To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, April 23, 2011

Alcohol and HIV/AIDS: Intertwining Stories

Human immunodeficiency virus (HIV)—the pathogen responsible for the current pandemic of acquired immune deficiency syndrome (AIDS)—targets the body’s immune system. HIV infection puts a person at risk for a multitude of diseases that someone with a healthy immune system generally would fight off. When HIV was recognized in the 1980s, testing positive for HIV infection was, in fact, a death sentence. Now, however, the availability of anti-HIV medications has made living with the virus a reality. Patients who stick to a careful medication regimen (i.e., taking several medicines at specific times throughout the day) may live from 20 and 40 years with HIV and do not always die of AIDS-related illnesses.

People with HIV are now living longer and healthier lives. Nevertheless, many challenges remain in preventing both infection with the virus and progression of the disease. One of the many factors that thwarts efforts to prevent the spread of the infection and the treatment of infected patients is the use and abuse of alcohol by those who are at risk for infection or who already are infected. Scientists are gaining a better understanding of the complex relationship between alcohol consumption and HIV infection. Abusing alcohol or other drugs can impair judgment, leading a person to engage in risky sexual behaviors. People who drink also tend to delay getting tested for HIV and, if they do test positive, tend to postpone seeking treatment. When receiving treatment, they may have difficulty following the complex medications regimen. All of these factors increase the likelihood that an infected person will infect others or will go on to develop AIDS.

Alcohol, then, occupies a prominent place in the HIV/AIDS landscape. This Alcohol Alert outlines the role that alcohol has in HIV/AIDS prevention, transmission, and disease progression and touches on recent efforts to reduce these strong, yet preventable, effects.   > > > >  Read More

Friday, April 22, 2011

What do We Know about the Economic Impact of Fetal Alcohol Spectrum Disorder? A Systematic Literature Review

The objective of this study was to conduct a systematic review of the literature related to the measurement of the economic impact of Fetal Alcohol Spectrum Disorder (FASD) in different countries and to categorize the available literature.  

A systematic literature search of the studies concerning the economic impact of FASD was conducted using multiple electronic bibliographic databases.
The literature on the economic burden of FASD is scarce. There are a limited number of studies found in Canada and the USA, and data from the rest of the world are absent. Existing estimates of the economic impact of FASD demonstrate significant cost implications on the individual, the family and society. However, these estimates vary considerably due to the different methodologies used by different studies.
Limitations and gaps in the existing methodologies of calculating the economic costs of FASD are discussed. It is evident that there is an urgent need to develop a comprehensive and sound methodology for calculating the economic impact of FASD to the society. 

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ADVANCE NOTICE Fifth National Biennial Conference on Adolescents and Adults with Fetal Alcohol Spectrum Disorder Social Justice - Moving Forward

WHEN April 18 - 21, 2012
WHERE The Hyatt Regency
655 Burrard Street, Vancouver, BC


This conference will provide a forum to share research, experience and practice in order to discuss how we can effectively sustain and enhance the lives of adolescents and adults with FASD, their families, service providers, and communities. Are we adequately addressing and supporting the needs and rights of adolescents and adults with FASD within our society? Do individuals with FASD have timely and appropriate access to health care, housing, social services, legal and civil justice and
employment? How can we build on the strengths of existing systems to identify and address barriers and move forward to provide effective ethical support? How do we provide focused and targeted approaches across services, and systems to create an integrated and collaborative approach to supporting individuals with FASD? These are the essential elements for social justice and we are just starting to explore and understand what will be required to put these into action.    > > > >   Read More

The 4th International Conference on Fetal Alcohol Spectrum Disorder The Power of Knowledge: Integrating Research, Policy, and Promising Practice Around the World

March 2-5, 2011
TheWestin Bayshore, Vancouver, BC, Canada

We are pleased to announce that the plenary sessions taken place at the FASD 2011 Conference is now available. Please click HERE to view videos of our plenary speakers and their powerpoints. Please note that only the presenters who gave us permission to upload their videos and/or their power points are featured on this website.

How safe are adolescents at Alcoholics Anonymous and Narcotics Anonymous meetings? A prospective investigation with outpatient youth

Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) have proven to be cost-effective recovery resources for adults and also appear helpful for youth.

