JSAD Press Releases

News coverage of alcohol’s harm may sway support for liquor-control laws

Freshman women's binge drinking tied to sexual assault risk

Under money strains, some older adults turn to alcohol

Heavy drinkers may die needlessly in house fires

Drug use tied to fatal car crashes

Athletes may have different reasons for marijuana use

Adult supervised drinking in young teens may lead to more alcohol use, consequences

Parental monitoring of opposite-gender child may decrease problem drinking in young adults

Lowering the drinking age is unlikely to curb college drinking

Heavy drinkers consume less over time, but not at 'normal' levels

Hispanic kids show greater risk of substance use

Scaling Properties of the Combined ICD-10 Dependence and Harms Criteria and Comparisons With DSM-5 Alcohol Use Disorder Criteria Among Patients in the

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), and the International Statistical Classification of Diseases and Related Health Problems, 10th Edition (ICD-10), alcohol use disorders (AUDs) classifications offer competing and somewhat overlapping diagnostic tools for assessing alcohol dependence and harms/abuse. Both systems are in active stages of development in anticipation of their next respective iterations. Although much psychometric work has been done studying DSM-IV criteria, efforts toward the ICD-11 have been less prevalent.

Data from 3,191 drinkers in seven emergency department sites in four countries (United States, Mexico, Argentina, and Poland) were used to study the psychometric properties of the combined ICD-10 dependence and harms criteria. Comparisons with the proposed set of DSM-5 criteria and diagnostic thresholds are also included.

Item response theory analyses of the combined ICD-10 dependence and harms criteria suggested a single underlying factor, both overall and for each site separately, with only moderate differential item functioning across sites. Overall agreement between the summative combined ICD-10 dependence and harms criteria and the proposed 11-criteria DSM-5 scale was very high (r = .97), as was agreement between proposed diagnostic threshold levels of 0–1 (negative AUD), 2–3 (moderate AUD), and 4 or more (severe AUD) criteria endorsed (κ = .84). Although disagreement between the two three-level diagnoses was only 5.5% of the sample, a majority of these were because of differences between endorsement rates of abuse versus harms criteria.

Although there is support for efforts to align the two schemes, results are consistent with other studies finding the largest differences between the two systems emanating from differences between the abuse and harms domains. More research is needed before differences between the two systems can be reconciled.


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Reducing Alcohol-Impaired Driving in Community Sports Clubs: Evaluating the Good Sports Program

The Good Sports program uses a systematic accreditation process to implement gradual alcohol-related harm-reduction strategies in Australian community sports clubs that aim to reduce the incidence of harmful alcohol-related behaviors, such as drink driving. This study tested whether the Good Sports program reduced the incidence of drink driving and whether reductions are related to the level of program implementation.

An adoption versus nonadoption pilot study was undertaken with 65 cricket and 48 Australian Football League clubs (N = 1,968 individuals). Associations between the stage of accreditation (Stage 1 and Stage 2) and the likelihood of driving with an illegal blood alcohol concentration (BAC) were examined. Alcohol-use diary accounts were used to calculate BAC before driving home from the club.

The percentage of club members driving at least once in the previous week with a BAC estimate greater than .05% (the legal limit in Australia) was lower in clubs that had achieved Stage 2 Good Sports accreditation (7%, 95% CI [5%, 9%]) than those that had not (8%, 95% CI [6%, 9%]), but this was not significantly different. However, multilevel modeling identified a larger number of the safe-transport strategies, implemented as part of Stage 2 accreditation, which were associated with a significantly lower probability of drink driving. Being a risky drinker at the club, and the average number of risky drinkers at the club, was also predictive of drink driving.

The findings of this pilot study suggest that implementation of the Good Sports program is likely to have a significant effect on harms associated with drink driving in Australia and elsewhere. Further community studies will be required, however, to examine precisely how the program is achieving improvements and whether it can be refined to have a greater impact in both Australia and overseas.


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Request Reprint E-Mail: bosco@adf.org.au

Does the prevention paradox apply to various alcohol habits and problems among Swedish adolescents?

The prevention paradox states that a majority of alcohol-related problems in a population come from moderate drinkers because they are more numerous than heavy drinkers, although the latter have a higher individual risk of adverse outcomes. We examined the extent to which the prevention paradox applies to the relationship between alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems in adolescents; an area in which studies are lacking.

A total of 7288 alcohol-consuming adolescents aged 13–17 years were examined. The proportions (%) of problems related to drinking measures [the upper 10% and bottom 90% of drinkers by annual alcohol intake, and those with frequent (monthly), less frequent, and no heavy drinking episodes] were calculated.

The bottom 90% of consumers by annual intake accounted for a large majority of the alcohol-related problems among boys and girls at all ages. The share of problems accounted for by monthly HEDs increased with age, from ∼10% among those aged 13 years to >50% among those aged 17 years. Attributable proportions for the top 10% alcohol consumers ranged between 22% and 37%.

Our analyses suggest that the prevention paradox is valid for adolescent boys and girls aged ≥15 years and applies to a large range of alcohol-related problems of varying severity. Our results imply that not only that prevention directed at all adolescents is essential, but also that HED should be particularly noticed.


