Daily Relationship Between Event-Specific Drinking Norms and Alcohol Use: A Four-Year Longitudinal Study

This study examined how social-influence processes operate during specific drinking contexts as well as the stability and change in these processes throughout the college years.

Using a measurement-burst design, a hybrid of longitudinal and daily diary methods, we assessed the relationship between event-specific descriptive drinking norms and personal drinking. College students (N = 523) completed a baseline survey followed by a 30-day daily diary each year for up to the 4 study years. The baseline survey assessed participant gender and social anxiety, and the daily survey assessed personal drinking and perceived peer drinking (i.e., event-specific descriptive norms) during social drinking events.

Multilevel modeling revealed that men's social drinking slightly increased over the 4 years, whereas women's drinking remained steady. Further, on social drinking days when event-specific descriptive norms were high, students drank more, but this relationship was stronger for men than women and did not change over time. However, men's drinking norm perceptions increased across years, whereas women's decreased. Social anxiety did not moderate the relationship between norms and drinking.

We demonstrate that although gender differences exist in the stability and change of personal drinking, norms, and normative influence on drinking across the years of college, the acute social influence of the norm on personal drinking remains a stable and important predictor of drinking throughout college. Our findings can assist with the identification of how, when, and for whom to target social influence–based interventions aimed at reducing drinking.



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Request Reprint E-Mail: armeli@fdu.edu

Alcohol Use and Related Problems Among College Students and Their Noncollege Peers: The Competing Roles of Personality and Peer Influence

Although alcohol use and related problems are highly prevalent in emerging adulthood overall, college students drink somewhat more than do their peers who do not attend college. The personal or social influences underlying this difference, however, are not yet well understood. The present study examined whether personality traits (i.e., self-regulation and sensation seeking) and peer influence (i.e., descriptive drinking norms) contributed to student status differences.

At approximately age 22, 4-year college students (n = 331) and noncollege emerging adults (n = 502) completed web-based surveys, including measures of alcohol use, alcohol-related problems, personality, and social norms.

College students drank only slightly more heavily. This small difference, however, reflected personality suppression. College students were lower in trait-based risk for drinking, and accounting for traits revealed a stronger positive association between attending college and drinking more heavily. Although noncollege emerging adults reported greater descriptive drinking norms for social group members, norms appeared to more strongly influence alcohol use among college students. Finally, despite drinking less, noncollege individuals experienced more alcohol-related problems.

The association between attending college and drinking heavily may be larger than previously estimated, and it may be masked by biased selection into college as a function of both self-regulation and sensation seeking. Differing patterns of alcohol use, its predictors, and its consequences emerged for the college and noncollege samples, suggesting that differing intervention strategies may best meet the needs of each population.



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Request Reprint E-Mail: pdquinn@mail.utexas.edu

Differential Relationships Between Continuity of Care Practices, Engagement in Continuing Care, and Abstinence Among Subgroups of Patients With Substa

We examined whether patient subgroups with differing substance use disorders (SUDs) and psychiatric severity levels varied on engagement in continuing care and abstinence outcomes, the association of continuity of care practices to engagement, and the association of engagement to abstinence.

Staff in 28 Veterans Affairs SUD treatment programs used the Addiction Severity Index to assess 865 (98% male) patients' alcohol, other drug, and psychiatric problems at treatment entry. At discharge, staff supplied data on patients' treatment, motivation, and continuity of care practices. Administrative data assessed continuing care engagement. Six months after discharge, 673 patients completed a self-reported Addiction Severity Index. The sample comprised four SUD subgroups (abstinent from alcohol and other drugs, used alcohol only, used other drugs only, used alcohol and other drugs) and two psychiatric severity subgroups (high and moderate to low).

Patients receiving more continuity of care services engaged in continuing care longer. This association was weaker for the high psychiatric severity subgroup than for the moderate-to-low psychiatric severity subgroup. Engagement in continuing care was the most important predictor of abstinence overall. The positive association between engagement in continuing care and abstinence was strongest for the SUD subgroup using both alcohol and other drugs. This group had the lowest likelihood of abstinence if they engaged in little or no continuing care but showed the greatest increase in abstinence with longer continuing care engagement.

Subgroups' differential responsiveness to continuity of care services and engagement highlights the crucial importance of continuing care interventions to improve abstinence outcomes for certain subgroups of patients who use both alcohol and other drugs.



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Request Reprint E-Mail: Jeanne.Schaefer@med.va.gov.

A Comprehensive Longitudinal Test of the Acquired Preparedness Model for Alcohol Use and Related Problems

According to the acquired preparedness model (APM), personality traits related to disinhibition (i.e., impulsivity and sensation seeking) may influence the learning process, contributing to individual differences in cognitions (e.g., expectations about outcomes) that may contribute to engagement in and consequences of risk behaviors, including alcohol use. Although there is strong support for the APM, longitudinal studies have involved short-term follow-ups, and the relevance of the APM for alcohol-related consequences has not been clearly established.

Participants were 2,245 (59.9% female) incoming freshmen who completed the first of eight web-based surveys during the summer before college matriculation. Structural equation modeling was used to test a comprehensive longitudinal APM for both alcohol use and related consequences. Multigroup models were used to examine measurement and structural invariance by gender.

