CLOCK is suggested to associate with comorbid alcohol use and depressive disorders

Depression and alcohol abuse or dependence (AUD) co-occur in the general population more frequently than expected by chance. Alcohol use influences the circadian rhythms generated by the central pacemaker in the suprachiasmatic nucleus, and circadian rhythm alterations in turn are common in depressive disorders as well as among persons addicted to alcohol.

32 SNPs in 19 circadian clockwork related genes were analyzed using DNA from 76 individuals with comorbid depression and AUD, 446 individuals with AUD and 517 healthy controls with no psychiatric diagnosis. The individuals participated in a nationwide health examination study, representative of the general population aged 30 and over in Finland.

The CLOCK haplotype TTGC formed by SNPs rs3805151, rs2412648, rs11240 and rs2412646, was associated with increased risk for comorbidity (OR = 1.65, 95% CI = 1.14-2.28, P = 0.0077). The SNPs of importance for this suggestive association were rs2412646 and rs11240 indicating location of the functional variation in the block downstream rs2412648. There was no indication for association between CLOCK and AUD.

Our findings suggest an association between the CLOCK gene and the comorbid condition of alcohol use and depressive disorders. Together with previous reports it indicates that the CLOCK variations we found here may be a vulnerability factor to depression given the exposure to alcohol in individuals having AUD.

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Alcohol Use Among Asian American Adolescent Girls: The Impact of Immigrant Generation Status and Family Relationships

Underage drinking among Asian American adolescent girls is not well understood. Based on family interaction theory, the study examined the interrelationships among acculturation variables, family relationships, girls’ depressed mood, peer alcohol use, and girls’ alcohol use in a sample of 130 Asian American mother–daughter dyads.

The mediating role of family relationships, girls’ depressed mood, and peer alcohol use on girls’ drinking was also assessed.

The study advances knowledge related to alcohol use among early Asian American adolescent girls, highlights the effect of immigrant generation status and family relationships, and has implications for culturally specific underage drinking prevention programs.



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Request Reprint E-Mail: schinke@columbia.edu

‘That's OK. He's a guy’: A mixed-methods study of gender double-standards for alcohol use

Although drinking and drunkenness have traditionally been considered masculine behaviours, young women's alcohol consumption has increased in recent years.

This mixed methods study was conducted to examine the extent to which young people endorse gender double-standards for alcohol use – i.e., less acceptance of drinking and drunkenness in women than men – and how these influence men's and women's alcohol consumption.

A sample of 731 English university students completed an online survey of gender role attitudes, beliefs about the gendered nature of alcohol use and recent alcohol consumption. Sixteen participants were then purposively selected for individual interviews: eight women and men with the most egalitarian gender role beliefs, and eight women and men with the least egalitarian beliefs.

The two sets of data revealed that although there were few sex differences in actual levels of drinking or drunkenness, gender double-standards for alcohol use persist: beer drinking, binge drinking and public drunkenness tended to be perceived as masculine, and even the most egalitarian respondents were more judgemental of women's drinking. Participants modified their drinking style so as to maintain a desired gender identity.

Although gender double-standards could be a focus of interventions to encourage moderate drinking, such approaches could reinforce gender inequalities.



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Request Reprint E-Mail: rd48@sussex.ac.uk

News Release - New study finds binge drinking as contagious as the common cold

Romantic partners are a powerful influence. But a new study conducted by Dalhousie University researchers has revealed that dating couples may have more influence over each other than you think – especially when it comes to binge drinking.

Key Points:

• Do couples influence each other's drinking habits? Over a 28 day time frame, researchers were able to predict one partner’s binge drinking based the other partner’s binge drinking.

• This study offers a unique explanation for why young adults are binge drinking: Because they are involved in a drinking partnership that promotes binge drinking.

• People who are dealing with an addiction are often quick to blame themselves and to look past social relationships and wider environments as possible contributors to their addiction. This research shows your partner can influence your binge drinking—a finding that has important implications for assessment, prevention, and treatment.

• The research studied 208 nonmarried, heterosexual dating couples in their early 20’s. Each couple had to be dating for at least 3 months, have face-to-face contact at least 5 days a week, and one member of each dating couple had to be a university/college student. On average, couples were dating for close to 2 years.

• The lead author in this study is Aislin Mushquash, 4th year PhD student in clinical psychology along with Dalhousie researchers Dr. Simon Sherry, assistant professor in the Department of Psychology, and Dr. Sherry Stewart, professor in the Departments of Psychiatry, Psychology, and Community Health and Epidemiology.

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Does minimum pricing reduce alcohol consumption? The experience of a Canadian province

Minimum alcohol prices in British Columbia have been adjusted intermittently over the past 20 years. The present study estimates impacts of these adjustments on alcohol consumption.

Time series and longitudinal models of aggregate alcohol consumption with price and other economic data as independent variables.

British Columbia (BC), Canada.

Data on alcohol prices and sales for different beverages were provided by the BC Liquor Distribution Branch for 1989 to 2010. Data on household income were sourced from Statistics Canada.

Longitudinal estimates suggest that a 10% increase in the minimum price of an alcoholic beverage reduced its consumption relative to other beverages by 16.1% (P < 0.001). Time series estimates indicate that a 10% increase in minimum prices reduced consumption of spirits and liqueurs by 6.8% (P = 0.004), wine by 8.9% (P = 0.033), alcoholic sodas and ciders by 13.9% (P = 0.067), beer by 1.5% (P = 0.043) and all alcoholic drinks by 3.4 % (P = 0.007).

Increases in minimum prices of alcoholic beverages can substantially reduce alcohol consumption.

