Selected risk factors associated with pulmonary tuberculosis among Saharia tribe of Madhya Pradesh, central India

Tuberculosis (TB) is a major public health problem among the Saharia, a marginalized tribal group in Madhya Pradesh state, central India. However, there is no information on the risk factors associated with the development of TB disease in this community. 

A cross-sectional TB prevalence survey was conducted among the Saharia residing in Sheopur district of Madhya Pradesh. Information on tobacco smoking and alcohol consumption was collected from all the individuals. 

Persons aged ≥45 years, males, smokers and alcohol consumers had higher risks of developing TB disease. 

There is an urgent need to develop and implement culturally appropriate awareness raising activities to target smoking and alcohol consumption to support the efforts to control TB in this community. 

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Request Reprint E-Mail:  drvgrao@rediffmail.com

 

Surviving Drug Addiction: The Effect of Treatment and Abstinence on Mortality

We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables.

We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality.

Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. 

Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months was related to a decreased likelihood of abstinence, suggesting that treatment timing is significant.

Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time. 

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Request Reprint E-Mail:  cscott@chestnut.org .

TLRs, Alcohol, HCV, and Tumorigenesis

Chronic liver damage caused by viral infection, alcohol, or obesity can result in increased risk for hepatocellular carcinoma (HCC). 

Ample epidemiological evidence suggests that there is a strong synergism between hepatitis C virus (HCV) and alcoholic liver diseases (ALD). The Toll-like receptor (TLR) signaling pathway is upregulated in chronic liver diseases. 

Alcoholism is associated with endotoxemia that stimulates expression of proinflammatory cytokine expression and inflammation in the liver and fat tissues. 

Recent studies of HCC have centered on cancer-initiating stem cell (CSC), including detection of CSC in cancer, identification of CSC markers, and isolation of CSC from human HCC cell lines. 

Synergism between alcohol and HCV may lead to liver tumorigenesis through TLR signaling.

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Alcohol intoxication and memory for events: A snapshot of alcohol myopia in a real-world drinking scenario

Alcohol typically has a detrimental impact on memory across a variety of encoding and retrieval conditions (e.g., Mintzer, 2007; Ray & Bates, 2006). 

No research has addressed alcohol's effect on memory for lengthy and interactive events and little has tested alcohol's effect on free recall. 

In this study 94 participants were randomly assigned to alcohol, placebo, or control groups and consumed drinks in a bar-lab setting while interacting with a “bartender”. Immediately afterwards all participants freely recalled the bar interaction. 

Consistent with alcohol myopia theory, intoxicated participants only differed from placebo and control groups when recalling peripheral information. 

Expanding on the original hypervigilance hypothesis, placebo participants showed more conservative reporting behaviour than the alcohol or control groups by providing more uncertain and “don't know” responses. 

Thus, alcohol intoxication had confined effects on memory for events, supporting and extending current theories. 

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Request Reprint E-Mail:   schreibe@fiu.edu  

Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion

Cognitive-behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients.

More specifically, by integrating clients' spiritual beliefs and practices into treatment, this modality may speed recovery, enhance treatment compliance, prevent relapse, and reduce treatment disparities by providing more culturally congruent services. 

The process of constructing spiritually modified CBT self-statements is described and illustrated, and suggestions are provided for working with client spirituality in an ethical manner.

The article concludes by emphasizing the importance of this approach in light of the growing spiritual diversity that characterizes contemporary society. 

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Request Reprint E-Mail: davidhodge@asu.edu    

Preoperative Alcohol Screening Scores: Association with Complications in Men Undergoing Total Joint Arthroplasty

The risks associated with preoperative alcohol misuse by patients before undergoing total joint arthroplasty are not well known, yet alcohol misuse by surgical patients is common and has been linked to an increased risk of complications after other procedures.  

The purpose of this study was to evaluate the association between a patient's preoperative standardized alcohol-misuse screening score and his or her risk of complications after total joint arthroplasty.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is an alcohol-misuse screening instrument administered annually to all patients receiving care through the Veterans Health Administration (VHA). The scores range from 0 to 12, with higher scores signifying greater and more frequent consumption. In a study of 185 male patients who had alcohol screening scores recorded in the year preceding surgery at a Palo Alto VHA facility, and who reported at least some alcohol use, we estimated the association between preoperative screening scores and the number of surgical complications in an age and comorbidity-adjusted regression analyses.