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Request Reprint E-Mail: anders.romelsjo@ki.se

2012 ISSUE BRIEFS FOR STATES

This is a package of simple briefs that address common issues about alcohol regulation that arise during state legislative sessions and in local government deliberations. It is designed for legislators and other policy-makers who need a short, straightforward explanation of a given issue. For each brief, research citations are given where they exist. Click here to open PDF

Global Actions on Harmful Drinking February 24, 2012

Key Recent Milestones:

· China: Chinese translations of these self-regulation documents are now available online: International Guide to developing a self-regulatory organization: Practical advice on setting up and consolidating an advertising self-regulatory system and Alcohol module: Looking at advertising self-regulatory standards related to alcoholic beverages.



Global Actions in Focus: Thailand Country Consultant and Conference

Global Actions initiatives in Thailand are making good progress, with recent milestones including a drink driving conference and the appointment of ICAP Country Consultant Panrasri Khonputsa.



On February 17, the conference Drink Driving in Thailand: From Findings to Actions presented the results of current drink driving assessment in Thailand. The study was conducted by the National Research Council of Thailand and the lead author is Dr. Angsana Tokitkla. The Industry plans of action were introduced in accordance with study findings from the Thai Foundation for Responsible Drinking (TFRD). Representatives from the alcohol industry, law enforcement, and the Department of Disaster Prevention and Mitigation (DDPM) were among those in attendance. A discussion on community approaches to reducing drink driving was led by Robert Klein.



As ICAP’s new Country Consultant, Khonputsa will be working throughout 2012 to develop strategy and specific plans for Thailand in support of the WHO Alcohol Strategy. Prior to joining ICAP, she worked as a Consultant for the Road Safety Group of the National Health Foundation. Based in Bangkok, Khonputsa is collaborating with scientists, academics, and industry members working with ICAP on Global Actions initiatives.



What’s Happening Next:

· Brazil: Channel Research will be in Brazil to evaluate Global Actions Self-Regulation and Noncommercial Alcohol projects from March 5 to 9.

· Vietnam: A launch event of the marketing code for wine and spirits will be held on March 20 in Hanoi.

The Relationship Between Underage Alcohol Possession and Future Criminal Behavior An Empirical Analysis Using Age–Period Cohort Characteristics Model

This study examines the relationship between underage alcohol possession and criminal behavior through a cohort, age, and period analysis.

Utilizing the Age–Period Cohort Characteristic (APCC) models method and national arrest data, while controlling for age and period effects, this study examined single-year age cohorts and determines that strict enforcement of PULA (Possession Under Legal Age) laws decreases the likelihood of strongly correlated vandalism and assaults as young adults.

The analysis indicates an increase in assaults and vandalism as cohort size increases, but little effect from single parent, resource deprivation.


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Prevalence of Alcohol Use Disorders Among American Surgeons

To determine the point prevalence of alcohol abuse and dependence among practicing surgeons.

Cross-sectional study with data gathered through a 2010 survey.

The United States of America.

Members of the American College of

Surgeons.

Alcohol abuse and dependence.

Of 25 073 surgeons sampled, 7197 (28.7%) completed the survey. Of these, 1112 (15.4%) had a score on the Alcohol Use Disorders Identification Test, version C, consistent with alcohol abuse or dependence. The point prevalence for alcohol abuse or dependence for male surgeons was 13.9% and for female surgeons was 25.6%. Surgeons reporting a major medical error in the previous 3 months were more likely to have alcohol abuse or dependence (odds ratio, 1.45; P < .001). Surgeons who were burned out (odds ratio, 1.25; P = .01) and depressed (odds ratio, 1.48; P < .001) were more likely to have alcohol abuse or dependence. The emotional exhaustion and depersonalization domains of burnout were strongly associated with alcohol abuse or dependence. Male sex, having children, and working for the Department of Veterans Affairs were associated with a lower likelihood of alcohol abuse or dependence.

Conclusions Alcohol abuse and dependence is a significant problem in US surgeons. Organizational approaches for the early identification of problematic alcohol consumption followed by intervention and treatment where indicated should be strongly supported.

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Study protocol: a randomized controlled trial of a computer-based depression and substance abuse intervention for people attending residential substan

A large proportion of people attending residential alcohol and other substance abuse treatment have a co-occurring mental illness. Empirical evidence suggests that it is important to treat both the substance abuse problem and co-occurring mental illness concurrently and in an integrated fashion. However, the majority of residential alcohol and other substance abuse services do not address mental illness in a systematic way. It is likely that computer delivered interventions could improve the ability of substance abuse services to address co-occurring mental illness. This protocol describes a study in which we will assess the effectiveness of adding a computer delivered depression and substance abuse intervention for people who are attending residential alcohol and other substance abuse treatment.

Participants will be recruited from residential rehabilitation programs operated by the Australian Salvation Army. All participants who satisfy the diagnostic criteria for an alcohol or other substance dependence disorder will be asked to participate in the study. After completion of a baseline assessment, participants will be randomly assigned to either a computer delivered substance abuse and depression intervention (treatment condition) or to a computer-delivered typing tutorial (active control condition). All participants will continue to complete The Salvation Army residential program, a predominantly 12-step based treatment facility. Randomisation will be stratified by gender (Male, Female), length of time the participant has been in the program at the commencement of the study (4 weeks or less, 4 weeks or more), and use of anti-depressant medication (currently prescribed medication, not prescribed medication). Participants in both conditions will complete computer sessions twice per week, over a five-week period. Research staff blind to treatment allocation will complete the assessments at baseline, and then 3, 6, 9, and 12 months post intervention. Participants will also complete weekly self-report measures during the treatment period.

This study will provide comprehensive data on the effect of introducing a computer delivered, cognitive behavioral therapy based co-morbidity treatment program within a residential substance abuse setting. If shown to be effective, this intervention can be disseminated within other residential substance abuse programs.