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Request Reprint E-Mail: timstock@uvic.ca

“We have to be robust in reducing harm caused by alcohol"

Alcohol-related problems are on the political agenda in South Africa, following a declaration of intent by the government to ban advertising on alcohol. South Africa has a relatively high level of alcohol consumption; 9.5 liters per capita 15 years and above according to the most recent WHO data. The African average is 6.2 liters. South Africa also has a substantial segment of the population with risky drinking patterns. Alcohol-related violence, the spread of HIV/AIDS and a sky-high prevalence of fetal alcohol spectrum disorders (FASD) are three areas of alcohol-related harm typical for South Africa.

The alcohol and advertising industries have recently circulated a petition aimed at pressuring government to abandon its intended ban on advertising alcohol. This is one of many initiatives by the industry to push the South African government to refrain from alcohol regulations and rather focus on underlying factors driving alcohol abuse and place resources in public information and education. In an article in The Sunday Independent the Minister of Social Development, Bathabile Dlamini, comes out very strongly against the industry approach to alcohol prevention. > > > > Read More

Focus on Alcohol Safe Environment - FASE: short summary of results

In its 2007 work plan, the European Commission called for the collection of best practices in work-place strategies to reduce the impact of harmful and hazardous alcohol consumption on the economy; networking, evaluation and collection of best practises on well-resourced community mobilisation and intervention projects to create safer drinking environments; and development of best practice in advertising, self regulation and monitoring. This was implemented in the project “FASE – Focus on Alcohol Safe Environment”.

With the help of FASE project partners more than 20 best practice policies or programmes (PPP) in 13 European countries were found. The examples came from different branches. Most of them belong to the production sector (ship building, energy supply, building industry, chemical industry, aluminium industry and the like). From the service sector good practices were received from the wellness and health industry, an insurance company, a mail order and some consulting companies. Furthermore, some good practice examples describe nationwide programmes or regional networks for companies which will be implemented currently. Fifty percent are big enterprises, that means more than 501 staff members, 30 per cent are medium-sized (50 - 500 staff members). Only five companies are situated at only one location, the others are multinationals. To identify good practices projects (PPP) the network partners received a list of criteria and indicators for policies, programmes, guidelines and measures to reduce alcohol at the workplace. In the different case studies you will find information about the PPP: the background, the main aims and target groups, the main prevention strategies, tools for the management, for the dissemination of the policy and for the participation of the employees, aspects for the evaluation, the main pre-conditions for success and the main results, and why each project is worth to be transferred.

Please have a look at the files of “Best Practices (PPP) from European countries” on the website.

Summary of the Scientific Opinion of the Science Group of the European Alcohol and Health Forum

Globally, alcohol is the world’s number one risk factor for ill-health and premature death amongst the 25-59 year old age group, the core of the working age population. It is unsurprising, therefore that lost productivity costs feature as the dominant element in social costs studies arising from the harm done by alcohol (contributing to one half or more of the total social costs). Becoming unemployed worsens alcohol-related harm, and heavy drinking, itself, leads to unemployment. Alcohol is a significant risk factor for absenteeism and presenteeism at work, largely in a dose response manner, with a relationship between societal and individual level of alcohol consumption and sickness absence. Although some studies have reported a positive impact of alcohol consumption on earnings, a proxy measure of productivity, a meta-analysis of relevant studies suggested that the relationship was an artefact. Often forgotten is the impact of drinkers on the productivity of people other than the drinker. An Australian study found this to be comparable in cost size as the lost productivity costs of the drinkers themselves. The work place itself also impacts on alcohol-related harm. Certain occupations (in particular bar staff and sea workers) are at particular risk, and, in general, stressful working environments increase the risk of alcohol-related harm.

Despite the extensive evidence base for the potential negative impact of alcohol consumption on productivity, the evidence base for effective responses is rather poor. It is not known if changing work structures can reduce workplace alcohol-related harm. Whilst there is some limited evidence from systematic reviews for an impact of counselling based interventions at the work place, peer support programmes and web based programmes, most of the evidence is based on self-report, with few outcomes that are objective. Mandatory screening programmes seem to have an impact and can be appropriate for those employees in high risk situations, such as in the transport sector. Although systematic reviews find in general that health promotion programmes at the workplace have little impact, with, perhaps the exception of programmes that promote physical activity, well-being at work programmes seem to bring a productivity return on investment of 2.73 financial units for every financial unit spent. Finally, policies outside the workplace seem to have an impact. Investing in social welfare programmes and active labour programmes to keep and reintegrate workers in jobs can mitigate the negative effective of economic downturns on alcohol-related deaths. Alcohol polices themselves, such as increases in the price of alcohol, can reduce sickness absence and overall unemployment and improve overall productivity.

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The Alcohol Clinical Trials Initiative (ACTIVE): Purpose and Goals for Assessing Important and Salient Issues for Medications Development in Alcohol U

Although progress has been made in the treatment of alcohol use disorders, more effective treatments are needed.

In the last 15 years, several medications have been approved for use in alcohol dependence but have only limited effectiveness and clinical acceptance. While academics have developed some ‘standards’ for the performance of clinical trials for alcohol dependence, they vary considerably, in the type of populations to be studied, the length of trials, salient outcome measures, and data analyses to be used (especially in the treatment of missing data). This variability impedes the commercial development of medications to treat alcohol dependence.

Using a model similar to that used to develop an expert consensus for medications to improve cognitive aspects of schizophrenia (MATRICS) and in the treatment of pain (IMMPACT), a workgroup has been formed under the auspices of ACNP, known as the ACTIVE (Alcohol Clinical Trials Initiative) group, to evaluate data from completed clinical trials to develop a consensus on key issues in the conduct of clinical trials in alcohol dependence.

