Effectiveness of brief alcohol interventions in primary care populations

Many trials reported that brief interventions are effective in reducing excessive drinking. However, some trials have been criticised for being clinically unrepresentative and unable to inform clinical practice.

To assess the effectiveness of brief intervention, delivered in general practice or based primary care, to reduce alcohol consumption. To assess whether outcomes differ between trials in research settings and those in routine clinical settings.

We searched the Cochrane Drug and Alcohol Group specialised register (February 2006), MEDLINE (1966 to February 2006), EMBASE (1980 to February 2006), CINAHL (1982 to February 2006), PsycINFO (1840 to February 2006), Science Citation Index (1970 to February 2006), Social Science Citation Index (1970 to February 2006), Alcohol and Alcohol Problems Science Database (1972 to 2003), reference lists of articles.

Randomised controlled trials, patients presenting to primary care not specifically for alcohol treatment; brief intervention of up to four sessions.

Two authors independently abstracted data and assessed trial quality. Random effects meta-analyses, sub-group, sensitivity analyses, and meta-regression were conducted.

Meta-analysis of 22 RCTs (enrolling 7,619 participants) showed that participants receiving brief intervention had lower alcohol consumption than the control group after follow-up of one year or longer (mean difference: -38 grams/week, 95% CI: -54 to -23), although there was substantial heterogeneity between trials (I2 = 57%). Sub-group analysis (8 studies, 2,307 participants) confirmed the benefit of brief intervention in men (mean difference: -57 grams/week, 95% CI: -89 to -25, I2 = 56%), but not in women (mean difference: -10 grams/week, 95% CI: -48 to 29, I2 = 45%). Meta-regression showed little evidence of a greater reduction in alcohol consumption with longer treatment exposure or among trials which were less clinically representative. Extended intervention was associated with a non-significantly greater reduction in alcohol consumption than brief intervention (mean difference = -28, 95%CI: -62 to 6 grams/week, I2 = 0%)

Overall, brief interventions lowered alcohol consumption. When data were available by gender, the effect was clear in men at one year of follow up, but not in women. Longer duration of counselling probably has little additional effect. The lack of evidence of any difference in outcomes between efficacy and effectiveness trials suggests that the current literature is relevant to routine primary care. Future trials should focus on women and on delineating the most effective components of interventions.

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Request Reprint E-Mail: . e.f.s.kaner@newcastle.ac.uk.

Genetics of emotion

Emotion is critical to most aspects of human behavior, and individual differences in systems recruited to process emotional stimuli, expressed as variation in emotionality, are characteristic of several neuropsychiatric disorders.

We examine the genetic origins of individual differences in emotion processing by focusing on functional variants at five genes: catechol-O-methyltransferase (COMT), serotonin transporter (SLC6A4), neuropeptide Y (NPY), a glucocorticoid receptor-regulating co-chaperone of stress proteins (FKBP5) and pituitary adenylate cyclase-activating polypeptide receptor (ADCYAP1R1).

These represent a range of effects of genes on emotion as well as the variety of mechanisms and factors, such as stress, that modify these effects.

The new genomic era of genome-wide association studies (GWAS) and deep sequencing may yield a wealth of new loci modulating emotion. The effects of these genes can be validated by neuroimaging, neuroendocrine and other studies accessing intermediate phenotypes, deepening our understanding of mechanisms of emotion and variation in emotionality.

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Request Reprint E-Mail: davidgoldman@mail.nih.gov

Lifestyle behaviours and quality-adjusted life years in middle and older age

To examine the relationship between combined lifestyle behaviours and quality-adjusted life years (QALYs) in a general population.

A population-based study was conducted in 13,358 men and women who participated in the European Prospective Investigation into Cancer (EPIC)-Norfolk (baseline 1993–97). A score of 1 was given to each of non-smoking, physically not inactive, moderate alcohol consumption (1–14 units) and consumption of at least five portions of fruit and vegetables (vitamin C level ≥50 µmol/l). Short-Form Six-Dimension (SF-6D) health utility index scores were derived from the SF-36. QALYs were estimated up to follow-up (July 2007).

