Free-alcohol project has improved lives of chronic drinkers

In October, the Vancouver Coastal Health Authority and the Portland Hotel Society began a pilot program that serves 12 daily doses of alcohol - one every hour from 10: 30 a.m. to 10: 30 p.m.- to eight chronic alcoholics living in the Downtown Eastside.

Four months later, there are some signs the program is having beneficial effects, said Dr. Ron Joe, Vancouver Coastal Health's manager of inner city addiction.

Known as the Managed Alcohol Program (MAP), Vancouver's is based on similar programs that have been operating in Ontario for 15 years, said Joe. > > > > Read More

Chronic Corticosterone Exposure during Adolescence Reduces Impulsive Action but Increases Impulsive Choice and Sensitivity to Yohimbine in Male Spragu

Chronic stress during adolescence is associated with an increased risk for alcoholism and addictive disorders. Addiction is also associated with increased impulsivity, and stress during adolescence could alter cortical circuits responsible for response inhibition.

Therefore, the present study determined the effect of chronic exposure to the stress hormone corticosterone (CORT) during adolescence on tests of impulsivity in adulthood and examined possible biochemical mechanisms.

Male Sprague-Dawley rats were exposed to CORT by their drinking water during adolescence (post-natal day 30–50). The rats were then tested in adulthood to assess behavior on the 5-choice serial reaction time task (5CSRTT), stop-signal reaction time task (SSRTT), and the delay-discounting task, which differentially assess attention, impulsive action, and impulsive choice. Yohimbine-induced impulsivity on the 5CSRTT and biochemical analysis of the lateral orbital frontal cortex (lOFC) was also assessed owing to the ability of yohimbine to activate the hypothalamic-pituitary-adrenal axis and influence impulsivity.

Adolescent CORT-treated rats were found to behave largely like controls on the 5CSRTT, but did show reduced premature responses when the intertrial interval was increased

Nevertheless, the CORT-treated rats tended to have more yohimbine-induced impulsive responses at low doses on this task, which was not found to be due to increased pCREB in the lOFC, but could be related to a higher expression/activity of the AMPA receptor subunit GluR1.

Adolescent CORT-treated rats performed more accurately on the SSRTT, but showed greater impulsivity on the delay-discounting task, as indicated by steeper discounting functions.

Therefore, adolescent CORT exposure reduced impulsive action but increased impulsive choice, indicating that chronic stress hormone exposure in adolescence can have long-term consequences on behavior.



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Request Reprint E-Mail: jane.taylor@yale.edu

Determinants of Early Alcohol Use In Healthy Adolescents: The Differential Contribution of Neuroimaging and Psychological Factors

Individual variation in reward sensitivity may have an important role in early substance use and subsequent development of substance abuse. This may be especially important during adolescence, a transition period marked by approach behavior and a propensity toward risk taking, novelty seeking and alteration of the social landscape. However, little is known about the relative contribution of personality, behavior, and brain responses for prediction of alcohol use in adolescents.

In this study, we applied factor analyses and structural equation modeling to reward-related brain responses assessed by functional magnetic resonance imaging during a monetary incentive delay task.

In addition, novelty seeking, sensation seeking, impulsivity, extraversion, and behavioral measures of risk taking were entered as predictors of early onset of drinking in a sample of 14-year-old healthy adolescents (N=324).

Reward-associated behavior, personality, and brain responses all contributed to alcohol intake with personality explaining a higher proportion of the variance than behavior and brain responses.

When only the ventral striatum was used, a small non-significant contribution to the prediction of early alcohol use was found.

These data suggest that the role of reward-related brain activation may be more important in addiction than initiation of early drinking, where personality traits and reward-related behaviors were more significant.

With up to 26% of explained variance, the interrelation of reward-related personality traits, behavior, and neural response patterns may convey risk for later alcohol abuse in adolescence, and thus may be identified as a vulnerability factor for the development of substance use disorders.


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High rates of injured motorcycle drivers in emergency rooms and the association with substance use in Porto Alegre, Brazil

Although the fleet of motorcycles and the number of traffic accidents (TA) is increasing in the world, few studies have evaluated intoxication by alcohol and/or drugs in this group of drivers. This study aims to evaluate the prevalence of motorcycle riders among drivers who are victims of TA, and ascertain factors associated with drug and alcohol use.

All TA victims admitted on a 24/7 routine between October and November 2008 to two trauma hospitals of Porto Alegre, Brazil were invited to participate, then submitted to an interview, breathalysed and had their saliva collected for drugs.

Among the overall sample of drivers, 78.4% were motorcycle riders. Toxicological analysis yielded a 15.3% prevalence of marijuana use, 9.2% of cocaine use, 3.2% benzodiazepine use and 7% of alcohol use. Factors associated with alcohol or drug intoxication were the diagnosis of alcohol abuse or dependence and history of previous TA.

