Alcohol, Mortality and Cardiovascular Events in a 35 Year Follow-up of a Nationwide Representative Cohort of 50,000 Swedish Conscripts up to Age 55

To assess the association between drinking patterns and mortality, and cardiovascular disease in a large cohort of young- and middle-aged men and to assess whether the net balance of harm and protective effect implies protective effect or not.

Information from health examinations, psychological assessments and alcohol use background in a nationally representative birth cohort of 49,411 male military conscripts aged 18–20 years in 1969/1970, were linked to mortality and hospitalization data through 2004. Cox regression analyses were conducted and attributable proportions (APs) calculated. Confounders (baseline social status, intelligence, personality and smoking) were taken into account.

Increasing alcohol use was associated with increasing mortality (2614 deceased) and with decreasing risk for myocardial infarction (MI). The hazard ratio (HR) for mortality was 1.42 [95% confidence interval (CI) 1.10–1.82] with a consumption corresponding to 30 g 100% ethanol/day or more in multivariate analysis. The risk for non-fatal MI was significantly reduced at 60 g 100% ethanol/day (HR 0.37, 95% CI 0.15–0.90), not reduced for fatal MI, and non-significantly reduced for total MI. There was a marked association between alcohol use at conscription and mortality and hospitalization with alcohol-related diagnosis. APs indicate that alcohol caused 420 deaths, 61 cases of non-fatal stroke and protected from 154 cases on non-fatal MI.

Many more deaths were caused by alcohol than cases of non-fatal MI prevented. From a strict health perspective, we find no support for alcohol use in men below 55 years.



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Global Actions on Harmful Drinking February 29, 2012

Key Recent Milestones:

· Nigeria: ICAP’s Senior Advisor for Africa Ken Williams was in Nigeria last week working on Global Actions initiatives. He and Global Actions Country Manager Lanre Onigbogi met with government agencies to update them on progress of Global Actions projects.



Global Actions in Focus: Mid-Term Drink Drive Workshop in Hanoi

A mid-term workshop of Global Actions drink driving program in Vietnam was held in Hanoi on February 21, 2012 and co-sponsored by the National Traffic Safety Committee (NTSC). Over 40 participants from government agencies and traffic safety representatives from seven provinces attended.

“The evaluation of pre and post campaign one shows encouraging results,” said Global Actions Country Manager Lan Huong Nguyen. “We have seen a reduction in drink driving accidents, with less people hospitalized for alcohol-related road traffic accidents since we implemented the project.”

The program began with remarks from ICAP Vice President Brett Bivans and comments from Diageo on behalf of sponsor companies including Asia Pacific Breweries Limited and Pernod Ricard. The Da Nang Traffic Safety Committee (TSC) reported on project achievement in 2011. The Institute of Population and Social Affairs and the National Economics University spoke about the expected outcomes and initial achievement of the first campaign in Da Nang.

“People are responding well to our message and educational materials,” Nguyen said. “The Global Actions model gives Da Nang TSC the chance to develop the project independently, suiting it to the needs of the local people.”

“This initiative has promoted the empowerment of Da Nang TSC directly,” said Bivans. “The design and implementation of the campaign and enforcement has been decided at the local level.”

“Capacity is further enhanced by a sense of ownership of the local traffic safety department and its partners in the community,” Bivans continued. “The TSC cites an improved harmonization and efficiency in their work which will be the trigger for future opportunities to expand the initiative in other parts of the city and province by local leaders.”

For more on Global Actions work in Vietnam, visit our website.

What’s Happening Next:

· Russia: ICAP is holding a Master Class in Moscow for industry stakeholders from Russia and Ukraine today, February 29. The session is part of ICAP’s effort to build capacity across the alcohol industry.

Substance Misuse, July-September 2011

Statistics on Substance Misuse in Wales include data concerning people presenting to treatment services for substance misuse. The latest release updates the statistics previously released on 17 November 2011.

The key points from the latest release are:

• There were more than 7,800 referrals for treatment of alcohol or drug misuse notified to the database. During the quarter just over 5,000 assessments were carried out by treatment services and over 3,500 treatments commenced.
• 54 per cent (4,200) of referrals related to misuse of alcohol, 38 per cent (3,000) related to misuse of drugs and 7.5 per cent (600) of referrals had no main substance reported.
• 72 per cent of referrals for any substance were assessed within 10 working days of referral and 91 per cent of people were given treatment within 10 working days of assessment.

