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 24, 2011
Acute alcohol consumption is associated with increased interatrial electromechanical delay in healthy men
Acute alcohol consumption can cause atrial fibrillation in patients with, and without, heart disease. Increased atrial electromechanical delay (EMD) has been associated with atrial fibrillation. We evaluated the atrial conduction properties by tissue Doppler imaging (TDI) echocardiography in healthy men following acute alcohol intake.
Thirty healthy male volunteers were included in this study. Baseline ECG, heart rate, blood pressure, and TDI echocardiographic findings were compared to readings take one hour after drinking six 12-oz cans of beer (76.8 g of ethanol).
Although the blood pressure and heart rate remained similar before and one hour after alcohol intake, Pmax and Pd values were significantly prolonged (114.2 ± 10.4 vs 100.8 ±
± 10.6, p = 0.002; 50.6 ± 9.6 vs 34.5 ± 8.8, p < 0.0001). Interatrial EMD was significantly
increased after drinking alcohol compared to the baseline (19.8 ± 9.2 vs 14.0 ± 5.5 ms, p < 0.0002).
Acute moderate alcohol intake was associated with an increased interatrial EMD obtained by TDI echocardiography. This finding may help explain how these patients express increased susceptibility to atrial fibrillation.
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Friday, December 23, 2011
Different guidelines for different countries? On the scientific basis of low-risk drinking guidelines and their implications
The scientific evidence for low-risk drinking guidelines was examined in a narrative review focusing on three points: definition of exposure, the best way to select outcomes and risk relations and how to determine thresholds.
With respect to exposure, at least two dimensions should be incorporated: average volume of alcohol consumption and patterns of irregular heavy drinking occasions.
Mortality should be selected as the most severe outcome, and a disaggregated approach should be adopted incorporating the regional demographic and cause of death structure.
Finally, our plea is for establishing a general threshold for acceptable risk on a societal level rather than ad hoc specific committees setting norms for specific risks. Acceptable thresholds will be different if the risk is to oneself or to others.
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Excessive alcohol consumption increases the likelihood of accidental injury. This pilot study reports on the prevalence of hazardous drinkers presenting to a minor injuries unit. The proportion of hazardous drinkers is broadly similar to that found in emergency departments, suggesting that such units could also host alcohol intervention and brief advice activities.
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As part of SAMHSA’s efforts to provide stakeholders the opportunity to comment on the working definition of recovery and related guiding principles, several public feedback forums were run during the period August 12- 26, 2011. In addition to the forums, feedback was also submitted via the comments on the Recovery Defined – Give Us Your Feedback blog post.
The response to our request for feedback was tremendous and clearly demonstrated the field’s interest and concern on this important issue. The blog post received 259 comments. The two forums combined had over 1,000 participants, nearly 500 ideas, and over 1,200 comments on the ideas. Over 8,500 votes were also cast in support of the ideas on the forums.
SAMHSA appreciates the many thoughtful responses and suggestions received. All ideas were given careful consideration, and suggestions were incorporated into the final definition and principles (see below). Of particular note, we have added a preamble to the definition and principles emphasizing that there are many different pathways to recovery, and we have highlighted the importance of hope as the catalyst to the recovery process.
SAMHSA will disseminate the definition and principles as a resource to policy-makers, systems administrators, providers, practitioners, consumers, peers, family members, advocates, and others. The definition and principles are intended to help with the design, measurement, and reimbursement of services and supports to meet the individualized needs of those with mental disorders and substance use disorders. > > > > Read More
Acquisition, expression, and reinstatement of ethanol-induced conditioned place preference in mice: effects of exposure to stress and modulation by me
Nicotinic acetylcholine receptors mediate some of the rewarding and motivational effects of ethanol, including relapses. Relapses are common in drug addicts during abstinence when exposure to any stressor ensues.
However, the role of nicotinic acetylcholine receptors in the ethanol- and stress-induced reinstatement of ethanol-induced conditioned place preference has not yet been explored. Therefore, the present study investigated the influence of mecamylamine, a nicotinic acetylcholine receptors antagonist on acquisition, expression, and reinstatement of ethanol-induced conditioned place preference in adult male Swiss mice.
The results revealed that mecamylamine (0.1–10 µg/mouse, intracerebroventricularly) dose dependently prevented the development, expression, and reinstatement of ethanol-induced conditioned place preference.
Further, acute treatment with mecamylamine blocked the restraint stress and forced swim stress-induced reinstatement of ethanol-induced conditioned place preference.