The prevalence of motorcycle riders among drivers who are victims of TA was alarming. The association of alcohol abuse or dependency and intoxication justify the need for therapeutic interventions specifically targeted to the treatment of drug dependency, as well as public policies directed to prevention of injuries–particularly among recidivist motorcycle riders.

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Request Reprint E-Mail: raqueldeboni@msn.com

Comparison of Ethyl Glucuronide in Hair with Self-Reported Alcohol Consumption

Ethyl glucuronide (EtG) in hair is a proposed biomarker for alcohol consumption. This study compares hair EtG concentrations with self-reported alcohol consumption data, in individuals with a range of alcohol use.

Hair was collected from 100 participants with a range of alcohol use. Participants completed an Alcohol Use Disorders Identification Test C questionnaire to record alcohol consumption. Participants were categorized into one of the four groups: tee-totallers (consuming 0 units a week), lower-risk drinkers (1–21 units a week), increasing-risk drinkers' consuming (22–50 units a week) and high-risk drinkers (over 50 units a week). Hair from the proximal 3 cm was analysed for EtG using gas chromatography–mass spectrometry/mass spectrometry.

EtG was detected in 29 out of 100 hair samples. Based on the Society of Hair Testing (SOHT) threshold of 30 pg/mg EtG, the hair test identified alcohol consumption in 57.9% of high-risk drinkers, 45.5% of increasing-risk drinkers and only 9.8% of lower-risk drinkers. EtG sensitivity was highest for high-risk drinkers (consuming more than 50 units a week), identified to be 0.52 using a 30 pg/mg threshold and 0.58 using a 45 pg/mg threshold. A positive result is highly likely to indicate any drinking (positive predictive value, 1.00). A negative result does not provide good evidence for abstinence (negative predictive value, 0.23).

EtG has been identified to be a low sensitivity marker that cannot be used quantitatively to determine alcohol exposure. EtG can be used qualitatively to indicate alcohol consumption with a positive result providing strong evidence for an individual drinking within the past 3 months.



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rosie.lees@bristol.ac.uk

Everyone’s problem The role of local alcohol services in tackling Wales’ unhealthy relationship with alcohol

Alcohol misuse continues to be a major challenge
in Wales, with many of us regularly drinking
beyond the recommended guidelines. This pattern of overuse is reflected in high levels of alcohol related illness, hospital admissions and deaths.

A wide range of alcohol services exist in Wales,
providing valuable guidance and support to
individual drinkers and their families, and to the
wider community. These services play a vital role
in dealing with the day to day consequences of
alcohol misuse, and in helping us in the longer
term to develop a healthier relationship with
alcohol. Research has shown that local alcohol
services can bring genuine personal and social
benefits, and long term financial benefits in terms
of reduced pressure on other public services due
to alcohol related problems.

Unsurprisingly, given the current outlook for public
spending, alcohol services in Wales have serious
concerns about their own financial future. These
concerns are intensified by the ongoing high
levels of demand for alcohol treatment. Whilst
recognising current public funding constraints,
Alcohol Concern argues that the immediate
and long term benefits of alcohol services to
individuals, society and the public purse justify
supporting, developing and investing in them.
> > > > Read More

Critique 071: Forum Comments on proposed new dietary guidelines for Australia – 16 February 2012

In 2008, the NHMRC commissioned the Dieticians Association of Australia to undertake systematic literature reviews to support the revision of the Dietary Guidelines for Australians. The primary aim was to undertake a series of systematic reviews of the national and international literature from the year 2002 on the food-diet-health-disease inter-relationship for different population subgroups. One of the 29 sections in the report (pp 613-678) covered the evidence for the risks and benefits of alcohol drinking. This critique is only of the alcohol section.

The systematic reviews were primarily conducted using the methods described in the NHMRC publication “How to use the evidence: assessment and application of scientific evidence”, and have resulted in body of evidence statements. Databases searched were CINAHL, PREMEDLINE, MEDLINE, EBM REVIEWS, DARE, COCHRANE, PUBMED, PSYCHINFO, ERIC and SCIENCE DIRECT. All reviewers were dieticians. The search considered only evidence published from 2002, to provide an update on literature published since the last edition of the Dietary Guidelines for Australians. The searches were mostly carried out to April 2009, so more recent publications are generally not included unless specifically requested by the NHMRC.

The report noted that when examining diet-health relationships, there is a notable dearth of evidence from Level I and Level II studies, and much of the scientific evidence is observational, especially from prospective cohort studies. It is rarely possible to conduct blinded intervention studies with whole foods or diets, and very few trials are conducted for long enough periods to assess long term health outcomes. Therefore in the review authors’ view, Level III prospective cohort studies often provide more important evidence for the development of dietary guidelines than Level I evidence summarising small short-term randomised controlled trials.

The review did not use cross-sectional epidemiological studies because of their low rating in the NHMRC evidence hierarchy (Level IV evidence) and because correlation cannot be used as evidence of causation. Only studies that provided total alcohol intake in grams, or enabled its calculation, were included. > > > > Read More

Alcohol Consumption as Self-Medication against Blood-Borne Parasites in the Fruit Fly

Plants and fungi often produce toxic secondary metabolites that limit their consumption [1,2,3,4], but herbivores and fungivores that evolve resistance gain access to these resources and can also gain protection against nonresistant predators and parasites [3,5,6,7,8].