ACTIVE consists of academic experts, industry representatives, and staff from the Food and Drug Administration, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.

This paper describes the rationale behind the effort, its history and organization, and initial key questions that have been identified as the primary focus of the workgroup.

Future papers will focus on knowledge gained from the re-analysis of completed trials and provide consensus opinions regarding the performance of clinical trials that might be undertaken in the future.


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Time pattern of reduction in risk of oesophageal cancer following alcohol cessation – A meta-analysis

To establish the current level of knowledge of the effect of drinking cessation on the risk of developing oesophageal cancer.

A meta-analysis was conducted based on relevant studies identified through a systematic literature review. A Generalised Least Squares model for trend estimation of summarised dose-response data were utilised in order to estimate the effect of years since drinking cessation on risk of oesophageal cancer.

17 studies that estimate the risk reduction after quantified drinking cessation were identified in the systematic literature review. Nine of these were appropriate for inclusion in the meta-analysis. A large degree of heterogeneity existed between the studies but this was explainable and the increased risk of oesophageal cancer caused by alcohol consumption was found to be reversible with a common trend between studies. A required time period of 16.5 years (95% CI 12.7-23.7) was estimated until no risk from former drinking remained, although this might have been an overestimation due to sample characteristics. The dose-response relationship was found to have an exponential decay. This means about half of the reduction in alcohol-related risk occurred after just a third of the time period required to eliminate the additional risk.

The alcohol-related increased risk of oesophageal cancer is reversible following drinking cessation. It is most likely that about 16 years are required until all elevated risk has disappeared. Due to lack of research and data, more research is urgently required to increase the robustness of the estimates and to approach study limitations.

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Request Reprint E-Mail: johan.jarl@med.lu.se

PhenX Newsletter Issue 17, December 16, 2011,

Overview

The PhenX project (consensus measures for Phenotypes and eXposures) is funded by the National Institutes of Health, The National Human Genome Research Institute. The initial phase of the project is complete, and the PhenX Toolkit now includes measures for each of the 21 domains selected by the PhenX Steering Committee. A Working Group of experts was convened for each domain, and a consensus-based process was used to select high priority, relatively low burden and well-established measures. Preliminary measures were vetted with the broader scientific community before final selections were made, resulting in the set of measures that were included in the Toolkit. The Toolkit includes detailed protocols to ensure that the data collected will be comparable across studies. Investigators who come to the Toolkit when designing or expanding a study can be confident that PhenX measures are high quality, having been validated in previous studies. This is particularly helpful for investigators who want to expand their study’s data collection beyond the primary research focus. We encourage you to provide feedback when you use the Toolkit, so we can ensure that the Toolkit meets the needs of the scientific community.

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Global Actions on Harmful Drinking December 14, 2011

Key Recent Milestones:

· China: Global Actions held a Self-Regulation workshop in Beijing on December 6 with the China Alcoholic Drinks Industry Association (CADIA), China Association of National Advertisers (CANA), and CSR Asia.

Global Actions Spotlight: Industry Workshop for Latin America

ICAP held a workshop in early December that brought together industry representatives from throughout Latin America. As part of ICAP’s effort to support industry engagement around the WHO Global Strategy, industry members convened in Miami.

The workshop was organized to facilitate the exchange of good practice around prevention initiatives, to help strengthen existing programs, and to generate new ones. “Prevention programs currently conducted by companies and trade associations across the region were showcased, as well as the work of social aspects organizations from other parts of the world,” said ICAP’s Senior Vice President Marjana Martinic. “Great strides have been made in Latin America over the past year as industry responds to the Global Strategy.”

Particular emphasis was placed on key aspects of building effective and sustainable practice. “The workshop was designed to provide guidance on activities ranging from situation assessment to evaluation of programs,” said ICAP’s Regional Coordinator for Latin America Denise Bussio. “Having a panel of experts with us for both days allowed very relevant insight and specific feedback, with a number of concrete pointers on how to strengthen industry interventions.”

“Overall, it became evident that meaningful strides have been made in Latin America since the initial ICAP Regional Consultation held in October 2010,” Bussio added. “Many industry players are well underway to demonstrate significant efforts aimed at supporting the WHO Global Strategy.”

What’s Happening Next:

· Vietnam: The Bus Driver Project in Vietnam will launch in Dak Lak province on December 17 and Khanh Hoa province on December 19.

Effects of noise and distraction on alcohol perception Sponsored Article

Recent research demonstrated that noise unconnected to the target stimulus can alter taste perception of food, but it is not clear whether similar effects might be seen with respect to alcohol. This is particularly important, as it might help explain previous reports of higher/faster alcohol consumption in loud music environments.

In the between subjects experiment here, participants (n = 80) completed standardised taste and olfactory tests, followed by a taste test of alcoholic beverages varying in strength (0, 1.9, 3.9, 5.6, and 7.5 pct abv) in a randomly allocated distractive or control condition. Distractive conditions were either music, shadow (listening and repeating a news story) or shadow and music (S-Music).

We found that exposure to music led to higher sweetness ratings compared to all remaining groups.

Interestingly, discrimination of alcohol strength was impaired for individuals in the S-Music compared to remaining groups which was accompanied by increased negative mood.

This is the first experimental work to demonstrate how music and other forms of distraction alter taste perception of alcohol and suggest a mechanism by which distraction leads to increases in alcohol consumption.



