The TM2 6' Position of GABAA Receptors Mediates Alcohol Inhibition.

Ionotropic γ-aminobutyric acid receptors (GABAARs), which mediate inhibitory neurotransmission in the central nervous system, are implicated in behavioral effects of alcohol and alcoholism. Site-directed mutagenesis studies support the presence of discrete molecular sites involved in alcohol enhancement and, more recently, inhibition of GABAARs.

We used Xenopus laevis oocytes to investigate the 6' position in the second transmembrane region of GABAARs as a site influencing alcohol inhibition.

We asked if modification of the 6' position by substitution with larger residues, or by methanethiol labeling (using methyl methanethiosulfonate, MMTS) of a substituted cysteine, reduced GABA action and/or blocked further inhibition by alcohols.

Labeling of the 6' position in either α2 or β2 subunits reduced responses to GABA. In addition, methanol and ethanol potentiation increased following MMTS labeling or substitution with tryptophan or methionine, consistent with elimination of an inhibitory site for these alcohols. Specific alcohols, but not the anesthetic etomidate, competed with MMTS labeling at the 6' position.

We verified a role for the 6' position in previously tested α2β2 as well as more physiologically relevant α2β2γ2s GABAARs.

Finally, we built a novel molecular model based on the GABAAR homolog GluCl, revealing that the 6' position residue faces the channel pore, and that modification of this residue alters volume and polarity of the pore-facing cavity in this region.

These results indicate that the 6' positions in both α2 and β2 GABAAR subunits mediate inhibition by short-chain alcohols, consistent with the presence of multiple, counteracting sites of action for alcohols on ligand-gated ion channels.


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

Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home.

A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts.

Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to, 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers.

Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.

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Low liver-related mortality among heavy drinkers: results of a long-term follow-up study

Epidemiological evidence demonstrates a J-shaped relationship between alcohol consumption and mortality, implying a lower risk of all cause mortality in moderate drinkers compared to non-drinkers and heavy drinkers. Furthermore, general beliefs are that heavy
drinkers die as a result of liver disease. However, there is a lack of long term follow-up (FU) data.

The aim of this study is to investigate prospectively the relationship between mortality and alcohol consumption, over 18 years of FU in a general population of elderly.

This study was based on participants (>55 years) of the Rotterdam Study, a large population-based study in the Netherlands. Baseline examinations took place between 1989 and 1993. Data on ethanol consumption was available for 3884 participants. Mortality outcomes were registered by International Classification of Diseases codes. Alcohol intake was determined by a standardized questionnaire and divided into four categories: non drinkers (0-0.7g/day), light drinkers (≤10 g/day), moderate drinkers (>10-≤30 g/day) and heavy drinkers (>30 g/day). The association between alcohol intake and mortality was examined by Cox Regression analyses, adjusting for age, sex, hypertension, cholesterol, BMI, diabetes, smoking, and educational level.

Of 3884 participants, 1398 (36.0%) were non drinkers, 1144 (29.4%) light drinkers, 963 (24.8%) moderate drinkers and 379 (9.7%) heavy drinkers. A total of 187 heavy drinkers died during FU: 63 participants (33.9%) died of cancer-related causes, 52 participants (28%) died of cardiovascular-related causes and only 2 participants (1%) died of liver-related causes. Multiple-adjusted mortality rates showed a U-shaped relationship between alcohol intake and mortality: compared to non-drinkers hazard ratio for light drinkers was 0.85 (95%CI 0.75-0.96; p=0.03), 0.86 (95%CI 0.76-0.98; p=0.007) for moderate drinkers and 0.95 (95%CI 0.8-1.14; p=0.6) for heavy drinkers. Similar results were observed, after exclusion of deaths in the first 3 years of FU, to eliminate the effect of possible pre-existing diseases on mortality rates among non-drinkers.

We confirmed a beneficial effect of light-moderate alcohol intake on long-term survival in a large elderly population. Only a minority of heavy drinkers (1%) die of liver-related mortality during a long-term follow up, the majority die because of cancer and cardiovascular diseases.

