Alcohol diagnoses among older Tennessee Medicare beneficiaries: race and gender differences

These analyses bolster a sparse body of research focusing on the rate of alcohol disorders among older adults, particularly race and gender subgroups.

 

We based the study on cross-sectional data from all Medicare billed physician/patient encounters. Analyses of these data included cross-tabulations, difference of means tests, and difference of proportions tests, logistic regression and multinomial logistic regression. These analyses were based Medicare billing records from physician/patient encounters in Tennessee. Data included Tennessee Medicare billings beneficiaries enrolled in Medicare Part B, who saw a physician at least once in 2000. Patients with billings containing ICD-9 codes: 303 (alcohol abuse), 305 (alcohol dependence), 291 (alcohol psychosis), or 571.1-571.3 (alcohol-related liver disease including cirrhosis of the liver) as to primary diagnosis were considered alcohol-disordered.

 

Analyses reveal the overall rate of alcohol disorders, subgroup variation in rates and differences in pattern of specific disorders. Merely 0.04% of Tennessee Medicare beneficiaries were diagnosed with any type of alcoholism, a rate much lower than those reported in previous studies. Rates of alcohol disorders varied across groups, with significantly higher rates for Black men. The type alcohol disorder also varied across groups.

 

Many encounters with the medical system result in missed opportunities to identify and treat alcohol disorders, a significant risk factor among older adults. Alcoholism both triggers and exacerbates many chronic conditions among older adults. The earlier in the disease trajectory the more of these conditions could be prevented or more efficiently managed, resulting in substantial savings in health care costs.


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Request Reprint E-Mail:   bkilbourne@mmc.edu   

Mothers in Recovery: An Occupational Perspective

The purposes of this study were to discover the stories of mothers regarding their journeys to addiction and through recovery, to explore the impact of addiction on the occupational performance of mothers and to identify the factors perceived by these mothers as important in their treatment.

A narrative inquiry with thematic analysis of data was utilized; semi-structured interviews were conducted with 10 women in treatment for alcohol or other drug addiction who were all mothers of minor children.

Alterations in occupational identity, occupational performance patterns and performance capacity were revealed. Environmental elements contributing to addiction and those important in recovery were identified and included structure (or the lack of it) and the persons populating the social environment.

This qualitative study is not generalizable and should be viewed as relevant to these informants in this context; participants had histories of chronic substance addiction and are not representative of all addictions patients. Findings can be viewed within the context of other research to help enrich the reader's understanding of the complexity of issues.

Further research is recommended to test the efficacy of occupational therapy interventions for substance addictions. Possible intervention studies might include those focused on environmental structure, exploration of interests in treatment and co-occupations of mother and child. 


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Request Reprint E-Mail:    lmartin@fgcu.edu 

Cnidoscolus aconitifolius Leaf Extract Protects against Hepatic Damage Induced by Chronic Ethanol Administration in Wistar Rats

This study focused on the possible protective effect of Cnidoscolus aconitifolius leaf extract (CA) against hepatic damage induced by chronic ethanol administration in rats.  

Male Wistar rats were distributed into seven groups of six rats each. The first group was the control, second group received 20% ethanol-only (7.9 g/kg), third and fourth groups were pre-treated with CA (100 and 200 mg/kg, respectively) before treatment with ethanol. The fifth and sixth groups received CA and kolaviron (KV; 200 mg/kg), respectively, while the seventh group received KV and ethanol. KV served as the reference antioxidant.

 

Ethanol-treated rats had significantly (P < 0.05) elevated serum and liver post-mitochondrial malondialdehyde, an index of lipid peroxidation. Ethanol toxicity lowered the antioxidant defense indices, such as reduced glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT). Specifically, the activities of hepatic SOD and CAT decreased by 48 and 51%, respectively, while the level of GSH decreased by 56%. In addition, serum total cholesterol, triglycerides and low-density lipoproteins-cholesterol levels were significantly (P < 0.05) elevated in ethanol-treated rats. Also, significant (P < 0.05) elevation in serum alanine and aspartate aminotransferases, and γ-glutamyl transferase activities were observed in ethanol-treated rats. Supplementation with CA significantly (P < 0.05) decreased the activities of liver marker enzymes, stabilized the lipid profiles and restored the antioxidants status of ethanol-treated rats. The activities of CA were comparable with KV in the ethanol-treated rats. This observation was supported by histopathological examination of liver slides.  

These findings suggest the hepatoprotective and antioxidant effects of CA leaf extract, which offered protection against ethanol-induced toxicity. 

