The impact of minimum legal drinking age laws on alcohol consumption, smoking, and marijuana use: Evidence from a regression discontinuity design usin

This paper uses a regression discontinuity design to estimate the impact of the minimum legal drinking age laws on alcohol consumption, smoking, and marijuana use among young adults.

Using data from the National Longitudinal Survey of Youth (1997 Cohort), we find that granting legal access to alcohol at age 21 leads to an increase in several measures of alcohol consumption, including an up to a 13 percentage point increase in the probability of drinking.

Furthermore, this effect is robust under several different parametric and non-parametric models.

We also find some evidence that the discrete jump in alcohol consumption at age 21 has negative spillover effects on marijuana use but does not affect the smoking habits of young adults.

Our results indicate that although the change in alcohol consumption habits of young adults following their 21st birthday is less severe than previously known, policies that are designed to reduce drinking among young adults may have desirable impacts and can create public health benefits.

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Request Reprint E-Mail: byoruk@albany.edu

Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis

Self-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet.

The objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions.

In all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis.

An overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90).

E-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well.



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Curbing Alcohol Use in Male Adults Through Computer Generated Personalized Advice: Randomized Controlled Trial

In recent years, interventions that deliver online personalized feedback on alcohol use have been developed and appear to be a feasible way to curb heavy drinking. Randomized controlled trials (RCTs) among the general adult population, however, are scarce. The present study offers an RCT of Drinktest.nl, an online personalized feedback intervention in the Netherlands.

The aim of this study was to assess the effectiveness of computer-based personalized feedback on heavy alcohol use in male adults.

Randomization stratified by age and educational level was used to assign participants to either the intervention consisting of online personalized feedback or an information-only control condition. Participants were told as a cover story that they would evaluate newly developed health education materials. Participants were males (n = 450), aged 18 to 65 years, presenting with either heavy alcohol use (> 20 units of alcohol weekly) and/or binge drinking (> 5 units of alcohol at a single occasion at least 1 day per week) in the past 6 months. They were selected with a screener from a sampling frame of 25,000 households. The primary outcome measure was the percentage of the participants that had successfully reduced their drinking levels to below the Dutch guideline threshold for at-risk drinking.

Intention-to-treat analysis showed that in the experimental condition, 42% (97/230) of the participants were successful in reducing their drinking levels to below the threshold at the 1-month follow-up as compared with 31% (67/220) in the control group (odds ratio [OR] = 1.7, number needed to treat [NNT] = 8.6), which was statistically significant (χ²₁ = 6.67, P = .01). At the 6-month follow-up, the success rates were 46% (105/230) and 37% (82/220) in the experimental and control conditions, respectively (OR = 1.4, NNT = 11.9), but no longer statistically significant (χ²₁ = 3.25, P = .07).

Personalized online feedback on alcohol consumption appears to be an effective and easy way to change unhealthy drinking patterns in adult men, at least in the short-term.



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Effects of a National Information Campaign on Compliance With Age Restrictions for Alcohol Sales

To investigate the effect of a national information campaign, introduced by the Dutch Food Retail Organization, named “Under 20? Show Your ID!,” on compliance with age restrictions on alcohol sales. The compliance level after the campaign was compared with a baseline compliance, that we calculated based on 458 preintervention compliance measurements.

Data were collected using the method of mystery shopping. Three teams, each consisting of two 15-year-old mystery shoppers, conducted 105 alcohol purchase attempts in supermarkets in three regions in the Netherlands.

A compliance rate of 24.8% was found, which is a significant improvement compared with Dutch basement compliance rate from the past (14.9%), but is nominally still very low.

This mass media intervention campaign failed to increase compliance to an acceptable level. Also the specific goal of the campaign (ask everybody under <20 years old for identification [ID]) failed because fewer than half of the 15-year-old mystery shoppers in the study were asked to show their ID when purchasing alcoholic beverages.

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Request Reprint E-Mail: j.f.gosselt@utwente.nl

Alcohol-Related Emergency Department Visits Double for Underage Males during Fourth of July Weekend

The Fourth of July is a time for celebrations, but it can also be a time of increased health risks for young people, particularly young men. Young men are more likely than females or older individuals to be injured by fireworks at holiday gatherings. Moreover, underage males are also at higher risk than their female peers of having an alcohol-related emergency department (ED) visit over the Fourth of July weekend.


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Physician Attitudes Regarding Alcohol Use Screening in Older Adult Patients

Alcohol use among older adults (65+) is thought to be one of the fastest growing health problems in the country. Although proper assessment and diagnosis is crucial in addressing problem drinking in this population, research suggests that physicians are not adequately screening their older adult patients for alcohol use.

The present study examined the relationship between family physicians’ attitudes and perceptions and their screening prevalence with their new and existing older adult patients collected and analyzed in 2007.

Results indicated that physicians in the study reported screening 73% of their new patients on intake and 44% of their existing patients.