Given that Drosophila melanogaster fruit fly larvae consume yeasts growing on rotting fruit and have evolved resistance to fermentation products [9,10], we decided to test whether alcohol protects flies from one of their common natural parasites, endoparasitoid wasps [11,12,13].

Here, we show that exposure to ethanol reduces wasp oviposition into fruit fly larvae. Furthermore, if infected, ethanol consumption by fruit fly larvae causes increased death of wasp larvae growing in the hemocoel and increased fly survival without need of the stereotypical antiwasp immune response.

This multifaceted protection afforded to fly larvae by ethanol is significantly more effective against a generalist wasp than a wasp that specializes on D. melanogaster.

Finally, fly larvae seek out ethanol-containing food when infected, indicating that they use alcohol as an antiwasp medicine.

Although the high resistance of D. melanogaster may make it uniquely suited to exploit curative properties of alcohol, it is possible that alcohol consumption may have similar protective effects in other organisms.

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Request Reprint E-Mail: todd.schlenke@emory.edu

Look to the Relationship: A Review of African American Women Substance Users’ Poor Treatment Retention and Working Alliance Development

Emergent findings specific to African American women confirm that their substance user treatment retention rates are significantly lower than other groups, which is problematic given that substance user treatment is effective largely to the extent that clients are retained in treatment.

This article reviews existing literature concerning disparities in treatment retention, highlights a significant barrier to treatment retention for this population, and presents support for an empirical focus on culturally responsive working alliance development as a promising step toward improving retention rates for African American women substance users.


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Request Reprint E-Mail: telsie.a.davis@emory.edu.

Hospitalization for Underage Drinkers in the United States

Underage drinking is common in the United States. This article presents nationally representative data on hospitalizations for alcohol use disorder (AUD) in youth.

Using the Nationwide Inpatient Sample database, discharge records of individuals between 15 and 20 years diagnosed with AUD were identified. Incidence rates of these hospitalizations were calculated based on population estimates from the US Census Bureau.

In 2008, there were 699,506 nonobstetric discharges in 15- to 20-year-olds, of which 39,619 (5.6%) had an AUD diagnosis with or without an injury diagnosis. The overall annual incidence of AUD hospitalization was 18.3 per 10,000 boys and 12.3 per 10,000 girls. Native American boys in the Midwest had the highest incidence (101 per 10,000), and Asian/Pacific Islander girls in the South had the lowest (2 per 10,000). The estimated total charges for these hospitalizations were $755 million in 2008.

Hospitalization care for underage drinking is common, especially in certain race and in certain geographic regions and is associated with a substantial health care expenditure.

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Request Reprint E-Mail: schneekloth.terry@mayo.edu

Identification of behaviour change techniques to reduce excessive alcohol consumption

Interventions to reduce excessive alcohol consumption have a small but important effect but a better understanding of their ‘active ingredients’ is needed.

This study aimed to (i) develop a reliable taxonomy of behaviour change techniques (BCTs) used in interventions to reduce excessive alcohol consumption (not to treat alcohol dependence), and (ii) to assess whether use of specific BCTs in brief interventions might be associated with improved effectiveness.

A selection of guidance documents and treatment manuals, identified via expert consultation, were analysed into BCTs by two coders. The resulting taxonomy of BCTs was applied to the Cochrane Review of brief alcohol interventions, and the associations between the BCTs and effectiveness were investigated using meta-regression.

Forty-two BCTs were identified, 34 from guidance documents and an additional eight from treatment manuals, with average inter-rater agreement of 80%. Analyses revealed that brief interventions that included the BCT ‘prompt self-recording’ (p=0.002) were associated with larger effect sizes.

It is possible to reliably identify specific BCTs in manuals and guidelines for interventions to reduce excessive alcohol consumption. In brief interventions, promoting self-monitoring is associated with improved outcomes. More research is needed to identify other BCTs or groupings of BCTs that can produce optimal results in brief interventions and to extend the method to more intensive interventions and treatment of alcohol dependence.

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Request Reprint E-Mail:

s.michie@ucl.ac.uk

Conference - WOMEN ON THE EDGE

Women On The Edge – 29th May 2012, Audrey Emerton Building , Brighton

This, our 3rd Annual conference will bring together a range of speakers from academia, medicine, nursing and social care to address issues facing this client group. Themes to be covered in both plenary sessions and workshops include:

Addressing Entrenched Neglect

Recovery in Primary Care

Meeting the sexual health needs of women substance misusers

Working with “troubled families”

Services f or young women

Patterns of Drug Use in women

Personality dis orders and women

Domestic violence and substance misuse

> > > > Read More

Determination of the effects of Alcohol Dehydrogenase (ADH) 1B and ADH1C polymorphisms on alcohol dependence in Turkey

Alcoholism is a complex genetically influenced disorder which refers to alcohol abuse and alcohol dependence. There are controversial results on the role of gene polymorphisms in alcohol dependence in the literature. Differences in population groups and selective inclusion criteria for alcohol dependence may affect results.

