Global Actions July 29, 2011

Key Recent Milestones

· Global Actions China has completed the translation from English to Chinese for the European Advertising Standards Alliance (EASA) “International Guide to developing a self-regulatory organization (SRO)” and “Alcohol Module,” offering guidance on setting up an SRO that will take into account the specifics of alcohol advertising. Global Actions Country Manager James Yu says “Hopefully these two documents will help the partners to build a self-regulatory system in China.”

Global Actions in Focus:

Vietnam Drink drive initiatives are progressing in Vietnam, with the completion of two workshops in Da Nang, and a project steering committee meeting on July 29. Funded by ICAP and Da Nang Traffic Safety Committee (TSC), the public awareness campaigns publicity workshop and Blood Alcohol Concentration (BAC) workshop received excellent ratings from the trainees.

“The training workshops not only ensure the project success but, more importantly, that Da Nang will have a capable public education team,” said National Traffic Safety Committee (NTSC) Chief Secretariat Mr. Thanh Van Thahn. “This team will effectively implement public awareness campaigns to contribute to the reduction of traffic accidents in Da Nang.”

“The very practical content of the workshop with various training materials and active learning methods have helped the trainees to gain the knowledge systematically and professionally,” noted Vice Chairman of Da Nang TSC Mr. Dang Viet Dung. “This way of ‘hold hands to do the work themselves’ is quite effective.”

The steering committee meets every three months to evaluate the projects. Global Actions Vietnam Country Coordinator Lan Huong Nguyen observed that the July 29 meeting was successful in bringing together key stakeholders to address timely topics. Representatives from six sponsor companies discussed promoting the drink drive message to the Da Nang public, and the Chairman of Vietnam Beer Alcohol Beverage Association (VBA) was present. Nguyen said that involvement with VBA could attract more participation from industry members locally.

What’s Happening Next

· Nigeria’s Country Manager Lanre Onigbogi will be meeting with Federal Road Safety Commission (FRSC) Chief Executive Mr. Osita Chidoka on August 1 to brief him on the outcome of the training and capacity-building session and ways to ensure effective implementation of the Abuja-Lokaja axis intervention.

Translation of an Evidence-Based Social Skills Intervention for Children with Prenatal Alcohol Exposure in a Community Mental Health Setting

Children with prenatal alcohol exposure (PAE) have significant social skills deficits and are often treated in community mental health settings. However, it remains unclear whether these children can be effectively treated using manualized, evidence-based interventions that have been designed for more general mental health populations.

To shed light on this issue, the effectiveness of Children’s Friendship Training (CFT) versus Standard of Care (SOC) was assessed for 85 children ages 6 to 12 years with and without PAE in a community mental health center.

Children participating in CFT showed significantly improved knowledge of appropriate social skills, improved self-concept, and improvements in parent-reported social skills compared to children in the SOC condition. Moreover, results revealed that within the CFT condition, children with PAE performed as well as children without PAE. Findings indicated that CFT, an evidence-based social skills intervention, yielded greater gains than a community SOC social skills intervention and was equally effective for children with PAE as for those without PAE.

Results suggest that children with PAE can benefit from treatments initiated in community settings in which therapists are trained to understand their unique developmental needs, and that they can be successfully integrated into treatment protocols that include children without PAE.

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Request Reprint E-Mail: moconnor@mednet.ucla.edu

Mood and Implicit Alcohol Expectancy Processes: Predicting Alcohol Consumption in the Laboratory

Implicit positive alcohol expectancy (PAE) processes are thought to respond phasically to external and internal stimuli—including mood states—and so they may exert powerful proximal influences over drinking behavior. Although social learning theory contends that mood states activate mood-congruent implicit PAEs, which in turn lead to alcohol use, there is a dearth of experimental research examining this mediation model relative to observable drinking. Moreover, an expectancy theory perspective might suggest that, rather than influencing PAEs directly, mood may moderate the association between PAEs and drinking. To test these models, this study examined the role of mood in the association between implicitly measured PAE processes (i.e., latency to endorse PAEs) and immediate alcohol consumption in the laboratory. Gender differences in these processes also were examined.