A total of 13,358 men and women were eligible to be included in the study (aged 40–79 years at baseline). A total of 12,921 people were alive at follow-up (117, 784 person-years). Mean follow-up period was ∼11.5 years. 437 (4.4% of men and 2.4% of women) died. The death rate was 6.5 times higher in people with health behaviour score 0 compared with those who scored 4 (8.4 versus 1.3%). People with higher scores had significantly higher QALYs.

Our findings support the view that modifiable lifestyle factors are an important component in health improvement.

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Request Reprint E-Mail: phyo.k.myint@uea.ac.uk

Alcohol use of older adults: drinking alcohol for medicinal purposes

Of Finnish adults aged 65–84 years, 54% of females and 77% of males had consumed alcohol in the preceding year in 2007 [ 1–3]. Older adults are sensitive to the effects of alcohol as a consequence of the physiological changes associated with ageing, a high prevalence of diseases and the concomitant use of multiple drugs. Older adults also experience higher blood alcohol concentrations for a given amount of alcohol than younger adults due to changes in body mass [ 4].

Research on older people's use of alcohol has focused mainly on problem-drinking and consequent health problems [5, 6]. However, there is also public awareness about the possible health promoting effects of moderate alcohol consumption demonstrated in epidemiological studies [ 7–13]. Alcohol has been used throughout history for medicinal purposes; since antiquity, wine has been believed to stimulate appetite and digestion [ 14].

Very few studies are available on how older people perceive the health effects of alcohol, and how they use alcohol for medicinal purposes [ 15]. The aim of this study was to investigate the medicinal use of alcohol by individuals aged 65 years and older. We investigated (i) the prevalence of alcohol consumption as self-medication, (ii) associated factors and (iii) the reasons for which alcohol is used to self-medicate.

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Global Actions Update

Global Actions in Focus: Noncommercial Alcohol Summaries about noncommercial alcohol in our focus countries are nearing completion. Results of pilot studies conducted by teams of independent scientists will be posted to www.global-actions.org. Here’s a glimpse of what the reports will show. In Belarus, local research teams interviewed residents of the Grodno region and found that noncommercial alcohol is most popular among the homeless, patients of substance abuse clinics, and rural residents, with affordability the main reason for its popularity. The main types of noncommercial alcohol consumed are samogon, counterfeit vodka, and medicinal preparations that contain alcohol and industrial alcohol. Preliminary findings in Botswana indicate that noncommercial alcohol is fairly widely available, and the traditional practice of informal home-based taverns (shebeens) producing and selling noncommercial alcohol is widespread. The results of interviews and focus group discussions in the urban location of Nkoyaphiri and the rural location of Mogobane found that the production and sale of noncommercial beverages is viewed by residents as a wholesome, socially acceptable activity. A number of households have traditionally relied on noncommercial alcohol production for their livelihood. The Ministry of Agriculture in Brazil estimates that 99.5% of Brazilian stills are clandestine. A large percentage of Brazil’s 30 to 40 thousand stills are producing cachaca rum, the distilled beverage most consumed by Brazilians. Of those surveyed in two municipalities in Brazil, 86% reported consuming homemade beverages, 81% distilled drinks, and 77% counterfeit beverages. In China’s Hubei Province, among those who say they consume noncommercial alcohol, researchers found a general consensus that noncommercial alcohol products are safe, and many of the informants believed the beverages to be “more pure” than commercial products. Results of villager one-on-one and small group interviews found that, with respect to drinking time, 22% reported consuming noncommercial alcohol with breakfast, 80% with lunch, and 99% with dinner. In Sri Lanka, noncommercial alcohol is produced in hard-to-reach places (forests, marshy lands) at a low cost. Studies conducted in Colombo (slums and semi-urban areas) and Puttalam (rural and deep rural areas) found that the majority of producers lack the education to find other employment or income sources with ease, with wives sometimes involved in selling the products produced by their husbands. In these households, some women choose this job as their main source of income. Other countries of focus, to be covered in future issues of Global Actions, are India, Kenya, Mexico, and Russia. In addition to the pilot studies, ICAP is initiating conversations with stakeholders in Uganda, Rwanda, and Tanzania regarding the launch of research projects in noncommercial alcohol. What’s Happening Next: · A training workshop on best practices in Self-Regulation will be held August 18 in Port-of-Spain, Trinidad. · In Da Nang, Vietnam, a Drink Drive Enhanced Enforcement workshop is scheduled for August 16-18, and will combine education and enforcement. · A Drink Drive launch event is scheduled for September 13-14 in Mexico City, Mexico. · In Argentina, self-regulatory organizations in Latin America will meet for a Conselho Nacional de Auto-Regulamentacão Publicitária (CONAR) CONARED conference on September 14-17. · World Federation of Advertisers (WFA) will be participating in a self-regulation conference to take place September 30 in Kiev, Ukraine.

