Patterns of Alcohol-Dependence Symptoms Using a Latent Empirical Approach: Associations With Treatment Usage and Other Correlates

The aim of this study was to understand the variation in response to alcohol use by identifying classes of alcohol users based on alcohol-dependence symptoms and to compare these classes across demographic characteristics, abuse symptoms, and treatment usage. 

 Data from combined 2002-2005 National Survey on Drug Use and Health identified 110,742 past-year alcohol users, age 18 years or older. Latent class analysis defined classes based on observed clustering of alcohol-dependence symptoms based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Chi-square statistics were used to test differences in sociodemographic and alcohol-abuse characteristics across classes. Multivariable latent class regressions were used to compare treatment usage across classes.

The four-class model had the best overall fit and identified classes that differed quantitatively and qualitatively, with 2.3% of the users in the most-severe class and 83.8% in the least-severe/ not-affected class. These classes differed in a number of demographic characteristics and alcohol-abuse symptoms. All individuals in the most-severe class met DSM-IV criteria for alcohol dependence; 80% of this class had alcohol-abuse symptoms. Twenty-six percent of the moderate and 50% of the moderate-high class met dependence criteria. Approximately 19% of the most-severe class and less than 5% of the moderate and moderate-high class received treatment for alcohol in the past year.

 This study demonstrates that meeting dependence criteria only partially captures variations in responses to severity of alcohol problems. Although individuals in the most-severe class were more likely to perceive need and receive treatment, the percentage of individuals receiving treatment was low. 

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TIP 48: Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery

Gives substance abuse counselors guidelines for treating clients with symptoms of depression and alcohol abuse or drug abuse problems. Covers screening, assessment, treatment, counseling, cultural competence, and continuing care. Tells program administrators how to integrate depression treatment into early drug treatment.

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Alcohol pricing is not the 'answer': the hypocrisy behind new drinking laws

The cheap cost of alcohol has been blamed for the culture of binge drinking in the UK. In Scotland, the introduction of a new minimum price per unit for alcohol was expected to ‘immediately save about 50 lives a year, cut hospital admissions by 1,200 a year and mean nearly 23,000 fewer days lost from work in the first year’, according to the Scottish National Party (1). Although the policy has not yet been passed, debate continues about the merits of placing a minimum cost on alcohol.

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Ignoring the Social Benefits of Drinking

Awareness raising” has become a common objective for health campaigns concerned about the dangers of alcohol. The gruesome Drinkaware television adverts and the National Health Service-sponsored posters are a case in point. They deface the back of every pub toilet door with a clear anti-drinking message. According to them, drinking alcohol leads to unprotected sex, violence and vomit (for the teenagers) and heart disease, liver failure and missed workdays (for the grown-ups).

There is a problem with this. Drinkaware campaigns totally ignore the social benefits of drinking, vilifying the majority of adults. They stifle the integration of young people into a socially acceptable drinking culture while also reinforcing the behavior they attempt to challenge. Adults know that drinking alcohol does not always cause you to throw up. Equally they also know that, no matter how hard some of us may try, a night on the town drinking more often leads to a burger at the end of the night than sex. Health warnings that don’t connect with people’s experience are easily filtered out.  > > > >  Read More

Effects of school district factors on alcohol consumption: results of a multi-level analysis among Danish adolescents

Area-level socio-economic factors are significantly related to a population’s health. This study investigates how school district-level factors affect the initiation of alcohol drinking of Danish adolescents. 

A survey sample of 11 223 female and male pupils in the 7th grade from 447 schools across Denmark was analysed for the outcome variable drinking initiation and a number of individual level predictors. Aggregated variables on school district level were created from national registry data for education, occupational level and household savings of residents, type of housing and land use characteristics.

 

About 40% of all respondents (45.8% males and 35.2% females) had ever drunk more than one glass of alcoholic beverage. Mixed-effects logistic regression showed that significant individual level predictors for drinking initiation were male gender, a lower performance at school, perceived peer group drinking and the perceived daily drinking of the father. On school district level, adolescents were more likely to initiate alcohol consumption in school districts with higher farming land use and less likely in those with higher proportion of private apartment buildings. Other school district factors were not associated with drinking initiation when controlled for individual level factors.

 

The impact of socio-economic variables at school district level seems to be smaller in the welfare state of Denmark than known for other countries. However, residence in rural areas may be a direct disadvantage for youth, indicating a need for region-specific prevention programmes. 

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Request Reprint E-Mail:  cstock@health.sdu.dk
 

First goal of David Cameron's 'nudge unit' is to encourage healthy living

David Cameron's "nudge unit" is at the heart of the coalition's thinking on public health reform.

The Behavioural Insight Team, as it is formally called, got into full swing at the end of last month when behavioural economics expert Dr David Halpern returned to No 10 and the Cabinet Office to lead the unit's work on "big society" and wellbeing.

