How Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) Work: Cross-disciplinary Perspectives

Conference held on September 25, 2009

John F. Kelly, Ph.D.

Associate Professor in Psychiatry

Harvard Medical School

Slides: "From iPod to "iGod"? Are 12-step Groups Hip Enough for Adolescents?"

Video: Addiction Conference Sept 24th 2009 - John Kelly

Alexandre B. Laudet, Ph.D

Presented at the University of Michigan, Sept. 24-25, 2009

Slides: "12-step Participation Among Polysubstance Users: Longitudinal Patterns, Effectiveness, and (some) Lessons Learned"

Video: Addiction Conference Sept 24th 2009 - Alexandre Laudet

Elizabeth A.R. Robinson, Ph.D.

Addiction Research Center

University of Michigan

Slides: "Alcoholics' Perceptions of AA's Helpfulness: Qualitative Responses and Association with Drinking Outcomes"

Video: Addiction Conference Sept 24th 2009 - Elizabeth Robinson

William L. White

Chestnut Health Systems

Slides: "The Varieties of Recovery Experience"

Video: Addiction Conference Sept 24th 2009 - William White

Presented by Sarah Zemore, Ph.D. 

Written by Lee Ann Kaskutas, Dr.P.H.

Alcohol Research Group, Emeryville, CA

University of California, Berkeley, CA

Slides: "AA Effectiveness - Faith Meets Science"

Video: Addiction Conference Sept 24th 2009 - Sarah Zemore

Other video files from the Addiction Conference:

Introduction (John Traynor and Bob Zucker)

Stephen Strobbe

Panel Discussion

Ernie Kurtz

Screening properties of questionnaires and laboratory tests for the detection of alcohol abuse or dependence in a general practice population.

Early identification of alcohol abuse or dependence is important in general practice because many diseases are influenced by alcohol. General practitioners, however, fail to recognise most patients with alcohol problems.

To assess the diagnostic performance of the CAGE and AUDIT questionnaires, their derivatives, and laboratory tests in screening for alcohol abuse or dependence in a primary care population (male and female patients), attending their general practitioner (GP).

A random sample of patients who were over 18 years of age (n = 1992) attending 69 general practices situated in the same region in Belgium.

Alcohol questionnaires (CIDI 1.1, section I, CAGE, AUDIT, AUDIT-C, Five-Shot, and AUDIT Piccinelli) were completed, demographic information was recorded, and patients underwent conventional blood tests, including mean corpuscular volume, liver function tests, the gamma-glutamyl transferase test, and carbohydrate-deficient transferrin (CDT, estimated using %CDT). Calculations of sensitivity, specificity, positive predictive value, negative predictive value, odds ratios with their 95% CIs, and receiver operating characteristic (ROC) curves for different scores of the questionnaires and laboratory tests, using DSM-III-R as the reference standard.

The past-year prevalence of alcohol abuse or dependence in this population was 8.9% (178/1992) of which there were 132 male and 45 female patients attending a general practice. The GPs identified 33.5% of patients with alcohol abuse or dependence. Among male patients, all questionnaires had reasonable sensitivities between 68% and 93% and hence at lower cut-points than recommended. Only the sensitivity of the CAGE, even at its lowest cut-point of > or = 1 was lower (62%). In female patients the sensitivities were lower; however, odds ratios were higher for different questionnaires. The receiver operating characteristic (ROC) curves did not differ between the questionnaires. The laboratory tests had low diagnostic accuracy with areas under the ROC curves (AUCs) between 0.60 and 0.67 for female patients and 0.57 and 0.65 for male patients.

This is one of the largest known studies on alcohol abuse or dependence among family care practices. We confirm earlier results that the AUDIT questionnaire seems equally appropriate for males and females; however, screening properties among male patients are higher. Nevertheless, the Five-Shot questionnaire is shorter and easier to use in a general practice setting and has nearly the same diagnostic properties in male and female general practice patient populations. We confirm that conventional laboratory tests are of no use for detecting alcohol abuse or dependence in a primary care setting. Also, the %CDT cannot been used as a screening instrument in this general practice population.

 
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Improving guideline adherence for cardiac rehabilitation in the Netherlands

In 2004, the Netherlands Society of Cardiology released the current guideline on cardiac rehabilitation. Given its complexity and the involvement of various healthcare disciplines, it was supplemented with a clinical algorithm, serving to facilitate its implementation in daily practice. Although the algorithm was shown to be effective for improving guideline adherence, several shortcomings and deficiencies were revealed. Based on these findings, the clinical algorithm has now been updated. This article describes the process and the changes that were made.