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Request Reprint E-Mail: lorenzo.Stafford@port.ac.uk

Association between Leptin Levels and Doses of Clomethiazole during Alcohol Withdrawal: A Pilot Study

The issue of leptin as a putative state marker of alcohol use and its role in craving has been raised in the last few years. Recently, a strong GABA-ergic modulation of leptin was postulated.

The aim of the pilot study was to examine leptin levels in correlation with the strongly GABA-mimetic active substance clomethiazole. The main hypothesis was that higher doses of the strong GABA-mimetic clomethiazole are positively correlated with higher leptin levels.

Twenty-eight alcohol-dependent patients (3 females, median age 36 years) undergoing alcohol withdrawal were included. In 18 patients with and 10 without clomethiazole, serum leptin was analyzed at day 1 and day 7 of alcohol withdrawal. Both groups did not differ by age, BMI, or alcohol use characteristics.

In the clomethiazole group, significant correlations were found between leptin levels at day 1 and clomethiazole dose (p = 0.004), clomethiazole and leptin at day 1/BMI (p = 0.009) and leptin at day 1 and clomethiazole/body surface (p = 0.006). Furthermore, patients with higher clomethiazole doses demonstrated significant higher leptin levels at day 1 (p = 0.044) and day 7 (p = 0.046).

Our pilot data show a strong association between leptin levels and clomethiazole doses, thus supporting further research.


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Request Reprint E-Mail: gerhard.dammann@stgag.ch

Alcohol Use Disorders among Patients Examined in Emergency Departments after a Suicide Attempt

To assess the prevalence of alcohol use disorders (AUD) in a population of patients examined following attempted suicide and compare suicide attempts with and without AUD.

180 patients examined in an emergency department after a suicide attempt were compared with 180 controls paired for sex and age. All patients answered the CAGE and the Fagerström questionnaire. The DSM-IV-R criteria for alcohol, nicotine and cannabis abuse and dependence, as well as for borderline and antisocial personality, were checked.

The prevalence of AUD was 43% among suicide attempters. Suicide attempters with AUD were more often men (52 vs. 30%), living alone (64 vs. 31%) and older (35.9 vs. 32.3 years). They were more often dependent on nicotine (87 vs. 43%) and smoked more cannabis joints (1.4 vs. 0.5). They had taken alcohol before committing suicide more often (61 vs. 23%) and had more previous suicide attempts (2.5 vs. 0.9). Additionally, suicide attempters had higher scores of sensation seeking and presented more often with an antisocial or borderline personality.

43% of the patients examined after a suicide attempt presented with AUD. Emergency units may provide an opportunity to identify their dependence disorder and offer information and treatment.


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Request Reprint E-Mail: michel.lejoyeux@bch.aphp.fr

Does the Alcohol Use Disorders Identification Test–Consumption identify the same patient population as the full 10-item Alcohol Use Disorders Identifi

The aim of this study was to evaluate whether a computer-based 3-item version (Alcohol Use Disorders Identification Test–Consumption [AUDIT-C]) of the Alcohol Use Disorders Identification Test (AUDIT) identifies alcohol use disorder (AUD) in the same patients as the full 10-item version in 809 women and 747 men in an anesthesiology preoperative assessment clinic.

According to cutoffs used (AUDIT: 5–8 points, AUDIT-C: 4–6 points), rate of disagreement (AUDIT-positive and AUDIT-C-negative or vice versa) ranged between 4% and 31% (men) and between 4% and 19% (women).

In male patients, 15% were positive for both the AUDIT (≥8 points) and the AUDIT-C (≥6 points), 7% were positive for AUDIT-C only, and 4% were positive for AUDIT only.

In female patients, using cutoffs of 5 more points (AUDIT) and 4 or more points (AUDIT-C), 16% were positive for both versions, 9% were positive for AUDIT-C only, and 2% were positive for AUDIT only.

The AUDIT and AUDIT-C seem to identify AUD in differing patients.

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Request Reprint E-Mail: tim.neumann@charite.de

Effects of Chronic Intermittent Ethanol Exposure on Orbitofrontal and Medial Prefrontal Cortex-Dependent Behaviors in Mice

In humans, stroke or trauma-induced damage to the orbitofrontal cortex (OFC) or medial prefrontal cortex (mPFC) results in impaired cognitive flexibility. Alcoholics also exhibit similar deficits in cognitive flexibility, suggesting that the OFC and mPFC are susceptible to alcohol-induced dysfunction.

The present experiments investigated this issue using an attention set-shifting assay in ethanol dependent adult male C57BL/6J mice. Ethanol dependence was induced by exposing mice to repeated cycles of chronic intermittent ethanol (CIE) vapor inhalation. Behavioral testing was conducted 72 hours or 10 days following CIE exposure to determine whether ethanol-induced changes in OFC-dependent (reversal learning) and mPFC-dependent (set-shifting) behaviors are long lasting.

During early ethanol abstinence (72 hrs), CIE mice showed reduced reversal learning performance as compared to controls. Reversal learning deficits were revealed as greater number of trials to criterion, more errors made, and a greater difficulty in performing a reversal learning task relative to baseline performance.

Furthermore, the magnitude of the impairment was greater during reversal of a simple discrimination rather than reversal of an intra-dimensional shift.

Reversal learning deficits were no longer present when mice were tested 10 days after CIE exposure, suggesting that ethanol-induced changes in OFC function can recover.

Unexpectedly, performance on the set-shifting task was not impaired during abstinence from ethanol. These data suggest reversal learning, but not attention set-shifting, is transiently disrupted during short-term abstinence from CIE.

Given that reversal learning requires an intact OFC, these findings support the idea that the OFC may be vulnerable to the cognitive impairing actions of ethanol.

