).

NS score, but not SL/SDL status, was positively correlated with drinks per month (P = 0.0054) and drinks per drinking day (P = 0.021). When tested individually, both NS and SL/SDL status predict having alcohol-related problems (NS: odds ratio [OR] = 5.3, P = 0.0016 and SL/SDL: OR = 5.8, P = 0.0001) with an OR similar to positive family history of alcoholism status (OR = 5.7, P = 0.0007). The combination of SL status and high NS score (greater than gender-specific 70th percentile) greatly increased the estimated odds of having alcohol-related problems

These results support the hypothesis that high NS and SL phenotypes are independently associated with risk of alcohol-related problems. The combination of both phenotypes greatly increases the likelihood of alcohol-related problems. Although confirmation is necessary, this suggests that these phenotypes could contribute to improved methods to assess risk for alcohol-related problems and provide additional insight into processes underlying progression to alcohol-related problems.


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Request Reprint E-Mail: jc_garbutt@med.unc.edu
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Appropriate Research Designs for Evaluating Community-level Alcohol Interventions: What Next?

The aim of this study was to explore the logistical and methodological strengths and weaknesses of some of the more common research designs which can be used to evaluate the impact of system- or population-level approaches for reducing alcohol-related harms.

This paper identifies studies that have evaluated system or population approaches to reduce alcohol-related harms. It highlights the tension caused by a desire for the most rigorous research designs, such as randomized controlled trials (RCTs), the most potentially efficacious interventions and the practical problems in applying the RCT to population-level research. Alternative research designs, which possess methodological rigour and are more feasible, are identified and described. The design with the strongest methodological characteristics and feasibility in allowing the evaluation of population interventions is considered to be the multiple baseline.

The multiple baseline design addresses potential problems of sample sizes, selection bias, the suitability and baseline stability of outcome measures, statistical analyses and the practicalities of conducting rigorous research in system- or population-level settings.

The multiple baseline design has the capacity to llow methodologically and statistically stringent evaluations with relatively small sample sizes, low cost and fewer of the complications imposed by RCTs. Like all research designs it has limitations, but arguably represents the most practical and methodologically rigorous approach to the evaluation of system- or population-level strategies.


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Request Reprint E-Mail: Conor.Gilligan@newcastle.edu.au

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Alcohol consumption is inversely associated with risk and severity of rheumatoid arthritis

To investigate the association between frequency of alcohol consumption and the risk and severity of RA.

Frequency of alcohol consumption was recorded by patients and controls in a self-completed questionnaire. Odds ratios (ORs) for RA risk were calculated according to alcohol consumption, adjusted for age, gender and smoking status. Median values of all RA severity measures were then calculated according to the frequency of alcohol consumption, and the non-parametric trend test was used to assess association. A negative binomial regression model was used to adjust for potential confounding.

Eight hundred and seventy-three patients with erosive RA, and 1004 healthy controls were included in the study. Risk of RA decreased according to frequency of alcohol consumption, such that non-drinkers had an OR for RA of 4.17 (3.01–5.77) compared with subjects consuming alcohol on >10 days per month (P for trend > including CRP, 28-joint DAS, pain visual analogue scale, modified HAQ (mHAQ) and modified Larsen score were inversely associated with increasing frequency of alcohol consumption (P for trend, each > in a multivariate regression model, frequency of alcohol consumption remained significantly and inversely associated with X-ray damage and mHAQ.

Although there are some limitations to this study, our data suggest that alcohol consumption has an inverse and dose-related association with both risk and severity of RA.

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Request Reprint E-Mail: j.maxwell@sheffield.ac.uk

Alcohol Consumption Is Inversely Associated with Risk and Severity of Rheumatoid Arthritis

Presentation Number: 386

Poster Board Number: 386

Purpose: Studies have suggested that consumption of alcohol associates with a lower risk for rheumatoid arthritis (RA), but the effect of alcohol on disease severity has not yet been investigated. Our objectives were to study the association between alcohol consumption, and susceptibility and severity of RA.