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Increasing Support for Alcohol-Control Enforcement Through News Coverage of Alcohol's Role in Injuries and Crime

Prior research has shown that the proportion of news stories about violent crimes, car crashes, and other unintended injuries that mention the possible contributing role of alcohol is far lower than the actual proportion of alcohol-related crimes and unintended injuries. An experiment was conducted to test the hypothesis that inclusion of such mention can increase concern about alcohol risks and support for alcohol-control measures, which have elsewhere been shown to decrease alcohol-related problems in community settings. Methodologically, we provide a model for experiments permitting generalization across randomly selected message stimuli.

Sixty randomly selected local news stories on violent crime, motor vehicle crashes, and other unintended injuries from newspapers throughout the United States were manipulated into versions including or not including alcohol as a causative factor. Participants (n = 785) were drawn from a national online research panel representative of the U.S. population; 66% of panel members contacted agreed to participate. Data were analyzed using mixed-effect, multilevel models to permit generalization across message and participant variability.

Mention of alcohol in news stories increased support for enforcement of alcohol-control laws.

Efforts to increase mention of alcohol as a causative factor in news reports of violent crime and unintended injury have the potential to increase public support for alcohol-control policies.


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Brief Field-Based Intervention to Reduce Alcohol-Related Problems Among Men Who Have Sex With Men

This study evaluated the utility of a brief field-based intervention to reduce alcohol use and alcohol-related problems among men who have sex with men.

A randomized control trial was designed to test a brief alcohol intervention against an attention-placebo control intervention. Over a 13-week period in fall 2009, a sample (n = 152) of men who have sex with men was recruited at a local gay bar in San Diego, CA, and were randomized to a brief alcohol intervention or an attention-placebo control group. Sober bar patrons were recruited before bar entrance and asked to undergo a brief survey and give a breath alcohol sample at exit from the bar.

Breath alcohol concentrations at exit from the bar were not significantly different between those in the experimental alcohol feedback condition and those in the attention-placebo control condition. However, among participants in the experimental condition, those categorized as high risk for alcohol-related problems at entrance drank significantly less than planned as compared with participants categorized as low risk for alcohol-related problems.

Brief, venue-based interventions may be appropriate for men who have sex with men who plan to drink at rates that would put them at higher risk of alcohol-related problems. Additional studies exploring the utility of brief intervention in risk settings are warranted.



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Request Reprint E-Mail: jdclapp@mail.sdsu.edu

Attribution of Alcohol to Violence-Related Injury: Self and Other's Drinking in the Event

Alcohol can result in harm (including injury) not only to the drinker but also to others; however, little research exists on the additional proportion of violence-related injuries that can be attributed to the perpetrator.

Data are reported from emergency department studies in 14 countries on the prevalence of patients' self-report of drinking within the 6 hours before the violence-related injury event, patients' belief that the event would not have happened if they had not been drinking at the time, and patients' perception that the perpetrator had been drinking. Alcohol-attributable fraction was calculated based on the patients' perception that their own drinking was causally related to the event and on their perception that the perpetrator had been drinking.

Across all countries, 62.9% of the violence-related injuries involved alcohol use on the part of the victim, the perpetrator, or both. Rates of others definitely drinking, as perceived by the victim, ranged from 14% to 73% across countries and was positively associated with patients' own drinking in the event and with attributing a causal association between their drinking and the event. Estimates of alcohol-attributable fraction were 38.8% when the victim and perpetrator were considered together compared with 23.9% when only the patient was considered and varied by country-level drinking pattern.

These findings suggest adustments that could be made to global burden of disease estimates because of violence-related injury morbidity to better reflect alcohol-attributable fraction when drinking by others and country-level drinking patterns are taken into account.


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Request Reprint E-Mail: ccherpitel@arg.org

Husband and Wife Alcohol Use as Independent or Interactive Predictors of Intimate Partner Violence

Men's heavy drinking has been established as a risk factor for their perpetration of intimate partner violence (IPV); however, the role of women's drinking in their perpetration of IPV is less clear. The current study examined the relative strength of husbands' and wives' alcohol use and alcohol dependence symptoms on the occurrence and frequency of husbands' and wives' IPV perpetration.

Married and cohabiting community couples (N = 280) were identified and recruited according to their classification in one of four drinking groups: heavy episodic drinking occurred in both partners (n = 79), the husband only (n = 80), the wife only (n = 41), and neither (n = 80). Husband and wife alcohol consumption, alcohol dependence symptoms, and IPV perpetration were assessed independently for both partners.

Husband and wife consumption and alcohol dependence symptoms contributed to the likelihood and frequency of husband IPV, both independently and interactively. Husband, but not wife, alcohol dependence symptoms contributed to the occurrence of any wife IPV, although both partners' alcohol dependence symptoms predicted the frequency of wife aggression. Couples with discrepant drinking were not more likely to perpetrate IPV.

Findings for husband IPV support previous research identifying alcohol use of both partners as a predictor. However, for wives, alcohol appears to play less of a role in IPV perpetration, perhaps reflecting that women experience less inhibition against physical aggression in their intimate relationships than do men.



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Request Reprint E-Mail: testa@ria.buffalo.edu

Subtance Use and Type and Severity of Injury Among Hospitalized Trauma Cases: Ohio, 2004-2007

The purpose of this study was to determine whether persons who were injured severely enough to require hospitalization suffered more severe injury when substance use was involved. This was accomplished by evaluating four proxy outcome measures with Ohio Trauma Registry data from January 2004 through December 2007.