College students (N = 146) were exposed to either a positive, negative, or neutral mood induction procedure, completed a computerized PAE reaction time (RT) task, and subsequently consumed alcohol ad libitum.

The mood manipulation had no direct effects on drinking in the laboratory, making the mediation hypothesis irrelevant. Instead, gender and mood condition moderated the association between RT to endorse PAEs and drinking in the laboratory. For males, RT to tension reduction PAEs was a stronger predictor of volume of beer consumed and peak blood alcohol concentration in the context of general arousal (i.e., positive and negative mood) relative to neutral mood. RT to PAEs did not predict drinking in the laboratory for females.

The results show that PAE processes are important determinants of immediate drinking behavior in men, suggesting that biased attention to mood-relevant PAEs—as indicated by longer RTs—predicts greater alcohol consumption in the appropriate mood context. The findings also highlight the need to consider gender differences in PAE processes. This study underscores the need for interventions that target automatic cognitive processes related to alcohol use.

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Request Reprint E-Mail: jwardell@buffalo.edu

A Role for Dynamin in Triggering Ethanol Tolerance

A prevailing hypothesis is that the set of genes that underlie the endophenotypes of alcoholism overlap with those responsible for the addicted state. Functional ethanol tolerance, an endophenotype of alcoholism, is defined as a reduced response to ethanol caused by prior ethanol exposure. The neuronal origins of functional rapid tolerance are thought to be a homeostatic response of the nervous system that counters the effects of the drug. Synaptic proteins that regulate neuronal activity are an important evolutionarily conserved target of ethanol.

We used mutant analysis in Drosophila to identify synaptic proteins that are important for the acquisition of rapid tolerance to sedation with ethanol. Tolerance was assayed by sedating flies with ethanol vapor and comparing the recovery time of flies after their first sedation and their second sedation. Temperature-sensitive paralytic mutants that alter key facets of synaptic neurotransmission, such as the propagation of action potentials, synaptic vesicle fusion, exocytosis, and endocytosis, were tested for the ability to acquire functional tolerance at both the permissive and restrictive temperatures.

The shibire gene encodes Drosophila Dynamin. We tested 2 temperature-sensitive alleles of the gene. The shi^ts1 allele blocked tolerance at both the permissive and restrictive temperatures, while shi^ts2 blocked only at the restrictive temperature. Using the temperature-sensitive property of shi^ts2, we showed that Dynamin function is required concomitant with exposure to ethanol. A temperature-sensitive allele of the Syntaxin 1A gene, Syx1A^3–69, also blocked the acquisition of ethanol tolerance.

We have shown that shibire and Syntaxin 1A are required for the acquisition of rapid functional tolerance to ethanol. Furthermore, the shibire gene product, Dynamin, appears to be required for an immediate early response to ethanol that triggers a cellular response leading to rapid functional tolerance.

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

Hepatic Safety and Antiretroviral Effectiveness in HIV-Infected Patients Receiving Naltrexone

We sought to determine the impact of naltrexone on hepatic enzymes and HIV biomarkers in HIV-infected patients.

We used data from the Veterans Aging Cohort Study-Virtual Cohort, an electronic database of administrative, pharmacy, and laboratory data. We restricted our sample to HIV-infected patients who received an initial oral naltrexone prescription of at least 7 days duration. We examined aspartate aminotransferase (AST) and alanine aminotransferase (ALT) and HIV biomarker (CD4 and HIV RNA) values for the 365 days prior to, during, and for the 365 days post-naltrexone prescription. We also examined cases of liver enzyme elevation (LEE; defined as >5 times baseline ALT or AST or >3.5 times baseline if baseline ALT or AST was >40 IU/l).

Of 114 HIV-infected individuals, 97% were men, 45% white, 57% Hepatitis C co-infected; median age was 49 years; 89% of the sample had a history of alcohol dependence and 32% had opioid dependence. Median duration of naltrexone prescription was 49 (interquartile range 30 to 83) days, representing 9,525 person-days of naltrexone use. Mean ALT and AST levels remained below the upper limit of normal. Two cases of LEE occurred. Mean CD4 count remained stable and mean HIV RNA decreased after naltrexone prescription.