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Request Reprint E-Mail: badanich@musc.edu

Assessment of Prenatal Exposure to Ethanol by Meconium Analysis: Results of an Italian Multicenter Study

This study estimated in 7 Italian cities the prevalence of prenatal exposure to ethanol by determining fatty acid ethyl esters (FAEEs; palmitic, palmitoleic, stearic, oleic, linoleic, linolenic, and arachidonic esters) and ethyl glucuronide (EtG) in neonatal meconium samples.

A total of 607 meconium samples were obtained from neonatal wards of 7 public hospitals: Verona and San Daniele del Friuli in the northeast of the country, Reggio Emilia in the middle east, Florence and Rome in the center, and Naples and Crotone in the southwest of the peninsula. Meconium biomarkers were assessed by a validated methodology using liquid chromatography–tandem mass spectrometry and the results categorized using the accepted cutoff of 2 nmol/g total amount of 7 FAEEs and 2 nmol/g EtG, to differentiate between heavy maternal ethanol use during pregnancy and occasional or no use at all.

On the basis of the above-reported cutoffs, the overall prevalence of newborns prenatally exposed to maternal ethanol was 7.9%: 0% in Verona, 4.0% in San Daniele del Friuli, 4.9% in Naples, 5.0% in Florence, 6.2% in Crotone, up to 10.6% in Reggio Emilia, and 29.4% in Rome. Low maternal education level and younger maternal age were associated with biomarker scores over the cutoff. There was also a significant correlation between the highest percentage of prenatal exposure in the capital and certain maternal sociodemographic characteristics.

These results indicate considerable variability in the prevalence of fetal exposure to ethanol in different Italian cities, as determined by the objective measurement of biomarkers in meconium. These data, together with previous ones obtained in Barcelona, Spain, indicate that gestational ethanol exposure is widespread, at least in parts of Europe.

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Request Reprint E-Mail: simona.pichini@iss.it

Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency Department

Brief interventions have the potential to reduce heavy drinking in young adults who present to the emergency department (ED), but require time and resources rarely available. Text-messaging (TM) may provide an effective way to collect drinking data from young adults after ED discharge as well as to provide immediate feedback and ongoing support for behavior change. The feasibility of screening young adults in the ED, recruiting them for a TM-based interventional trial, collecting weekly drinking data through TM, and the variance in drinking outcomes remains unknown.

Young adults in 3 urban EDs (n = 45; aged 18 to 24 years, 54% women) identified as hazardous drinkers by the Alcohol Use Disorders Identification Test-Consumption score were randomly assigned to weekly TM-based feedback with goal setting (Intervention), weekly TM-based drinking assessments without feedback (Assessment), or control. Participants in the Intervention group who reported ≥5 (for men) and ≥4 (for women) maximum drinks during any one 24-hour period were asked whether they would set a goal to reduce their drinking the following week. We describe the interaction with TM and goal setting. We also describe the heavy drinking days (HDDs), drinks per drinking day (DPDD) using timeline follow-back procedure at baseline and 3 months.

We screened 109 young adults over 157 hours across 24 unique days and 52 (48%; 95% CI 38 to 50) screened positive for hazardous drinking. Of these, 45 (87%; 95% CI 74 to 94) met inclusion criteria, were enrolled and randomized, and 6 (13%; 95% CI 5 to 27) did not complete 3-month web-based follow-up; 88% (95% CI 84 to 91) of weekly TM-based drinking assessments were answered, with 77% (95% CI 58 to 90) of participants responding to all 12 weeks. Agreeing to set a goal was associated with a repeat HDD 36% (95% CI 17 to 55) of the time compared with 63% (95% CI 44 to 81) when not willing to set a goal. At 3 months, participants that were exposed to the TM-based intervention had 3.4 (SD 5.4) fewer HDDs in the last month and 2.1 (SD 1.5) fewer DPDD when compared to baseline.

TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.

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Request Reprint E-Mail: suffbp@upmc.edu

Alcohol Use and Crime: Findings from a Longitudinal Sample of U.S. Adolescents and Young Adults

A positive relationship between alcohol use and criminal activity has been well documented among adults, but fewer studies explore this relationship among adolescents.

Using data from 4 waves of the National Longitudinal Study of Adolescent Health (Add Health), we examine alcohol use patterns and criminal activity from adolescence to young adulthood. Fixed-effects models partially address the potential endogeneity of alcohol use, and, because numerous studies indicate that males are more likely than females to engage in drinking and criminal activity, the analyses are segmented by gender.

We find a strong positive relationship between alcohol consumption, the commission of crimes, and criminal victimization for both genders. Various sensitivity analyses and robustness checks support this core finding.

Our results have important policy implications, as public policy tools that aim to reduce drinking among adolescents could also reduce criminal activity. Moreover, effective alcohol abuse treatment may indirectly reduce delinquency and thus have greater long-term economic benefits than previously estimated.

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Request Reprint E-Mail: mfrench@miami.edu

Protect children from alcohol misuse: Turning Point call for early intervention

The health and social care provider Turning Point has said alcohol misuse within families is an escalating concern in its new report "Bottling it up: the next generation". It says early screening and identification of families is needed urgently to prevent the ‘inter-generational cycle’ of alcohol misuse which blights the lives of children and undermines their chances of school and job success.

Up to 2.6 million children live with parents who drink at "hazardous" levels and around 700,000 children are thought to live with dependent drinkers. As covered in the Daily Express, pressure put on women to be "supermums" was adding to the chances of using alcohol as a coping mechanism. Turning Point said more than 5,000 people who used their alcohol treatment services last year were parents. See further reports from the Press Association and Children & Young People Now.