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Call for Papers: Special Issue on Fetal Alcohol Spectrum Disorders

The International Journal of Alcohol and Drug Research (IJADR) invites the submission of papers on biomedical, psychological, and sociological aspects related to Fetal Alcohol Spectrum Disorder (FASD), to be featured in this special issue to be published in September, 2013. Accepted papers will be published online prior to their inclusion in this special issue in order to make the research available more quickly.

Original articles (including both quantitative and qualitative research), methodological pieces, reviews, and case reports will be considered for publication and submitted for peer review, if eligible.

FASD describes permanent birth defects and encompasses a range of effects (including physical, behavioral, and cognitive) that result from maternal alcohol consumption during pregnancy. The goal of this special issue of the Journal is to publish papers that expand our current knowledge of FASD. We invite all FASD-related research submissions, and we especially encourage submission of papers from authors in developing countries (i.e., low- and middle-income countries). > > > > Read More

Addiction, History and Historians: A Symposium

This month, the journal Addiction published an essay by David Courtwright, “Addiction and the Science of History.” For readers unfamiliar with the journal, Addiction is one of the oldest and most influential interdisciplinary journals focusing on issues related to substance abuse and addiction.

Recently, the journal has begun a series called “Addiction and Its Sciences,” in which leading scholars from various disciplines discuss the relationship between their field and the addiction field generally. Recent entries in this series include Bennett Foddy, “Addiction and Its Sciences–Philosophy,” Addiction 106 (January 2011), 25-31, and Jonathan Caulkins and Nancy Nicosia, “Addiction and Its Sciences: What Economics Can Contribute to the Addiction Sciences,” Addiction 105 (July 2010), 1156-1163. David Courtwright’s essay has a kind of twofold purpose: first, to explain history (and historians) to the addiction research field and, second, to take stock of where both fields are in relation to one another. In that latter instance, David’s essay offers a useful set of reflections for those of us interested in where history is/should be headed. That includes Points readers, of course, and so it seemed like a good idea to make this essay available through this site. The editors and publishers of Addiction have generously agreed, and readers of this blog may access the article for free by following this link. > > > > Read More

Self-Reported Consumption Measures in Sample Surveys: A Simulation Study of Alcohol Consumption

Four methods of measuring alcohol consumption by self-report in sample surveys are compared on the basis of simulation studies of the drinking process in human populations.

Properties of population estimates and the classification of individuals are considered and the implications of the results for population surveys and epidemiological studies discussed.


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A new understanding of recovery residences

Recovery residences provide a vital tool for initiating and sustaining long-term recovery. They are desirable in their emphasis on structure and community in a recovery setting, their service provision over an extended period of time, and their cost-effectiveness.

Outcome studies show that the longer an individual remains in a recovery or treatment environment, the greater are her or his chances of sustaining recovery.1,2 Unfortunately, people in early recovery often are discharged from institutions or programs only to return to the environment where alcohol or other drug use triggers were experienced and addictive lifestyles were supported. Recovery residences provide a safe, healthy, community-based alternative for facilitating recovery at all stages of the recovery process.

Many convergent pathways to recovery exist, ranging from mutual support groups to professional treatment—each of which may be found in various types and levels of recovery residences. The residential spectrum offers a broad variety in terms of types of communities, intensity of structure, and degrees of services offered. Heretofore the field has lacked uniformity and precision of terms necessary to match presenting needs with the appropriate level of residential support.

The National Association of Recovery Residences (NARR) began in response to a call for residential providers across the service spectrum to create a uniform language and standards for all types of recovery residences. This association has attained a broad reach, finding commonality of standards, practice and language for the vast scope of residential operators. A seminal event of 2011 for the association was the adoption of a national standard for recovery residences, to include universal nomenclature. > > > > Read More

Effects of Alcohol Taxes on Alcohol-Related Disease Mortality in New York State from 1969 to 2006

The relationship of increased alcohol taxes to reductions in alcohol-related harm is well established. Few studies, however, have examined the effects of sudden decreases in alcohol tax rates or effects of narrow tax changes limited to specific beverage types. In the current study, we: (1) examine whether tax increases on spirits have similar effects in reducing alcohol-related disease mortality as increasing taxes on all types of alcoholic beverages simultaneously, and (2) evaluate effects of beer-specific tax decreases in New York State on mortality.

We used a time-series, quasi-experimental research design, including non-alcohol deaths within New York State and other states’ rates of alcohol-related disease mortality for comparison. The dataset included 456 monthly observations of mortality in New York State over a 38-year period (1969–2006). We used a random-effects approach and included several other important covariates.