In this study, we investigated the role of ADH1B Arg48His (rs1229984) and, ADH1C Ile350Val (rs698) gene polymorphisms in Turkish population. 100 healthy volunteers and 75 patients who were admitted to Ege University Alcohol Dependence Unit enrolled in the study.

We found significant increase both in ADH1B (Arg48His) polymorphism Arg allele and Arg/Arg genotype frequency in patients. No profound connection between alcohol dependence and ADH1C Ile350Val gene polymorphism was detected.

Alcohol dependence is an important health problem that depends on many genetic and environmental factors but we think that it is possible to interpret genetic risk for developing early diagnostic methods and treatment strategies by comprehensive linkage and association studies.


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More than 7 Million Children Live with a Parent with Alcohol Problems

An annual average of 7.5 million children younger than the age of 18 (10.5 percent of all children; Figure) live with a parent who had an alcohol use disorder in the past year.1 These children are at a greater risk for depression, anxiety disorders, problems with cognitive and verbal skills, and parental abuse or neglect.2 Furthermore, they are 4 times more likely than other children to develop alcohol problems themselves.3

Children may be exposed to family alcohol problems regardless of their household composition. According to the 2005 to 2010 National Surveys on Drug Use and Health (NSDUHs), of the 7.5 million children living with a parent with an alcohol use disorder, most of these children (6.1 million) lived with two parents and either one or both of these parents had an alcohol problem. However, 1.4 million children lived in households with single parents who had alcohol use disorders. In these households, 1.1 million children lived with a mother, and 0.3 million lived with a father. > > > > Read More

Minimum pricing speculation continues as Prime Minster speaks out on 'alcohol scandal'

Alcohol policy hit the headlines again this week with David Cameron talking tough on the "alcohol scandal" costing the NHS close to £3 billion per year. Visiting a hospital in north-east England, the Prime Minister spoke of the unacceptable impact of public drunkenness on the NHS and police services across the country. > > > > Read More

NIAAA Spectrum February 2012

IN THIS ISSUE

FEATURES
1 Underage Drinking: One Step Forward, Many More to Go

2 New Clinician’s Guide Simplifies Screening for Underage Drinking

A CLOSER LOOK
2 Kids Drink in the Darndest Ways…Or Do They?

NEWS FROM THE FIELD
4 Early Liver Transplant Can Improve Survival

5 Social Media May Help Identify College Drinking Problems

5 Hospitalizations Increase for Alcohol and Drug Overdoses

7 Doctors May Miss Alcohol Screening Opportunities

BY THE NUMBERS
6 A Younger Start Means Higher Risk for Alcohol Dependence

5 QUESTIONS WITH...
7 Antonio Noronha, Ph.D.


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Co-existing mental health and substance use and alcohol difficulties – why do we persist with the term “dual diagnosis” within mental health services?

The term “dual diagnosis” has been widely accepted as referring to co-existing mental illness and substance misuse. However, it is clear from the literature that individuals with these co-existing difficulties continue to be excluded from mainstream mental health services. The term “dual diagnosis” can be pejorative and therefore, complicate or obstruct engagement. It is argued within this paper that the association between mental illness and substance misuse (including alcohol misuse) is an intricate and often a complex relationship involving a multitude of psychosocial factors that cannot be simply explained by an individual having two co-existing disorders. From this perspective, this paper seeks to argue that the term “dual diagnosis” should be actively de-emphasised.

This paper offers a critique of “dual diagnosis” and the potential impact on access and treatment through discussion of the literature and reflections on service provision.

The paper identifies five principles termed the “5 key principles”, which support individuals with a wide spectrum of co-existing difficulties and to counteract the stigma often associated with the term “dual diagnosis”. These collective principles allow the practitioner to consider the needs of the service user from the service user's perspective and therefore not be distracted by the perceived set of expected behaviours that are implied by the “dual diagnosis” label.

This paper offers a critique of the term “dual diagnosis” and explores the impact of this in terms of service users and makes practical suggestions for alternative ways of conceptualising co-existing mental health and substance difficulties.

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Differential Impact of a Dutch Alcohol Prevention Program Targeting Adolescents and Parents Separately and Simultaneously: Low Self-Control and Lenien

To test whether baseline levels of the factors accountable for the impact of the Prevention of Alcohol use in Students (PAS) intervention (self-control, perceived rules about alcohol and parental attitudes about alcohol), moderate the effect of the intervention.

A cluster randomized trial including 3,490 Dutch early adolescents (M age = 12.66, SD = 0.49) and their parents randomized over four conditions: 1) parent intervention, 2) student intervention, 3) combined intervention and 4) control group. Moderators at baseline were used to examine the differential effects of the interventions on onset of (heavy) weekly drinking at 34-month follow-up.