Comorbidity between attention deficit/hyperactivity disorder and substance use disorders: evidence from animal models

To describe some recent theories regarding the comorbidity between attention deficit/hyperactivity disorder and substance use disorders and discuss the utility of using spontaneously hypertensive rats (an animal model of attention deficit/hyperactivity disorder) for the study of attention deficit/hyperactivity disorder and substance use disorders comorbidity.

We compiled the main results of studies investigating the behavioral effects of drugs of abuse in spontaneously hypertensive rats.

Spontaneously hypertensive rats, in addition to expressing the main features of attention deficit/hyperactivity disorder (impulsivity, hyperactivity, and attention deficit), appear to be more sensitive to psychostimulants, cannabinoids, and opioids and drink large amounts of alcohol. Repeated treatment of spontaneously hypertensive rats with methylphenidate (a first-choice drug for the treatment of attention deficit/hyperactivity disorder) or exposure to an enriched environment during adolescence resulted in an increase or decrease, respectively, in alcohol consumption in adulthood.

These results suggest that environmental factors can either favor or confer resistance to attention deficit/hyperactivity disorder and substance use disorders comorbidity. Although research is at the very early stage in this field, spontaneously hypertensive rats appear to be a useful animal model for the study of attention deficit/hyperactivity disorder and substance use disorders comorbidity.



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The Danish longitudinal study of alcoholism 1978-2008 A clinical high-risk study

Based on a Danish birth cohort (n=9182), a high risk group of sons of alcoholic fathers (HR, n=223) and a low risk group of sons without parental alcoholism (LR, n=106) has been followed prospectively from pregnancy to age 40.

The HR sons are characterized by a high prevalence of alcohol dependence (31%) and a high rate of remission (55%).

Most powerful predictors for alcohol dependence in adulthood are: low birth weight, ADHD, conduct disorder, low cognitive efficiency and high behavioural dyscontrol in childhood.

A 50 year follow-up examination of the sample, including DNA-testing, is planned in the nearest future.



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Endogenous Treatment Effects for Count Data Models with Sample Selection or Endogenous Participation

In this paper we propose a method to estimate models in which an endogenous dichotomous treatment aects a count outcome in the presence of either sample selection or endogenous participation using maximum simulated likelihood. We allow for the treatment to have an effect on both the sample selection or the participation rule and the main outcome.

Applications of this model are frequent, but are not limited to, health economics. We show an application of the model using data from Kenkel and Terza (2001), who investigate the effect of physician advice on the amount of alcohol consumption.

Our estimates suggest that in these data (i) neglecting treatment endogeneity leads to a wrongly signed effect of physician advice on drinking intensity, (ii) neglecting endogenous participation leads to an upward biased estimate of the treatment effect of physician advice on drinking intensity.


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Modeling the Cost-Effectiveness of Health Care Systems for Alcohol Use Disorders: How Implementation of eHealth Interventions Improves Cost-Effectiven

Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed.

The aim of ALCMOD is to estimate the cost-effectiveness of competing health care systems in curbing alcohol use at the national level. This is illustrated for scenarios where new eHealth technologies for alcohol use disorders are introduced in the Dutch health care system.