Positive (but not negative) alcohol expectancies during freshman year of college partially mediated the relation between senior year of high school disinhibition and both alcohol use and related problems during the fourth year of college, and multigroup models suggested that the relationships proposed in the APM operated similarly for women and men.

This study demonstrates the temporal relations proposed in the APM across a longer period (4 years) than in previous studies among a large sample of ethnically diverse students. Further, the results are the first to validate the APM with respect to drinking consequences while controlling for levels of alcohol use. The results lend support for brief interventions targeting positive alcohol expectancies, particularly for individuals high in trait disinhibition.




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Request Reprint E-Mail: wcorbin@asu.edu

Drug and Alcohol Involvement in Four Types of Fatal Crashes

The aim of this study was to explore the relationship of drunk and drugged driving to the occurrence of fatal crashes associated with speeding, failure to obey/yield, inattention, and seat belt nonuse.

We examined data for fatally injured drivers involved in single-vehicle crashes killed in states in which more than 79% of the drivers were tested for drugs other than alcohol and had a known result.

About 25% of the drivers tested positive for drugs, a figure almost double that estimated by the 2007 National Roadside Survey. Cannabinoids and stimulants each contributed to about 23% of the drug-positive results (6% among all fatally injured single-vehicle drivers). Stimulants more than cannabinoids were found to be associated with the four types of crashes under study. Some drugs showed a protective effect over the four crash types under study. Significant interactions between drugs and alcohol were observed. Stimulants contributed to the different types of fatal crashes irrespective of the levels of alcohol consumed by the drivers.

This study provides further vidence of a link between drug consumption and fatal crashes. It also opens the door to some interesting and sometimes unexpected questions regarding the way drugs contribute to crashes, which we found varies depending on the type of crash considered, the class of drug, and the presence of alcohol. Research is also needed on drugs that could have a protective effect on the occurrence of fatal crashes. These findings could be highly relevant to the design of drug-related traffic laws and programs targeted at curbing drugged driving.



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Drinking Style and Dating Violence in a Sample of Urban, Alcohol-Using Youth

This study examined childhood abuse, problem behavior, drinking style, and dating violence (DV). Our goal was to assess whether (a) alcohol use–related beliefs and behaviors ("drinking style") would be associated with DV perpetration and victimization, (b) drinking style would mediate the relationship between childhood abuse and DV, and (c) the drinking style–DV relationship would be attributable to propensity for problem behavior.

Cross-sectional survey data were collected from 456 youth ages 14–21 years who were patients in an urban emergency department. Participants were eligible if they were unmarried and reported past-month alcohol use and dating in the past year. By design, the sample was 50% female. Data were analyzed using structural equation modeling.

For both males and females, past-year DV was associated with a more risky drinking style, characterized by more frequent alcohol use, alcohol-aggression expectancies, drinking to cope, and beliefs that alcohol is disinhibiting and that being drunk provides a "time-out" from behavioral expectations. Drinking style mediated the childhood victimization–DV relationship for males and females. However, when propensity for problem behavior was included in the model, the effect of drinking style on DV was no longer significant. Substantial path differences for males and females were observed.

The current study examined adolescent drinking style as a potential mediator between childhood victimization and DV. Drinking style was associated with DV for males and females and mediated the relationship between childhood victimization and DV. The relationship between drinking style and DV appeared to reflect adolescents' propensity for problem behavior. Variations in males' and females' pathways to DV were observed. The implications of these findings are discussed.



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Request Reprint E-Mail: erothman@bu.edu

Trait and State Hostile Rumination Facilitate Alcohol-Related Aggression

his investigation attempted to determine whether trait and state hostile rumination functioned as risk factors for the relation between acute alcohol intoxication and aggression.

Participants were 516 social drinkers (252 men and 264 women). Trait hostile rumination was assessed using Caprara's Dissipation–Rumination Scale. Following the consumption of either an alcohol or a placebo beverage, participants were tested on a laboratory task in which electric shocks were received from and administered to a fictitious opponent under the guise of a competitive reaction-time task. Aggression was operationalized as the combined mean responses for shock intensity and duration across all trials. In a subset of the sample (n = 320), state hostile rumination was assessed following the aggression task using a self-report measure.

As expected, both trait and state measures acted as moderators. Specifically, acute alcohol intoxication was more likely to increase aggression in persons with higher trait and state hostile rumination scores compared with their

This was the first investigation to demonstrate that trait or state rumination significantly heighten the risk of intoxicated aggression. We believe that hostile rumination facilitates intoxicated aggression because ruminators have difficulty diverting their attention away from anger-provoking stimuli and related thoughts, thus making violent reactions more likely. Clinical and public health interventions would benefit by developing strategies to distract ruminative attention away from violence-promoting messages, especially when persons are under the influence of alcohol.




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Request Reprint E-Mail: borders@tcnj.edu

Paternal Drinking, Intimate Relationship Quality, and Alcohol Consumption in Pregnant Ukrainian Women

Maternal alcohol consumption during pregnancy and fetal alcohol spectrum disorders (FASDs) represent a significant public health problem. The influence of the male partner's alcohol consumption patterns and the quality of the partner's intimate relationship might be important factors to consider in the design of successful FASD prevention programs.