Of the 185 patients reporting at least some drinking in the year before their total joint replacement, 17% (thirty-two) had an alcohol screening score suggestive of alcohol misuse; six of those thirty-two patients had one complication, four had two complications, and two had three complications. The screening scores were significantly related to the number of complications in a negative binomial regression analysis (exp[β] = 1.29, p = 0.035), which demonstrated a 29% increase in the expected number of complications with every additional point of the screening score above 1, although with wide confidence intervals for the higher scores.

Complications following total joint arthroplasty were significantly related to alcohol misuse in this group of male patients treated at a VHA facility. The AUDIT-C has three simple questions that can be incorporated into a preoperative evaluation and can alert the treatment team to patients with increased postoperative risk. Preoperative screening for alcohol misuse, and perhaps preoperative counseling or referral to treatment for heavy drinkers, may be indicated for patients who are to undergo total joint arthroplasty.


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Request Reprint E-Mail:   Alexander.Harris2@va.gov
  

Ethanol Influences on Bax Translocation, Mitochondrial Membrane Potential, and Reactive Oxygen Species Generation Are Modulated by Vitamin E and Brain-Derived Neurotrophic Factor

This study investigated ethanol influences on intracellular events that predispose developing neurons toward apoptosis and the capacity of the antioxidant α-tocopherol (vitamin E) and the neurotrophin brain-derived neurotrophic factor (BDNF) to modulate these effects. Assessments were made of the following: (i) ethanol-induced translocation of the pro-apoptotic Bax protein to the mitochondrial membrane, a key upstream event in the initiation of apoptotic cell death; (ii) disruption of the mitochondrial membrane potential (MMP) as a result of ethanol exposure, an important process in triggering the apoptotic cascade; and (iii) generation of damaging reactive oxygen species (ROS) as a function of ethanol exposure.

These interactions were investigated in cultured postnatal day 8 neonatal rat cerebellar granule cells, a population vulnerable to developmental ethanol exposure in vivo and in vitro. Bax mitochondrial translocation was analyzed via subcellular fractionation followed by Western blot, and mitochondrial membrane integrity was determined using the lipophilic dye, JC-1, that exhibits potential-dependent accumulation in the mitochondrial membrane as a function of the MMP.

Brief ethanol exposure in these preparations precipitated Bax translocation, but both vitamin E and BDNF reduced this effect to control levels. Ethanol treatment also resulted in a disturbance of the MMP, and this effect was blunted by the antioxidant and the neurotrophin. ROS generation was enhanced by a short ethanol exposure in these cells, but the production of these harmful free radicals was diminished to control levels by cotreatment with either vitamin E or BDNF.

These results indicate that both antioxidants and neurotrophic factors have the potential to ameliorate ethanol neurotoxicity and suggest possible interventions that could be implemented in preventing or lessening the severity of the damaging effects of ethanol in the developing central nervous system seen in the fetal alcohol syndrome (FAS).


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Request Reprint E-Mail:  heaton@mbi.ufl.edu    

Changes in Heart Rate Variability Associated With Acute Alcohol Consumption: Current Knowledge and Implications for Practice and Research

Alcohol consumption is associated with a broad array of physiologic and behavioral effects including changes in heart rate

However, the physiologic mechanisms of alcohol effects and the reasons for individual differences in the cardiac response remain unknown. 

Measuring changes in resting heart rate (measured as beats/min) has not been found to be as sensitive to alcohol’s effects as changes in heart rate variability (HRV). 

HRV is defined as fluctuations in interbeat interval length which reflect the heart’s response to extracardiac factors that affect heart rate. HRV allows simultaneous assessment of both sympathetic and parasympathetic activity and the interplay between them. 

Increased HRV has been associated with exercise and aerobic fitness, while decreased HRV has been associated with aging, chronic stress, and a wide variety of medical and psychiatric disorders. 

Decreased HRV has predictive value for mortality in general population samples and patients with myocardial infarction and used as an indicator of altered autonomic function. 

A significant inverse correlation was found between HRV and both the severity of depression and the duration of the depressive episode. 

HRV analysis provides insights into mechanisms of autonomic regulation and is extensively used to clarify relationships between depression and cardiovascular disease. 

This article will review the methodology of HRV measurements and contemporary knowledge about effects of acute alcohol consumption on HRV. 

Potential implications of this research include HRV response to alcohol that could serve as a marker for susceptibility to alcoholism. At present however there is almost no research data supporting this hypothesis.

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Request Reprint E-Mail: 
-karpyak.victor@mayo.edu    

Alcohol, Smoking, and Drug Use Among Inuit Women of Childbearing Age During Pregnancy and the Risk to Children

Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking is a well-known public health concern.

This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified.