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Request Reprint E-Mail:  aoadaramoye@yahoo.com   

A Randomized Clinical Trial of a Therapeutic Workplace for Chronically Unemployed, Homeless, Alcohol-Dependent Adults

To assess the efficacy of the Therapeutic Workplace, a substance abuse intervention that promotes abstinence while simultaneously addressing the issues of poverty and lack of job skills, in promoting abstinence from alcohol among homeless alcoholics. 

Participants (n = 124) were randomly assigned to conditions either requiring abstinence from alcohol to engage in paid job skills training (Contingent Paid Training group), offering paid job skills training with no abstinence contingencies (Paid Training group) or offering unpaid job skill training with no abstinence contingencies (Unpaid Training group).  

Participants in the Contingent Paid Training group had significantly fewer positive (blood alcohol level ≥ 0.004 g/dl) breath samples than the Paid Training group in both randomly scheduled breath samples collected in the community and breath samples collected during monthly assessments. The breath sample results from the Unpaid Training group were similar in absolute terms to the Contingent Paid Training group, which may have been influenced by a lower breath sample collection rate in this group and fewer reported drinks per day consumed at intake. 

Overall, the results support the utility of the Therapeutic Workplace intervention to promote abstinence from alcohol among homeless alcoholics, and support paid training as a way of increasing engagement in training programs. 

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Request Reprint E-Mail:   ksilverm@jhmi.edu 

Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Recent Drinking in Alcohol-Dependent Outpatients Treated with Acamprosate or Placebo

Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are sensitive and specific biomarkers for recent alcohol ingestion. This study compared urinary EtG and EtS measurement with self-reports for detection of prior drinking in alcohol-dependent outpatients treated with the anti-craving medication acamprosate or placebo.  

Alcohol-dependent outpatients (26 women, 30 men) were randomized to 21 days of oral acamprosate (2 g/day) or placebo treatment in a double-blind design. They were instructed to refrain from drinking during the study. Return visits to the ward for blood and urine sampling and filling out questionnaires were made on Day 7, 14 (urine sample optional) and 22 (urine sample mandatory). EtG and EtS were determined by liquid chromatography-mass spectrometry.

On the first day (Day 0), 72% of all patients (acamprosate 65%, placebo 78%) tested positive for recent drinking according to urinary EtG (reporting limit ≥0.5 mg/l) and EtS (≥0.1 mg/l). On the final day (Day 22), the frequency of positive tests was significantly reduced to 30% in the acamprosate group (P = 0.0374) and 33% for placebo (P = 0.0050). However, there was no difference between the treatment groups. When both groups were combined, the EtG (P = 0.025) and EtS (P = 0.015) concentrations were lower on the final day. Altogether, EtG and EtS were detected in 76 of 156 (49%) urine samples. When drinking in the day before sampling was admitted, 93% of urines tested positive; when drinking was denied, still 28% of the samples were positive.
 

These results confirmed the value of urinary EtG and EtS as reliable indicators of recent drinking during outpatient treatment of persons with alcohol-related problems, and as objective outcome measures when evaluating new alcohol treatment strategies and pharmacotherapies. 

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Request Reprint E-Mail:  anders.helander@ki.se  

Effect of acute ethanol and acute allopregnanolone on spatial memory in adolescent and adult rats

The effects of ethanol differ in adolescent and adult rats on a number of measures. The evidence of the effects of ethanol on spatial memory in adolescents and adults is equivocal. Whether adolescents are more or less sensitive to ethanol-induced impairment of spatial memory acquisition remains unclear; with regard to the effects of acute ethanol on spatial memory retrieval there is almost no research looking into any age difference. 

Thus, we examined the effects of acute ethanol on spatial memory in the Morris Watermaze in adolescents and adults. Allopregnanolone (ALLO) is a modulator of the GABAA receptor and has similar behavioral effects as ethanol. We sought to also determine the effects of allopreganolone on spatial memory in adolescent and adults. 

Male adolescent (post natal [PN]28–30) and adult (PN70–72) rats were trained in the Morris Watermaze for 6 days and acute doses of ethanol (saline, 1.5 and 2.0g/kg) or ALLO (vehicle, 9 and 18mg/kg) were administered on Day 7. A probe trial followed on Day 8. 

As expected, there were dose effects; higher doses of both ethanol and ALLO impaired spatial memory. However, in both the ethanol and ALLO conditions adolescents and adults had similar spatial memory impairments. 

