An international website dedicated to providing current information on news, reports, publications,and peer-reviewed research articles concerning alcoholism and alcohol-related problems throughout the world. Postings are provided by international contributors who monitor news, publications and research findings in their country, geographical region or program area of interest. All postings are entered without editorial or contributor opinion or comment.
For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.
Saturday, November 19, 2011
:Bupa Health Pulse 2011: International Healthcare Survey - Global Trends, Attitudes and Influences
The Bupa Health Pulse 2011 report focuses on research in 12 developed and developing countries in Europe (Spain and the UK), the Americas (Brazil, Mexico and the US ), the Middle East (Saudi Arabia), Asia (China, India, Hong Kong and Thailand) and Australasia (Australia and New Zealand) and examines the key factors that influence people’s behaviour with regard to their health.
It is based on interviews in 2011 with 13,373 adult members of the general public aged 18+.
The report aims to deepen understanding not only of the trends but also the influences, attitudes, perceptions and behaviours which, on every continent, account for those trends and which potently determine the quality of health of individuals and of nations.
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Atkinson Series: When the drink comes calling
Hang out in the brightly lit rooms of AA, or in coffee shops, talking to dozens of women who have given up drinking, and this is the conclusion you come to: for most people, booze is a loan shark, someone they trusted for a while, came to count on, before it turned ugly. Every alcoholic, it seems, learns this the hard way.
And no matter what the circumstances, certain parts of the story are always the same. Here is how the story goes:
At first, alcohol is that elegant figure standing in the corner by the bar, the handsome one in the beautiful black tuxedo. Or maybe he’s in black leather and jeans. It doesn’t matter. You can’t miss him. He’s always at the party — and he always gets there first.
Maybe you first saw him in high school. Many do. Others meet him long, long before. He finds his moment, some time when you’re wobbly or nervous, excited or scared. You’re heading into a big party or a dance. All of a sudden your stomach begins to lurch. You’re overdressed, or underdressed; too tall, too short; heartsick or heart-in-your-mouth anxious. Doesn’t matter. Booze wastes no time. He sidles up with a quick hit of courage. You grab it. It feels good. It works. > > > > Read More
‘You want to know about my drinking? I lost my friends, my children, my mind’
Beata Klimek is remarkable: a woman willing to tell her story with unflinching candour, name included. A mother of two, comfortable sharing the details of her serious alcohol abuse, her recovery, and her life in the aftermath. Read her story in the first of an important series on why women are driving a growth in alcohol consumption around the world.
It’s 11 a.m. on a radiant morning in the Studio Café, a picture-perfect moment in the signature room of Toronto’s Four Season’s Hotel. Bright wedges of sunlight illuminate dozens of polished glass tables. The room is virtually empty. By noon, the café — perched high above Yorkville — will be full. But for now, there is just a handful of twosomes: Belinda Stronach deep in conversation with a gray-haired gentleman, a well-known film producer huddled with an actress in a corner. People who mean business. > > > > Read More
PS1-10: The Effectiveness of Screening and Brief Intervention on Reducing DWI Citations
The purpose of this study was to use retrospective data to assess the long-term effectiveness of screening and brief intervention (SBI) for at-risk alcohol users and its impact on traffic safety by looking at DWI citations. A second objective was to study ethnicity differences in response to SBI.
During the time period from 1998 to 1999 LCF Research, together with the Lovelace Health System, participated in the Cutting Back study of screening and brief intervention for at-risk drinkers. A total of 426 subjects exhibiting at-risk drinking behaviors from the New Mexico cohort included 211 subjects who received a brief intervention and 215 in the control group who received usual care were used for the study. This study examined DWI citations for all 426 subjects during the five years following the Cutting Back study.
The brief interventions were shown to have had a significant impact on reducing DWI citations for at-risk drinkers with the benefit lasting for the 5 years duration of the study. The screening and brief intervention was found to be most effective in reducing DWI citations for Hispanic at-risk drinkers.
Evidence is presented to support that screening to identify at-risk drinkers followed by a brief intervention has a statistically significant lasting impact on improving traffic safety.
