A cross-sectional survey of compliance with national guidance for alcohol consumption by children: measuring risk factors, protective factors and soci

The Chief Medical Officer for England has developed the first guidance in England and some of the first internationally on alcohol consumption by children. Using the most recent iteration of a large biennial survey of schoolchildren we measure the extent to which young people's drinking fell within the guidelines just prior to their introduction and the characteristics of individuals whose drinking does not; how alcohol related harms relate to compliance; and risk factors associated with behaving outside of the guidance.

A cross-sectional survey was conducted utilising a self-completed questionnaire with closed questions. A total of 11,879 schoolchildren, aged 15-16 years, from secondary schools in North West England participated in the study. Data were analysed using chi square and conditional logistic regression.

Alcohol consumption is an established norm by age 15 years (81.3%). Acute alcohol related violence, regretted sex and forgetfulness were experienced by significantly fewer children drinking within the guidance (than outside of it). Over half of drinkers (54.7%) reported routinely drinking more heavily than guidance suggests (here [greater than or equal to]5 drinks/session [greater than or equal to] once a month), or typically drinking unsupervised at home or at a friend's home when parents were absent (57.4%). Both behaviours were common across all deprivation strata. Children with greater expendable incomes were less likely to consume within guidance and reported higher measures for unsupervised, frequent and heavy drinking. Although drinking due to peer pressure was associated with some measures of unsupervised drinking, those reporting that they drank out of boredom were more likely to report risk-related drinking behaviours outside of the guidance.

Successful implementation of guidance on alcohol consumption for children could result in substantial reductions in existing levels of alcohol related harms to young people. However, prolonged social marketing, educational and parental interventions will be required to challenge established social norms in heavy and unsupervised child drinking across all social strata. Policy measures to establish a minimum price for alcohol and provide children with entertaining alternatives to alcohol should also increase compliance with guidance.

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May alcohol-induced increase of HDL be considered as atheroprotective ?

It is well known that the consumption of moderate doses of alcohol leads to the increase of HDL-cholesterol (HDL-C). Atheroprotectivity of HDL particles is based primarily on their role in reverse cholesterol transport (RCT).

In the study with a crossover design 13 male volunteers were studied in two different regimens: i) drinking of 36 g alcohol daily and ii) drinking only non-alcoholic beverages, to test whether alcohol-induced increase of HDL cholesterol can affect cholesterol efflux (CHE) from cell culture of labeled human macrophages.

Alcohol consumption induced significant (p> cholesterol from 1.25±0.32 to 1.34±0.38 mmol/l and Apo A1 from 1.34±0.16 to 1.44±0.19 g/l. These changes were combined with a slight increase of cholesterol efflux from 13.8±2.15 to 14.9±1.85 % .

There were significant correlations between individual changes of HDL-C and Apo A1 concentrations and individual changes of CHE (0.51 and 0.60, respectively).

In conclusion, moderate alcohol consumption changes the capacity of plasma to induce CHE only at a border line significance.



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Alcohol framework for primary care updated

The primary care service framework developed by NHS Primary Care Commissioning (PCC) to support commissioning of appropriate services for adults drinking to harmful or hazardous levels has been updated to include recent policy changes.

The framework is supported by a range of enhanced tools to support implementation. A complementary suite of resources and supportive notes is also available.

Please see link below for details.


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Genetics of Addictions

Addictions include a group of common, heritable psychiatric illnesses that have multiple psychiatric and medical comorbidities.

Robust genetic associations have been found for alcohol dependence, nicotine dependence, and cocaine dependence. Common genetic associations have been found between alcohol dependence and aerodigestive cancers and between nicotine dependence and lung disease.

These associations highlight the importance of understanding the genetics of substance dependence in the context of its multiple medical and psychiatric comorbidities.


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Request Reprint E-Mail: laura@wustl.edu

Impulsivity: an overview of a biopsychosocial model

The demographics of individuals applying for rehabilitation services have changed in the last several decades (Lee, Chronister, Tsang, Ingraham, & Oulvey, 2005).

This shift in the applicant population has required rehabilitation service providers to re-evaluate not only the services they are providing, but also to develop new skills in order to serve their customers.

For instance, Certified Rehabilitation Counselors (CRCs) surveyed in 2001, as compared those queried in 1993, reported that knowledge requirements for effective practice had expanded to also include the ability to work with persons with substance-related disabilities, persons with psychiatric disabilities, and the related information regarding mental health concepts (Leahy et al., 2003).