The current results suggest that ethanol and ALLO both impair hippocampal-dependent spatial memory regardless of age in that once learning has occurred, ethanol or ALLO does not differentially impair the retrieval of spatial memory in adolescents and adults. 

Given the mixed results on the effect of ethanol on cognition in adolescent rats, additional research is needed to ascertain the factors critical for the reported differential results.

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Request Reprint E-Mail:  dbmatthews@ntu.edu.sg  

GABA transport modulates the ethanol sensitivity of tonic inhibition in the rat dentate gyrus

In recent years, the effect of ethanol on tonic inhibition mediated by extrasynaptic GABAA receptors (GABAARs) has become a topic of intensive investigation and some controversy. The high ethanol sensitivity of extrasynaptic GABAA receptors containing the δ subunit combined with the role of tonic inhibition in maintaining the background inhibitory “tone” in hippocampal circuits has suggested that they may play a key role mediating certain behavioral effects of ethanol, including those related to learning and memory. 

We have found that ethanol disrupts learning and learning-related hippocampal function more potently in adolescent animals than in adults and that ethanol promotes extrasynaptic receptor-mediated GABAergic tonic currents more potently in adolescents than in adults. However, there have been no studies of potential mechanisms that may underlie the enhanced ethanol sensitivity of the tonic current in adolescents. 

In this study, we recorded GABAA receptor-mediated tonic currents in dentate gyrus granule cells in hippocampal slices from adolescent and adult rats. As previously reported, we found that ethanol potentiated the currents more efficaciously in cells from adolescents than in those from adults. We also found that the GAT-1 blocker NO-711 eliminated this developmental difference in ethanol sensitivity. 

These findings suggest that regulation of ambient GABA by GABA transporters may contribute to the difference in ethanol sensitivity between adolescents and adults.

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Request Reprint E-Mail:   rebekah.fleming@duke.edu  

Selected impulsivity facets with alcohol use/problems: The mediating role of drinking motives

Impulsivity is associated with alcohol use and related problems, yet limited research has examined the different facets of impulsivity with these outcomes. 

This study aimed to examine whether sensation seeking, positive urgency, and negative urgency, as separate constructs, would differentially predict alcohol use/problems, and to investigate whether specific drinking motives would mediate these relationships. Self-reported data from an online survey of undergraduate drinkers (n = 317) was used in the current study.

Findings indicate that sensation seeking and the urgency traits represent unique personality constructs in the prediction of alcohol use/problems, and should be considered separately in future research and when designing prevention and intervention strategies.


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Request Reprint E-Mail:  amanda.george@canberra.edu.au  

8th annual International Network on Brief Interventions for Alcohol Problems (INEBRIA) Conference

In 2011, the International Network on Brief Interventions for Alcohol Problems (INEBRIA) will hold it’s annual conference in the United States for the first time. 

 

8th annual INEBRIA Conference September 21-23, 2011 Liberty Hotel, Boston, MA

September 22-23- New Frontiers: Translating Science to Enhance Health (INEBRIA Conference)

September 21 – Implementing and Sustaining Alcohol and Other Drug Screening and Brief Intervention (AOD-SBI) Meeting: Lessons from Large Scale Efforts

These conferences will communicate new findings from research on screening and brief intervention (SBI, also known as early identification and brief intervention, EIBI), foster professional collaborations, and facilitate the development and dissemination of SBI research with a particular focus on implementation and sustainability.

 

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What Time Do You Want it to Be? Finessing Science, Part Two

In the first segment of this post, Ron Roizen explored the congenial relationship between the free and easy scientific method that prevailed at the Yale School during the late 1940s and Marty Mann’s message-driven National Council on Alcoholism. The second installment in his story brings in another character– Alcoholics Anonymous– and shows how they all held hands.   > > > >   Read More

Effects of Policies to Restrict Malt Liquor Sales on Neighborhood Crime

We examined the effectiveness of malt liquor sales restrictions adopted in 2005 in three liquor stores in a large Midwestern U.S. city. 

We hypothesized that the restrictions would be associated with crime reductions in adjacent neighborhoods. Using Poisson regression modeling, we compared crime rates two years prior to, and two years following policy adoption. 

Findings were mixed; malt liquor restrictions were associated with reductions in disorderly conduct citations, but increases in larceny/theft, beyond citywide trends. 

Limitations and implications of our study are discussed, and further research suggested.



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Request Reprint E-Mail:    jones010@umn.edu. 