Its first area of focus will be the problems of obesity, diet and alcohol,  working alongside the health secretary's Responsibility Deal Behaviour Change group.

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Alcohol Use, Abuse, and Treatment in People of African Descent

The use and abuse of alcohol is prevalent in many nations across the globe, but few studies have examined within-group differences found in people of African descent in the United States, in Africa, and in the Caribbean. 

A review of current research about alcohol use, abuse, and treatment in people of African descent is presented, including information about risk factors and contributors to alcohol use. 

Examples of education and prevention interventions are also described. 

Finally, conclusions based on the review of the research literature as well as recommendations for future research are explained. 

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Request Reprint E-Mail:  ms781@albany.edu  

McDonald's and PepsiCo to help write UK health policy

The Department of Health is putting the fast food companies McDonald's and KFC and processed food and drink manufacturers such as PepsiCo, Kellogg's, Unilever, Mars and Diageo at the heart of writing government policy on obesity, alcohol and diet-related disease, the Guardian has learned.  > > > >

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Three (or More) Alcohol-Dependence Symptoms but Not Clustered in the Same 12 Months: Diagnostic Orphans From a Longitudinal Perspective

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), currently uses a polythetic classification system for defining alcohol use disorders (AUD; alcohol abuse and dependence). This classification results in individuals who are subthreshold for an official AUD diagnosis but still endorse one or two criteria of dependence: so-called "diagnostic orphans." To our knowledge, however, there has been no attention given to diagnostic orphans from a lifetime perspective. 

The goal of the current article was to compare various diagnostic groups based on lifetime reports of abuse and dependence symptoms on a range of outcomes. 

Data taken from the National Epidemiological Survey of Alcohol and Related Conditions study were used to form seven mutually exclusive diagnostic groups based on lifetime abuse and dependence symptomatology. 

Diagnostic groups that experienced extensive dependence symptoms, regardless of past-12-month clustering (i.e., formal diagnostic criteria), tended to exhibit poorer outcomes compared with participants that met formal lifetime diagnosis for an AUD through abuse alone. It is notable that a significant group of individuals who failed to meet formal lifetime AUD diagnosis, but who endorsed a number of dependence symptoms, consistently demonstrated more problematic outcomes on a range of measures compared with individuals who never reported dependence symptoms but who were formally diagnosed with lifetime AUD through alcohol abuse. 

DSM-IV lifetime diagnostic criteria may exclude individuals with a history of extensive dependence symptomatology. Implications regarding lifetime diagnosis conceptualization are discussed.


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DSM-IV Alcohol Abuse Due to Hazardous Use: A Less Severe Form of Abuse?

A majority of individuals that meet criteria for alcohol abuse based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), do so by endorsing the hazardous use criterion. 

We used a large, nationally representative data set to investigate whether alcohol abuse due to hazardous use is distinct from abuse attributable to other abuse criteria and whether abuse due to hazardous use is a less severe form of alcohol abuse. 

Two waves of data, collected 3 years apart, from 34,653 individuals who participated in the National Epidemiological Survey on Alcohol and Related Conditions were used. Logistic regression was used to compare those with alcohol abuse due to hazardous use and those with alcohol abuse due to other criteria across several sociodemographic and psychiatric correlates at Wave 1 and across alcohol-related outcomes at the 3-year follow-up. Those with a lifetime history of alcohol dependence at Wave 1 were excluded. 

Abuse due to hazardous use was more commonly noted in older individuals, those not living below the poverty line, and those without nicotine dependence and was more likely to be noted in White participants. Abuse due to hazardous use was also associated with lower rates of problematic drinking, alcohol dependence, and help seeking at 3-year follow-up. 

Individuals endorsing hazardous use are at greater risk than those endorsing no abuse criteria, but abuse due to hazardous use may represent a less severe form of alcohol-use disorders. This is troubling, because current DSM conceptualizations allow for endorsement of hazardous use to denote alcohol-use disorders. Future classifications may wish to consider a higher threshold for alcohol-use disorders, particularly when hazardous use is endorsed.

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Request Reprint E-Mail:  arpana@wustl.edu 

Adolescents At Risk for Alcohol Abuse Demonstrate Altered Frontal Lobe Activation During Stroop Performance

Children and adolescents, family history positive (FH+) for alcoholism, exhibit differences in brain structure and functional activation when compared to family history negative (FH−) counterparts. Given that frontal brain regions, and associated reciprocal connections with limbic structures, undergo the most dramatic maturational changes during adolescence, the objective of this study was to compare functional brain activation during a frontally mediated test of response inhibition in 32 adolescents separated into low-risk (FH−) and high-risk (FH+) groups.

Functional magnetic resonance (fMRI) blood oxygen level–dependent data were acquired at 1.5 Tesla during performance of Stroop Color Naming, Word Reading, and Interference. Preprocessing and statistical analyses, covaried for age, were conducted in SPM99 using a search territory that included superior, middle, and inferior frontal gyri (trigone region), anterior cingulate gyrus (CG), and left and right amygdala.