Four injury outcomes were identified: injury severity score, admission to an intensive care unit, presence of at least one medical complication, and hospital length of stay. We examined their association with substance (alcohol and/or other drug) use stratified by the likelihood of being tested for substance use, mechanism of injury, sex, age, race, and insurance status. Relative risks and t test scores were calculated.

Among 89,129 trauma cases reported to the Ohio Trauma Registry during 2004–2007, more than 21% were substance users. Those younger than 45 years of age were 65% more likely to use substances than those 45 or older, men were 110% more likely than women, Blacks were 86% more likely than non-Blacks, and uninsured persons were 127% more likely than insured persons. Stratified analyses yielded 16 comparisons (4 Injury Outcomes 4 Age-Insurance Subgroups). For 13 of these 16 comparisons, injury severity was significantly worse (p < .0001) among substance users than nonusers.

The evidence is strong enough to conclude that, among hospitalized trauma patients, use of substances (alcohol and/or drug) was associated with increased injury severity. These findings appear to be true for the young and old, regardless of insurance status.



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Request Reprint E-Mail: rosemary.duffy@odh.ohio.gov

Leisure Activities, the Social Weekend, and Alcohol Use: Evidence From a Daily Study of First-Year College Students

The aim of this study was to document within-person and between-persons associations between the duration of day-to-day activities (volunteering, spiritual activities, media use, socializing, entertainment/campus events and clubs, athletics, classes, working for pay) and alcohol use (quantity and heavy drinking) and to examine whether these associations differed by gender and the time of week.

First-semester college students (N = 717 persons; 51.6% female) provided up to 14 consecutive days of data (N = 9,431 days) via daily web-based surveys. Multilevel analyses tested whether alcohol use was associated with activity duration, gender, and time of week.

Between-persons associations indicated that alcohol use was higher among individuals who spent more time involved in athletics and socializing and lower among students who spent more time in spiritual and volunteer activities. Within-person associations indicated that students consumed more alcohol and were more likely to drink heavily on weekends, on days they spent more time than usual socializing, and on days they spent less time than usual in spiritual activities and using media.


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Request Reprint E-Mail: akf134@psu.edu

Select activities and days were linked with less alcohol use at both the between- and within-person levels, suggesting that attention should be paid to both selection effects and social context to understand the mechanisms linking activity duration and student drinking.

Cluster Analysis of Undergraduate Drinkers Based on Alcohol Expectancy Scores

Expectancies of alcohol's effects have been associated with problem drinking in undergraduates. If subgroups can be classified based on expectancies, this may facilitate identifying those at highest risk for problem drinking.

Undergraduates (N = 612) from two state universities completed a web-based survey. Responses to the Comprehensive Effects of Alcohol scale were analyzed using k-means cluster analysis separately within each university sample.

Hartigan's heuristic was used to determine that five was the optimal number of clusters in each sample. Clusters were distinguishable based on their overall magnitude of expectancy endorsement and by a tendency to endorse stronger positive than negative expectancies. Subsequent analyses were conducted to compare clusters on alcohol involvement and trait disinhibition. A cluster characterized by endorsement of positive and negative expectancies ("strong expectancy") was associated with a particularly problematic risk profile, specifically concerning difficulties with self-control (i.e., trait disinhibition and impaired control over alcohol use). A cluster with higher positive and lower negative expectancies reported frequent heavy drinking but appeared to be at lower risk than the strong expectancy cluster in a number of respects. Negative expectancy endorsement appeared to represent added risk above and beyond positive expectancies.

Results suggest that both the magnitude and combination of expectancies endorsed by subgroups of undergraduate drinkers may relate to their risk level in terms of alcohol involvement and personality traits. These findings may have implications for interventions with young adult drinkers.


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Request Reprint E-Mail: robert.leeman@yale.edu

Cost-Effectiveness Analysis of Motivational Interviewing With Feedback to Reduce Drinking Among a Sample of College Students

This study evaluated the costs and cost-effectiveness of combining motivational interviewing with feedback to address heavy drinking among university freshmen.

Microcosting methods were used in a prospective cost and cost-effectiveness study of a randomized trial of assessment only (AO), motivational interviewing (MI), feedback only (FB), and motivational interviewing with feedback (MIFB) at a large public university in the southeastern United States. Students were recruited and screened into the study during freshman classes based on recent heavy drinking. A total of 727 students (60% female) were randomized, and 656 had sufficient data at 3-months' follow-up to be included in the cost-effectiveness analysis. Effectiveness outcomes were changes in average drinks per drinking occasion and number of heavy drinking occasions.

Mean intervention costs per student were 16.51 for MI, 17.33 for FB, and 36.03 for MIFB. Cost-effectiveness analysis showed two cost-effective interventions for both outcomes: AO (0 per student) and MIFB (36 per student).

This is the first prospective t-effectiveness study to our knowledge to examine MI for heavy drinking among students in a university setting. Despite being the most expensive intervention, MIFB was the most effective intervention and may be a cost-effective intervention, depending on a university's willingness to pay for changes in the considered outcomes.


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Request Reprint E-Mail: cowell@rti.org

Medical experts warn of "tipping point" in prevantable alcohol deaths

A new comment in The Lancet outlines the opinions of leaders in the medical field that England and Wales are approaching a "tipping point" in the level of alcohol-related deaths.

Professor Iain Gilmore, former president of the Royal College of Physicians, and Dr Nick Sheron, from the National Institute of Health Research, together with members of the British Society of Gastroenterologists, set out a "worst case scenario" of up to 210,000 preventable deaths over the next 20 years.

