The cost of substance abuse to society has reached unsustainable levels. With the annual cost of alcohol use in California at $38.4 billion and illicit drug abuse at $23.8 billion, the combined toll on the state ($62.2 billion) cannot be sustained from a fiscal standpoint.

This, in conjunction with the very real human toll the disease of addiction takes on individuals, families and communities, makes it critical for policy makers to take a proactive role in addressing the complex substance abuse issues facing the state.
 
Recognizing the costly nature of addiction on many public service systems, California’s publicly funded Alcohol and Other Drug (AOD) services system has been on a path over the last several years to increase effectiveness and cost efficiency of services to those Californians in need. The AOD Field has made much progress in instituting evidence based practices, process improvements and performance measures to increase effectiveness of services as part of its Continuum of Services System Re-engineering efforts.
 
The state Department of Alcohol and Drug Programs (ADP) has taken the next step in reengineering efforts by instituting system improvements through development of a data informed planning and decision making process. The Statewide Needs Assessment and Planning (SNAP) process has been established within ADP business operations to fill that role. This first report represents the beginning of the assessment phase of the process which will culminate in establishing state-level priorities. This is followed by a planning, implementation and evaluation phase.
 
Based on the data analysis in this report the following recommendations were developed to be considered in establishing state-level priorities.

Recommendations for the Continuum of Services

 Employ more science-based population level prevention strategies.
 Identify new funding or resource strategies to expand Prevention activities in California.
 Build the AOD system capacity for early intervention strategies such as SBIRT.
 Continue to focus on increasing treatment effectiveness through strategies such as evidence-based practices, process improvements, performance measures, etc.
 Build the AOD system capacity for Recovery Support Services including identifying funding or other resource strategies.
 
Recommendations for Health Care Reform

 Develop a plan based on the “knowns” of health care reform and add to it as further information and details come to light.
 Consider how to partner with and educate the primary care system on AOD issues.
 A thorough examination of the Medicaid and California's Medi-Cal system must be undertaken in relation to impacts on the AOD system and services.
 Understanding and planning for the uninsured population will be just as important as building capacity to serve additional insured individuals.
 Appropriately preparing and developing the AOD workforce will be a critical step.

Recommendations for Specific Substances

 Institute specific programs aimed at preventing and reducing the high rate of underage and excessive alcohol use and abuse.
 Institute strategies to arrest the growth of prescription drug and opiate abuse.

Recommendations for Specific Populations

 To address overall need:
o Target youth aged 12 through 20 for evidence-based universal prevention strategies.
o Target youth aged 16 and 17 years old for evidence-based selective prevention strategies.
o Target young adults aged 21 through 25 for evidence-based early intervention strategies.
o Target youth aged 18 through 25 for evidence-based prevention, early intervention, and treatment services.
 Complete an in-depth analysis of race/ethnicity data to understand its relationship to the AOD service needs in California to inform program decisions.
 Consider instituting programs to increase the treatment capacity for the following subpopulations in the listed order:
o Veterans
o Individuals with SMI and a concurrent AOD problem
o Pregnant women
o Homeless individuals
 
These are all strategies that the data in this report indicate would be of most value in impacting the state’s substance use issues. Decisions related to the setting of state-level priorities will be made by senior leaders within the AOD Field at the state and county levels. While the data suggest certain courses of action, decisions must also factor in resource and other environmental issues.



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Evaluation of the California Outcomes Measurement System (CalOMS) Final Report 2008

During the past several years, the landscape of substance abuse problems and treatments has continued to change in the State of California.  The emergence of new drug abuse problems (e.g., prescription drugs), the impact of precursor restrictions on the domestic production of methamphetamine and the compensatory increases in methamphetamine importation, the development and expanded use of medications for addiction, and the increasing awareness of the chronic nature of alcohol and other drug (AOD) conditions have dramatically transformed the way we conceptualize treatment for addiction, what we expect from treatment, and how we evaluate treatment.