Significantly greater activation in the fronto-limbic search territory was observed in FH+ relative to FH− subjects during Stroop Interference. In addition, a significant regression between brain activation and family history density was observed, with a greater density being associated with increased activation in regions including middle frontal gyrus (BA9) and CG (BA24).

These data demonstrate a significant influence of FH status on brain activation during the performance of a response inhibition task, perhaps reflecting a neurobiological vulnerability associated with FH status that may include reduced neuronal efficiency and/or recruitment of additional neuronal resources. These findings are important given that the adolescent developmental period is already associated with reduced inhibitory capacity, even prior to the onset of alcohol use.


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

Impaired Delay and Trace Eyeblink Conditioning in School-Age Children With Fetal Alcohol Syndrome

Classical eyeblink conditioning (EBC) involves contingent temporal pairing of a conditioned stimulus (e.g., tone) with an unconditioned stimulus (e.g., air puff). Impairment of EBC has been demonstrated in studies of alcohol-exposed animals and in children exposed prenatally at heavy levels.

Fetal alcohol syndrome (FAS) was diagnosed by expert dysmorphologists in a large sample of Cape Coloured, South African children. Delay EBC was examined in a new sample of 63 children at 11.3 years, and trace conditioning in 32 of the same children at 12.8 years. At each age, 2 sessions of 50 trials each were administered on the same day; 2 more sessions the next day, for children not meeting criterion for conditioning.

Six of 34 (17.6%) children born to heavy drinkers were diagnosed with FAS, 28 were heavily exposed nonsyndromal (HE), and 29 were nonexposed controls. Only 33.3% with FAS and 42.9% of HE met criterion for delay conditioning, compared with 79.3% of controls. The more difficult trace conditioning task was also highly sensitive to fetal alcohol exposure. Only 16.7% of the FAS and 21.4% of HE met criterion for trace conditioning, compared with 66.7% of controls. 

The magnitude of the effect of diagnostic group on trace conditioning was not greater than the effect on short delay conditioning, findings consistent with recent rat studies. Longer latency to onset and peak eyeblink CR in exposed children indicated poor timing and failure to blink in anticipation of the puff. Extended training resulted in some but not all of the children reaching criterion.

These data showing alcohol-related delay and trace conditioning deficits extend our earlier findings of impaired EBC in 5-year-olds to school-age. Alcohol-related impairment in the cerebellar circuitry required for both forms of conditioning may be sufficient to account for the deficit in both tasks. Extended training was beneficial for some exposed children. EBC provides a well-characterized model system for assessment of degree of cerebellar-related learning and memory dysfunction in fetal alcohol exposed children.


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Request Reprint E-Mail:  sandra.jacobson@wayne.edu 

Associations Between Heavy Drinking and Changes in Impulsive Behavior Among Adolescent Boys

Impulsive behavior in humans predicts the onset of drinking during adolescence and alcohol use disorders (AUDs) in adulthood. It is also possible, however, that heavy drinking may increase impulsive behavior by affecting the development of brain areas that support behavioral control or through other associated mechanisms. 

This study examined whether drinking heavily during adolescence is related to changes in impulsive behavior with a specific focus on how the association differs across individuals, contingent on the developmental course of their impulsiveness.

Data came from a sample of boys (N = 503) who were followed annually from approximate age 8 to age 18 and again at approximate age 24/25. Heavy drinking was defined as experiencing a blood alcohol concentration (BAC) level of 0.08% or higher. At each assessment, the parent and child each reported whether the child was impulsive.

First, group-based trajectory analysis was used to identify 4 groups differing in the level and slopes of their trajectories of impulsive behavior from age 9 to age 17: low (13.9%), early adolescence-limited (18.7%), moderate (60.8%), and high (6.6%). These trajectory groups differed in their prevalence of any heavy drinking, peak BACs, and rates of alcohol dependence in adolescence and AUD in early adulthood, with the less impulsive groups being lower on these measures than the more impulsive groups. Heavy drinking was then entered into the model as a time-varying covariate; this measure was lagged so that the results represent change in impulsive behavior the year following heavy drinking. Among boys on the moderate trajectory, those who drank heavily were rated as significantly more impulsive the following year compared to those who did not drink heavily.

The association between heavy drinking and impulsive behavior may depend on earlier levels of impulsive behavior with those who are moderately impulsive appearing to be at greatest risk for increased impulsive behavior following heavy drinking. Further research is needed to clarify this association.


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Request Reprint E-Mail:  hewhite@rci.rutgers.edu 

Negative mood, implicit alcohol-related memory, and alcohol use in young adults: The moderating effect of alcohol expectancy

Alcohol-related implicit (preconscious) cognitive processes are established and unique predictors of alcohol use, but most research in this area has focused on alcohol-related implicit cognition and anxiety. This study extends this work into the area of depressed mood by testing a cognitive model that combines traditional explicit (conscious and considered) beliefs, implicit alcohol-related memory associations (AMAs), and self-reported drinking behavior.