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Gender Differences in Early Maladaptive Schemas in a Treatment-Seeking Sample of Alcohol-Dependent Adults

The current study examined early maladaptive schemas among alcohol-dependent men and women and sought to determine whether men and women differed in their early maladaptive schemas.

Using preexisting patient records of adults diagnosed with alcohol dependence from a residential treatment center in the Southeastern United States, from 2005 to 2010 (N = 854), results showed that women scored significantly higher than men on 14 of the 18 early maladaptive schemas assessed.

Both women and men endorsed having a number of early maladaptive schemas, with four schemas being particularly prevalent across gender.

Study limitations are noted and implications of these findings for treatment and future research are discussed.

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Request Reprint E-Mail: rshorey@utk.edu.

Health Committee concerns over Public Health budgets - risks to investment in alcohol treatment and prevention?

The Health Committee has voiced concerns over plans to pass control of Public Health budgets to Local Government in a new Public Health report. Launching the report, Health Select Committee Chair Rt Hon Stephen Dorrell MP said "Public Health England (PHE) must be visibly and operationally independent of Ministers. It must demonstrate that it is able to, and regularly does, speak 'truth unto power'."

Dorrell also said the Committee remained "unconvinced that the new Responsibility Deal will, by itself, resolve major issues such as obesity and alcohol abuse. The Government must set out clearly how progress will be monitored, and when tougher action will be taken if ‘nudging’ does not work." A Lords Select Committee earlier the year had said the 'nudge' approach alone is not enough. > > > > Read More

Drug-Related Emergency Department Visits Attributed to Intentional Poisoning

• In 2009, there were an estimated 14,720 emergency department (ED) visits attributed to intentional drug poisoning
  
• Three quarters (73 percent) of drug-related ED visits attributed to intentional poisoning were made by patients aged 21 or older
  
• Females accounted for nearly two thirds of drug-related ED visits attributed to intentional poisoning (63 percent)
  
• Approximately 60 percent of these ED visits in 2009 involved unidentified drugs, and a similar percentage involved alcohol in combination with other drugs

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Ethanol Increases GABAergic Transmission and Excitability in Cerebellar Molecular Layer Interneurons from GAD67-GFP Knock-in Mice

This study assessed the acute effect of ethanol on GABAergic transmission at molecular layer interneurons (MLIs; i.e. basket and stellate cells) in the cerebellar cortex. The actions of ethanol on spontaneous firing of these pacemaker neurons were also measured.

Transgenic mice (glutamic acid-decarboxylase 67-green fluorescent protein knock-in mice) that express green fluorescence protein in GABAergic interneurons were used to aid in the identification of MLIs. Parasagittal cerebellar slices were prepared and whole-cell patch-clamp electrophysiological techniques were used to measure GABA_A receptor-mediated spontaneous and miniature inhibitory postsynaptic currents (sIPSCs and mIPSCs). Loose-seal cell-attached recordings were used to measure spontaneous action potential firing.

Stellate cells received spontaneous GABAergic input in the form of a mixture of action potential-dependent events (sIPSCs) and quantal events (mIPSCs); ethanol increased sIPSC frequency to a greater extent than mIPSC frequency. Ethanol increased spontaneous action potential firing of MLIs, which could explain the increase in sIPSC frequency in stellate cells. Basket cells received GABAergic input in the form of quantal events only. Ethanol significantly increased the frequency of these events, which may be mediated by a different type of interneuron (perhaps, the Lugaro cell) or Purkinje cell collaterals.

Ethanol exposure differentially increases GABA release at stellate cell vs. basket cell-to-Purkinje cell synapses. This effect may contribute to the abnormalities in cerebellar function associated with alcohol intoxication.

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

Hidden realities: children's exposure to risks from parental drinking in Ireland.