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Friday, November 18, 2011
Social Norm Influences on Evaluations of the Risks Associated with Alcohol Consumption: Applying the Rank-Based Decision by Sampling Model to Health J
The research first tested whether perceptions of other people's alcohol consumption influenced drinkers' perceptions of the riskiness of their own consumption. Second, the research tested how such comparisons are made—whether, for example, people compare their drinking to the ‘average’ drinker's or ‘rank’ their consumption amongst other people's. The latter untested possibility, suggested by the recent Decision by Sampling Model of judgment, would imply different cognitive mechanisms and suggest that information should be presented differently to people in social norm interventions.
Study 1 surveyed students who provided information on (a) their own drinking, (b) their perceptions of the distribution of drinking in the UK and (c) their perceived risk of various alcohol-related disorders. Study 2 experimentally manipulated the rank of ‘target’ units of alcohol within the context of units viewed simultaneously.
In both studies, the rank of an individual's drinking in a context of other drinkers predicted perceptions of developing alcohol-related disorders. There was no evidence for the alternative hypothesis that people compared with the average of other drinkers' consumption. The position that subjects believed they occupied in the ranking of other drinkers predicted their perceived risk, and did so as strongly as how much they actually drank.
Drinking comparisons are rank-based, which is consistent with other judgments in social, emotional and psychophysical domains. Interventions should be designed to work with people's natural ways of information processing, through providing clients with information on their drinking rank rather than how their drinking differs from the average.
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Evaluation of NIAAA’s Alcohol Screening Guide for Children and Adolescents (R01)
The purpose of this Funding Opportunity Announcement is to solicit applications to evaluate the new NIAAA alcohol screener for youth as described in "Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide". Although the questions were empirically developed, are based on a vast amount of data from national surveys as well as numerous prospective studies, and have high sensitivity and specificity in the sample studied, it is important that the precision of the screener be evaluated in practice.
Applications are being sought that will evaluate the two question screener in youth ages 9 to 18 both: 1) as a predictor of alcohol risk, alcohol use, and alcohol problems including AUDs; and 2) as an initial screen for other behavioral health problems, for example other drug use, smoking, or conduct disorder. > > > > Read More
Atypical frontal lobe activity during verbal working memory in youth with a family history of alcoholism
Abnormal brain functioning during verbal working memory (VWM) tasks has been shown in individuals with alcohol use disorders (AUDs). Since adolescents with a familial history of alcoholism (FHP) are at high risk for developing an AUD, it is important to consider whether atypical brain activity during VWM may help to explain FHP vulnerability toward developing alcoholism.
To that end, using functional magnetic resonance imaging, we examined brain response during a VWM 2-back task in 19 FHP adolescents and 16 age and gender-matched family history negative (FHN) controls.
Despite no group differences in task accuracy, FHP youth had significantly slower average reaction time when making correct responses during the 2-back condition than FHN youth. In contrast to a vigilance control condition, while covarying for reaction time, FHP adolescents showed less activation during VWM than FHN youth in multiple areas of the prefrontal cortex (PFC) – a brain region crucial to intact working memory skills.
These results suggest that even prior to heavy alcohol use, FHP adolescents show atypical executive brain functioning during VWM, and that these differences are independent of slower working memory reaction time in FHP youth. Given the importance of working memory in numerous areas of day-to-day functioning, such as adaptive decision-making, these abnormalities may contribute to FHP youth vulnerability toward developing AUDs.
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Noradrenergic vs Serotonergic Antidepressant with or without Naltrexone for Veterans with PTSD and Comorbid Alcohol Dependence
The wars in Iraq and Afghanistan are associated with high rates of post-traumatic stress disorder (PTSD) and comorbid alcohol use disorders. The pharmacotherapy of these comorbid conditions has received relatively little study.
The current study compared the serotonin uptake inhibitor, paroxetine, to the norepinephrine uptake inhibitor, desipramine. It also evaluated the adjunctive efficacy of the Food and Drug Administration (FDA)-approved alcoholism pharmacotherapy, naltrexone, relative to placebo.
Four groups of predominately male veterans (n=88) meeting current diagnostic criteria for both alcohol dependence (AD) and PTSD were randomly assigned under double-blind conditions to one of four groups: paroxetine+naltrexone; paroxetine+placebo; desipramine+naltrexone; desipramine+placebo. Main outcome measures included standardized scales that assessed symptoms of PTSD and alcohol consumption.