Using a sample of 106 university students, depressed mood was manipulated using a musical mood induction procedure immediately prior to completion of implicit then explicit alcohol-related cognition measures. A bootstrapped two-group (weak/strong expectancies of negative affect and tension reduction) structural equation model was used to examine how mood changes and alcohol-related memory associations varied across groups.

Expectancies of negative affect moderated the association of depressed mood and AMAs, but there was no such association for tension reduction expectancy.

Subtle mood changes may unconsciously trigger alcohol-related memories in vulnerable individuals. Results have implications for addressing subtle fluctuations in depressed mood among young adults at risk of alcohol problems.

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Request Reprint E-Mail:   a.kelly@uq.edu.au

Gender Differences in Drinking Practices in Middle Aged and Older Russians

The study investigated gender differences in drinking patterns and the reasons behind them among men and women in the Russian city of Novosibirsk.  

 A mixed method, combining quantitative and qualitative data, was conducted based on the Health, Alcohol and Psychosocial factors In Eastern Europe cohort study. The quantitative study included 4268 men and 5094 women aged 45–69 years; of those, 20 men and 24 women completed an in-depth interview.  

The quantitative data revealed a large gap in drinking patterns in general between genders. Women drank less often and much smaller quantities than that of men. For example, 19% of men, vs. 1% of women, were classified as problem drinkers (two or more positive answers on the CAGE questionnaire). These differences were not explained by socioeconomic factors. Qualitative data have shown that gender roles and a traditional culture around women's and men's drinking were the main reasons for the reported drinking behaviour, whereby women were consistently expected to drink much less than men in terms of preference for strong beverages, drinking frequency and quantity of alcohol consumed.  

The study confirmed that large differences exist between Russian men's and women's drinking; these differences may be largely explained by gender roles. 

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Request Reprint E-Mail:  n.bobrova@ucl.ac.uk

  

A New Measure of Alcohol Affordability for the UK

To present revisions to the official UK measure of alcohol affordability published by the National Health Service (NHS) Information Centre. The revisions address the following problems in the official measure:

• (a) The income measure used in the calculation is a measure of the income for the whole population of the UK, not income per capita.
• (b) The income measure includes ‘imaginary’ items, namely imputed rentals and attributed income from insurance policies.
• (c) The income measure is inconsistent in its treatment of housing costs.
• (d) The adjustment for inflation makes the measure unnecessarily complex and can have counter-intuitive effects.

The revised measure has the same essential structure as the NHS measure, being the ratio of income to price of alcohol. Adjustments were applied to official income figures, and adjustments for inflation were removed. Results: The revised measure shows that affordability has levelled off since 2003, in contrast to the NHS measure, which shows it continuing to rise until 2008.  

The revised measure corrects a basic error of failing to divide total income for the UK by number of people in the population. This alters the measure but is more correct. Further improvements result in a measure that correlates more closely with UK alcohol consumption over the last decade. 


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Request Reprint E-Mail: rseabrook@ias.org.uk
 

Energy Drink Consumption and Increased Risk for Alcohol Dependence

Energy drinks are highly caffeinated beverages that are increasingly consumed by young adults. Prior research has established associations between energy drink use and heavier drinking and alcohol-related problems among college students. 

This study investigated the extent to which energy drink use might pose additional risk for alcohol dependence over and above that from known risk factors.

Data were collected via personal interview from 1,097 fourth-year college students sampled from 1 large public university as part of an ongoing longitudinal study. Alcohol dependence was assessed according to DSM-IV criteria.

After adjustment for the sampling design, 51.3%_wt of students were classified as “low-frequency” energy drink users (1 to 51 days in the past year) and 10.1%_wt as “high-frequency” users (≥52 days). Typical caffeine consumption varied widely depending on the brand consumed. Compared to the low-frequency group, high-frequency users drank alcohol more frequently (141.6 vs. 103.1 days) and in higher quantities (6.15 vs. 4.64 drinks/typical drinking day). High-frequency users were at significantly greater risk for alcohol dependence relative to both nonusers (AOR = 2.40, 95% CI = 1.27 to 4.56, p = 0.007) and low-frequency users (AOR = 1.86, 95% CI = 1.10, 3.14, p = 0.020), even after holding constant demographics, typical alcohol consumption, fraternity/sorority involvement, depressive symptoms, parental history of alcohol/drug problems, and childhood conduct problems. Low-frequency energy drink users did not differ from nonusers on their risk for alcohol dependence.

Weekly or daily energy drink consumption is strongly associated with alcohol dependence. Further research is warranted to understand the possible mechanisms underlying this association. College students who frequently consume energy drinks represent an important target population for alcohol prevention.