The combined intervention was only effective in preventing weekly drinking among those adolescents who reported to have lower self-control and more lenient parents at baseline.

No differential effect was found for the onset of heavy weekly drinking. No moderating roles of self-control and lenient parenting were found for the separate student and parent interventions regarding the onset of drinking.

The combined intervention is more effective among adolescents with low-self control and lenient parents at baseline, both factors that were a specific target of the intervention.

The relevance of targeting self-control in adolescents and restrictive parenting is underlined.



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“Have a drink, you'll feel better.” Predictors of daily alcohol consumption among extraverts: the mediational role of coping

An abundance of information exists pertaining to individual differences in college drinking behaviors with much attention being provided to the role of personality. However, plausible explanations for what prompts engagement in or avoidance of these behaviors have remained largely ambiguous or underexplored, particularly with respect to extraversion (E). Research has since explored how coping behaviors contribute to these associations.

The present study built on this research by evaluating differences in daily alcohol consumption as a function of coping choice. The mediational effects of two specific strategies frequently observed in high E individuals (i.e., problem-focused coping and social support) were examined.

Using a daily diary approach, 365 undergraduates reported their most stressful experience, how they coped with it, and the number of drinks consumed for five consecutive days.

Resulting multilevel-models were consistent with hypotheses indicating the relationship between E and alcohol consumption was partially mediated by problem-focused and support-seeking strategies.

The use of problem-focused coping by high E individuals was associated with lower levels of daily alcohol consumption, suggesting this strategy may play a protective role in influencing drinking behaviors.

Conversely, the positive effect observed for social support approached significance (p=.054) and was indicative of a potential risk-factor for daily alcohol consumption.



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Request Reprint E-Mail: cmccabe@projects.sdsu.edu

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Hangover sensitivity after controlled alcohol administration as predictor of post-college drinking.

Predicting continued problematic levels of drinking after the early 20's could help with early identification of persons at risk.

This study investigated whether hangover insensitivity could predict postcollege drinking and problems beyond the variance due to drinking patterns.

In a preliminary study, 134 college seniors from a laboratory study of hangover (Time 1) were contacted and assessed 1–4 years (M = 2.3) later (Time 2). Hangover severity was studied after controlled alcohol administration to a specific dose while controlling sleep and environmental influences. Hangover severity at Time 1 was used to predict Time 2 drinking volume and problems while controlling for releant demographics and Time 1 drinking volume.

Hangover insensitivity at Time 1 tended to predict a clinical level of alcohol problems with a large statistical effect size. Hangover sensitivity also correlated positively with sensitivity to alcohol intoxication. Hangover severity did not predict future drinking volume.

Hangover insensitivity correlates with insensitivity to intoxication and might predict more serious alcohol problems in the future, suggesting that a future larger study is warranted.

Hangover insensitivity could result from physiological factors underlying low sensitivity to alcohol or risk for alcoholism.



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Request Reprint E-Mail:
Damaris_Rohsenow@Brown.EDU

US Mortality from Liver Cirrhosis and Alcoholic Liver Disease in 1999–2004: Regional and State Variation in Relation to Per Capita Alcohol Consumptio

Apparent per-capita alcohol consumption in 2001 in four US regions (West, Northeast, South, and Midwest), and in 50 states was examined in relation to mortality rates (1999–2004) from liver cirrhosis and for the subcategory alcoholic liver disease.

Alcohol consumption and mortality rates were highest in the west. The alcoholic liver disease mortality rate by state was strongly correlated with alcohol consumption, but several outlier or mismatch states were identified.

Per-capita alcohol consumption should be useful for US public health policy, as suggested for Europe and Canada, but outlier states require further study.


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Request Reprint E-Mail: appoled7@yahoo.com

Prevalence and Determinants of Personality Disorders in a Clinical Sample of Alcohol-, Drug-, and Dual-Dependent Patients

The present study compares the prevalence rates of 12 personality disorders (PDs) among patients with alcohol, drug, and dual dependence through chi-square tests and analyses of variance. It further investigates possible predictors of these PDs through multiple linear regression analyses.

Data were gathered in 2007–2008 among 274 patients admitted to intensive, residential substance abuse treatment programs in Belgium, using the ADP-IV (Assessment of DSM-IV Personality Disorders), the EuropASI (European version of the Addiction Severity Index), and the MINI (Mini International Neuropsychiatric Interview).

The analyses showed that drug- and dual-dependent patients have higher PD prevalence rates than alcohol-dependent patients.

The severity, but not the nature of the dependence, appears as an important predictor for personality pathology.


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Request Reprint E-Mail: kathy.colpaert@ugent.be

The Impact of Parental Drinking on Children's Use of Health Care

While a significant body of literature documents the health problems of children caused by and/or associated with parental alcohol misuse, little research has been conducted on the relationship between parental problem drinking and children's use of health care.