In HIV-infected patients, oral naltrexone is rarely associated with clinically significant ALT or AST changes and does not have a negative impact on biologic parameters. Therefore, HIV-infected patients with alcohol or opioid dependence can be treated with naltrexone.

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Request Reprint -Mail: jeanette.tetrault@yale.edu

Hazardous drinking and military community functioning: Identifying mediating risk factors.

Hazardous drinking is a serious societal concern in military populations. Efforts to reduce hazardous drinking among military personnel have been limited in effectiveness.

There is a need for a deeper understanding of how community-based prevention models apply to hazardous drinking in the military.

Community-wide prevention efforts may be most effective in targeting community functioning (e.g., support from formal agencies, community cohesion) that impacts hazardous drinking via other proximal risk factors.

The goal of the current study is to inform community-wide prevention efforts by testing a model of community functioning and mediating risk factors of hazardous drinking among active duty U.S. Air Force personnel.

A large, representative survey sample of U.S. Air Force active duty members (N = 52,780) was collected at 82 bases worldwide. Hazardous drinking was assessed with the widely used Alcohol Use Disorders Identification Test (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). A variety of individual, family, and community measures were also assessed. Structural equation modeling was used to test a hypothesized model of community functioning, mediating risk factors and hazardous drinking.

Depressive symptoms, perceived financial stress, and satisfaction with the U.S. Air Force were identified as significant mediators of the link between community functioning and hazardous drinking for men and women. Relationship satisfaction was also identified as a mediator for men.

These results provide a framework for further community prevention research and suggest that prevention efforts geared at increasing aspects of community functioning (e.g., the U.S. Air Force Community Capacity model) may indirectly lead to reductions in hazardous drinking through other proximal risk factors.



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Request Reprint E-Mail: heather.foran@sunysb.edu

Alcohol consumption and body weight: a systematic review

Based on the fact that energy content in 1 gram of alcohol is 29 kJ or 7.1 kcal, alcohol consumption can lead to weight gain. The present review was conducted to analyze the effects of alcohol consumption on body weight.

A search of the Medline database for the period 1984 to March 2010 was conducted to identify cross-sectional, prospective cohort studies and intervention trials investigating the relationship between alcohol consumption and the risk of weight gain. Thirty-one publications were selected on the basis of relevance and quality of design and methods.

The findings from large cross-sectional studies as well as from well-powered, prospective, cohort studies with long periods of follow-up were contradictory. Findings from short-term experimental trials also did not show a clear trend.

The overall results do not conclusively confirm a positive association between alcohol consumption and weight gain; however, positive findings between alcohol intake and weight gain have been reported, mainly from studies with data on higher levels of drinking. It is, therefore, possible that heavy drinkers may experience such an effect more commonly than light drinkers. Moreover, light-to-moderate alcohol intake, especially wine intake, may be more likely to protect against weight gain, whereas consumption of spirits has been positively associated with weight gain.

Further research should be directed towards assessing the specific roles of different types of alcoholic beverages. Studies should also take the effect of consumption patterns into account.

In addition, a potential effect modifier that has not been evaluated before but might be important to consider is the subjects' previous tendency to gain weight.

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Request Reprint E-Mail: mbes@unav.es,

Fewer 11-15 year olds drinking finds NHS survey

Latest figures from a national survey of 11-15 year old pupils suggests fewer young people are drinking, and are less accepting of drunkenness. However it also finds no clear trend in consumption levels for those that do drink. The findings come from an annual survey which in 2010 included 7,296 pupils from 246 schools. > > > > Read More

Neocortical excitation/inhibition balance in information processing and social dysfunction

Severe behavioural deficits in psychiatric diseases such as autism and schizophrenia have been hypothesized to arise from elevations in the cellular balance of excitation and inhibition (E/I balance) within neural microcircuitry.

This hypothesis could unify diverse streams of pathophysiological and genetic evidence, but has not been susceptible to direct testing.