ALCMOD assesses short-term (12-month) incremental cost-effectiveness in terms of reductions in disease burden, that is, disability adjusted life years (DALYs) and health care budget impacts.

Introduction of new eHealth technologies would substantially increase the cost-effectiveness of the Dutch health care system for alcohol use disorders: every euro spent under the current system returns a value of about the same size (€1.08, ie, a “surplus” of 8 euro cents) while the new health care system offers much better returns on investment, that is, every euro spent generates €1.62 in health-related value.

Based on the best available evidence, ALCMOD's computations suggest that implementation of new eHealth technologies would make the Dutch health care system more cost-effective. This type of information may help (1) to identify opportunities for system innovation, (2) to set agendas for further research, and (3) to inform policy decisions about resource allocation.


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A qualitative investigation of barriers to entry into couples' treatment for alcohol problems

This study used qualitative methodology to evaluate barriers to entry into couples' treatment for alcohol problems.

Data were collected using semistructured interviews. Patients were recruited from (a) treatment for primary substance use disorders, (b) treatment for psychiatric disorders (other than substance use disorders), and (c) court-mandated outpatient domestic violence programs. Mental health experts were recruited based on expertise in (a) couples' treatment, (b) alcohol treatment, and (c) couples' treatment for alcohol problems.

Patients (N = 57) met criteria for hazardous drinking and were in committed romantic relationships. Partners (n = 19) and mental health experts (n = 12) also completed interviews. Interviews were analyzed using accepted qualitative strategies.

Barriers to treatment entry were identified at the patient, partner, and couple level. Barriers identified included psychological barriers, alcohol illness factors, treatment preferences and beliefs, and interpersonal factors.

Although many barriers are similar to those previously identified in individual alcohol treatment, barriers unique to couples' treatment provide guidance for next directions for dissemination.

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Correlates of participation in peer recovery support groups as well as voluntary and mandated substance abuse treatment among rural and urban probatio

This study explores the correlates of probationers' participation in 12-step programs, voluntary treatment, and mandated treatment, with respect to the geographic location of where the services are being provided as the primary covariate of interest.

Data were derived from face-to-face interviews with rural and urban probationers (N = 1,464).

Results of the three logistic regression models suggested that even when all the covariates are taken into account, urban probationers were significantly more likely to have been involved in 12-step programs, voluntary treatment, and mandated treatment over their lifespan.

Despite high levels of self-reported substance use among all participants, treatment services were underused by rural probationers.

These data suggest that individuals residing in rural communities may face additional barriers to receiving treatment services and that criminal involvement is associated with participation in peer recovery support groups and treatment.

Future studies can investigate criminal involvement as an avenue to enhance recovery and how to overcome treatment barriers in rural areas.



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Request Reprint E-Mail: cboser0@uky.edu

Critique 051: Types of alcohol in relation to acute pancreatitis – 11 August 2011

Forum Summary

A very well-done analysis from scientists in Sweden has related the type of alcoholic beverage, and the amount consumed per occasion, to the risk of acute pancreatitis. The study suggests that a greater number of drinks per occasion (“binge drinking”) of spirits increases the risk of acute pancreatitis, but no such relation was seen for the consumption of beer or wine. Forum reviewers suggested that a faster rate of drinking, with a greater rise in BAC, for spirits drinkers may be an important factor in the observed higher risk of pancreatitis; the increased risk may not necessarily be due to lower levels of antioxidants or to the presence of other toxic substances in spirits.

In any case, the average total alcohol consumption did not affect the risk of pancreatitis; instead, it was the number of drinks consumed per occasion (of spirits, in this study) that was associated with an increase in risk. Residual confounding by the pattern of drinking, diet, or by other lifestyle factors could still be operating, and it will require replication of these results in other studies to support the conclusions of the authors.