Paroxetine did not show statistical superiority to desipramine for the treatment of PTSD symptoms. However, desipramine was superior to paroxetine with respect to study retention and alcohol use outcomes. Naltrexone reduced alcohol craving relative to placebo, but it conferred no advantage on drinking use outcomes.
Although the serotonin uptake inhibitors are the only FDA-approved medications for the treatment of PTSD, the current study suggests that norepinephrine uptake inhibitors may present clinical advantages when treating male veterans with PTSD and AD.
However, naltrexone did not show evidence of efficacy in this population.
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Welcome to the Alcohol Policy Information System
The Alcohol Policy Information System (APIS) provides detailed information on a wide variety of alcohol-related policies in the United States at both State and Federal levels. Detailed, state-by-state, information is available for the 35 policies listed below. APIS also provides a variety of informational resources of interest to alcohol policy researchers and others involved with alcohol policy issues. > > > > Read More
Thursday, November 17, 2011
Evolutionary differences in food preference rely on Gr64e, a receptor for glycerol
Very little is known about how stimuli that are typically not rich in sugars, such as beer, trigger attractive gustatory responses in Drosophila.
We identified a member of the gustatory receptor family, Gr64e, as a receptor that is required for feeding preference for beer and other sources that have fermenting yeast.
We found that Gr64e is required for neuronal and behavioral responses to glycerol, an abundant component of growing yeast and fermentation products. Ectopic expression of Gr64e in an olfactory neuron conferred responsiveness to glycerol.
We also found that Drosophila species that are predicted to carry pseudogenes of Gr64e had reduced glycerol sensitivity.
Our results provide insight into the molecular mechanisms of feeding acceptance of yeast products and raise the possibility that Gr64e contributes to specific evolutionary variations in appetitive selectivity across Drosophila species.
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'From one to many: The risks of frequent excessive drinking' - report calls for understanding of 'risky drinking'
A report from 2020health, a health and technology policy body, has emphasised the importance of addressing 'risky drinking' as a key part of public health policy. The report highlights the importance of brief interventions [or IBA] for risky drinkers, the need to promote alcohol-free days, and Government action including minimum pricing. > > > > Read More
Alterations in neural aneuploidy by drugs of abuse during fetal brain development
Scientific Presentation: Sunday, Nov. 13, 11–12 p.m., Washington Convention Center
Mosaic aneuploidy, defined as coincidental chromosome losses and/or gains to deviate from the haploid chromosome complement, has been identified in both the developing and the adult mammalian central nervous system, including neural progenitor cells and functionally integrated mature neurons.
Aneuploidy arises through altered cellular mechanisms controlling growth, DNA synthesis and replication, and neurogenesis; during development, these processes are influenced by neurotransmitters and their associated signaling cascades.
Exposure to non-endogenous agonists such as amphetamines and nicotine can result in cell damage including oxidative stress or cleavage regulation problems and may contribute to DNA damage and misrepair through which aneuploidy can arise.
When used during pregnancy, drugs of abuse and alcohol can cross the placental barrier from the mother into the fetal brain, and are linked to developmental defects including abnormalities of cell proliferation, differentiation and death, loss of synaptic activity,
Sudden Infant Death Syndrome (SIDS), as well as pre- and postnatal growth retardation and Fetal Alcohol Disorders (FAD).
Here we show that in utero exposure to amphetamines or alcohol increases the incidence of aneuploidy in the developing brain.
Using metaphase spread analysis, embryos exposed at embryonic day 13.5 (E13.5) show a two-fold increase in total aneuploidy, from 23-25% in vehicle control versus 52% with d-amphetamine (10mg/kg) and 55-65% with ethanol (3-4.5mg/kg). For both drugs, hypoploidy (loss of chromosomes) was more prevalent than hyperploidy (chromosomal gains).
Metaphase spreads were also categorized by severity of aneuploidy: a mildly aneuploid spread has fewer than five chromosomes lost or gained; severe spreads have lost or gained more than five chromosomes.
Embryos exposed to d-amphetamine show a three-fold increase in the amount of mild aneuploidy compared to vehicle controls, while levels of severe aneuploidy remained consistent between treated and control embryos.