As part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders, 166 pregnant women in two regions in Ukraine participated in an in-person interview at an average gestational age of 18–19 weeks. Subjects were classified cross-sectionally as abstainers/light drinkers (n = 80), defined as low or no consumption of alcohol in the periconceptional period and none in the most recent 2 weeks of pregnancy; discontinuers (n = 43), defined as moderate to heavy alcohol use in the periconceptional period but none during the most recent 2 weeks of pregnancy; or continuing drinkers (n = 43), defined as continued moderate to heavy alcohol use within the most recent 2 weeks of pregnancy. Women also reported on their partner's drinking behavior and on the quality of their intimate relationship.

Heavy paternal drinking was significantly associated with both continuing maternal drinking in the most recent 2 weeks (adjusted odds ratio [OR] = 34.1; 95% CI [5.9, 195.8]) and being a risky drinker only around conception (adjusted OR = 27.0; 95% CI [5.0, 147.7]). In addition, women who consumed alcohol during pregnancy had lower mean scores for satisfaction with partners' relationship and ability to discuss problems (p < .05) compared with light drinkers/abstainers.

This study suggests that development of partner-based interventions, as opposed to those solely focused on maternal drinking, might be warranted as a strategy to prevent FASD.




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Request Reprint E-Mail: lbakhireva@salud.unm.edu

Evaluation of a Service Provider Short Course for Prevention of Fetal Alcohol Syndrome

South Africa has among the highest reported rates of Fetal Alcohol Syndrome (FAS) globally. Primary prevention targeting women at risk for alcohol-exposed pregnancies could substantially reduce the incidence of FAS.

We evaluated the effectiveness of a short training intervention to improve service providers' screening, identification, and management of women at risk for alcohol-exposed pregnancies.

Training to screen and counsel women at risk for alcohol-exposed pregnancies was offered to 86 service providers (95% of whom were female) in two municipalities in the Western Cape Province, South Africa. Effectiveness was evaluated through a before–after study of service providers' knowledge and confidence levels and a comparison of service providers' practices (assessed indirectly via service user exit interviews) at intervention and control clinics.

The proportion of service providers indicating that alcohol use during pregnancy is harmful to the fetus increased after training (23% vs. 67%; p < .001). After training, providers expressed significantly more confidence for four skills indicators related to the identification and management of women at risk for an alcohol-exposed pregnancy. Female clients at intervention clinics were more likely than those at the control clinics to receive alcohol advice (odds ratio [OR] = 2.13, 95% CI [1.27, 3.53]), counseling (OR = 1.3, 95% CI [1.05, 1.56]), and an offer of family planning (OR = 1.1, 95% CI [1.06, 2.10]) after the training. Time Group interaction variable analysis in multiple logistic regression modeling confirmed these effects as related to training.

A short training course based on brief motivational interviewing principles appears to be effective in building service provider capacity to better prevent and manage women at risk for alcohol-exposed pregnancies.



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Request Reprint E-Mail: Leslie.London@uct.ac.za

Monitoring Alcohol Marketing in Africa - MAMPA Project

To support governments decide on what measures to take regarding alcohol advertising, it is essential to provide insight into the impact of advertising, specifically in terms of volume, frequency, and content of alcohol advertising and promotion. The study on alcohol marketing was commissioned by the WHO Regional Office for Africa in 2010 and its findings generated data on alcohol advertising and promotion in Uganda, Nigeria, Ghana and Gambia. The content of advertisements and marketing styles appeal to young people. The results underline the need for countries to strengthen policy and legislation to restrict alcohol marketing.

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Parents Know Best, But Are They Accurate? Parental Normative Misperceptions and Their Relationship to Students' Alcohol-Related Outcomes

Parents often look to other parents for guidance, but how accurate are their perceptions? Expanding on existing normative literature to include parents of college students, this study first sought to determine whether parents accurately estimated the attitudes of other parents concerning their college student's alcohol-related behaviors.

The effect of these (mis)perceived injunctive norms on the alcohol-related attitudes and behaviors of the parents' own children was then examined.

Participants were 270 college student–parent dyadic pairs who completed independent online surveys. The student sample was 59% female; the parent sample was 78% female.

A structural equation model demonstrated that parents significantly overestimated other parents' approval of alcohol use by their respective child and, further, that these misperceptions strongly influenced parental attitudes toward their own child's drinking. Parental attitudes were subsequently found to be significantly associated with their child's attitudes toward drinking but were only marginally associated with the child's actual drinking, thereby underscoring the mediational effect of the child's attitudes.

This is the first study to document the influence of parental normative misperceptions regarding alcohol use by their college-age children, reinforcing the importance of parental attitudes on children's alcohol-related attitudes and behaviors in college. These findings support the need to complement student-based interventions with parent-based interventions aimed at increasing parental awareness and involvement. Further, the current findings indicate that normative interventions targeting parents offer a promising avenue by which to indirectly and positively influence college students' alcohol use.




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Request Reprint E-Mail: labrie@lmu.edu

Alcohol drinking and risk of subsequent hospitalisation with pneumonia

The dose-response relationship between alcohol consumption and pneumonia risk in healthy individuals is poorly understood.

