Following Problem Drinkers Over Eleven Years: Understanding Changes in Alcohol Consumption

Much of what we know about the course of alcohol consumption in problem and dependent drinkers comes from studies of in-treatment populations. Less is known about the natural course of alcohol consumption among such drinkers in the general population and what predicts how much they drink. 

This study examined alcohol consumption over the course of 11 years in a randomly selected sample of 672 problem and dependent drinkers from a single, heterogeneous U.S. county.

 Alcohol consumption declined and leveled off over time but did not decrease to the average general U.S. population level. Several indicators of ongoing problems with drinking are associated with high levels of drinking over time: having a heavy-drinking network, receiving suggestions to do something about one's drinking, and going to treatment. 

Factors associated with less drinking include having contact with community agencies and going to Alcoholics Anonymous (AA).

Results suggest that problem and dependent drinkers continue to drink at an elevated level over the course of years. Gatekeepers, family members, and policymakers should encourage and facilitate contact with social service agencies and with AA for problem drinkers.

Suggestions from others to do something about one's drinking and seeking specialty care occur more often in those with more severe problems and do not appear to be linked to less drinking over time.

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Grasping the thistle: The role of alcohol brief interventions in Scottish alcohol policy

Scotland has experienced a substantial rise in alcohol-related harm, which is now one of the biggest public health challenges it faces.
 

Alcohol problems in Scotland are described along with national alcohol policy response in addressing them. The role of a program of Alcohol Brief Interventions is discussed therein.

In Scotland, considerable proportions of the population are drinking hazardously or harmfully, common across different age and socioeconomic groups. Rising consumption has been set in wider environmental changes with alcohol becoming more available and affordable. Scotland has had one of the fastest growing chronic liver disease mortality rates in the world at a time when rates in most of Western Europe are falling. Scotland's alcohol policy has an explicit aim to reduce population consumption and includes legislative measures to tackle price and availability. A national program to deliver Alcohol Brief Interventions for hazardous drinkers is a key plank of this wider strategy. A portfolio of studies will monitor and evaluate national policy and, through contribution analysis, describe the role Alcohol Brief Interventions play in reducing alcohol misuse.
 

Effective alcohol policy recognises that determinants of health not only lie at individual level, but include wider social, environmental and economic factors. Scotland's policy is addressing these determinants with both population-based and population-targeted interventions.

Scotland has a serious problem with alcohol. A comprehensive, evidence-based, resourced alcohol policy is being implemented, which will need continual review to ensure it remains anchored in evidence while maintaining its ambition.


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Breaking new ground in the study and practice of alcohol brief interventions

This article amplifies the decision to subtitle the INEBRIA2009 Conference ‘Breaking New Ground’. 

The effectiveness of screening and brief intervention (SBI) for hazardous and harmful drinking is now well-established for primary health care and is promising for other medical settings. In addition, significant advances in the implementation of SBI are being made in various parts of the world. 

But, because of the need to establish efficacy and effectiveness, and perhaps too because of a preoccupation with meta-analysis of existing research findings, progress in other aspects of the theory and practice of SBI has been slower than ideal. There may also be a risk of complacency in the SBI field of study. 

For these reasons and others, the Conference Organizing Committee decided to focus the conference and invite presentations on a number of specific topics in the field of alcohol SBI and these are listed here followed by a discussion of other areas in which new ground needs to be broken.

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Request Reprint E-Mail:   : nick.heather@unn.ac.uk     

NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England

This paper describes the development of the first set of national guidance focused on the prevention of alcohol problems in England. 

These guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) working with a multidisciplinary program development group of scientists, practitioners and lay members. In this work, screening and brief alcohol interventions represent a key element of a comprehensive public health strategy to prevent alcohol-related risk and harm across the population.

The first controlled trials of brief alcohol intervention were published in the mid to late 1980's and there are now around 60 published trials in this field. After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners. 

This paper summarises a suite of complementary system-level and practice recommendations, which were published by NICE in June 2010, and considers their likely impact on screening and brief alcohol in England.