In contrast, embryos exposed to either 3mg/kg or 4.5mg/kg of ethanol display a three-fold increase in severe aneuploidy and less than twice as much mild aneuploidy.
These data identify alterations in neural aneuploidy as a new component in the etiology of disorders associated with prenatal exposure to alcohol and drugs of abuse.
Abstract 166.04 Summary and News Release
Dry Pushback Against Mann’s Alcoholism Movement and Robert King Merton’s Manifest and Latent Functions: A Perplexing Combination
My thinking on this post started off in one direction and then suddenly veered into another direction entirely. As you’ll see.
My original plan was simply to recount a triangular correspondence involving Laurance L. Cross, Harry Emerson Fosdick, and Marty Mann that occurred in 1947.
Their letters to one another captured a telling instance of pushback against Mann’s then-fledgling alcoholism-is-a-disease campaign from a disgruntled dry. > > > > Read More
What is the Physician Clinical Support System - Primary Care? (PCSS-P)
The Physician Clinical Support System for Primary Care is a federally supported program that brings you resources and information about how to address alcohol, tobacco, and drug screening, brief interventions and treatment in primary care settings. It is a system designed to provide you access to useful information and support. When you sign up with PCSS-P you are linked with a mentor whom you can contact for assistance directly by email or telephone. There is a core group of mentors with expertise in primary care and addiction medicine. > > > > Read More
Awareness of legal blood alcohol concentration limits amongst respondents of a national roadside survey for alcohol and traffic behaviours in Brazil
In Brazil the legal blood alcohol content (BAC) allowed for driving was changed to zero in 2008. If the BAC found is above 0.6 g/L, drivers may be arrested. However, there are limited data on drivers’ awareness of such limits.
Drivers from 27 major metropolitan areas (n = 3397) were randomly asked to participate in roadside survey from 12 a.m. to 12 p.m. on Fridays and Saturdays. They were breathalized by highway patrol officers, and after consent interviewers collected data on drinking behaviours, knowledge about the law, and breath tests results.
The mean age was 37.3 ± 11.3 years; 94.3% were male and 26.5% had some college education. When asked about the BAC that could result in arrest, 34.5% of the subjects claimed to know it. However, only 23.5% (8.1% of the total sample) provided correct answers. Factors associated with the right answers were: male gender (p = 0.04; OR = 2.08; CI = 1.01–4.27); higher education (p < 0.0001); negative BAC or self-report of driving under the influence (DUI) (p = 0.02); higher family income (p = 0.01) and non-professional driving (p = 0.041). Age was not statistically different between groups. After multivariate analysis, male gender (p = 0.002), higher education (p < 0.0001) and negative BAC or DUI (p = 0.046) remained in the model.
The knowledge that BAC levels over 0.6 g/L may result in arrest is sparse amongst Brazilian drivers, notably amongst women, the less educated and those who drink and drive. Educational programmes targeted at those specific groups may be necessary in order to increase awareness about the legal BAC limit and its consequences.
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New findings alcohol related harm and crime
One in 11 people report they or a member of their family has been assaulted over the past year by someone under the influence of alcohol - with half saying they have not reported the assault to the Garda. Meanwhile 50 % of people stated they had experienced some form of alcohol-related intimidation, threat or violence in the past year.
Alcohol Action Ireland - the national charity for alcohol-related issues - commissioned leading market research company Behaviour and Attitudes to survey people on their experiences of alcohol-related harm in the community as part of their Alcohol - Where’s the Harm? conference which is being opened by Minister Roisin Shortall in the Royal College of Physicians this morning. > > > > Read More
Alcohol Action Ireland’s Conference - Presentations, 15th November 2011
To download a soft copy of the presentations click on the presenter’s name. All presentations are available in adobe, portable document format (PDF)
Session One - Alcohol and Crime in Ireland, Counting the Costs
National Quantitative Research, Director of Alcohol Action Ireland, Fiona Ryan
National and International Context - Dr. Anne Hope
Economic Costs of Alcohol Related Crime - Senior Lecturer, Sean Byrne
Session Two - Exploring Responses to Alcohol and Crime
Garda Juvenile Diversion Program - Superintendent, Colette Quinn
HSE South - Health Promotion Officer, Sandra Coughlan
Session Three - Hidden Harm - Sexual and Domestic Violence and Alcohol
Rape Crisis Network Ireland - Cliona Saidlear
SAFE Ireland - Director, Sharon O’ Halloran
Alcohol Concern - Director, Christine Toft
Men Overcoming Violence (MOVE) - CEO, Thomas Bibby
Head of Crime Reduction Branch, Martine Mc Killop & Belfast Community Safety Partnership, Stevie Lavery
Nature Reviews Neuroscience: Addiction
Addiction: from mechanisms to treatment
Transcriptional and epigenetic mechanisms of addiction
Chronic drug exposure induces long-term changes in the brain, which are partly due to alterations in gene expression. Robison and Nestler review the mechanisms by which drugs of abuse alter the transcriptional potential of genes through the regulation of transcription factors and epigenetic mechanisms, including the regulation of gene expression by non-coding RNAs.