Specifically, the needs and challenges posed by persons with mental health, cognitive, or substance-related issues may differ from their peers with physical or sensory disabilities.

Further, the increases in applications from these populations of persons with disabilities pose unique challenges to rehabilitation professionals.

Complicating rehabilitation efforts is the notion coursework in master's programs has focused on service provision geared toward individuals with physical and developmental disabilities (Chan, et al., 1998) and have resulted in rehabilitation counselors and related service providers feeling ill-prepared to work with persons with psychiatric or substance-related disabilities (Cardoso, Chan, Pruett, & Tansey, 2006; Lee at al.; Tansey, Chan, Chou, and Cardoso, 2005). > > > > >



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ICAP - Asia-Pacific Regional Consultation, Singapore

Start Date:	Wednesday, October 20, 2010
End Date:	Wednesday, October 20, 2010
Recurring Event:	One time event
Description:	The Asia-Pacific Regional Consultation will take place on October 20, 2010 in Singapore at the Grand Copthorne Waterfront hotel. Further details, including the final program, will be sent to registered participants directly in advance of the meeting date. Participants to the Consultation are encourage to also attend the ICAP Asia-Pacific Forum, an open-forum with participation from governments and nongovernmental organizations, which will be held at the same venue in Singapore on October 21-22. ICAP Forum invitations and program details will be announced shortly. Meeting Venue Grand Copthorne Waterfront 392 Havelock Road Singapore 169663 T: +65 6733 0880 http://www.millenniumhotels.com.sg/

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ICAP - Africa Consultation, Johannesburg, South Africa

Start Date:	Friday, October 15, 2010
End Date:	Friday, October 15, 2010
Recurring Event:	One time event
Description:	The regional industry consultation for Africa will take place on October 15, 2010. The meeting will be held at the SAB World of Beer in Newtown, Johannesburg, South Africa (www.worldofbeer.co.za). Further details, including the final program, will be sent to registered participants directly in advance of the meeting date. Participants are responsible for arranging their own travel and hotel accommodations, as well as for all costs. Meeting Venue SAB World of Beer 15 President Street, (Entrance on Becker St.) Newton Cultural Precinct Johannesburg, South Africa Enroll for this event

ICAP - Europe Consultation, Amsterdam, Netherlands

The WHO Global Strategy to Reduce the Harmful Use of Alcohol, approved in May 2010, calls for engagement of all stakeholders, including economic operators, in its implementation. In response to a request by the CEOs of companies sponsoring Global Actions to Reduce Harmful Drinking, ICAP has undertaken the coordination of appropriate industry activities.

As a first step, industry-wide consultations will be convened in four geographic regions – Africa, Asia-Pacific, Europe, and Latin America – to identify priority countries and areas for action. If you have received an invitation to one of the consultations listed below, please select the appropriate event below to register.

Start Date:	Monday, October 11, 2010
End Date:	Monday, October 11, 2010
Recurring Event:	One time event
Description:	The regional industry consultation for Europe will take place on 11 October 2010. It is a one-day meeting scheduled to be held at the Heineken Experience, Amsterdam, Netherlands. Further details will be e-mailed to you closer to the meeting date. You are responsible for arranging your travel and booking accommodations, as well as for all costs. ICAP recommends the NH Museum Quarter Hotel and Park Hotel Amsterdam. Location details follow. Meeting Venue Heineken Experience "Koelschip" Meeting Room Stadhouderskade 78 1072 AE Amsterdam, Netherlands

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Adolescents Who Participate in Extracurricular Activities Less Likely to Use Alcohol, Cigarettes, and Illicit Drugs

Extracurricular activities, such as sports, band, clubs, and dance lessons, are an important part of growing up for millions of American teens. These activities promote physical fitness, intellectual growth, and social interaction, and have been associated with higher self-esteem, better academic performance, and improved interpersonal skills.

The latest findings from the National Survey on Drug Use and Health (NSDUH) indicate that 22.4 million adolescents aged 12 to 17 (89.3 percent) participate in extracurricular activities and that those who participate in these activities are less likely to have used alcohol, cigarettes, and illicit drugs in the past month. In particular, adolescents who participated in these activities were half as likely as nonparticipants to have smoked cigarettes.


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Gender and family differences in adolescent’s heavy alcohol use: the power-control theory perspective

According to the power-control theory, growing independence of adolescent girls, manifest in more prevalent problem behaviors, may be explained by changes in family structure (increasing level of authority gained in the workplace by mothers).