All of these treatments had no influence on the locomotor activity. Therefore, it is concluded that mecamylamine blocks the acquisition, expression and reinstatement of conditioned reinforcing effects of ethanol without per se reinforcing or aversive influence.
This ability of mecamylamine might be a potential advantage in the treatment of alcoholism.
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Thursday, December 22, 2011
Wednesday, December 21, 2011
What is the student poster award contest? The American Public Health Association, Alcohol, Tobacco and Other Drugs Section features a poster contest to students in the field of alcohol, tobacco or other drugs. The 2012 contest will be the fifth contest of its kind. Unlike other abstract submissions, there are only a very limited number of slots open for consideration. During the program planning process, abstract reviewers will determine which of the submissions are eligible for a slot in the contest. If chosen, posters will be reviewed and judged at the APHA conference in San Francisco by experts in their respective fields (alcohol, tobacco, or other drugs) and one poster in each category will be recognized with an award.
What are the criteria for awards? Several features are important for a good poster. Below you’ll find the criteria by which the posters are scored and judged:
- Innovation and Importance: what is new, creative, ground-breaking about the project? How important is the work for ATOD and/or public health in general?
- Project Design and Implementation: quality and level of detail and fit of method with the project aims. How was the project conducted to achieve its goals?
- Implications and Generalizability: How well are implications for practice or policy discussed? Are results broad enough to change the way the field thinks or acts?
- Quality of Communication—is the poster well organized, graphically interesting, appealing to the eye, self explanatory and clearly presented?
- During the session, is the presenter able to supplement the poster with a brief and clear presentation in person?
- Overall Rating: is the whole greater or lesser than its component parts (above)?
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This pocket guide is condensed from the NIAAA Guide, Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide. It was produced in collaboration with the American Academy of Pediatrics.
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Interrelationship of substance use and psychological distress over the life course among a cohort of urban African Americans
Substance use and psychological problems are major public health issues because of their high prevalence, co-occurrence, clustering in socio-economically disadvantaged groups, and serious consequences. However, their interrelationship over time is not well understood.
This study identifies and compares the developmental epidemiology from age 6 to 42 of substance use and psychological distress in a population of African American men and women. Data come from the Woodlawn study, a longitudinal study of an urban community cohort followed since 1966. We use structural equation modeling to examine pathways between substance use (i.e., alcohol, marijuana, and cocaine) and psychological distress over time by gender.
We find significant continuity from adolescence to midlife for substance use and for psychological distress, as well as significant correlations within time periods between substance use and psychological distress, particularly among women. We also find greater adolescent substance use predicts psychological distress in young adulthood for men, but no cross-lag associations for women. Women's adolescent psychological distress and substance use are linked uniquely to that of their mothers. Findings show additional gender differences in the developmental etiology of substance use and psychological distress.
Findings demonstrate the continuity of substance use and psychological distress over time; the contemporaneous relationships between psychological distress and substance use within time periods, and minimal cross-lagged relationships. Findings also show that adolescent substance use may set boys on a pathway of long-term psychological distress, thus adding to evidence of negative consequences of frequent use.
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Alcohol-Only Admissions Comprised 23% of Treatment Admissions in 2009; Nearly 40% of Admissions Were for Drugs Other Than Alcohol
The percentage of substance abuse treatment admissions for drug-only problems has risen since 1992 while the percentage for alcohol-only and the co-abuse of alcohol and drugs has declined, according to the most recent data from the Treatment Episode Data Set (TEDS).
The percentage of drug-only treatment admissions increased from 20% in 1992 to 38% in 2009 (the most current year for which data are available). Alcohol-only treatment admissions, which had surpassed drug-only admissions prior to 1999, decreased from 37% to 23% over the same period. The percentage of treatment admissions for the co-abuse of alcohol and other drugs also decreased, from a high of 44% in 1997 to 37% in 2009.
While these findings may reflect actual changes in substance abuse and dependence, they may also be the result of other factors, such as changes in insurance policies or access to treatment.
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Critique 065: Are there differences in mortality between people consuming wine and those consuming other types of alcoholic beverages? — 20 December 2
Holahan CJ, Schutte KK, Brennan PL, North RJ, Holahah CK, Moos BS, Moos RH. Wine consumption and 20-year mortality among late-life moderate drinkers. J Stud Alcohol Drug 2012; 73: 80–88.