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Alcohol Direct Enhanced Service (DES) Guidance released

Guidance to improve the delivery of alcohol brief interventions (Identification and Brief Advice) for Primary Care practices incentivised through the DES has been released:

Improving Delivery of the Alcohol Direct Enhanced Service: A Step-By-Step Guide for Commissioners, Primary Care Practitioners and Practice Managers [pdf] > > > > Read More

Does Rehab Work as a Treatment for Alcoholism and Other Addictions?

Singer Amy Winehouse's fame and infamy have now been forever linked to one word: rehab. She is only one of many recent high-profile cases in which attempts at rehabilitation from substance abuse failed. Amidst strange public outbursts earlier this year, actor Charlie Sheen asserted that it was not rehab, but rather he, himself, that had been his secret weapon against abusing cocaine and booze.

And celebrities are not the only ones with untreated substance abuse problems. More than 20 million Americans ages 12 and older needed—but were not receiving—treatment as of 2007, according to the Substance Abuse and Mental Health Services Administration. > > > > Read More

Celebrating sobriety in society

THE SECOND ANNUAL European Young People in Alcoholics Anonymous Conference, one of the largest European conventions for people in recovery from addiction, takes place this weekend in Citywest, Dublin.

The convention is aimed at young people and their families and the aim is to celebrate “sobriety and have fun”. Over the course of the weekend, events include workshops, talks, nightly entertainment, and a range of activities from yoga classes to outdoor pursuits.

The aim in effect is to make young people’s sobriety more public and understood, in a society where addiction, particularly at a young age, often carries with it a certain social shame and secrecy. > > > > Read More

Latency Periods Between Alcohol-Related Traffic Violations: Implications for Recidivism

Before October 1, 2002, Maryland's regulations for relicensing drivers with 2 recorded alcohol-related traffic violations distinguished between offenders with 5 or more years between their first and second violations and those with less than 5 years.

Our research examined whether this policy was supported by differential probabilities of recidivism and violation-free survival.

We compared recidivism rates and survival probabilities among the 2 latency subgroups and 2 control groups (first offenders and drivers with no previous alcohol-related traffic violation). Data were extracted from Maryland's driver record database and segregated files and analyzed by age quintiles using Cox proportional hazards models containing identifiers for risk factors, including prior violations. All drivers (N = 64,536) were matched on age quintile, gender, and month of offenders’ index violations. Effects of violation histories on survival and recidivism probabilities were measured by contrasts of regression coefficients.

Among second offenders, the shorter latency subgroup consistently had higher recidivism and lower violation-free survival than the longer latency subgroup, whose rates fell between those of first offenders and the shorter latency subgroup. Although highly significant, the subgroup differences were small and paled by comparison to differences between first and zero offenders in probability of a subsequent violation.

An earlier study that showed similar overall recidivism for these latency subgroups helped encourage Maryland to change its regulations governing license reinstatement. New regulations issued October 1, 2002, focused on 2 alcohol violations “during any period of time” where investigation indicated alcoholism or unaddressed alcohol problems. To obtain relicensure, these offenders could be required to enter or complete a lengthy certified alcohol treatment program. Our current results are consistent with these requirements. License reinstatement should be primarily guided by the extent of alcohol impairment, especially because both latency subgroups showed higher risks of recidivism than first offenders, who themselves had comparatively high risk.

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Community Preventive Services Task Force Finds Commercial Liability an Effective Strategy to Reduce Alcohol-Related Harms

Holding Alcohol Retailers Liable

Far too often, newspaper headlines tragically announce alcohol-related deaths. Excessive drinking kills more than 79,000 people in the U.S. each year; these deaths are preventable. One way to prevent excessive drinking, and related injuries and deaths, is to reduce binge drinking that occurs outside the home. Drinking in bars and restaurants is strongly associated with binge drinking and with alcohol-impaired driving. Managers and servers in retail alcohol establishments play a key role in the community by not serving intoxicated and underage customers. Laws that hold alcohol retailers liable for the injuries and damages caused by their intoxicated and underage customers help to encourage responsible service. > > > > Read More

Affect and alcohol use: An ecological momentary assessment study of outpatients with borderline personality disorder.