The projected figures include a possible 70,000 deaths from liver disease. With an estimated £2.7bn cost to the NHS from alcohol related harm, the comments by Professor Gilmore and his associates come swiftly after the British Liver Trust described deaths from liver disease as the equivalent of a jumbo jet crashing every 17 days. > > > > Read More

Predicting Dropout in the First 3 Months of 12-Step Residential Drug and Alcohol Treatment in an Australian Sample

Premature termination from treatment is a major factor associated with poorer drug and alcohol treatment outcomes. The present study investigated client-related baseline predictors of dropout at 3 months from a faith-based 12-step residential drug treatment program.

Data were collected over a period of 14 months from eight residential drug and alcohol treatment programs run by The Australian Salvation Army. The final sample consisted of 618 participants, including 524 men (84.8%) and 94 women (15.2%). Predictor variables of interest were age, gender, primary drug of concern, criminal involvement, psychological distress, drug cravings, self-efficacy to abstain, spirituality, forgiveness of self and others, and life purpose. At 3 months, 264 participants (42.7%) remained in the treatment program, and 354 participants (57.3%) had dropped out.

Binary logistic regression revealed that individuals were more likely to drop out by the 3-month time frame if at intake their primary drug of concern was a drug other than alcohol or they reported greater forgiveness of self.

To the authors' knowledge, this is the first study to examine forgiveness as a predictor of dropout from a drug treatment program. Assessing patient's primary drug of concern and levels of forgiveness may be useful for residential drug treatment providers in constructing programs that provide differential treatment based on the results of these assessments.


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Request Reprint E-Mail: fdeane@uow.edu.au

Effects of Alcohol Availability, Access to Alcohol, and Naltrexone on Self-Reported Craving and Patterns of Drinking in Response to an Alcohol-Cue Ava

Craving has long been cited by patients and providers as a principal construct in alcohol use disorders and an essential target for treatment. The goal of the current study was to examine the effects of alcohol availability (20% vs. 80% availability), access to alcohol ("open" vs. "locked" trials), and medication (oral naltrexone [Revia] vs. placebo) on self-reported craving and two behavioral measures of drinking (latency of attempt to access alcohol, amount of alcohol consumed when access permitted) in response to an alcohol-cue availability procedure.

Non-treatment-seeking, alcohol-dependent men and women (N = 58) self-referred for an alcohol administration study and were administered a modified alcohol-cue availability procedure under two medication conditions (naltrexone, placebo) using a within-subjects, repeated-measures design.

Analyses demonstrated that the experimental manipulations used in this study had differential effects on craving and patterns of drinking. Specifically, reduced availability of alcohol (i.e., when alcohol was available in only 20% as opposed to 80% of trials) resulted in greater amounts of alcohol consumed per open trial; the unanticipated blocking of access to alcohol (i.e., a "locked" trial during the 80% availability condition) triggered more rapid attempts to obtain alcohol on subsequent trials. Naltrexone, relative to placebo, was associated with significant reductions in cravings for alcohol.

Taken together, these findings offer partial support for the cognitive processing model and reinforce the utility of evaluating both self-report and behavioral indicators of motivation to drink in studies designed to identify factors associated with the construct of craving.


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Request Reprint E-Mail: Marc.Kruse@va.gov

Comparison Across Two Generations of Prospective Models of How the Low Level of Response to Alcohol Affects Alcohol Outcomes

This article presents the first direct comparison of level of response (LR)–based prospective models in two generations of the same families. To accomplish this, we describe results from the first prospective evaluation of potential mediators of how an earlier low LR to alcohol relates to adverse alcohol outcomes in offspring from the San Diego Prospective Study (SDPS).

To compare with data from probands in the SDPS, new data were gathered from 86 drinking offspring (age 20 years) during the 25-year follow-up of these families. Consistent with the usual effect of a low LR, outcomes 5 years later for both generations focused on drinking quantities as well as alcohol problems during the follow-up. A structural equation model (SEM) was used to analyze the relationships among variables, and the models in proband and offspring generations were compared using direct observations of the model results and through invariance procedures.

In these drinking offspring, LR correlated with 5-year outcomes (r = .48, p < .001) and the SEM R² was .48, with good fit statistics. As predicted, the LR relationship to alcohol-related outcomes was both direct and partially mediated by heavier peer drinking, positive alcohol expectancies, and using alcohol to cope with stress. These results were similar to a previously published prospective model in SDPS probands, although path coefficients were generally higher in the younger group.

The LR-based model of heavier drinking operated similarly across generations, with some modest differences. These results indicate that the model may be meaningful in both younger and middle-age groups.



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Request Reprint E-Mail: mschuckit@ucsd.edu

Nucleus Accumbens Response to Incentive Stimuli Anticipation in Children of Alcoholics: Relationships with Precursive Behavioral Risk and Lifetime Alc

Children of alcoholics (COAs) are at elevated risk to develop alcohol and other substance use disorders. The neurobiological underpinnings of this heightened vulnerability are presently not well understood.

This study investigated whether, in humans, COAs have different functioning of the mesolimbic reward circuitry beyond previous substance use confounds and examined potential group differences in neural response in relation to alcohol use and behavioral risk.

We studied 20 18- to 22-year-old COAs and 20 controls, developmentally well characterized for substance use and selected to match on sex, age, IQ, lifetime substance use and associated problems, and precursive (ages 12–14 years) externalizing behavioral risk. None met criteria for Diagnostic and Statistical Manual of Mental Disorders IV diagnosis. Neural responses to anticipation of reward and loss were assessed using functional magnetic resonance imaging during a monetary incentive delay task.

