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, December 3, 2011
Council conclusions on closing health gaps within the EU through concerted action to promote healthy lifestyle behaviours
The Council adopted the following conclusions:
"THE COUNCIL OF THE EUROPEAN UNION RECALLS
that under Article 168 of the Treaty on the Functioning of the European Union, a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities. Union action, which shall complement national policies, shall be directed towards improving public health, preventing illness and disease, and obviating sources of danger to physical and mental health. The Union and Member States shall foster cooperation with third countries and the competent international organisations in the sphere of public health. > > > > Read More
Light drinking during pregnancy: still no increased risk for socioemotional difficulties or cognitive deficits at 5 years of age?
This study examines the relationship between light drinking during pregnancy and the risk of socioemotional problems and cognitive deficits at age 5 years.
Data from the nationally representative prospective UK Millennium Cohort Study (N=11 513) were used. Participants were grouped according to mothers' reported alcohol consumption during pregnancy: never drinker; not in pregnancy; light; moderate; heavy/binge. At age 5 years the strengths and difficulties questionnaire (SDQ) and British ability scales (BAS) tests were administered during home interviews. Defined clinically relevant cut-offs on the SDQ and standardised scores for the BAS subscales were used.
Boys and girls born to light drinkers were less likely to have high total difficulties (for boys 6.6% vs 9.6%, OR=0.67, for girls 4.3% vs 6.2%, OR=0.69) and hyperactivity (for boys 10.1% vs 13.4%, OR=0.73, for girls 5.5% vs 7.6%, OR=0.71) scores compared with those born to mothers in the not-in-pregnancy group. These differences were attenuated on adjustment for confounding and mediating factors. Boys and girls born to light drinkers had higher mean cognitive test scores compared with those born to mothers in the not-in-pregnancy group: for boys, naming vocabulary (58 vs 55), picture similarities (56 vs 55) and pattern construction (52 vs 50), for girls naming vocabulary (58 vs 56) and pattern construction (53 vs 52). Differences remained statistically significant for boys in naming vocabulary and picture similarities.
At age 5 years cohort members born to mothers who drank up to 1–2 drinks per week or per occasion during pregnancy were not at increased risk of clinically relevant behavioural difficulties or cognitive deficits compared with children of mothers in the not-in-pregnancy group.
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Friday, December 2, 2011
Correlating the Blood Alcohol Concentration with Outcome after Traumatic Brain Injury: Too Much Is Not a Bad Thing
Although recent evidence suggests a beneficial effect of alcohol for patients with traumatic brain injury (TBI), the level of alcohol that confers the protective effect is unknown.
Our objective was to investigate the relationship between admission blood alcohol concentration (BAC) and outcomes in patients with isolated moderate to severe TBI.
From 2005 to 2009, the Los Angeles County Trauma Database was queried for all patients ≥14 years of age with isolated moderate to severe TBI and admission serum alcohol levels. Patients were then stratified into four levels based on admission BAC: None (0 mg/dL), low (0-100 mg/dL), moderate (100-230 mg/dL), and high (≥230 mg/dL). Demographics, patient characteristics, and outcomes were compared across levels.
In evaluating 3794 patients, the mortality rate decreased with increasing BAC levels (linear trend P < 0.0001).
In determining the relationship between BAC and mortality, multivariable logistic regression analysis demonstrated a high BAC level was significantly protective (adjusted odds ratio 0.55; 95% confidence interval: 0.38-0.8; P = 0.002).
In the largest study to date, a high (≥230 mg/dL) admission BAC was independently associated with improved survival in patients with isolated moderate to severe TBI.
Additional research is warranted to investigate the potential therapeutic implications.
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Key Recent Milestones:
· In Nairobi, ICAP’s Ken Williams and Guillermo Cantor recently concluded their participation in Working Towards a Better Understanding of the Informal Alcohol Markets in Five Countries. The meeting explored the extent of the unrecorded alcohol market in Kenya, Uganda, Tanzania, Botswana, and Rwanda.
Global Actions Spotlight:
Mexico Summit Global Actions recently held a landmark summit in Mexico City. A joint effort of the Mexico Council for Injury Prevention (CONAPRA), the Police Department of Mexico City, the Mexico Global Road Safety Partnership (GRSP), and the International Center for Alcohol Policies (ICAP), Toward Zero Alcohol Deaths centered on traffic safety issues, with emphasis on drink driving prevention.