The overall purpose of this research study is to collate the research evidence and to help profile the extent of hazardous and harmful use of alcohol on children in Ireland, in particular in the North West Region. The research aims
• To gather data on the negative effects of parental and other adult drinking habits on children
• To gather data on the effectiveness of health and social care responses to such harm
• To make recommendations to ensure greater protection for children and to reduce children’s exposure to risk from alcohol
• To make recommendations to improve the health and social services response for children and their families


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Selected sociodemographic factors and related differences in patterns of alcohol use among university students in Slovakia

Alcohol use and misuse and their relation to sociodemograhic factors are well studied among university students in Western European countries and the USA, but less is known about students in Eastern Europe. The historical past as communistic countries might have affected the social life among these populations, which is again one of the main factors determining the alcohol consumption among university students. The aim of our study was to assess the association of selected sociodemographic factors with different patterns of alcohol use among university students in Slovakia.

A sample of 813 young adults (mean age 21.1 years, 63.8% females; response rate of 71%) from four universities in Kosice answered questions about their sociodemographic background and about alcohol use. To obtain a detailed picture of different aspects, alcohol use was measured by four variables: frequency of alcohol use, heavy episodic drinking, frequency of drunkenness and problem drinking. Four separate logistic regression models were used to assess the association between sociodemographic and alcohol-related variables. To assess the potentially different effects in both genders, all two-way interactions with gender were tested.

While 41% of the students drank alcohol once a week or more often, 77% reported heavy episodic drinking and 49% had been drunk more than once in the last month. Problem drinking existed in 23.3% of the sample. Gender was consistently associated with all four alcohol-related variables, with males being at higher risk. A higher study year was associated only with lower levels of heavy episodic drinking, but displayed no association with the other studied variables. Living with parents during the semester was consistently associated with less frequent heavy episodic drinking, drunkenness episodes, and problem drinking while having an intimate relationship was associated with less problem drinking only.

Our findings for the university students from Slovakia are in line with previous studies in Western Europe. Additionally, it appears that frequent alcohol use, excessive alcohol use (heavy episodic drinking and drunkenness) and problem drinking among university students represent a continuum and are influenced by the same sociodemographic factors.

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CALL FOR A COMPREHENSIVE ALCOHOL POLICY STRATEGY IN THE EUROPEAN UNION 2013 - 2020

Alcohol is the world’s number one risk factor for ill-health and premature death amongst the 25-59 year old age group, a core of the working age population. Europe is the heaviest drinking region of the world.

Consumption levels in some countries are around 2.5 times higher than the global average (WHO 2009). Alarmingly 43% among 15-16 year old European students reported heavy binge drinking during the past 30 days (ESPAD 2007) and alcohol is the single biggest cause of death among young men of age 16 to 24.

The World Economic Forum's 2010 Global Risks Report identifies non-communicable diseases (NCDs) as the second most severe threat to the global economy in terms of likelihood and potential economic loss. NCDs are a global risk equal in cost to the current global financial crisis. NCDs account for 86% of deaths globally, cardio-vascular diseases alone cost the EU economy €192 billion a year; similarly diabetes type II affects nearly 10% of entire adult population and costs €166 billion annually. The World Economic Forum and Harvard School of Public Health estimate that NCDs will cause a €25 trillion global economic output loss over the period 2005-2030. Alcohol abuse is one of the 4 risk factors for developing NCDS such as cancer (1 in 3 European will get cancer in the coming years) and cardiovascular disease. It is important to address alcohol in this context and give it the attention needed.

Addressing the issue of alcohol abuse through effective policies will offer measurable health system savings and enhance the growth and productivity agenda for Europe 2020. > > > > Read More

Report says alcohol enforcement laws are not fully used, but enforcement alone is not the solution

A new report explores whether UK laws relating to the sale and consumption of alcohol are 'fit for purpose' and are being effectively enforced. The report finds that many laws are not being fully utilised, although a variety of measures are still required to achieve alcohol harm reduction. > > > > Read More

Early Liver Transplantation for Severe Alcoholic Hepatitis

A 6-month abstinence from alcohol is usually required before patients with severe alcoholic hepatitis are considered for liver transplantation. Patients whose hepatitis is not responding to medical therapy have a 6-month survival rate of approximately 30%. Since most alcoholic hepatitis deaths occur within 2 months, early liver transplantation is attractive but controversial.