Overall, COAs showed reduced ventral striatum activation during anticipation of monetary reward and loss compared with controls.

However, additional analysis revealed that blunted nucleus accumbens (NAcc) response was only observed in COAs who have not demonstrated any problem drinking behavior.

In addition, uniquely in COAs, NAcc activation was positively correlated with precursive externalizing risk, as well as current and lifetime alcohol consumption.

These findings suggest a multilevel developmental process whereby lower precursive behavioral risk appears protective of later problem alcohol use in COAs, which is further associated with a blunted NAcc response to incentive anticipation, potentially reflecting a resilience mechanism.

Moreover, the results suggest that a close association between motivational responses, alcohol consumption, and behavioral risk may underlie addiction vulnerability in COAs.


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Request Reprint E-Mail: mheitzeg@umich.edu

Autosomal linkage scan for loci predisposing to comorbid dependence on multiple substances

Multiple substance dependence (MSD) trait comorbidity is common, and MSD patients are often severely affected clinically.

While shared genetic risks have been documented, so far there has been no published report using the linkage scan approach to survey risk loci for MSD as a phenotype.

A total of 1,758 individuals in 739 families [384 African American (AA) and 355 European American (EA) families] ascertained via affected sib-pairs with cocaine or opioid or alcohol dependence were genotyped using an array-based linkage panel of single-nucleotide polymorphism markers. Fuzzy clustering analysis was conducted on individuals with alcohol, cannabis, cocaine, opioid, and nicotine dependence for AAs and EAs separately, and linkage scans were conducted for the output membership coefficients using Merlin-regression.

In EAs, we observed an autosome-wide significant linkage signal on chromosome 4 (peak lod = 3.31 at 68.3 cM; empirical autosome-wide P = 0.038), and a suggestive linkage signal on chromosome 21 (peak lod = 2.37 at 19.4 cM).

In AAs, four suggestive linkage peaks were observed: two peaks on chromosome 10 (lod = 2.66 at 96.7 cM and lod = 3.02 at 147.6 cM] and the other two on chromosomes 3 (lod = 2.81 at 145.5 cM) and 9 (lod = 1.93 at 146.8 cM). Three particularly promising candidate genes, GABRA4, GABRB1, and CLOCK, are located within or very close to the autosome-wide significant linkage region for EAs on chromosome 4.

This is the first linkage evidence supporting existence of genetic loci influencing risk for several comorbid disorders simultaneously in two major US populations.



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Request Reprint E-Mail: joel.gelernter@yale.edu

Performance on an Everyday Life Activity in Persons Diagnosed with Alcohol Dependency Compared to Healthy Controls: Relations between a Computerized S

Persons diagnosed with alcohol dependency often suffer from cognitive impairments. Little is known, however, concerning how these cognitive deficits impact complex, everyday life activities. We set out to better characterize the nature of everyday life difficulties in patients with alcohol dependency using a computerized shopping task.

A computerized real-life activity task (shopping task) required participants to shop for a list of eight grocery store items. Twenty individuals diagnosed with alcohol dependency and 20 healthy controls were administered a battery of cognitive tests, clinical scales and the shopping task.

Performance on the shopping task significantly differentiated patients and healthy controls for several variables and, in particular, for total time. Total time to complete the task correlated significantly with poor performance on measures of processing speed, verbal episodic memory, cognitive flexibility and inhibition. Total time was significantly correlated with poorer everyday life functioning and longer duration of illness.

This computerized task is a good proxy measure of the level of everyday life and cognitive functioning of persons diagnosed with
alcohol dependency.


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Request Reprint E-Mail: flaroi@ulg.ac.be

Alcohol-Related Brain Damage: Report from a Medical Council on Alcohol Symposium, June 2010

Alcohol is a toxic and dependence-producing substance that can damage most organs in the body, and is implicated in more than 60 different diseases (Oforei-Adjei et al., 2007). Alcohol is now the third leading cause of ill health in Europe (Rehm et al., 2009). In the UK, alcohol-related morbidity and mortality have been increasing over the last 30 years, and alcohol-related hospital admissions now exceed 1 million per annum in England (North West Public Health Observatory, 2011).

The brain is particularly sensitive to the toxic effects of alcohol either directly, particularly in the foetus and young people, or in the context of malnutrition and thiamine deficiency leading to Wernicke–Korsakoff syndrome; or following repeated episodes of alcohol withdrawal. The precise mechanisms of alcohol-related brain damage (ARBD) remain to be fully understood and several papers in this series describe the limits of knowledge. However, enough is already known to make a significant impact on the prevalence of ARBD through relatively inexpensive preventive strategies. Yet, such preventive strategies are poorly implemented in the UK. Why is this the case?

First, there has been a lack of training and clear guidance to clinicians on preventing and managing alcohol problems, including ARBD. This has resulted in low levels of identification and intervention of patients at risk of alcohol-related complications in medical and psychiatric care (Barnaby et al., 2003; Cheeta et al., 2008). The recently published suite of NICE guidance on alcohol-use disorders aims to improve detection, prevention and management (NICE, 2010a, b, 2011). However, effective implementation will require a significant investment in staff training to raise awareness, knowledge and skills.