Two hundred and eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented
.

Ninety-two percent of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which correspond to 38% of pregnant women. Thirty-six percent of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy, and the number of young children living with the mother.

These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs.


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Request Reprint  E-Mail: george@nbresearch.com    

Subcortical Volumes in Long-Term Abstinent Alcoholics: Associations With Psychiatric Comorbidity

Research in chronic alcoholics on memory, decision-making, learning, stress, and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated.
 

Structural MRI was used to compare volumes of 8 subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) in 24 female and 28 male LTAA (mean abstinence = 6.3 years, mean age = 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age = 45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC.

We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with versus without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption.

Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with the recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.


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Request Reprint E-Mail:  george@nbresearch.com  

Assessment of Voluntary Ethanol Consumption and the Effects of a Melanocortin (MC) Receptor Agonist on Ethanol Intake in Mutant C57BL/6J Mice Lacking the MC-4 Receptor

The melanocortin (MC) system is composed of peptides that are cleaved from the polypeptide precursor proopiomelanocortin (POMC). Recent evidence shows that chronic exposure to ethanol significantly blunts central MC peptide immunoreactivity and MC receptor (MCR) agonists protect against high ethanol intake characteristic of C57BL/6J mice. 

Here, we assessed the role of the MC-4 receptor (MC4R) in voluntary ethanol intake and in modulating the effects of the nonselective MCR agonist melanotan-II (MTII) on ethanol consumption.

To assess the role of the MC4R, MC4R knockout (Mc4r^−/−) and littermate wild-type (Mc4r^+/+) mice on a C57BL/6J background were used. Voluntary ethanol (3, 5, 8, 10, 15, and 20%, v/v) and water intake were assessed using standard two-bottle procedures. In separate experiments, Mc4r^−/− and Mc4r^+/+ mice were given intracerebroventricular (i.c.v.) infusion of MTII (0, 0.5, or 1.0 μg/1 μl) or intraperitoneal (i.p.) injection of MTII (0 or 5 mg/kg/5 ml). The effects of MTII (0 or 0.5 μg/1 μl, i.c.v.) on 10% sucrose and 0.15% saccharin intake were assessed in C57BL/6J mice.

Mc4r^−/− mice showed normal consumption of ethanol over all concentrations tested. I.c.v. infusion of MTII significantly reduced ethanol drinking in Mc4r^+/+ mice, but failed to influence ethanol intake in Mc4r^−/− mice. When administered in an i.p. injection, MTII significantly reduced ethanol drinking in both Mc4r^−/−+/+ mice. MTII attenuated consumption of caloric (ethanol, sucrose, and food) and noncaloric (saccharin) reinforcers.

When given centrally, the MCR agonist MTII reduced ethanol drinking by signaling through the MC4R. On the other hand, MTII-induced reduction of ethanol drinking did not require the MC4R when administered peripherally. Together, the present observations show that the MC4R is necessary for the central actions of MCR agonists on ethanol drinking and that MTII blunts the consumption natural reinforcers, regardless of caloric content, in addition to ethanol.

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Request Reprint E-Mail:  thiele@unc.edu 

Smoking and alcohol drinking increased the risk of esophageal cancer among Chinese men but not women in a high-risk population

Although the association for esophageal cancer with tobacco smoking and alcohol drinking has been well established, the risk appears to be less strong in China. 

To provide more evidence on the effect of smoking and alcohol consumption with esophageal cancer in China, particularly among Chinese women, a population-based case–control study has been conducted in Jiangsu, China, from 2003 to 2007. 

A total of 1,520 cases and 3,879 controls were recruited. Unconditional multivariate logistic regression analysis was applied. 

Results showed that the odds ratio (OR) and confidence interval (CI) for ever smoking and alcohol drinking were 1.57 (95% CI: 1.34–1.83) and 1.50 (95% CI: 1.29–1.74). Dose–response relationships were observed with increased intensity and longer duration of smoking/drinking. Risk of smoking and alcohol drinking at the highest joint level was 7.32 (95% CI: 4.58–11.7), when compared to those never smoked and never drank alcohol. Stratifying by genders, smoking and alcohol drinking increased the risk among men with an OR of 1.74 (95% CI: 1.44–2.09) and 1.76 (95% CI: 1.48–2.09); however, neither smoking nor alcohol consumption showed a significant association among women.

In conclusion, smoking and alcohol drinking were associated with esophageal cancer risk among Chinese men, but not among Chinese women. 