Alcohol use may be viewed as an attempt (albeit maladaptive) to regulate negative emotional states.

We examined associations between both negative and positive affects and alcohol use in outpatient women diagnosed with borderline personality disorder (BPD; n = 74), a prototype of emotional dysregulation, as well as a psychiatric control group of women with current depressive disorder (major depressive disorder/dysthymic disorder [MDD\DYS]; n = 50). Participants completed randomly prompted reports of mood and alcohol use up to six times a day over a 28-day period using electronic diaries.

Mean levels of either positive or negative affects did not distinguish between drinkers and nondrinkers in either diagnostic group. However, levels of both negative and positive affects were positively associated with alcohol use at the momentary level in BPD drinkers.

More robust findings were obtained with respect to within-person affective variability, which was related to alcohol use in multiple ways.

BPD drinkers showed higher within-person variability for most negative affects than BPD nondrinkers; MDD\DYS drinkers in general showed less within-person variability than MDD\DYS nondrinkers for negative affects.

Multilevel lagged analyses for BPD drinkers indicated that alcohol use was positively related to variability in all affects, concurrently, but fewer significant effects of affect variability on the next day's drinking or significant effects of alcohol use on the next day's affect variability were observed.

Among MDD\DYS drinkers, we observed more significant associations between affect variability on next day's alcohol use and of alcohol use on next day's affect variability.

We discuss theoretical and methodological issues relevant to these findings as well as implications for future research.



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Request Rerprint E-Mail: TrullT@missouri.edu

Do executive and reactive disinhibition mediate the effects of familial substance use disorder

The present study examined the potential mediating roles of executive and reactive disinhibition in predicting conduct problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, and substance use among adolescents with and without a family history of substance use disorders.

Using data from 247 high-risk adolescents, parents, and grandparents, structural equation modeling indicated that reactive disinhibition, as measured by sensation seeking, mediated the effect of familial drug use disorders on all facets of the adolescent externalizing spectrum.

Executive disinhibition, as measured by response disinhibition, spatial short term memory, and “trait” impulsivity, was associated with ADHD symptoms. Moreover, although executive functioning weakness were unrelated to familial substance use disorders, adolescents with familial alcohol use disorders were at risk for “trait” impulsivity marked by a lack of planning.

These results illustrate the importance of “unpacking” the broad temperament style of disinhibition and of studying the processes that underlie the commonality among facets of the externalizing spectrum and processes that predict specific externalizing outcomes.



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Request Reprint E-Mail: elizabeth.handley@asu.edu

The subjective effects of alcohol–tobacco co-use: An ecological momentary assessment investigation

Alcohol and tobacco use covary at multiple levels of analysis, and co-use of the 2 substances may have profound health consequences.

To characterize the motivationally relevant processes contributing to co-use, the current study used ecological momentary assessment (EMA) to examine the subjective consequences of naturally occurring simultaneous use of alcohol and tobacco.

Current smokers who reported frequently drinking alcohol (N = 259) used electronic diaries to monitor their daily experiences for 21 days. Participants responded to prompted assessments and also initiated recordings when they smoked a cigarette or completed the first drink in a drinking episode.

Momentary reports of smoking and alcohol consumption were associated with one another, and these effects remained after adjustment for occasion- and person-level covariates.

When participants consumed alcohol, they reported increased pleasure and decreased punishment from the last cigarette. Smoking was associated with small increases in pleasure from the last drink.

Ratings of buzzed and dizzy were synergistically affected by co-use of alcohol and tobacco. Co-use was also followed by higher levels of craving for both alcohol and tobacco.

Results point to the importance of reward and incentive processes in ongoing drug use and suggest that alcohol intensifies real-time reports of the motivational consequences of smoking more strongly than smoking affects corresponding appraisals of alcohol effects.



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Request Reprint E-Mail: piaseckit@missouri.edu

Mortality among Substance-using Mothers in California: A 10-year Prospective Study

To examine mortality rates and causes of death among a cohort of substance-using mothers and to identify risk factors that predict mortality.