Given that most treatment for substance use disorders is provided through public funding, there is considerable interest in ensuring that treatment programs in California are using public dollars responsibly by performing efficiently (providing quality services) and producing positive client outcomes.  As part of this effort to improve treatment accountability and outcomes, the California Department of Alcohol and Drug Programs (ADP) developed the California Outcomes Measurement System (CalOMS) for treatment, the first statewide data collection and management system implemented in all 58 counties to comprehensively measure AOD client outcomes.  The CalOMS core data set includes questions on client functioning across medical, psychiatric, employment, legal, family/social, and alcohol and drug use areas.  Treatment programs are responsible for collecting this core data from all clients at treatment admission and discharge. 

One year after the implementation of CalOMS, the Integrated Substance Abuse Programs (ISAP) group from the University of California, Los Angeles (UCLA), conducted the first evaluation of CalOMS under the guise of four objectives:

Objective 1:      Use CalOMS data to improve knowledge of AOD treatment services in California           

Objective 2:      Enhance the capability of county administrators to use CalOMS data to improve treatment service

Objective 3:      Evaluate the quality and validity of CalOMS data

Objective 4:      Develop recommendations for improvement of the CalOMS system

This final report is divided into eight chapters that address research questions specific to each of the four evaluation objectives. While information in each chapter is relevant to each of the four objectives, the first five chapters provide information that responds to Objective 1, Chapter 6 specifically addresses Objective 2, Chapter 7 is in response to Objective 3, and the last chapter responds to Objective 4.

Addressing these objectives will help ADP improve the quality and performance of AOD treatment services in California and maximize the usability of CalOMS data to enhance treatment policies and 

practices in California.

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RE-AIM Evaluation of the Alcohol and Pregnancy Project: Educational Resources to Inform Health Professionals About Prenatal Alcohol Exposure and Fetal Alcohol Spectrum Disorder

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). 

The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. 

The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. 

The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. 

One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). 

The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD. 

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Request Reprint E-Mail:    janp@ichr.uwa.edu.au

 

Effects of Cue-Exposure Treatment on Neural Cue Reactivity in Alcohol Dependence: A Randomized Trial

In alcohol-dependent patients, alcohol-associated cues elicit brain activation in mesocorticolimbic networks involved in relapse mechanisms. Cue-exposure based extinction training (CET) has been shown to be efficacious in the treatment of alcoholism; however, it has remained unexplored whether CET mediates its therapeutic effects via changes of activity in mesolimbic networks in response to alcohol cues. 

In this study, we assessed CET treatment effects on cue-induced responses using functional magnetic resonance imaging (fMRI).

In a randomized controlled trial, abstinent alcohol-dependent patients were randomly assigned to a CET group (n = 15) or a control group (n = 15). All patients underwent an extended detoxification treatment comprising medically supervised detoxification, health education, and supportive therapy. The CET patients additionally received nine CET sessions over 3 weeks, exposing the patient to his/her preferred alcoholic beverage. Cue-induced fMRI activation to alcohol cues was measured at pretreatment and posttreatment.

Compared with pretreatment, fMRI cue-reactivity reduction was greater in the CET relative to the control group, especially in the anterior cingulate gyrus and the insula, as well as limbic and frontal regions. Before treatment, increased cue-induced fMRI activation was found in limbic and reward-related brain regions and in visual areas. After treatment, the CET group showed less activation than the control group in the left ventral striatum.

The study provides first evidence that an exposure-based psychotherapeutic intervention in the treatment of alcoholism impacts on brain areas relevant for addiction memory and attentional focus to alcohol-associated cues and affects mesocorticolimbic reward pathways suggested to be pathophysiologically involved in addiction.


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

Activation of Nuclear PPARγ Receptors by the Antidiabetic Agent Pioglitazone Suppresses Alcohol Drinking and Relapse to Alcohol Seeking.