Family physicians with more positive perceptions of their alcohol-management skills with older adults performed more screening with their new and existing older adult patients. Year of medical school graduation was related to screening but only with new patients.



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lcsharp@rams.colostate.edu

Alcohol Expectancies Among Adolescent Nondrinkers: They May Not Be Drinking Now, But They're “thinkin bout it”

To examine the associations of alcohol expectancy outcomes and valuations with intention to use.

A total of 157 adolescent nonusers completed anonymous self-report surveys.

Adolescents who perceived more access to alcohol, expected less negative and more positive drinking outcomes, and evaluated positive outcomes favorably reported greater intentions to drink in adulthood.

Findings may be useful for efforts to further delay the initiation of alcohol use.

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Request Reprint E-Mail: bzamboan@smith.edu

Age of first alcohol intoxication: Association with risky drinking and other substance use at the age of 20

To determine whether first alcohol intoxication before the age of 15 is associated with risky drinking patterns [Weekly Risky Drinking (WRD) and Binge Drinking (BD)], tobacco use, cannabis use at age 20 and other illicit substance use at somepoint within their lifetime.

A survey was conducted among 20-year-old French-speaking Swiss men attending the mandatory army recruitment process, using a self-administered questionnaire on alcohol and other substance use, as well as demographics (age, employment status, education level and living location).

Of the 12’133 men attending the recruitment centre between January 2007 and September 2008, 9’686 were included in the study. Among them, 89% reported been intoxicated from alcohol at least once in the past, 11% reported WRD, 59% reported BD, 50% reported current tobacco use, 30% reported current cannabis use, and 19% reported other illicit substance use at somepoint within their lifetime. Subjects who reported first alcohol intoxication before age 15 were more likely to present current WRD (OR [95%CI]: 3.75[3.27–4.29]), BD (3.14[2.86–3.44]), current tobacco (3.17 [2.89–3.47]) or current cannabis use (3.26[2.97–3.58]), and other illicit drug use at somepoint within their lifetime (4.02[3.61–4.48]), than those who had a first intoxication at age 15 or older, or who had never been intoxicated.

This study was consistent with the literature, and showed an association between age at first intoxication and future risky alcohol use patterns and other substance use at age 20. Although the results showing an association between age at first intoxication and later risky drinking do not necessarily imply causation, knowing the age of first intoxication may be useful to health care professionals in targeting adolescents and young adults who are at a high risk for developing alcohol and other substance use problems. As such, age at first intoxication may be used to identify vulnerable individuals in a clinical prevention setting.

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Chemosensory event-related potentials in alcoholism: A specific impairment for olfactory function

Olfactory abilities are crucial in the development and maintenance of alcoholism, but while they have been widely explored in other psychiatric states, little is known concerning this sensorial modality among alcoholics.

The present study explored the brain correlates of the olfaction deficit in alcoholism.

Ten alcoholics and ten matched controls took part in psychophysical and electrophysiological olfactory testing.

At behavioural level, we showed odor identification deficits in alcoholism, for orthonasal and retronasal testing. Electrophysiological data showed abnormalities (in latency and amplitude) for N1 and P2 olfactory components among alcoholics, which constitutes the first description of the cerebral correlates of olfactory impairments in alcoholism. This deficit appears associated with alterations in the brain structures responsible for the secondary, “cognitive” processing of odors.

These results underline the need to take into account olfactory deficits in clinical practice and in studies exploring brain correlates of craving by means of alcohol odors.

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Request Reprint E-Mail: pierre.maurage@uclouvain.be

Daily ethanol exposure during late ovine pregnancy: physiological effects in the mother and fetus in the apparent absence of overt fetal cerebral dysm

High levels of ethanol (EtOH) consumption during pregnancy adversely affect fetal development; however the effects of lower levels of exposure are less clear.

Our objectives were to assess the effects of daily EtOH exposure (3.8 USA standard drinks) on fetal-maternal physiological variables and the fetal brain, particularly white matter.

Pregnant ewes received daily intravenous infusions of EtOH (0.75g/kg maternal body-weight over 1h, 8 fetuses) or saline (8 fetuses) from 95-133 days of gestational age (DGA, term ~145 DGA). Maternal and fetal arterial blood was sampled at 131-133 DGA. At necropsy (134 DGA) fetal brains were collected for analysis. Maternal and fetal plasma EtOH concentration reached similar maximal concentration (~0.11 g/dL) and declined at the same rate.

EtOH infusions produced mild reductions in fetal arterial oxygenation but there were no changes in maternal oxygenation, maternal and fetal PaCO₂, or in fetal mean arterial pressure or heart rate.