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Alcohol and You: An Interactive Body

Virtually every organ system is affected by alcohol. Drinking in moderation may cause problems to one's body, and drinking heavily over the years can cause irreversible damage. However, most diseases caused by excessive drinking can be prevented.

Interactive Body

3rd Annual Jack Mendelson Honorary Lecture

Event:	3rd Annual Jack Mendelson Honorary Lecture
Location:	Masur Auditorium, Building 10, National Institutes of Health, Bethesda, MD
Start Date:	4/12/2011 1:30:00 PM
End Date:	4/12/2011 3:30:00 PM
Event Details	NIAAA Jack Mendelson Honarary Lecuture Series: As a tribute to Dr. Mendelson's remarkable scientific contributions to the field of alcohol research, NIAAA has established this honorary lecture series to highlight clinical/human research in the alcohol field by featuring an outstanding investigator who has made significant and long-term contributions to our understanding of alcoholism susceptibility, alcohol's effects on the brain and other organs, and the prevention and treatment of alcohol use disorders.  NIAAA is please to present this series of scientific lectures both to acknowledge continuing advances in alcohol-related areas of clinical research and to honor the memory of an individual whose pioneering research in alcoholism remains relevant today. About the Honoree-Dr. Anna Mae Diehl    Contact:    Nancy Colladay, NIAAA                 301-443-4733                  ncollada@mail.nih.gov

Ethanol as a Prodrug: Brain Metabolism of Ethanol Mediates its Reinforcing Effects

While the molecular entity responsible for the rewarding effects of virtually all drugs of abuse is known, that for ethanol remains uncertain. Some lines of evidence suggest that the rewarding effects of alcohol are mediated not by ethanol per se but by acetaldehyde generated by catalase in the brain. However, the lack of specific inhibitors of catalase has not allowed strong conclusions to be drawn about its role on the rewarding properties of ethanol. 

The present studies determined the effect on voluntary alcohol consumption of two gene vectors, one designed to inhibit catalase synthesis and one designed to synthesize alcohol dehydrogenase (ADH), to respectively inhibit or increase brain acetaldehyde synthesis.

The lentiviral vectors, which incorporate the genes they carry into the cell genome, were (i) one encoding a shRNA anticatalase synthesis and (ii) one encoding alcohol dehydrogenase (rADH1). These were stereotaxically microinjected into the brain ventral tegmental area (VTA) of Wistar-derived rats bred for generations for their high alcohol preference (UChB), which were allowed access to an ethanol solution and water.

Microinjection into the VTA of the lentiviral vector encoding the anticatalase shRNA virtually abolished (−94%p < 0.001) the voluntary consumption of alcohol by the rats. Conversely, injection into the VTA of the lentiviral vector coding for ADH greatly stimulated (2 to 3 fold p < 0.001) their voluntary ethanol consumption.

The study strongly suggests that to generate reward and reinforcement, ethanol must be metabolized into acetaldehyde in the brain. Data suggest novel targets for interventions aimed at reducing chronic alcohol intake.


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Request Reprint E-Mail:  yisrael@uchile.cl   

Decision Making and Response Inhibition as Predictors of Heavy Alcohol Use: A Prospective Study

Very few studies have investigated the “real world” prospective, predictive value of behavioral instruments used in laboratory studies to test decision-making abilities or impulse control.

The current study examines the degree to which 2 commonly used decision-making/impulse control measures prospectively predict (heavy) alcohol use in a sample of college students.

Two hundred healthy young adults (50% women) performed the Iowa Gambling Task (IGT) and a StopSignal inhibition task in the second college year. At testing and at the end of the fourth college year, heavy alcohol use was assessed.

Disadvantageous performance on the IGT was associated with higher scores on a heavy drinking measure and higher quantity/frequency of alcohol use 2 years past neurocognitive testing in male students even after controlling for prior drinking. These results were corrected for heavy drinking and alcohol use in the period before neurocognitive testing. Interactions with gender indicated that this general pattern held for male but not for female students. Level of response inhibition was not associated with either of the alcohol use measures prospectively.

These findings indicate that a neurocognitive decision-making task is predictive of maladaptive alcohol use. Advantageous decision makers appear to show adaptive real-life decision making, changing their drinking habits to the changing challenges of early adulthood (e.g., finishing college), whereas disadvantageous decision makers do not, and continue to drink heavily. 

These findings extend earlier findings of neurocognitive predictors of relapse in clinical substance-dependent groups, to subclinical alcohol use and abuse.