Changing Drinking Styles in Denmark and Finland. Fragmentation of Male and Female Drinking Among Young Adults

A traditional heavy intoxication-oriented drinking style, “heroic drinking,” is a central drinking practice in Denmark and Finland, especially among men. 

However, it seems that another drinking style leading to intoxication, “playful drinking,” has become more prevalent in Denmark as well as in Finland. Playful drinking is characterized by self-presentations in diverse forms of game situations in which you need to play with different aspects of social and bodily styles. 

We approach the positions of heroic drinking and playful drinking among young adults (between 17 and 23 years) in Denmark and Finland by analyzing how they discuss these two drinking styles in focus groups (N = 16).

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Request Reprint E-Mail:  jd@crf.au.dk.   

Heavy Drinking, Perceived Discrimination, and Immigration Status Among Filipino Americans

Filipino American drinkers (N = 1,443) in Honolulu and San Francisco were selected from the 1998–1999 Filipino American Community Epidemiological Survey to examine the association between perceived discrimination and heavy drinking behavior by immigration status. 

 

Results indicate that living in San Francisco, lower religious participation, and higher perceived discrimination were associated with increased odds for heavy drinking among US-born individuals, whereas being male was a risk factor among foreign-born individuals. 

 

Thus, perceived discrimination and immigration status should be considered when designing prevention and intervention strategies to address heavy drinking behavior in this population.

 

 

 

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Request Reprint E-Mail:   kimisok@umich.edu.

Underestimations of Blood Alcohol Concentration Predict Event-Specific Negative Consequences

The current study sought to establish in vivo misperception of blood alcohol concentration (BAC) as a predictor of event-specific alcohol-consumption-related negative consequences. 

During spring 2010, 225 (56.4% male) college students, who had consumed at least one alcoholic drink within the 2 hr prior to assessment, completed a questionnaire, gave a breath sample to assess breath alcohol content, and later completed a follow-up questionnaire. 

Underestimation of BAC was predictive of event-specific, alcohol-consumption-related negative consequences, over and above other factors including total drinks consumed. 

This study highlights the need for more focused BAC education strategies at American universities.

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Request Reprint E-Mail:  jlabrie@lmu.edu..   

Predictors and Outcome of Aftercare Participation of Alcohol and Drug Users Completing Residential Treatment

This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between 2004 and 2007 at Bellwood Health Services in Toronto, Canada. 

 

Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. 

 

The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. 

 

Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up.

 

Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.

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Request Reprint E-Mail:  jhambley@bellwood.ca. 

Hazardous Drinking and Drinking Patterns Among the Reindeer-Herding Sami Population in Sweden

The objective of this study was to investigate hazardous drinking among reindeer-herding Sami in Sweden. 

 

A cross-sectional questionnaire study was conducted in 2007, which included the Alcohol Use Disorder Identification Test. A total of 319 reindeer-herding Sami were compared with urban and rural reference populations of 1,393 persons. Data were analyzed with regard to population, gender, age group, education, anxiety, depression, and work-related stress.

The Sami population did not report a higher prevalence of hazardous drinking compared with the reference groups; however, subgroups of Sami men with symptoms of depression were revealed as at risk, in contrast to Sami women who were not found to be at risk at all. 

 

Limitations of the study are discussed.

 

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Request Reprint E-Mail:  niclas.kaiser@psychiat.umu.se.   

Predicting alcohol consumption in adolescence from alcohol-specific and general externalizing genetic risk factors, key environmental exposures and their interaction

Alcohol consumption is influenced by specific genetic risk factors for alcohol use disorders (AUDs), non-specific genetic risk factors for externalizing behaviors and various environmental experiences. We have limited knowledge of how these risk factors inter-relate through development.

Retrospective assessments in 1796 adult male twins using a life history calendar of key environmental exposures and alcohol consumption from early adolescence to mid-adulthood. Analysis by linear mixed models.

The importance of non-specific genetic risk factors on maximal alcohol consumption rose rapidly in early to mid-adolescence, peaked at ages 15–17 years and then declined slowly. Alcohol-specific genetic risk factors increased slowly in influence through mid-adulthood. We detected robust evidence for environmental moderation of genetic effects on alcohol consumption that was more pronounced in early and mid-adolescence than in later periods. Alcohol availability, peer deviance and low prosocial behaviors showing the strongest moderation effects. More interactions with environmental risk factors were seen for the non-specific externalizing disorder risk than for specific genetic risk for AUDs.