Following EtOH infusions, plasma lactate levels were elevated in ewes and fetuses, but arterial pH fell only in ewes. Fetal body and brain weights were similar between groups but relative heart weight was increased after EtOH exposure. In 3/8 EtOH exposed fetuses there were small subarachnoid hemorrhages in the cerebrum and cerebellum associated with focal cortical neuronal death and gliosis

Overall, there was no evidence of cystic lesions, inflammation, increased apoptosis or white matter injury.

We conclude that daily EtOH exposure during the third trimester-equivalent of ovine pregnancy has modest physiological effects on the fetus and no gross effects on fetal white matter development.



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Request Reprint E-Mail: robert.dematteo@med.monash.edu.au

Differential Activity by Polymorphic Variants of a Remote Enhancer that Supports Galanin Expression in the Hypothalamus and Amygdala: Implications for

The expression of the galanin gene (GAL) in the paraventricular nucleus (PVN) and in the amygdala of higher vertebrates suggests the requirement for highly conserved, but unidentified, regulatory sequences that are critical to allow the galanin gene to control alcohol and fat intake and modulate mood.

We used comparative genomics to identify a highly conserved sequence that lay 42 kb 5′ of the human GAL transcriptional start site that we called GAL5.1.

GAL5.1 activated promoter activity in neurones of the PVN, arcuate nucleus and amygdala that also expressed the galanin peptide. Analysis in neuroblastoma cells demonstrated that GAL5.1 acted as an enhancer of promoter activity after PKC activation. GAL5.1 contained two polymorphisms; rs2513280(C/G) and rs2513281(A/G), that occurred in two allelic combinations (GG or CA) where the dominant GG alelle occurred in 70-83 % of the human population.

Intriguingly, both SNPs were found to be in LD (R² of 0.687) with another SNP (rs2156464) previously associated with major depressive disorder (MDD).

Recreation of these alleles in reporter constructs and subsequent magnetofection into primary rat hypothalamic neurones showed that the CA allele was 40 % less active than the GG allele.

This is consistent with the hypothesis that the weaker allele may affect food and alcohol preference.

The linkage of the SNPs analysed in this study with a SNP previously associated with MDD together with the functioning of GAL5.1 as a PVN and amygdala specific enhancer represent a significant advance in our ability to understand alcoholism, obesity and major depressive disorder.



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Request Reprint E-Mail: alasdair.mackenzie@abdn.ac.uk

Alcohol consumption after laryngectomy

The aim of the study was the analysis of drinking behaviour in laryngectomized patients and its concomitants in quality of life and mental health.

Multi-centered cross-sectional study.

225 laryngectomized patients were asked to participate in the study. 179 patients (80%) were interviewed after laryngectomy at six different ENT clinics in Germany.

“Questionnaire of Health Behaviour” (FEG), “Short Questionnaire of Alcohol Risk” (KFA), Hospital Anxiety and Depression Scale (HADS), Hornheider Questionnaire (HFB), Visual Analogue Scales (VAS) and the Quality of Life Questionnaires of the EORTC (EORTC QLQ-C30, EORTC QLQ-H & N35).

Alcohol dependence was found in 7% of the patients. Half of the respondents showed a constant consumption of alcohol with 6% of the patients who wanted to change their consumption. Patients with alcohol dependence indicated in comparison with non-dependent persons increased anxiety (p=0.03), problems in coping with illness (p=0.03), increased psychosocial care needs (p=0.02), fatigue (p=0.04), shortness of breath (p=0.04), diarrhea (p=0.02) and a worse emotional functioning level (p=0.03). Alcohol intake was independent of tumor stage (p=0.48), employment status (p=0.54), social class (p=0.82), the time interval since laryngectomy (p=0.64), and type of voice substitute (p=0.76). The quality of life and mental state were independent of the amount of alcohol consumed.

The results show that alcohol dependence is associated with adverse psychosocial and medical consequences, which require treatment. Socio-demographic and medical parameters do not allow any conclusions to alcoholism risk. Therefore, an individual exploration of the patients′ drinking behaviour is needed which could prepare the ground to specific treatment.

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Request Reprint E-Mail: Helge.Danker@medizin.uni-leipzig.de

Strain-specific vulnerability to alcohol exposure in utero via hippocampal parent-of-origin expression of deiodinase-III

Prenatal exposure to alcohol is thought to be the most prevalent nongenetic cause of a wide range of neurodevelopmental deficits.

Insufficient thyroid hormone levels are one mechanism that hampers development of the alcohol-exposed brain, and we hypothesized that altered dosage of the imprinted thyroid hormone-inactivating gene deiodinase-III (Dio3) is responsible.

To follow parent-of-origin allelic expression of Dio3 in the fetal and adult offspring of alcohol-consuming and control dams, we reciprocally crossed 2 polymorphic rat strains.

In the frontal cortex, prenatal alcohol exposure altered imprinting patterns and total expression of Dio3 in the fetus and produced a permanent hypothyroid milieu in the adult.