 

The revision consisted of three phases. First, the reliability of the measurement instruments included in the 2004 Clinical Algorithm was investigated by evaluating between-centre variations of the baseline assessment data. Second, based on the available evidence, a multidisciplinary expert advisory panel selected items needing revision and provided specific recommendations. Third, a guideline development group decided which revisions were finally included, also taking practical considerations into account.

 

A total of nine items were revised: three because of new scientific insights and six because of the need for more objective measurement instruments. In all revised items, subjective assessment methods were replaced by more objective assessment tools (e.g. symptom-limited exercise instead of clinical judgement). 

 

In addition, four new key items were added: screening for anxiety/depression, stress, cardiovascular risk profile and alcohol consumption.

 

Based on previously determined shortcomings, the Clinical Algorithm for Cardiac Rehabilitation was thoroughly revised mainly by incorporating more objective assessment methods and by adding several new key areas.

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Behavior Matters

Behavior has a broad and central role in health. Behavioral interventions can be effectively used to prevent disease, improve management of existing disease, increase quality of life, and reduce healthcare costs. 

A summary is presented of evidence for these conclusions in cardiovascular disease/diabetes, cancer, and HIV/AIDS as well as with key risk factors: tobacco use, poor diet, physical inactivity, and excessive alcohol consumption. 

For each, documentation is made of (1) moderation of genetic and other fundamental biological influences by behaviors and social–environmental factors; (2) impacts of behaviors on health; (3) success of behavioral interventions in prevention; (4) disease management; (5) quality of life, and (6) improvements in the health of populations through behavioral health promotion programs. 

Evidence indicates the cost effectiveness and value of behavioral interventions, especially relative to other common health services as well as the value they add in terms of quality of life. 

Pertinent to clinicians and their patients as well as to health policy and population health, the benefits of behavioral interventions extend beyond impacts on a particular disease or risk factor. Rather, they include broad effects and benefits on prevention, disease management, and well-being across the life span. 

Among priorities for dissemination research, the application of behavioral approaches is challenged by diverse barriers, including socioeconomic barriers linked to health disparities. However, behavioral approaches including those emphasizing community and social influences appear to be useful in addressing such challenges. 

In sum, behavioral approaches should have a central place in prevention and health care of the 21st century.


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Request Reprint E-Mail:   fishere@email.unc.edu 

Prevalence of Alcohol in Blood Samples From Traffic Accident Cases in Turkey

Alcohol is one of the main causes of traffic accidents worldwide. With a population of 70 million, 12 million vehicles, and 18 million drivers (16% women), Turkey is one of the European countries that has a high incidence of road traffic accidents.

In accordance with Turkish laws, subjects were considered to be positive when alcohol blood concentration exceeded 50 mg/100 mL. 

The objective of the present study was to obtain reliable and comparable data about alcohol use in traffic cases in Turkey. 

All cases are admitted to the emergency department at Ege University Medical Faculty. The cases from police officers are described as traffic control cases. 

Alcohol was detected in the blood of about 54.4% of the traffic-related cases during October 2005 to March 2007. It has been observed that, in 17.4% of the traffic accident cases, the blood alcohol level was 50 mg/dL or less, which is the legal limit in Turkey for car drivers. 

Alcohol prevalence was 57.2% in male cases and 43.6% in female cases. In alcohol-positive cases; the ratios for males were 1.73 times more frequent in traffic-related cases. 

Prevalence data will help traffic safety professionals to adequately allocate resources and plan future efforts in reducing drinking-and-driving behavior and thereby reduce traffic accidents.

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Request Reprint E-Mail:   enderaltintoprak@gmail.com 

Brief intervention for women with risky drinking and medical diagnoses: A randomized controlled trial.

This is a randomized controlled trial of 511 eligible women treated for diabetes, hypertension, infertility, or osteoporosis on an outpatient basis to test the hypothesis that those randomized to a brief intervention (BI) will drink less than those in the control condition 12 months later. A secondary goal was to identify the characteristics associated with changes in drinking outcome.

All 511 completed the initial alcohol assessment, and 96% completed the 12-month follow-up interview. Those receiving the BI also had 3- and 6-month interviews. Four outcomes were assessed: (a) mean drinks per drinking day, (b) percent drinking days, (c) binge episodes defined as four or more drinks per occasion, and (d) weeks of drinking exceeding the National Institute on Alcohol Abuse and Alcoholism sensible drinking limits.