Alcohol-related disease mortality declined by 7.0% after a 1990 tax increase for spirits and beer. A spirits-only tax increase (in 1972) was not significantly associated with mortality but a data anomaly increased error in this effect estimate. Small tax decreases on beer between 1996 and 2006 had no measurable effect on mortality. Doubling the beer tax from $0.11 to $0.22 per gallon, a return to New York State's 1990 levels, would decrease deaths by an estimated 250 deaths per year.

Excise tax increases on beer and spirits were associated with reductions in alcohol-related disease mortality. Modifying tax rates on a single beverage type does not appear to be as effective as doing so on multiple alcoholic beverages simultaneously. In New York, small decreases in beer taxes were not significantly associated with alcohol-related disease mortality.

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Kerala church commission pushes for declaring alcoholism as sin

Catholic prohibitionists in India's Kerala state have proposed making alcoholism a sin in the nation's largest Christian enclave.

"Alcoholism is a serious problem in Kerala, and we have to take tough measures to counter it," Bishop Sebastian Thekethecheril, chairman of the Temperance Commission of the Kerala Catholic Bishops' Council, told Catholic News Service Feb. 1 during the general assembly of the Catholic Bishops' Conference of India in Bangalore.

More than 100 Temperance Commission delegates from 30 dioceses met in Kerala Jan. 29 and drafted a policy that says anyone who consumes alcohol moderately should be kept away from the church at all levels -- from teaching catechism to parish committees and any other nominated or elected post. > > > > Read More

Ethnic Drinking Cultures and Alcohol Use among Asian American Adults: Findings from a National Survey

To investigate the influence of ethnic drinking cultures on alcohol use by Asian Americans and how this influence may be moderated by their level of integration into Asian ethnic cultures.

A nationally representative sample of 952 Asian American adults extracted from the Wave 2 National Epidemiologic Survey of Alcohol and Related Conditions data was used. Multiple logistic and linear regression models were fitted, some of which were stratified by nativity.

Controlling for financial stress, discrimination and demographic variables, a hypothesized, positive relationship between ethnic drinking cultures and alcohol outcomes held for most drinking outcomes. A hypothesis on the moderating effect of integration into ethnic cultures indicated by ethnic language use was supported for US-born Asian Americans.

Ethnic drinking cultures may significantly influence alcohol use by Asian Americans. The influence of ethnic drinking cultures may be conditioned by the degree of integration into the ethnic cultures. To inform alcohol interventions for reducing harmful and hazardous alcohol use among immigrants, future research needs to explore the cultural and social processes occurring in immigrant communities that might significantly influence drinking.



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Request Reprint E-Mail: wcook@arg.org

NIAAA Jack Mendelson Honorary Lecture Series:

Event: 4th Annual Jack Mendelson Honorary Lecture Location: Lipsett Amphitheater, NIH Clinical Center (Bldg. 10), Bethesda, MD Start Date: 4/19/2012 1:30:00 PM End Date: 4/19/2012 3:30:00 PM

As a tribute to Dr. Mendelson's remarkable scientific contributions to the field of alcohol research, NIAAA has established this honorary lecture series to highlight clinical/human research in the alcohol field by featuring an outstanding investigator who has made significant and long-term contributions to our understanding of alcoholism susceptibility, alcohol's effects on the brain and other organs, and the prevention and treatment of alcohol use disorders. NIAAA is please to present this series of scientific lectures both to acknowledge continuing advances in alcohol-related areas of clinical research and to honor the memory of an individual whose pioneering research in alcoholism remains relevant today.

> > > > > Read More

IAS Alcohol Alert 2011 issue 3

The Institute for Alcohol Studies' (IAS) latest Alcohol Alert is available, with the cover feature exploring the Prime Minister's recent indications of support for minimum pricing. See our recent report here after the Cameron spoke out on Britain's "alcohol scandal". > > > > Read More

Blunting the legacy of alcohol abuse in Western Australia

After bravely ushering in alcohol sale restrictions proposed by its residents, a remote Western Australian community is tackling the long-term effects of alcohol misuse.

Tony Kirby reports.

Fitzroy Crossing, an isolated town with approximately 2500 residents in Australia's remote northwest, was typical of such communities, with a large Indigenous population (around 60%), high rates of harmful alcohol use, and depressingly high rates of alcohol-related violence and crime.