In the hippocampus, alcohol affected the paternal and total expression of Dio3 in the fetus and in the adult male, where thyroid hormone levels were concomitantly increased. Hippocampus-dependent behavioral deficits were identified exclusively in males, suggesting they are dependent on aberrant allelic Dio3 expression. None of these effects were observed in offspring of the reciprocal cross.

Thus, genetic background and sex modify vulnerability to prenatal alcohol via brain region-specific expression of Dio3.

This finding implies that phenotypic heterogeneity in human fetal alcohol spectrum disorder can be linked to genetic vulnerability in affected brain regions.



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Request Reprint E-Mail: e-redei@northwestern.edu

Emergent pharmacology of conscious experience: new perspectives in substance addiction

We here review experimental findings relevant for the pharmacology of conscious experience, an issue largely neglected in pharmacological research.

First, we focus on self-awareness, a pivotal component of conscious experience and its integration within the global neuronal network (GNW), a theoretical concept that unifies convergent approaches on the neural bases of conscious processing.

We report recent evidence to show that self-awareness mobilizes a paralimbic circuitry of γ synchrony, and that such synchrony is, in particular, regulated by GABA interneurons under the control of acetylcholine and dopamine. Recent data illustrate that these neurotransmitters establish a causal relationship with the control of self-awareness.

The hypothesis is presented that not only is self-awareness chemically regulated, but the reverse may be true. Long-term deficit in self-control of drug intake would result in compulsive substance use, accompanied, in particular, with lesions of the paralimbic circuitry of self-awareness, leading to aggravation of substance abuse, resulting in addiction in a vicious circle.

Finally, we propose that the emergent pharmacology of conscious experience may provide new perspectives, not only in substance addiction but also in the many other pathological conditions with deficient self-awareness.



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Request Reprint E-Mail: hansLou1@gmail.com

The SK channel as a novel target for treating alcohol use disorders

We recently described the SK-type potassium channel as a novel target for treatment of excessive alcohol intake.

SK channel function is reduced in the nucleus accumbens (NAcb) core in rats consuming alcohol under intermittent (IAA) but not continuous (CAA) access, and the FDA-approved SK activator chlorzoxazone reduces the excessive alcohol intake in IAA rats but not the more moderate intake in CAA rats.

Here, we discuss the implications of these and related findings for SK as a treatment for alcohol use disorders. In addition, we report that many NAcb core electrophysiological parameters related to action potential waveform or basal parameters were not altered in alcohol-drinking rats.

These results are in strong contrast to those reported for cocaine, where several NAcb ion channels show adaptations after cocaine exposure.

These results suggest that alcohol intake is associated with only limited ion channel neuro-adaptations in the NAcb relative to cocaine, and support the hypothesis that SK represents a selective and potent intervention to reduce excessive alcohol intake.

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Request Reprint E-Mail: woody@gallo.ucsf.edu

Behavioral Couples Therapy for Substance Abusers: Where Do We Go From Here?

Behavioral couples therapy (BCT) is an evidence-based family treatment for substance abuse.

he results of numerous investigations over the past 30 years indicate that participation in this treatment by married or cohabiting substance-abusing patients, compared with more traditional individual-based interventions, results in greater reductions in substance use, higher levels of relationship satisfaction, greater reductions in partner violence, and more favorable cost outcomes.

This review examines the rationale for using BCT, the empirical literature supporting its use, methods used as part of this intervention, and future research directions.



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Request Reprint E-Mail: kklostem@odu.edu.

Recovery Support: Collaboration, Coordination, and Recovery Management

While the first steps toward long-term recovery are major achievements for individuals with substance use and mental disorders, the next challenge is learning how to sustain recovery over time.

Long-term recovery requires addressing the factors and conditions that contributed to the dependence in the first place. For many, recovery involves healing relationships, developing improved life skills, and attaining “emotional sobriety,” which makes it possible to contribute to their families and communities in healthy and meaningful ways.

This show will examine the elements that contribute to long-term recovery and how advances in improved collaborations, service coordination, and recovery management have led to more effective systems of support.

Effective models for providing this support, such as recovery-oriented systems of care (ROSC) and peer-to-peer support, will be discussed, along with the resources individuals can access to assist them at every stage of recovery.


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Genetic Risk for Alcoholic Chronic Pancreatitis

In recent years many studies have examined the genetic predisposition to pancreatic diseases. Pancreatic disease of an alcoholic etiology was determined to be a multi-factorial disease, where environmental factors interact with the genetic profile of the individual.

In this review we discuss the main results from studies examining the frequency of genetic mutations in alcoholic chronic pancreatitis.



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Joint Meeting of the NIDA and NIAAA Councils - September 2011

View event:	You will be able to view the event at http://videocast.nih.gov when the event is live.
Air date:	Monday, September 12, 2011, 10:00:00 AM Time displayed is Eastern Time, Washington DC Local
Description:	NIDA and NIAAA councils will be meeting with Dr. Collins in Wilson Hall
Author:	Dr. Francis Collins, NIH Director

Red wine: Exercise in a bottle?