This is a prospective study of a cohort of 4,447 substance-using mothers (pregnant or parenting) who were enrolled during 2000 to 2002 in 40 drug abuse treatment programs across California.

All mothers were assessed at baseline using the Addiction Severity Index. Mortality data were obtained from the National Death Index and causes of death were coded using ICD-10. Standardized mortality ratios (SMR) were calculated relative to women in the general population adjusted for age. Proportional hazard

(Cox) regression was used to identify risk factors predicting death.

By the end of 2010, 194 deaths were confirmed, corresponding to a crude mortality rate of 4.47 per 1000 person-years and SMR of 8.4 (95% CI=7.2-9.6). Drug overdose (28.8%), cardiovascular disease (10%), and alcohol or drug disorders (8.9%) were the leading causes of death. Baseline factors associated with higher mortality included older age, being white (relative to African American or Hispanic), heroin, alcohol, cocaine, or marijuana (relative to methamphetamine) as the primary drug problem, drug injection, and greater severity of employment, medical/health, and psychiatric problems.

Substance-using mothers have 8.4 times the mortality than that observed among US women of similar age. Greater severity of employment, medical/health, and psychiatric problems contributed to the elevated mortality.

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Request Reprint E-Mail: yhser@ucla.edu

Trends in adolescent alcohol use: Effects of age, sex and cohort on prevalence and heritability

To determine the effect of age, sex, and cohort on the prevalence and genetic architecture of adolescent alcohol use (AAU). Design Survey study in participants registered with the Netherlands Twin Register. Setting Twins from the general population.

Two cohorts (data collected in 1993 and 2005-8) of twins aged 13-15, 16-17 and 18-21. In 1993 and 2005-8 a total of respectively 3269 and 8207 twins took part.

Survey data on initiation and frequency of alcohol use and quantity of alcohol consumed.

The prevalence of alcohol initiation increased between 1993 and 2005-8, for both males and females. The largest difference was observed at age 13-15, where the prevalence increased from 62.5% to 73.7%. We also found increases in prevalence across cohorts for quantity of alcohol consumed and non-significant increases for frequency of alcohol use. From age 16 onwards, boys drank more frequently and larger quantities than girls. Genetic model fitting revealed that the genetic architecture of AAU does not differ between birth cohorts, nor were there differences between boys and girls. Genetic factors explained between 21% and 55% of individual differences in alcohol measures throughout adolescence. Shared environment explained between 17% and 64% of variance in alcohol use, across different age groups and alcohol measures.

In the Netherlands, the prevalence of alcohol initiation, frequency and quantity has increased in adolescents over a 15 year period, but there are no changes in the genetic architecture of adolescent alcohol use.



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Request Reprint E-Mail: L.M.Geels@vu.nl.

Age differences in diagnostic criteria of DSM-IV alcohol dependence among adults with similar drinking behavior

To test age differences in the prevalence of DSM-IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behavior.

Cross-sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two-stage probability sampling design. The survey used self-administered questionnaires and telephone interviews (mixed-mode design; 45% response rate).

The analytical sample consisted of n = 6,984 individuals aged 18 to 64 years reporting alcohol consumption within the previous year.

Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socioeconomic variables.

When controlling for drinking behavior, to 24-year-olds were more likely to meet the criteria ‘tolerance’, ‘larger/longer’, and ‘time spent’ relative to older age groups. In contrast, the likelihood of experiencing ‘withdrawal’ symptoms increased with age. There was no significant age effect on the diagnosis of AD.

Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as ‘tolerance', ‘drinking larger amount or for longer than intended' and ‘time spent recovering' cannot be fully explained by differences in drinking behavior.



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Campus Life 101: Staying Sober

As a high school senior, Aaron Weir decided to attend Texas Tech University in Lubbock, not for any particular academic program but for the hospitality that school extends toward students in recovery from alcoholism and drug addiction.