The report says children of parents who misuse alcohol are more at risk of depression, anxiety and increased anger. Turning Point also highlighted JRF research which found that children who see their parents drunk are twice as likely to get drunk themselves. Children living with drinking parents are also more likely to experiment at an early age with alcohol and drugs, increasing the risk of their own later life substance problems.

In the report Turning Point call on the Government to place a duty on Local Authorities to develop strategies that take into account the harms to family life and children's development. They also advocate the development of services which are more family focused and home-based, better liaison between adult and children's services, and more information available to help children with alcohol dependent parents. > > > > Read More

STATE OF KNOWLEDGE: FEMALE DRUNK DRIVERS

EXECUTIVE SUMMARY

Purpose and objectives

>> The purpose of this report is to provide a current state of knowledge about drunk driving among female drivers. Its objectives are to describe the magnitude of the female drunk driver problem, the characteristics of these offenders, the current involvement of female drivers testing positive for alcohol in fatal crashes, and effective strategies that are available and being applied to manage this population.


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Why Do Young People Start Drinking? Motives for First-Time Alcohol Consumption and Links to Risky Drinking in Early Adolescence

To investigate which motives young adolescents indicate for first-time alcohol consumption and whether these motives are linked to risky drinking.

Logistic regressions were used based on a nationally representative sample of 1,654 11- to 14-year-olds who had consumed alcohol at least once

‘To toast’ (42.5%), ‘to find out what effect it would have’ (36.4%), and ‘to have more fun at a party’ (31.0%) were most frequently indicated as motives. Boys indicated curiosity about the effect more often than girls who instead more frequently indicated coping motives. Those who had their first drink ‘to have more fun at a party’ or ‘because it was exciting’ had a higher likelihood of risky drinking. Moreover, those who indicated depression as a motive were three times more likely to have 5 or more drinks on a single occasion.

Information on young people’s motives for first-time drinking appears to play a significant role in primary prevention, e.g. to prevent risky drinking or alcohol-related problems later in life by postponing alcohol use.



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Request Reprint E-Mail: ekuntsche@addiction-info.ch

Drinking behaviours and blood alcohol concentration in four European drinking environments: a cross-sectional study

Reducing harm in drinking environments is a growing priority for European alcohol policy yet few studies have explored nightlife drinking behaviours. This study examines alcohol consumption and blood alcohol concentration (BAC) in drinking environments in four European cities.

A short questionnaire was implemented among 838 drinkers aged 16-35 in drinking environments in four European cities, in the Netherlands, Slovenia, Spain and the UK. Questions included self-reported alcohol use before interview and expected consumption over the remainder of the night. Breathalyser tests were used to measured breath alcohol concentration (converted to BAC) at interview.

Most participants in the Dutch (56.2%), Spanish (59.6%) and British (61.4%) samples had preloaded (cf Slovenia 34.8%). In those drinking <3 h at interview, there were no differences in BAC by gender or nationality. In UK participants, BAC increased significantly in those who had been drinking longer, reaching 0.13% (median) in females and 0.17% in males drinking >5 h. In other nationalities, BAC increases were less pronounced or absent. High BAC (>0.08%) was associated with being male, aged >19, British and having consumed spirits. In all cities most participants intended to drink enough alcohol to constitute binge drinking.

Different models of drinking behaviour are seen in different nightlife settings. Here, the UK sample was typified by continued increases in inebriation compared with steady, more moderate intoxication elsewhere. With the former being associated with higher health risks, European alcohol policy must work to deter this form of nightlife.

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Ethanol promotes mammary tumor growth and angiogenesis: the involvement of chemoattractant factor MCP-1

Alcohol consumption is a risk factor for breast cancer in humans. Experimental studies indicate that alcohol exposure promotes malignant progression of mammary tumors.

However, the underlying cellular and molecular mechanisms remain unclear. Alcohol induces a pro-inflammatory response by modulating the expression of cytokines and chemokines. Monocyte chemoattractant protein-1 (MCP-1), also known as chemokine (C–C motif) ligand 2, is a pro-inflammatory chemokine implicated in breast cancer development/malignancy.

We investigated the role of MCP-1 in alcohol-promoted mammary tumor progression. Using a xenograft model, we demonstrated that alcohol increased tumor angiogenesis and promoted growth/metastasis of breast cancer cells in C57BL/6 mice.

Alcohol up-regulated the expression of MCP-1 and its receptor CCR2 in breast cancer cells in vitro and in vivo. Using a three-dimensional tumor/endothelial cell co-culture system, we demonstrated MCP-1 regulated tumor/endothelial cell interaction and promoted tumor angiogenesis.

More importantly, MCP-1 mediated alcohol-promoted angiogenesis; an antagonist of the MCP-1 receptor CCR2 significantly inhibited alcohol-stimulated tumor angiogenesis.

The CCR2 antagonist abolished ethanol-stimulated growth of mammary tumors in mice.

We further demonstrated that MCP-1 enhanced the migration, but not the proliferation of endothelial cells as well as breast cancer cells.

These results suggest that MCP-1 plays an important role in ethanol-stimulated tumor angiogenesis and tumor progression.



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UNDERSTANDING HETEROGENEITY IN PRICE ELASTICITIES IN THE DEMAND FOR ALCOHOL FOR OLDER INDIVIDUALS

This paper estimates the price elasticity of demand for alcohol using Health and Retirement Study data.

To account for unobserved heterogeneity in price responsiveness, we use finite mixture models. We recover two latent groups, one is significantly responsive to price, but the other is unresponsive.