However, anecdotal concerns about adolescents' safety at meetings have dampened enthusiasm regarding youth participation. Unfortunately, little information exists to evaluate such concerns. 

Outpatients (N = 127; 24% female) were assessed at intake and at 3, 6, and 12 months regarding perceived safety at AA/NA, experience of negative incidents, and reasons for nonattendance/discontinuation. 

By 12-month follow-up, 57.5% reported some AA/NA attendance with a combined lifetime exposure of 5,340 meetings. Of these, 21.9% reported at least one negative experience, which was more common among NA than AA attendees. 

Overall, youth reported feeling very safe at meetings, and ratings did not differ by age or gender. 

Reasons for discontinuation or nonattendance were unrelated to safety or negative incidents. 

Weighing risks against documented benefits, these preliminary findings suggest that referral to AA/NA should not be discouraged, but, similar to adults, youth experiences at meetings should be monitored.

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States and Cities – Brief Reports

This site contains a brief overview of the substance abuse and mental health issues within a single state, including the prevalence of substance use and abuse, treatment resources, mental health indicators, and SAMHSA grant funding. 

Two reports are available for each state: an overall profile of the state and an examination of gender differences among adolescents in the state.  > > > >   Read More

Thursday, April 21, 2011


Numerous studies have shown that alcohol intake  causes neuropsychological disorders that affect various brain structures. The «premature ageing» hypothesis proposes that the brain areas of alcoholics undergo deterioration similar to that observed in old age. 

We investigated whether alcohol abuse by young people (binge drinking) causes alterations comparable to some found in elderly people. 

Ninety-one people were divided into four groups: a) young people who abused alcohol; b) young people who drank alcohol in moderation; c) young people who did not drink alcohol; and d) elderly adults without any significant cognitive deterioration. All of them were assessed with a neuropsychological battery. 

We observed some similarities in the results obtained by young drinkers and the elderly participants, which would provide some support for the hypothesis of premature aging. The tasks that young drinkers performed worse were those related to executive functions, in which the prefrontal cortex plays an essential role. 

We also found differences between the two groups of young drinkers (moderate and high consumption), which leads us to believe that the amount of alcohol consumed and the pattern of consumption are factors to consider in relation to cognitive impairment.

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A randomized, controlled study of treatment for alcohol dependence in patients awaiting liver transplantation

Alcohol is the second most common cause of cirrhosis necessitating liver transplantation in the United States, yet rates of posttransplant drinking approach 50% and no controlled clinical trials of alcoholism treatment exist in this population. 

Eligible patients were randomly assigned to receive Motivational Enhancement Therapy (MET), or referral to local treatment sources (“treatment as usual” [TAU]). Addictive behavior, mood states, and general health were compared. Candor concerning alcohol use was encouraged by keeping drinking questionnaires in confidence, except in medical emergencies. Ninety-one subjects were studied; 46 received MET, 45 received TAU, 29 proceeded to transplantation (MET, n = 13; TAU, n = 16). A total of 69 subjects completed 24 weeks of observation, and 25 subjects were assessed at 96 weeks. 

No difference in study attendance was observed, but significantly more MET subjects attended 1 or more treatment sessions. 

Twenty-three subjects (25% of sample) drank after randomization but before transplant. Excluding an extreme outlier, MET drinkers had significantly fewer drinks per drinking days than TAU drinkers. 

Neither treatment plan resulted in significant variances in measures of psychosocial health. 

In conclusion, although MET afforded no significant benefit over TAU for mood or general health outcomes, this study provides some degree of support for MET to limit the quantity and frequency of pretransplant alcohol consumption among liver transplant candidates with alcohol dependence. However, because of the limited number of study subjects, these data must be interpreted cautiously. 

Further research to validate our findings or to identify better methods to identify and intervene with patients at risk of pretransplant and posttransplant drinking should continue. 