Overall, there were no differences in drinking outcome by treatment group. Characteristics associated with changes in drinking, however, were identified to provide possible direction for future investigation.



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Request Reprint E-Mail:   gchang@partners.org

Courses & Events

• 10-May-11 : RCP Conference - Alcohol Related Disorders: Towards an Integrated Care Pathway
• 11-May-11 : SMMGP Training Day - Problematic Use of Over-the-Counter (OTC) Medication
• 12-May-11 : RCGP 16th National Conference
• 19-May-11 : Naloxone Saves Lives Conference
• 24-May-11 : Brighton Oasis Project Conference - Where Now for Women Substance Misusers?
• 26-May-11 : RCGP Cert. in Harm Reduction, Health & Wellbeing for Substance Users
• 01-Jun-11 : The Role of Treatment in Recovery - A One Day National Conference
• 08-Jun-11 : Addiction and the Liver 2011 - 4th National Conference
• 27-Jun-11 : Psychotherapy of Addiction - 11th Annual Conference
• 11-Jul-11 : CEU Summer University Human Rights and Drug Policy Course
• 01-Oct-11 : DrugFAM 3rd Bereaved by Addiction Conference
• 13-Oct-11 : SMMGP: 6th National Primary Care Development Conference
• Ongoing : Moving Parents and Children Together (M-PACT) Accreditation

Lesotho: Training session held on evidence-based alcohol policies

In her closing address to an alcohol policy training course in Maseru Ms Ramaili made reference to the current situation of Lesotho: “Alcohol is readily available anywhere in this country, 24 hours a day, seven days a week. It is an essential part of all celebrations; births, traditional festivals, funerals, sports event. There will be very few attendants at such events if you do not serve alcohol. Alcohol consumption is a complex issue. It brings economic benefits, but these benefits come at very high costs. Even if alcohol is a legal commodity the sale of this product cannot go unchecked”, said the Minister of Tourism.

The training session on evidence-based alcohol policies, which was held in the end of March, was part of a process to revise and improve the existing alcohol policy of Lesotho. Around 30 participants from government agencies and NGOs took part in a three-day program based on the book “Alcohol No Ordinary Commodity”. By their commitment, their competence and by active participation the participants contributed towards a successful training with a high level of energy.

> > > >   Read More

This analysis assesses the 12-month prevalence of coronary heart disease (CHD) in individuals according to their category of alcohol use. 

The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions study (the NESARC, n = 43,093) identified 16,147 abstinent individuals, 15,884 moderate consumers, 9,578 hazardous drinkers-defined as exceeding sex-specific weekly limits established by the World Health Organization, and 1,484 alcohol-dependent subjects. 

Diagnoses were generated using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. 

Both moderate and hazardous drinking were associated with decreased odds of CHD when compared with abstinence, whereas odds of CHD were not significantly different between alcohol-dependent and abstinent participants. 

A moderate or even a hazardous consumption of alcohol is associated with a decreased likelihood of CHD after controlling for sociodemographic, psychiatric, and addictive risk factors.

Our study shows that alcohol may have cardioprotective effects not only in moderate drinkers, but also in individuals with patterns of use traditionally considered as hazardous.



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Request Reprint E-Mail:  yann.lestrat@inserm.fr.

2011 Alcohol Education and Rehabilitation Foundation Annual Alcohol Poll: Community Attitudes and Behaviours

Since 2010, the Alcohol Education and Rehabilitation Foundation (AER Foundation) has conducted annual nation-wide polling to determine community attitudes and behaviours relating to alcohol. This is the first time that the polling has been made public in its entirety. Previously, the purpose of the poll was to guide internal strategic directions and communications activities.
 
While the specific purpose of the poll has varied depending on the AER Foundation’s alcohol policy objectives, some key objectives have remained consistent throughout polling. These include:
 
• Determining community attitudes towards alcohol in Australia;
 
• Gaining an understanding of self-reported alcohol consumption patterns in Australia; and
 
• Determining current perspectives on various alcohol-related policies.
 
In January 2011, Galaxy Research was commissioned by the AER Foundation to conduct the annual study into attitudes and behaviours. 

In addition to the key objectives, the 2011 poll also sought to:
 
• Gain an understanding of community awareness of the risks associated with alcohol misuse; and
 
• Determine how alcohol impacts on local communities.
 