Background: There are consistent data showing that moderate consumers of alcohol have lower risk of cardiovascular disease and many other diseases of ageing, as well as lower risk of mortality, than do abstainers.1,2 Experimental data in animals and humans have defined a large number of mechanisms for such an effect.3 There is still some inconsistency as to differential effects according to the type of beverage consumed. In most epidemiologic studies, wine consumers have been shown to have higher levels of education and income, to consume a healthier diet, and have other characteristics that are associated with better health outcomes than consumers of other beverages.4,5 A recent meta-analysis by Constanzo et al6 showed that moderate consumers of both wine and beer had lower risk of cardiovascular disease than did people who generally consumed spirits.
Experimental data clearly show that polyphenols and other constituents in wine, in addition to the alcohol, have beneficial effects on cardiovascular risk in animals, including humans.3, 7-9 The question is whether epidemiologic studies comparing people who consume certain beverages (rather than comparing the beverages themselves) demonstrate such differences in terms of health effects.
A Forum reviewer points out that studies often show that “it is the type of alcoholic beverage which is consumed most frequently in a population which exerts the clearest protective effect. For example, in France it is moderate wine consumption and in Germany moderate beer consumption associated with the healthiest outcomes.10-11 Wine consumers in a customary non-wine drinking country like Denmark may be especially different from the general population. Hence, attempting to adjust for the potential confounding by other lifestyle factors is an ongoing challenge for epidemiologists who are seeking to determine if the consumption of one type of beverage containing alcohol has different effects on health from the consumption of other types of beverage.” > > > > Read More
As the global alcohol industry becomes increasingly concentrated in a few big international companies, its practices around the world become remarkably similar. Public health professionals seeking to reduce the harm from alcohol can benefit from documenting and analyzing these trends and from studying the efficacy of differing responses. Several recent reports illustrate these convergences. > > > > Read More
Monday, December 19, 2011
The NHS Operating Framework 2012/13 was recently published and sets out business planning arrangements and national priorities for the year ahead. The framework contains a number of 'Domain areas' within which there is scope to consider implications for alcohol harm reduction.
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Positive Alcohol Expectancies Mediate the Influence of the Behavioral Activation System on Alcohol Use: A Prospective Path Analysis
Gray's (1975, 1987) behavioral activation (BAS) and behavioral inhibition systems (BIS) are thought to underlie sensitivity to reinforcement and punishment, respectively.
Consistent with Gray's theory and the Acquired Preparedness model, BAS may facilitate the learning of positive alcohol expectancies (PAEs) over time, leading to increases in drinking. Yet, no prospective tests of this pathway have been reported.
The present study investigated whether BAS prospectively predicted PAEs and whether PAEs mediated the association between BAS and subsequent alcohol use. We hypothesized that BAS would influence drinking specifically via enhancement-related PAEs. We also explored the role of BIS in PAEs and drinking.
College students (N = 557) completed online BAS, PAE, and alcohol use measures in September of their first (T1), second (T2), and third (T3) years of college. We conducted autoregressive path analyses with three BAS subscales and BIS (T1) as predictors, four PAE types (T2) as mediators, and quantity and frequency of drinking (T3) as outcomes.
The BAS Fun-Seeking scale was prospectively associated with PAEs, and there was a significant indirect path from Fun-Seeking to alcohol use mediated specifically through activity enhancement PAEs. BIS was positively associated with some PAE types, but did not have indirect effects on drinking.
Findings are consistent with both the theory of the BAS and the Acquired Preparedness model, as individuals high on BAS Fun-Seeking may find the rewarding properties of alcohol more reinforcing, leading to stronger enhancement PAEs and increased drinking over time.
The prospective design helps establish the temporal association between BAS and alcohol-related learning, and points to the need for prevention efforts that target these at-risk students.
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The failure to consider the future consequences of one's behavior is a major risk factor for aggression. Aggressive people tend to act first, and think later.
Some people focus on the “here and now” rather than on the future, a tendency measured by the Consideration of Future Consequences (CFC) scale (Strathman, Gleicher, Boninger, & Edwards, 1994).
Alcohol intoxication is a neuro-biological variable that produces similar effects. Participants in the present experiment completed the CFC scale and then consumed either an alcohol or a placebo beverage. Next, they competed against a same-sex ostensible partner on an interpersonally adversarial competitive task in which the winner could administer electric shocks to the loser (the aggression measure).