To verify this hypothesis, self-report data from Warsaw adolescents (N = 3087, age 14–15 years, 50% boys) were used.

Results indicate that parenting practices differ across child gender and structure of parents’ work authority. Girls, especially in patriarchal households, spend more time with mothers and perceive stronger maternal control. In egalitarian families, fathers tend to be more involved with sons than with daughters.

When parental control, support and adolescents’ risk preferences are controlled, the gender-by-household type interaction effect is observed—girls in patriarchal families have the lowest risk of getting drunk.

Study results provide support for power-control theory showing the relationship between parental work authority and adolescent’s heavy alcohol use.


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Request Reprint E-Mail: kokulicz@ipin.edu.pl

FINANCING RECOVERY SUPPORT SERVICES: REVIEW AND ANALYSIS OF FUNDING RECOVERY SUPPORT SERVICES AND POLICY RECOMMENDATIONS

For many individuals with substance use conditions and their families, the provision of recovery support services (RSS) is critical to achieving a greater quality of life. Yet, RSS are often insufficiently funded throughout the prevention, treatment, and recovery continuum of care largely due to funding constraints and a lack of information about alternative funding options.

RSS are wide-ranging and should be provided based on the needs of individuals and their families. RSS are nonclinical services that assist individuals and families working toward recovery from substance use conditions.

They include social supports and services such as child care, employment services, housing, peer coaching, and drug-free social activities.

This report provides information about the funding sources that support RSS throughout the continuum of care. Existing literature, policies, statutes, and regulations were reviewed to identify funding streams for RSS. Medicaid, the Substance Abuse Prevention and Treatment (SAPT) Block Grant, the Access to Recovery (ATR) grant program, the Recovery Community Services Program (RCSP), State and local funding, and other funding streams were reviewed and analyzed.

The report describes each funding stream in detail and highlights how the funding source supports the provision of RSS.

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Sociodemographic Characteristics of Substance Abuse Treatment Admissions Aged 50 or Older: 1992 to 2008

Between 1992 and 2008, the number of admissions to substance abuse treatment aged 50 or older more than doubled (from approximately 102,700 in 1992 to 231,200 in 2008).

Unemployment among older treatment admissions rose from nearly one fifth (19.4 percent) in 1992 to nearly one third (31.0 percent) in 2008, while full-time employment declined (from 23.4 percent in 1992 to 16.7 percent in 2008).

Among admissions aged 50 or older, wages/salary as a principal source of income dropped from 32.3 percent in 1992 to 24.4 percent in 2008.


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Alcohol consumption predicts the EU suicide rates in young women aged 15–29 years but not in men: analysis of trends and differences among early and n

The aims of this study were to study suicide rates in youths aged 15–29 years in the European Union (EU), to identify differences between early members and new members to the EU since 2004, and to evaluate the association between alcohol-related variables and suicide rates, while controlling for indicators of social stress.

We explored temporal trends in age-adjusted suicide rates for youths aged 15–29 years resident in EU nations since 1980.

Social changes in EU nations were associated with increased inequalities between the countries in suicide, especially in male youths (new/early EU members: relative risk=1.55; 95% confidence interval: 1.48/1.61).

Pure alcohol consumption predicts suicide rates in female youths, whereas social stress related to violence against youths predicts suicide rates in male youths.

EU political and heath agencies should devise policies to prevent youth suicide with a focus on alcohol misuse and societal stress associated with violence against youths.


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Request Reprint E-Mail: mpompili@mclean.harvard.edu

Phenotype prediction of deleterious nonsynonymous single nucleotide polymorphisms in human alcohol metabolism-related genes: a bioinformatics study

Nonsynonymous single nucleotide polymorphisms (nsSNPs) are thought as potential disease modifiers because they alter the encoded amino acid sequence and are likely to affect the function of the proteins accounting for susceptibility to disease.

Distinguishing the functionally significant nsSNPs from tolerant nsSNPs is helpful to characterize the genetic basis of human diseases and assess individual susceptibility to diseases. Many nsSNPs have been found in alcohol metabolism-related genes but there is poor knowledge on the relationship between the genotype and phenotype of nsSNPs in these genes.

In this study, we have identified a total of 203 nsSNPs in 29 human alcohol metabolism-related genes from the National Center for Biotechnology Information (NCBI) dbSNP and SWISS-Prot databases.

Using the PolyPhen and SIFT algorithms, 43% of nsSNPs in alcohol metabolism-related genes were predicted to have functional impacts on protein function with a significant concordance of the prediction results between the two algorithms.

