An international website dedicated to providing current information on news, reports, publications,and peer-reviewed research articles concerning alcoholism and alcohol-related problems throughout the world. Postings are provided by international contributors who monitor news, publications and research findings in their country, geographical region or program area of interest. All postings are entered without editorial or contributor opinion or comment.
For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.
Thursday, January 26, 2012
Medical Treatment of Alcohol Dependence: A Systematic Review
To summarize published data on pharmacologic treatments for alcohol dependence alone and in combination with brief psychosocial therapies that may be feasible for primary care and specialty medical settings.
We conducted electronic searches of published original research articles and reviews in MEDLINE, SCOPUS, CINAHL, Embase, and PsychINFO. In addition, hand searches of reference lists of review articles, supplemental searches of internet references and contacts with experts in the field were conducted. Randomized controlled studies published between January 1960 and August 2010 that met our inclusion/exclusion criteria were included.
A total of 85 studies, representing 18,937 subjects, met our criteria for inclusion. The evidence base for oral naltrexone (6% more days abstinent than placebo in the largest study) and topiramate (prescribed off-label) (e.g., 26.2% more days abstinent than placebo in a recent study) is positive but modest. Acamprosate shows modest efficacy with recently abstinent patients, with European studies showing better results than U.S. ones. The evidence-base for disulfiram is equivocal. Depot naltrexone shows efficacy (25% greater reduction in rate of heavy drinking vs. placebo, in one of the largest studies) in a limited number of studies. Some studies suggest that patients do better with extensive psychosocial treatments added to medications while others show that brief support can be equally effective.
Although treatment effects are modest, medications for alcohol dependence, in conjunction with either brief support or more extensive psychosocial therapy, can be effective in primary and specialty care medical settings.
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Why should I comply? Sellers' accounts for (non-)compliance with legal age limits for alcohol sales.
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Monday, January 23, 2012
Wine and Health: A Review
As indicated by epidemiological studies, regular and moderate wine consumption, particularly red wine, has been associated with health benefits. Clinical studies and work performed with animal models indicate that wine may protect against cardiovascular disease, atherosclerosis, hypertension, certain types of cancer, type 2 diabetes, neurological disorders, and metabolic syndrome.
The mechanism of action has been attributed to antioxidant, lipid regulating, and anti-inflammatory effects. A variety of wine constituents have been studied in various disease models. Both the alcoholic and polyphenolic components of wine are believed to contribute to these beneficial effects.
As wine is a complex mixture, it is likely that a multitude of chemical constituents, as well as their metabolites, work synergistically to impact human health. In sum, although wine drinking may be contraindicated in certain individuals, in healthy people, regular consumption of moderate amounts of wine may protect against certain chronic health conditions
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APHA 140th Annual Meeting and Exposition San Francisco, CA • October 27-31, 2012
2012 Annual Meeting Call for Abstracts Now Open
The American Public Health Association is announcing the Call for Abstracts for the 2012 Annual Meeting to be held October 27-31 in San Francisco, CA. The theme is Prevention and Wellness Across the Lifespan.
We encourage abstracts in all areas of public health and are also interested in abstracts that focus on the Annual Meeting theme. All abstracts must be submitted online. An easy to use online form will walk you through the process step-by-step. The deadlines for submission of abstracts range from Feburary 6-10, 2012 depending on the Section, SPIG, Caucus or Forum to which you wish to submit your abstract. All submissions will end at 11:59 pm Pacific Standard Time on the due date listed on the Call for Abstracts. No late submissions will be accepted.
You do not need to be an APHA member to submit an abstract. However, if your abstract is accepted for presentation, the presenting author MUST become an APHA Individual member and MUST register for the Annual Meeting by the September advance registration deadline. Submission of an abstract implies a commitment to make the presentation at the annual meeting, therefore please make sure you understand what is required of you before submitting.
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A prospective study of mortality up to eight years after starting treatment for alcohol and drug problems in Stockholm County: 2000–2008 Read More:
Research indicates an association between substance use and premature death and that misuse of illicit drugs is more closely linked to mortality than alcohol misuse. Given that these studies often are based on homogeneous treatment populations, we sought to analyse long-term mortality among both alcohol and drug misusers in a representative treatment system sample by examining: (1) excess death ratios (SMR, standardised mortality ratio) in comparison with the general population and (2) risk factors for mortality within the sample.
Prospective study (N = 1659; 28% women) interviewed when starting treatment in Stockholm County, 2000–2002, and followed-up with regard to mortality up to 8 years after baseline. Analyses were based on death certificates and intake interview data (demographics, social situation/support, ICD-10 alcohol/drug dependence, treatment experiences). The strength of the study is the prospective design, that we have been able to link mortality to interview data, and to reach a heterogeneous treatment population.