Common cellular and molecular mechanisms in obesity and drug addiction
The regulation of the hedonic properties of food and addictive drugs involves common neural circuits and molecular substrates. Kenny reviews the shared mechanisms that may contribute to both obesity and drug addiction.
Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications
Functional imaging studies have pointed to a key role for the prefrontal cortex (PFC) in addiction, both through its regulation of limbic regions and its involvement in higher-order executive function. Goldstein and Volkow review these studies, showing that disruption of the PFC in addiction not only underlies compulsive drug taking but also accounts for the disadvantageous behaviours that are associated with addiction and the erosion of non-drug related motivation and self-control.
Pharmacogenetic approaches to the treatment of alcohol addiction
Current addiction pharmacotherapies have limited success. Focusing on alcohol addiction, Heilig and colleagues review the evidence that genetic heterogeneity in the opioid, corticotropin-releasing factor, GABA and serotonin systems may underlie differential treatment responses, and that personalized therapies tailored to patient genotype may lead to more successful treatment for alcohol addiction.
Opiate versus psychostimulant addiction: the differences do matter
Current theories of addiction all argue for a unitary account of drug addiction. Badiani and colleagues challenge this view by highlighting behavioural, cognitive and neurobiological differences between opiate addiction and psychostimulant addiction. They argue that these differences have important implications for addiction treatment, addiction theories and future research.
Current Issue: September–October 2011
A dedicated section on alcohol- and other drug-related HIV/HCV research
- Efficacy of Alcohol Brief Intervention in Primary Care by Nonphysicians
- Electronic Self-Help Interventions for Adults with Unhealthy Alcohol Use Moderately Reduce Drinking
- Alcohol and Other Drug Use Decreased During a Statewide Screening and Brief Intervention Program
- Adding Gabapentin to Naltrexone for Alcohol Dependence: No Improvement in Longer Term Outcomes
- No Clear Evidence on How Best to Manage Insomnia in People with Alcohol Dependence
- Benzodiazepine Use among Patients Receiving Methadone Maintenance
- One in 12 US College Students Report K2 Use
- Patients with Amphetamine Use Disorders Are More Likely to Be Hospitalized or Die from Parkinson’s Disease
- Type of Alcoholic Beverage Consumed Affects Acute Pancreatitis Risk
HIV and HCV
- Naltrexone Has Little, If Any, Liver Toxicity in HIV-Infected Patients and Does Not Adversely Affect HIV Biomarkers
- Behavioral Intervention Associated with Improved Liver Enzymes in HCV-infected Young People Who Use Injection Drugs
- Combination of Substance Use Treatment and Risk Reduction Most Effective at Preventing HCV Seroconversion in People who Inject Drugs
- Counseling and Case Management Increases Eligibility for HCV Treatment
- Update on Alcohol, Other Drugs, and Health
- Journal Club
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Wednesday, November 16, 2011
Subtypes of Alcohol Dependence and Their Effect on Sexual Behavior Change
We categorized women who met lifetime criteria for alcohol dependence (using the DIS) and who also had used cocaine (n = 324) into four alcohol typologies based on onset of regular drinking and the length of time to dependence. The Risk Behavior Assessment measured sex behaviors, combined into a risk index, before and after the program. Generalized linear modeling compared decreases over time.
Women who began drinking regularly later and became dependent more slowly significantly decreased risky sex behaviors.