Pioglitazone and rosiglitazone belong to the class of thiazolidinediones (TZDs). They were first developed as antioxidants and then approved for the clinical treatment of insulin resistance and Type 2 diabetes. TZDs bind with high affinity and activate peroxisome proliferator-activated receptor-gamma (PPARγ) receptors, which in the brain are expressed both in neurons and in glia.

We evaluated the effect of PPARγ activation by TZDs on alcohol drinking, relapse-like behavior, and withdrawal in the rat. We also tested the effect of TZDs on alcohol and saccharin self-administration.

We showed that activation of PPARγ receptors by pioglitazone (0, 10, and 30 mg/kg) and rosiglitazone (0, 10 and 30 mg/kg) given orally selectively reduced alcohol drinking. 

The effect was blocked by pretreatment with the selective PPARγ antagonist GW9662 (5 μg/rat) given into the lateral cerebroventricle, suggesting that this TZD's effect is mediated by PPARγ receptors in the central nervous system. 

Pioglitazone abolished reinstatement of alcohol seeking, a relapse-like behavior, induced by yohimbine, a pharmacologic stressor, but did not affect cue-induced relapse. In the self-administration experiments, pioglitazone reduced lever pressing for alcohol but not for saccharin. Finally, pioglitazone prevented the expression of somatic signs of alcohol withdrawal.

These findings provide new information about the role of brain PPARγ receptors and identify pioglitazone as candidate treatments for alcoholism and possibly other addictions.


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Request Reprint E-Mail:  roberto.ciccocioppo@unicam.it  

Functional Role of the Polymorphic 647 T/C Variant of ENT1 (SLC29A1) and Its Association with Alcohol Withdrawal Seizures

Adenosine is involved in several neurological and behavioral disorders including alcoholism. In cultured cell and animal studies, type 1 equilibrative nucleoside transporter (ENT1, slc29a1), which regulates adenosine levels, is known to regulate ethanol sensitivity and preference. Interestingly, in humans, the ENT1 (SLC29A1) gene contains a non-synonymous single nucleotide polymorphism (647 T/C; rs45573936) that might be involved in the functional change of ENT1.
 

Our functional analysis showed that prolonged ethanol exposure increased adenosine uptake activity of mutant cells (ENT1-216Thr) compared to wild-type (ENT1-216Ile) transfected cells, which might result in reduced extracellular adenosine levels. 

We found that mice lacking ENT1 displayed increased propensity to ethanol withdrawal seizures compared to wild-type littermates. 

We further investigated a possible association of the 647C variant with alcoholism and the history of alcohol withdrawal seizures in subjects of European ancestry recruited from two independent sites. 

Analyses of the combined data set showed an association of the 647C variant and alcohol dependence with withdrawal seizures at the nominally significant level.
 

Together with the functional data, our findings suggest a potential contribution of a genetic variant of ENT1 to the development of alcoholism with increased risk of alcohol withdrawal-induced seizures in humans.


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Parenting to Prevent Childhood Alcohol Use

Drinking alcohol undoubtedly is a part of American culture, as are conversations between parents and children about its risks and potential benefits. However, information about alcohol can seem contradictory. Alcohol affects people differently at different stages of life—small amounts may have health benefits for certain adults, but for children and adolescents, alcohol can interfere with normal brain development. Alcohol’s differing effects and parents’ changing role in their children’s lives as they mature and seek greater independence can make talking about alcohol a challenge. Parents may have trouble setting concrete family policies for alcohol use. And they may find it difficult to communicate with children and adolescents about alcohol-related issues.

Research shows, however, that teens and young adults do believe their parents should have a say in whether they drink alcohol. Parenting styles are important—teens raised with a combination of encouragement, warmth, and appropriate discipline are more likely to respect their parents’ boundaries. Understanding parental influence on children through conscious and unconscious efforts, as well as when and how to talk with children about alcohol, can help parents have more influence than they might think on a child’s alcohol use. Parents can play an important role in helping their children develop healthy attitudes toward drinking while minimizing its risk. > > > >   Read More

Privatizing kills! Or does it?