As strange as it sounds, a new research study published in the FASEB Journal (http://www.fasebj.org), suggests that the "healthy" ingredient in red wine, resveratrol, may prevent the negative effects that spaceflight and sedentary lifestyles have on people. > > > > Read More

Resveratrol prevents the wasting disorders of mechanical unloading by acting as a physical

Long-term spaceflight induces hypokinesia and hypodynamia, which, along microgravity per se, result in a number of significant physiological alterations, such as muscle atrophy, force reduction, insulin resistance, substrate use shift from fats to carbohydrates, and bone loss. Each of these adaptations could turn to serious health deterioration during the long-term spaceflight needed for planetary exploration.

We hypothesized that resveratrol (RES), a natural polyphenol, could be used as a nutritional countermeasure to prevent muscle metabolic and bone adaptations to 15 d of rat hindlimb unloading. RES treatment maintained a net protein balance, soleus muscle mass, and soleus muscle maximal force contraction.

RES also fully maintained soleus mitochondrial capacity to oxidize palmitoyl-carnitine and reversed the decrease of the glutathione vs. glutathione disulfide ratio, a biomarker of oxidative stress. At the molecular level, the protein content of Sirt-1 and COXIV in soleus muscle was also preserved.

RES further protected whole-body insulin sensitivity and lipid trafficking and oxidation, and this was likely associated with the maintained expression of FAT/CD36, CPT-1, and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) in muscle.

Finally, chronic RES supplementation maintained the bone mineral density and strength of the femur.

For the first time, we report a simple countermeasure that prevents the deleterious adaptations of the major physiological functions affected by mechanical unloading.

RES could thus be envisaged as a nutritional countermeasure for spaceflight but remains to be tested in humans.



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Request Reprint E-Mail: stephane.blanc@iphc.cnrs.fr

Alcohol: A Major Public Health Problem-South Asian Perspective

Over the years, use of alcohol, excessive and prolonged, has been associated with various health hazards.

With increasing clinical experience and research in the area, the association has become stronger and progressively more alarming. The evidence from different treatment settings viz. the outpatient department, inpatient setup, emergency department, and the consultation liaison services has linked the use of alcohol with a wide array of hazards to the physical and the psychological health of the users. The impact on psychological health extends beyond the users of alcohol to involve caregivers and other family members of users.

Alcohol consumption is the leading risk factor for disease burden in low-mortality developing countries and the third largest risk factor in developed countries.

Added to this is the fact that a significant proportion of those needing the help of deaddiction service providers and of mental health professionals present to various other departments including medicine, surgery, gastroenterology, nephrology, and cardiology, among others.

We present here a comprehensive review of the impact of alcohol use on health. We have reviewed the relevant literature from south Asian countries using Pubmed search. In addition, other information sources such as Cork Bibliography, published monographs, and study reports have been included in the review.


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Request Reprint E-Mail: ypsbalhara@gmail.com

The Association between Social Determinants and Drunken Driving: A 15-Year Register-based Study of 81,125 Suspects

The aim of the study was to examine the association between social background and drunken driving.

A Finnish register on suspected drunken driving was combined with data on social background. There were 81,125 drivers arrested for drunken driving and 86,279 references from 1993 to 2007.

A low level of education, unemployment, living alone and divorce were strongly associated with drunken driving. In addition, for persons aged 15–24 years, low parental education and income, high own income and possession of a car correlated with higher odds of drunken driving. For working-aged men and women, low income was associated with a higher risk of drunken driving. For working-aged women, also possession of a car was a risk factor.

Social factors are associated with drunken driving. In general, people with a lower social position are more prone to drive after drinking. Social differences are visible already in youth, whereas working and own income of young persons signal different risk mechanisms for youth than for working-aged people. Measures for preventing drunken driving are needed within public health policies.



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Request Reprint E-Mail: antti.impinen@thl.fi

Measurement of the Risk for Substance Use Disorders: Phenotypic and Genetic Analysis of an Index of Common Liability

The inability to quantify the risk for disorders, such as substance use disorders (SUD), hinders etiology research and development of targeted intervention. Based on the concept of common transmissible liability to SUD related to illicit drugs, a method enabling quantification of this latent trait has been developed, utilizing high-risk design and item response theory.

This study examined properties of a SUD transmissible liability index (TLI) derived using this method. Sons of males with or without SUD were studied longitudinally from preadolescence to young adulthood. The properties of TLI, including its psychometric characteristics, longitudinal risk assessment and ethnic variation, were examined.

A pilot twin study was conducted to analyze the composition of TLI’s phenotypic variance. The data suggest that TLI has concurrent, incremental, predictive and discriminant validity, as well as ethnic differences.

The data suggest a high heritability of the index in males. The results suggest applicability of the method for genetic and other etiology-related research, and for evaluation of individual risk.