This report provides an overview of the findings of the 2011 nation-wide poll. It also provides information regarding trends observed between 2010 and 2011.


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Student drinking on the rise despite economic hardships, survey reveals

A survey conducted by The University Observer has revealed that the number of UCD students drinking excessive amounts of alcohol has risen since the recession.

78 per cent of students surveyed said they suffered memory loss as a result of alcohol consummation on a night out, in comparison with the 67.9 per cent of students who answered positively to the same question asked by this newspaper as part of a similar survey in April 2009.

Students were asked how many alcoholic drinks they would normally consume on a night out, with 48 per cent admitting to consuming six or more drinks per night and 28 per cent saying five to six drinks.

The results also revealed that 89 per cent believe alcohol is an inherent part of university culture.   > > > >   Read More

Long-Term Effects of a Parent and Student Intervention on Alcohol Use in Adolescents: A Cluster Randomized Controlled Trial

Early onset of drinking among Dutch adolescents is highly prevalent. A lower age of onset is associated with several developmental and social risks.

To evaluate the long-term effectiveness of two preventive interventions targeting heavy drinking in third-year high school students.

Cluster RCT using four conditions for comparing two active interventions (separately and simultaneously) with a control group.

152 classes of 19 high schools in the Netherlands; 3490 first-year high school students (M=12.6 years, SD=0.49) and their parents.

(1) parent intervention aimed at encouraging restrictive parental rule-setting concerning their children's alcohol consumption; (2) student intervention aimed at increasing self-control and healthy attitudes toward alcohol, consisting of four digital lessons based on the principles of the theory of planned behavior and social cognitive theory; (3) interventions 1 and 2 combined; and (4) the regular curriculum as control condition.

There were 2937 students eligible for analyses in this study. At follow-up, only the combined student–parent intervention showed substantial and significant effects on heavy weekly and weekly drinking.

The short-term effects found in the present study further support that adolescents as well as their parents should be targeted in order to delay the onset of (heavy) drinking.

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Request Reprint E-Mail:  i.koning@uu.nl  

Exercise and Substance Use Among American Youth, 1991–2009

The National Institute on Drug Abuse has called for increased research into the use of physical activity in substance abuse prevention, specifically research into physical activity type and context.

This paper examines the relationships between (1) secondary school student substance use and (2) exercise in general and school athletic team participation, and examines such relationships over time.

Nationally representative cross-sectional samples of 8th-, 10th-, and 12th-grade students were surveyed each year from 1991 to 2009. Substance use measures included past 2-week binge drinking and past 30-day alcohol, cigarette, smokeless tobacco, marijuana, and steroid use. Analyses were conducted during 2009–2010.

Across grades, higher levels of exercise were associated with lower levels of alcohol, cigarette, and marijuana use. Higher levels of athletic team participation were associated with higher levels of smokeless tobacco use and lower levels of cigarette and marijuana use across grades and to higher levels of high school alcohol and steroid use. Exercise helped suppress the undesired relationship between team participation and alcohol use; exercise and athletic team participation worked synergistically in lowering cigarette and marijuana use. Observed relationships were generally stable across time.

There appear to be substantive differences between exercise and team sport participation in relation to adolescent substance use. These findings from cross-sectional data suggest that interventions to improve levels of general physical activity should be evaluated to determine if they help delay or reduce substance use among youth in general as well as among student athletes.


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Request Reprint E-Mail:  yterry@umich.edu 

News Release - Research casts sober light on Russia's mortality crisis

With the collapse of the Soviet Union, Russians were faced with more than the demise of a political system. Working-age men began dying in droves, and the country saw a 40 percent surge in deaths between 1990 and 1994.

The killer was often alcohol – that much was clear. And for years, many economists and political scientists have blamed Russia's lurch toward democracy and capitalism for driving those men to drink. They reasoned that privatization left many people unskilled and unemployable, ushering in a sense of listlessness and depression that mixed too easily with cheap vodka.