Attendees included law enforcement, traffic safety, and health professionals from across Mexico. Dr. Othon Sanchez Cruz of the Mexico City Police, Jalisco Legislative Deputy Director Jesus Casillas, ICAP’s Bill Georges, and John Sullivan of the New York State STOP-DWI Association presented on topics ranging from legislative issues, criminal activity and traffic safety, and developing comprehensive programs to reduce drink driving. Participants reviewed current trends, examined best practices, and will use information from the summit to assist them in planning efforts to combat drink driving.
“The summit was a significant launch of our efforts with representatives from jurisdictions across Mexico,” said ICAP Vice President Brett Bivans. “We have a shared commitment to work with all interested parties toward the goal of zero drink driving deaths.” Global Actions and our Mexico partners continue to work under the leadership of CONAPRA Secretary Dr. Arturo Cervantes Trejo to develop comprehensive programs that demonstrate long-term positive impact to reduce harmful drinking and can be replicated across the country.
What’s Happening Next:
· Miami: ICAP’s Industry Workshop for Latin America is taking place December 1-2, as part of our efforts to support industry engagement around the WHO Global Strategy. The meeting will bring together industry members from across Latin America
Thursday, December 1, 2011
Strong evidence links alcohol use to partner violence perpetration among adults, but the relation between youth alcohol use and dating violence perpetration (DVP) is not as well studied.
The authors used meta-analytic procedures to evaluate current knowledge on the association between alcohol use and DVP among youth. The authors reviewed 28 studies published in 1985–2010; most (82%) were cross-sectional. Alcohol use was measured in 3 main ways: 1) frequency or quantity of use, 2) frequency of heavy episodic drinking, or 3) problem use.
Collectively, results support the conclusion that higher levels of alcohol use are positively associated with youth DVP. With fixed-effects models, the combined odds ratios for DVP for frequency/quantity, heavy episodic drinking, and problem use were 1.23 (95% confidence interval (CI): 1.16, 1.31), 1.47 (95% CI: 1.17, 1.85), and 2.33 (95% CI: 1.94, 2.80), respectively. This association persisted even after accounting for heterogeneity and publication bias.
No studies were designed to assess the immediate temporal association between drinking and DVP. Future research should assess whether there are acute or pharmacologic effects of alcohol use on youth DVP.
Furthermore, few studies have been hypothesis driven, controlled for potential confounding, or examined potential effect measure modification.
Studies designed to investigate the youth alcohol–DVP link specifically, and whether results vary by individuals’ gender, dev
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Market research has overwhelmingly rejected the alcohol health warning labels recently launched by the Australian alcohol industry in favour of informative, clear and specific labels produced by the Foundation for Alcohol Research & Education (FARE).
Across all categories, the alcohol industry’s labels were dismissed in preference for the FARE labels:
• 95% selected the FARE health warning labels as being more noticeable.
• 89% believed the FARE health warning labels are more likely to raise awareness of alcohol‐related harms.
• 88% felt the FARE health warning labels would be more likely to prompt conversations about alcoholrelated harms.
• 88% believed the FARE warning labels would be more likely to result in people drinking less alcohol.
• 60% selected the FARE labels as telling them something they did not already know while only 10% selected the DrinkWise labels. > > > > Read More
The second international conference of SAFFrance to be organised on the 15th and 16th of December in Strasbourg is linked to the first conference organised in the Senate in September 2009 to which the higher head of state participated.
Its aim will be to facilitate the professionals’ awareness on the link between prenatal alcohol, brain damage, difficulties to learn and social maladjustment and hence, on the way to prevent these issues.
With the help of the Ministries of Health, Social Cohesion and Education this international conference’s aim is to focus on :
- The short and long term effects of prenatal alcohol on the developing brain (clinical, neuro-imaging, biomedical)
The aims of the conference:
- on the diagnostic tools and the on the diagnostic tools and the assessment from the antenatal period to school age
- on the methods of coaching, compensation and on the diagnostic tools and the assessment from the antenatal period to school age
-on the methods of coaching, compensation and taking care of Neurodevelopmental Disorders linked to alcohol (through a support network, rehabilitations, adapted teaching, psychological support…)
- on the prevention of FASD with the help of a cross-wise network support based on a real national plan for the next ten years.
It has the ambition to bring together the best specialists worldwide and all french professionals involved, from near or far in this issue through a crosswise approach : Medico - psycho - educational - social.
Alcohol brief interventions in the workplace? Feasibility study finds opportunities for IBA at work do exist
A research project into the feasibility of alcohol brief interventions (or 'IBA') in the workplace has shown that opportunities to deliver IBA do exist - though may have limitations and are not without barriers.
A project delivered by the North London alcohol hub saw hundreds of workplace roles - ranging from senior managers to staff supervisors - trained in alcohol awareness and how to deliver 'Identification and Brief Advice' (IBA). Roles completed pre and post-training surveys to assess their attitude and knowledge around alcohol use.