The impact of specific and non-specific genetic influences on alcohol consumption have different development trajectories. Genetic effects on alcohol use are more pronounced when social constraints are minimized (e.g. low prosocial behaviors or parental monitoring) or when the environment permits easy access to alcohol and/or encourages its use (e.g. high alcohol availability or peer deviance). Gene–environment interactions influencing alcohol intake may be more robust at younger ages, indicating greater plasticity of genetic influences early in the development of drinking patterns.

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Request Reprint E-Mail:  kendler@hsc.vcu.edu  

Interventions for alcohol-related offending by women: A systematic review

Treatment programmes specifically for women offenders are under-developed. A systematic review of studies that could inform interventions for alcohol-related offending by women is reported. 

Three questions were addressed: 1) What is the most up to date knowledge of ‘what works’ with females who commit alcohol-related offences? 2) What are the identifiable risk–needs factors for non-alcohol dependent women who commit offences involving alcohol misuse? 3) Are there differences between male and female alcohol-related offending?
 
Four studies addressed the effectiveness of psychosocial interventions; three addressed identifiable risk–needs; and 19 addressed differences between male and female offenders' alcohol-related offending. Heterogeneity of these studies precluded meta-analyses, and so a narrative synthesis method was used. 

There is insufficient evidence to answer the question of what treatment works with women who commit alcohol-related offences. 

Drunk-driving is most widely studied, and women offenders appear to have more psychosocial problems than men. Alcohol increases the likelihood of violence for both men and women, and, while the mechanisms whereby alcohol increases the likelihood of violence are likely the same in men and women, the effect may be moderated by gender-associated issues.

Again, women offenders appear to have more psychosocial problems than men. Implications for developing interventions are discussed.


 
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Request Reprint E-Mail:  Mary.McMurran@nottingham.ac.uk  

Polish Expert Conference 'Alcohol Policy in Poland and around Europe', 11-12 October 2011, Poznan Poland

The State Agency for Prevention of Alcohol Related Problems is organising an expert conference which will continue on the themes touched upon at the Swedish Presidency Expert Conference. It will be an opportunity to discuss the future of the Alcohol Strategy among policy makers at European, national and municipality levels as well as scientist, public health experts and representatives of the civil society.

The main themes of the conference will include:

- alcohol and cancer
- alcohol and heart disease
- alcohol and liver
- alcohol and violence
- economic aspect of alcohol related harm
- FASD diagnosis and prevention

Conference will focus on evidence based policy recommendations and recent research findings.   > > > >   Read More

Under the Influence: Protecting teens from the impact of alcohol marketing, 21 June 2011, European Parliament (Brussels)

Place: European Parliament (Brussels)
Date: Tuesday 21 June 2011
Time: 12h00 - 14h30
Room: A3E-2

Hosted by MEPs: Anna Hedh (S&D) and Marian Harkin (ALDE)

Alcohol is one of the most heavily marketed products on our shelves. 

Young people are an important target audience for the alcohol industry and they are exposed to unprecedented levels of sophisticated marketing, from mass media advertising to sponsorship of events, product placement, internet, merchandise, social networks etc. 

Alcohol marketing has a powerful impact on young people’s drinking behavior and undercut the efforts by public health authorities to reduce harmful drinking among youth.

The speakers will analyze the scientific evidence on the cumulative impact of alcohol marketing and will present the results of two recent European projects on how to better regulate the content and volume of marketing in order to protect young people.   > > > >   Read More

Convergent functional genomic studies of omega-3 fatty acids in stress reactivity, bipolar disorder and alcoholism

Omega-3 fatty acids have been proposed as an adjuvant treatment option in psychiatric disorders. Given their other health benefits and their relative lack of toxicity, teratogenicity and side effects, they may be particularly useful in children and in females of child-bearing age, especially during pregnancy and postpartum. A comprehensive mechanistic understanding of their effects is needed. 

Here we report translational studies demonstrating the phenotypic normalization and gene expression effects of dietary omega-3 fatty acids, specifically docosahexaenoic acid (DHA), in a stress-reactive knockout mouse model of bipolar disorder and co-morbid alcoholism, using a bioinformatic convergent functional genomics approach integrating animal model and human data to prioritize disease-relevant genes. 

Additionally, to validate at a behavioral level the novel observed effects on decreasing alcohol consumption, we also tested the effects of DHA in an independent animal model, alcohol-preferring (P) rats, a well-established animal model of alcoholism. 