The prediction accuracy is about 77–81% of all the nsSNPs based on the results of in vivo and in vitro studies. These amino acid substitutions are supposed to be the pathogenetic basis for the alteration of metabolism enzyme activity and the association with disease susceptivity.

The phenotype of nsSNPs predicted as deleterious needs to be clarified in further studies and the prediction of nsSNPs in human alcohol metabolism-related genes would be useful hints for further genotype–phenotype studies on the individual difference in susceptivity to alcohol-related diseases.

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Request Reprint E-Mail: liyong@bjmu.edu.cn

The Neurokinin 1 Receptor Antagonist, Ezlopitant, Reduces Appetitive Responding for Sucrose and Ethanol

The current obesity epidemic is thought to be partly driven by over-consumption of sugar-sweetened diets and soft drinks. Loss-of-control over eating and addiction to drugs of abuse share overlapping brain mechanisms including changes in motivational drive, such that stimuli that are often no longer ‘liked’ are still intensely ‘wanted’ [7], . The neurokinin 1 (NK1) receptor system has been implicated in both learned appetitive behaviors and addiction to alcohol and opioids; however, its role in natural reward seeking remains unknown.

We sought to determine whether the NK1-receptor system plays a role in the reinforcing properties of sucrose using a novel selective and clinically safe NK1-receptor antagonist, ezlopitant (CJ-11,974), in three animal models of sucrose consumption and seeking. Furthermore, we compared the effect of ezlopitant on ethanol consumption and seeking in rodents. The NK1-receptor antagonist, ezlopitant decreased appetitive responding for sucrose more potently than for ethanol using an operant self-administration protocol without affecting general locomotor activity. To further evaluate the selectivity of the NK1-receptor antagonist in decreasing consumption of sweetened solutions, we compared the effects of ezlopitant on water, saccharin-, and sodium chloride (NaCl) solution consumption. Ezlopitant decreased intake of saccharin but had no effect on water or salty solution consumption.

The present study indicates that the NK1-receptor may be a part of a common pathway regulating the self-administration, motivational and reinforcing aspects of sweetened solutions, regardless of caloric value, and those of substances of abuse. Additionally, these results indicate that the NK1-receptor system may serve as a therapeutic target for obesity induced by over-consumption of natural reinforcers.

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Neuroimmune Mechanisms of Brain Function and Alcohol Related Disorders

Event:	Neuroimmune Mechanisms of Brain Function and Alcohol Related Disorders
Location:	Satellite Symposium at the Society for Neuroscience Annual Meeting in the Columbia Room at the San Diego Marriott Hotel and Marina in San Diego, CA
Start Date:	11/12/2010 8:30 AM
End Date:	11/12/2010 5:00 PM
Event Details:	Program Agenda Registration Contact

Tightening the Genotype-Phenotype Gap: From Genetic Variation to Gene Function

Event:	Ancillary Symposium entitled "Tightening The Genotype-Phenotype Gap: From Genetic Variation to Gene Function"
Location:	60th Annual Meeting of the American Society of Human Genetics (ASHG) at the Walter E. Washington Convention Center, 801 Mount Vernon Place, NW, Washigton, DC 20001-3614.
Start Date:	11/2/2010 8:00 AM
End Date:	11/2/2010 5:30 PM
Event Details:	Program Agenda Registration Contact

15th Annual Mark Keller Lecture - October 26, 2010

Event:	15th Annual Mark Keller Lecture on "Alcohol and the Brain: From Molecules to Humans"
Location:	Lipsett Amphitheater NIH Clinical Center (Bldg. 10) Bethesda, MD
Start Date:	10/26/2010 1:30 PM
End Date:	10/26/2010 3:30 PM
Event Details:	Presented by: R. Adron Harris, Ph.D. Waggoner Center for Alcohol and Addiction Research University of Texas at Austin

The Importance of Glucocorticoids in AlcoholDependence and Neurotoxicity

Alterations in hypothalamo-pituitary adrenal (HPA) function have been described in alcoholics and in rodents after chronic alcohol consumption but the role of glucocorticoids in alcohol consumption, and the mechanisms involved, has received little attention until recently.

Both alcohol consumption and withdrawal from chronic alcohol intake raise circulating glucocorticoid levels, and prolonged high concentrations of glucocorticoids are known to have detrimental effects on neuronal function and cognition.