Tailored prevention protocols may more effectively decrease HIV risk.
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Alcohol-related harms and chronic diseases: Where are we now and where are we going?
Tuesday 7 February 2012
Venue: Royal Society of Medicine, 1 Wimpole Street, LONDON, W1G 0AE
A joint meeting with The Alcohol Health Alliance
Aims: Improve understanding of the population health impact of alcohol-related harms on chronic disease, and ways for clinicians and policymakers to intervene.
Presentation of reliable evidence of effects of alcohol on liver disease, mental health, cancer and cardiovascular disease.
Methods by which to implement evidence into policy and practice, including the effects on marketing, primary care and regulation.
Objectives: Reliable evidence of alcohol-related harms on liver disease, mental health, cancer and cardiovascular disease.
Demonstration of current/ongoing and future policy initiatives and good practice in order to reduce the burden of alcohol-related harms in chronic disease.
Formal and informal interaction with senior medical experts and politicians in order to reduce the burden of alcohol-related harms in chronic disease. > > > > Read More
News Release - LEADING ALCOHOL RESEARCHERS TO MEET AT LOYOLA
Leading alcohol researchers from the United States and Canada will discuss their latest findings at an all-day meeting Friday, Nov. 18, at Loyola University Chicago Stritch School of Medicine.
Scientists will discuss the often negative effects that alcohol can have on how genes function in cells. Such changes are passed along to future generations of cells. These modifications, known as epigenetic changes, do not involve changes in the DNA sequence.
Much of the discussion will revolve around epigenetic changes caused by alcohol, especially two key events in the expression of genes -- DNA histone deacetylation and DNA methylation.
"Epigenetics is one of the many frontiers in alcohol research," said Elizabeth J. Kovacs, PhD, director of Loyola's Alcohol Research Program and associate director of Loyola's Burn & Shock Trauma Institute. At Loyola, about 50 faculty members, technicians, postdoctoral fellows and students are conducting alcohol research.
The conference is sponsored by the Alcohol and Immunology Research Interest Group and supported by Loyola's Alcohol Research Program and Department of Surgery; the Society for Leukocyte Biology; and the National Institute on Alcohol Abuse and Alcoholism. > > > > Read More
Balance speaks out on alcohol advertising targetting young people in the North East
Alcohol advertising is risking the lives and futures of children across the North East by encouraging them to drink early and more, according to a campaign launched this week by Balance, the North East Alcohol Office.
Through its ‘See What Sam Sees’ campaign Balance says it is inviting North Easterners to take a child's eye view and witness the way the alcohol industry is bombarding young people with ads which make drinkers appear popular, successful and attractive. In the region 55% of people already agree that alcohol targets under18s. > > > > Read More
A Brief Report on Perceptions of Alcohol and Society among Scottish Medical Students
To assess perceptions on alcohol misuse and addiction among medical students prior to in-depth training in order to determine areas of the curriculum that need to be reshaped or focused on.
A questionnaire assessment of first- and second-year medical students' perceptions of alcohol misuse.
Students had some misconceptions about current alcohol misuse rates, including a perception that addiction is common among health professionals, that the under-25s had the fastest increasing rate of alcohol addiction and that British women had a more rapidly increasing rate of alcohol addiction than British men.
Encouragingly, students overwhelmingly felt that alcohol addiction was something to which they could make a difference. It highlights that early education about alcohol misuse is important in terms of teaching students how to recognize hazardous and harmful drinkers and how to manage them.
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General and Cancer Mortality in a Large Cohort of Italian Alcoholics
The consumption of alcohol is an underappreciated risk factor for a wide range of conditions. Overall, it is associated with high mortality rates and causes approximately 4% of all deaths worldwide. This study aimed to evaluate the general and cancer mortality in a cohort of subjects with alcohol addiction residing in Tuscany (Central Italy).
Overall, 2,272 alcoholics (1,467 men and 805 women; mean age at first examination 43.8 years ± 13.0), treated at the Alcohol Centre of Florence in the period April 1985 to September 2001, were followed until the end of the study period (median follow-up: 9.6 years). A total of 21,855 person-years were available for analyses. Expected deaths were estimated by using age, sex, and calendar-specific regional mortality rates. Standardized mortality ratios (SMR) and 95% confidence intervals (CI) were calculated.