We examined 22,485 males and 24,682 females from Denmark who were aged 50–64 yrs. Subjects were without major chronic diseases at baseline and had median 12 yrs follow-up for first-time hospitalisation with pneumonia.

1,091 (males) and 944 (females) had a pneumonia-related hospitalisation. Among males, the risk of pneumonia was increased for alcohol abstainers and those who drank large weekly amounts: Adjusted hazard ratios (HRs) for 0, 7–20, 21–34, 35–50, and >50 drinks per week were 1.49 (95% CI 1.00–2.21), 0.88 (0.76–1.03), 0.87 (0.72–1.05), 1.15 (0.93–1.44), and 1.81 (1.40–2.33), respectively, compared with 1–6 drinks per week. The association between high alcohol intake and pneumonia persisted after controlling for subsequent chronic diseases. Among females, HRs for 0, 7–20, 21–35, and >35 drinks weekly were 1.26 (0.89–1.79), 1.01 (0.88–1.17), 1.10 (0.88–1.37), and 0.54 (0.29–1.01), respectively. For the same moderate to high weekly alcohol amount, infrequent intake yielded higher pneumonia HRs than more regular intake in both sexes.

Regular moderate alcohol intake is not associated with increased risk of hospitalisation for pneumonia. High weekly alcohol consumption in males and infrequent heavy drinking in both sexes may increase pneumonia risk.

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Request Reprint E-Mail: j.kornum@rn.dk

Alcohol drinking and primary liver cancer: A pooled analysis of four Japanese cohort studies

Because studies of the association between alcohol intake and the risk of primary liver cancer use varying cut-off points to classify alcohol intake, it is difficult to precisely quantify this association by meta-analysis of published data. Furthermore, there are limited data for women in prospective studies of the dose-specific relation of alcohol intake and the risk of primary liver cancer.

We analyzed original data from 4 population-based prospective cohort studies encompassing 174,719 participants (89,863 men and 84,856 women). After adjustment for a common set of variables, we used Cox proportional hazards regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of primary liver cancer incidence according to alcohol intake. We conducted a meta-analysis of the HRs derived from each study.

During 1,964,136 person-years of follow-up, 804 primary liver cancer cases (605 men and 199 women) were identified. In male drinkers, the multivariate-adjusted HRs (95% CI) for alcohol intakes of 0.1-22.9, 23.0-45.9, 46.0-68.9, 69.0-91.9, and ≥92.0 g/day, as compared with occasional drinkers, were 0.88 (0.57-1.36), 1.06 (0.70-1.62), 1.07 (0.69-1.66), 1.76 (1.08-2.87), and 1.66 (0.98-2.82), respectively (P for trend = 0.015). In women, we observed a significantly increased risk among those who drank ≥23.0 g/day, as compared with occasional drinkers (HR: 3.60; 95% CI: 1.22-10.66).

This pooled analysis of data from large prospective studies in Japan indicates that avoidance of (1) heavy alcohol drinking (≥69.0 g alcohol/day) in men and (2) moderate drinking (≥23.0 g alcohol/day) in women may reduce the risk of primary liver cancer.

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Request Reprint E-Mail: tshimazu@ncc.go.jp

Influence of Liver Pathology on Markers of Postmortem Brain Tissue Quality

Postmortem brain tissue provides an important resource to investigate various brain disorders, including those resulting from the effects of alcohol abuse. Unlike the traditionally recognized confounders to tissue quality (e.g., coma, hypoxia), our understanding of the effects of liver disease is incomplete.

The aim of this study was to determine the effects of liver pathology, and in particular cirrhosis resulting in hepatic encephalopathy (HE), on 2 postmortem brain tissue quality markers, brain pH and RNA integrity.

We measured tissue quality markers in a cohort of alcohol abuse and control cases collected by the NSW Tissue Resource Centre. Cerebellar tissue was used to evaluate both brain pH and RNA quality (as indicated by the RNA integrity number: RIN). A histological assessment was performed on each case to exclude coexisting pathologies (e.g., cerebrovascular disease, hypoxic encephalopathy, neurodegenerative disease) and to assess the presence or absence of HE. Autopsy reports were reviewed for liver pathology and toxicology.

Analysis revealed that cases of alcohol abuse had a lower mean (±SD) brain pH, 6.46 (±0.3) as compared with the control mean 6.64 (±0.2). The mean RIN for the alcohol abuse group was 6.97 (±1.3) and controls 7.66 (±0.5). The severity of liver pathology affected both brain pH (p < 0.0001) and RIN (p < 0.0001). The comparison between cirrhotic cases highlighted increased degradation of RNA in cases with cirrhosis resulting in HE (p = 0.0095). A similar effect was seen on brain pH (p = 0.0019).

The results show that the presence of cirrhosis and, more so, HE reduces the pH and RIN of postmortem brain tissue.

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Request Reprint E-Mail: jillian.kril@sydney.edu.au

Alcohol in Pregnancy: Attitudes, Knowledge, and Information Practice Among Midwives in Denmark 2000 to 2009

Most pregnant women in Denmark say they have not talked to their midwives about alcohol in pregnancy, and they have mostly been advised that some alcohol intake is all right. From 1999 to 2007, the Danish National Board of Health advised pregnant women that some alcohol intake was acceptable. Since 2007, the recommendation has been alcohol abstinence.