Method: Frequency of alcohol consumption was recorded by patients and controls in a self completed questionnaire. Odds ratios for RA risk were calculated according to alcohol consumption, adjusted for age, gender and smoking status. Median values of all RA severity measures were then calculated according to frequency of alcohol consumption, and the non-parametric trend test was used to assess association. A quantile regression model was used to adjust for potential confounding.

Results: 873 patients with erosive RA, and 1004 healthy controls were included in the study. Risk of RA decreased according to frequency of alcohol consumption, such that non drinkers had an odds ratio for RA of 4.17 (3.01 – 5.77) compared to subjects consuming alcohol on >10 days per month. All measures of RA severity including C-reactive protein, 28 joint disease activity score, pain visual analogue scale , modified Health Assessment Questionnaire, and modified Larsen score were inversely associated with increasing frequency of alcohol consumption. After adjustment for potential confounders in a multivariate regression model, frequency of alcohol consumption remained significantly and inversely associated with X ray damage ).

Conclusion: This study suggests that alcohol consumption has an inverse and dose related association with both risk and severity of RA, but we would recommend a prospective study to confirm our findings.

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Examining the Associations Among Severity of Injunctive Drinking Norms, Alcohol Consumption, and Alcohol-Related Negative Consequences

This study examined a range of injunctive norms for alcohol use and related consequences from less severe behaviors (e.g., drinking with friends) to more severe behaviors (e.g., drinking enough alcohol to pass out), and their relationship with alcohol consumption and alcohol-related negative consequences among college students.

In addition, this research aimed to determine whether these relationships between injunctive norms and consequences were moderated by alcohol consumption and level of identification with the typical same-gender college student.

A random sample (N = 1,002) of undergraduates (56.9% women) completed a Web-based survey that was comprised of measures of drinking behavior, perceived approval of drinking behaviors that ranged in severity (i.e., injunctive norms), and level of identification with the typical same-gender college student.

Results suggest that the association between negative consequences and injunctive drinking norms depend on one's own drinking behavior, identification with other students, and the severity of the alcohol use and related consequences for which injunctive norms are assessed.

Findings are discussed in terms of false consensus and false uniqueness effects, and deviance regulation perspectives.

Implications for preventive interventions are discussed.

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

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The Language of Motivational Interviewing and Feedback: Counselor Language, Client Language, and Client Drinking Outcomes

Previous research has suggested that motivational interviewing (MI) may affect client language, which in turn predicts client drinking outcome.

In this study, we examined the relationship between counselor language and client language, personalized feedback and client language, and client language and client drinking outcome, in a sample of heavy-drinking college students.

MI was delivered in a single session with or without a personalized feedback report (MI with feedback [MIF]; MI only). Sessions were coded using the Motivational Interviewing Skill Code 2.1. A composite drinking outcome score was used, consisting of drinks per week, peak blood alcohol concentration, and protective drinking strategies.

We found three main results. First, in the MIF group, MI consistent counselor language was positively associated with client change talk. Second, after receiving feedback, MIF clients showed lower levels of sustain talk, relative to MI only clients. Finally, in the MIF group, clients with greater change talk showed improved drinking outcomes at 3 months, while clients with greater sustain talk showed poorer drinking outcomes.

These results highlight the relationship between counselor MI skill and client change talk, and suggest an important role for feedback in the change process


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Request Reprint E-Mail: Scott.Walters@utsouthwestern.edu


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Longitudinal Validation of the Acquired Preparedness Model of Drinking Risk

This paper reports on the first longitudinal test of the Acquired Preparedness (AP) model of alcoholism risk, which holds that individual differences in key personality traits influence drinking behavior by influencing alcohol-related learning (Smith and Anderson, 2001).

We studied 418 individuals making the transition to the independence of college across 3 longitudinal waves.

Each of 2 longitudinal models predicting typical drinking quantity provided support for the AP process.