STATS critiques a new study claiming that private liquor stores are hazardous to our health, while government liquor stores save lives.

A study making waves in Canada has spilled over into Virginia’s debate over privatizing state liquor stores. When researchers charged that British Columbia’s privatization program has increased alcohol-related deaths, Virginia and Washington D.C.-based media were quick to play up the local angle. For example, under the headline “Research adds a new twist to Virginia liquor debate,” the Norfolk-based Virginian Pilot reported on January 20:   > > > >    Read More

Alcohol exposure during late gestation adversely affects myocardial development with implications for postnatal cardiac function

Prenatal exposure to high levels of ethanol is associated with cardiac malformations, but the effects of lower levels of exposure on the heart are unclear. 

Our aim was to investigate the effects of daily exposure to ethanol during late gestation, when cardiomyocytes are undergoing maturation, on the developing myocardium. 

Pregnant ewes were infused with either ethanol (0.75g/kg) or saline for one hour each day from gestational days 95 to 133 (term ~145 days); tissues were collected at 134 d. In sheep, cardiomyocytes mature during late gestation as in humans. Within the left ventricle (LV), cardiomyocyte number was determined using unbiased stereology and cardiomyocyte size and nuclearity determined using confocal microscopy. Collagen deposition was quantified using image analysis. Genes relating to cardiomyocyte proliferation and apoptosis were examined using quantitative real-time PCR. 

Fetal plasma ethanol concentration reached 0.12g/dL after EtOH infusions. Ethanol exposure induced significant increases in relative heart weight, relative LV wall volume and cardiomyocyte cross-sectional area. Ethanol exposure advanced LV maturation in that the proportion of binucleated cardiomyocytes increased by 12% and the number of mononucleated cardiomyocytes was decreased by a similar amount. 

Apoptotic gene expression increased in the ethanol-exposed hearts, although there were no significant differences between groups in total cardiomyocyte number or interstitial collagen. 

Daily exposure to a moderate dose of ethanol in late gestation accelerates the maturation of cardiomyocytes and increases cardiomyocyte and LV tissue volume in the fetal heart. These effects on cardiomyocyte growth may program for long-term cardiac vulnerability. 

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Request Reprint E-Mail:    jane.black@med.monash.edu.au

 

Alcohol Use Among Arab Americans: What is the Prevalence?

Information is limited on alcohol use among Arab Americans. 

 

The purpose of this study was to describe and analyze the alcohol use pattern among Arab Americans by reviewing existing surveys using an acculturation model. Secondary data analysis. 

 

Nationally, English-speaking immigrant Arab Americans reported lower rates of lifetime alcohol use (50.8%), past month use (26.4%) and binge drinking (10%) than the White majority group. 

 

In a state survey, self-identified English-speaking Arab Americans were less likely to report past month use (45.6%) than the White majority group but reported similar rate of binge drinking (17.0%). 

 

Locally, lifetime drinking was reported by 46.2% of the immigrants but only 13.4% of refugees fleeing war. 

 

Few databases are available to estimate alcohol use pattern among Arab Americans; the limited data suggest a drinking pattern consistent with acculturation. However, the potential influence of other factors is unknown and needs to be investigated. 

 

 

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Request Reprint E-Mail:   carfken@med.wayne.edu 

Healthy lifestyle factors associated with reduced cardiometabolic risk

Minimal data are available regarding the cumulative effects of healthy lifestyle behaviours on cardiometabolic risk. 

The objective of the present study was to examine a combination of healthy lifestyle behaviours associated with cardiometabolic risk reduction. 

The analysis was based on a cross-sectional study of 1454 participants from the population-based Lipid Research Clinic's Princeton Follow-up Study. 

The healthy lifestyle factors included fruit and vegetable intake ≥ 5 servings/d, meat intake ≤ 2 servings/d, never smoking, consuming 2–6 alcoholic drinks/week, television (TV) viewing time ≤ 2 h/d and moderate to vigorous physical activity ≥ 4 h/week. 