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Alcohol-induced memory blackouts as an indicator of injury risk among college drinkers

An alcohol-induced memory blackout represents an amnesia to recall events but does not involve a loss of consciousness. Memory blackouts are a common occurrence among college drinkers, but it is not clear if a history of memory blackouts is predictive of future alcohol-related injury above and beyond the risk associated with heavy drinking episodes.

To determine whether baseline memory blackouts can prospectively identify college students with alcohol-related injury in the next 24 months after controlling for heavy drinking days.

Data were analysed from the College Health Intervention Project Study (CHIPS), a randomised controlled trial of screening and brief physician intervention for problem alcohol use among 796 undergraduate and 158 graduate students at four university sites in the USA and one in Canada, conducted from 2004 to 2009. Multivariate analyses used generalised estimating equations with the logit link.

The overall 24-month alcohol-related injury rate was 25.6%, with no significant difference between men and women (p=0.51). Alcohol-induced memory blackouts at baseline exhibited a significant dose–response on odds of alcohol-related injury during follow-up, increasing from 1.57 (95% CI 1.13 to 2.19) for subjects reporting 1–2 memory blackouts at baseline to 2.64 (95% CI 1.65 to 4.21) for students acknowledging 6+ memory blackouts at baseline. The link between memory blackouts and injury was mediated by younger age, prior alcohol-related injury, heavy drinking, and sensation-seeking disposition.

Memory blackouts are a significant predictor of future alcohol-related injury among college drinkers after adjusting for heavy drinking episodes.

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Request Reprint E-Mail: marlon.mundt@fammed.wisc.edu

Social Work Services and Recovery from Substance Misuse: A Review of the Evidence

The research review involved three components:

1. To review the evidence on the effectiveness of social work/social care interventions with people with substance use problems.

2. To collate the available evidence on social services’ workforce development in the area of substance use.

3. To gain an insight into the range of specific roles and functions that social work has with people who have substance use problems


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'Family' support for alcoholics

Casually stirring tea and instant coffee as their spoons chime like bells, four members of Cambodia’s AA signal the start of their one-hour meeting by distributing stacks of literature to one another. Although fewer than 20 individuals are part of AA in the Kingdom, they are a tightknit group.
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Editorial - Let’s Be Straight Up about the Alcohol Industry

If medical journals and public health advocates are concerned with corporate conflicts of interest, inappropriate marketing to children, impotent self-regulation, and general flouting of the rules, why are we ignoring the alcohol industry?

The crisis of confidence that surrounds the behavior and practices of Big Tobacco and Big Pharma —bias in funded research, unsupported claims of benefit, and inappropriate promotion and marketing, among others—should be enough to provoke in us all a high degree of skepticism with any industry involvement in health research and policy. But the evidence and critical voices highlighting the practices of the alcohol industry—a massive and growing US$150 billion global business—have not yet received adequate prominence in medical journals. Indeed, attention to and scientific research on the alcohol industry have not kept pace with the industry’s ability to grow and evolve its markets and influence in the

health arena . > > > > Read More

Pharmacological Treatment of Insomnia in Alcohol Recovery: A Systematic Review

To conduct a systematic review of pharmacological agents used to treat sleep problems in alcohol recovery.

In accordance with the Quorum statement, we searched PubMed, EMBASE, Psych Info and Medline databases using the terms alcohol, insomnia/sleep and treatment/management with no year/language restrictions.

The search revealed 1239 articles and 20 met inclusion criteria. Trazodone was compared against placebo and found to be superior in two trials. Trazodone and gabapentin improved sleep measures with gabapentin performing significantly better in an open-label study. The data regarding gabapentin are equivocal with few studies showing a clear benefit. In one randomized trial, topiramate resulted in improved subjective sleep measures and a reduction in the percentage of heavy drinking days. Two randomized control trials of carbamazepine revealed improvement in subjective sleep measures. A randomized study showed lormetazepam was better than zopiclone on some measures. In a small placebo-controlled trial, acamprosate was found to result in improvements on some sleep measures. In single, small, mostly open-label studies, quetiapine, triazolam, ritanserin, bright light and magnesium have shown efficacy, while chlormethiazole, scopolamine and melperone showed no difference or worsening.

Trazodone has the most data suggesting efficacy. This finding is tempered by a study suggesting its association with a return to heavy drinking in some patients. Data regarding the efficacy of gabapentin are unclear at this point.


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Request Reprint E-Mail: kolla.bhanuprakash@mayo.edu

UPDATE on Lithuania: will the alcohol advertising ban survive?

Civil society and public health organisations in Lithuania are asking help from international institutions and NGO-s to stress the evidence base for advertising ban in reducing alcohol consumption among young people.