We selected patients from seven centers for early liver transplantation. The patients had no prior episodes of alcoholic hepatitis and had scores of 0.45 or higher according to the Lille model (which calculates scores ranging from 0 to 1, with a score ≥0.45 indicating nonresponse to medical therapy and an increased risk of death in the absence of transplantation) or rapid worsening of liver function despite medical therapy. Selected patients also had supportive family members, no severe coexisting conditions, and a commitment to alcohol abstinence. Survival was compared between patients who underwent early liver transplantation and matched patients who did not.

In all, 26 patients with severe alcoholic hepatitis at high risk of death (median Lille score, 0.88) were selected and placed on the list for a liver transplant within a median of 13 days after nonresponse to medical therapy. Fewer than 2% of patients admitted for an episode of severe alcoholic hepatitis were selected. The centers used 2.9% of available grafts for this indication. The cumulative 6-month survival rate (±SE) was higher among patients who received early transplantation than among those who did not (77±8% vs. 23±8%, P<0.001). This benefit of early transplantation was maintained through 2 years of follow-up (hazard ratio, 6.08; P=0.004). Three patients resumed drinking alcohol: one at 720 days, one at 740 days, and one at 1140 days after transplantation.

Early liver transplantation can improve survival in patients with a first episode of severe alcoholic hepatitis not responding to medical therapy.

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Request Reprint E-Mail: philippe.mathurin@chru-lille.fr.

The Longitudinal Relationships Between Rural Adolescents’ Prosocial Behaviors and Young Adult Substance Use

While many adolescents and young adults experiment with substances (e.g., alcohol, cigarette smoking, marijuana), recent research suggests that rural youth and young adults may be more at risk for substance use than their urban counterparts.

This study was designed to examine the longitudinal relationships between rural adolescents’ prosocial behaviors and substance use in young adulthood. Furthermore, we examined the potential mediating effects of adolescent substance use, academic investment, and delinquency.

Rural youth (N = 531; 263 girls) were surveyed in grades 10–12 (Time 1; M age = 16.17; SD = .91) and again in early adulthood (Time 2). Measures of prosocial behaviors, substance use, academic investment, and deviant activities were assessed at Time 1. At Time 2, measures of marijuana use, cigarette smoking, and getting drunk were administered.

Overall, the findingsshowed that rural adolescents who frequently exhibit prosocial behaviors are less likely to engage in substance use in young adulthood than those who exhibit relatively low levels of prosocial behaviors.

These findings indicate that prosocial behaviors may have positive health consequences, establishing behavioral trajectories that lead to lower levels of risky health behaviors in adulthood in rural populations.


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Readiness to change, drinking, and negative consequences among Polish SBIRT patients

The aim of this study is to examine the longitudinal relationship of readiness to change, drinking pattern, amount of alcohol consumed, and alcohol-related negative consequences among at-risk and dependent drinkers enrolled in a Screening, Brief Intervention and Referral to Treatment (SBIRT) trial in an emergency department in southern Poland.

The study examined 299 patients randomized to either an assessment or intervention condition and followed at 3 and 12 months after initial presentation.

Patients indicating a readiness or were unsure of changing drinking behavior were significantly more likely to decrease the maximum number of drinks per occasion and the usual number of drinks in a sitting in the 3-months following study entry when compared to those that rated changing drinking behavior as unimportant.

Readiness to change was not predictive of outcomes between the baseline and 12-month follow-up. Drinking outcomes and negative consequences by readiness and research condition were non-significant.

This is the first Polish study utilizing SBIRT to enable patients to identify their hazardous drinking and reduce alcohol consumption.

While some drinking outcomes improved with motivation, these improvements were not maintained at 12-months following SBIRT.

Attention to additional constructs of readiness to change and drinking patterns may augment the effectiveness of SBIRT.