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Alcohol-Related Traffic Risk Behaviors Common Among College Students; Increase Significantly When They Reach Age 21

College students are significantly more likely to drink and drive after they turn 21, according to the College Life Study, a longitudinal study of undergraduate students attending a large mid-Atlantic university. Nearly one-half of underage students with access to a car admitted to driving after having had anything to drink. This percentage increased to 63% and 64% at ages 21 and 22 (see figure below). Similar increases at age 21 were found for riding with an intoxicated driver and driving while intoxicated. In addition, males were more likely than females to engage in any of these alcohol-related traffic risk behaviors. The authors suggests that it is time for “increased levels of high visibility enforcement to occur on or around college campuses” and that college campuses should “embrace and enforce zero tolerance policies that actively deter alcohol-related traffic risk behaviors” (p. 1477).  > > > >  Read More

Substance Use Disorder Education for Medical Students: Reflections on Our Betty Ford Institute Training Experience

This article shares the personal reflections of four 3rd-year medical students and two faculty members from the Texas Tech University Health Sciences Center who participated in the Summer Institute for Medical Students (SIMS) program provided by the Betty Ford Institute. 

The SIMS program is a one-week experiential program of participating in treatment activities with patients and their family members at the Betty Ford Center as well as educational instruction on addiction as a treatable disease. 

We would like to share how the SIMS experience affected us as professionals and individuals and how we will incorporate this experience in our future efforts as health care providers and educators.

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Brief Intervention for Emergency Department Patients with Alcohol Misuse: Implications for Current Practice

This article reviews studies and current practices of brief motivational intervention in the emergency department and identifies factors related to the effectiveness of brief intervention. 

Studies of brief intervention in the emergency department have had mixed results with most studies finding improvements in intervention and control groups. 

Most report brief intervention reducing alcohol's negative consequences without reducing consumption. 

Clinical practice is incorporating brief intervention as part of emergency treatment, and further research is needed to determine the factors responsible for the improvements noted in most studies.

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Brain Damage and Alcohol Dependence: How One May Influence the Other

Alcohol dependence is associated with brain cell loss and other changes leading to brain damage. The issue of which comes first, damage then dependence or vice versa, has not been established. 

This article provides an overview of our understanding of putative mechanisms underlying alcohol-induced brain damage and the possible involvement of these processes in alcoholism. 

Potential pharmacological adjuncts to treatment are discussed based on the effectiveness of anti-oxidant drugs in attenuating alcohol-induced neurodegeneration in an animal model of alcohol dependence and the effect of anti-inflammatory drugs on reducing excessive alcohol drinking.

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The Association of Blood Pressure and the Risk of Alcohol Use Disorders Among Smokers: Implications for Screening and Treatment

The current study explored the relation between blood pressure and the Alcohol Use Disorders Identification Test (AUDIT) scores among cigarette smokers and their nonsmoking peers. 

When participants were assessed collectively, only a modest positive correlation between blood pressure and AUDIT score was observed. 

When assessed by smoking status, however, smokers demonstrated a significant relation between higher blood pressure and increased AUDIT scores. 

Findings from this study suggest that there is an additive increase in blood pressure when increasing levels of alcohol use and related problems is combined with cigarette smoking. 

Screening and treatment implications are also discussed.

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Targeting Alcohol-Induced Epigenetic Changes: A Pharmacotherapeutic Approach for Alcoholism Treatment

Alcoholism is a significant worldwide health problem, and yet current therapeutic approaches do not consistently prevent relapse. Epigenetics is an emerging science, providing fresh insight into developmental mechanisms preceding many diseases. Research over the last decade has exposed ethanol as an agent capable of producing epigenetic changes associated with alcohol tolerance, dependence, craving, and tissue toxicity. 

This article outlines research into these ethanol-mediated changes and possible directions for future pharmacotherapy treatments for alcohol-related disorders.

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Assessment Reactivity: Can Assessment of Alcohol Use During Research be an Active Treatment?

Assessment reactivity refers to the finding that the action of having a behavior queried, monitored, or become a focus of attention during a research study independently can affect the expression of that behavior regardless of other interventions or manipulations used in the study. 

This article reviews recent efforts to empirically evaluate the independent impact of assessment reactivity on reducing alcohol use and problems in addition to examining how assessment reactivity may act to reduce alcohol use and related problems. 

The potential of taking advantage of assessment reactivity in alcohol use disorder treatment is discussed.

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Biological Mechanisms in Alcohol Dependence—New Perspectives

Neurobiological research in alcohol dependence has led to a new understanding of this addictive disease. While some important mechanisms like alterations in the mesolimbic reward system or changes in the hypothalamus–pituitary–adrenocortical axis have been well studied, other possible neurobiological mechanisms are still unrevealed. This applies for the role of specific neuroendocrinological pathways like the appetite-regulating system and the modification of gene expression, particularly the influence of genetic variants of transcription factors or epigenetic mechanism like DNA methylation or histone acetylation. 