The aim of this study was to describe the attitudes toward, knowledge about, and information practice concerning alcohol drinking in pregnancy among midwives in Denmark in 2000 and 2009 and how their answers related to the 2 different official recommendations at the time.

In 2000, we invited all midwives in the antenatal care center at Aarhus University Hospital. Ninety-four percent were interviewed about their attitudes toward and beliefs and knowledge about alcohol during pregnancy. Questions were also asked about information on alcohol provided to pregnant women. Identical questions were asked to all midwives (100%) in the antenatal care center in 2009.

In 2000, most midwives (69%) considered some alcohol intake in pregnancy acceptable, mostly on a weekly level, and only 28% advised abstinence. Binge drinking, on the other hand, was considered harmful by most. There was considerable inter-person variation in the participants’ attitudes and what they recommended to pregnant women. In 2009, substantially more midwives (48%) considered abstinence to be best, and significantly, more midwives (61%) gave this advice to pregnant women. Participants had received information on alcohol mostly in a professional context. Their knowledge about the official recommendations about alcohol was good, but many did not inform about the official recommendation.

The attitudes toward and beliefs and knowledge about drinking in pregnancy among midwives have changed along with a change in official policy. The change was mostly independent of personal characteristics of the midwives, including age, gender, and place of work.

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Request Reprint E-Mail: ukes@soci.au.dk

Positron Emission Tomography Imaging of Mu- and Delta-Opioid Receptor Binding in Alcohol-Dependent and Healthy Control Subjects

The endogenous opioid system plays a significant role in alcohol dependence. The goal of the current study was to investigate regional brain mu-opioid receptor (MOR) and delta-opioid receptor (DOR) availability in recently abstinent alcohol-dependent and age-matched healthy control men and women with positron emission tomography (PET) imaging.

Alcohol-dependent subjects completed an inpatient protocol, which included medically supervised withdrawal and PET imaging on day 5 of abstinence. Control subjects completed PET imaging following an overnight stay. PET scans with the MOR-selective ligand [¹¹C]carfentanil (CFN) were completed in 25 alcohol-dependent and 30 control subjects. Most of these same subjects (20 alcohol-dependent subjects and 18 controls) also completed PET scans with the DOR-selective ligand [¹¹C]methylnaltrindole (MeNTL).

Volumes of interest and statistical parametric mapping analyses indicated that alcohol-dependent subjects had significantly higher [¹¹C]CFN binding potential (BP_ND) than healthy controls in multiple brain regions including the ventral striatum when adjusting for age, gender, and smoking status. There was an inverse relationship between [¹¹C]CFN BP_ND and craving in several brain regions in alcohol-dependent subjects. Groups did not differ in [¹¹C]MeNTL BP_ND; however, [¹¹C]MeNTL BP_ND in caudate was positively correlated with recent alcohol drinking in alcohol-dependent subjects.

Our observation of higher [¹¹C]CFN BP_ND in alcohol-dependent subjects can result from up-regulation of MOR and/or reduction in endogenous opioid peptides following long-term alcohol consumption, dependence, and/or withdrawal. Alternatively, the higher [¹¹C]CFN BP_ND in alcohol-dependent subjects may be an etiological difference that predisposed these individuals to alcohol dependence or may have developed as a result of increased exposure to childhood adversity, stress, and other environmental factors known to increase MOR. Although the direction of group differences in [¹¹C]MeNTL BP_ND was similar in many brain regions, differences did not achieve statistical significance, perhaps as a result of our limited sample size. Additional research is needed to further clarify these relationships. The finding that alcohol-dependent subjects had higher [¹¹C]CFN BP_ND is consistent with a prominent role of the MOR in alcohol dependence.

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Request Reprint E-Mail: eweerts@jhmi.edu

Promoting Behavior Change from Alcohol Use Through Mobile Technology: The Future of Ecological Momentary Assessment

Interactive and mobile technologies (i.e., smartphones such as Blackberries, iPhones, and palm-top computers) show promise as an efficacious and cost-effective means of communicating health-behavior risks, improving public health outcomes, and accelerating behavior change.

The present study was conducted as a “needs assessment” to examine the current available mobile smartphone applications (e.g., apps) that utilize principles of ecological momentary assessment (EMA)—daily self-monitoring or near real-time self-assessment of alcohol-use behavior—to promote positive behavior change, alcohol harm reduction, psycho-education about alcohol use, or abstinence from alcohol.

Data were collected and analyzed from iTunes for Apple iPhone^©. An inventory assessed the number of available apps that directly addressed alcohol use and consumption, alcohol treatment, or recovery, and whether these apps incorporated empirically based components of alcohol treatment.

Findings showed that few apps addressed alcohol-use behavior change or recovery. Aside from tracking drinking consumption, a minority utilized empirically based components of alcohol treatment. Some apps claimed they could serve as an intervention; however, no empirical evidence was provided.

More studies are needed to examine the efficacy of mobile technology in alcohol intervention studies. The large gap between availability of mobile apps and their use in alcohol treatment programs indicates several important future directions for research.