But Stanford researchers have dug up evidence that helps get democracy and capitalism off the hook and points to a new culprit: the end of an anti-alcohol campaign that contributed to a plunge in mortality rates during its short life in the Gorbachev era.  > > > >  Read More

The Gorbachev Anti-Alcohol Campaign and Russia’s Mortality Crisis

Political and economic transition is often blamed for Russia’s 40% surge in deaths between 1990 and 1994 (the “Russian Mortality Crisis”). Highlighting that increases in mortality occurred primarily among alcohol- related causes and among working-age men (the heaviest drinkers), this paper investigates a different explanation: the demise of the 1985-1988 Gorbachev Anti-Alcohol Campaign. We use archival sources to build a new oblast-year data set spanning 1970-2000 and find that:

• The campaign was associated with substantially fewer campaign year deaths,
• Oblasts with larger reductions in alcohol consumption and mortality during the campaign experienced larger transition era increases, and
• Other former Soviet states and Eastern European countries exhibit similar mortality patterns commensurate with their campaign exposure.

The campaign’s end explains between 32% and 49% of the mortality crisis, suggesting that Russia’s transition to capitalism and democracy was not as lethal as commonly suggested.

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Alcohol expectancy challenges for college students: A narrative review

Heavy alcohol use among college students has become a substantial health concern. With national survey data indicating that 40% of college students report consuming five or more alcoholic drinks at least monthly (Johnston, O'Malley, Bachman, & Schulenberg, 2009), prevention and intervention programs are needed to address this problem. 

The Task Force on College Drinking, commissioned by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), designated alcohol expectancy challenges (ECs) as a recommended treatment strategy to reduce alcohol use among college students (NIAAA, 2002). 

This paper is a systematic critical review of the studies that have been conducted to assess for the efficacy of ECs among college students with a focus on changes in expectancies and alcohol consumption, and possible differences in efficacy for men and women. 

The review revealed that ECs were most efficacious when administered to male-only groups of participants; while ECs for female-only and mixed-gender groups demonstrated less consistent results. 

The implications of the findings of this critical review for the direction of future research are discussed.

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Request Reprint E-Mail:  akswezey@syr.edu

Celebrating the passage of alcohol tax

The Lorraine Sheehan Alcohol Tax Coalition commends the Maryland General Assembly for voting to raise an alcohol specific tax for the first time in 40 years. We urge Governor Martin O’Malley to sign this life-saving measure.

This historic public health measure will save numerous lives by reducing underage drinking and preventing thousands of alcohol related harmful incidents. It will also raise significant revenue that will help fund chronically under funded programs for people with developmental disabilities. In future years, we will work with the Governor and General Assembly to use this revenue to help fund all the critical needs identified in the original Lorraine Sheehan legislation (health care coverage, programs for people with developmental disabilities and mental health needs, drug, tobacco and alcohol abuse prevention, cessation and treatment, and health care worker training).  > > > >   Read More

Lawmakers approve tuition break for illegal immigrants, new sales tax on alcohol

Maryland's Democratic General Assembly passed a pair of historic — and divisive — measures in the final hours of the 2011 legislative session Monday night, increasing the tax on alcohol for the first time in more than a generation and making Maryland the 11th state to extend in-state college tuition breaks to illegal immigrants.

Gov. Martin O'Malley, a Democrat, has said he approves of both plans; his first round of bill signings is set for Tuesday.

Beginning July 1, the sales tax for beer, wine and spirits would jump from 6 percent to 9 percent, raising an estimated $85 million per year. Lawmakers chose to dedicate the funds to school construction and aid to Baltimore and Prince George's County, as well as to programs for the developmentally disabled.   > > > >   Read More

Harmful Alcohol Habits were No More Common in a Sample of Newly Sick-Listed Swedish Women and Men Compared with a Random Population Sample

To estimate harmful alcohol habits in a sample of incident sick-listed individuals compared with a random sample from the general population taking social background, health and work-related factors into account.

 

Data for this cross-sectional questionnaire study were collected in 2008 in the Västra Götaland region, Sweden. The study population (19–64 year olds) consisted of 2888 consecutive incident sick-leave sample (ISS) and 3567 individuals from a random population sample (RPS). The mailed questionnaire included Alcohol Use Disorder Identification Test and validated instruments on health and work-related factors. Socio-demographic data came from register data. Analyses were made with χ² tests and logistic regression analyses.  

No differences in prevalence of harmful alcohol habits were found between men in the ISS (22%) and the RPS (21%). Compared with women in the ISS, a higher proportion of women in the RPS were likely to report harmful alcohol habits [14 versus 9% (P < 0.001)]. This difference was confirmed in the logistic regression analyses where women in the RPS had higher odds of having harmful alcohol habits compared with women in the ISS [odds ratio (OR) = 1.54 (95% confidence interval (CI): 1.23–1.89)]. Even after controlling for significant confounders (age, low income, high self-reported health and high level of perceived symptoms), we found that the differences in harmful alcohol habits remained [OR = 1.44 (95% CI: 1.16–1.81)].  