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Request Reprint E-Mail:  aarria@umd.edu 

Diageo In Talks With Trade Body Over Alcohol Taxes .

Diageo PLC (DGE.LN), the world's largest spirits company by sales, is in talks Friday with the British Beer & Pub Association (BBPA) over the equalization of alcohol taxes in the U.K., as the ongoing dispute jeopardizes the company's involvement in the trade association. 

The London-based maker of Jose Cuervo Tequila, Baileys Irish Cream Liqueur and Guinness stout is calling on the U.K. government to equalize duty levels on all forms of alcohol. The move, known as 'equivalence', would result in more taxation on beer, wine and cider and therefore act to make spirits comparatively cheaper for consumers.   > > > > Read More

Policies Favouring Lower Alcohol Content Beverages: Motives and Consequences

Copenhagen, Hotel Admiral, 16-17 of March, 2011

The effects of favouring lower alcohol-content beverages have in different times been a topical issue in Nordic alcohol policy debate. A preference for lower-alcohol beverages is visible in policies such as higher taxes on spirits and greater availability and advertising opportunities for beer and other lower alcohol content products. These policies convey a hierarchy of perceived effects by beverages according to their alcohol content. As of yet the reasoning and the outcomes of this preferential treatment has not been properly mapped. There are no satisfying answers to questions such as: Does harm per litre vary between different beverages? What are the short and long term consequences of people being lead, due to various reasons, to drink low alcohol beverages rather than high?  

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The Scottish Health Survey: Topic Report: The Glasgow Effect

The link between socio-economic circumstances and health is well known, and there is an increasing evidence base supporting the hypothesis of a 'Scottish Effect', and more specifically a 'Glasgow Effect', the terminology used to identify higher levels of mortality and poor health found in Scotland and Glasgow beyond that explained by socio-economic circumstances. The last study which investigated the existence of a 'Glasgow Effect' in a wide range of health behaviours and outcomes used data from the 1995, 1998 and 2003 Scottish Health Surveys, using the Carstairs measure of area-based deprivation, which is less spatially sensitive than the Scottish Index of Multiple Deprivation ( SIMD) now available. Additionally, that study only investigated whether socio-economic factors explained any differences between Glasgow and the rest of Scotland, and did not investigate other potential explanations. This report therefore both updates and extends that work by using the 2008 and 2009 Scottish Health Survey data. The overall aim of this work was to investigate whether residence in Glasgow was independently associated with poorer health outcomes and worse health behaviours compared to the rest of Scotland, after controlling for socio-economic, behavioural, biological and other health-related risk factors.

To accomplish this aim a series of logistic regression models were carried out for a variety of adverse health behaviours and mental and physical health outcomes, and the extent to which any observed differences between Greater Glasgow and Clyde and the rest of Scotland were explained was examined by first adjusting for age and sex, then additionally adjusting for area level deprivation using the Scottish Index of Multiple Deprivation ( SIMD), individual level socio-economic factors, behavioural, biological, relationship and social mobility variables.

This study showed that combined area and individual level socio-economic circumstances explained the differences found between Greater Glasgow and Clyde and the rest of Scotland for the majority of outcomes investigated. However four outcomes remained where differences were not explained by socio-economic factors: anxiety, doctor diagnosed heart attack, high GHQ scores, and being overweight. Of these, the latter two were explained by differences in biological factors. However there remained an unexplained 'Glasgow Effect' in relation to prevalence of anxiety and doctor diagnosed heart attack, with higher levels found in Greater Glasgow and Clyde. Therefore further research is needed into the reasons behind the increased levels of anxiety and heart attacks found in Greater Glasgow and Clyde.

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An integrated genome research network for studying the genetics of alcohol addiction

Alcohol drinking is highly prevalent in many cultures and contributes to the global burden of disease. In fact, it was shown that alcohol constitutes 3.2% of all worldwide deaths in the year 2006 and is linked to more than 60 diseases, including cancers, cardiovascular diseases, liver cirrhosis, neuropsychiatric disorders, injuries and foetal alcohol syndrome. Alcoholism, which has been proven to have a high genetic load, is one potentially fatal consequence of chronic heavy alcohol consumption, and may be regarded as one of the most prevalent neuropsychiatric diseases afflicting our society today.
 

The aim of the integrated genome research network ‘Genetics of Alcohol Addiction’—which is a German inter-/trans-disciplinary life science consortium consisting of molecular biologists, behavioural pharmacologists, system biologists with mathematicians, human geneticists and clinicians—is to better understand the genetics of alcohol addiction by identifying and validating candidate genes and molecular networks involved in the aetiology of this pathology. For comparison, addictive behaviour to other drugs of abuse (e.g. cocaine) is studied as well. 

Here, we present an overview of our research consortium, the current state of the art on genetic research in the alcohol field, and list finally several of our recently published research highlights. 

As a result of our scientific efforts, better insights into the molecular and physiological processes underlying addictive behaviour will be obtained, new targets and target networks in the addicted brain will be defined, and subsequently, novel and individualized treatment strategies for our patients will be delivered.