Here we design and use several novel optogenetic tools to causally investigate the cellular E/I balance hypothesis in freely moving mammals, and explore the associated circuit physiology.

Elevation, but not reduction, of cellular E/I balance within the mouse medial prefrontal cortex was found to elicit a profound impairment in cellular information processing, associated with specific behavioural impairments and increased high-frequency power in the 30–80 Hz range, which have both been observed in clinical conditions in humans.

Consistent with the E/I balance hypothesis, compensatory elevation of inhibitory cell excitability partially rescued social deficits caused by E/I balance elevation.

These results provide support for the elevated cellular E/I balance hypothesis of severe neuropsychiatric disease-related symptoms.



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Request Reprint E-Mail: yizhar@stanford.edu

Trajectories of Alcohol and Cigarette Use Among Sexual Minority and Heterosexual Girls

To examine disparities between sexual minority girls (SMGs) and heterosexual girls in trajectories of substance use over time.

Girls were included in the analyses if they were 12–18 years of age at wave 1 and did not miss sexual orientation data at wave 4 (n = 7,765). Latent curve models were estimated across all four waves (extending from middle adolescence into young adulthood) to examine trajectories of cigarette and alcohol use.

Initial levels of substance use were higher for SMGs than they were for heterosexual girls. SMGs also exhibited sharper escalations in use across all substances over time as they were transitioning into young adulthood.

Persistent rates of cigarette and heavy alcohol use among SMGs may increase their risk for a host of mental and physical health problems in adulthood. Clinicians should be prepared to discuss SMG health topics effectively and in private, and discuss prevention and intervention programs with girls at risk.

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Request Reprint E-Mail: marshalmp@upmc.edu

College students’ evaluations of alcohol consequences as positive and negative

Alcohol expectancy, motivation, and consequences measures assume a known valence of ‘positive’ and ‘negative’ outcomes. However, different individuals may rate the same consequences of alcohol use as good or bad.

The current study examines the extent to which: (a) college students rate researcher-defined positive consequences as good and researcher-defined negative consequences as bad, and (b) these evaluations predict alcohol use and problems after controlling for previous use.

In longitudinal self-reports via web-surveys across the first three semesters of college, students (N= 600; 54% women) reported their alcohol use and problems, experienced consequences, and evaluations of those consequences.

Contrary to the generally-accepted valence of positive consequences, Fun/Social consequences were viewed as neutral or negative by 22% (having more fun) to 73% (relieving boredom) of participants. Over half of participants evaluated each of the Relaxation, Sex, and Image consequences items as neutral or negative. Consistent with the generally-accepted valence of negative consequences, Physical/Behavioral consequences were viewed by the majority as negative, although 11% (getting in trouble with police/authorities) to 34% (doing/saying something embarrassing) of students rated these consequences as neutral or positive.

Independent of levels of previous drinking, more positive evaluations of Fun/Social consequences prospectively predicted frequency, quantity, and maximum drinks. Less negative evaluations of Physical/Behavioral consequences predicted more alcohol problems.

There is variation in the evaluations of consequences among college students, and understanding characteristics of those who view consequences as positive or negative may have implications for future alcohol-related behaviors and problems.

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Request Reprint E-Mail: meganpat@isr.umich.edu

Alcohol dependence symptoms among recent onset adolescent drinkers

This study examined prevalence of alcohol dependence symptoms and diagnosis among a nationally representative sample of recent onset adolescent drinkers aged 12-21 years (mean 17 years) across different levels of drinking drawn from National Survey of Drug Use and Health (N = 9,490).

We assessed whether the relationship between level of alcohol use and alcohol dependence was similar for individuals from different socio-demographic groups (i.e., gender, age group, ethnic group, family income, and substance use in the past year).

The most prevalent DSM-IV alcohol dependence criteria at low levels of alcohol use were “unsuccessful efforts to cut down”, “tolerance”, and “time spent” in activities necessary to obtain alcohol or recover from its effect.

Logistic regression with polynomial contrasts indicated increasing rates of each criterion and an overall dependence diagnosis with increasing alcohol exposure that differed most between the lowest levels of recent drinking frequency.