Six hundred and thirty-six of the 2,272 patients (28.0%) died, yielding an SMR of 5.0 (95% CI: 4.6 to 5.4). The alcoholics had significantly elevated mortality risk from all malignant cancers (SMR = 3.8, 95% CI: 3.3 to 4.4) and a series of specific diseases (infections: SMR = 10.1, 95% CI: 4.8 to 21.1; diabetes: SMR = 3.6, 95% CI: 1.9 to 6.7; immunological system, including AIDS: SMR = 8.1, 95% CI: 4.1 to 16.2; nervous system: SMR = 3.5, 95% CI: 1.9 to 6.4; cardiovascular system: SMR = 2.4, 95% CI: 2.0 to 2.9; respiratory system: SMR = 5.8, 95% CI: 4.2 to 8.0; digestive system: SMR = 26.4, 95% CI: 22.6 to 30.8, including liver cirrhosis (SMR = 40.0, 95% CI: 33.9 to 47.1); violent causes: SMR = 6.6, 95% CI: 5.0 to 8.6). Among malignant cancers, the highest SMRs were found for cancers of the pharynx (SMR = 22.8, 95% CI: 9.5 to 54.8), oral cavity (SMR = 22.2, 95% CI: 13.2 to 37.6), liver (SMR = 13.5, 95% CI: 9.2 to 19.8), and larynx (SMR = 10.7, 95% CI: 5.8 to 19.9). Although women showed higher SMR in comparison with the general population of the area, their overall survival estimates during the follow-up were higher than those for male alcoholics.
This large series of Italian alcoholics showed a significant increase in total and cancer mortality in comparison with the general population, with female alcoholics reporting higher survival rates.
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Cannabinoid Receptor 1 Gene is Associated with Alcohol Dependence
Alcohol dependence (AD) vulnerability is determined by a complex array of genetic factors. Given the potential role of endocannabinoid system in AD, polymorphisms within cannabinoid receptor 1 gene (CNR1) have been potentially associated with susceptibility to this disease. We thus aimed to examine the relationship between 3 allelic variants of CNR1 (rs6454674, rs1049353, and rs806368) and AD.
Genotyping of the aforementioned polymorphisms was carried out by PCR in 298 male alcoholics (187 of them with AD) and 155 healthy controls. Single-marker, haplotype, and interaction analysis were performed to analyze the influence of CNR1 gene on AD susceptibility.
We found an association between CNR1 gene and AD after haplotype analysis. Alcoholic patients with TGT haplotype (corresponding to rs6454674-rs1049353-rs806368 polymorphisms in this order) were less prone to have AD (p = 0.017). Besides, alcoholics with a G/T substitution of the first marker (GGT haplotype) or a C/T substitution of the third marker (TGC haplotype) were more likely to develop AD (p = 0.006 and 0.004, respectively) and an interaction was found between the G allele of rs6454674 single nucleotide polymorphism (SNP) and the C allele of rs806368 SNP (p = 0.009).
Our findings support previously reported associations of CNR1 with dependence to alcohol and other substances and emphasizes the relevance of endocannabinoid system in AD.
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Reduced Fronto-Cerebellar Functional Connectivity in Chronic Alcoholic Patients
Alcohol dependence is associated with neurocognitive deficits related to neuropathological changes in structure, metabolism, and function of the brain. Impairments of motor functioning in alcoholics have been attributed to well-characterized neuropathological brain abnormalities in cerebellum.
Using functional magnetic resonance imaging (fMRI), we studied in vivo the functional connectivity between cerebellar and cortical brain regions. Participants were 10 uncomplicated chronic alcoholic patients studied after 5 to 7 days of abstinence when signs of withdrawal had abated and 10 matched healthy controls. We focused on regions of prefrontal, frontal, temporal, and parietal cortex that exhibited an fMRI response associated with nondominant hand finger tapping in the patients but not in the controls. We predicted that fronto-cerebellar functional connectivity would be diminished in alcoholics compared with controls.