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Request Reprint E-Mail:   rainer.spanagel@zi-mannheim.de

Female Veterans Aged 20 to 39 Less Likely to Use Most Substances than Male Counterparts

The proportion of women in the military has grown exponentially since the Vietnam war, and increasingly women have been deployed to combat areas not just as nurses but also as combat support troops. The Department of Veterans Affairs estimates that in 2009 there were approximately 1.8 million female veterans in the United States. Many of these women had faced the same service-related stressors as their male counterparts, as well as the additional stressors attendant to being a female in a male-dominated profession.

Although some studies have shown that, overall, veterans are more likely than nonveterans to use substances, there are few available published data that compare rates of substance use between female and male veterans. Data from the 2002 to 2009 National Surveys on Drug Use and Health (NSDUHs) showed that female veterans were significantly less likely than their male counterparts to engage in binge alcohol use, smoke cigarettes, or use any illicit drugs, including marijuana (Figure). However, female and male veterans were equally likely to engage in nonmedical use of prescription-type drugs.


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Drinking in transition: trends in alcohol consumption in Russia 1994-2004

Heavy alcohol consumption is widespread in Russia, but studying changes in drinking during the transition from Communism has been hampered previously by the lack of frequent data. 

This paper uses 1-2 yearly panel data, comparing consumption trends with the rapid concurrent changes in economic variables (notably around the "Rouble crisis", shortly preceding the 1998 survey round), and mortality.

Data were from 9 rounds (1994-2004) of the 38-centre Russia Longitudinal Monitoring Survey. Respondents aged over 18 were included (>7,000 per round). Trends were measured in alcohol frequency, quantity per occasion (by beverage type) and 2 measures of potentially hazardous consumption: (i) frequent, heavy spirit drinking (>=80g per occasion of vodka or samogon and >weekly) (ii) consuming samogon (cheap home-distilled spirit). Trends in consumption, mean household income and national mortality rates (in the same and subsequent 2 years) were compared. Finally, in a subsample of individual male respondents present in both the 1996 and 1998 rounds (before and after the financial crash), determinants of changes in harmful consumption were studied using logistic regression.

Frequent, heavy spirit drinking (>=80g each time, >weekly) was widespread amongst men (12- 17%) throughout, especially in the middle aged and less educated; with the exception of a significant, temporary drop to 10% in 1998. 

From 1996-2000, samogon drinking more than doubled, from 6% to 16% of males; despite a decline, levels were significantly higher in 2004 than 1996 in both sexes. Amongst women, frequent heavy spirit drinking rose non-significantly to more than 1% during the study. 

Heavy frequent male drinking and mortality in the same year were correlated in lower educated males, but not in women. Individual logistic regression in a male subsample showed that between 1996 and 1998, those who lost their employment were more likely to cease frequent, heavy drinking; however, men who commenced drinking samogon in 1998 were more likely to be rural residents, materially poor, very heavy drinkers or pessimistic about their finances. These changes were unexplained by losses to follow-up.

Sudden economic decline in late 1990s Russia was associated with a sharp, temporary fall in heavy drinking, and a gradual and persistent increase in home distilled spirit consumption, with the latter more common amongst disadvantaged groups. 

The correlation between heavy drinking and national mortality in lower educated men is interesting, but the timing of RLMS surveys late in the calendar year, and the absence of any correlation between drinking and the subsequent year's mortality, makes these data hard to interpret conclusively. 

Potential study limitations include difficulty in measuring multiple beverages consumed per occasion, and not specifically recording "surrogate" (non-beverage) alcohols.

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Administration of Memantine During Ethanol Withdrawal in Neonatal Rats: Effects on Long-Term Ethanol-Induced Motor Incoordination and Cerebellar Purkinje Cell Loss

Alcohol consumption during pregnancy can damage the developing fetus, illustrated by central nervous system dysfunction and deficits in motor and cognitive abilities. Binge drinking has been associated with an increased risk of fetal alcohol spectrum disorders, likely due to increased episodes of ethanol withdrawal. 

We hypothesized that overactivity of the N-methyl-D-aspartate (NMDA) receptor during ethanol withdrawal leads to excitotoxic cell death in the developing brain. Consistent with this, administration of NMDA receptor antagonists (e.g., MK-801) during withdrawal can attenuate ethanol’s teratogenic effects. 

The aim of this study was to determine whether administration of memantine, an NMDA receptor antagonist, during ethanol withdrawal could effectively attenuate ethanol-related deficits, without the adverse side effects associated with other NMDA receptor antagonists.

Sprague–Dawley pups were exposed to 6.0 g/kg ethanol or isocaloric maltose solution via intubation on postnatal day 6, a period of brain development equivalent to a portion of the 3rd trimester. Twenty-four and 36 hours after ethanol, subjects were injected with 0, 10, or 15 mg/kg memantine, totaling doses of 0, 20, or 30 mg/kg. Motor coordination was tested on a parallel bar task and the total number of cerebellar Purkinje cells was estimated using unbiased stereology.