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Request Reprint E-Mail:   A.E.Goudriaan@amc.uva.nl 

Differential Expression of 14-3-3 Isoforms in Human Alcoholic Brain

Neuropathological damage as a result of chronic alcohol abuse often results in the impairment of cognitive function. The damage is particularly marked in the frontal cortex. The 14-3-3 protein family consists of 7 proteins, β, γ, ε, ζ, η, θ, and σ, encoded by 7 distinct genes. They are highly conserved molecular chaperones with roles in the regulation of metabolism, signal transduction, cell-cycle control, protein trafficking, and apoptosis. They may also play an important role in neurodegeneration in chronic alcoholism.

We used real-time PCR to measure the expression of 14-3-3 mRNA transcripts in both the dorsolateral prefrontal cortex and motor cortex of human brains obtained at autopsy.

We found significantly lower 14-3-3β, γ, and θ expression in both cortical areas of alcoholics, but no difference in 14-3-3η expression, and higher expression of 14-3-3σ in both areas. Levels of 14-3-3ζ and ε transcripts were significantly lower only in alcoholic motor cortex.

Altered 14-3-3 expression could contribute to synaptic dysfunction and altered neurotransmission in chronic alcohol misuse by human subjects.


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Request Reprint E-Mail:    j.lewohl@griffith.edu.au

Alcohol Effects on Cerebral Blood Flow in Subjects With Low and High Responses to Alcohol

Although there are multiple indications that alcohol can alter many physiological brain functions, including cerebral blood flow (CBF), studies of the latter have generally used small- or modest-sized samples. Few investigations have yet evaluated how CBF changes after alcohol relate to subsets of subjects with elevated alcoholism risks, such as those with lower levels of response (LR) to alcohol.
 
This study used arterial spin labeling (ASL) after alcohol administration to evaluate a large sample of healthy young men and women with low and high alcohol responses, and, thus, varying risks for alcohol use disorders (AUD).

Healthy young adult social drinkers with low and high LR (N = 88, 50% women) matched on demography and drinking histories were imaged with whole-brain resting ASL ∼1 hour after ingesting ∼3 drinks of ethanol and after a placebo beverage (i.e., 178 ASL sessions). The relationships of CBF changes from placebo to alcohol for subjects with low and high LR were evaluated.

CBF increased after alcohol when compared to placebo in 5 frontal brain regions. Despite identical blood alcohol concentrations, these increases with alcohol were less prominent in individuals who required more drinks to experience alcohol-related effects (i.e., had a lower LR to alcohol). The LR group differences remained significant after covarying for recent drinking quantities.

The results confirm that alcohol intake is associated with acute increases in CBF, particularly in frontal regions. Less intense CBF changes were seen in subjects with a genetically influenced characteristic, a low LR to alcohol, that relates to the future risk of heavy drinking and alcohol problems.


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Request Reprint E-Mail:   mschuckit@ucsd.edu

Expand+Inpatient Detoxification Procedure and Facilities: Financing Considerations from an Eastern European Perspective

Eastern Europe and the Balkans region report high rates of alcohol abuse and addiction ( OECD, 2009). 

Alcohol detoxification procedures in the countries of the European Union (EU) tend to be conducted at the primary care level or at specialized units associated with the psychiatric clinics. These facilities provide medical treatment to help achieve and maintain abstinence, often through initial 24-h psychiatric supervision. 

In the EU, these patients often already have an awareness of the reality of addiction and show a will to decisively tackle it ( Hayashida, 1998). By visiting these facilities, they attempt and often succeed in preventing an abstinence crisis when they end a period of heavy drinking. Treatment protocols are intended to reduce and eliminate most symptoms of withdrawal (Beshai, 1990). 

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Request Reprint E-Mail:   jakovljevicm@medf.kg.ac.

Comparison of the Relationships of Alcohol Intake with Atherosclerotic Risk Factors in Men with and without Diabetes Mellitus

The purpose of this study was to determine whether diabetes affects relationships between alcohol intake and atherosclerotic risk factors.

 

Age- and alcohol intake-matched groups of Japanese men with and without diabetes (each group: n = 1440) were prepared. Relationships of alcohol intake with atherosclerotic risk factors were compared among four subgroups divided by alcohol intake [non-, light (<22 g/day), moderate (≥22 and <44 g/day) and heavy (≥44 g/day) drinkers].  