Harmful alcohol habits were no commoner in men and women who belonged to the sample of incident sick-leave cases. Future studies are needed to analyse the predictive value of harmful alcohol habits on sickness absence length and the time until return to work after sickness absence. 






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Request Reprint E-Mail:   gunnel.hensing@socmed.gu.se   

Stakeholder meeting

In the framework of the PROTECT project, a meeting with all stakeholders involved in alcohol labelling policy was organized by the CRIOC and Eurocare on the 17th of March 2011 in the European Parliament in Brussels. The European institutions (European Commission - EC - and Parliament - EP), the beverage industry, consumer organisations, NGOs, media, youth organizations as well as the public were invited to exchange around measurable best practices on alcohol labelling.
 
The seminar was hosted by Alyn Smith (The Green /EFA Alliance in the EP), who said in his introductory speech that “even though the EU does not have direct competence in health matters, all members states could greatly benefit from such meetings, in order to exchange ideas and best practices”. He was in this sense “delighted to see representatives from all stakeholders, especially from the industry” since he does not believe in “digging trenches” but rather in “open and genuine debates”.
 
This introduction was followed by a series of presentations by public health experts, focusing on alcohol health hazards, alcohol labeling policies in Europe (PROTECT) as well as the point of vue of the European Commission on the subject. The complete program, all the presentations as well as video recordings of the different speakers can be found here.



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How do young consumers respond to alcohol labelling and prevention?

This report is the synthesis of a qualitative research financed by the Executive Agency for Health and Consumers of the European Union and EU consumers and coordinated by CRIOC, Research and Information Centre for Consumer Organizations (Belgium).
 
Alcohol consumption is very common and harmful in Europe, especially among young people. A 2009 Eurobarometer survey showed that one third of 15-24 years old Europeans binge drink (more than 5 drinks on one occasion) at least once a week, more than any other age group. While alcohol is known to present very serious health hazards, both on the short term (road accidents, risky behaviours…) and on the long term (addiction, cirrhosis, cancers…).
 
Adding health warning labels to alcohol containers could be one prevention tool to establish social understanding that alcohol is a special and hazardous commodity. There are at the moment no EU comprehensive rules on the labelling of ingredients in alcoholic beverages, neither on the ingredients nor on the healthwarnings.
 
This qualitative research was conducted to provide some background information on young people‟s perception toward labelling of alcoholic beverages. Focus groups were organised in six Member States (Belgium, France, Hungary, Lithuania, Romania, and Spain) in collaboration with consumer associations active in these respective countries (CRIOC, INC, OFE, LNCF, ANPCPPS, and MAG). The subject of the discussions was the youngster‟s alcohol consumption behaviours, their opinion about many prevention health claims and whether it is necessary or not to put health warnings on alcohol beverages. 

This work may serve as a baseline for future European labelling policy or in creating educational tools for an information campaign.


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Alcohol consumption appears to protect against non-alcoholic fatty liver disease

Moderate alcohol consumption may have certain beneficial effects against non-alcoholic fatty liver disease, which is associated with metabolic syndrome.

To determine the association between drinking pattern and fatty liver in Japanese men and women.


A cross-sectional study was performed with health checkup data including information concerning alcohol consumption and ultrasonographic assessment of fatty liver.

We analysed 4957 men and 2155 women without reported liver diseases (median age, 49 years). In men, 40% of nondrinkers and 28% of drinkers had fatty liver. 

Alcohol consumption was inversely associated with fatty liver (adjusted odds ratio, 0.54; 95% confidence interval, 0.46–0.63). The prevalence of fatty liver in each category of drinking frequency was 38% (1–3 days/week), 29% (4–6 days/week), and 24% (daily drinking); there was a significant inverse correlation between drinking frequency and the prevalence of fatty liver (P < 0.001). In women, 16% of nondrinkers and 10% of drinkers had fatty liver. Drinking less than 20 g on 1–3 days/week was associated with low prevalence of fatty liver (adjusted odds ratio, 0.47; 95% confidence interval, 0.23–0.96).

Alcohol consumption appears to protect against non-alcoholic fatty liver disease.