"I was 16 years old when I got clean and sober and I want to stay that way in college," says Mr. Weir, a 20-year-old business major now entering his junior year at Texas Tech. Among amenities including a sober-student hangout with study pods, pool tables and 12-step meetings, Mr. Weir receives a $3,000-a-year scholarship from the university for earning near-perfect grades while staying sober.

A growing number of universities are following Texas Tech's model by creating so-called recovery communities, which often feature on-campus clubhouses, recreational opportunities, academic support and recovery courses.

To promote the spread of the concept, about 20 colleges this summer formed the Association for Recovery in Higher Education. On the campus of one founding member—Georgia's Kennesaw State University—the community of 50 recovering students is up from three when the program was launched in 2008. > > > > Read More

Longitudinal study on quality of life, craving and psychological adjustment in alcohol-dependent patients: variations depending on the personality dis

The goal of this study was to determine the
evolution of variables such as quality of life, craving, or psychological adjustment during treatment in a sample of 65 patients with alcohol-dependence disorder, 56.3% of whom also presented a personality disorder (PD).

Five measurements were taken over the course of the treatment, at 3-month intervals. The analysis of tendencies of the variables craving, quality of life, and psychological adjustment assessed at the five assessment points revealed that the cognitive-behavioral treatment influences each one of these variables differently: a quadratic and cubic relation was identified for craving, whereas for quality of life there were linear, quadratic and cubic relationships in its diverse scales depending on the time point in question, and for psychological adjustment there were linear and quadratic relationships.

At the end of treatment, the patients assessed presented significantly higher levels of quality of life than at the beginning, but the results showed that, although the patients with PD had better perceived quality of life at three months, it was lower over the entire course of the treatment compared to patients without PD.

It was also found that quality of life and craving at the start of the treatment predicted alcohol use during the first three months.

The implications of these results are discussed with a view to psychological intervention with alcohol-dependent patients.



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Ethanol drinking reduces extracellular dopamine levels in the posterior ventral tegmental area of nondependent alcohol-preferring rats

Moderate ethanol exposure produces neuroadaptive changes in the mesocorticolimbic dopamine (DA) system in nondependent rats and increases measures of DA neuronal activity in vitro and in vivo. Moreover, moderate ethanol drinking and moderate systemic exposure elevates extracellular DA levels in mesocorticolimbic projection regions. However, the neuroadaptive changes subsequent to moderate ethanol drinking on basal DA levels have not been investigated in the ventral tegmental area (VTA).

In the present study, adult female alcohol-preferring (P) rats were divided into alcohol-naive, alcohol-drinking, and alcohol-deprived groups. The alcohol-drinking group had continuous access to water and ethanol (15%, vol/vol) for 8 weeks. The alcohol-deprived group had 6 weeks of access followed by 2 weeks of ethanol deprivation, 2 weeks of ethanol re-exposure, followed again by 2 weeks of deprivation.

The deprived rats demonstrated a robust alcohol deprivation effect (ADE) on ethanol reinstatement. The alcohol-naïve group had continuous access to water only. In the last week of the drinking protocol, all rats were implanted with unilateral microdialysis probes aimed at the posterior VTA and no-net-flux microdialysis was conducted to quantify extracellular DA levels and DA clearance.

Results yielded significantly lower basal extracellular DA concentrations in the posterior VTA of the alcohol-drinking group compared with the alcohol-naive and alcohol-deprived groups (3.8±0.3nM vs. 5.0±0.5nM [P<.02] and 4.8±0.4nM, [P<.05], respectively). Extraction fractions were significantly (P<.0002) different between the alcohol-drinking and alcohol-naive groups (72±2% vs. 46±4%, respectively) and not significantly different (P=.051) between alcohol-deprived and alcohol-naive groups (61±6% for the alcohol-deprived group).

The data indicate that reductions in basal DA levels within the posterior VTA occur after moderate chronic ethanol intake in nondependent P rats. This reduction may result, in part, from increased DA uptake and may be important for the maintenance of ethanol drinking.

These adaptations normalize with ethanol deprivation and may not contribute to the ADE.



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