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Request Reprint E-Mail: :amycohn@usf.edu

Alcoholic and Non-alcoholic Fatty Liver in Adolescents: A Worrisome Convergence

Health problems related to alcohol abuse are characterized by a heavy socio-economic impact with major consequences on health costs and national productivity both in industrialized and developing countries (Leon and McCambridge, 2006a; Morrison et al., 2006).

The observation that alcohol-related problems seem to disproportionately affect adolescents and young adults constitutes an additional reason for concern (Leon and McCambridge, 2006b; Bosetti et al., 2007).

Indeed, independently of gender and of region of the world, individuals in the age range 15–29 years consistently present the highest proportion of alcohol-attributable deaths (Larsson and Wolk, 2007).

In addition, a growing body of evidence suggests that the introduction to alcohol use in childhood followed by alcohol abuse in adolescence lead to an increased risk for high-impact diseases in adulthood such as cancer, liver cirrhosis, respiratory and cardiovascular disease, mental and behavioural disorders (Anderson et al., 1993; Byrne et al., 2004). Besides these long-term risks, alcohol abuse in childhood and adolescence is associated with an increased risk of developing acute and chronic liver diseases (Mathurin and Deltenre, 2009).

Binge drinking is the most common pattern of alcohol consumption among high-school youth (Mathurin and Deltenre, 2009) and is more frequent in males than in females. In 2001, 22.7% of males and 7.2% of females reported binge drinking in the USA. In this country, between 1993 and 2001, binge drinking episodes per person per year increased by 17%, with the highest rates occurring among subjects in the age range 18–25 years (Naimi et al., 2003).

In European countries, with the exception of the UK and Denmark, alcohol abuse among adults has been declining over the past decade with an overall decrease in the mortality due to alcoholic cirrhosis. This is at least in part related to improvements in …

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Subjective Measures of Binge Drinking, Suboptimal Subjective Health and Alcohol-Specific Hospitalizations Among Working-Aged Adults: A Prospective Coh

The purpose of this prospective study was to determine how subjective measures of binge drinking predict suboptimal subjective health. In order to contribute to the understanding of potential causal mechanisms, we also aimed to determine the factors through which subjective health predicts alcohol-specific hospitalizations.

A total of 16,111 alcohol-drinking men and women, aged 20–54 years, participated in the Health and Social Support baseline postal survey in 1998, and also responded to the repeated measurement 5 years later in 2003 (T2). Suboptimal subjective health was defined as self-reported overall health status being fair, rather poor or poor. Subjective measures of binge drinking were frequency of subjective intoxications/drunkenness, frequency of hangovers and frequency of alcohol-induced pass-outs.

Frequency of intoxications, hangovers and alcohol-induced pass-outs, all predicted suboptimal subjective health regardless of several potential confounders, including beverage-specific total intake. Those reporting suboptimal subjective health at baseline had a 5-fold odds ratio (5.08, 95% confidence interval: 3.43, 6.48) for alcohol-related hospitalizations, compared with those rating their health above fair, when gender and age were controlled. Binge drinking, together with concurrent symptoms of depression, explained over 50% of this relationship, and when additionally taking into account smoking, over two-thirds of this relation was explained.

Mental health is an important mediating factor between binge drinking, suboptimal subjective health and alcohol-specific hospitalizations, and symptoms of depression should therefore be taken into account in prevention of alcohol-related adverse health outcomes.




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Request Reprint E-Mail: tapio.paljarvi@helsinki.fi

NGOs express concern over conflict of interest

79 NGOs from various sectors have issued a statement of concern to the President of the UN General Assembly. The NGOs are concerned about the lack of clarity of roles for the industry sector in the recently held UN interactive hearing for civil society and the UN High Level Meeting on non-communicable diseases (NCD) in September. > > > > Read More

Our invisible addicts First Report of the Older Persons’ Substance Misuse Working Group of the Royal College of Psychiatrists

This report has brought together a group of health professionals with expertise in substance misuse in older people, whose remit it has been to develop the existing knowledge base according to the following terms of reference:

• examining the nature and extent of substance misuse in older people

• identifying precipitants and complications highlighting best-­practice guidance

• exploring training opportunities

• developing future strategy, encompassing clinical service provision and developments, training and education, research, and policy.

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Press Release - Conclusion of new WHO report: Global alcohol companies use unethical marketing instruments in Africa

International alcohol companies misbehave in the African continent. The dominating and unethical character of alcohol marketing of these companies in African countries strengthens the urgent need to increase legislation on alcohol advertising in the African continent. That is one of the main conclusions of a new report published by the World Health Organization (WHO).


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Collegiate Recovery Conference April 6-8, 201

2011 Conference Presentations

Can substance-abuse recovery take place on a college campus?

College students who are lucky enough to realize they need treatment for substance-use disorders are faced not only with the daunting task of recovery but also with reintegration into college life -- otherwise known as the land of pills and booze.

A new program, however, may begin cropping up on U.S. campuses to assist young people who are trying to recover and aid those who wish to achieve sobriety.