After controlling for drinking quantity, younger adolescents, females, Native American/Alaskans and Asian/Pacific Islanders were most likely to experience alcohol dependence symptoms and a diagnosis of dependence, suggesting that these demographic subgroups may experience dependence symptoms or develop dependence more quickly after beginning to drink.

Recognizing early symptoms of alcohol dependence may assist in early identification and intervention of those at risk for heavier drinker in the future.

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Request Reprint E-Mail: ldierker@wesleyan.edu

Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review.

This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change.

Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include PsycINFO, PUBMED/MEDLINE, and Educational Resources Information Center. Twenty-one independent studies, representing 5,471 participants, were located and analyzed.

An omnibus weighted mean effect size for all identified MI interventions revealed a small, but significant, posttreatment effect size (mean d = .173, 95% CI [.094, .252], n = 21). Small, but significant, effect sizes were observed at follow-up suggesting that MI interventions for adolescent substance use retain their effect over time. MI interventions were effective across a variety of substance use behaviors, varying session lengths, and different settings, and for interventions that used clinicians with different levels of education.

The effectiveness of MI interventions for adolescent substance use behavior change is supported by this meta-analytic review. In consideration of these results, as well as the larger literature, MI should be considered as a treatment for adolescent substance use.



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Request Reprint E-Mail: rsteele@ku.edu

It is time for low-risk drinking goals to come out of the closet

Recovery from alcohol problems includes low-risk drinking outcomes, especially for those not severely dependent.We suggest the failure by alcohol counselors in the United States to offer low-risk drinking goals is due to their being trained through an apprenticeship model rather than an evidence-based academic model, as used to train other health professionals.


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How cognitive assessment through clinical neurophysiology may help optimize chronic alcoholism treatment

Alcohol dependence constitutes a serious worldwide public health problem. The last few decades have seen many pharmacological studies devoted to the improvement of alcoholism treatment.

Although psychosocial treatments (e.g. individual or group therapy) have historically been the mainstay of alcoholism treatment, a successful approach for alcohol dependence consists in associating pharmacologic medications with therapy, as 40–70% of patients following only psychosocial therapy typically resume alcohol use within a year of post-detoxification treatment.

Nowadays, two main pharmacological options, naltrexone and acomprosate, both approved by the US Food and Drug Administration, are available and seemingly improve on the results yielded by standard techniques employed in the management of alcoholism.

However, insufficient data exist to confirm the superiority of one drug over the other, and research is ongoing to determine what type of alcohol-dependent individual benefits the most from using either medication.

Available data on the application of both drugs clearly suggest different practical applications. Thus, a fundamental question remains as to how we can identify which alcoholic patients are likely to benefit from the use of naltrexone, acamprosate or both, and which are not.

The aim of the present manuscript is to suggest the use of cognitive event-related potentials as an interesting way to identify subgroups of alcoholic patients displaying specific clinical symptoms and cognitive disturbances.

We propose that this may help clinicians improve their treatment of alcoholic patients by focusing therapy on individual cognitive disturbances, and by adapting the pharmaceutical approach to the specific needs of the patient.

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Request Reprint E-Mail: salvatore.campanella@chu-brugmann.be

AAI invites tenders to conduct research to measure young people’s exposure to alcohol marketing in Ireland

To date, there has been no baseline measurement of young people’s exposure to alcohol marketing. This research will establish such a baseline. A necessary pre-requisite of the research is that it be capable of being repeated at regular intervals in order to monitor and evaluate change with a view to informing evidence-based policy and the development of an effective regulatory framework which will reduce young people’s exposure to alcohol marketing. > > > > Read More

The End of Marin Institute

We are now called "Alcohol Justice," the one and only alcohol industry watchdog. Our laser focus is on the world's most harmful drug, and the companies that make and market it.

This rebranding of Marin Institute reflects our global mission: To hold the industry accountable for the harm alcohol inflicts upon our many diverse communities.

We use research, media and organizing to expose the industry's products and practices, and actively advocate for effective policies such as increasing alcohol prices, restricting youth-oriented products, limiting ubiquitous and inappropriate alcohol advertising, and supporting state alcohol control.