Secondly, there is the issue of stigma. Patients who misuse alcohol face stigma and opprobrium, …

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Differential Hippocampal Response to Chronic Alcohol Consumption of Young Adult and Mature Adult Rats

Early ethanol consumption could be a risk factor for young brain integrity and its maturation, and also for the development of addictive behaviors in adulthood. Neuronal nitric oxide synthase (nNOS) expressing neurons are specifically located in the subgranular layer (SGL) of dentate gyrus and may be relevant for hippocampal neurogenesis. The focus of this work is aimed to determine local changes in the nNOS-like immunoreactive (nNOS-LIR) cell populations of the SGL after chronic ethanol exposure in young adult and mature adult rats.

We used the nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase (NADPH-d) reaction as a qualitative marker of nNOS enzyme activity. We also analyzed the nNOS-LIR cell density by the nNOS immunocytochemistry in order to compare these two methods of labeling. Dorsal striatum (CPu) was also analyzed in order to compare two neural areas with high nNOS-LIR cell density.

The young adult group showed less hippocampal NADPH-d⁺ cell density than the mature adult group. Interestingly, the NADPH-d⁺ cell density was increased in the SGL of the young adult ethanol-treated group, whereas it decreased in the mature adult ethanol-treated group, when compared with their respective controls. No change was observed in any of the groups for the hippocampal nNOS-LIR cell density and no differences could be established in CPu for nNOS-LIR and NADPH-d⁺ cell densities in any of the groups studied.

The NADPH-d expression is affected by chronic ethanol exposure in opposite ways between both age groups studied. Further studies are needed to evaluate the relative importance of these findings, especially when considering human subjects.



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The Moderating Role of Working Memory Capacity and Alcohol-Specific Rule-Setting on the Relation Between Approach Tendencies and Alcohol Use in Young

Dual process models of alcohol addiction propose that the transition from normative alcohol consumption to heavy drinking is the result of an imbalance in interplay between relatively impulsive or automatic and reflective or controlled processes. The current study examines whether impulsive and reflective processes are also detectable in a sample of adolescents with limited alcohol use.

Specifically, we tested the interaction between alcohol approach tendencies and 2 types of reflective processes, working memory capacity (WMC) and alcohol-specific rule-setting, on changes in alcohol use of 238 young adolescents (mean age: 13.82 years). Gender differences in these associations were also explored.

Results showed that WMC did not moderate the relation between approach tendencies and subsequent alcohol use, whereas rule-setting did, with stronger associations between approach tendencies and alcohol use for male adolescents reporting more permissive parents than male adolescents with parents enforcing stricter rules involving alcohol use. Associations between approach tendencies and subsequent alcohol use did not emerge for female adolescents.

Results indicate that even in a sample of adolescents with limited drinking experience, automatic processes are positively associated with alcohol use for male adolescents that are not motivated by parents to control their drinking.

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Request Reprint E-Mail: sarapieters@gmail.com

Alcohol Outlet Density and Intimate Partner Violence-Related Emergency Department Visits

Previous research has identified risk factors for intimate partner violence (IPV) severity, injury, and emergency department (ED) visits. These risk factors have been shown at both the individual level (heavy drinking and other substance use on the part of 1 or both partners) and the neighborhood level (residence in an area characterized by poverty and social disadvantage). Alcohol outlet density has been linked with assaultive violence in community settings, but has not been analyzed in relation to IPV-related ED visits. This study examined the effects of outlet densities on IPV-related ED visits throughout California between July 2005 and December 2008.

Half-yearly counts of ED visits related to IPV (E-code 967.3) were computed for each zip code from patient-level public data sets. Alcohol outlet density measures, calculated separately for bars, off-premise outlets, and restaurants, were derived from California Alcohol Beverage Control records. Census-based neighborhood demographic characteristics previously shown to be related to health disparities and IPV (percent black, percent Hispanic, percentage below 150% of poverty line, percent unemployed) were included in models. This study used Bayesian space–time models that allow longitudinal analysis at the zip code level despite frequent boundary redefinitions. These spatial misalignment models control for spatial variation in geographic unit definitions over time and account for spatial autocorrelation using conditional autoregressive (CAR) priors. The model incorporated data from between 1,686 (2005) and 1,693 (2008) zip codes across California for 7 half-year time periods from 2005 through 2008 (n = 11,836).

Density of bars was positively associated with IPV-related ED visits. Density of off-premise outlets was negatively associated with IPV-related ED visits; this association was weaker and smaller than the bar association. There was no association between density of restaurants and IPV-related ED visits.

Furtearch is needed to understand the mechanisms by which environmental factors, suher resch as alcohol outlet density, affect IPV behaviors resulting in ED visits.

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Varenicline Potentiates Alcohol-Induced Negative Subjective Responses and Offsets Impaired Eye Movements

Varenicline (VAR) is a partial nicotinic receptor agonist that is an effective smoking cessation medication. Preliminary evidence indicates that it may also reduce alcohol consumption, but the underlying mechanism is not clear. For example, VAR may reduce alcohol consumption by attenuating its subjectively rewarding properties or by enhancing its aversive effects. In this study, we examined the effects of an acute dose of VAR upon subjective, physiological, and objective responses to low and moderate doses of alcohol in healthy social drinkers.

Healthy men and women (N = 15) participated in 6 randomized sessions; 3 sessions each with 2 mg VAR and placebo (PL) followed 3 hours later by a beverage containing PL, low-dose alcohol (0.4 g/kg), or high-dose alcohol (0.8 g/kg). Subjective mood and drug effects (i.e., stimulation, drug liking), physiological measures (heart rate, blood pressure), and eye tracking tasks were administered at various intervals before and after drug and alcohol administration.