An independent evaluation by the University of Middlesex (download full report here) found that the training resulted in many roles going on to deliver IBA, or at least discuss alcohol with colleagues or share information and resources. > > > > Read More
Experts on alcohol consumption have accused the government of giving in to ‘corporate bullying’ by the alcohol industry. Speaking last week during Mayo Drug and Alcohol Awareness Week, Professor Joe Barry and Dr Ann Hope argued that the government has allowed the industry to self regulate and has failed to curb alcohol advertising. The two experts, both of Trinity College, spoke at ‘Sláinte’, a seminar that explored the relationship between Irish culture and alcohol. During the seminar, which was held in Hotel Ballina, they both spoke of alcohol lobby groups’ power to shape policy on the issue.
A former National Alcohol Policy Advisor, Dr Ann Hope helped produce a 1996 report that predicted that alcohol consumption was set to increase in the Irish population over the next ten years, in line with projected economic growth.
She told the seminar that instead of implementing policy to counteract this projected increase in alcohol consumption, various governments ignored it. Worse, responding to increased lobbying from the alcohol industry, policy increased the availability of alcohol and led to increased consumption. > > > > Read More
Ten-year Stability and Variability, Drinking Patterns, and Impairment in Community Youth with Diagnostic Orphan Status of Alcohol Dependence
Some adolescents and young adults who do not fulfil criteria for DSM-IV alcohol abuse (AA) report symptoms of DSM-IV alcohol dependence (AD) below the diagnostic threshold (diagnostic orphans, DOs; 1 or 2 symptoms). Contemporarily, little is known on the long-term stability, risk of progression to AD, impairment, and drinking patterns possibly associated with this status in the first decades of life.
(1) To identify prevalence rates of the DO status from adolescence to early adulthood. To investigate (2) stability and variability of the DO status over time and (3) associations between DO status, drinking patterns and impairment in comparison to subjects with AA, with AD, or without any symptoms.
N = 2039 community subjects (aged 14 – 24 years at baseline) were assessed at baseline and at about four and ten years after baseline. DSM-IV AUD diagnoses were obtained with the DIA-X/M-CIDI.
About 11-12% of the sample were classified as DOs at all waves. Over a period of ten years, 18% of DOs were stable in their diagnosis and additional 10% progressed to AD. DOs were comparable to subjects with AA in drinking patterns, impairment and stability of diagnostic status. DOs progressed to AD significantly more often than AA. AD was associated with highest levels in all outcomes of interest.
The DO status in adolescence and early adulthood is associated with considerable stability, risk of progression and problematic alcohol intake. In consequence, it can be meaningful for the timely identification of early stages of clinically relevant alcohol problems. For subjects with DO status early specific interventions are required.
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Wednesday, November 30, 2011
Over 30 Slovenian experts participated in a two-day capacity-building workshop in Ljubljana, in October 2011, to estimate the economic burden of alcohol drinking in their country. Alcohol consumption in Slovenia is relatively high – above the average for countries in the European Union – and an understanding the economic burden of alcohol-related diseases is needed to advocate relevant anti-alcohol policy in the country. The Ministry of Health of Slovenia is committed to strengthen efforts to decrease the high average consumption of alcohol.
Income levels and alcohol consumption in Slovenia are clearly linked. People who live in municipalities with the lowest income-tax base per capita have greater risks of premature death from both causes wholly attributable to alcohol (2.5 times greater for men and 2.8 times greater for women) and liver cirrhosis (3.1 times for men and 4.5 times for women). In addition, drinking habits show a significant gender difference: both heavy drinking and episodic heavy drinking are five times more likely among men. > > > > Read More
Media Release - Youth smoking at all-time low; teen binge drinking, driving after cannabis use remain concerns, CAMH 2011 OSDUHS reports
Fewer Ontario teens are smoking cigarettes than ever before -- good news that is tempered by continuing concerns around binge drinking, and driving while under the influence of cannabis, according to the 2011 Ontario Student Drug Use and Health Survey released today by the Centre for Addiction and Mental Health (CAMH). The survey, which included 9,288 students across Ontario in grades 7 to 12, is the longest running student survey in Canada.