We should expect to see an increase in children's health care if alcohol-misusing parents were responsive to their children's higher physical and mental health needs. Contrarily, it would decrease (conditional on health status) if alcohol-misusing parents were irresponsive to those needs.

Analyzing a nationally representative sample of parents and children, we find a positive and significant association between parental high intensity drinking and pediatric visits for their children.

We also find evidence linking parental drinking to more emergency room use.

These findings suggest that the impact of parental drinking on child well-being should be considered when assessing the full costs of alcohol misuse.


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Request Reprint E-Mail: mfrench@miami.edu.

Assessment of the Average Price and Ethanol Content of Alcoholic Beverages by Brand—United States, 2011

There are no existing data on alcoholic beverage prices and ethanol (EtOH) content at the level of alcohol brand. A comprehensive understanding of alcohol prices and EtOH content at the brand level is essential for the development of effective public policy to reduce alcohol use among underage youth. The purpose of this study was to comprehensively assess alcoholic beverage prices and EtOH content at the brand level.

Using online alcohol price data from 15 control states and 164 online alcohol stores, we estimated the average alcohol price and percent alcohol by volume for 900 brands of alcohol, across 17 different alcoholic beverage types, in the United States in 2011.

There is considerable variation in both brand-specific alcohol prices and EtOH content within most alcoholic beverage types. For many types of alcohol, the within-category variation between brands exceeds the variation in average price and EtOH content among the several alcoholic beverage types. Despite differences in average prices between alcoholic beverage types, in 12 of the 16 alcoholic beverage types, customers can purchase at least 1 brand of alcohol that is under $1 per ounce of EtOH.

Relying on data or assumptions about alcohol prices and EtOH content at the level of alcoholic beverage type is insufficient for understanding and influencing youth drinking behavior. Surveillance of alcohol prices and EtOH content at the brand level should become a standard part of alcohol research.

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Request Reprint E-Mail: mbsiegel@bu.edu

Self-Reported Alcohol-Impaired Driving in the U.S., 2006 and 2008

Alcohol-impaired driving caused 10,839 deaths in 2009. Alcohol-impaired driving fatalities as a percentage of all motor vehicle fatalities decreased from 1982 to 1999 but have remained stable since. Understanding characteristics of those who engage in this behavior is critical to achieving future reductions.

The purpose of this study is to estimate the number of episodes of self-reported alcohol-impaired driving and to explore the related demographic factors and drinking patterns.

Data from the 2006 and 2008 Behavioral Risk Factor Surveillance System were used in 2010 to produce annualized estimates of alcohol-impaired driving episodes. Logistic regression modeling was used to explore the effects of drinking patterns, seatbelt use, and sociodemographics.

The percentage of the population reporting at least one alcohol-impaired driving episode in the past 30 days was 2.2% for 2006 and 2008 combined. The number of annualized episodes of alcohol-impaired driving was 147 million. Annualized episode rates varied across states from 165 to 1242 episodes per 1000 population. Characteristics associated with alcohol-impaired driving differed by gender. The strongest correlate of alcohol-impaired driving was binge drinking, with those reporting binge drinking at least once per month being five to six times as likely to report alcohol-impaired driving when adjusting for all other variables.

Understanding who is most likely to report alcohol-impaired driving is important in developing interventions to prevent this behavior. Interventions that are known to be effective, such as sobriety checkpoints and installing ignition interlocks on the vehicles of people convicted of alcohol-impaired driving, should be widely implemented.

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Request Reprint E-Mail: gbergen@cdc.gov

A mixed non-homogeneous hidden Markov model for categorical data, with application to alcohol consumption

Hidden Markov models (HMMs) are frequently used to analyse longitudinal data, where the same set of subjects is repeatedly observed over time. In this context, several sources of heterogeneity may arise at individual and/or time level, which affect the hidden process, that is, the transition probabilities between the hidden states.

In this paper, we propose the use of a finite mixture of non-homogeneous HMMs (NH-HMMs) to face the heterogeneity problem.

The non-homogeneity of the model allows us to take into account observed sources of heterogeneity by means of a proper set of covariates, time and/or individual dependent, explaining the variations in the transition probabilities. Moreover, we handle the unobserved sources of heterogeneity at the individual level, due to, for example, omitted covariates, by introducing a random term with a discrete distribution.

The resulting model is a finite mixture of NH-HMM that can be used to classify individuals according to their dynamic behaviour or to estimate a mixed NH-HMM without any assumption regarding the distribution of the random term following the non-parametric maximum likelihood approach.

We test the effectiveness of the proposal through a simulation study and an application to real data on alcohol abuse.


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Request Reprint E-Mail: antonello.maruotti@uniroma3.it

Alcohol News - 7/2012

The Local (Sweden) - 'Vodka-mobile' selling booze to Swedish kids

Police in Stockholm are looking to beef up efforts to put the brakes on a “vodka-mobile” that delivers hard liquor to school children in the Swedish capital who place their orders via text message.