Our studies uncover sex differences, brain region-specific effects and blood biomarkers that may underpin the effects of DHA. Of note, DHA modulates some of the same genes targeted by current psychotropic medications, as well as increases myelin-related gene expression. Myelin-related gene expression decrease is a common, if nonspecific, denominator of neuropsychiatric disorders. 

In conclusion, our work supports the potential utility of omega-3 fatty acids, specifically DHA, for a spectrum of psychiatric disorders such as stress disorders, bipolar disorder, alcoholism and beyond.

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Alcoholic leaf extract of Plectranthus amboinicus regulates carbohydrate metabolism in alloxan-induced diabetic rats

The present investigation was undertaken to explore the possible mechanisms of Plectranthus amboinicus leaf extract in alloxan-induced diabetic rats.

 Control and alloxan-induced diabetic albino rats received different treatments; orally control (vehicle), 200 mg/kg and 400 mg/kg of ethanol extract of Plectranthus amboinicus (PAEE) and 600 μg/kg of glibenclamide (standard) for 15 days. At the end of the experiment, the animals were sacrificed and enzyme activities of carbohydrate metabolism were measured in the liver.

Diabetic control rats showed a significant elevation (P < 0.001) in fasting blood glucose on successive days of the experiment as compared with their basal values, which was maintained over a period of 2 weeks. Daily oral treatment with PAEE showed a significant reduction (P < 0.001) in the blood glucose levels on successive days of the experiment as compared with their basal values. The most pronounced antihyperglycemic effect was obtained with the dose of 400 mg/kg. PAEE shows a dose-dependent reduction in gluconeogenic enzymes like glucose-6-phosphatase and fructose-1,6-disphosphatase. After 15 days of treatment with PAEE, glycolytic enzymes like phosphoglucoisomerase resulted in a significant increase with a concomitant significant decrease in the activities of aldolase. On the other hand, glucose-6-phosphate dehydrogenase was significantly improved in diabetic rats on administration of PAEE; the 400 mg/kg dose of PAEE elicited a more potent effect compared with the 200 mg/kg dose.

The results obtained in this study provide evidence of the antidiabetic activity of PAEE, mediated through the regulation of carbohydrate metabolic enzyme activities.

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Critique 043: Frequent moderate drinking of alcohol is associated with a lower risk of fatty liver disease – 23 May 2011

Forum Comments

Background: Excessive alcohol consumption is a leading cause of cirrhosis and other serious types of liver disease. On the other hand, the most common liver disease in many populations, fatty liver disease, is associated primarily with obesity and other features of the metabolic syndrome. And recent reports have consistently shown that moderate alcohol intake may not only not increase the risk, but may actually decrease the risk of this common disease.  > > > >   Read More

An observational study to determine the prevalence of alcohol use disorders in advanced cancer patients

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Observational studies in North America suggest alcohol dependence is a common problem in advanced cancer patients and is associated with a high burden of physical and psychological symptoms. The prevalence of all types of alcohol use disorders, and the relationship between alcohol use disorders and symptoms, has not been studied. 

This observational, cross-sectional study was designed to determine the prevalence of alcohol use disorders in patients with advanced cancer and establish if such patients have a higher symptom burden. 

Sequential patients referred to the palliative medicine team at a United Kingdom cancer centre completed the Alcohol Use Disorders Identification Test, Hospital Anxiety and Depression Scale (HADS) and Memorial Symptom Assessment Scale-Short Form (MSAS-SF). 

120 patients participated in the study. Twenty-two (18%) patients screened positively for the presence of an alcohol use disorder. This study found no significant association between alcohol use disorders and the presence of anxiety (P = 0.38) or depression (P = 0.81) on the HADS or the global distress index subscale (P = 0.142), physical symptom distress index subscale (P = 0.734), or the psychological distress index subscale (P = 0.154) on the MSAS-SF. Current smoking status was the only independent predictor for the presence of an alcohol use disorder (P < 0.001). Seven (6%) patients screened positively for high-risk alcohol use disorders. Current smoking status (P < 0.001) and male gender (p < 0.001) were independent predictors of this problem. 

 

Alcohol use disorders in this cohort of patients were not associated with a higher symptom burden, and the prevalence was lower than the general United Kingdom population.

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Request Reprint E-Mail: kath.webber@rmh.nhs.uk    

Use of AUDIT, and measures of drinking frequency and patterns to detect associations between alcohol and sexual behaviour in male sex workers in Kenya

Previous research has linked alcohol use with an increased number of sexual partners, inconsistent condom use and a raised incidence of sexually transmitted infections (STIs). However, alcohol measures have been poorly standardised, with many ill-suited to eliciting, with adequate precision, the relationship between alcohol use and sexual risk behaviour. This study investigates which alcohol indicator - single-item measures of frequency and patterns of drinking (>=6 drinks on 1 occasion), or the Alcohol Use Disorders Identification Test (AUDIT) - can detect associations between alcohol use and unsafe sexual behaviour among male sex workers.