Both in diabetic and non-diabetic groups, blood pressure was significantly higher in moderate and heavy drinkers than in non-drinkers, triglycerides were significantly higher in heavy drinkers than in non-drinkers, and high-density lipoprotein (HDL) cholesterol was significantly higher in all drinker groups than in non-drinkers. In the diabetic group, body mass index (BMI) was significantly lower (P < 0.01) in moderate and heavy drinkers than in non-drinkers [26.11 ± 0.17 kg/m² (non-drinkers) vs. 24.83 ± 0.19 kg/m²² (heavy drinkers)], while these differences were not found in the non-diabetic group [23.33 ± 0.13 kg/m² (non-drinkers) vs. 23.30 ± 0.15 kg/m² (moderate drinkers) vs. 23.46 ± 0.18 kg/m² (heavy drinkers)]. Both in the diabetic and non-diabetic groups, low-density lipoprotein (LDL) cholesterol was significantly lower in moderate and heavy drinkers than in non-drinkers. In the non-diabetic group, LDL cholesterol was also significantly lower in light drinkers than in non-drinkers [124.7 ± 1.3 mg/dl (non-drinkers) vs. 114.5 ± 2.4 mg/dl (light drinkers), P < 0.01], while this difference was not found in the diabetic group [123.6 ± 1.4 mg/dl (non-drinkers) vs. 123.1 ± 2.6 mg/dl (light drinkers)]. 

The positive associations of alcohol intake with blood pressure, triglycerides and HDL cholesterol are similar in men with and without diabetes, while the negative associations of alcohol intake with BMI and LDL cholesterol are stronger and weaker, respectively, in men with diabetes than in men without diabetes. 

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Request Reprint E-Mail: wakabaya@hyo-med.ac.jp 

Statistics from the National Alcohol Treatment Monitoring System (NATMS) 1st April 2009 – 31st March 2010

Executive Summary
 
There were 111,381 clients in contact with structured treatment aged 18 and over who cited alcohol as their primary problematic substance in 2009/10. This is an increase of 11,283 (11%) from 100,098 clients in the previous year.
 

There were a further 31,733 clients aged 18 and over who cited alcohol misuse as an adjunctive problem to a range of other primary problematic substances.

 
Clients’ median age at their first point of contact with treatment in 2009/10 was 41 and 65% of clients in treatment were male.
 
Most clients were White British (97,089 or 88%), while other ethnic groups each accounted for no more than two percent of clients.
 
Where reported (71,779 or 99% of clients starting treatment in 2009/10), 26,662 (37%) were self referrals and 15,166 (21%) were referrals from GP’s. Onward referrals from other substance misuse services together accounted for 8,474 clients (12%).
 
More than three quarters (54,242 or 79%) of all clients waited less than three weeks to commence treatment.
 
The most common intervention type received was ‘structured psychosocial’ with 45% of clients receiving this treatment modality in their latest journey (equating to 50,379 interventions delivered).
 
Where reported (63,458 or 87% of clients starting treatment in 2009/10), one in twenty five clients (2,416 or 4%) had No Fixed Abode on presenting for treatment; a further 10% of clients (6,510) had other housing problems.
 
Of the 63,632 clients exiting treatment in 2009/10; 30,533 (48%) were no longer dependent on alcohol (had completed treatment successfully); a further 4,640 (7%) were transferred for further treatment within the community, while 475(1%) were transferred into appropriate treatment while in custody.

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News Release - An estimated 709,000 youths age 12 to 14 currently drink alcohol in the U.S. – many get alcohol from family or home

A new study by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 5.9 percent of adolescents aged 12 to 14 drank alcohol in the past month and that the vast majority of them (93.4 percent) received their alcohol for free the last time they drank. About 317,000 (44.8 percent) 12 to 14 year olds who drank in the past month received their alcohol for free from their family or at home. This includes 15.7 percent (or an estimated 111,000) who were provided alcohol for free by their parents or guardians.  > > > >  Read More

NIAAA Spectrum Volume 3, Issue 1, February 2011

IN THIS ISSUE

Features
1 FDA Examined NIAAA -Supported Research in its Caffeinated Alcoholic Beverage Review

2 When Too Much AlcoholTurns Into Alcohol Poisoning

Charticle
2 Popularity and “Addictability” of Drugs Among U.S. Adults

Photo Essay
4 In Your Face? We Hope Not.

News From The Field
5 Reducing Off-Campus Drinking
5 Brain’s Reward Circuits May Contribute to Alcohol Abuse
6 Impulsivity, Alcohol, and Violence
7 Why Are Adolescents Less Sensitive to Alcohol?

 Questions With...
7 Ralph Hingson, Sc.D.


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Alcohol policy in tatters as health experts revolt

The government's "responsibility" deal on alcohol looks likely to fall apart as health experts, angered by the limited concessions required of the drinks industry, consider walking away from the table.