Alcohol exposure induced significant parallel bar motor incoordination and reduced Purkinje cell number. Memantine administration significantly attenuated both ethanol-associated motor deficits and cerebellar cell loss in a dose-dependent manner.

Memantine was neuroprotective when administered during ethanol withdrawal. These data provide further support that ethanol withdrawal contributes to fetal alcohol spectrum disorders.



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Request Reprint E-Mail:  thomas3@mail.sdsu.edu 

Increased Oxidative DNA Damage in Patients With Alcohol Dependence and Its Correlation With Alcohol Withdrawal Severity

Chronic and excessive alcohol consumption enhances the formation of reactive oxygen species (ROS) and ethanol-derived free radicals. 8-Hydroxy-2′-deoxyguanosine (8-OHdG) is a marker to estimate ROS-induced DNA damage. 

The study objective was to compare serum 8-OHdG levels between patients with alcohol dependence and healthy controls and to investigate the correlation between this marker and the severity of alcohol withdrawal syndrome (AWS).

 
We recruited 79 patients with alcohol dependence and 63 healthy control subjects. The severity of AWS was evaluated using the Chinese version of the revised Clinical Institute Withdrawal Assessment for Alcohol Scale (CIWA-Ar-C) every 8 hours. Levels of 8-OHdG, malondialdehyde (MDA), and other biologic indexes were assayed at baseline for patient and control groups, and after 1-week detoxification for the patient group.

The 8-OHdG and MDA levels in the alcoholic group were significantly higher than those in the control group (0.34 vs. 0.27 ng/ml and 13.5 vs. 10.1 μM, respectively). Both 8-OHdG and MDA were significantly correlated with the highest CIWA-Ar-C (correlation coefficient = 0.39, p < 0.001 and 0.26, p = 0.02, respectively). In linear regression analysis, only 8-OHdG level was significantly correlated with the highest CIWA-Ar, but not MDA level (regression coefficient beta = 0.33, p = 0.003 and 0.17, p = 0.12, respectively). MDA, but not 8-OHdG levels, significantly decreased after 1 week of detoxification.

These results indicate that our alcohol-dependent individuals are vulnerable to excessive production of free radicals. Notably, the oxidative DNA damage persisted after 1-week detoxification. The AWS severity was correlated with the increase in oxidative stress, particularly the 8-OHdG levels. The impact of sustained abstinence in alcoholic patients needs to be investigated in future studies.


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Request Reprint E-Mail: mch@tpech.gov.tw 

The Influence of Selection for Ethanol Withdrawal Severity on Traits Associated With Ethanol Self-Administration and Reinforcement

Several meta-analyses indicate that there is an inverse genetic correlation between ethanol preference drinking and ethanol withdrawal severity, but limited work has characterized ethanol consumption in 1 genetic animal model, the Withdrawal Seizure-Prone (WSP) and-Resistant (WSR) mouse lines selected for severe or mild ethanol withdrawal, respectively.

We determined whether line differences existed in: (i) operant self-administration of ethanol during sucrose fading and under different schedules of reinforcement, followed by extinction and reinstatement of responding with conditioned cues and (ii) home cage drinking of sweetened ethanol and the development of an alcohol deprivation effect (ADE).

Withdrawal Seizure-Prone-1 mice consumed more ethanol than WSR-1 mice under a fixed ratio (FR)-4 schedule as ethanol was faded into the sucrose solution, but this line difference dissipated as the sucrose was faded out to yield an unadulterated 10% v/v ethanol solution. 

In contrast, WSR-1 mice consumed more ethanol than WSP-1 mice when a schedule was imposed that procedurally separated appetitive and consummatory behaviors. After both lines achieved the extinction criterion, reinstatement was serially evaluated following oral ethanol priming, light cue presentation, and a combination of the 2 cues. 

The light cue produced maximal reinstatement of responding in WSP-1 mice, whereas the combined cue was required to produce maximal reinstatement of responding in WSR-1 mice. 

There was no line difference in the home cage consumption of a sweetened ethanol solution over a period of 1 month. Following a 2-week period of abstinence, neither line developed an ADE.

Although some line differences in ethanol self-administration and reinstatement were identified between WSP-1 and WSR-1 mice, the absence of consistent divergence suggests that the genes underlying these behaviors do not reliably overlap with those that govern withdrawal severity.


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Effects of 7-keto dehydroepiandrosterone on voluntary ethanol intake in male rats

 

Administration of dehydroepiandrosterone (DHEA), a neurosteroid that can negatively modulate the GABAA receptor, has been shown to decrease voluntary intake of ethanol in rats. In vivo, DHEA can be metabolized to a variety of metabolites, including 3β-acetoxyandrost-5-ene-7,17-dione (7-keto DHEA), a metabolite without the prohormonal effects of DHEA. 