This minireview covers the ways in which glucocorticoids may be involved in drinking behavior, from social drinking to dependence, and the negative consequences of alcohol consumption seen during withdrawal which may have a detrimental effect on treatment outcome.

Research shows prolonged increases in brain glucocorticoid concentrations and decreased brain glucocorticoid receptor availability (consistent with increased levels of endogenous ligand) after withdrawal from chronic alcohol treatment.

Evidence suggests that increased glucocorticoid levels in the brain after chronic alcohol treatment are associated with the cognitive deficits seen during abstinence which impact on treatment efficacy and quality of life.

Studies on organotypic cultures also demonstrate the importance of glucocorticoids in the neuropathological consequences of alcohol dependence.

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Request Reprint E-Mail: Abi.Rose@liverpool.ac.uk

Decision-Making in People Who Relapsed to Driving Under the Influence of Alcohol

Alcohol use has been previously associated with neurocognitive impairments, especially in decision-making cognition. However, some studies have shown little to no decision-making deficits in relation to different characteristics of people with drinking problems. Relapsing to driving under the influence (DUI) of alcohol is an important issue with legal and psychosocial aspects.

We evaluated decision-making performance in second-time DUI offenders by using the Iowa Gambling Task (IGT).

Thirty-four male second-time DUI offenders who had been selected for an official psychoeducational rehabilitation program and 31 healthy controls that were matched for age, education, and alcohol use were included. Along with psychiatric assessment, we applied conventional neuropsychological testing comprising cognitive set-shifting, response inhibition, attention, and visuospatial abilities. Also, we used the Temperament and Character Inventory (TCI) to assess personality patterns. A computerized version of IGT was used.

No significant differences were found between the groups in regard to sociodemographics and conventional neuropsychological testing. DUI participants had significantly higher scores only in “self-transcendence” subdomain of TCI. On the fifth block of the IGT, DUI participants had significantly lower net scores than controls.

Our results suggest that there may be subtle decision-making deficits in DUI participants, which goes undetected on conventional neuropsychological testing and which is not correlated with TCI subdomains related with impulsivity patterns.

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Request Reprint E-Mail: muzafferkasar@hotmail.com

Assessing the cumulative impact of alcohol marketing on young people's drinking: Cross-sectional data findings

As alcohol marketing remains a highly debated and politically charged issue, we examine the cumulative impact of alcohol marketing on alcohol initiation and drinking behaviour among youth (12–14 years).

Cross-sectional data come from a cohort of 920 second year school pupils from Scotland. Regression models, with multiple control variables, were employed to examine the relationship between awareness of, and involvement with, a range of alcohol marketing communications, and drinking behaviour and intentions. Marketing variables were constructed for 15 different types of alcohol marketing, including marketing in new media. Drinking behaviour measures included drinking status and future drinking intentions.

Significant associations were found between awareness of, and involvement with, alcohol marketing and drinking behaviour and intentions to drink alcohol in the next year.

Given these associations, our study suggests the need for a revision of alcohol policy: one limiting youth exposure to these seemingly ubiquitous marketing communications.

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Request Reprint E-Mail: r.gordon@open.ac.uk

Acamprosate for alcohol dependence

Alcohol dependence is an important health risk factor that can lead to disability and death for people in developed and developing countries. Alcohol consumption is potentially avoidable, which emphasizes the need for effective strategies to help people who are dependent on alcohol to reduce excessive drinking and maintain abstinence following detoxification. Psychosocial programs have limited success in preventing relapse after detoxification programs. The addition of a pharmacological agent could provide support in achieving or maintaining abstinence or to cut down alcohol consumption. The synthetic glutamate antagonist acamprosate and naltrexone, which is an opioid antagonist, are used for this purpose.

This systematic review shows that acamprosate appears to be an effective and safe treatment in alcohol dependent patients for supporting continuous abstinence after detoxification from alcohol. When added to psychosocial treatment strategies, acamprosate reduced the risk of returning to any drinking after detoxification compared with treatment with a placebo (number need to treat (NNT) for one person to benefit was nine). The cumulative abstinence time was also clearly increased. Return to heavy drinking did not change. Even though the size of the treatment effect was moderate, the benefit should be valued because of the relapsing nature of alcoholism and the limited treatment options that are currently available. Diarrhea was the most frequently reported side effect with acamprosate. Overall, side effects did not cause more participants to stop treatment when taking acamprosate compared with placebo.