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IceNews (Iceland) - No Motörhead wine for Icelanders, branding too negative

ÁTVR, Iceland’s public sector alcohol retail monopoly, has refused to sell a red wine marketed under the branding of British rock band Motörhead. The decision was taken because the name is apparently a nod to amphetamine abuse and because the band sings about war, unsafe sex and drugs.

Read more

The Local (Sweden) - 'Drunkorexia' on the rise in Sweden: report

An increasing number of young Swedes are starving themselves by day to be able to binge on calorie-rich alcoholic drinks by night, as a well known phenomenon in the US is becoming more common in Sweden, according to experts.

Read more

Baltic Review (Lithuania) - Opinion: Strange combination of alcohol and democracy in Lithuania

Several employees of a Lithuanian authority were caught partying wildly in a drunken state during working hours on Thursday. Lithuanian journalist reflects on the alcohol issues of his country’s bureaucrats in an article published on February 6.

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Associated Press (UK) - London to test alcohol monitors for offenders

London will be the first city in England to test electronic monitoring to force persistent alcohol offenders to stop drinking, Mayor Boris Johnson said Friday.

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CNN (Ukraine) - Most Ukraine cold deaths alcohol-related, minister says

Alcohol has been involved in most of the deaths blamed on the extreme cold in Ukraine, the country worst affected by the icy temperatures gripping eastern Europe, the country's emergencies minister said Wednesday.

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Great Falls Tribune (USA) - Sioux tribe sues brewers, stores for alcohol woes

The Oglala Sioux Tribe is suing some of the world's largest beer brewers, saying they knowingly have contributed to devastating alcohol-related problems on Pine Ridge Indian Reservation.

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Asia News Network (Bhutan) - The money cost of alcohol abuse in Bhutan

About Nu 30 M(US$607,165) went into treating alcohol related diseases in 2010 a study by Bhutan's National Statistical Bureau's socio-economic research and analysis division (SERAD) estimates.

Read more

Press Association (Ireland) - Plan to ban alcohol sport sponsors

The Government is to consider stamping out alcohol sponsorship of sporting events and festivals to curb Ireland's drink culture.

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Science Daily - After-School Program Can Reduce Alcohol Use Among Middle School Students, Study Finds

A voluntary substance prevention program held after school and presented by trained facilitators can help reduce alcohol use among young adolescents, according to a new RAND Corporation study.

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Maneater (USA) - New government study says alcohol abuse is higher among college students

According to the Chicago Tribune, a national study found United States college students abuse alcohol more than other drugs such as heroin, cocaine or methamphetamines compared to their non-student peers.

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BBC News (Wales) - Nurse advice cuts binge drinking in Cardiff University project

Nurses will be trained to help patients with alcohol problems across Wales after a pilot project led to about a quarter of people cutting drinking.

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Sydney Morning Herald (Australia) - Time for govt to focus on alcohol: AMA

The Gillard government is being urged to crack down on junk food and alcohol advertising now that it has taken on big tobacco by legislating for plain packaging of cigarettes.

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News-Medical-Net (Spain) - Most young Spaniards do not consume alcohol or illegal drug

Despite the clich-s surrounding the habits of adolescents, the results of a study by the University of Seville show that most young people do not fit the risk profile of taking substances.

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PRWeb - Global Market for Beer to Reach 191.8 Million Kiloliters by 2015, According to New Report by Global Industry Analysts, Inc.

GIA announces the release of a comprehensive global outlook on the Beer Industry. Growth in the world market for beer in the upcoming years will be driven by strong gains in developing countries in Asia-Pacific, Latin America and Middle East.

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Daily Telegraph (South Africa) - South Africa considers law banning sale of alcohol to pregnant women

The move is designed to cut one of the world's highest rates of Fetal Alcohol Syndrome, which sees babies develop mental and physical defects in the womb due to a mother's heavy drinking.

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Alcohol Use and Health-Related Quality of Life among Hospital Outpatients in South Africa

This study examined the association of alcohol use and health-related quality of life (HRQOL) in a clinic population in South Africa.

A probability sample of 1532 (56.4% men and women 43.6%) patients from different hospital outpatient departments completed the Alcohol Use Disorder Identification Test and the social functioning (SF)-12 Health Survey. Physical and Mental Health Component Summaries and primary scales of the SF-12 were used as measures of HRQOL.

The study did not find a significant association between alcohol-use disorders and HRQoL [Physical Component Summary (PCS) and Mental health Component Summary (MCS)] in this clinic population. However, probable alcohol dependence was associated with poorer quality of life in three areas of functioning measured by the SF-12 (physical functioning, general health and mental health) compared with patients not meeting the criteria of alcohol dependence. The magnitude of the decrement in the PCS and MCS for daily or almost daily tobacco use, severe psychological distress and the number of other chronic conditions was significantly greater than for alcohol abuse or dependence.

It appears that hospital outpatients in this study did not experience a diminished quality of life related to their alcohol use compared with other attenders at these clinics. Also, intervention studies with hazardous drinkers may not be able to identify treatment-related changes in global HRQoL.