This review describes the current knowledge regarding these factors, focusing particularly on the role of appetite- and volume-regulating hormones, the role of genetic variants of specific transcription factors and the function of epigenetic alterations in the genomic sequence of candidate genes for alcohol dependence. 

A further understanding of the influence of transcription factors and epigenetic regulation may help to elucidate the pathophysiological mechanisms in the neurobiology of alcohol dependence. 

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“Walking with the Wounded: Helping Sisters Overcome Addictions and Compulsive Behavior"

This workshop is for sisters in leadership who are responsible for community health care policies and services, and for personnel and ministry issues.

The workshops start at 9:00am Wednesday and end 3:00pm Friday.
Three dates to choose from:
May 4-6, 2011
June 1-3, 2011
October 5-7, 2011
Some topics to be covered include:
  • Knowledge and understanding of addiction problems and compulsive behavior in women religious
  • Skills for helping sisters from addictions and compulsive behavior
  • Confidential assistance preparing community policies related to wellness and recovery
  • A confidential forum for leadership to discuss concerns related to wellness and recovery in their community members
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Different alcohol exposures induce selective alterations on the expression of dynorphin and nociceptin systems related genes in rat brain

Molecular mechanisms of adaptive transformations caused by alcohol exposure on opioid dynorphin and nociceptin systems have been investigated in the rat brain.

Alcohol was intragastrically administered to rats to resemble human drinking with several hours of exposure: water or alcohol (20% in water) at a dose of 1.5 g/kg three times daily for 1 or 5 days. The development of tolerance and dependence were recorded daily. Brains were dissected 30 minutes (1- and 5-day groups) or 1, 3 or 7 days after the last administration for the three other 5-day groups (groups under withdrawal). 

Specific alterations in opioid genes expression were ascertained. In the amygdala, an up-regulation of prodynorphin and pronociceptin was observed in the 1-day group; moreover, pronociceptin and the kappa opioid receptor mRNAs in the 5-day group and both peptide precursors in the 1-day withdrawal group were also up-regulated. 

In the prefrontal cortex, an increase in prodynorhin expression in the 1-day group was detected. 

These data indicate a relevant role of the dynorphinergic system in the negative hedonic states associated with multiple alcohol exposure. 

The pattern of alterations observed for the nociceptin system appears to be consistent with its role of functional antagonism towards the actions of ethanol associated with other opioid peptides. 

Our findings could help to the understanding of how alcohol differentially affects the opioid systems in the brain and also suggest the dynorphin and nociceptin systems as possible targets for the treatment and/or prevention of alcohol dependence.

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Alpha4 subunit-containing GABAA receptors in the accumbens shell contribute to the reinforcing effects of alcohol

The α4βδ gamma-aminobutyric acid A receptor (GABAAR) has been proposed to mediate the rewarding effects of low-to-moderate concentrations of alcohol (ethanol) that approximate those achieved by social drinking. If this is true, then this receptor should be necessary for the reinforcing effects of ethanol as assessed in an instrumental self-administration procedure in which rats are trained to lever press for oral ethanol. 

We used viral-mediated RNA interference to transiently reduce expression of the α4 GABAAR subunit in the shell region of the nucleus accumbens (NAc). 

We found that responding for ethanol was significantly reduced after α4 reductions in the NAc shell, but not NAc core. This reduction was specific to ethanol, as responding for sucrose was not altered. 

The presence of ethanol was also required as unreinforced responding for ethanol in subjects previously trained to respond for ethanol (i.e. responding during an extinction test) was not altered. In addition, responding during reinforced sessions was not altered during the initial 5 minutes of the session, but decreased after 5 minutes, following multiple reinforced responses. Together, these findings indicate that the α4 GABAAR subunit in the NAc shell is necessary for the instrumental reinforcing effects of oral ethanol, further supporting a role for α4-containing GABAARs in the rewarding/reinforcing effects of ethanol. 

Possible pharmacological and 
non-pharmacological explanations for these effects are considered.

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Age, Period and Cohort Analysis of Light and Binge Drinking in Finland, 1968–2008

To analyse the effects of age, period and cohort (APC) on light and binge drinking in the general population of Finland over the past 40 years.