The group with greater responsiveness is disadvantaged in multiple domains, including health, financial resources, education and perhaps even planning abilities.

These results have policy implications. The unresponsive group drinks more heavily, suggesting that a higher tax would fail to curb the negative alcohol-related externalities. In contrast, the more disadvantaged group is more responsive to price, thus suffering greater deadweight loss, yet this group consumes fewer drinks per day and might be less likely to impose negative externalities.


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padmaja-ayyagari@uiowa.edu

Fatal alcohol intoxication in women: A forensic autopsy study from Slovakia

Plenty of information related to alcoholism can be found in the literature, however, the studies have mostly dealt with the predominance of male alcoholism and data related to addiction in women are desperately scarce and difficult to find. Basic demographic data focusing on the impact of acute alcohol intoxication on the circumstances of death and social behaviour in the alcohol addicted female population are needed especially in the prevention of alcohol related mortality.

A retrospective forensic autopsy study of all accidental deaths due to alcohol intoxication over a 12-year period was performed in order to evaluate the locations, circumstances, mechanisms and causes of death.

A sample of 171 cases of intoxicated women who died due to blood alcohol concentration (BAC) equal to or higher than 2 g/kg was selected. Among them 36.26% (62/171) of women died due to acute alcohol intoxication (AAI). We noted an increase in the number of deaths in women due to AAI from 2 in 1994 up to 5 in 2005 (an elevation of 150% between the years 1994-2005). The age structure of deaths in women due to BAC and AAI followed the Gaussian distribution with a dominant group of women aged 41-50 years (45.16% and 35.09% respectively). The most frequent place of death (98%) among women intoxicated by alcohol was their own home. The study suggests a close connection between AAI and violence against women.

The increasing number of cases of death of women suffering from AAI has drawn attention to the serious problem of alcoholism in women in the Slovak Republic during the process of integration into "western" lifestyle and culture.

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News Release - Marijuana use continues to rise among U.S. teens, while alcohol use hits historic lows

Among the more important findings from this year’s Monitoring the Future survey of U.S. secondary school students are the following:

• Marijuana use among teens rose in 2011 for the fourth straight year—a sharp contrast to the considerable decline that had occurred in the preceding decade. Daily marijuana use is now at a 30-year peak level among high school seniors.
  

• “Synthetic marijuana,” which until earlier this year was legally sold and goes by such names as “K2” and “spice,” was added to the study’s coverage in 2011; one in every nine high school seniors (11.4%) reported using that drug in the prior 12 months.
  

• Alcohol use—and, importantly, occasions of heavy drinking—continued a long-term gradual decline among teens, reaching historically low levels in 2011.
  

• Energy drinks are being consumed by about one third of teens, with use highest among younger teens.
  

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News Release - New strain of lab mice mimics human alcohol consumption patterns

A line of laboratory mice developed by a researcher from the School of Science at Indiana University-Purdue University Indianapolis drinks more alcohol than other animal models and consumes it in a fashion similar to humans: choosing alcohol over other options and binge drinking.

Animal models previously available to alcohol abuse and alcoholism researchers do not get as drunk as the new strain, unless alcohol is the only choice of fluids, or alcohol is administered by the experimenter. When given the option, previously bred mouse lines continue to drink water even when they can select alcohol.

These new mice, selectively bred over 40 generations at the School of Science at IUPUI to prefer alcohol over all other choices, will help researchers explore new aspects of the behavioral and genetic determinants of alcoholism.

In a study published online ahead of print in the journal Addiction Biology on Nov. 29, senior author Nicholas Grahame, associate professor of psychology in the School of Science at IUPUI, reports on the mice he has bred since 1997. The rodents reach blood-alcohol levels of more than 260 mg/dl of alcohol daily, over three times the equivalent of the human legal driving limit and the approximate consumption level that the severest human alcoholics attain. > > > > Read More

Computer Assessment of Simulated Patient Interviews (CASPI): Psychometric Properties of a Web-Based System for the Assessment of Motivational Intervie

Benefits of empirically supported interventions hinge on clinician skill, particularly for motivational interviewing (MI). Existing MI skill assessments are limited with respect to validity (e.g., self-report) and practicality (e.g., coding session tapes). To address these limitations, we developed and evaluated two versions of a web-based assessment of MI skills, the Computer Assessment of Simulated Patient Interviews (CASPI).

Ninety-six counselors from the community and 24 members of the Motivational Interviewing Network of Trainers (MINT) completed the CASPI (N = 120), in which they verbally responded via microphones to video clips comprising three 9-item vignettes. Three coders used an emergent coding scheme, which was compared with alternative MI skills measures.

CASPI demonstrated excellent internal consistency when averaging across two or three vignettes (α's = .86–.89). Intraclass correlations were above .40 for most items. Confirmatory factor analyses supported a correlated three-factor model: MI-consistent, resistance-engendering, and global change talk orientation rating. Means and factor loadings were invariant across forms (i.e., the two alternative versions of CASPI), and factor loadings were invariant across subgroup (i.e., community counselor or MINT member). Test–retest reliability was good for MI-consistent and resistance-engendering scores (r = .74 and .80, respectively) but low for change talk orientation (r = .29) unless coder was taken into account (r = .69). CASPI showed excellent construct and criterion-related validity.

CASPI represents a promising method of assessing MI skills. Future studies are needed to establish its performance in real-world contexts.



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Sources of Biased Inference in Alcohol and Drug Services Research: An Instrumental Variable Approach

This study examined the potential for biased inference due to endogeneity when using standard approaches for modeling the utilization of alcohol and drug treatment.