This study compared the effectiveness of 7-keto DHEA with DHEA for reducing ethanol intake in the same group of rats. The subjects, previously trained to drink ethanol using a saccharin-fading procedure, had access to ethanol for 30min daily and the amount consumed was recorded. Subjects were administered 10 and 56mg/kg of DHEA or 7-keto DHEA intraperitoneally 15min before drinking sessions. Subjects received each particular dose daily until one of two criteria was met, that is, either ethanol intake did not differ by more than 20% of the mean for 3 consecutive days or for a maximum of 8 days. 

Both 10 and 56mg/kg of 7-keto DHEA significantly reduced the dose of ethanol consumed. Although 10mg/kg of 7-keto DHEA produced decreases similar to those found with DHEA, the 56-mg/kg dose of 7-keto DHEA was significantly more effective at decreasing the dose of ethanol consumed than the same dose of DHEA. 

These results show that 7-keto DHEA is comparable with, or possibly more effective than, DHEA at decreasing ethanol consumption in rats, and that 7-keto DHEA is a compound deserving further investigation as a possible clinical treatment for alcohol abuse without the prohormonal effects of DHEA.

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Request Reprint E-Mail:  pwinsa@lsuhsc.edu 

The role of alcohol in maxillofacial trauma—a comparative retrospective audit between the two centers

Alcohol abuse and maxillofacial trauma, particularly that due to interpersonal violence, have a well-established relationship in the literature. 

We present a retrospective audit comparing the role of alcohol in maxillofacial trauma between Selly Oak Hospital in Birmingham, United Kingdom and Westmead Hospital in Sydney, Australia, and the association between alcohol involvement and patient demographics, including age, sex, marital status, and employment status. 

Also presented are the differences between the two centers in terms of mechanisms and types of injuries and the locations where these injuries were sustained. 

Alcohol was involved in 34.78 and 30.77% of patients at Westmead and Birmingham, respectively. A multiple logistic regression analysis revealed a reduced likelihood of alcohol involvement in episodes of maxillofacial trauma where patients were unemployed (P=.04), and where injuries were sustained secondary to mechanisms other than assault (P<.001) and in locations other than pubs and nightclubs (P=.024). 

There appeared to be no statistically significant contribution to the likelihood of alcohol involvement by treating center, marital status, patient sex, or age. 

Alcohol continues to be a strong driving factor in cases of maxillofacial trauma, particularly those due to alleged assault, with a typical patient demographic of the gainfully employed frequenting drinking establishments being most at risk for alcohol-related trauma, most commonly sustaining their injuries secondary to assault. 

Identifying patient groups most at risk is a key step in developing public health strategies aimed at prevention, and our findings would appear to suggest this group of patients as being the most worthwhile to target with measures aimed at reducing alcohol-fueled maxillofacial trauma.

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Request Reprint E-Mail: rosselledge@doctors.net.uk  

Prognosis of osteopenia in chronic alcoholics

Osteoporosis is frequent among alcoholics all by a direct effect of ethanol, malnutrition, and liver failure. Therefore, it may be related to survival. 

The aim of this study was to assess bone mineral density (BMD), bone mineral content, hormonal status, and to determine prognostic value of these parameters in a total of 124 alcoholics followed up for a median period of 57 months. 

Several bone homeostasis-related hormones were measured in patients and age- and sex-matched controls. Whole-body densitometry was performed by a Hologic QDR-2000 (Waltham, MA) densitometer; nutritional status and liver function were assessed. Sixty patients underwent a second evaluation 6 months later. 

Patients showed lower serum insulin-like growth factor-1 (median=58, interquartile range [IQR]=33–135 vs. 135ng/mL, IQR=116–243ng/mL, P<.001), vitamin D (25.5, IQR=18.3–36.8 vs. 79.9pg/mL, IQR=59.2–107.8pg/mL, P<.001), and osteocalcin (2.1, IQR=1.1–4.5 vs. 6.5ng/mL, IQR=4.7–8.7ng/mL, P<.001) than controls, and lower BMD values, and lower Z- and T-scores at right and left legs and arms, thoracic and lumbar spine, pelvis, and right and left ribs. 

By multiple regression analysis, BMD mainly depends on nutritional parameters and liver function. 

Kaplan–Meier curves show that subtotal BMD and BMD at both arms and pelvis were significantly related with survival. 

Patients who had lost total hip BMD after 6 months showed a shorter survival than those who had not, but using Cox’s regression, encephalopathy, ascites, and nutritional parameters displaced BMD as prognostic factor. 

Therefore, osteopenia ensues in chronic alcoholic patients. It mainly depends on poor nutrition and is related to survival, although surpassed in this sense by encephalopathy, ascites, and nutritional parameters.

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Request Reprint E-Mail:  egonrey@ull.es