“We were pleasantly surprised to find that students’ use of most of the substances tracked by this survey declined during the past decade, even for those substances that historically have been used at high rates," said Dr. Robert Mann, CAMH Senior Scientist and Principal Investigator on the survey. “Most notably, the proportion of students who smoke cigarettes dropped from 12 per cent in the previous 2009 survey to 9 per cent, an all-time low since 1977. Also, the proportion using cannabis dropped from 26 per cent to 22 per cent. However, pockets of real concern remain. For instance, one in eight students (13 per cent) reported symptoms of a drug use problem, and among those who drink, a third reported drinking hazardously or harmfully as measured by a validated screening instrument." One in six students (16 per cent) reported being drunk or high at school a least once in the past year. > > > > Read More
Cerebral effects of binge drinking: Respective influences of global alcohol intake and consumption pattern
Binge drinking is a major health concern, but its cerebral correlates are still largely unexplored. We aimed at exploring (1) the cognitive step at which these deficits appear and (2) the respective influence of global alcohol intake and specific binge-drinking consumption pattern on this deficit.
On the basis of a screening phase (593 students), 80 participants were selected and distributed in four groups (control non-drinkers, daily drinkers, low and high binge drinkers). Event-related potentials (ERPs) were recorded while performing a simple visual oddball task.
Binge drinking was associated with massive ERP impairments, starting at the perceptive level (P100/N100 and N170/P2) and spreading through the attentional (N2b/P3a) and decisional (P3b) ones. Moreover, these deficits were linked with global alcohol intake and also with the specific binge-drinking consumption pattern.
Binge drinkers presented early and global ERP deficits, affecting basic and high-level cognitive stages. Moreover, we showed that binge drinking is deleterious for the brain because of alcohol consumption per se, and also because of its specific consumption pattern.
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Early attentional modulation by alcohol-related cues in young binge drinkers: An event-related potentials study
Episodic excessive alcohol consumption (i.e., binge drinking) is now considered to be a major concern in our society. Previous studies have shown that alcohol cues can capture attentional resources in chronic alcoholic populations and that the phenomenon is associated with the development and maintenance of alcoholism. Using event-related potentials (ERPs), we investigated the responses of binge drinkers to alcohol-related pictures.
Two groups of college students (n = 18 in each group) were recruited for the study. One group was composed of binge drinkers and the other of controls. Each student completed a simple visual oddball paradigm in which alcohol-related and non-alcohol-related pictures (positive, neutral or negative) were presented. ERPs were recorded to explore the electrophysiological activity associated with the processing of each cue during the different cognitive steps.
Although there were no behavioural differences between the two groups after detection of alcohol- and non-alcohol-related cues, the ERP data indicated that processing of alcohol-related stimuli was modulated by binge drinking: in the binge drinkers, the P100 amplitudes elicited by the alcohol-related pictures were significantly larger than those elicited by the non-alcohol pictures.
The present study provides evidence for an early processing enhancement, indexed by increased P100 amplitude, in binge drinkers when confronted with alcohol cues.
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Environmental enrichment blocks ethanol-induced locomotor sensitization and decreases BDNF levels in the prefrontal cortex in mice
The use of addictive drugs can lead to long-term neuroplastic changes in the brain, including behavioral sensitization, a phenomenon related to addiction. Environmental enrichment (EE) is a strategy used to study the effect of environment on the response to several manipulations, including treatment with addictive drugs. Brain-derived neurotrophic factor (BDNF) has been associated with behaviors related to ethanol addiction.
The aim of the present study was to evaluate the effects of EE on ethanol-induced behavioral sensitization and BDNF expression.
Mice were exposed to EE and then repeatedly treated with a low dose (1.8 g/kg) of ethanol. Another group of mice was first subjected to repeated ethanol treatment according to the behavioral sensitization protocol and then exposed to EE.
Environmental enrichment prevented the development of ethanol-induced behavioral sensitization and blocked behavioral sensitization in sensitized mice. Both repeated ethanol and EE decreased BDNF levels in the prefrontal cortex but not in the hippocampus. However, BDNF levels were lower in ethanol-treated mice exposed to EE.
These findings suggest that EE can act on the mechanisms implicated in behavioral sensitization, a model for drug-induced neuroplasticity and relapse.
Additionally, EE alters BDNF levels, which regulate addiction-related behaviors.
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Pharmacologically relevant intake during chronic, free-choice drinking rhythms in selectively bred high alcohol-preferring mice
Multiple lines of high alcohol-preferring (HAP) mice were selectively bred for their intake of 10% ethanol (v/v) during 24-hour daily access over a 4-week period, with the highest drinking lines exhibiting intakes in excess of 20 g/kg/day.
We observed circadian drinking patterns and resulting blood ethanol concentrations (BECs) in the HAP lines. We also compared the drinking rhythms and corresponding BECs of the highest drinking HAP lines to those of the C57BL/6J (B6) inbred strain.