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Request Reprint E-Mail: kpeltzer@hsrc.ac.za

Current status of alcohol marketing policy—an urgent challenge for global governance

To review research literature and available information on the extent and impacts of marketing, current policy response and the interests engaged in the policy debate in order to inform recommendations for policy change on alcohol marketing.

Relevant literature, including systematic reviews and publicly available information (websites and participant observation) is reviewed and synthesized.

Alcohol marketing has expanded markedly in the past 50 years and, while there remains uncertainty about the impact across the population, there is now clear evidence of its impact on the consumption of young people. Few countries have effective policy in place restricting alcohol marketing, and there is a lack of an international response to alcohol marketing which crosses national boundaries. The protection of alcohol marketing has been a major focus for vested interest groups and this has affected governmental response at national and international levels. There has been a lack of non-governmental organization engagement. The policy response to tobacco marketing provides a clear contrast to that of alcohol marketing policy and provides a model for alcohol marketing policy.

The global exposure of young people to alcohol marketing requires an urgent policy response. The Framework Convention on Tobacco Control provides an appropriate model for global governance to control alcohol marketing. There are extant examples of national level legislation achieving comprehensive bans with France's Loi Evin providing a feasible model. Resources from philanthropic organizations to allow non-governmental organization engagement are urgently required, as is engagement by the governmental sector independent of commercial influence.

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Request Reprint E-Mail: s.casswell@massey.ac.nz

Alcohol taxation policy in Thailand: implications for other low- to middle-income countries

Prevention of drinking initiation is a significant challenge in low- and middle-income countries that have a high prevalence of abstainers, including life-time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol-attributable harms.

Theoretical evaluation, simulation and empirical analysis.

The taxation method of Thailand, ‘Two-Chosen-One’ (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful.

'Two-chosen-one’ (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low- and middle-income countries.

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Request Reprint E-Mail: jtrehm@aol.com

Does Session Attendance by a Supportive Significant Other Predict Outcomes in Individual Treatment for Alcohol Use Disorders?

A significant amount of research has supported the efficacy of couple versus individual treatment for alcohol use disorders, yet little is known about whether involving a significant other during the course of individual treatment can improve outcomes. Likewise, several barriers to couple treatment exist and a more flexible approach to significant other involvement may be warranted.

This study constituted secondary analyses of the COMBINE data, a randomized clinical trial that combined pharmacotherapy and behavioral intervention for alcohol dependence. Data were drawn from the 16-week individual combined behavioral intervention (CBI), which had 776 participants, 31% of which were female, and 23% were non-white. The current study examined whether attendance by a supportive significant other (SSO) during CBI sessions would predict better outcomes. It was further hypothesized that active SSO involvement, defined by attendance during drink refusal or communication skills training sessions, would predict better outcomes.

SSOs attended at least 1 session for 26.9% of clients. Clients with SSOs who attended at least 1 session had significantly fewer drinking days and fewer drinking-related problems at the end of treatment. The presence of an SSO during a drink refusal training session predicted significantly better outcomes, as compared to SSO attendance at other sessions and drink refusal training without an SSO present. SSO attendance at a communication training session did not predict better outcomes.

These results suggest that specific types of active involvement may be important for SSO-involved treatment to have greater efficacy than individual treatment.

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Request Reprint E-Mail: dorianhr@gmail.com

Acetaldehyde Oral Self-Administration: Evidence from the Operant-Conflict Paradigm

Acetaldehyde (ACD), ethanol's first metabolite, has been reported to interact with the dopaminergic reward system, and with the neural circuits involved in stress response. Rats self-administer ACD directly into cerebral ventricles, and multiple intracerebroventricular infusions of ACD produce conditioned place preference. Self-administration has been largely employed to assess the reinforcing and addictive properties of most drugs of abuse. In particular, operant conditioning is a valid model to investigate drug-seeking and drug-taking behavior in rats.

This study was aimed at the evaluation of (i) the motivational properties of oral ACD in the induction and maintenance of an operant-drinking behavior; (ii) ACD effect in a conflict situation employing the punishment-based Geller–Seifter procedure; and (iii) the onset of a relapse drinking behavior, following ACD deprivation. The lever-pressing procedure in a sound-attenuated operant-conditioning chamber was scheduled into 3 different periods: (i) training—rewarded responses with a fixed ratio 1; (ii) conflict—rewarded responses periodically associated with a 0.2 mA foot-shock; and (iii) relapse—rewarded lever presses following 1-week ACD abstinence.

Our results show that oral self-administrated ACD induced: a higher rate of punished responses in Geller–Seifter procedures; and the establishment of a relapse behavior following ACD deprivation.

In conclusion, our results indicate that ACD is able to induce an operant-drinking behavior, which is also maintained besides the conflict procedure and enhanced by the deprivation effect, supporting the hypothesis that ACD itself possesses motivational properties, such as alcohol and other substances of abuse.

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carla.cannizzaro@katamail.com