The Collegiate Recovery Communities emerged from a program at Texas Tech University and now has spin-offs at several U.S. universities. The program is a peer-based, on-campus model that aims to promote a culture of recovery. Little is known about how these programs can help students, but data so far suggest students benefit from the support. After six months, students reported feeling strong levels of support for their recovery and satisfaction with their lives, according to the first study to assess collegiate recovery programs. > > > > Read More

Nutritional profile of asymptomatic alcoholic patients

Alcoholism may interfere with nutritional status, but reports are often troubled by uncertainties about ingested diet and organ function, as well as by ongoing abuse and associated conditions.

To identify nutritional and body compartment changes in stable alcoholics without confounding clinical and dietetic variables, a prospective observational pilot study was designed. Three well-matched populations were considered: subjects with chronic alcoholic pancreatitis, alcoholics without visceral disease, and healthy never-drinking adults (controls).

Subjects (n = 60) were asymptomatic males with adequate diet, no superimposed disease or complication, and alcohol-free for at least 6 months. After exclusions, 48 patients were compared. Variables encompassed dietary recall, bioimpedance analysis, biochemical profile and inflammatory markers. Main outcome measures were body fat, lean body mass, serum lipids, C-reactive protein, and selected minerals and vitamins.

Both alcoholic populations suffered from reduced lean body mass (P = 0.001), with well-maintained body fat.Magnesium was depleted, and values of vitamin D and B12 correlated with alcohol abuse. LDL and total cholesterol was increased in alcoholics without pancreatitis (P = 0.04), but not in those with visceral damage. C-reactive protein and serum amyloid A correlated with duration of excessive drinking (P = 0.01).

Undernutrition (diminished lean body mass, risk of magnesium and vitamin -deficiencies) contrasted with dyslipidemia and increased cardiovascular risk. This second danger was masked during chronic pancreatitis but not in alcoholics without visceral disease. Further studies should focus special requirements of this population.



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Substance abuse treatment utilization among adults living with HIV/AIDS and alcohol or drug problems

This is a prospective cohort study to identify factors associated with receipt of substance abuse treatment (SAT) among adults with alcohol problems and HIV/AIDS.

Data from the HIV Longitudinal Interrelationships of Viruses and Ethanol study were analyzed. Generalized estimating equation logistic regression models were fit to identify factors associated with any service utilization.

An alcohol dependence diagnosis had a negative association with SAT (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [95% CI] = 0.19–0.67), as did identifying sexual orientation other than heterosexual (AOR = 0.46, CI = 0.29–0.72) and having social supports that use alcohol/drugs (AOR = 0.62, CI = 0.45–0.83).

Positive associations with SAT include presence of hepatitis C antibody (AOR = 3.37, CI = 2.24–5.06), physical or sexual abuse (AOR = 2.12, CI = 1.22–3.69), social supports that help with sobriety (AOR = 1.92, CI = 1.28–2.87), homelessness (AOR = 2.40, CI = 1.60–3.62), drug dependence diagnosis (AOR = 2.64, CI = 1.88–3.70), and clinically important depressive symptoms (AOR = 1.52, CI = 1.08–2.15).

While reassuring that factors indicating need for SAT among people with HIV and alcohol problems (e.g., drug dependence) are associated with receipt, nonneed factors (e.g., sexual orientation, age) that should not decrease likelihood of receipt of treatment were identified.

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Comparative utility of a single-item versus multiple-item measure of self-efficacy in predicting relapse among young adults

Single-item measures of psychological experiences are often viewed as psychometrically suspect. The purpose of this study was to evaluate the validity and utility of a single-item measure of self-efficacy in a clinical sample of treatment-seeking young adults.

Inpatient young adults (N = 303, age = 18–24, 26% female) were assessed at intake to residential treatment, end of treatment, and at 1, 3, and 6 months following discharge.

The single-item measure of self-efficacy consistently correlated positively with a well-established 20-item measure of self-efficacy and negatively with temptation scores from the same scale, demonstrating convergent and discriminant validity.

It also consistently predicted relapse to substance use at 1-, 3-, and 6-month assessments postdischarge, even after controlling for other predictors of relapse (e.g., controlled environment), whereas global or subscale scores of the 20-item scale did not.

Based on these findings, we encourage the use of this single-item measure of self-efficacy in research and clinical practice.

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Life goals and alcohol use among first-year college students: The role of motives to limit drinking

The main objective of the present study was to advance our understanding of how life goals are associated with hazardous alcohol use among first-year university students.

One-hundred and seventeen students rated a series of self-generated life goals on meaning and efficacy and then completed alcohol assessments.

Higher goal meaning ratings were associated with less alcohol use and fewer heavy drinking episodes. Tests of indirect effects showed that the associations between goal meaning ratings and alcohol use indices were mediated by motives to limit drinking, particularly the motive to maintain self-control/standards.

These results replicate and extend previous work on goal meaning and hazardous drinking among students. Findings are consistent with the view that engagement in university life goals may serve as a protective factor against hazardous drinking among first-year students due to greater concern with the impact of drinking on their ability to attain goal standards.

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Parental problem drinking predicts implicit alcohol expectancy in adolescents and young adults

The present study aimed to investigate the influence of parental problem drinking on implicit and explicit alcohol expectancy of adolescents and young adults (12–24 years).