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Request Reprint E-Mail:   

yiwasaki@cc.okayama-u.ac.jp

Alcohol Concern report: A&E action to address alcohol harms to young people

A new Alcohol Concern briefing report outlines steps A&E departments can take to provide harm reduction to young people who attend hospital as a result of their drinking:   > > > >   Read More

Impulsiveness and insula activation during reward anticipation are associated with genetic variants in GABRA2 in a family sample enriched for alcoholism

Genetic factors, externalizing personality traits such as impulsivity, and brain processing of salient stimuli all can affect individual risk for alcoholism. One of very few confirmed genetic association findings differentiating alcoholics from non-alcoholics is with variants in the inhibitory γ-amino butyric acid α2 receptor subunit (GABRA2) gene.

Here we report the association of two of these GABRA2 variants with measures of alcohol symptoms, impulsivity and with insula cortex activation during anticipation of reward or loss using functional magnetic resonance imaging (fMRI). 

In a sample of 173 families (449 subjects), 129 of whom had at least one member diagnosed with alcohol dependence or abuse, carriers for the G allele in two single-nucleotide polymorphisms (SNPs) and haplotypes were more likely to have alcohol dependence symptoms (rs279858, P=0.01; rs279826, P=0.05; haplotype, P=0.02) and higher NEO Personality Inventory-Revised (NEO-PI-R) Impulsiveness scores (rs279858, P=0.016; rs279826, P=0.012; haplotype, P=0.032) with a stronger effect in women (rs279858, P=0.011; rs279826, P=0.002; haplotype, P=0.006), all P-values are corrected for family history and age. 

A subset of offspring from these families (n=44, 20 females), genotyped for GABRA2, participated in an fMRI study using a monetary incentive delay task. Increased insula activation during reward (r²=0.4; P=0.026) and loss (r²=0.38; P=0.039) anticipation was correlated with NEO-PI-R Impulsiveness and further associated with the GG genotype for both SNPs (P's<0.04). 

Our results suggest that GABRA2 genetic variation is associated with Impulsiveness through variation of insula activity responses, here evidenced during anticipatory responses.

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Request Reprint E-Mail:  svillafu@umich.edu  

Braking and Accelerating of the Adolescent Brain

Adolescence is a developmental period often characterized as a time of impulsive and risky choices leading to increased incidence of unintentional injuries and violence, alcohol and drug abuse, unintended pregnancy, and sexually transmitted diseases. 

Traditional neurobiological and cognitive explanations for such suboptimal choices and actions have failed to account for nonlinear changes in behavior observed during adolescence, relative to childhood and adulthood. 

This review provides a biologically plausible conceptualization of the mechanisms underlying these nonlinear changes in behavior, as an imbalance between a heightened sensitivity to motivational cues and immature cognitive control. 

Recent human imaging and animal studies provide a biological basis for this view, suggesting differential development of subcortical limbic systems relative to top-down control systems during adolescence relative to childhood and adulthood. 

This work emphasizes the importance of examining transitions into and out of adolescence and highlights emerging avenues of future research on adolescent brain development.

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Critical thoughts on current rodent models for evaluating potential treatments of alcohol addiction and withdrawal

Despite years of neurobiological research that have helped to identify potential therapeutic targets, we do not have a reliable pharmacological treatment for alcoholism. There are a range of possible explanations for this failure, including arguments that alcoholism is a spectrum disorder and that different population subtypes may respond to different treatments. This view is supported by categorisations such as early- and late-onset alcoholism, whilst multifactorial genetic factors may also alter responsivity to pharmacological agents. Furthermore, experience of alcohol withdrawal may play a role in future drinking in a way that may distinguish alcoholism from other forms of addiction.

Additionally, our neurobiological models, based largely upon results from rodent studies, may not mimic specific aspects of the human condition and may reflect different underlying phenomena and biological processes from the clinical pattern. As a result, potential treatments may be targeting inappropriate aspects of alcohol-related behaviours. Instead, we suggest a more profitable approach is a) to identify well defined intermediate behavioural phenotypes in human experimental models that reflect defined aspects of the human clinical disorder, and b) to develop animal models that are homologous with those phenotypes in terms of psychological processes, and underlying neurobiological mechanisms.

This review describes an array of animal models currently used in the addiction field, and what they tell us about alcoholism. We will then examine how established pharmacological agents have been developed using only a limited number of these models, before describing some alternative novel approaches to achieving homology between animal and human experimental measures.

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Request Reprint E-Mail:  t.l.ripley@sussex.ac.uk