Results from standard regression analysis were compared with those that controlled for endogeneity using instrumental variables estimation. Comparable models predicted the likelihood of receiving alcohol treatment based on the widely used Aday and Andersen medical care–seeking model. Data were from the National Epidemiologic Survey on Alcohol and Related Conditions and included a representative sample of adults in households and group quarters throughout the contiguous United States.

Findings suggested that standard approaches for modeling treatment utilization are prone to bias because of uncontrolled reverse causation and omitted variables. Compared with instrumental variables estimation, standard regression analyses produced downwardly biased estimates of the impact of alcohol problem severity on the likelihood of receiving care.

Standard approaches for modeling service utilization are prone to underestimating the true effects of problem severity on service use. Biased inference could lead to inaccurate policy recommendations, for example, by suggesting that people with milder forms of substance use disorder are more likely to receive care than is actually the case.



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Request Reprint E-Mail: laura.schmidt@ucsf.edu

Implicit Cognition and Substance Use: The Role of Controlled and Automatic Processes in Children

Most cognitive models of substance abuse and dependence posit that controlled and automatic processes are central to substance use. Tests of these models rely on methods that are interpreted to measure one or the other of these processes. There has been growing interest in the use of implicit substance use tasks, which are posited to reflect automatic processes. Recent model advancements suggest that behavior is determined by multiple cognitive processes and that dual-process models may provide an overly simplistic account of the cognitive process involved in the assessment of implicit cognition. The goal of the current study was to apply the Quad Model to children's performance on implicit substance use tasks and consider associations with early substance use.

Children (N = 378; 52% girls) ranging from 10 to 12 years old completed alcohol and cigarette Single Category Implicit Association Tests (SC-IATs) and self-reports of substance use.

Four distinct cognitive processes were found to influence SC-IAT performance, one of which reflected automatic activation, the process typically viewed as central to IAT performance. Differences across drinking status revealed weaker automatic activation of negative alcohol associations for those who had (vs. had not) initiated drinking, and a strong likelihood to overcome biased attitudes was supported for all children. The low prevalence of cigarette use in our young sample prohibited examination of the model across smoking status.

Findings suggest that performance on implicit substance use tasks is not process pure. Quantifying and interpreting the multiple influencing processes are crucial for further development and evaluation of cognitive risk models of substance use.


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Use of the Screening Suggested by the National Institute on Alcohol Abuse and Alcoholism and of a Newly Derived Tool for the Detection of Unhealthy Al

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has developed a two-question tool for the detection of unhealthy drinking (NIAAA-2Q) that investigates excessive alcohol consumption per single occasion. NIAAA-2Q can be commuted into a four-question tool (NIAAA-4Q) by the addition of two questions aimed at investigating excessive weekly alcohol intake. NIAAA-2Q and NIAAA-4Q may prove useful in busy settings such as an anesthesiological environment. However, to date, no study has evaluated their efficacy in a surgical setting. The purpose of this study was to evaluate the accuracy of NIAAA-2Q and NIAAA-4Q in detecting unhealthy drinking among surgical patients using the more complex Alcohol Use Disorders Identification Test (AUDIT) comprising 10 questions as the criterion method.

NIAAA-4Q and AUDIT were administered to 200 surgical patients by three anesthetists.

A total of 23.5%, 12.5%, and 28.5% surgical patients were unhealthy drinkers according to AUDIT, NIAAA-2Q, and NIAAA-4Q, respectively. NIAAA-2Q negative and positive predictive values were 0.78 and 0.36, respectively, and positive and negative likelihood ratios were 1.80 and 0.90, respectively. NIAAA-4Q negative and positive predictive values were 0.93 and 0.65, respectively, and positive and negative likelihood ratios were 6.00 and 0.24, respectively.

NIAAA-4Q demonstrated a better satisfactory agreement than NIAAA-2Q with AUDIT in detecting unhealthy alcohol drinking among surgical patients. These results suggest that the detection of unhealthy alcohol drinking may be increased by the administration of questions aimed at assessing the weekly average of alcohol intake. The modest time required for NIAAA-4Q administration is a major advantage in clinical practice with respect to AUDIT. Further research will compare NIAAA-2Q and NIAAA-4Q with other brief alcohol screening tests.



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Hispanic Americans Baseline Alcohol Survey (HABLAS): Effects of Container Size Adjustments on Estimates of Alcohol Consumption Across Hispanic Nationa

This study was conducted to examine discrepancies in alcohol consumption estimates between a self-reported standard quantity–frequency measure and an adjusted version based on respondents' typically used container size.

Using a multistage cluster sample design, 5,224 Hispanic individuals 18 years of age and older were selected from the household population in five metropolitan areas of the United States: Miami, New York, Philadelphia, Houston, and Los Angeles. The survey-weighted response rate was 76%. Personal interviews lasting an average of 1 hour were conducted in respondents' homes in either English or Spanish.

The overall effect of container adjustment was to increase estimates of ethanol consumption by 68% for women (range across Hispanic groups: 17%–99%) and 30% for men (range: 14%–42%). With the exception of female Cuban American, Mexican American, and South/Central American beer drinkers and male Cuban American wine drinkers, all percentage differences between unadjusted and container-adjusted estimates were positive. Second, container adjustments produced the largest change for volume of distilled spirits, followed by wine and beer. Container size adjustments generally produced larger percentage increases in consumption estimates for the higher volume drinkers, especially the upper tertile of female drinkers.

Self-reported alcohol consumption based on standard drinks underreports consumption when compared with reports based on the amount of alcohol poured into commonly used containers.



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