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e.f.s.kaner@newcastle.ac.uk

Exploring the emergence of alcohol use disorder symptoms in the two years after onset of drinking: Findings from the National Surveys on Drug Use and Health

This study investigates the occurrence of clinical features of alcohol dependence and socially-maladaptive drinking during the first 24 months after the onset of alcohol use.  

Data for this study are from the nationally representative 2004-2007 National Surveys on Drug Use and Health (NSDUH). 

General population of the US, aged 12 years and older. Participants: Newly-onset alcohol users (NOAUs) were drinkers who started to drink alcohol within 24 months of the NSDUH assessment and consumed alcohol during the last 12 months.  

The NSDUH assessed for clinical features of alcohol dependence and socially-maladaptive drinking, 

consistent with the DSM-IV. 

NOAUs frequently experienced problems relating to self-reported tolerance, spending a lot of time getting over the effects of alcohol, and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features steadily increased in the first nine months after use, but appeared to plateau or only gradually increase thereafter. 

Strong evidence emerged that the clinical features measured a single latent dimensional of ‘alcohol use disorder’ (AUD) in this sample. 

The majority of the clinical features were good indicators of the underlying AUD continuum in the two years after first drinking onset. 

There may be a period of time during the second year of alcohol use when level of alcohol use disorder fluctuates rather than increases. Public health and safety efforts designed to target problematic alcohol use in the earliest stages of alcohol involvement could be useful in preventing the escalation of alcohol problems in this group of drinkers.

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Request Reprint E-Mail: o.mcbride@ulster.ac.uk 

Folic Acid and Selenite during Reproduction, Gestation and Lactation Protect against Ethanol Changed Se Bioavailability

Levels of antioxidants such as folic acid and selenium decrease in dams exposed to ethanol during gestation and lactation, affecting their antioxidant status, their reproductive function and consequently the health of their progeny.

We will study whether a Se (0.5 p.p.m.) plus folic acid (8 p.p.m.) supplemented diet administered to ethanol-exposed dams and male rats prevents the effects provoked by ethanol in Se bioavailability and in their glutathione peroxidase (GPx) activity, thus improving the health of their offspring.  

Se levels in tissue were measured by graphite-furnace atomic absorption spectrometry and serum GPx activity by spectrophotometry. 

 

Results show that ethanol decreases Se retention in dams, affecting their tissues’ Se deposits, decreasing serum GPx activity, gestational parameters and the weight of their progeny. 

Se plus folic acid balance Se bioavailability, something that is especially important during gestation and lactation, and as a direct result, the health of their progeny is improved. 

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Request Reprint E-Mail:  olimpia@us.es

Altered fronto-cerebellar connectivity in alcohol-naïve youth with a family history of alcoholism

Fronto-cerebellar connections are thought to be involved in higher-order cognitive functioning. It is suspected that damage to this network may contribute to cognitive deficits in chronic alcoholics. However, it remains to be elucidated if fronto-cerebellar circuitry is altered in high-risk individuals even prior to alcohol use onset. 

The current study used functional connectivity MRI (fcMRI) to examine fronto-cerebellar circuitry in 13 alcohol-naïve, at-risk youth with a family history of alcoholism (FH+) and 14 age-matched controls. 

In addition, we examined how white matter microstructure, as evidenced by fractional anisotropy (FA) related to fcMRI. FH + youth showed significantly reduced functional connectivity between bilateral anterior prefrontal cortices and contralateral cerebellar seed regions compared to controls. 

We found that this reduction in connectivity significantly correlated with reduced FA in the anterior limb of the internal capsule and the superior longitudinal fasciculus. 

Taken together, our findings reflect associated aberrant functional and structural connectivity in substance-naïve FH + adolescents, perhaps suggesting an identifiable neurophenotypic precursor to substance use. 

Given the role of frontal and cerebellar brain regions in subserving executive functioning, the presence of premorbid abnormalities in fronto-cerebellar circuitry may heighten the risk for developing an alcohol use disorder in FH + youth through atypical control processing.