Click here to learn more about our new name,"Alcohol Justice."

Associations of Cigarette Smoking and Alcohol Consumption With Advanced or Multiple Colorectal Adenoma Risks: A Colonoscopy-based Case-Control Study i

The associations between alcohol consumption and cigarette smoking habits and the risk for colorectal adenomatous polyps according to the detailed clinical information about polyps were assessed in a large colonoscopy-based study.

The study enrolled participants who visited the National Cancer Center of the Republic of Korea for cancer screening between April 2007 and April 2009.

In 1,242 newly diagnosed colorectal adenoma patients and 3,019 polyp-free controls, past smokers (odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.04, 1.65) and current smokers (OR = 1.70, 95% CI: 1.37, 2.11) had increased risks for adenomas compared with nonsmokers.

Cigarette smoking conferred an even higher risk for advanced adenomas and 3 or more adenomas than for low-risk adenomas or a single adenoma. Dose-response relations were observed among the daily number of cigarettes smoked, the duration of smoking, the pack-years of smoking, and the risk for adenomas.

A longer duration of alcohol consumption was associated with a higher risk for advanced adenomas (for >28 years of consumption: OR = 2.0, 95% CI: 1.10, 3.64) and 3 or more adenomas (OR = 2.19, 95% CI: 1.27, 3.76).

In conclusion, cigarette smoking and alcohol consumption play roles in colorectal carcinogenesis, and the association differs by the clinical features of the adenomas.



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Request Reprint E-Mail: hong@ncc.re.kr

Alcohol Research & Health Volume 34, Issue Number 1

Fetal Alcohol Spectrum Disorders

1 In This Issue [PDF]

4 Fetal Alcohol Spectrum Disorders: Research Challenges and Opportunities [PDF]
Kenneth R. Warren, Ph.D.; Brenda G. Hewitt; and Jennifer D. Thomas, Ph.D.

15 Maternal Risk Factors for Fetal Alcohol Spectrum Disorders: Not As Simple As It Might Seem [PDF]
Philip A. May, Ph.D., and J. Phillip Gossage, Ph.D.

27 Combination Drug Use and Risk for Fetal Harm [PDF]
Wei-Jung A. Chen, Ph.D., and Susan E. Maier, Ph.D.

29 Focus On: Epigenetics and Fetal Alcohol Spectrum Disorder [PDF]
Michael S. Kobor, Ph.D., and Joanne Weinberg, Ph.D.

38 Understanding the Effects of Prenatal Alcohol Exposure Using Three-Dimensional Facial Imaging [PDF]
Leah Wetherill, M.S., and Tatiana Foroud, Ph.D.

42 Discriminating the Effects of Prenatal Alcohol Exposure From Other Behavioral and Learning Disorders [PDF]
Claire D. Coles, Ph.D.

51 The Quest for a Neurobehavioral Profile of Heavy Prenatal Alcohol Exposure [PDF]
Sarah N. Mattson, Ph.D., and Edward P. Riley, Ph.D.

56 Focus On: Biomarkers of Fetal Alcohol Exposure and Fetal Alcohol Effects[PDF]
Ludmila N. Bakhireva, M.D., Ph.D., M.P.H., and Daniel D. Savage, Ph.D.

64 Behavioral Interventions for Children and Adolescents With Fetal Alcohol Spectrum Disorders[PDF]
Blair Paley, Ph.D., and Mary J. O’Connor, Ph.D.

76 Fetal Alcohol Spectrum Disorders: Experimental Treatments and Strategies for Intervention[PDF]
Nirelia M. Idrus, Ph.D., and Jennifer D. Thomas, Ph.D.

86 Prenatal Alcohol Exposure and Miscarriage, Stillbirth, Preterm Delivery, and Sudden Infant Death Syndrome [PDF]
Beth A. Bailey, Ph.D., and Robert J. Sokol, M.D.