A cross-sectional survey in 2008 recruited male sex workers who sell sex to men from 65 venues in Mombasa district, Kenya, similar to a 2006 survey. Information was collected on socio-demographics, substance use, sexual behaviour, violence and STI symptoms. Multivariate models examined associations between the three measures of alcohol use and condom use, sexual violence, and penile or anal discharge.

The 442 participants reported a median 2 clients/week (IQR=1-3), with half using condoms consistently in the last 30 days. Of the approximately 70% of men who drink alcohol, half (50.5%) drink two or more times a week. Binge drinking was common (38.9%). As defined by AUDIT, 35% of participants who drink had hazardous drinking, 15% harmful drinking and 21% alcohol dependence. Compared with abstinence, alcohol dependence was associated with inconsistent condom use (AOR=2.5, 95%CI=1.3-4.6), penile or anal discharge (AOR=1.9, 95%CI=1.0-3.8), and two-fold higher odds of sexual violence (AOR=2.0, 95%CI=0.9-4.9). Frequent drinking was associated with inconsistent condom use (AOR=1.8, 95%CI=1.1-3.0) and partner number, while binge drinking was only linked with inconsistent condom use (AOR=1.6, 95%CI=1.0-2.5).

Male sex workers have high levels of hazardous and harmful drinking, and require alcohol-reduction interventions. Compared with indicators of drinking frequency or pattern, the AUDIT measure has stronger associations with inconsistent condom use, STI symptoms and sexual violence. Increased use of the AUDIT tool in future studies may assist in delineating with greater precision the explanatory mechanisms which link alcohol use, drinking contexts, sexual behaviours and HIV transmission. 

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NIAAA Newsletter Spring 2011 • Issue 22

THIS ISSUE

• Bridging the Gap in Drug Development
• International Collaborations to Prevent Fetal Alcohol Spectrum Disorders
• APIS Announces Update of Alcohol Policy Information
• The Cool Spot Carnival: Teaching Teens About Alcohol
• Dr. Ralph Hingson Appointed Chair of WHO Task Force
• INEBRIA 8th Annual Conference Registration and Call for Abstracts Now Open
• The 2011 Jack Mendelson Honorary Lecture
• New Publications
• Personnel

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The Efficacy of Disulfiram for the Treatment of Alcohol Use Disorder

Alcohol use disorders (AUD) involving hazardous, harmful, and addictive misuse of alcohol are widespread in most parts of the world. The aim of this study was to review the effect of disulfiram in the treatment of patients with AUD. The effect of disulfiram was evaluated according to the primary outcome of an intake of alcohol below 30 and 20 g/d for men and women, respectively, as well as secondary outcomes such as days until relapse, alcohol intake, and numbers of drinking days.

A systematic review of the literature was conducted using MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL).

Eleven randomized controlled trials were included with a total of 1,527 patients. They compared disulfiram treatment with placebo, none or other abstinence-supportive treatments. Overall, 6 studies reported of a significant better effect on abstinence for patients treated with disulfiram. Six of 9 studies measuring secondary outcomes reported that patients treated with disulfiram had significantly more days until relapse and fewer drinking days, respectively. The quality of the included studies was moderate. Heterogeneity was significant in most of the meta-analyses, but valid results were found regarding the effect of disulfiram versus placebo over 12 months and unsupervised disulfiram versus other or no treatment. The vast majority of significant studies were of shorter duration, while only 3 studies of 12 months were significant regarding more days until relapse and/or reduction in drinking days.

Supervised treatment with disulfiram has some effect on short-term abstinence and days until relapse as well as number of drinking days when compared with placebo, none, or other treatments for patients with alcohol dependency or abuse. Long-term effect on abstinence has not been evaluated yet. However, there is a need for more homogeneous and high-quality studies in the future regarding the efficacy of disulfiram.


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Request Reprint E-Mail:  Lottehjort@hotmail.com   

Striatal Involvement in Human Alcoholism and Alcohol Consumption, and Withdrawal in Animal Models

Different regions of the striatum may have distinct roles in acute intoxication, alcohol seeking, dependence, and withdrawal.