A tipping point came in 2007 when there were 55 deaths in the community, 13 being suicides. Alcohol was a factor in most deaths. After much consultation, community elders took what at the time was unthinkable action: proposing that all stores selling take-away alcohol be restricted only to low-strength beverages, with a maximum of 2·5% alcohol by volume. Take-away sales of stronger beers or ciders, wine, and spirits were prohibited, meaning these could only be bought in the bar of the town's two licensed premises that were prohibitively expensive to many residents. The nearest town selling take-away high strength alcohol is 250 km away. Despite stern opposition and personal threats to those leading the reform, there was sufficient community support to implement a trial of the restrictions.

12 months after their introduction, independent assessment showed a 28% reduction in alcohol-related incidents attended by police, a 42% reduction in alcohol-related hospital presentations, and a 14% increase in school attendance. Fitzroy Crossing suddenly became a more pleasant place to live and work. Local police could engage proactively with the community, rather than responding to incidents over which they had no control. So successful were the restrictions that the West Australian Liquor Licensing authorities extended them indefinitely. > > > > Read More

Social contexts of sports-practicing youths’ hazardous drinking

Sports-practicing youths are at an elevated risk for alcohol use and misuse. Although much attention has recently been given to depicting subgroups facing the greatest threats, little evidence exists on the contexts in which their drinking takes place.

Using data from a cross-sectional study on youth sports participation and substance use in the French-speaking part of Switzerland, this study focused on the social contexts associated with hazardous drinking of 894 sports-practicing adolescents aged 16 to 20. Divided between those who had been drunk in the last month (hazardous drinkers, n = 315) and those who had not (n = 579), sports-practicing adolescents were compared on reported gatherings (sports-related, sports-unrelated, mixed) likely linked to their drinking behaviour.

Mixed social contexts, followed by sports-unrelated ones, were reported as the most common context by both male and female youths who practiced sports.

After controlling for several possible confounders, male hazardous drinkers were more than 3 times more likely to report sports-unrelated social contexts as the most common, compared to sport-related ones, while females were more than 7 times more likely to do so.

Our findings seem to indicate that, rather than focusing only on sports-related factors, prevention of alcohol misuse among sports-practicing youths should also pay attention to the social contextualisation of their hazardous drinking.


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mTOR-STAT3-notch signalling contributes to ALDH2-induced protection against cardiac contractile dysfunction and autophagy under alcoholism

Mitochondrial aldehyde dehydrogenase-2 (ALDH2) has been shown to benefit myopathic changes following alcohol intake, although the precise mechanism is still unclear.

This study was designed to evaluate the role of ALDH2 on chronic alcohol intake-induced myocardial geometric and functional damage with a focus on autophagic signalling.

Wild-type friendly virus B (FVB) and transgenic mice overexpressing ALDH2 driven by chicken β-actin promoter were fed a 4% alcohol liquid diet for 12 weeks. Cardiac geometry and function were assessed using echocardiographic and IonOptix systems. Western blot analysis was used to evaluate the essential autophagy markers, Akt and AMP-dependent protein kinase (AMPK) as well as their downstream signalling mammalian target of rapamycin (mTOR) and signal transducer and activator of transcription 3 (STAT3).

Alcohol intake altered cardiac geometry and function as demonstrated by lessened LV wall and septal thickness, enlarged end systolic and diastolic diameters, decreased fractional shortening and cell shortening, the effects of which were mitigated by ALDH2 transgene.

Chronic alcohol intake triggered myocardial autophagy as shown by LC3B II isoform switch, as well as decreased phosphorylation of mTOR, the effects of which were ablated by ALDH2.

Chronic alcohol intake suppressed phosphorylation of Akt and AMPK, which was reconciled by ALDH2. Levels of Notch1 and STAT3 phosphorylation were dampened by chronic alcohol intake in FVB but not ALDH2 myocardium.

Moreover, the γ-secretase Notch inhibitor N\xE2\x80\x90[N-(3,5-difluorophenacetyl)-1-alany1]-S-phenyglycine t-butyl ester exacerbated ethanol-induced cardiomyocyte contractile dysfunction, apoptosis and autophagy.

In summary, these findings suggested that ALDH2 elicits cardioprotection against chronic alcohol intake-induced cardiac geometric and functional anomalies by inhibition of autophagy possibly via restoring the Akt-mTOR-STAT3-Notch signalling cascade.

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Home Drinking in the UK: Trends and Causes

To explore the trend in the UK to consume alcohol at home rather than at licensed premises.

A Medline search entering the terms ‘home drinking’, ‘alcohol’ and ‘adult’ covering the period 2000–2011yielded 48 articles, of which 6 met the criteria to be included in the review. Grey literature including survey and market research data were reviewed.