92 Focus On: The Use of Animal Models for the Study of Fetal Alcohol Spectrum Disorders[PDF]
Shannon E. Wilson, D.V.M., Ph.D, and Timothy A. Cudd, D.V.M., Ph.D.

SPECIAL SECTION: Update on Brain Pathology

99 Focus On: Magnetic Resonance–Based Studies of Fetal Alcohol Spectrum Disorders in Animal Models [PDF]
Shonagh K. O’Leary-Moore, Ph.D.; Scott E. Parnell, Ph.D.; Elizabeth A. Godin, Ph.D.; and Kathleen K. Sulik, Ph.D.

106 Focus On: Neurotransmitter Systems [PDF]
C. Fernando Valenzuela, M.D., Ph.D.; Michael P. Puglia; and Stefano Zucca, M.Sc.

121 Focus On: Structural and Functional Brain Abnormalities in Fetal Alcohol Spectrum Disorders [PDF]
S. Christopher Nuñez, Ph.D.; Florence Roussotte; and Elizabeth R. Sowell, Ph.D.

Auditory event-related potentials (P3) and cognitive changes induced by frontal direct current stimulation in alcoholics according to Lesch alcoholism

Frontal lobe dysfunction is a hallmark of alcohol dependence. Recent studies have shown that a simple but powerful technique of cortical modulation – transcranial direct current stimulation (tDCS) – can induce significant cognitive changes.

We therefore aimed to assess the clinical and electrophysiological (as indexed by P3) effects of tDCS of left dorsolateral prefrontal cortex (DLPFC) in different types of alcoholic patients according to Lesch's typology.

We enrolled 49 alcoholic subjects, aged between 18 and 75 yr, during the subacute abstinence period to participate in this study. Subjects underwent event-related potential (ERP) registration of alcohol-related and neutral sounds before, during and after active tDCS (1 mA, 35 cm², during 10 min) or sham procedure in a counterbalanced and randomized order. Frontal assessment battery (FAB) and five items of the Obsessive Compulsive Drinking Scale were applied at the beginning and at the end of each experimental session.

ERP analysis showed an increase in the mean amplitude of P3 associated with alcohol-related sounds after tDCS. This effect was not seen for neutral sounds. This change was more pronounced in Lesch IV alcoholics.

Secondary exploratory analysis showed a significant improvement of FAB performance after active tDCS compared to sham tDCS in Lesch IV alcoholics only.

We showed clinical and electrophysiological evidence of tDCS-induced frontal activity enhancement that was specific for Lesch IV alcoholics.

Given that frontal dysfunction may contribute to the loss of control over drinking behaviour, local increase in frontal activity induced by tDCS might have a beneficial clinical impact in the future.



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Request Reprint E-Mail: ester.palacios@terra.com.br

Alcohol Dependence Treatments: Comprehensive Healthcare Costs, Utilization Outcomes, and Pharmacotherapy Persistence

To determine the healthcare costs associated with treatment of alcohol dependence with medications versus no medication and across the 4 medications approved by the US Food and Drug Administration (FDA).

Retrospective claims database analysis.

Eligible adults with alcohol dependence were identified from a large US health plan and the IMS PharMetrics Integrated Database. Data included all medical and pharmacy claims at all available healthcare sites. Propensity score–based matching and inverse probability weighting were applied to baseline demographic, clinical, and healthcare utilization variables for 20,752 patients, half of whom used an FDA-approved medication for alcohol dependence. A similar comparison was performed among 15,502 patients treated with an FDA-approved medication: oral acamprosate calcium (n = 8958), oral disulfiram (n = 3492), oral naltrexone (NTX) hydrochloride (n = 2391), or extended-release injectable naltrexone (XR-NTX; n = 661). Analyses calculated 6-month treatment persistence, utilization, and paid claims for: alcoholism medications, detoxification and rehabilitation, alcohol-related and nonrelated inpatient admissions, outpatient services, and total costs.