The combination of healthy lifestyle behaviours was strongly and negatively associated with the presence of cardiometabolic risk, as well as with a composite cardiometabolic risk score after adjustment for race, age, generation and sex. 

With each additional healthy lifestyle factor, cardiometabolic risk decreased by 31 % (OR 0·69; 95 % CI 0·61, 0·78). A higher healthy lifestyle score was associated with a lower prevalence of cardiometabolic risk (P for trend < 0·001). 

Compared with individuals having 0–1 healthy lifestyle behaviours, those with 5 or 6 healthy lifestyle behaviours had a 70 % lower prevalence of cardiometabolic risk (OR 0·30; 95 % CI 0·13, 0·67). 

Healthy lifestyle behaviours including sufficient fruit and vegetable intake, less meat intake, less TV viewing time, abstinence from smoking, modest alcohol intake and regular exercise are associated with reduced cardiometabolic risk.



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Request Reprint E-Mail:  

ling.shi@umb.edu

  

Does Active Substance Use at Housing Entry Impair Outcomes in Supported Housing for Chronically Homeless Persons?

Recent clinical and policy trends have favored low-demand housing (provision of housing not contingent on alcohol and drug abstinence) in assisting chronically homeless people. This study compared housing, clinical, and service use outcomes of participants with high levels of substance use at time of housing entry and those who reported no substance use.

Participants in the outcome evaluation of the 11-site Collaborative Initiative on Chronic Homelessness (N=756), who were housed within 12 months of program entry and received an assessment at time of housing and at least one follow-up (N=694, 92%), were classified as either high-frequency substance users (>15 days of using alcohol or >15 days of using marijuana or any other illicit drugs in the past 30 days; N=120, 16%) or abstainers (no days of use; N=290, 38%) on entry into supported community housing. An intermediate group reporting from one to 15 days of use (N=284, 38%) was excluded from the analysis. Mixed-model multivariate regression adjusted outcome findings for baseline group differences.

During a 24-month follow-up, the number of days housed increased dramatically for both groups, with no significant differences. High-frequency substance users maintained higher, though declining, rates of substance use throughout follow-up compared with abstainers. High-frequency users continued to have more frequent or more severe psychiatric symptoms than the abstainers. Total health costs declined for both groups over time.

Active-use substance users were successfully housed on the basis of a low-demand model. Compared with abstainers, users maintained the higher rates of substance use and poorer mental health outcomes that were observed at housing entry but without relative worsening.

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Request Reprint E-Mail:  ellen.edens@va.gov 

Pharmacologically induced alcohol craving in treatment seeking alcoholics correlates with alcoholism severity, but is insensitive to acamprosate

Modulation of alcohol craving induced by challenge stimuli may predict the efficacy of new pharmacotherapies for alcoholism. 

We evaluated two pharmacological challenges, the α₂-adrenergic antagonist yohimbine, which reinstates alcohol seeking in rats, and the serotonergic compound meta-chlorophenylpiperazine (mCPP), previously reported to increase alcohol craving in alcoholics. 

To assess the predictive validity of this approach, the approved alcoholism medication acamprosate was evaluated for its ability to modulate challenge-induced cravings.

A total of 35 treatment seeking alcohol dependent inpatients in early abstinence were randomized to placebo or acamprosate (2997 mg daily). Following two weeks of medication, subjects underwent three challenge sessions with yohimbine, mCPP or saline infusion under double blind conditions, carried out in counterbalanced order, and separated by at least 5 days. Ratings of cravings and anxiety, as well as biochemical measures were obtained. 

In all, 25 subjects completed all three sessions and were included in the analysis. 

Cravings were modestly, but significantly higher following both yohimbine and mCPP challenge compared with saline infusion. The mCPP, but not yohimbine significantly increased anxiety ratings. Both challenges produced robust ACTH, cortisol and prolactin responses. 

There was a significant correlation between craving and the degree of alcoholism severity. 