These conclusions are based on 24 randomised controlled trials with 6915 participants who were treated as outpatients in all but one trial that involved adolescent inpatients. The majority of participants were men, median age 42 years. Most studies were conducted in Europe; two studies were conducted in the United States and one study in each of South Korea,Australia and Brazil. The effects of acamprosate did not differ in industry-sponsored and non-profit funded trials.

Three trials compared acamprosate and naltrexone and did not indicate a superiority of one or the other drug on return to any drinking, return to heavy drinking and cumulative abstinence duration.

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Assessing Cost-Effectiveness in Prevention

ACE Prevention is a large, 5-year study that was funded by the National Health and Medical Research Council (NHMRC) and jointly led by professor Theo Vos of the Centre for Burden of Disease and Cost-Effectiveness at the University of Queensland and professor Rob Carter of the Deakin Health Economics Unit at Deakin University.

The overall aim of this project was to provide a comprehensive analysis of the comparative cost-effectiveness of preventive intervention options addressing the non-communicable disease burden in Australia, with a specific focus on Indigenous Australians.

ACE Prevention is the most comprehensive evaluation of health prevention measures ever conducted world-wide, involving input from 130 top health experts. The research team assessed 123 illness prevention measures to identify those which will prevent the most illness and premature deaths and those that are best value for money. For comparison purposes 27 treatment interventions were included.


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Effect of modest alcohol consumption over 1–2 weeks on the coronary microcirculation of normal subjects

It has been reported that imbibing red wine increases coronary blood flow reserve acutely. In the absence of changes in coronary driving pressure, any increases in coronary blood flow reserve should occur through a decrease in capillary resistance, which in turn is determined by capillary dimensions and whole-blood viscosity. Since alcohol intake is unlikely to acutely change capillary dimensions, we hypothesized that it must increase coronary blood flow reserve by reducing whole-blood viscosity.

Forty-five normal subjects were randomly assigned to water (n = 12), vodka (n = 11), white wine (n = 11), and red wine (n = 11). Myocardial blood flow reserve was measured at baseline and after up to 2 weeks of beverage consumption using myocardial contrast echocardiography. In addition, whole-blood viscosity and its principal determinants (haematocrit; erythrocyte deformability, mobility, and charge; plasma fibrinogen; and total serum protein, glucose, and lipids) were also measured. Systolic and diastolic blood pressure and heart rate did not change between the two examinations either at rest or following dipyridamole infusion. Neither did myocardial blood flow reserve nor whole-blood viscosity or any of its determinants. Only high-density lipoprotein-2 increased for all alcohol consumers (12.4 ± 5.3 vs. 10.9 ± 4.7, P = 0.007).

It is concluded that modest alcohol consumption for up to 2 weeks does not increase myocardial blood flow reserve. It also does not alter whole-blood viscosity or any of its principal determinants. Therefore, the beneficial cardiovascular effects of modest alcohol consumption over 1–2 weeks cannot be attributed either to its effect on the coronary microcirculation or haemorheology.

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Request Reprint E-Mail: kauls@ohsu.edu

Call for papers - the economic efficiency of alcohol policy

The international peer-reviewed journal Applied Health Economics and Health Policy invites the submission of original manuscripts on the health economic implications of various alcohol policies, to be featured in a special issue on the economic efficiency of alcohol policy in 2011. > > > >

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Linkage scan of alcohol dependence in the UCSF Family Alcoholism Study

Ample data suggest that alcohol dependence represents a heritable condition, and several research groups have performed linkage analysis to identify genomic regions influencing this disorder.

In the present study, a genome-wide linkage scan for alcohol dependence was conducted in a community sample of 565 probands and 1080 first-degree relatives recruited through the UCSF Family Alcoholism Study. The Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) was used to derive DSM-IV alcohol dependence diagnoses.

Although no loci achieved genome-wide significance (i.e., LOD score > 3.0), several linkage peaks of interest (i.e., LOD score > 1.0) were identified.

When the strict DSM-IV alcohol dependence diagnosis requiring the temporal clustering of symptoms served as the phenotype, linkage peaks were identified on chromosomes 1p36.31–p36.22, 2q37.3, 8q24.3, and 18p11.21–p11.2.

When the temporal clustering of symptoms was not required, linkage peaks were again identified on chromosomes 1p36.31–p36.22 and 8q24.3 as well as novel loci on chromosomes 1p22.3, 2p24.3–p24.1, 9p24.1–p23, and 22q12.3–q13.1.