All analyses were based on six Drinking Habits Surveys between 1968 and 2008 of representative samples of the Finnish population aged between 15 and 69 (n = 16,400). The number of drinking occasions per year involving 1–2 drinks (light) and 4+ or 6+ drinks (binges) was used as a dependent variable in APC modelling. Descriptive cohort profiles and negative binomial models were used to assess the effects of APC. 

Descriptive cohort profiles differed for light and binge drinking. No substantial differences were found across cohort profiles for light drinking, while APC modelling predicted declining cohort and increasing period effects. Differences between cohorts were found for binge drinking, with predictions of slightly declining or increasing period and increasing cohort effects.  

Light drinking has increased over time for each cohort, with no substantial differences between cohort profiles. Binge drinking has increased with more recent cohorts and there are distinct differences between cohort profiles, especially among women. 

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Predicting and Measuring Premises-Level Harm in the Night-Time Economy

To assess associations between measures of premises-level alcohol-related harm and risk factors for harm.
Thirty-two licensed premises with a history of on-premises violent assault were recruited. An environmental survey of the drinking context of each premises was undertaken. Levels of patron intoxication were assessed using a breathalyser and a visual assessment of customers at each premises. Premise-level violence was identified via routine police and hospital emergency department data. Analyses examined associations between hospital and police data, surveyor and objective ratings of intoxication and the relationship between intoxication, drinking context and violence at the premises level.
Hospital and police data were associated. Aggregate levels of surveyor-rated intoxication were associated with aggregate alcometer breath alcohol levels. Analyses further suggest that premises with the highest levels of violence also had customers whose entry–exit change in intoxication was greatest, were open for longer hours, had alcohol promotions and had visible security staff present. 

Police and hospital data can be used to identify violent premises and to assess outcomes from premises-level interventions to reduce violence. Relatively low-cost observational survey methods can be used to identify high-risk premises, and can be used as outcomes for premises-level interventions. Features of premises that promote intoxication are associated with violence, suggesting that targeting resources at risky premises will likely address two public health concerns: excessive intoxication and assault-related injury. 

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Level and Change in Alcohol Consumption, Depression and Dysfunctional Attitudes among Females Treated for Alcohol Addiction

To examine whether individual changes in alcohol consumption among female alcoholics under treatment are predicted by level of and changes in depression and dysfunctional attitudes.

A total of 120 women who were treated for alcohol addiction at the Karolinska Hospital in Stockholm (Sweden) were assessed twice over a 2-year period using the Depression scale from the Symptom Checklist-90, the Alcohol Use Inventory and the Dysfunctional Attitude Scale (DAS). Latent growth curve analysis was used. 

Decrease in alcohol consumption, depression and dysfunctional attitude variables were found at group level. The results also showed significant individual variation in change. Changes in alcohol consumption were predicted by baseline alcohol drinking, as well as by level and changes in depression. Stronger reduction in depression was related to higher level of depression at baseline, and with reduction in dysfunctional attitudes. Different DAS sub-scales resulted in different magnitude of the model relations. Good treatment compliance was related to lower baseline level in depression, but also with higher baseline level in dysfunctional attitudes, and predicted stronger reduction in alcohol consumption. 

This paper shows the importance of incorporating both individual level and change in depression as predictors of change in alcohol consumption among subjects treated for alcohol addiction. Also, dysfunctional attitudes are both indirectly and directly related to treatment outcome. By incorporating alcohol consumption, depression and dysfunctional attitudes as targets of intervention, treatment compliance and outcome may be enhanced. 

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Do We Act upon What We See? Direct Effects of Alcohol Cues in Movies on Young Adults’ Alcohol Drinking

Ample survey research has shown that alcohol portrayals in movies affect the development of alcohol consumption in youth. Hence, there is preliminary evidence that alcohol portrayals in movies also directly influence viewers’ drinking of alcohol while watching movies. One process that might account for these direct effects is imitation. The present study therefore examined whether young people imitate actors sipping alcohol on screen. 