Acamprosate administration did not influence craving. 

Both yohimbine and mCPP challenges lead to elevated alcohol craving in a clinical population of alcoholics, and these cravings correlate with alcoholism severity. 

Under the experimental conditions used, alcohol cravings induced by these two stimuli are not sensitive to acamprosate at clinically used doses.

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Request Reprint E-Mail:  markus.heilig@mail.nih.gov  

Baclofen for alcohol withdrawal.

In recent years, baclofen demonstrated its ability to reduce symptoms of severe alcohol withdrawal syndrome (AWS) in alcoholic patients, without producing any significant side effects. 

This review attempted to evaluate if baclofen is generally effective and safe as a therapy for AWS. 

Among the pertinent literature, there was only one study meeting our inclusion criteria. In general, baclofen is efficacious, safe and well tolerated for the treatment of AWS. 

The evidence of recommending baclofen for AWS is insufficient. 

More well designed randomised controlled clinical trials (RCTs) are demanded to further prove its efficacy and safety.


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Acetaldehyde Burst Protection of ADH1B*2 Against Alcoholism: An Additional Hormesis Protection Against Esophageal Cancers Following Alcohol Consumption?

This account of recent work presented at the 4th International Symposium on Alcohol Pancreatitis and Cirrhosis reports animal studies aimed at determining the role of the “acetaldehyde burst,” generated shortly upon ethanol intake, as the mechanism of protection against alcoholism conferred by the ADH1B*2 polymorphism. 

Literature studies discussed suggest an additional role of the acetaldehyde burst on the paradoxical (hormesis) protection of the ADH1B*2 polymorphism against esophageal cancers in alcoholics.

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Request Reprint E-Mail:  yisrael@uchile.cl    

The Hepatocarcinogenic Effect of Methionine and Choline Deficient Diets: An Adaptation to the Warburg Effect?

Normal differentiated hepatocytes primarily metabolize methionine, via homocysteine synthesis, through the transsulfuration pathway. 

In addition to glutathione, this pathway produces α-ketobutyrate that is further metabolized in the mitochondria. 

It is only under low methionine conditions that differentiated hepatocytes predominantly regenerate methionine from homocysteine. 

In contrast, proliferating hepatocytes and liver cancer cells regenerate methionine from homocysteine regardless of the availability of methionine. 

Here we propose that this less efficient metabolism of methionine in proliferating hepatocytes and cancer cells is an adaptation to the “Warburg effect” that is, to the well known phenomenon that cancer cells rely on aerobic glycolysis instead of oxidative phosphorylation to generate energy. 

The observation that knockout mice with impaired S-adenosylmethionine (SAMe) synthesis (the first step in methionine metabolism) or catabolism spontaneously develop fatty liver and hepatocellular carcinoma, together with the observation that SAMe administration induces apoptosis in hepatoma cells and prevents liver cancer support this hypothesis.

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Request Reprint E-Mail:   

director@cicbiogune.es

Alcoholic Liver Disease and Malnutrition

Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). 

Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol.

The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. 

Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. 

Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. 

Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.

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Request Abstract E-Mail:  cjmccl01@gwise.louisville.edu  

Drinks Like a Fish: Using Zebrafish to Understand Alcoholic Liver Disease

Steatosis is the most common consequence of acute alcohol abuse, such as occurs during a drinking binge. Acute alcohol induced steatosis may predispose to more severe hepatic disease. 

We have developed a model of alcoholic liver disease (ALD) in zebrafish larvae to provide a system in which the genes and pathways that contribute to steatosis can be rapidly identified. 

Zebrafish larvae represent an attractive vertebrate model for studying acute ALD because they possess the pathways to metabolize alcohol, the liver is mature by 4 days post-fertilization (dpf), and alcohol can be simply added to their water. 

Exposing 4 dpf zebrafish larvae to 2% ethanol (EtOH) for 32 hours achieves ∼80 mM intracellular EtOH and upregulation of hepatic cyp2e1, sod, and bip, indicating that EtOH is metabolized and provokes oxidative stress. 