In the UK, since 1970 there has been trend for beer to be consumed at home more often than in licensed premises and that the overall trend towards greater home drinking has increased since 2000. The main reasons given are convenience, cost, safety, autonomy and stress relief. There has also been an increase in the practice known as ‘pre-loading’ (drinking before going out). Adults who drink mainly at home report that they are aware that they run a risk of higher overall alcohol consumption but tend to play down the possibility that increased consumption may lead to longer-term harm.

Home drinking trends may have long-term public health consequences. Greater understanding of the drivers of this trend will help policy-makers to respond to these societal changes.



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Age and ethnic differences in the onset, persistence and recurrence of alcohol use disorder

To estimate ethnic differences in three components of alcohol use disorder and alcohol dependence course (onset, persistence and recurrence) in a developmental framework.

Longitudinal data from The National Epidemiologic Survey of Alcohol and Related Conditions (NESARC), collected using face-to-face interviews.

Civilian non-institutionalized US population aged 18 years and older, with oversampling of Hispanics, blacks and those aged 18–24 years.

Individuals who completed both NESARC assessments, were not life-long abstainers and were either white (n = 17 458), black (n = 4995), US-born Hispanic (n = 2810) or Hispanic-born outside the United States (n = 2389).

Alcohol dependence (AD) and alcohol use disorder (AUD; abuse or dependence) onset, persistence and recurrence were examined using the Alcohol Use Disorders and Associated Disabilities Interview Schedule, DSM-IV version.

Among men: relative to whites aged 18–29, AUD onset and persistence were elevated only in US-born Hispanics aged 40 years and older; odds were reduced for all non-US-born Hispanics, older whites, most blacks and US-born Hispanics aged 30–39. For AD, onset risk was elevated for all younger minority men and only reduced among non-US-born aged Hispanics 40 or older. For women: compared to young whites, non-US-born Hispanics were at decreased AUD and AD onset risk; AUD and AD onset and persistence were increased for older blacks and US-born Hispanics.

In the United States, ethnic differences in alcohol disorder transitions (onset, persistence, and recurrence) vary across age, gender and whether a broad (alcohol use disorder) or narrow (alcohol dependence) alcohol definition is used. Evidence of increased risk for some transitions in minority groups suggests that attention should be paid to the course of alcohol use disorders, and that differences in prevalence should not be assumed to reflect differences in specific transitions.

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Request Reprint E-Mail: grantj@psychiatry.wustl.edu

Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?

This study aimed to examine age, cohort and period trends in alcohol abstinence.

Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

The samples were representative of the Swedish population.

Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

Alcohol abstinence was determined by asking ‘Do you ever drink wine, beer, or spirits?’, where a ‘no’ response indicated abstinence.

Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

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Request Reprint E-Mail: kozma.ahacic@ki.se

Involvement of general practitioners in managing alcohol problems: a randomised controlled trial of a tailored improvement programme.

To assess the effect of a tailored multi-facetted improvement programme on GPs' behaviour towards prevention of hazardous and harmful alcohol consumption. The improvement programme consisted of activities aimed at the GP, organisation and patient. Educational trainings and visits by a facilitator were tailored to the GPs’ needs and attitudes.

Cluster randomised controlled trial.

General practices in the Netherlands.

77 general practices, 119 GPs participated. Data from 6318 patients were available of whom 765 (12.1%) were at risk. 1502 patients’ electronic medical records were reviewed.

The primary outcome was the number of eligible patients who received screening and advice.

Difficulties in recruiting GPs and in motivating GPs for participation in the tailored parts of the programme impeded optimal implementation of the programme. Although GPs in both group became more involved after enrolment, this improvement faded during the trial. The quality improvement programme enhanced the initial improvement in behaviour and it tempered fading (intervention group), compared to our control condition, resulting in average improvement rates of 5% (screening) and 2% (advice giving) at 12-month follow-up (not significant).

A tailored, multi-facetted programme aimed at improving GP management of alcohol consumption in their patients failed to show an effect and proved difficult to implement. There remains little evidence to support the use of such intensive implementation programme to improve the management of harmful and hazardous alcohol consumption in primary care.

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Request Reprint E-Mail: I van Beurden ivonnevb@hotmail.com

Assessment of Generalizability, Applicability, and Predictability (GAP) for evaluating external validity in studies of universal family-based preventi

To assess external validity characteristics of studies from two Cochrane systematic reviews of the effectiveness of universal family-based prevention of alcohol misuse in young people.