The deal, between the industry, the government and health experts – including the chiefs of groups such as Alcohol Concern and the British Liver Trust, as well as senior doctors working on alcohol-related health problems – was billed, when launched last summer, as a fresh, collaborative approach to a serious public health problem.

But an investigation by the Guardian has found that the major issues flagged up by health experts, such as the price of a unit of alcohol and marketing, are not even up for discussion.   >  > > >  Read More

News Release - California Health Interview Survey releases newest data on state residents' health

The California Health Interview Survey (CHIS), the nation's largest state health survey and a primary source of information on California's diverse population, released its latest data today on more than 100 topics affecting the health and well-being of the state's residents. 

 

The random–digit-dial telephone survey, conducted every two years by the UCLA Center for Health Policy Research, gathers essential information from tens of thousands of California households on a wide variety of topics, from health insurance and public program participation to diabetes, obesity and cancer screening.  

The latest survey also includes new questions on suicide, emergency preparedness, medical homes, veteran status, registered domestic partner status, flu shots and prediabetes. 

The data can be examined by state, region and county at http://www.askchis.com/, the survey's free, easy-to-use online data search tool. (A quick tutorial on how to use the search tool is also available.) > > > >  Read More

example:

Binge drinking in the past year 2009
     No binge drinking in past year 68.7%
        (67.6 - 69.8) 18,916,000

     Binge drinking in past year 31.3%
        (30.2 - 32.4) 8,631,000

     TOTAL 100.0% 27,547,000


Source: 2009 California Health Interview Survey (95% confidence intervals are displayed in table)

Alcohol-related peripheral neuropathy: Nutritional, toxic, or both?

Alcohol-related peripheral neuropathy (ALN) is a potentially debilitating complication of alcoholism that results in sensory, motor, and autonomic dysfunction. Unfortunately, ALN is rarely discussed as a specific disease entity in textbooks because it is widely assumed to primarily reflect consequences of nutritional deficiency. 

This hypothesis is largely based on observations first made over eight decades ago when it was demonstrated that thiamine deficiency (beriberi) neuropathy was clinically similar to ALN. 

In recent studies, failure of thiamine treatment to reverse ALN, together with new information demonstrating clinical and electrophysiological distinctions between ALN and nutritional deficiency neuropathies, suggests that alcohol itself may significantly predispose and enhance development of neuropathy in the appropriate clinical setting. 

We reviewed the evidence on both sides and conclude that ALN should be regarded as a toxic rather than nutritional neuropathy.

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Request Reprint E-Mail:  mmellion1@lifespan.org 

Rutgers Alcohol Problem Index Scores at Age 18 Predict Alcohol Dependence Diagnoses 7 Years Later

The Rutgers Alcohol Problem Index (RAPI) is widely used to assess adolescent drinking-related problems. We asked how well RAPI, administered in late adolescence, predicts alcohol diagnoses at age 25 in a 7-year follow-up.

At age 18, a population-based sample of Finnish twins completed RAPI by postal questionnaire; 597 (300 male) twins, from pairs discordant and concordant for age 18 RAPI scores, were interviewed at age 25 with the SSAGA, yielding DSM-IIIR diagnoses. Polychoric correlations between RAPI and alcohol diagnoses and symptoms, the area under the response operator characteristic (ROC) curve, and the odds ratio of outcome diagnosis per unit change in adolescent RAPI were analyzed. Twin pairs discordant for both adolescent RAPI and adult diagnoses permitted within-family replications for the full sample and separately by sex.

Nearly half the interviewed twins met diagnostic criteria for alcohol dependency (46.2%) or abuse (1.5%). Age 18 RAPI scores significantly correlated with diagnoses (0.52) and symptom counts (0.55). ROC analysis found a 74% probability that adolescent RAPI scores will be higher among those with an alcohol diagnosis at age 25 than for those without. The odds ratio of outcome alcohol diagnosis per unit increase in adolescent 18 RAPI exceeded 10.0. Within-family comparisons of 117 twin pairs discordant for both age 18 RAPI and age 25 alcohol diagnoses replicated the between-family associations. In both between-family and within-family analyses, RAPI was more predictive of alcohol diagnoses among females.

Our results offer evidence, including that from informative comparisons of co-twins discordant for both predictor and outcome, that RAPI scores in late adolescence robustly predict alcohol diagnoses in early adulthood. Accordingly, our results also provide new evidence that one pathway to problem drinking in early adulthood is a direct one from problem drinking in adolescence.