EtOH-treated larvae develop ALD as demonstrated by hepatomegaly and steatosis. Increased lipogenesis driven by the sterol response element binding protein (SREBP) transcription factors is essential for steatosis associated with chronic alcohol ingestion but it has not been determined if the same pathway is essential for steatosis following a drinking binge. 

We report that several Srebp target genes are induced in the liver of zebrafish exposed to EtOH. 

We used fish which harbor a mutation in the gene encoding the membrane bound transcription factor protease 1 (mbtps1; also called site-1 protease) and embryos in which the Srebp cleavage activating protein (scap) is knocked down to determine the requirement of this pathway in acute ALD. 

We find that both means of blocking Srebp activation prevents steatosis in response to 2% EtOH. Moreover, this is accompanied by the failure to activate several Srebp target genes in response to alcohol. We conclude that Srebps are required for steatosis in response to acute alcohol exposure. 

Moreover, these data highlight the utility of zebrafish as a useful new vertebrate model to study ALD.

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Request Reprint E-Mail:   kirsten.edepli@mssm.edu 

Investigating the Pathobiology of Alcoholic Pancreatitis

Alcohol abuse is one of the most common causes of pancreatitis. The risk of developing alcohol-induced pancreatitis is related to the amount and duration of drinking. However, only a small portion of heavy drinkers develop disease, indicating that other factors (genetic, environmental, or dietary) contribute to disease initiation. 

Epidemiologic studies suggest roles for cigarette smoking and dietary factors in the development of alcoholic pancreatitis. 

The mechanisms underlying alcoholic pancreatitis are starting to be understood. Studies from animal models reveal that alcohol sensitizes the pancreas to key pathobiologic processes that are involved in pancreatitis. 

Current studies are focussed on the mechanisms responsible for the sensitizing effect of alcohol; recent findings reveal disordering of key cellular organelles including endoplasmic reticulum, mitochondria, and lysosomes. 

As our understanding of alcohol’s effects continue to advance to the level of molecular mechanisms, insights into potential therapeutic strategies will emerge providing opportunities for clinical benefit.

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Request Reprint E-Mail:  stephen.pandol@va.gov

Teenage drinking cultures

The researchers identified eight groups of friends covering a mix of social class, gender and education, using data from the Belfast Youth Development Study. The 41 participants – aged 18 or 19 when interviewed – were asked about their drinking between the ages of 12 and 18. In this way, the researchers construct a picture of the groups’ drinking culture and how it developed as the friends grew older.

The report:

• discusses the development of tacit informal rules and regulations about drinking with groups ('drinking etiquette');
• investigates how teenagers manage their intoxication within the group;
• considers the importance of relationships both within the group and outside it (e.g. parents);
• presents findings about underage experiences of alcohol-related harm;
• discusses the implications of these findings, including restricting access to alcohol, teaching harm reduction skills and the role of parents.
• 
  

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Research on treatment systems for substance abuse

6/10 Volume 27

All Nordic countries, as many other Western countries, have recently reformed treatment systems for substance abuse, looking for the most cost-efficient mix and model of organisation.  For some time now, the focus of research on treatment has moved away from evaluations of specific clinical techniques to real-world-settings. But still, we don’t know what really works in reducing problems on the population level (Babor & Poznyak 2011).

This issue of NAD proves a rich collection of empirical examples and theoretical perspectives on treatment systems from many countries.