Follow-up analyses were conducted by performing linkage analysis for the 12 alcohol dependence symptoms assessed by the SSAGA across the support intervals for the observed linkage peaks.

These analyses demonstrated that different collections of symptoms often assessing distinct aspects of alcohol dependence (e.g., uncontrollable drinking and withdrawal vs. tolerance and drinking despite health problems) contributed to each linkage peak and often yielded LOD scores exceeding that reported for the alcohol dependence diagnosis.

Such findings provide insight into how specific genomic regions may influence distinct aspects of alcohol dependence.

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Request Reprint E-Mail: kirk@med.unc.edu

Obstacles to 12-step group participation as seen by addiction professionals: Comparing Norway to the United States

Twelve-step groups (TSGs) are a valuable recovery resource for substance-dependent individuals. However, some aspects of these fellowships are controversial and may limit clinician referrals.

This study describes attitude- and knowledge-based barriers to TSG participation as seen by addiction professionals in Norway, a treatment culture in which less than 5% of programs use the 12-step philosophy, and compares the findings with those of a similar study in the United States.

Data were collected in Norway in mid-2008 using a self-administered questionnaire, and the U.S. sample was obtained from historical data. The Norwegian professionals (n = 291) considered the religious aspects of TSGs a considerable obstacle to participation, whereas the U.S. providers (n = 100) did not.

Treatment providers unfamiliar with the 12-step philosophy need to be better informed of TSGs' “higher power” concept to educate patients and maximize the utilization of TSGs.

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Request Reprint E-Mail: john-kare.vederhus@sshf.no

The effects of binge drinking and social capital on violent victimisation: findings from Moscow

Rates of violence in Russia are among the highest in the world, and violent victimisation represents a major public health threat in the country. As yet, however, little research has been undertaken on what factors are associated with non-lethal violent victimisation in this setting.

This study used data from the Moscow Health Survey 2004 to examine the effects of binge drinking and social capital on individuals' risk of non-fatal violent victimisation.

A stratified random sampling strategy was used across Moscow's 125 municipal districts to collect data from 1190 individuals aged 18+ years. Respondents reported if they had been a victim of physical violence in the previous 12 months. Data were also collected on binge drinking (defined for men as consuming ≥80 g of pure alcohol, and for women≥60 g of pure alcohol, at least once per month) and social capital (frequency of interaction with relatives, friends and acquaintances).

Overall, 8.7% of the respondents had been a victim of violence in the past 12 months. Men who binge drink were more than twice as likely to have been a victim of non-lethal violence (OR 2.19, CI 1.23 to 3.92), while greater levels of social capital acted as a protective factor against male victimisation (OR 0.82, CI 0.69 to 0.97). Neither binge drinking nor social capital was associated with violent victimisation among women.

Urgent public health measures are now needed to reduce excessive alcohol consumption and detrimental drinking patterns to bring down the high levels of violent victimisation in Russia.

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Request Reprint E-Mail: andrew.stickley@sh.se

Body Mass Index Is Associated With Brain Metabolite Levels in Alcohol Dependence—A Multimodal Magnetic Resonance Study

Recent studies demonstrated that alcohol dependence and excessive alcohol consumption are associated with increased rates of obesity. In healthy light-drinkers, we and others have observed associations between elevated body mass index (BMI) and reductions in brain volumes, lower concentrations of N-acetyl-aspartate (NAA, marker of neuronal viability) and choline-containing compounds (Cho, involved in membrane turnover), and lower glucose utilization, particularly in frontal lobe—a brain region that is particularly vulnerable to the effects of alcohol dependence.

Here, we evaluated whether BMI in alcohol-dependent individuals was independently associated with regional measures of brain structure, metabolite concentrations, and neocortical blood flow.

As part of a study on the effects of alcohol dependence on neurobiology, we analyzed retrospectively data from 54 alcohol-dependent males, abstinent from alcohol for about 1 month and with BMI between 20 and 37 kg/m² by structural MRI, perfusion MRI (blood flow), and proton magnetic resonance spectroscopic imaging.

After correction for age, smoking status, and various measures of alcohol consumption, higher BMI was associated with lower concentrations of NAA, Cho, creatine and phosphocreatine (Cr, involved in high energy metabolism), and myo-inositol (m-Ino, a putative marker of astrocytes) primarily in the frontal lobe, in subcortical nuclei, and cerebellar vermis

.The results suggest that BMI, independent of age, alcohol consumption, and common comorbidities, is related to regional NAA, Cho, Cr, and m-Ino concentrations in this cohort of alcohol-dependent individuals.