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TYPES OF DRINKERS AND DRINKING SETTINGS: AN APPLICATION OF A MATHEMATICAL MODEL

U.S. college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate, and heavy drinkers. Light drinkers become moderate under social influence, moderate drinkers may change environments and become heavy drinkers. 

We estimate the drinking reproduction number, Rd, the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers.  

Ways of assessing and ranking progression of drinking risks and data-driven definitions of high- and low-risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess Rd variability and to analyze the role of context on drinking dynamics.

 Our estimates show Rd well above the critical value of 1. Rd estimates correlate positively with the proportion of time spent by moderate drinkers in high-risk drinking environments. Rd is most sensitive to variations in local social mixing contact rates within low-risk environments. The parameterized model with college data, suggests that high residence times of moderate drinkers in low-risk environments maintain heavy drinking.  

With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues, and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long-term prediction of the drinking dynamics.


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Request Reprint E-Mail: anujmubayi@yahoo.com 

Alcohol News - 43/2010

 

The Wall Street Journal Blog (EU) - EU Mulls Booze Warning Labels
Brussels is a battlefield of rule-making; there are always a thousand small skirmishes taking place off-camera, many with an impact on your future and the bottom lines of big companies.
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The Forigner (Norway) - Norway’s ‘no-no’ to alcohol ads could be corked
TV channels transmitting from abroad with content aimed at Norwegian viewers are not permitted to advertise alcohol under current Norwegian legislation, but this could contravene European law.
Read more

Helsinkin Sanomat (Finland) - Working group proposes new alcohol restrictions for Helsinki
A working group of the City of Helsinki is proposing radical measures to curtail what it sees as an “alcohol-friendly culture” that permeates in the city. The task force wants to ban alcohol advertising in advertising space that is owned by the city. It also proposes that the city stop serving alcoholic beverages at city events, and take stronger action against drinking among young people.
Read more

New York Times (Iraq) - Drug and Alcohol Abuse Growing in Iraqi Forces
A growing number of Iraqi security force members are becoming dependent on drugs or alcohol, which has led to concerns about a significant addiction problem among the country’s armed services as the insurgency remains a potent force and American troops prepare to depart at the end of next year.
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Morning Advertiser (UK) - Underage drinking costs NHS £19m a year
Underage drinking, fuelled by the "ludicrously cheap price of alcohol" in supermarkets, is costing the National Health Service £19m a year.
Read more

New Zealand Herald (New Zealand) - Cut drink-drive limit: doctor
The Government believes New Zealand drivers aren't ready to moderate their drinking. We know they are. So take responsibility for keeping our roads safe by signing up: Two Drinks Max.
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MSN India - Smart people drink more alcohol, says new study
In the National Child Development Study in the UK and the National Longitudinal Study of Adolescent Health in the US, childhood intelligence was measured before the age of 16.
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ABC Online (Australia) - NSW wants to ban energy drinks on tap
The New South Wales Government says it plans to ban the sale of energy drinks on tap at clubs and pubs.
Read more

Ivanhoe - Heavy Alcohol Use May Cause Change In Teen Cognitive Development
Alcohol, to an adolescent, is usually seen as a rite of passage. Many teenagers view drinking as a gateway into adulthood, or independence.
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Businessweek - Study Confirms It: Booze Impairs Decision-Making
A new study confirms what many people may know first- or secondhand: Too much alcohol slows reaction time and increases errors during decision-making.
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USA Today - Alcohol and caffeine drinks: The next student health problem?
Three beers, a can of Red Bull and a large espresso: no big deal, many college students might say. Three beers, a can of Red Bull and a large espresso times three or four, and they still might tell you they're not intoxicated.
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Medscape - Variants in Region of Ethanol Metabolism Gene Predict Alcoholism Risk
A search for genetic factors that influence individuals' early experience with ethanol has found variants in or near CYP2E1 associated with stronger responses and inebriation after relatively low alcohol intake.
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Arka News Agency (Armenia) - Minister: Armenia conducts serious negotiations with WTO on taxation of alcohol drinks and tobacco
Armenia conducts serious negotiations with WTO on taxation of alcohol drinks and cigarettes, said Armenian Minister of Economy Nerses Yeritzyan during the parliamentary discussions of state budget 2011.
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Crikey (Australia) - Universities: a marketing arm of the alcohol industry?
Public health efforts to reduce the harm caused by risky alcohol consumption should be paying much more attention to university campuses, says public health policy consultant Margo Saunders.
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The Guardian (UK) - Charity calls for ban on alcohol ads on pre-watershed TV and online
Alcohol Concern has called for a ban on TV and internet alcohol ads after conducting research claiming that well over a million under-16-year-olds saw multiple drinks commercials while watching England games during the World Cup.
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FairWarning (USA) - Looser About Drinking and Driving, U.S. Suffers More Alcohol-Related Deaths
Compared to most other countries, the U.S. has a lax standard for determining whether someone behind the wheel is driving drunk. The U.S. is one of only 16 nations with a limit for blood alcohol content of .08.
Read more