Adult male and female crossed HAP (cHAP), HAP replicate lines 1, 2, 3 and B6 mice had free-choice access to 10% ethanol and water for 3 weeks prior to bi-hourly assessments of intake throughout the dark portion of the light–dark cycle.
All HAP lines reached and maintained a rate of alcohol intake above the rate at which HAP1 mice metabolize alcohol, and BECs were consistent with this finding.
Further, cHAP and HAP1 mice maintained an excessive level of intake throughout the dark portion of the cycle, accumulating mean BEC levels of 261.5 ± 18.09 and 217.9 ± 25.02 mg/dl, respectively.
B6 mice drank comparatively modestly, and did not accumulate high BEC levels (53.63 + 8.15 mg/dl).
Free-choice drinking demonstrated by the HAP1 and cHAP lines may provide a unique opportunity for modeling the excessive intake that often occurs in alcohol-dependent individuals, and allow for exploration of predisposing factors for excessive consumption, as well as the development of physiological, behavioral and toxicological outcomes following alcohol exposure.
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Gene–environment interaction in problematic substance use: interaction between DRD4 and insecure attachments
To investigate the combined effect of an exon III variable number tandem repeat in the dopamine receptor gene (DRD4) and insecure attachment style on risk for tobacco, cannabis and alcohol use problems in young adulthood
It was hypothesized that (1) individuals with 5, 6, 7 or 8 repeats (labelled 7R+) would be at increased risk for problematic drug use, and (2) risk for drug use would be further increased in individuals with 7R+ repeats who also have a history of insecure parent–child attachment relations.
Data were drawn from the Victorian Adolescent Health Cohort Study, an eight-wave longitudinal study of adolescent and young adult development. DRD4 genotypes were available for 839 participants. Risk attributable to the combined effects of 7R+ genotype and insecure attachments was evaluated within a sufficient causes framework under the assumptions of additive interaction using a two-by-four table format with a common reference group. 7R+ alleles were associated with higher tobacco, cannabis and alcohol use (binging).
Insecure attachments were associated with higher tobacco and cannabis use but lower alcohol use. For tobacco, there was evidence of interaction for anxious but not avoidant attachments. For cannabis, there was evidence of interaction for both anxious and avoidant attachments, although the interaction for anxious attachments was more substantial.
There is no evidence of interaction for binge drinking.
Results are consistent with a generic reward deficit hypothesis of drug addiction for which the 7R+ disposition may play a role. Interaction between 7R+ alleles and attachment insecurity may intensify risk for problematic tobacco and cannabis use.
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Tuesday, November 29, 2011
Chemosensory responsiveness to ethanol and its individual sensory components in alcohol-preferring, alcohol-nonpreferring and genetically heterogeneou
Alcohol activates orosensory circuits that project to motivationally relevant limbic forebrain areas that control appetite, feeding and drinking.
To date, limited data exists regarding the contribution of chemosensory-derived ethanol reinforcement to ethanol preference and consumption.
Measures of taste reactivity to intra-orally infused ethanol have not found differences in initial orofacial responses to alcohol between alcohol-preferring (P) and alcohol-non-preferring (NP) genetically selected rat lines. Yet, in voluntary intake tests, P rats prefer highly concentrated ethanol upon initial exposure, suggesting an early sensory-mediated attraction.
Here, we directly compared self-initiated chemosensory responding for alcohol and prototypic sweet, bitter and oral trigeminal stimuli among selectively bred P, NP and non-selected Wistar (WI) outbred lines to determine whether differential sensory responsiveness to ethanol and its putative sensory components are phenotypically associated with genetically influenced alcohol preference.
Rats were tested for immediate short-term lick responses to alcohol (3–40%), sucrose (0.01–1 M), quinine (0.01–3 mM) and capsaicin (0.003–1 mM) in a brief-access assay designed to index orosensory-guided behavior.
P rats exhibited elevated short-term lick responses to both alcohol and sucrose relative to NP and WI lines across a broad range of concentrations of each stimulus and in the absence of blood alcohol levels that would produce significant post-absorptive effects.
There was no consistent relationship between genetically mediated alcohol preference and orosensory avoidance of quinine or capsaicin.
These data indicate that enhanced initial chemosensory attraction to ethanol and sweet stimuli are phenotypes associated with genetic alcohol preference and are considered within the framework of downstream activation of oral appetitive reward circuits.
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To date, 16 states have passed medical marijuana laws, yet very little is known about their effects.
Using state-level data, we examine the relationship between medical marijuana laws and a variety of outcomes.
Legalization of medical marijuana is associated with increased use of marijuana among adults, but not among minors.
In addition, legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption.
Our estimates provide strong evidence that marijuana and alcohol are substitutes.