“There is real need for international support mostly to tell that this ban is evidence based measure to reduce children's alcohol consumption and that this is implementable,” said Aurelijus Veryga, President of the Lithuanian National Tobacco and Alcohol Control Coalition. > > > > Read More

Could a continuous measure of individual transmissible risk be useful in clinical assessment of substance use disorder? Findings from the National Epi

Toward meeting the need for a measure of individual differences in substance use disorder (SUD) liability that is grounded in the multifactorial model of SUD transmission, this investigation tested to what degree transmissible SUD risk is better measured using the continuous Transmissible Liability Index (TLI) (young adult version) compared to alternative contemporary clinical methods.

Data from 9535 18- to 30-year-olds in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions, a U.S. representative sample, were used to compute TLI scores and test hypotheses. Other variables were SUDs of each DSM-IV drug class, clinical predictors of SUD treatment outcomes, treatment seeking and usage, age of onset of SUDs and substance use (SU), and eligibility for SUD clinical trials.

TLI scores account for variation in SUD risk over and above parental lifetime SUD, conduct and antisocial personality disorder criteria and frequency of SU. SUD risk increases two- to four-fold per standard deviation increment in TLI scores. The TLI is associated with SUD treatment seeking and usage, younger age of onset of SU and SUD, and exclusion from traditional clinical trials of SUD treatment.

The TLI can identify persons with high versus low transmissible SUD risk, worse prognosis of SUD recovery and to whom extant SUD clinical trials results may not generalize. Recreating TLI scores in extant datasets facilitates etiology and applied research on the full range of transmissible SUD risk in development, treatment and recovery without obtaining new samples.

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Alcohol and distraction interact to impair driving performance

Recognition of the risks associated with alcohol intoxication and driver distraction has led to a wealth of simulated driving research aimed at studying the adverse effects of each of these factors. Research on driving has moved beyond the individual, separate examination of these factors to the examination of potential interactions between alcohol intoxication and driver distraction. In many driving situations, distractions are commonplace and might have little or no disruptive influence on primary driving functions. Yet, such distractions might become disruptive to a driver who is intoxicated.

The present study examined the interactive impairing effects of alcohol intoxication and driver distraction on simulated driving performance in 40 young adult drivers using a divided attention task as a distracter activity. The interactive influence of alcohol and distraction was tested by having drivers perform the driving task under four different conditions: 0.65 g/kg alcohol; 0.65 g/kg alcohol + divided attention; placebo; and placebo + divided attention.

As hypothesized, divided attention had no impairing effect on driving performance in sober drivers. However, under alcohol, divided attention exacerbated the impairing effects of alcohol on driving precision.

Alcohol and distraction continue to be appropriate targets for research into ways to reduce the rates of driving-related fatalities and injuries. Greater consideration of how alcohol and distraction interact to impair aspects of driving performance can further efforts to create prevention and intervention measures to protect drivers, particularly young adults

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Alcohol use and its consequences in South India: Views from a marginalised tribal population

Alcohol consumption in India is disproportionately higher among poorer and socially marginalised groups, notably Scheduled Tribes (STs). We lack an understanding of STs own views with regard to alcohol, which is important for implementing appropriate interventions.

This study was undertaken with the Paniyas (a previously enslaved ST) in a rural community in Kerala, South India. The study, nested in a participatory poverty and health assessment (PPHA). PPHA aims to enable marginalized groups to define, describe, analyze, and express their own perceptions through a combination of qualitative methods and participatory approaches (e.g. participatory mapping and ranking exercises). We worked with 5 Paniya colonies between January and June 2008.

Alcohol is viewed as a problem among the Paniyas who reported that consumption is increasing, notably among younger men. Alcohol is easily available in licensed shops and is produced illicitly in some colonies. There is evidence that local employers are using alcohol to attract Paniyas for work. Male alcohol consumption is associated with a range of social and economic consequences that are rooted in historical oppression and social discrimination.

Future research should examine the views of alcohol use among a variety of marginalised groups in developing countries and the different policy options available for these populations. In addition, there is a need for studies that untangle the potential linkages between both historical and current exploitation of marginalized populations and alcohol use.

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Predictive value of Obsessive-Compulsive Drinking Scale (OCDS) for outcome in alcohol-dependent inpatients: Results of a 24-month follow-up study

The present study examined whether craving as measured by the obsessive-compulsive drinking scale (OCDS) predict long-term outcome in alcohol-dependent inpatients.

This was a 24-month prospective, observational study in 198 alcohol-dependent inpatients treated under standardized conditions. The primary outcome criterion was abstinence, defined as no subjective report or objective indication of alcohol consumption since discharge from treatment. The patients self-rated their craving for alcohol at the 6- and 12-month follow-ups by using the German version of the OCDS, which measures obsessive and compulsive aspects of craving. Univariate and logistic regression analyses with covariates were performed.