(1) SMR was 5.7 (no sex difference). (2) Logistic regression showed that being older, male, retired and having reported living with a substance misuser were identified as risk factors for mortality within the sample. Housing organised by authorities and no dependence on alcohol/drugs were protective factors. The mortality risk did not differ between alcohol and drug-dependent cases. Neither was homelessness, living situation (3 years) nor education predictive of mortality.
No difference regarding mortality risk between treated alcohol and drug-dependent patients in Sweden is found when controlling for age.
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FASD News - 3/2012
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A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region
To measure the prevalence, pattern and associated financial cost of alcohol-related ambulance call outs in the North East of England using routinely collected data from the North East Ambulance Service (NEAS).
A retrospective cohort study over a 1-year time period (1 April 2009 to 31 March 2010) using NEAS patient record forms.
In the North East, 10% of ambulance call outs were alcohol-related. Males were 2.5 times more likely than females to be attended by an ambulance on the street rather than at home. People aged 10–19 had the highest relative risk ratio (3.4) of an ambulance pick up being on the street compare with those aged over 60. These call outs and subsequent accident and emergency (A&E) attendances cost over £9 million in a 1-year period. When extrapolated to the whole country the cost could be as much as £152 million per year.
In a 1-year period, we estimated that over 31,000 ambulance call outs were alcohol-related. A large discrepancy was found between manual and electronic recording of alcohol-related ambulance attendances to A&E. The workload and cost of alcohol-related call outs is high and mostly preventable. Ambulance visits may present a teachable moment for brief intervention to reduce alcohol-related risk and harm.
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Mapping the Maintenance Stage of Recovery: A Qualitative Study among Treated and Non-treated Former Alcohol Dependents in Poland
The study provides an in-depth qualitative understanding of the maintenance stage when recovering from alcohol dependence with a focus on the broader social context of change of addictive behaviour. It explores the recovery as a subjective process within the abstinence-oriented Polish treatment system organized on the basis of the Minnesota model and is probes for group differences between treated and non-treated populations.
The study is based on qualitative data from a media-recruited sample of 29 treated and non-treated former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. They reported a recovery time of at least 2 years (Mrecovery = 11, SD = 9). In-depth, semi-structured interviews were analysed according to the problem-centred interview method using ATLAS.ti software.
A wide range of maintenance strategies potentially contributing to the stabilization of recovery from alcohol dependence was identified. However, from the respondents' point of view, the change process is contingent upon the subjective weighing of specific maintenance factors and the importance attributed to their interplay. This includes time management as well as one's ability to invest available resources and strengths in shaping and pursuing personal goals.
More commonalities than differences can be observed between groups during the maintenance stage, regardless of respondents' type of the pathway out of addiction. However, when confronting professional concepts of recovery with subjective accounts, only a subgroup conforms to the invasive, potentially normative definitions of recovery, while others do not link their recovery with identity transformation.
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Interactive Influences of Neighborhood and Individual Socioeconomic Status on Alcohol Consumption and Problems
To assess cross-level interactions between neighborhood and individual socioeconomic status (SES) on alcohol consumption and problems, and investigate three possible explanations for such interactions, including the double jeopardy, status inconsistency and relative deprivation hypotheses.
Data from the 2000 and 2005 US National Alcohol Surveys were linked to the 2000 US Census to define respondent census tracts as disadvantaged, middle-class and advantaged. Risk drinking (consumption exceeding national guidelines), monthly drunkenness and alcohol problems were examined among low-, middle- and high-SES past-year drinkers (n = 8728). Gender-stratified, multiple logistic regression models were employed, and for outcomes with a significant omnibus F-test, linear contrasts were used to interpret interactions.
Cross-level SES interactions observed for men indicated that residence in advantaged neighborhoods was associated with markedly elevated odds of risk drinking and drunkenness for low-SES men. Linear contrasts further revealed a nearly 5-fold increased risk for alcohol problems among these men, relative to middle-SES and high-SES men also living in advantaged neighborhoods. Among women, neighborhood disadvantage was related to increased risk for alcohol problems, but there were no significant SES interactions. These findings did not support theories of double jeopardy and status inconsistency.
Consistent with the relative deprivation hypothesis, findings highlight alcohol-related health risks among low-SES men living in affluent neighborhoods. Future research should assess whether this pattern extends to other health risk behaviors, investigate causal mechanisms and consider how gender may influence these.