The recent advances are reviewed and discussed in our understanding of the role of the dorsolateral striatum (DLS), dorsomedial striatum (DMS), and ventral striatum in behavioral responses to alcohol, including alcohol craving in abstinent alcoholics, and alcohol consumption and withdrawal in rat, mouse, and nonhuman primate models.

Reduced neuronal activity as well as dysfunctional connectivity between the ventral striatum and the dorsolateral prefrontal cortex is associated with alcohol craving and impairment of new learning processes in abstinent alcoholics. Within the DLS of mice and nonhuman primates withdrawn from alcohol after chronic exposure, glutamatergic transmission in striatal projection neurons is increased, while GABAergic transmission is decreased. Glutamatergic transmission in DMS projection neurons is also increased in ethanol withdrawn rats. Ex vivo or in vivo ethanol exposure and withdrawal causes a long-lasting increase in NR2B subunit-containing NMDA receptor activity in the DMS, contributing to ethanol drinking. Analyses of neuronal activation associated with alcohol withdrawal and site-directed lesions in mice implicate the rostroventral caudate putamen, a ventrolateral segment of the DMS, in genetically determined differences in risk for alcohol withdrawal involved in physical association of the multi-PDZ domain protein, MPDZ, with 5-HT_2C receptors and/or NR2B.
 

Alterations of dopaminergic, glutamatergic, and GABAergic signaling within different regions of the striatum by alcohol is critical for alcohol craving, consumption, dependence, and withdrawal in humans and animal models.



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Do Alcohol-dependent Individuals with DRD2 A1 Allele Have an Increased Risk of Relapse? A Pilot Study

The TaqIA polymorphism of the dopamine D2 receptor (DRD2) gene has been extensively studied in relation to alcoholism, and the TaqI A1 allele appears to be over-represented in alcohol-dependent individuals. In a recent study, this allele has also been associated with a highly increased mortality rate in alcohol-dependent individuals. In the present study, we investigated whether the TaqI A1 allele of the DRD2 gene region was associated with a higher relapse rate in alcohol-dependent individuals.  

Adult women (n = 10) and men (n = 40) with a diagnosis of alcohol-dependence were recruited from two Swedish 12-step treatment units for alcoholism. Subjects were genotyped for the TaqIA polymorphism. On average, 1½ year after the end of the treatment program, subjects were re-interviewed by using the alcohol-related items from the Addiction Severity Index follow-up version. 

Thirty-three (66%) subjects self-reported relapse and 17 (34%) abstinence during the follow-up period. Thirty-sex percent (18/50) were carriers of the A1 allele of the DRD2 gene region, and 64% (32/50) were non-carriers. Among the carriers of the A1 allele, 89% (16/18) reported relapse in contrast to 53% (17/32) in the non-carriers (P = 0.01; odds ratio = 7.1). 

The present study is, to our knowledge, the first report of an association between the TaqI A1 allele and a substantially increased relapse rate. It should be emphasized that the number of subjects is relatively small, and this investigation should therefore be considered as a pilot study. 

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The Acute Effect of Ethanol on Adrenal Cortex in Female Rats—Possible Role of Nitric Oxide

The present study was designed to investigate a possible role of endogenous nitric oxide (NO) in the adrenal response to an acute alcohol administration in female rats. To this end, N^ω-nitro-l-arginine-methyl ester (l-NAME), a competitive inhibitor of all isoforms of NO synthase, was used. 

Adult female Wistar rats showing diestrus Day 1 were treated with: (a) ethanol (2 or 4 g/kg, intraperitoneally); (b) l-NAME (30 or 50 mg/kg, subcutaneously) followed by either ethanol or saline 3 h later. Untreated and saline-injected rats were used as controls. The animals were killed 30 min after last injection. Adrenal cortex was analyzed morphometrically, and plasma levels of adrenocorticotropic hormone (ACTH) and serum concentrations of corticosterone were determined.

 

Acute ethanol treatment enhanced the levels of ACTH and corticosterone in a dose-dependent manner. Stereological analysis revealed that acute alcohol administration induced a significant increase in absolute volume of the cortex and the zona fasciculata (ZF). In addition, ethanol at a dose of 4 g/kg increased volume density and length of the capillaries in the ZF. However, other stereological parameters were unaffected by alcohol exposure. Pretreatment with both doses of l-NAME had no effect on ethanol-induced changes. 

Obtained findings indicate that acute ethanol treatment stimulates the activity of the adrenal cortex and that this effect is not mediated by endogenous NO in female rats under these experimental conditions. 

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