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The microstructural integrity of the corpus callosum and associated impulsivity in alcohol dependence: A tractography-based segmentation study using diffusion spectrum imaging

Previous post-mortem and structural magnetic resonance imaging (MRI) studies in patients with alcohol dependence have demonstrated abnormalities of brain white matter. 

The present study investigated the microstructural integrity in the corpus callosum and the associations of this integrity with neurobehavioral assessments. 

Twenty-five male cases fulfilling the DSM-IV diagnosis of alcohol dependence and 15 male control subjects were scanned using a 3T MRI system. Callosal fiber tracts were reconstructed by diffusion spectrum imaging tractography and were subdivided into seven functionally distinct segments. The microstructural integrity was quantified in terms of generalized fractional anisotropy (GFA). 

Compared with normal subjects, men with alcohol dependence showed lower GFA values on all segments of the corpus callosum. The segment interconnecting the bilateral orbitofrontal cortices was the most affected. The score on the Barratt Impulsivity Scale showed an inverse relationship with GFA on the callosal fiber tracts connecting the bilateral orbitofrontal cortices. Furthermore, the duration of regular use was negatively associated with GFA on the callosal fiber tracts connecting the bilateral temporal and parietal cortices. 

Our findings suggest that a high self-rated impulsivity level was associated with low anisotropy in white matter of corpus callosum sectors extending to the orbitofrontal cortex.

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Request Reprint E-Mail:  wytseng@ntu.edu.tw

Signs of Preclinical Wernicke's Encephalopathy and Thiamine Levels as Predictors of Neuropsychological Deficits in Alcoholism without Korsakoff's Syndrome

The purpose of this study was to determine whether meeting historical criteria for unsuspected Wernicke's encephalopathy (WE), largely under-diagnosed in vivo, explains why some alcoholics have severe neuropsychological deficits, whereas others, with a similar drinking history, exhibit preserved performance.

Demographic, clinical, alcohol related, and neuropsychological measures were collected in 56 abstinent alcoholics and 38 non-alcohol-dependent volunteers. Alcoholics were classified using the clinical criteria established by Caine et al (1997) and validated in their neuropathological study of alcoholic cases.

Our alcoholics who met a single criterion were considered ‘at risk for WE’ and those with two or more criteria with ‘signs of WE’. Whole blood thiamine was also measured in 22 of the comparison group and 28 alcoholics.

Of the alcoholics examined, 27% met no criteria, 57% were at risk for WE, and 16% had signs of WE. Neuropsychological performance of the alcoholic subgroups was graded, with those meeting zero criteria not differing from controls, those meeting one criterion presenting mild-to-moderate deficits on some of the functional domains, and those meeting two or more criteria having the most severe deficits on each of the domains examined. Thiamine levels were selectively related to memory performance in the alcoholics. 

Preclinical signs of WE can be diagnosed in vivo, enabling the identification of ostensibly ‘uncomplicated’ alcoholics who are at risk for neuropsychological complications. 

The graded effects in neuropsychological performance suggest that the presence of signs of WE explains, at least partially, the heterogeneity of alcoholism-related cognitive and motor deficits.

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edie@stanford.edu