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The relationship between naloxone-induced cortisol and delta opioid receptor availability in mesolimbic structures is disrupted in alcohol-dependent s
Hypothalamic-pituitary-adrenal (HPA) axis responses following naloxone administration have been assumed to provide a measure of opioid receptor activity. Employing positron emission tomography (PET) using the mu opioid receptor (MOR) selective ligand [11C] carfentanil (CFN), we demonstrated that cortisol responses to naloxone administration were negatively correlated with MOR availability.
In this study, we examined whether naloxone-induced cortisol and adrenocorticotropin (ACTH) responses in 15 healthy control and 20 recently detoxified alcohol-dependent subjects correlated with delta opioid receptor (DOR) availability in 15 brain regions using the DOR-selective ligand [11C] methyl-naltrindole (MeNTL) and PET imaging.
The day after the scan, cortisol responses to cumulative doses of naloxone were determined.
Peak cortisol and ACTH levels and area under the cortisol and ACTH curve did not differ by group. There were negative relationships between cortisol area under curve to naloxone and [11C] MeNTL-binding potential (BPND) in the ventral striatum, anterior cingulate, fusiform cortices, temporal cortex, putamen and a trend in the hypothalamus of healthy control subjects.
However, in alcohol-dependent subjects, cortisol responses did not correlate with [11C]MeNTL BPND in any brain region. Plasma ACTH levels did not correlate with [11C]MeNTL BPND in either group.
The study demonstrates that naloxone provides information about individual differences in DOR availability in several mesolimbic structures.
The data also show that the HPA axis is intimately connected with mesolimbic stress pathways through opioidergic neurotransmission in healthy subjects but this relationship is disrupted during early abstinence in alcohol-dependent subjects.
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Widespread and sustained cognitive deficits in alcoholism: a meta-analysis
The cognitive repercussions of alcohol dependence are well documented. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are more susceptible to impairment in alcoholism and to how duration of abstinence affects cognitive recovery.
Some theories claim alcohol negatively affects specific cognitive functions, while others assert that deficits are more diffuse in nature.
This is the first meta-analysis to examine cognition in alcohol abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. A literature search yielded 62 studies that assessed cognitive dysfunction among alcoholics. Effect size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 12 cognitive domains: intelligence quotient, verbal fluency/language, speed of processing, working memory, attention, problem solving/executive functions, inhibition/impulsivity, verbal learning, verbal memory, visual learning, visual memory and visuospatial abilities.
Within these 12 domains, three effect size estimates were calculated based on abstinence duration. The three groups were partitioned into short- (<1 month), intermediate- (2 to 12 months) and long- (>1 year) term abstinence.
Findings revealed moderate impairment across 11 cognitive domains during short-term abstinence, with moderate impairment across 10 domains during intermediate term abstinence. Small effect size estimates were found for long-term abstinence.
These results suggest significant impairment across multiple cognitive functions remains stable during the first year of abstinence from alcohol. Generally, dysfunction abates by 1 year of sobriety.
These findings support the diffuse brain hypothesis and suggest that cognitive dysfunction may linger for up to an average of 1 year post-detoxification from alcohol.
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Sunday, January 22, 2012
Alcohol administration attenuates hypothalamic–pituitary–adrenal (HPA) activity in healthy men at low genetic risk for alcoholism, but not in high-ris
Acute alcohol challenge studies in rodents and naturalistic observations in drinking alcoholics suggest that alcohol stimulates the hypothalamic–pituitary–adrenal (HPA) system.
The literature on respective studies in healthy volunteers is more inconsistent, suggesting differential alcohol effects depending on dosage, recent drinking history, family history of alcoholism and alcohol-induced side effects.
These papers and the putative pharmacologic mechanisms underlying alcohol effects on the HPA system are reviewed here and compared with a new study, in which we investigated how secretion of adrenocorticotrophin (ACTH) and cortisol is affected by ingestion of 0.6 g/kg ethanol in 33 young healthy socially drinking males with a paternal history of alcoholism (PHP) versus 30 family history negative (FHN) males.
Alcohol and placebo were administered in a 2-day, double-blind, placebo controlled crossover design with randomized administration sequence
After administration of placebo, ACTH and cortisol decreased steadily over 130 minutes. In FHN subjects, secretion of both hormones was even more attenuated after alcohol, resulting in significantly lower levels compared with placebo. In PHP subjects, no alcohol effect on hormone secretion could be detected. The ratio of cortisol to ACTH secretion, each expressed as area under the secretion curve, was significantly increased by alcohol in FHN and PHP participants.
These results argue against HPA stimulation being a mechanism that promotes the transition from moderate to dependent drinking. The fact that alcohol-induced HPA suppression was not detected in PHP males is consistent with the general concept that subjects at high risk for alcoholism exhibit less-pronounced alcohol effects.
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