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Generational Association Studies of Dopaminergic Genes in Reward Deficiency Syndrome (RDS) Subjects: Selecting Appropriate Phenotypes for Reward Depen
Abnormal behaviors involving dopaminergic gene polymorphisms often reflect an insufficiency of usual feelings of satisfaction, or Reward Deficiency Syndrome (RDS). RDS results from a dysfunction in the “brain reward cascade,” a complex interaction among neurotransmitters (primarily dopaminergic and opioidergic).
Individuals with a family history of alcoholism or other addictions may be born with a deficiency in the ability to produce or use these neurotransmitters. Exposure to prolonged periods of stress and alcohol or other substances also can lead to a corruption of the brain reward cascade function.
We evaluated the potential association of four variants of dopaminergic candidate genes in RDS (dopamine D1 receptor gene [DRD1]; dopamine D2 receptor gene [DRD2]; dopamine transporter gene [DAT1]; dopamine beta-hydroxylase gene [DBH]).
We genotyped an experimental group of 55 subjects derived from up to five generations of two independent multiple-affected families compared to rigorously screened control subjects (e.g., N = 30 super controls for DRD2 gene polymorphisms). Data related to RDS behaviors were collected on these subjects plus 13 deceased family members.
Among the genotyped family members, the DRD2 Taq1 and the DAT1 10/10 alleles were significantly (at least p < 0.015) more often found in the RDS families vs. controls. The TaqA1 allele occurred in 100% of Family A individuals (N = 32) and 47.8% of Family B subjects (11 of 23). No significant differences were found between the experimental and control positive rates for the other variants.
Although our sample size was limited, and linkage analysis is necessary, the results support the putative role of dopaminergic polymorphisms in RDS behaviors. This study shows the importance of a nonspecific RDS phenotype and informs an understanding of how evaluating single subset behaviors of RDS may lead to spurious results.
Utilization of a nonspecific “reward” phenotype may be a paradigm shift in future association and linkage studies involving dopaminergic polymorphisms and other neurotransmitter gene candidates.
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This study tested a cognitive–behavioral treatment protocol for adolescents with a co-occurring alcohol or other drug use disorder (AOD) and suicidality in a randomized clinical trial.
Forty adolescents (Mage = 15 years; 68% female, 89% White) and their families recruited from an inpatient psychiatric hospital were randomly assigned to an integrated outpatient cognitive–behavioral intervention for co-occurring AOD and suicidality (I-CBT) or enhanced treatment as usual (E-TAU). Primary measures include the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Suicide Ideation Questionnaire, Columbia Impairment Scale, Timeline Followback, Rutgers Alcohol Problem Index, and Rutgers Marijuana Problem Index. Assessments were completed at pretreatment as well as 3, 6, 12, and 18 months postenrollment.
In intent-to-treat analyses, I-CBT was associated with significantly fewer heavy drinking days and days of marijuana use relative to E-TAU but not with fewer drinking days. Those randomized to I-CBT in comparison to E-TAU also reported significantly less global impairment as well as fewer suicide attempts, inpatient psychiatric hospitalizations, emergency department visits, and arrests. Adolescents across groups showed equivalent reductions in suicidal ideation.
I-CBT for adolescents with co-occurring AOD and suicidality is associated with significant improvement in both substance use and suicidal behavior, as well as markedly decreased use of additional health services including inpatient psychiatric hospitalizations and emergency department visits. Further testing of integrated protocols for adolescent AOD and suicidality with larger and more diverse samples is warranted.
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The March 2011 Budget raised the duty on strong beers (above 7.5% ABV) by 25% and cut the duty on weak beers (2.8% or less) by half. The Home Office has also announced plans to ban 'below-cost' alcohol sales in England and Wales, with 'cost' defined as the total tax (duty and VAT) due on each purchase, though precisely when the ban is to be implemented is unclear. In Scotland, the SNP Government has introduced a Bill to implement a minimum price per alcohol unit from 2012, following an unsuccessful attempt to do so last year. A new Briefing Note published today looks at these three policies in depth, using detailed data recording the off-licence alcohol purchases of more than 25,000 British households.