Two reviewers used an a priori developed external validity rating form and independently assessed three external validity dimensions of generalizability, applicability, and predictability (GAP) in randomized controlled trials.

The majority (69%) of the included 29 studies were rated ‘unclear’ on the reporting of sufficient information for judging generalizability from sample to study population. Ten studies (35%) were rated “unclear” on the reporting of sufficient information for judging applicability to other populations and settings. No study provided an assessment of the validity of the trial endpoint measures for subsequent mortality, morbidity, quality of life or other economic or social outcomes. Similarly, no study reported on the validity of surrogate measures using established criteria for assessing surrogate endpoints.

Studies evaluating the benefits of family-based prevention of alcohol misuse in young people are generally inadequate at reporting information relevant to generalisability of the findings or implications for health or social outcomes. Researchers, study authors, peer reviewers, journal editors and scientific societies should take steps to improve the reporting of external validity in prevention trials.

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Request Reprint E-Mail: david.foxcroft@brookes.ac.uk

Predictors of the two-year recurrence and persistence of alcohol dependence

To identify independent risk factors of the recurrence of alcohol dependence (AD) in persons with a remitted disorder at baseline and persistence of AD in persons with a current disorder at baseline.

Prospective cohort study with assessments at baseline and two-year follow-up.

Recruitment from the general population, primary care and outpatient mental health care services.

Persons with remitted AD (n=253) and current AD (n=135).

Recurrence and persistence of AD during two-year follow-up were established with the CIDI interview based on DSM-IV. Logistic regression analyses were performed to explore the role of potential risk factors (i.e., baseline severity of alcohol problems, measures for depression and anxiety, sociodemographics, vulnerability factors, and addiction-related factors) as independent predictors of a negative course.

Overall recurrence and persistence rates of AD were 14.6% and 40.7%, respectively, and were highly conditional on the severity of alcohol problems (adjusted OR per SD increase: OR=3.64, 95%CI=2.21-6.01 and OR=2.12, 95%CI=1.32-3.40, respectively). Severity of depressive/anxiety symptoms was an additional independent predictor of the recurrence of AD, whereas male gender and high education were significant, independent risk factors of the persistence of AD.

Alcohol dependence has a dynamic course with only moderate levels of diagnostic stability. Both recurrence and persistence of alcohol dependence are highly dependent on severity of baseline alcohol problems, whereas severity of depressive/anxiety symptoms only predicts the recurrence of alcohol dependence. Both measures may be useful in identifying persons at an increased risk of a negative course and who could be targeted by prevention strategies.

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Request Reprint E-Mail: l.boschloo@ggzingeest.nl

EUCAM News Updates

The following news items have been published on www.EUCAM.info in February of 2012:

New study concludes movies influence youngsters drinking

02/23/12 - Young people who watch a lot of movies featuring alcohol use, are twice as likely to drink, according to new research by Dartmouth Medical School. In the span of two years, the American researchers questioned more than 6,500 youngsters four times, asking in each session whether they had seen any of 50 randomly selected films.

Read the full article >>



Alcohol Companies set up guidelines for responsible digital marketing

02/16/12 - This week, a new campaign, set up by the European Forum for Responsible Drinking (EFRD), has started promoting responsible marketing practices for the alcohol industry on social media. Members of the EFRD include Bacardi, Martini and Diageo, who last year signed a significant deal with Facebook, the world’s most popular social network site.

Read the full article >>



Denmark: first time ruling against alcohol marketing aimed at minors

02/11/12 - Recently, Denmark has seen a unique court verdict, ruling that alcohol has no place in advertising targeted at minors. The verdict is a victory for both the Consumer Ombudsman, and Alcohol and Society (former Danish Alcohol Policy Network), being the fruit of several complaints throughout the years.

Read the full article >>



Madonna: The Queen of Alcopop

02/09/12 - This February saw Madonna, the queen of pop, release her new single Give me all your luvin’, the accompanying video clip features product placement by Diageo’s vodka brand Smirnoff. This development means an extension of the existing partnership between the pop star and drinks producer Diageo.

Read the full article >>



Australian government urged to crack down on alcohol advertising

02/07/12 - The Australian administration of Julia Gillard is being urged by the Australian Medical Association (AMA) to strengthen regulations on junk food and alcohol advertising. This recommendation follows on the tough stance the government has taken against big tobacco, by measures that mean that tobacco can only be sold in plain packages without logo’s or brand colors.