Functional connectivity in a circuit involving premotor areas (Brodmann Area 6) and Lobule VI of the superior cerebellum was reduced in the patients compared with the controls. Functional connectivity was also reduced in a circuit involving prefrontal cortex (Brodmann Area 9) and Lobule VIII of the inferior cerebellum. Reductions in connectivity were specific to fronto-cerebellar circuits and were not found in other regions examined.
Our findings show a pattern in recently abstinent alcoholic patients of specific deficits in functional connectivity and recruitment of additional brain regions for the performance of a simple finger-tapping task. A small sample, differences in smoking, and a brief abstinence period preclude definitive conclusions, but this pattern of diminished fronto-cerebellar functional connectivity is highly compatible with the characteristic neuropathological lesions documented in alcoholics and may reflect brain dysfunction associated with alcoholism.
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The Legacy of Minimum Legal Drinking Age Law Changes: Long-Term Effects on Suicide and Homicide Deaths Among Women
Prior to the establishment of the uniform drinking age of 21 in the United States, many states permitted legal purchase of alcohol at younger ages. Lower drinking ages were associated with several adverse outcomes, including elevated rates of suicide and homicide among youth. The objective of this study is to examine whether individuals who were legally permitted to drink prior to age 21 remained at elevated risk in adulthood.
Analysis of data from the U.S. Multiple Cause of Death files, 1990 to 2004, combined with data on the living population from the U.S. Census and American Community Survey. The assembled data contained records on over 200,000 suicides and 130,000 homicides for individuals born between 1949 and 1972, the years during which the drinking age was in flux. Logistic regression models were used to evaluate whether adults who were legally permitted to drink prior to age 21 were at elevated risk for death by these causes. A quasi-experimental analytical approach was employed, which incorporated state and birth-year fixed effects to account for unobserved covariates associated with policy exposure.
In the population as a whole, we found no association between minimum drinking age and homicide or suicide. However, significant policy-by-sex interactions were observed for both outcomes, such that women exposed to permissive drinking age laws were at higher risk for both suicide (OR = 1.12, 95% CI: 1.05, 1.18, p = 0.0003) and homicide (OR = 1.15, 95% CI: 1.04, 1.25, p = 0.0028). Effect sizes were stronger for the portion of the cohort born after 1960, whereas no significant effects were observed for women born prior to 1960.
Lower drinking ages may result in persistent elevated risk for suicide and homicide among women born after 1960. The national drinking age of 21 may be preventing about 600 suicides and 600 homicides annually.
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Evidence-Based Guidelines for Mental, Neurological, and Substance Use Disorders in Low- and Middle-Income Countries: Summary of WHO Recommendations
- The treatment gap for mental, neurological, and substance use (MNS) disorders is more than 75% in many low- and middle-income countries.
- In order to reduce the gap, the World Health Organization (WHO) has developed a model intervention guide within its Mental Health Gap Action Programme (mhGAP).
- The model intervention guide provides evidence-based recommendationsdeveloped with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.
- This article presents the management recommendations for MNS disorders, with a link to the World Health Organization website where all the background material may be accessed.
- To our knowledge, this is a first exercise involving such an extensive and systematic evaluation of evidence in this area.
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Monday, November 14, 2011
Initiation and Persistence of Alcohol Use in United States Black, Hispanic, and White Male and Female Youth
The relation between early and frequent alcohol use and later difficulties is quite strong. However, the degree that alcohol use persists, which is often a necessary cause for developing alcohol-related problems or an alcohol use disorder, is not well studied, particularly with attention to race and gender. A novel statistical approach, the Multi-facet Longitudinal Model, enables the concurrent study of age of initiation and persistence.
The models were applied to longitudinal data on youth alcohol use from ages 12 through 19, collected in the (U.S.) National Longitudinal Survey of Youth 1997 cohort (N = 8,984).
Results confirmed that Black adolescents initiate alcohol use at later ages than do White youth. Further, after initiation, White adolescents were substantially more likely than Black adolescents to continue reporting alcohol use in subsequent years. Hispanic teens showed an intermediate pattern. Gender differences were more ambiguous, with a tendency for boys to be less likely to continue drinking after initiation than were girls.
Novel findings from the new analytic models suggest differential implications of early alcohol use by race and gender. Early use of alcohol might be less consequential for males who initiate alcohol use early, Black, and Hispanic youth than for their female and White counterparts.
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