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Request Reprint E-Mail: rkorcha@arg.org

Did lifetime rates of alcohol use disorders increase by 67% in 10 years? A comparison of NLAES and NESARC.

Two nationally representative epidemiological samples (the National Longitudinal Alcohol Epidemiological Survey and the National Epidemiological Survey of Alcohol and Related Conditions) have been used to track changes in the prevalence of alcohol use disorders (AUDs) between 1992 and 2002 in the United States.

Strikingly, estimates from these two data sets suggest that the lifetime prevalence of AUD increased by approximately 67% (from 18.2% to 30.3%) during this time frame.

This article explores potential reasons for these discrepant estimates. Analyses indicated that a vast majority of change in lifetime AUD occurred with respect to alcohol abuse and not alcohol dependence. Most of this increase in abuse was attributable to self-reported changes in hazardous use that did not track with other archival measures of outcomes related to hazardous use in the population.

Key methodological differences regarding the frequency requirements for prior-to-past-year alcohol abuse appeared to explain most of the discrepancy in lifetime AUD estimates.

These findings, in conjunction with the relative lack of differences in the 12-month prevalence of AUDs, suggest that the discrepant lifetime estimates are likely due to methodological differences between the two surveys.

These findings have important implications for substance use and other psychiatric surveillance and epidemiology where meaningful cross-temporal comparisons are desired.



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Request Reprint E-Mail: avhz6@mail.missouri.edu

The social gradient of alcohol availability in Victoria, Australia

To explore the socioeconomic gradient of alcohol availability in Victoria, Australia.

Using data for the smallest geographic units available, per-capita and area-based measures of alcohol outlet density were calculated for four types of alcohol outlet (broadly: restaurants, hotels, packaged liquor outlets and licensed clubs). These densities were aggregated across deciles of socioeconomic disadvantage, to compare the average density of alcohol outlets across ten levels of socioeconomic status. In addition, negative binomial regression models were developed, assessing the relationship between density and socioeconomic status while controlling for relevant covariates.

In urban areas, both takeaway liquor outlets and licensed clubs were significantly more likely to be located in areas of socioeconomic disadvantage, while hotel and restaurant licences were more prevalent in advantaged areas. In rural and regional Victoria, all types of outlet types were more prevalent in areas of socioeconomic disadvantage.

The findings suggest that disparities in exposure to alcohol outlets in Victoria may play a role in explaining socioeconomic disparities in health outcomes, with Victorians living in disadvantaged areas generally faced with higher levels of alcohol availability.

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Request Reprint E-Mail: michaell@turningpoint.org.au

Four-fifths of women drank alcohol ‘close to conception’

A total of 81 per cent of women reported alcohol consumption during the peri-conceptual period, the prevalence study of alcohol exposure in pregnancy at the Coombe Women and Infants University Hospital has shown.

Records on 61,241 women who booked for antenatal care and delivered between 2000 and 2007 were examined as part of this study. Of those women who consumed alcohol during the peri-conceptual period, some 43,455 (71 per cent) reported low alcohol intake (0-5 units per week), another 6,059 (9.9 per cent) reported moderate intake (6-20 units per week) and 114 (0.2 per cent) reported high intake (over 20 units per week). > > > > Read More

Press Release - Drinking during pregnancy increases the risk of premature birth

Drinking alcohol during pregnancy is associated with an increased risk of miscarriage, premature birth, and low birth weight. But there are conflicting reports about how much alcohol, if any, it is safe for a pregnant woman to drink. New research, carried out in the Coombe Women & Infants University Hospital looked at the amount of alcohol women drank during their early pregnancy and showed the effect this had on their babies.