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Ireland to ban alcohol sports sponsorship?

02/07/12 - The National Substance Misuse Strategy for Northern Ireland, expected to be published early 2012, is presumed to recommend a ban of all alcohol outdoor advertising as well as alcohol sponsorship of sports events, concerts or festivals. The strategy is also expected to include minimum pricing.

Read the full article >>

In silico models of alcohol dependence and treatment

In this paper we view alcohol dependence and the response to treatment as a recurrent bio-behavioral process developing in time and propose formal models of this process combining behavior and biology in silico. The behavioral components of alcohol dependence and treatment are formally described by a stochastic process of human behavior, which serves as an event generator challenging the metabolic system. The biological component is driven by the biochemistry of alcohol intoxication described by deterministic models of ethanol pharmacodynamics and pharmacokinetics to enable simulation of drinking addiction in humans.

Derived from the known physiology of ethanol and the literature of both ethanol intoxication and ethanol absorption, the different models are distilled into a minimal model (as simple as the complexity of the data allows) that can represent any specific patient.

We use these modeling and simulation techniques to explain responses to placebo and ondansetron treatment observed in clinical studies. Specifically, the response to placebo was explained by a reduction of the probability of environmental reinforcement, while the effect of ondansetron was explained by a gradual decline in the degree of ethanol-induced neuromodulation.

Further, we use in silico experiments to study critical transitions in blood alcohol levels after specific average number of drinks per day, and propose the existence of two critical thresholds in the human – one at 5 and another at 11 drinks/day – at which the system shifts from stable to critical and to super critical state indicating a state of alcohol addiction.

The advantages of such a model-based investigation are that (1) the process of instigation of alcohol dependence and its treatment can be deconstructed into meaningful steps, which allow for individualized treatment tailoring, and (2) physiology and behavior can be quantified in different (animal or human) studies and then the results can be integrated in silico.


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Hazardous Alcohol Consumption Is a Major Factor in Male Premature Mortality in a Typical Russian City: Prospective Cohort Study 2003–2009

Russia has experienced massive fluctuations in mortality at working ages over the past three decades. Routine data analyses suggest that these are largely driven by fluctuations in heavy alcohol drinking. However, individual-level evidence supporting alcohol having a major role in Russian mortality comes from only two case-control studies, which could be subject to serious biases due to their design.

A prospective study of mortality (2003–9) of 2000 men aged 25–54 years at recruitment was conducted in the city of Izhevsk, Russia. This cohort was free from key limitations inherent in the design of the two earlier case-control studies. Cox proportional hazards regression was used to estimate hazard ratios of all-cause mortality by alcohol drinking type as reported by a proxy informant. Hazardous drinkers were defined as those who either drank non-beverage alcohols or were reported to regularly have hangovers or other behaviours related to heavy drinking episodes.

Over the follow-up period 113 men died. Compared to non-hazardous drinkers and abstainers, men who drank hazardously had appreciably higher mortality (HR = 3.4, 95% CI 2.2, 5.1) adjusted for age, smoking and education. The population attributable risk percent (PAR%) for hazardous drinking was 26% (95% CI 14,37). However, larger effects were seen in the first two years of follow-up, with a HR of 4.6 (2.5, 8.2) and a corresponding PAR% of 37% (17, 51).

This prospective cohort study strengthens the evidence that hazardous alcohol consumption has been a major determinant of mortality among working age men in a typical Russian city. As such the similar findings of the previous case-control studies cannot be explained as artefacts of limitations of their design. As Russia struggles to raise life expectancy, which even in 2009 was only 62 years among men, control of hazardous drinking must remain a top public health priority.

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Alcohol and Obesity: National Obesity Observatory report explores links

The National Obesity Observatory has published a report on the links between alcohol consumption and obesity:

Download: Obesity and alcohol – an overview

The report states that although there is no clear causal relationship between alcohol consumption and obesity, there are associations between the two which are heavily influenced by lifestyle, genetic and social factors. Many people are also not aware of the calories contained in alcoholic drinks which can contain "nutrient poor" calories, for instance there are up to 180 calories in a large glass of wine and 250 calories in a pint of strong lager.