We observed sipping behaviours of 79 young adults (ages 18–25) watching a 60-min movie clip, ‘What Happens in Vegas’, in a semi-naturalistic home setting. Each of the 79 participants was exposed to 25 alcohol cues. Two-level logistic regression analyses were used to analyse whether participants in general imitated actors’ sipping during this clip. In addition, we applied proportional hazard models in a survival analysis framework (Cox regression) to test whether there was a difference in imitation of the cues between male and female participants, and to test whether the timing of the actors’ sipping throughout the movie played a role. 

The findings showed that participants were more likely to sip in accordance with the actors’ sipping than without such a cue. Further, we found that men were more likely to imitate actors’ sipping than females and that participants tended to respond to actors’ sipping at the beginning of the movie rather than at the end. 

Exposure to actors sipping alcohol in a movie seems to have an immediate impact on the drinking behaviour of viewers, via the mechanism of imitation. 

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The Relationship between Alcohol Consumption and Perceived Drunkenness: a Multilevel Cross-National Comparison in Samples of Adolescents

Alcohol consumption seems to be the best predictor of drunkenness and evidence suggests that individual and country factors influence the perception of drunkenness. This study examines if the relationship between volume of alcohol consumption and perceived drunkenness varies across European countries in samples of adolescents.  

Data came from the 2007 European School Survey Project on Alcohol and other Drugs (ESPAD). The analytical sample consisted of n = 60,114 (93%) 15–16-year-old students in 24 countries reporting alcohol consumption on the last drinking occasion. At the individual level, perceived drunkenness on the last drinking occasion was measured with a 10-point scale, alcohol consumption on the last drinking occasion with a beverage-specific quantity index. Six individual characteristics were assessed and used as control variables. At the country level, a total of five country-level variables were included in the study. Data were analysed using multilevel regression models simultaneously considering both individual level (Level 1) and group (country) level (Level 2) variables.
The relationship between alcohol consumption and perceived drunkenness varied across countries. This variation could partly be explained by drinking patterns and geographical region. 

The perception of the effects of alcohol in terms of drunkenness seems to vary across countries. Future studies should develop sound indicators.

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The Financial Burden of Substance Abuse in West Virginia: Final Report in Series 1

The growing financial cost of drug and alcohol abuse puts tremendous pressure on every social sector. The present report, part of a larger Family Funding Study project, is final in the series that examined the
cost of drug and alcohol abuse to West Virginia’s criminal justice, healthcare, education, welfare, and workforce systems. This final summative report incorporates estimates from all these sectors as well as includes data from the Governor’s Highway Safety Program (GHSP) and the Commission on Drunk Driving prevention (CDDP).

The first part of this report examines the magnitude of substance abuse in West Virginia. Although the overall picture is useful, delving into regional and age group variations may lead to more targeted and effective efforts to combat substance abuse in the state. Hence, the first section also examines regional and age group differences in substance use and abuse. The second part of this report will present the total cost of substance abuse in the state based on findings from the previous five reports and financialdata from the CDDP and GHSP database.

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Wednesday, April 20, 2011

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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Alcohol inhibition of the NMDA receptor function, long-term potentiation, and fear learning requires striatal-enriched protein tyrosine phosphatase

Alcohol's deleterious effects on memory are well known. Acute alcohol-induced memory loss is thought to occur via inhibition of NMDA receptor (NMDAR)-dependent long-term potentiation in the hippocampus. 

We reported previously that ethanol inhibition of NMDAR function and long-term potentiation is correlated with a reduction in the phosphorylation of Tyr1472 on the NR2B subunit and ethanol's inhibition of the NMDAR field excitatory postsynaptic potential was attenuated by a broad spectrum tyrosine phosphatase inhibitor. These data suggested that ethanol's inhibitory effect may involve protein tyrosine phosphatases. 

Here we demonstrate that the loss of striatal-enriched protein tyrosine phosphatase (STEP) renders NMDAR function, phosphorylation, and long-term potentiation, as well as fear conditioning, less sensitive to ethanol inhibition. 

Moreover, the ethanol inhibition was “rescued” when the active STEP protein was reintroduced into the cells. 

Taken together, our data suggest that STEP contributes to ethanol inhibition of NMDAR function via dephosphorylation of tyrosine sites on NR2B receptors and lend support to the hypothesis that STEP may be required for ethanol's amnesic effects. 

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Association between alcohol intake and risk for gastric cancer with regard to ALDH2 genotype in the Korean population

The relationship between alcohol intake and the risk for gastric cancer is not fully understood. The association between alcohol consumption and the risk for gastric cancer was investigated in the Korean population with the ALDH2 genotype. 