Researchers in the Coombe Women & Infants University Hospital questioned more than 60,000 pregnant women during their booking interview, which usually occurred 10 - 12 weeks after conception. The women were asked about their home life, whether they worked, what their nationality was, as well as their drinking habits prior to their antenatal booking visit. This data was compared to data from the birth record and to records from the hospital's Special Care Baby Unit. > > > > Read More

Modulation of miroRNA 20b with resveratrol and longevinex is linked with their potent anti-angiogenic action in the ischemic myocardium and synergesti

Resveratrol, a constituent of red wine, and γ-tocotrienol, a constituent of palm oil are important for cardioprotection. Although MicroRNAs are known regulators for genes involved in cardiac remodeling the regulatory pathway involving microRNA has not been studied so far.

We explored the cardioprotection by resveratrol, longevinex and γtocotrienol in ischemia/reperfusion(I/R) model of rat and determined miRNA profile from isolated RNA. Systemic analyses of miRNA array and theirs targets were determined using a number of computational approaches.

Resveratrol and γ-tocotrienol, either alone or in combination, modulated the expression pattern of miRNAs close to the control level based on PCA analyses. Differential expression was observed in over 75 miRNAs, some of them, such as miR-21 and miR-20b (antiangiogenic) were previously implicated in cardiac remodeling. The target genes for the highest differentially expressed miRNA include genes of various molecular function such as TGFβ1–Smad3 signaling pathway, inflammation and their transcription factors, which may play key role in reducing I/R injury. Administration of antagomiR-20 attenuated I/R induced VEGF and HIF1α level.

All the interventions treated for 3 weeks lead to significant cardioprotection against ischemia/reperfusion injury. A unique signature of miRNA profile is observed in control heart pretreated with resveratrol or γ-tocotrienol. We have determined specific group of miRNA in heart that have altered during IR injuries. Most of those altered microRNA expressions modulated close to their basal level in resveratrol or longevinex treated I/R rat. Interestingly, resveratrol and γ-tocotrienol resulted in synergestic action.

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Request Reprint E-Mail: DDAS@NEURON.UCHC.EDU

The pre-synaptic metabotropic glutamate receptor 7 “mGluR7” is a critical modulator of ethanol sensitivity in mice

Recent studies demonstrated that the metabotropic glutamate receptor subtype 7 “mGluR7” activation may reduce motivational aspects of ethanol dependence. We investigated the role of mGlu7 receptor in ethanol-related behaviors using the allosteric agonist AMN082 in mice.

Results have shown that mGluR7 activation increased the sedative effect of ethanol as measured by the duration of loss of righting reflex (LORR) and reduced the severity of ethanol-induced withdrawal.

Importantly, the protective effect of the drug on alcohol-induced withdrawal was found when the AMN082 was injected before, but not after, injection of ethanol suggesting that mGluR7 activation prevented development of dependence rather than producing an anti-convulsant effect.

In addition, ethanol-induced locomotor stimulation was blocked by following mGluR7 activation.

Furthermore, mice injected with AMN082 consumed less ethanol in a two-bottle free-choice paradigm and in a drinking in the dark (DID) model. Impairment in reward mechanisms in AMN082-injected mice was confirmed by the lack of ethanol-induced conditioned place preference (CPP).

Follow-up control experiments have shown that plasma alcohol concentrations of AMN082 and vehicle-treated mice were similar.

Taken together, these findings provide evidence for the crucial role of mGluR7 in ethanol-related behaviors, especially in voluntary alcohol drinking and alcohol reward. Thus, pharmacological targeting mGluR7 with AMN082-like compounds might be a potential means to tackle ethanol abuse and alcoholism in the future.


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Request Reprint E-Mail: amine.bahi@uaeu.ac.ae

Press Release - Mental Health and Addiction Treatment Leaders Join Forces for a Solution to Growing Co-Occurring Disorders Crisis

Hazelden has joined forces with the leaders in behavioral health, mental health, and addiction treatment to advance a model of integrated treatment as the solution to the growing co-occurring disorders crisis. > > > > Read More

Apparent Per Capita Alcohol Consumption: National, State, and Regional Trends, 1977–2009

This surveillance report on 1977–2009 apparent per capita alcohol consumption in the United States is the 25th in a series of consumption reports produced annually by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Findings are based on alcoholic beverage sales data, either collected directly by the Alcohol Epidemiologic Data System (AEDS) from the States or provided by beverage industry sources. Population data provided by the U.S. Census Bureau are used as denominators to calculate per capita rates.