The changes to beer duty came into force in October. For the products affected, the effect is significant: the total tax (including VAT) due on a 4 x 440ml purchase of 2% ABV lager fell from 78p to 39p, whilst at 8% ABV the tax rose from £3.33 to £4.17. However, strong beers made up just 0.8% of all off-licence alcohol units purchased in 2010 and weak beers just 0.2%, so the policy has a big effect on a very small part of the market. The biggest impact is likely to be on households who consume large amounts of alcohol (more than 35 units per adult per week), who buy 23% of all off-licence units but 53% of strong beer units. Notably, the reform did not affect cider. This means that, on a per-unit basis, the duty on a strong 7.6% ABV beer (23.2p) is now more than three times higher than the duty on a 7.6% ABV cider (7.1p). Rather than switching to low-strength beer, the reform might encourage strong beer drinkers to consume strong cider instead. > > > > Read More
NDSAG 2012: Rollnick to speak on 21 years and the future of motivational interviewing; Ron McKechnie bursary prize announced
The conference will include a keynote from Professor Stephen Rollnick, author of 'Behaviour Change: a guide for health care professionals' and co-author with Bill Miller of the seminal 'Motivational Interviewing'. > > > > Read More
Monday, November 28, 2011
Members of the National Association of Alcoholism and Drug Abuse Counselors (n = 231) participated in a survey concerning their view of the role of personal responsibility in addictions treatment and its relation to their exposure to neuroscience (i.e., the amount to which members considered themselves familiar with current neuroscience research).
We used the two-dimensional model of responsibility (Responsible/not responsible for development × Responsible/not responsible for recovery) proposed by P. Brickman et al. (1982) to guide our assessment of responsibility, thus inquiring about counselors' views of clients' responsibility for both the development of a substance-related addiction and its resolution.
Findings suggest that counselors rate biological factors as most influential in the development of an addiction and assign clients less personal responsibility for the development of an addiction than for recovery from an addiction.
Counselors' level of neuroscience exposure was negatively correlated with their ratings of client responsibility for the development of an addiction but positively correlated to ratings of client responsibility for recovery.
This suggests that counselors are integrating neuroscientific findings with what is learned from other modes of enquiry in a way that diminishes the view that clients are responsible for addiction development but accentuates the view that clients are responsible for recovery.
We explore reasons for why this is and why this approach may be beneficial.
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Confirmatory Factor Analysis of the Brazilian Version of the Drinking Motives Questionnaire-Revised (DMQ-R)
The main objective of this study was to evaluate the factor structure of the Brazilian version of the Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994) in a sample of 584 university students. A secondary goal was to investigate the relationships between motives and measures of alcohol use and drinking problems.
The DMQ-R assesses four motive dimensions: social, enhancement, coping, and conformity. Confirmatory factor analysis supported a revised four-factor model identical to the original, with the exception of one item that did not load on its intended factor.
Relative to coping and conformity motives, enhancement and social motives were strongly related to both alcohol use and drinking problems.
Overall results indicate that the factor structure of the Brazilian DMQ-R parallels that observed in North America and Europe using the original English language DMQ-R, despite a distinct pattern of relationships with alcohol use and drinking problems.
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Young people's beliefs about the harmfulness of alcohol, cannabis and tobacco for mental disorders: Findings from two Australian national surveys of y
Using cross-sectional national survey data, we assessed young peoples’ beliefs about the role of alcohol, tobacco and marijuana in the prevention and treatment of mental disorders as well as the predictors of these beliefs. We also compared these findings with those from a similar survey carried out in 2006.
Between January and May 2011, a national computer-assisted telephone survey was conducted on a representative sample of Australian youths aged 15–25 years. 3,021 young people were presented with a case vignette portraying depression, depression with suicidal thoughts, psychosis, social phobia, depression with alcohol misuse, or post-traumatic stress disorder in a young person.
Respondents were asked about their beliefs regarding the role of using alcohol, tobacco and marijuana in preventing or dealing with the mental disorders described in the
vignettes. Level of psychological distress was assessed by the Kessler 6 scale (K6).
Over 75% of respondents agreed that the three substances were harmful for the young people in the vignettes, and that not using marijuana or drinking alcohol in excess is preventive. Males, young adults and more distressed respondents were less likely to endorse these beliefs. No significant changes were observed between `surveys.
Most young people in Australia are aware of the negative impact of substance use on mental disorders, but a few high risk groups remain: males, young adults, and those with more psychological distress. Future public health campaigns need to target these groups and focus on translating young people's substance use beliefs into behavioral change.
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The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers
This study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics.
A nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information–advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change.
Recidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type.
The results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.
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Parsing the Undercontrol–Disinhibition Pathway to Substance Use Disorders: A Multilevel Developmental Problem
A long-standing and diverse body of evidence has documented the importance of externalizing characteristics as very early etiologic predictors of a pathway to severe alcohol and other drug problems and substance use disorder (SUD).
the same time, much remains unclear about the mechanistic structure of this pathway, including understanding what the defining characteristics are that encompass the diverse behaviors included in the externalizing domain.