From 2003 to 2008, 445 patients with gastric cancer and 370 control subjects ≥50 years of age were included in the analysis. Logistic regression models including age, gender, education, smoking and drinking status, Helicobacter pylori infection and ALDH2 genotype were evaluated to estimate the adjusted odds ratios (ORs) for the development of gastric cancer. 

For all subjects, the risk for gastric cancer was increased in ex-drinkers [OR 1.68, 95% confidence interval (CI) 1.07–2.64], but not in current drinkers. Subjects with inactive ALDH2 *2 allele(s) showed a lower level of alcohol consumption than ALDH2 *1/*1 homozygotes (P < 0.001). Among the ALDH2 *1/*2 carriers (n = 243), current/ex-drinkers had a significantly increased risk for gastric cancer compared with never/rare drinkers (OR 2.80, 95% CI 1.51–5.19). Among heavy drinkers (n = 115), ALDH2 *1/*2 heterozygotes had a 4-fold increased risk for gastric cancer compared with *1/*1 homozygotes (OR 4.26, 95% CI 1.10–16.47); however, no risk increase was seen among never/rare drinkers. 

A dose–response association between alcohol intake and the risk for gastric cancer was not observed. However, ALDH2 polymorphisms were found to modify the susceptibility to the development of gastric cancer associated with alcohol intake, especially in case of ALDH2 *1/*2 genotype. The findings suggest an alcohol–ALDH2 genotype interaction in gastric carcinogenesis. 

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Critique 039: The role that alcohol drinking may play in the risk of cancer – 17 April 2011

Schűtze M, Boeing H, Pischon T, et al, Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ 2011; 342:d1584 doi: 10.1136/bmj.d1584 (Published 7 April 2011)

Forum Comments

Overview: This is a very well-done analysis of data collected from the large EPIC study. The investigators had good follow-up data over a mean of 8.8 years on more than 300,000 subjects. There were large numbers of subjects developing the most common types of cancer, but limited numbers of cases of upper aerodigestive cancer and liver cancer. The authors classified a number of cancers as “alcohol-attributable;” many of these were “alcohol-related,” with the latter meaning that other factors (smoking, diet, obesity, etc.) may be more important “causes” of such diseases. 

While this is a valuable dataset, the intentions of the authors in the preparation of this paper seem to focus mainly on indicting alcohol as a major cause of cancer. Many important observations that would be very helpful to clinicians (such as the role of moderate drinking, rather than intake greater than recommended, as a cause of cancer) are not presented clearly. 

For example, the authors give very detailed tables of the proportion of cancer related to alcohol intake, but do not explicitly indicate the numbers of cases that relate just to heavy alcohol intake, even though they state that among men the percentage of cancers related to > 2 drinks/day accounted for 57% to 87% of the total alcohol-attributable fractions; consumption > 1/day accounted for 40% to 98% of the fractions for women. It would have been preferable if they presented data separately for associations with cancer incidence for moderate drinking and for heavier drinking.

It is also unfortunate that the authors do not present stratified data (separately for non –smokers and smokers) to clearly indicate the role that smoking plays in the development of certain cancers. For upper aero-digestive cancers, in particular, it would be important to demonstrate how smoking, independently and in an interaction with alcohol, relates to such cancers. As stated by one Forum reviewer: ¨Smoking is a well-known confounder of the alcohol-cancer association. However, the authors do not acknowledge that The Million Women Study1 found no association between cancers of the upper aerodigestive tract and intake of alcohol in non-smoking women.” Another reviewer comments that the authors state that “In the groups of never smokers the number of cases of cancer was limited in the EPIC study, which led to a limited power to assess the association between the consumption of alcohol and risk of cancer in this subgroup.” The authors do not comment that this is a serious problem; this raises concerns that the a priori purpose of the study was just to demonstrate an association between any alcohol intake and cancer.   > > > >  Read More

Clinical Center Grand Rounds - Fetal Alcohol Syndrome

Fetal Alcohol Syndrome: Etiology, Epidemiology and Advances in Diagnosis
Kenneth R. Warren, PhD
Acting Director, NIAAA

Wednesday, April 27, 2011
12 noon - 1 p.m.

Lecture on videocast