In the first, drinking quantity at the end of the first year of college was predicted by positive urgency (the tendency to act rashly when experiencing extremely positive affect) at the start of college, and that predictive relationship appeared to have been mediated by expectancies that alcohol provides positive, arousing effects.

In the second, drinking quantity was predicted by negative urgency (the tendency to act rashly when experiencing extremely negative affect) at the start of college, and that relationship appeared to have been mediated by the motive to drink alcohol to cope with subjective distress.

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Request Reprint E-Mail: gsmith@email.uky.edu

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Invocations and Intoxication: Does Prayer Decrease Alcohol Consumption?

Four methodologically diverse studies (N= 1,758) show that prayer frequency and alcohol consumption are negatively related.

In Study 1 (n = 824), we used a cross-sectional design and found that higher prayer frequency was related to lower alcohol consumption and problematic drinking behavior.

Study 2 (n = 702) used a longitudinal design and found that more frequent prayer at Time 1 predicted less alcohol consumption and problematic drinking behavior at Time 2, and this relationship held when controlling for baseline levels of drinking and prayer.

In Study 3 (n = 117), we used an experimental design to test for a causal relationship between prayer frequency and alcohol consumption. Participants assigned to pray every day (either an undirected prayer or a prayer for a relationship partner) for 4 weeks drank about half as much alcohol at the conclusion of the study as control participants.

Study 4 (n = 115) replicated the findings of Study 3, as prayer again reduced drinking by about half.

These findings are discussed in terms of prayer as reducing drinking motives.

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Request Reprint E-Mail: nlambert@fsu.edu


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Specificity of P3 Event-Related Potential Reactivity to Alcohol Cues in Individuals Low in Alcohol Sensitivity

Recent research using event-related potentials (ERPs) has shown that individuals low in alcohol sensitivity show increased P3 reactivity to alcohol cues (Bartholow, Henry, & Lust, 2007).

The current research sought to test the specificity of this effect by including other arousing cues in addition to alcohol, and by controlling for individual differences in trait impulsivity.

Forty-seven participants varying in self-reported alcohol sensitivity completed a visual oddball task including neutral, arousing (erotic and adventure-related), and beverage-related images while ERPs were recorded.

Low-sensitivity participants showed increased P3 reactivity to alcohol cues relative to their high-sensitivity peers.

However, P3 amplitude elicited by all other targets did not differ as a function of alcohol sensitivity levels.

Differences in impulsivity and recent alcohol consumption did not account for sensitivity group differences in alcohol cue reactivity.

These results point to the specific motivational salience of alcohol cues to individuals at risk for alcohol problems because of low alcohol sensitivity and suggest that P3 reactivity to alcohol cues could be a new endophenotype for alcohol use disorder risk.

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Request Reprint E-Mail: bartholowb@missouri.edu

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Use of Drinking Protective Behavioral Strategies in Association to Sex-Related Alcohol Negative Consequences: The Mediating Role of Alcohol Consumptio

Alcohol use has been implicated as a risk factor for sexual negative consequences, such as unprotected sexual intercourse.

The present research was conducted to examine the relationship between drinking protective behavioral strategies and consensual sex-related alcohol negative consequences, and whether this relationship varied by gender.

Additionally, typical number of drinks during sexual behavior was evaluated as a potential mediator of this association.

Heavy drinking, sexually active college students (N = 297, 50.2% women) completed self-report measures of drinking protective behavioral strategies, alcohol consumption, and sex-related alcohol negative consequences.

Findings indicated that women who used drinking protective behavioral strategies more frequently were less likely to experience sex-related alcohol negative consequences whereas this relationship was not significant for men.

For women, this relationship was mediated by the typical number of drinks consumed during sexual behavior.

The current research demonstrates that use of drinking protective behavioral strategies is related to a reduction in women's sex-related risks when drinking.

Findings are discussed in terms of alcohol myopia theory. Implications for interventions aimed to reduce higher risk sexual behavior among college students are discussed.

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

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