This article proposes that the core risk phenotype unifying this domain is behavioral undercontrol–disinhibition.
It describes the defining features of this phenotype and outlines the mediators, moderators, and developmental course that characterize the pathway from early risk to a SUD endpoint.
A brief summary of the neurocognitive and brain functional response systems that underlie the behavioral phenotype emphasizes the operation of two systems in dynamic tension, one an effortful control system, the other an incentive reactivity system.
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Developmental Endophenotypes: Indexing Genetic Risk for Substance Abuse With the P300 Brain Event-Related Potential
Although substance use disorders (SUDs) are heritable, their complexity has made identifying genes underlying their development challenging. Endophenotypes, biologically informed quantitative measures that index genetic risk for a disorder, are being recognized for their potential to assist the search for disorder-relevant genes.
After outlining criteria for an endophenotype that includes developmental considerations, this article reviews how the brain P300 response serves as an index of genetic risk for substance abuse and related externalizing disorders.
The P300 response is highly heritable and associated broadly with characteristics of externalizing disorder, including childhood disruptive disorders, antisociality, and precocious expression of deviant behavior.
This association appears to be mediated by shared genetic influences. Prospective studies confirm that reduced P300 amplitude present in youth prior to significant exposure to addictive substances is associated with the subsequent development of SUDs.
Despite pronounced change in mean level over the course of development, P300 amplitude shows strong rank-order stability with repeated assessment through young adulthood.
In addition, P300 developmental trajectories based on multiple assessments show very high heritability and may be especially informative as measures of genetic risk.
Collectively, these findings provide strong support for the idea that P300 amplitude and its change through development reflect genetic vulnerability to substance abuse and related externalizing psychopathology.
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Adolescent Neurobehavioral Characteristics, Alcohol Sensitivities, and Intake: Setting the Stage for Alcohol Use Disorders?
The transition to adolescence is characterized by rapid biological transformations that include not only the hormonal and physiological changes of puberty but also dramatic changes in the brain as well. Similar neural and physiological changes are associated with the transition from immaturity to maturity across a variety of mammalian species, along with a variety of common adolescent-typical behavioral characteristics.
Among the neural systems undergoing alterations during adolescence are those that modulate sensitivity to a variety of alcohol effects, potentially increasing the propensity for relatively high levels of adolescent alcohol use, which in turn may set the stage for later alcohol use disorders.
This article reviews research on adolescent alcohol sensitivities and suggests possible implications of these findings for the frequent initiation and relatively high levels of alcohol intake seen at this age.
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Understanding how genetic influences affect alcohol use and dependence necessitates a developmental perspective.
The importance of genetic influences on alcohol use and dependence varies dramatically across development, with environmental influences playing the predominant role early in adolescence and genetic influences assuming increasing importance across adolescence and into young adulthood.
In addition, converging lines of evidence suggest that the genetic predisposition to adult alcohol dependence shows heterotypic continuity and is related to conduct problems much earlier in development.
It is clear that the genetic susceptibility for alcohol use and dependence unfolds through a complex series of interactions with the environment, with evidence that genetic predispositions influence the selection of environments, such as deviant peers, which further elevate risk for alcohol problems, and that the environment can mitigate or augment the expression of genetic predispositions related to substance use.
As genes influencing alcohol dependence are increasingly identified, exciting opportunities exist to integrate these findings with the rich developmental literature in order to map pathways of risk associated with identified genes and their interactions with the environment across development.
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Depression, Alcohol Use and Adherence to Antiretroviral Therapy in Sub-Saharan Africa: A Systematic Review
This study evaluated estimates of depression symptoms, major depression, alcohol use or disorders and their association with ART adherence in sub-Saharan Africa.
Studies published between January 1, 2006 and July 31, 2011 that documented rates of these mental health problems were identified through electronic databases.
A pooled analysis of 23 studies reporting rates of depression symptoms and six studies reporting rates of major depression indicated a pooled estimate of 31.2% (95% CI 25.5–38.2%, Tau2 = 0.23) and 18% (95% CI 12.3–25.8%, Tau2 = 0.19) respectively.
Few studies reported rates of alcohol use or disorders, and so we did not pool their estimates. Likelihood of achieving good adherence was 55% lower among those with depression symptoms compared to those without (pooled OR = 0.45 (95% CI 0.31–0.66, Tau2 = 0.20, P value = 0.000).
Interventions to improve mental health of HIV-positive individuals and to support adherence are desperately needed in sub-Saharan Africa.
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Fetal alcohol spectrum disorder, the leading cause of developmental disability in Canada, is an umbrella term used to describe a range of disabilities that result from prenatal exposure to alcohol.
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