As expected, aggression was highest in intoxicated persons with low CFC scores.
Being unconcerned about the future consequences of one's actions, in conjunction with acute alcohol intoxication, combine in a pernicious manner to increase aggression.
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Dr. David Jernigan, director of the Center on Alcohol Marketing and Youth, walks us through the issues surrounding alcohol marketing in the digital age.
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Digital Alcohol Marketing (Part 1): Alcohol Marketing in the Digital Age
Digital Alcohol Marketing (Part 2): Social Media Tour
Digital Alcohol Marketing (Part 3): Rules of the Road
Digital Alcohol Marketing (Part 4): A Path Forward
Alcohol is the number one drug problem among youth, causing 4,600 deaths among persons under 21 every year. At least 13 longitudinal studies have found a strong association between youth exposure to alcohol marketing and underage drinking. The alcohol industry observes a voluntary 30 percent limit on the size of the underage audience for its advertising. The National Research Council and Institute of Medicine, 24 state attorneys general and the Federal Trade Commission have all encouraged the industry to adopt a more restrictive standard.
Radio continues to be a vibrant medium among youth, despite the proliferation and innovation of digital media. For this report, the Center on Alcohol Marketing and Youth (CAMY) at the Johns Hopkins Bloomberg School of Public Health analyzed alcohol advertisements placed on radio in the 75 local markets in the United States in 2009 for which full-year data from a consistent survey methodology were available. These markets represent approximately 46.5 percent of the U.S. population age 12 and above.
Key findings from the report include:
- Approximately 9 percent of all alcohol product advertisements aired on programming with underage audiences in violation of the industry's 30 percent standard. These advertisements generated 18 percent of youth exposure to alcohol advertising.
- Three brands (Bud Light, Coors Light, and Miller Lite) placed close to half of the noncompliant ads.
- Close to one-third (32%) of advertising placements occurred when proportionately more youth were listening than adults age 21 and above.
- These overexposing ads generated more than half of youth exposure to radio advertising for alcohol in 2009.
- In the majority of markets measured by Arbitron's new Portable People Meter™ technology in 2009, girls ages 12 to 20 were more likely than boys in the same age group to be exposed to alcohol advertising for alcopops, distilled spirits, and wine.
The alcohol industry's current standard covers all people below the age of 21; however, more than two-thirds of underage exposure to alcohol advertising on the radio went to young people between the ages of 12 and 20. Protecting this age group, which is less than 15 percent of the population, from undue exposure to alcohol advertising is the reason why the National Research Council and Institute of Medicine and 24 state attorneys general have called for the industry to adopt a new standard limiting alcohol advertising to programming where they are less than 15 percent of the audience.
In summary, this report finds that alcohol advertisers frequently violate a relatively weak voluntary standard, resulting in substantial undue youth exposure and overexposure to alcohol advertising.
Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Low levels of alcohol consumption (or about three drinks a week) were associated with a significantly increased risk of breast cancer – in findings derived from a larger study of nurses recently published in the Journal of the American Medical Association.
The study of about 106,000 U.S. nurses found women who self-reported drinking the equivalent of three to six glasses of wine each week were 15 percent more likely to develop breast cancer than women who never or rarely drank alcohol. The differences between the groups were moderate but statistically significant.
Moreover, the study found the participants who reported they drank the equivalent of two glasses of wine a day over time were 51 percent more likely to develop breast cancer than women who never or rarely drank. Hence, the study suggests higher drinking levels significantly increases the risk of developing breast cancer.
The study also found an increased risk of breast cancer was more linked to cumulative drinking over time rather than what type of alcohol participants drank, or the age when a woman begins to consume wine, spirits, or beer. > > > > Read More
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Human beings, like animals, are greatly influenced by the conditions amidst which they exist. If we crowd animals together, limit their supply of air and sunlight, they become weak and irritable, they mope, sicken, and die. Man differs from animals in his greater impressionability and consequent greater capacity for enjoyment, as well as in his tendency to deteriorate under adverse conditions.