The following are highlights from the current report, which updates consumption trends through 2009:

• In the United States, per capita consumption of ethanol from all alcoholic beverages combined in 2009 was 2.30 gallons, representing a 0.9 percent decrease from 2.32 gallons in 2008.

• Between 2008 and 2009, changes in overall per capita consumption of ethanol included increases in 9 States, decreases in 34 States and the District of Columbia,and no change in 7 States.

• Analysis of overall per capita alcohol consumption by census region between 2008 and 2009 indicated decreases of 0.4% in the Midwest, 0.9% in the South, and 1.2% in the West, with no change in the Northeast.

• Healthy People 2010 has set the national objective for reducing per capita alcohol consumption to no more than 1.96 gallons of ethanol. However, the prospect of reaching the Year 2010 national objective does not appear promising. From 1999 to 2008, there was a trend of increasing per capita consumption. 2009 is the first year in a decade in which a decrease in per capita consumption has been observed. To meet the 2010 objective, per capita alcohol consumption will need to decrease by 14.8 percent within one year.

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Racial/Ethnic Variations in Substance-Related Disorders Among Adolescents in the United States

While young racial/ethnic groups are the fastest growing population in the United States, data about substance-related disorders among adolescents of various racial/ethnic backgrounds are lacking.

To examine the magnitude of past-year DSM-IV substance-related disorders (alcohol, marijuana, cocaine, inhalants, hallucinogens, heroin, analgesic opioids, stimulants, sedatives, and tranquilizers) among adolescents of white, Hispanic, African American, Native American, Asian or Pacific Islander, and multiple race/ethnicity.

The 2005 to 2008 National Survey on Drug Use and Health.

Academic research.

Noninstitutionalized household adolescents aged 12 to 17 years.

Substance-related disorders were assessed by standardized survey questions administered using the audio computer–assisted self-interviewing method.

Of 72 561 adolescents aged 12 to 17 years, 37.0% used alcohol or drugs in the past year; 7.9% met criteria for a substance-related disorder, with Native Americans having the highest prevalence of use (47.5%) and disorder (15.0%). Analgesic opioids were the second most commonly used illegal drugs, following marijuana, in all racial/ethnic groups; analgesic opioid use was comparatively prevalent among adolescents of Native American (9.7%) and multiple race/ethnicity (8.8%). Among 27 705 past-year alcohol or drug users, Native Americans (31.5%), adolescents of multiple race/ethnicity (25.2%), adolescents of white race/ethnicity (22.9%), and Hispanics (21.0%) had the highest rates of substance-related disorders. Adolescents used marijuana more frequently than alcohol or other drugs, and 25.9% of marijuana users met criteria for marijuana abuse or dependence. After controlling for adolescents' age, socioeconomic variables, population density of residence, self-rated health, and survey year, adjusted analyses of adolescent substance users indicated elevated odds of substance-related disorders among Native Americans, adolescents of multiple race/ethnicity, adolescents of white race/ethnicity, and Hispanics compared with African Americans; African Americans did not differ from Asians or PaRead Full Abstractcific Islanders.

Substance use is widespread among adolescents of Native American, white, Hispanic, and multiple race/ethnicity. These groups also are disproportionately affected by substance-related disorders.

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Request Reprint E-Mail: litzy.wu@duke.edu

Personality Disorders and the 3-Year Course of Alcohol, Drug, and Nicotine Use Disorders

Little is known about the role of a broad range of personality disorders in the course of substance use disorder (SUD) and whether these differ by substance. The existing literature focuses mostly on antisocial personality disorder and does not come to clear conclusions.

To determine the association between the 10 DSM-IV personality disorders and the persistence of common SUDs in a 3-year prospective study of a national sample.