Additionally, as some common comorbid conditions in alcohol dependence such as cigarette smoking are associated with BMI, their associations with regional brain metabolite levels in alcohol-dependent individuals may also be influenced by BMI.

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Request Reprint E-Mail: Stefan.Gazdzinski@uj.edu.pl

Predictors of Transitions Across Stages of Alcohol Use and Alcohol-Use Disorders in South Africa

High rates of alcohol use and alcohol-use disorders have been noted in South Africa. Although a number of risk factors for alcohol use and abuse/dependence have been identified, there is a lack of information regarding risk factors for progression through the different stages of alcohol use and alcohol-use disorders.

Our aim was to examine sociodemographic predictors of transition across stages of alcohol use, abuse and dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and remission in the South African population.

A national probability sample of 4,315 adult South Africans was administered Version 3.0 of the World Health Organization Composite International Diagnostic Interview.

We found high rates of transition from regular alcohol use to abuse but low rates from alcohol abuse to dependence. All stages of alcohol use and alcohol-use disorders were more common in younger than in older respondents at comparable time points. Younger age (below 50), male gender, lower education, and having been a student were all associated with ever using alcohol, but only male gender was associated with the transition to regular use and abuse. Furthermore, younger age and late age at onset of alcohol abuse were associated with remission from abuse.

The importance of socio-demographic predictors appears to vary across stages of alcohol use and could be used to guide the precision of intervention strategies.


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Request Reprint E-Mail: sharain@sun.ac.za

Do Premorbid Predictors of Alcohol Dependence Also Predict the Failure to Recover From Alcoholism?

In a search for viable endophenotypes of alcoholism, this longitudinal study attempted to identify premorbid predictors of alcohol dependence that also predicted the course of alcoholism.

The 202 male subjects who completed a 40-year follow-up were originally selected from a Danish birth cohort (N = 9,182). Two thirds of the subjects were high-risk biological sons of treated alcoholics. A large number of measures (361) were obtained at different periods before any subject had developed an alcohol-use disorder. At age 40, a psychiatrist provided mutually exclusive lifetime diagnoses of alcohol abuse or alcohol dependence that were characterized as currently active or currently in remission according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, course specifiers.

The majority of subjects with a diagnosis of alcohol abuse were in remission at age 40 compared with those with a diagnosis of alcohol dependence (88% vs. 58%). Treatment did not predict remission. Fourteen of the 18 predictors of remission that also predicted dependence were submitted to an exploratory factor analysis (varimax). Two premorbid dimensions were identified: cognitive efficiency and early behavioral dyscontrol in childhood. Both factors predicted the failure to remit (low cognitive efficiency and high behavioral dyscontrol) even when lifetime alcoholism severity was controlled.

This 4-decade study found a striking disconnect between measures that predicted alcohol dependence and measures that predicted remission from alcohol dependence. Reduced cognitive efficiency and increased behavioral dyscontrol may be basic to gaining a fuller understanding of the etiology of alcoholism.


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Performance of a Craving Criterion in DSM Alcohol Use Disorders

Adding a craving criterion--presently in the International Classification of Diseases, 10th Revision, diagnosis of alcohol dependence--has been under consideration as one possible improvement to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), and was recently proposed for inclusion by the DSM Substance-Related Disorders Work Group in the Fifth Revision of diagnostic criteria for alcohol use disorders.

To inform cross-cultural applicability of this modification, performance of a craving criterion was examined in emergency departments in four countries manifesting distinctly different culturally based drinking patterns (Mexico, Poland, Argentina, United States).

Exploratory factor analysis and item response theory were used to examine psychometric properties and individual item characteristics of the 11 DSM-IV abuse and dependence criteria with and without craving for each country separately. Differential item functioning analysis was performed to examine differences in the difficulty of endorsement (severity) and discrimination of craving across countries.

Exploratory factor analysis found craving fit well within a one-dimensional solution, and factor loadings were high across all countries. Results from item-response theory analyses indicated that both discrimination and difficulty estimates for the craving item were located in the middle of the corresponding discrimination and difficulty ranges for the other 11 items for each country but did not substantially increase the efficiency (or information) of the overall diagnostic scheme. Across the four countries, no differential item functioning was found for difficulty, but significant differential item functioning was found for discrimination (similar to other DSM-IV criteria).

Findings suggest that, although craving performed similarly across emergency departments in the four countries, it does not add much in identification of individuals with alcohol use disorders.


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