VAR acutely increased blood pressure, heart rate, ratings of dysphoria and nausea, and also improved eye tracking performance. After alcohol drinking (vs. PL), VAR increased dysphoria and tended to reduce alcohol liking ratings. It also attenuated alcohol-induced eye-tracking impairments. These effects were independent of the drug’s effects on nausea before drinking.

Our data support the theory that VAR may reduce drinking by potentiating aversive effects of alcohol. VAR also offsets alcohol-induced eye movement impairment. The evidence suggests that VAR may decrease alcohol consumption by producing effects, which oppose the rewarding efficacy of alcohol.

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Neural Processes of an Indirect Analog of Risk Taking in Young Nondependent Adult Alcohol Drinkers—An fMRI Study of the Stop Signal Task

1. Alcohol abuse and dependence are common problems in the United States that stem from a variety of factors, one of which may be a period of high level social drinking during college and early adulthood. Extant study implicates risk taking as a cognitive factor that contributes to habitual and heavy drinking. We sought to examine the neural processes of risk taking in young, nondependent drinkers.

   We compared 20 young adult social drinkers with a high level of alcohol use (AH), as defined by number of drinks per month, and 21 demographically matched drinkers with low to moderate alcohol use (ALM) in a functional magnetic resonance imaging study of the stop signal task. By contrasting risk taking (speeded) to risk aversion (slowed) trials, we examined the neural correlates of risk taking. Brain imaging data were analyzed with Statistical Parametric Mapping. Regions of interest were identified and corresponding effect sizes were examined for correlations with self-reported alcohol use.

   The results showed that, compared with ALM, AH demonstrated decreased activation in right superior frontal gyrus and left caudate nucleus when contrasting risk taking and risk aversion trials at p < 0.001, uncorrected. Furthermore, examination of the effect size data showed that the extent of these decreased regional activations correlated with frequency of drinking in women, but not men.

   These findings suggest a neural analog of nondependent, high level drinking. Specifically, high level social drinking is associated with altered activation of the caudate and superior frontal cortex, an association that appears to be stronger in women than in men and is strongly tied to the frequency of drinking. These results are relevant in understanding risk taking behavior in social drinking as well as in examining the potential path from high level social use in young adults to dangerous alcohol consumption later in life.

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Request Reprint E-Mail: chiang-shan.li@yale.edu

Twin Study of the Relationship Between Adolescent Attention-Deficit/Hyperactivity Disorder and Adult Alcohol Dependence

Adolescent problem behaviors such as conduct disorder and attention-deficit/hyperactivity disorder (ADHD) are often associated with alcohol problems in adulthood, particularly alcohol dependence. This association is partly a result of shared genetic liability. However, it is unclear whether ADHD, or an ADHD subtype, shares genetic influences with alcohol dependence beyond those also shared by conduct disorder.

We evaluated phenotypic associations between adolescent conduct disorder and ADHD phenotypes with adult alcohol dependence in a population-based sample of adult male twins (N = 1,774). We then assessed genetic and environmental relationships among phenotypes using structural equation modeling.

Individually, conduct disorder and each ADHD factor were associated with adult alcohol dependence. Results from twin modeling indicate that a genetic factor common to conduct disorder and ADHD also loads strongly onto alcohol dependence. Even after controlling for genetic factors shared with conduct disorder and other ADHD factors, the hyperactivity component of ADHD shared significant residual genetic influences with alcohol dependence.

Most of the genetically mediated association between adolescent ADHD and adult alcohol dependence is shared with conduct disorder, reflecting a generalized risk to externalizing behaviors. The significant residual genetic covariance between the ADHD factor hyperactivity/impulsivity and alcohol dependence implies that impulsive behaviors less destructive/harmful than those manifested by conduct disorder can be indicative of genetic risk for adult alcohol dependence. However, the ADHD factors inattention and forgetfulness are not uniquely predictive of genetic/environmental risk for alcohol dependence.


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Comparing media and family predictors of alcohol use: a cohort study of US adolescents

To compare media/marketing exposures and family factors in predicting adolescent alcohol use.

Cohort study.

Confidential telephone survey of adolescents in their homes.

Representative sample of 6522 US adolescents, aged 10–14 years at baseline and surveyed four times over 2 years.

Time to alcohol onset and progression to binge drinking were assessed with two survival models. Predictors were movie alcohol exposure (MAE), ownership of alcohol-branded merchandise and characteristics of the family (parental alcohol use, home availability of alcohol and parenting). Covariates included sociodemographics, peer drinking and personality factors.

Results Over the study period, the prevalence of adolescent ever use and binge drinking increased from 11% to 25% and from 4% to 13%, respectively. At baseline, the median estimated MAE from a population of 532 movies was 4.5 h and 11% owned alcohol-branded merchandise at time 2. Parental alcohol use (greater than or equal to weekly) was reported by 23% and 29% of adolescents could obtain alcohol from home. Peer drinking, MAE, alcohol-branded merchandise, age and rebelliousness were associated with both alcohol onset and progression to binge drinking. The adjusted hazard ratios for alcohol onset and binge drinking transition for high versus low MAE exposure were 2.13 (95% CI 1.76 to 2.57) and 1.63 (1.20 to 2.21), respectively, and MAE accounted for 28% and 20% of these transitions, respectively. Characteristics of the family were associated with alcohol onset but not with progression.

The results suggest that family focused interventions would have a larger impact on alcohol onset while limiting media and marketing exposure could help prevent both onset and progression.

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