Further key points from the report include:

• The effects of alcohol on body weight may be more pronounced in overweight and obese people
• Alcohol consumption can lead to an increase in food intake
• Heavy, but less frequent drinkers seem to be at higher risk of obesity than moderate, frequent drinkers
• The relationships between obesity and alcohol consumption differ between men and women
• Excess body weight and alcohol consumption appear to act together to increase the risk of liver cirrhosis > > > > > Read More
  

Parental supply of alcohol and adolescent risky drinking

In Australia, 20% of 14- to 19-year-olds drink at least weekly. Some parents supply alcohol to their adolescent children with the intention of limiting the quantity consumed, but it is possible that such supply facilitates risky drinking. We sought to determine whether there is an association between parental supply and risky drinking.

A cross-sectional survey was conducted in seven high schools in New South Wales, Australia. Five hundred and thirty students (mean age 16.0 years, SD 1.3) completed survey items relating to their alcohol consumption, sources of alcohol, circumstances of parental supply, and peers' consumption.

Among respondents (response rate 43%), 93% of participants had tried alcohol, 66% had consumed at least a full glass, and 40% had consumed more than four drinks on a single occasion in the preceding month (risky drinking). Risky drinkers obtained alcohol mainly from friends (48%) and parents (19%). After controlling for school year and gender, and adjusting for clustering, parental supply for drinking under ‘other’ supervision (P = 0.004) and with no supervision (P = 0.007), the number of close friends believed to have consumed alcohol in the past month (P < 0.001), and Aboriginal or Torres Strait Islander status (P = 0.02) were all significantly associated with risky drinking.

Parental supply of alcohol for unsupervised drinking is associated with risky drinking among 13- to 17-year-olds. Longitudinal studies would assist in studying the temporal sequence and controlling for confounding.

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Request Reprint E-Mail: conor.gilligan@newcastle.edu.au

Alcohol in the European Union - Consumption, harm and policy approaches, 27 March 2012, Copenhagen, Denmark

WHO Regional Office for Europe and Alcohol and Society invites you to their conference "Alcohol in the European Union - Consumption, harm and policy approaches".The conference will be chaired by Dr. Lars Möller (WHO Europe) and is organised by WHO Europe and Alcohol&Society.

At the conference a new WHO Europe publication will be launched.

Alcohol in the European Union covers the main areas of alcohol policy and gives the most recent data among the EU countries, Norway and Switzerland. > > > > Read More

Czech teenagers increasingly drink alcohol - ESPAD study

The number of sixteen-year persons regularly drinking alcohol and getting drunk is on the rise in the Czech Republic, according to the European School Survey Project on Alcohol and Other Drugs (ESPAD) for last year and unveiled today. > > > > > Read More

Baseline trajectories of heavy drinking and their effects on postrandomization drinking in the COMBINE Study: empirically derived predictors of drinki

The Combined Pharmacotherapies and Behavioral Interventions (COMBINE) Study sought to answer questions about the benefits of combining behavioral and pharmacological interventions (naltrexone and acamprosate) in alcohol-dependent patients.

Our goals were to identify trajectories of heavy drinking before randomization in COMBINE, to characterize patients in these trajectories, and to assess whether prerandomization trajectories predict drinking outcomes.

We analyzed daily indicators of heavy drinking 90 days before randomization using a trajectory-based approach. Each patient was assigned to the most likely prerandomization heavy-drinking trajectory, and the baseline characteristics of participants in the baseline trajectories were compared.

The main and interactive effects of these trajectories and treatment factors (acamprosate, naltrexone, or combined behavioral intervention) on summary drinking measures during active treatment (16 weeks) were assessed.

We identified five trajectories of heavy drinking prerandomization: “T1: frequent heavy drinkers”; “T2: very frequent heavy drinkers”; “T3: nearly daily heavy drinkers”; “T4: daily heavy drinkers”; and “T5: daily heavy drinkers stopping early” before randomization.

Trajectory membership was significantly associated with all drinking outcomes. Patients in “T5: daily heavy drinkers stopping early” had comparable drinking outcomes to those in “T1: frequent heavy drinkers,” whereas the remaining trajectories were associated with significantly worse outcomes.

The baseline trajectory did not interact significantly with the treatment condition.

These exploratory analyses confirmed the hypothesis that baseline trajectories predict postrandomization drinking outcomes.

Interestingly, “T5: daily heavy drinkers stopping early” had outcomes that were comparable to the least severe baseline trajectory “T1: frequent heavy drinkers,” and baseline trajectories of heavy drinking did not moderate the treatment effects.



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Request Reprint E-Mail: ralitza.gueorguieva@yale.edu

Risk Factors for Alcohol-Related Problems Among Victims of Partner Violence

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied.

We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010.

Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence.

Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking.

Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.

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Request Reprint E-Mail: tami.sullivan@yale.edu