Data were drawn from participants in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who had alcohol dependence (n = 1172), cannabis use disorder (n = 454), or nicotine dependence (n = 4017) at baseline and who were reinterviewed 3 years later. Control variables included demographic characteristics, family history of substance disorders, baseline Axis I disorders and treatment status, and prior SUD duration.

Persistent SUD, defined as meeting full criteria for the relevant SUD throughout the 3-year follow-up period.

Persistent SUD was found among 30.1% of participants with alcohol dependence, 30.8% with cannabis use disorder, and 56.6% with nicotine dependence at baseline. Axis I disorders did not have strong or consistent associations with persistent SUD. In contrast, antisocial personality disorder was significantly associated with persistent alcohol, cannabis, and nicotine use disorders (adjusted odds ratios, 2.46-3.51), as was borderline personality disorder (adjusted odds ratios, 2.04-2.78) and schizotypal personality disorder (adjusted odds ratios, 1.65-5.90). Narcissistic, schizoid, and obsessive-compulsive personality disorders were less consistently associated with SUD persistence.

The consistent findings on the association of antisocial, borderline, and schizotypal personality disorders with persistent SUD indicates the importance of these personality disorders in understanding the course of SUD. Future studies should examine dimensional representations of personality disorders and the role of specific components of these disorders, biological and environmental contributors to these relationships, and potential applications of these findings to treatment development.

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Request Reprint E-Mail: dsh2@columbia.edu

Persistence of Addictive Disorders in a First-Offender Driving While Impaired Population

We compared the prevalence of alcohol use and other psychiatric disorders in offenders 15 years after a first conviction for driving while impaired with a general population sample.

To determine whether high rates of addictive and other psychiatric disorders previously demonstrated in this sample remain disproportionately higher compared with a matched general population sample.

Point-in-time cohort study.

Pacific Institute for Research and Evaluation, Albuquerque, New Mexico.

We interviewed convicted first offenders using the Composite International Diagnostic Interview 15 years after referral to a screening program in Bernalillo County, New Mexico. We calculated rates of diagnoses for non-Hispanic white and Hispanic women (n = 362) and men (n = 220) adjusting for missing data using multiple imputation and compared psychiatric diagnoses with findings from the National Comorbidity Survey Replication by sex and Hispanic ethnicity.

Eleven percent of non-Hispanic white women and 12.8% of Hispanic women in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with 1.0% and 1.8%, respectively, in the National Comorbidity Survey Replication (comparison) sample. Almost 12% of non-Hispanic white men and 17.5% of Hispanic men in the driving while impaired sample reported 12-month alcohol abuse or dependence, compared with to 2.0% and 1.8%, respectively, in the comparison sample. These differences were statistically significant. Rates of drug use disorders and nicotine dependence were also elevated compared with the general population sample, while rates of major depressive disorder and posttraumatic stress disorder were similar.

In this sample, high rates of addictive disorders persisted over 10 years among first offenders and greatly exceeded those found in a general population sample.

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Request Rerprint E-Mail: slapham@bhrcs.org

Care For Veterans With Mental And Substance Use Disorders: Good Performance, But Room To Improve On Many Measures

In 2006 the Department of Veterans Affairs commissioned the Altarum Institute and the RAND Corporation to do an evaluation of its mental health treatment system.

We found that veterans with mental illness and substance use disorders represented 15.4 percent of all veterans using Veterans’ Health Administration (VHA) services in 2007 and that they accounted for 32.9 percent ($12 billion) of VHA costs, of which the majority was for non–mental health conditions. The average cost for a veteran with mental illness and substance use in our study was $12,337, or 2.7 times the cost for an average veteran without these conditions.

The quality of care for the veterans in our study, although similar to or better than the care given to comparable privately insured patients or those enrolled in Medicare or Medicaid, varied by as much as twenty-three percentage points among regional service networks.

Performance on some indicators, such as whether those with alcohol dependence received pharmacotherapy, was low.

There is a need for substantial improvement in the care of these veterans, particularly with respect to ensuring the delivery of evidence-based treatments.


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