Editorial  -    Alcohol and drug treatment systems research:
a question of money, professionals, and democracy   (PDF) 

Research reports and commentaries

PART I Theoretical perspectives on systems and models – critique and practice

Harold D. Holder Substance abuse treatment as part of a total system of community response

Anders Bergmark On the idea of treatment systems

Robin Room Alcohol and drug treatment systems: What is meant, and what determines their development

PART II Comparing national systems or part of systems – descriptions and analysis

Astrid Skretting & Pia Rosenqvist Shifting focus in substitution treatment in the Nordic countries

Lynda Berends & Barbara Hunter It seemed like a good idea at the time: Experiences in centralised intake for alcohol and drug treatment across three jurisdictions

Jacek Moskalewicz The forgotten stakeholders in the drug treatment system

Brian Rush Tiered frameworks for planning substance use service delivery systems: Origins and key principles

Douglas Cameron Implementing an ideology. A case study from Leicestershire, England

Mads Uffe Pedersen Tiered frameworks and implementing ideologies in a Danish context 

Sverre Nesvaag & Terje Lie The Norwegian substance treatment reform: between New Public Management and conditions for good practice

Kristiina Kuussaari & Airi Partanen Administrative challenges in the Finnish alcohol and drug treatment system

Constance Weisner & Agatha Hinman & Yun Lu & Felicia W. Chi & Jennifer Mertens Addiction treatment ultimatums and U.S. health reform: A case study 

Kristian Wahlbeck Moving towards integrated addiction treatment systems

PART III Treatment systems from a global perspective

Thomas Babor & Vladimir Poznyak The World Health Organization Substance Abuse Instrument for mapping services: rationale, structure and functions

Nordic Studies on Alcohol and Drugs 5/10 Volume 27

  

Research Reports

Petra Meier Polarized drinking patterns and alcohol deregulation. Trends in alcohol consumption, harms and policy: United Kingdom 1990 – 2010

Mats Ramstedt Change and stability? Trends in alcohol consumption, harms and policy: Sweden 1990–2010

Alexandra Lysova & William Pridemore Dramatic problems and weak policy. Trends in alcohol consumption, harms and policy: Russia 1990–2010

Ingeborg Rossow Challenges in an affluent society. Trends in alcohol consumption, harms and policy: Norway 1990 – 2010

Allaman Allamani & Franca Beccaria & Fabio Voller The puzzle of Italian drinking. Trends in alcohol consumption, harms and policy: Italy 1990–2010 

Ann Hope & Shane Butler Changes in consumption and harms, yet little policy progress. Trends in alcohol consumption, harms and policy: Ireland 1990 – 2010

Thomas Karlsson & Pia Mäkelä & Esa Österberg & Christoffer Tigerstedt A new alcohol environment. Trends in alcohol consumption, harms and policy: Finland 1990 – 2010

Norman Giesbrecht & Gerald Thomas A complex picture. Trends in alcohol consumption, harms and policy: Canada 1990 – 2010

Editorial - Alcohol and society: A population health perspective

A context
 
In 1975 when the International Study of the Alcohol Control Experiences (ISACE) was initiated, the experience in many established economies was that of several decades of relaxation of state and informal controls combined with rising rates of alcohol consumption. A parallel development in many jurisdictions was the rise of social, chronic and acute problems related to alcohol consumption.
 
A unique contribution of the project was the focus on several forces in seven jurisdictions: systems of alcohol production and supply, drinking cultures, state and local controls, and prevention and treatment initiatives. In addition to numerous published papers and working documents, it produced an edited volume of the social history of alcohol control in seven countries (Single et al. 1981) and a synthetic comparative volume (Mäkelä et al. 1981). The project focused on developments in five countries (Finland, Ireland, the Netherlands, Poland, Switzerland) and two regional jurisdictions (California and Ontario) for the period 1950–1975. The structure of the comparative volume (Mäkelä et al. 1981) signals the main themes: alcohol consumption, production and trade, alcohol-related problems, alcohol control policies, effects of alcohol control policies, and the post-war era and future.   > > > >  Read More

Women and Alcohol Fact Sheet

Women’s drinking patterns are different from men’s—especially when it comes to type of beverage, amounts, and frequency. Women’s bodies also react differently to alcohol than men’s bodies. As a result, women face particular health risks and realities. 

Women should be aware of the health risks associated with drinking alcohol, especially because most women drink at least occasionally, and many women drink a lot.   > > > >  Read More