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Request Reprint E-Mail:   rose@indiana.edu 

The Neighborhood Alcohol Environment and At-Risk Drinking Among African-Americans

Our objective was to examine whether components of the neighborhood alcohol environment—liquor store, on-premise outlet, convenience store, and supermarket densities—are positively associated with at-risk alcohol consumption among African-American drinkers.

A multilevel cross-sectional sample of 321 African-American women and men ages 21 to 65 years recruited from April 2002 to May 2003 from three community-based healthcare clinics in New Orleans, Louisiana, was studied.

The alcohol environment had a significant impact on at-risk alcohol consumption among African-American drinkers, specifically liquor store density (adjusted OR = 3.11, 95% CI = 1.87, 11.07). Furthermore, the influence of the alcohol environment was much stronger for African-American female drinkers (adjusted OR = 6.96, 95% CI = 1.38, 35.08).

Treatment and prevention programs should take into account the physical environment, and the concentration of outlets in minority neighborhoods must be addressed as it poses potential health risks to the residents of these neighborhoods.



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Request Reprint E-Mail: ktheall@tulane.edu  

Variation in Genes Encoding the Neuroactive Steroid Synthetic Enzymes 5α-Reductase Type 1 and 3α-Reductase Type 2 Is Associated With Alcohol Dependence

Studies of alcohol effects in rodents and in vitro implicate endogenous neuroactive steroids as key mediators of alcohol effects at GABA_A receptors. 

We used a case-control sample to test the association with alcohol dependence (AD) of single nucleotide polymorphisms in the genes encoding two key enzymes required for the generation of endogenous neuroactive steroids: 5α–reductase, type I (5α-R), and 3α-hydroxysteroid dehydrogenase, type 2 (3α-HSD), both of which are expressed in human brain.

We focused on markers previously associated with a biological phenotype. For 5α-R, we examined the synonymous SRD5A1 exon 1 SNP rs248793, which has been associated with the ratio of dihydrotestosterone to testosterone. For 3α-HSD, we examined the nonsynonymous AKR1C3 SNP rs12529 (H5Q), which has been associated with bladder cancer. The SNPs were genotyped in a sample of 1,083 non-Hispanic Caucasians including 552 controls and 531 subjects with AD.

The minor allele for both SNPs was more common among controls than subjects with AD: SRD5A1 rs248793 C-allele (χ²(1) = 7.6, p = 0.006) and AKR1C3 rs12529 G-allele (χ²(1) = 14.6, p = 0.0001). There was also an interaction of these alleles such that the “protective” effect of the minor allele at each marker for AD was conditional on the genotype of the second marker.

We found evidence of an association with AD of polymorphisms in two genes encoding neuroactive steroid biosynthetic enzymes, providing indirect evidence that neuroactive steroids are important mediators of alcohol effects in humans.



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Request Reprint E-Mail: jocovault@uchc.edu    

Sleep Following Alcohol Intoxication in Healthy, Young Adults: Effects of Sex and Family History of Alcoholism

This study evaluated sex and family history of alcoholism as moderators of subjective ratings of sleepiness/sleep quality and polysomnography (PSG) following alcohol intoxication in healthy, young adults.

Ninety-three healthy adults [mean age 24.4 ± 2.7 years, 59 women, 29 subjects with a positive family history of alcoholism (FH+)] were recruited. After screening PSG, participants consumed alcohol (sex/weight adjusted dosing) to intoxication [peak breath alcohol concentration (BrAC) of 0.11 ± 0.01 g% for men and women] or matching placebo between 20:30 and 22:00 hours. Sleep was monitored using PSG between 23:00 and 07:00 hours. Participants completed the Stanford Sleepiness Scale and Karolinska Sleepiness Scale at bedtime and on awakening and a validated post-sleep questionnaire.

Following alcohol, total sleep time, sleep efficiency, nighttime awakenings, and wake after sleep onset were more disrupted in women than men, with no differences by family history status. 

Alcohol reduced sleep onset latency, sleep efficiency, and rapid eye movement sleep while increasing wakefulness and slow wave sleep across the entire night compared with placebo. Alcohol also generally increased sleep consolidation in the first half of the night, but decreased it during the second half.

Sleepiness ratings were higher following alcohol, particularly in women at bedtime. Morning sleep quality ratings were lower following alcohol than placebo.

Alcohol intoxication increases subjective sleepiness and disrupts sleep objectively more in healthy women than in men, with no differences evident by family history of alcoholism status. Evaluating moderators of alcohol effects on sleep may provide insight into the role of sleep in problem drinking.


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Request Reprint E-Mail:   tarnedt@med.umich.edu