Medication was associated with fewer admissions of all types. Despite higher costs for medications, total healthcare costs, including inpatient, outpatient, and pharmacy costs, were 30% lower for patients who received a medication for their alcohol dependence. XR-NTX was associated with greater refill persistence and fewer hospitalizations for any reason and lower hospital costs than any of the oral medications. Despite higher costs for XR-NTX itself, total healthcare costs were not significantly different from oral NTX or disulfiram, and were 34% lower than with acamprosate. Conclusion: In this largest cost study to date of alcohol pharmacotherapy, patients who received medication had lower healthcare utilization and total costs than patients who did not. XR-NTX showed an advantage over oral medications in treatment persistence and healthcare utilization, at comparable or lower total cost.



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Request Reprint E-Mail: david.gastfriend@alkermes.com.

The effects of polyunsaturated fatty acids in alcohol dependence treatment - A Double-Blind, Placebo-Controlled Pilot Study

The lipid fraction of cell membranes consists of polyunsaturated fatty acids (PUFAS), and chronic alcohol use alters it, modifying its permeability, what might contribute for the dysfunctional metabolism observed in the central nervous system of alcohol dependent patients. Therefore, the supplementation of PUFAS can be an important adjuvant in alcoholism treatment.

This was a placebo controlled, double blind, randomized study where, 80 alcohol dependent patients, according to DSM-IV, were allocated in four groups with 20 patient each: 'PUFAS', 'Naltrexone', 'Naltrexone + PUFAS' and 'Placebo'. Those substances were administered for 90 days and scales were applied to assess patients craving (OCDS) and alcohol dependence severity (SADD) at baseline and after 90 days. PUFAS serum levels were assessed before and after treatment by high performance liquid chromatography assay.

Forty-three patients completed the trial. There was a significant improvement over time on drinking days, SADD and OCDS scores in all groups (p < 0.001). The drinking days comparison between groups did not show statistical significant difference. The same effect was observed for compulsion (OCDS) and severity of dependence scale (SADD). The serum levels of PUFAS increased in all the supplemented groups after treatment, although not significantly.

The oral supplementation of 2g PUFAS for 3 months did not significantly differ from placebo in reducing the amount of alcohol ingestion, or OCDS and SADD scores in a group of alcohol dependent patient.

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2010 National Drug Strategy Household Survey report

The 2010 National Drug Strategy Household Survey was conducted between late-April and early-September 2010. This was the 10th survey in a series which began in 1985, and was the fifth to be managed by the Australian Institute of Health and Welfare (AIHW). More than 26,000 people aged 12 years or older participated in the survey, in which they were asked about their knowledge of and attitudes towards drugs, their drug consumption histories, and related behaviours. Most of the analysis presented is of people aged 14 years or older, so that results can be compared with previous reports.

Alcohol

The proportion of the population aged 14 years or older who consumed alcohol daily declined between 2007 (8.1%) and 2010 (7.2%). However, there was little change in the proportion of people drinking alcohol at levels that put them at risk of harm over their lifetime (20.3% in 2007 and 20.1% in 2010), or from a single drinking occasion at least once a month (28.7% in 2007 and 28.4% in 2010). As the Australian population has increased, the number of people drinking at risky levels increased between 2007 and 2010. Around 7% of recent drinkers changed their drink preference, shifting away from pre-mixed spirits; this preference was particularly evident for those aged less than 29 years.

There was higher support in 2010 (compared with 2007) given to alcohol measures related to venues, such as restricted trading and limiting the number of venues. Abstainers and those drinking at low‑risk levels were more likely than risky drinkers to support policies aimed at reducing alcohol-related harm.

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The Outstation Model of Rehabilitation as Practiced in Central Australia: The Case for Its Recognition and Acceptance

This paper describes and analyzes the model of care provided by the Ilpurla remote outstation rehabilitation program in Australia's Northern Territory.

Reflections are offered about the cultural antecedents of the model, and how it addresses the needs of young Indigenous people. Data describing client numbers, length of stay, the underlying approach to rehabilitation, and the practices of the program are presented.

The paper aims to promote an understanding of the outstation model of care, highlight difficulties between programs and their funding sources, and encourages recognition of its importance in the response to drug and alcohol use-related problems among Indigenous people.



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Request Reprint E-Mail: gillanddavid@apex.net.au.