In nearly all our most populous districts it will be found that the people are surrounded by circumstances which are directly opposed to their comfort, health, and general well-being. What is most of all important is that women and children, those most susceptive to the action of deteriorative influences, are those who are most exposed. Take the case of the mothers of families in these localities. Restricted within the limits of small confined dwellings, which are so shut in on all sides that the invigorating rays of the sun seldom gain direct access; the air heavy with impurities; a life of care and anxiety, unrelieved by change or pleasurable incident; wearied by the monotonous aspect of all around them, worn by nursing and by toil, fretted by narrow means, pained by the cries or worried by the fractiousness of children, is it surprising that they lose their health, elasticity, good looks, cheery smiles, and interest in themselves and their families? Is it any wonder that, becoming spiritless, they lack neatness, allow their children and dwellings to become untidy and neglected? Is it then any wonder that the husbands of such women become petulant and unkind, or that their children become disrespectful? Is it any wonder that in this accumulation of misery these unfortunate women are easily persuaded to seek solace in the deceitful and seductive properties of gin or beer? A woman under such adverse circumstances languishes, whilst in beer she finds that which speedily raises her failing spirits, in wine or gin she renews her youth, and banishes melancholy. Need we be surprised that in tens of thousands of cases the women who reside amid conditions so adverse to health and to comfort slide into habits of drinking which only aggravate their misfortunes, making the craving for relief all the greater, until after a time the love of liquor becomes a consuming passion?
As if these incentives to indulgence in a disastrous habit were not in themselves sufficiently potent, our rulers plant in the midst of these miserable districts all sorts of places for the sale of an article which infatuates and degrades – makes it, in fact, the interest of a large number of persons to spread the love of liquor and to pander to its victims. > > > > Read More
Cunningham & McCambridge’s  thoughtful analysis excavates long-standing questions about conceptualizing and pursuing the intertwined, but distinct, goals of advancing scientific knowledge about alcohol misuse versus positioning alcohol services within clinical and public health care. Their sound basic argument would benefit from further qualification distinguishing the utility of the dependence concept for these related, but not identical, enterprises. Dependence has been defined variously as a clinical diagnostic category, a syndrome, a continuum reflecting problem severity and biological involvement and, most recently, a chronic health disorder . Like the earlier disease concept of alcoholism , these conceptions, especially McLellan’s , have value in positioning services in the health-care system for patients who experience withdrawal and relapse and who make multiple quit attempts. Such patients often require repeated treatment before achieving stable sobriety, typically abstinence. The thesis is persuasive that serious alcohol dependence should be managed like other chronic health problems(e.g. diabetes, hypertension) with long-term monitoring and stepped-care interventions and, accordingly, reformed reimbursement schemes and evaluation metrics.
Despite benefits for advancing long-term care of people with serious alcohol problems, a generalized chronic care model breaks down quickly in two key directions. First, it has little relevance for guiding interventions outside specialty health care. It does not fit with the robust success of screening and brief interventions for resolving mild to moderate alcohol problems in nonspecialty settings . It serves little purpose for guiding public health programs for risky drinkers and problem drinkers who do not seek clinical care and comprise the majority of drinkers with problems [5,6]. As Cunningham& McCambridge noted, a population perspective indicates that a spectrum of interventions encompassing clinical, community-based and telehealth interventions is needed to close the gap between need and service access. > > > > Read More
Alcohol abuse does its neurological damage more quickly in women than in men, new research suggests. The finding adds to a growing body of evidence that is prompting researchers to consider whether the time is ripe for single-gender treatment programs for alcohol-dependent women and men.
Over the past few decades scientists have observed a narrowing of the gender gap in alcohol dependence. In the 1980s the ratio of male to female alcohol dependence stood at roughly five males for every female, according to figures compiled by Shelly Greenfield, a professor of psychiatry at Harvard Medical School. By 2002 the "dependence difference" had dropped to about 2.5 men for every woman. But although the gender gap in dependence may be closing, differences in the ways men and women respond to alcohol are emerging. Writing in the January 2012 issue of Alcoholism: Clinical and Experimental Research, principal investigator Claudia Fahlke from the Department of Psychology at the University of Gothenburg in Sweden and her colleagues found that alcohol's ability to reduce serotonin neurotransmission, was "telescoped" in alcoholic women compared with their male counterparts. In other words, although the alcohol-dependent men and women in the study differed substantially in their mean duration of excessive drinking—four years for the women and 14 years for the men—both sexes showed similar patterns of reduced serotonin activity compared with controls. The researchers gauged serotonergic neurotransmission by measuring its response to citalopram, a drug that stalls serotonin molecules in the synaptic gap (as measured by the hormone prolactin's response to citalopram. This pattern of reduced serotonergic neurotransmission matters, because some of the alcohol-induced abnormalities were found in brain regions involved in judgment, self-control and emotional regulation. > > > > Read More