The study was conducted via the Internet, employing a between-subjects design. We measured alcohol expectancy by means of an Implicit Association Test (IAT) and a self-report questionnaire. A short version of the Children of Alcoholics Screening Test (CAST) was used to measure alcohol-related parental problem behavior.

Our results showed that increased CAST-scores were correlated with a stronger implicit association between the concepts alcohol and arousal. In contrast, no such relationship was observed between parental problem drinking and self-reported expectancy of alcohol arousal.

These findings provide tentative evidence that an implicit cognitive processing bias is implicated in the intergenerational transmission of addictive behaviors.

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Request Reprint E-Mail: stefan.belles@tu-dortmund.de

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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Contextual Determinants of Alcohol Consumption Changes and Preventive Alcohol Policies: A 12-Country European Study in Progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior.

We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants.

This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.


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Prevalence of Children with Severe Fetal Alcohol Spectrum Disorders in Communities Near Rome, Italy: New Estimated Rates Are Higher than Previous Esti

To determine the population-based epidemiology of fetal alcohol syndrome (FAS) and other fetal alcohol spectrum disorders (FASD) in towns representative of the general population of central Italy.

Slightly revised U.S. Institute of Medicine diagnostic methods were used among children in randomly-selected schools near Rome. Consented first grade children (n = 976) were screened in Tier I for height, weight, or head circumference and all children


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Older people advised to drink less than adult guidelines by Royal College of Psychiatrists

A report from the Royal College of Psychiatrists advises people over 65 should not drink more than 1.5 units of alcohol a day - at least half the standard adult daily guidelines. The reduced amount advised for older adults is the equivalent of about half a pint of lager (5%) or a small glass of wine. > > > > Read More

Nicotine Modulates Alcohol-Seeking and Relapse by Alcohol-Preferring (P) Rats in a Time-Dependent Manner

Alcohol is frequently co-abused with smoking. In humans, nicotine use can increase alcohol craving and consumption. The objectives of the current study were to assess the acute effects of nicotine on alcohol seeking and relapse at 2 different time points.

Adult female alcohol-preferring (P) rats were trained in 2-lever operant chambers to self-administer 15% ethanol (EtOH) (v/v) and water on a concurrent fixed-ratio 5–fixed-ratio 1 (FR5-FR1) schedule of reinforcement in daily 1-hour sessions. Following 10 weeks of daily 1-hour sessions, rats underwent 7 extinction sessions, followed by 2 weeks in their home cages. Rats were then returned to the operant chambers without EtOH or water being present for 4 sessions (Pavlovian Spontaneous Recovery [PSR]). Rats were then given a week in their home cage before being returned to the operant chambers with access to EtOH and water (relapse). Nicotine (0, 0.1, 0.3, or 1.0 mg/kg) was injected subcutaneously immediately or 4 hours prior to PSR or relapse testing.

Injections of nicotine immediately prior to testing reduced (5 to 10 responses PSR; 50 to 60 responses relapse), whereas injections of nicotine 4 hours prior to testing increased (up to 150 responses for PSR; up to 400 responses for relapse with 1.0 mg/kg dose) responses on the EtOH lever during PSR and relapse tests.

The results of this study demonstrate that acute effects of nicotine on EtOH-seeking and relapse behaviors may be time dependent, with the immediate effects being a result of nicotine possibly acting as a substitute for EtOH, whereas with a delay of 4 hours, priming effects of nicotine alterations in nicotinic receptors, and/or the effects of nicotine’s metabolites (i.e., cotinine and nornicotine) may enhance the expression of EtOH-seeking and relapse behaviors.

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IQ in adolescence and later risk of alcohol-related hospital admissions and deaths – 37 year follow-up of Swedish conscripts

To investigate the relationship between intelligence measured at age 18-19 and later alcohol-related hospital admission and mortality among men, while controlling for possible confounders.

Cohort study.

49 321Swedish men who were conscripted for military training in 1969-70 and followed until 2007.

IQ measured at conscription is the exposure, while alcohol-related hospital admission and death are the two outcomes. Adjustments for following variables were made: early life circumstances (childhood socioeconomic position, father's drinking), mental health, social adjustment and behavioural factors measured at age 18 (psychiatric diagnosis, contact with police and child care, low emotional control, daily smoking, risky use of alcohol) and adult social position (attained education, SEP and income at age 40).

IQ had an inverse and graded association with later alcohol-related problems. For alcohol-related hospital admissions the crude hazard ratio (HR) was 1.29 (95% CI = 1.26 – 1.31) and for alcohol-related mortality it was 1.21 (95% CI = 1.17-1.24) for every one point decrease on the nine point IQ scale. Adjustment for risk factors measured at age 18 attenuated the association somewhat for both outcomes. After adjustment for social position as adult, the HR was considerably lower resulting in a HR of 1.06 (95% CI=1.02-1.10) for alcohol-related hospital admissions and 1.01 (95% CI=0.95-1.08) for alcohol-related mortality.

In Swedish men there is an association between IQ in early adulthood and later alcohol-related hospital admission and death. Social position as adult could be an important contributory factor.



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Request Reprint E-Mail: sara.sjolund@ki.se