Of the 104 patients interviewed at the 24-month follow-up, 60% (n = 62) were abstinent. We found significant associations between total OCDS scores at 6 months and outcome at 12 months and between total OCDS scores at 12 months and outcome at 24 months: the higher the OCDS total score at one follow-up evaluation, the less likely patients were to be abstinent at the subsequent one. The same association was found for each of the two OCDS subscales, control and consequences and drinking obsessions.

These results support earlier findings that OCDS scores can predict outcome in alcohol-dependent patients. This information can be used for the timely development of protective resources. Hence, decisions over the use of resources can be made on the basis of objectified parameters to develop a personalized treatment concept. Consequently, economic considerations can induce a reduction of high medical costs.

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PhenXNewsletter Issue 16. June 29, 2011

PhenX In Focus

Substance Abuse and Addiction The PhenX Toolkit currently contains 295 measures spanning 21 research domains and 16 collections (sets of related measures). The Alcohol, Tobacco and Other Substances (ATOS) domain includes 14 measures of substance abuse and addiction (SAA). There are also measures related to SAA in 6 other domains: Cancer, Environmental Exposures, Infectious Diseases and Immunity, Oral Health, Reproductive Health, and Respiratory. Using key words in the Toolkit Search function will enable you to see the current SAA protocols that are recommended. To expand the breadth and depth of SAA-related measures, a project to identify additional PhenX measures was launched in March 2011, with funding and logistic support of NIDA, NIAAA, and NHGRI. The goal is to create six “specialty” collections and one “core” collection of measures for use by SAA and other investigators. Working Groups composed of SAA experts will select up to eight high-priority measures for each of the six specialty areas for inclusion in the Toolkit. It is expected that these SAA measures will be added to the Toolkit by spring 2012.

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Questionable Health Claims by Alcohol Companies From Protein Vodka to Weight-loss Beer

For years, food companies have used advertising, packaging, and brand image to lead people to believe certain products are healthier than they really are. Whether it’s putting a sports star’s face on a Coca-Cola ad, labeling junk food as a “smart choice,” or attaching arbitrary designations such as “all natural” to foods high in fat, sugar, and salt, the food industry knows it must attract health-conscious shoppers. Over the past few years, alcohol companies have begun appropriating many of these misleading advertising techniques.

Spirits companies are positioning their vodka as “all natural,” even though the products haven’t changed. Beer companies are sponsoring marathons and running ads showing toned drinkers meeting up at a bar after a work-out. Superstars of grueling, high-endurance sports are being tapped to promote alcoholic beverages.

These advertising practices are legally tenuous, morally unsound, and potentially dangerous. Alcohol consumption costs society billions of dollars annually while causing immeasurable human suffering every day. Using health messages to sell products that can cause such widespread harm is not only unethical, it’s illegal, and yet the regulatory system has failed miserably to protect the American public.

Because market research shows purchase intent and consumption of a brand increase when people believe alcoholic products are all-natural or fitness-friendly, intense scrutiny and strict regulation of such misleading claims is essential.

This report examines this disturbing trend to promote alcohol as a health and fitness product, analyzes the potential legal implications, and makes policy recommendations.


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Chronic ethanol treatment alters purine nucleotide hydrolysis and nucleotidase gene expression pattern in zebrafish brain

Ethanol is a widely consumed drug that acts on the central nervous system (CNS), modifying several signal transduction pathways activated by hormones and neurotransmitters. The zebrafish is an experimental model for the study of human diseases and the use of this species in biochemical and behavioral studies on alcoholism and alcohol-dependence has increased recently. However, there are no data concerning the effects of chronic ethanol exposure on the purinergic system, where extracellular nucleotides act as signaling molecules. Purinergic signaling is controlled by a group of enzymes named ectonucleotidases, which include NTPDases and ecto-5′-nucleotidase already characterized in zebrafish brain.

The aim of this study was to evaluate nucleotide hydrolysis by NTPDases and ecto-5′-nucleotidase after long-term ethanol exposure. Additionally, the gene expression patterns of NTPDases1–3 and 5′-nucleotidase were determined.

Animals were exposed to 0.5% ethanol for 7, 14, and 28 days. There were no significant changes in ATP and GTP hydrolysis after all treatments. However, a decrease in ADP (46% and 34%) and GDP (48% and 36%) hydrolysis was verified after 7 and 14 days, respectively.

After 7 and 14 days of ethanol exposure, a significant decrease in AMP hydrolysis (48% and 36%) was also observed, whereas GMP hydrolysis was inhibited only after 7 days (46%). NTPDase2_mv and NTPDase3 mRNA transcript levels decreased after 7 and 14 days, respectively.

In contrast, ethanol increased NTPDase1, NTPDase2_mq, and NTPDase3 transcript levels after 28 days of exposure. NTPDase2_mg and 5′-nucleotidase gene expression was not altered.

Therefore, the ectonucleotidase pathway may be a target of chronic ethanol toxicity and the regulation of purinergic system could play a key role in the neurochemical mechanisms underlying the effects of ethanol on the CNS.

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