Teaching the Biological Consequences of Alcohol Abuse through an Online Game: Impacts among Secondary Students

A multimedia game was designed to serve as a dual-purpose intervention that aligned with National Science Content Standards, while also conveying knowledge about the consequences of alcohol consumption for a secondary school audience. A tertiary goal was to positively impact adolescents' attitudes toward science through career role-play experiences within the game.

In a pretest/delayed posttest design, middle and high school students, both male and female, demonstrated significant gains on measures of content knowledge and attitudes toward science.

The best predictors of these outcomes were the players' ratings of the game's usability and satisfaction with the game.

The outcomes suggest that game interventions can successfully teach standards-based science content, target age-appropriate health messages, and impact students' attitudes toward science.



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Request Reprint E-Mail: Yvonne.Klisch@rice.edu

Alcohol use and abuse among rural Zimbabwean adults: A test of a community-level intervention

Understanding what factors contribute to alcohol abuse in resource-poor countries is important given its adverse health consequences. Past research shows that social peers influence substance abuse, suggesting that the social environment may be an effective target for reducing alcohol abuse across a population. This study investigates the determinants of alcohol use and abuse in rural Zimbabwe and tests a Community Popular Opinion Leader (CPOL) community-based intervention partly directed at reducing alcohol abuse.

Tests were conducted on the impact of the CPOL intervention on alcohol use patterns across communities in rural Zimbabwe over three waves from 2003 to 2007, including community- and individual-level tests using data based on in-person interviews of adult men and women (ages 18-30; N=5543). Data were analyzed using paired-sample t-tests, as well as logistic and ordinary least-squares regression with random effects.

Higher drinking (any use, more frequent use, greater quantity, and/or frequent drunkenness) was generally associated with being male, older, not married, more highly educated, of Shona ethnicity, away from home frequently, employed, having no religious affiliation, or living in areas with a higher crude death rate or lower population density. Over the study period, significant declines in alcohol use and abuse were found in intervention and control sites at relatively equal levels.

Although no support was found for the effectiveness of the CPOL study in reducing alcohol abuse, Zimbabwe is similar to other countries in the impact of socio-demographic and cultural factors on alcohol use and abuse.

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Request Reprint E-Mail: cubbinsl@battelle.org

Lysergic acid diethylamide (LSD) for alcoholism: meta-analysis of randomized controlled trials

Assessments of lysergic acid diethylamide (LSD) in the treatment of alcoholism have not been based on quantitative meta-analysis. Hence, we performed a meta-analysis of randomized controlled trials in order to evaluate the clinical efficacy of LSD in the treatment of alcoholism.

Two reviewers independently extracted the data, pooling the effects using odds ratios (ORs) by a generic inverse variance, random effects model.

We identified six eligible trials, including 536 participants. There was evidence for a beneficial effect of LSD on alcohol misuse (OR, 1.96; 95% CI, 1.36–2.84; p = 0.0003).

Between-trial heterogeneity for the treatment effects was negligible (I² = 0%). Secondary outcomes, risk of bias and limitations are discussed.

A single dose of LSD, in the context of various alcoholism treatment programs, is associated with a decrease in alcohol misuse.



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Very young adolescents and alcohol: Evidence of a unique susceptibility to peer alcohol use

The aim of this study is to examine the susceptibility of very young adolescents (10-12years of age) to peer alcohol-related influences, compared to older adolescents (13-14years of age).

The analysis sample consisted of 7064 adolescents in grade 6 (modal age 11) or grade 8 (modal age 13) from 231 schools in 30 communities across three Australian States. Key measures were adolescent reports of alcohol use (past 30days) and the number of peers who consume alcohol without their parent's awareness. Control variables included parent alcohol use, family relationship quality, pubertal advancement, school connectedness, sensation seeking, depression, length of time in high school, as well as age, gender, father/mother education, and language spoken at home. A multi-level model of alcohol use was used to account for school-level clustering on the dependent variable.

For both groups, the number of peers who consumed alcohol was associated with alcohol use, but Grade 6 students showed a unique susceptibility to peripheral involvement with peer drinking networks (having one friend who consumed alcohol).

The results point to the importance of monitoring and responding to comparatively minor shifts in the proportion of peers who use alcohol, particularly among very young adolescents.

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Request Reprint E-Mail: a.kelly@uq.edu.au

Maternal and Paternal Alcohol Misuse and Alcohol-Related Outcomes Among College Students

Using a large college student sample (N = 1,095), the present study examined whether the relationship between parental alcohol abuse and offspring alcohol use varied as a function of parent and offspring gender, and whether the relationship to the non-substance-abusing mother or father buffered against the risk associated with being an adult child of an alcoholic (ACOA).

Among women, maternal ACOAs (i.e., the mother only was suspected of alcohol misuse) had the greatest risk of problematic alcohol consumption, whereas among men, both parent ACOAs (i.e., both parents were suspected of alcohol misuse) had the greatest risk of problematic alcohol consumption.

No support was found for the buffering hypothesis. We discuss implications of our findings and future directions.

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Request Reprint E-Mail: mpear008@odu.edu

Quantitative trait loci for sensitivity to ethanol intoxication in a C57BL/6J 3 129S1/SvImJ inbred mouse cross

Individual variation in sensitivity to acute ethanol (EtOH) challenge is associated with alcohol drinking
and is a predictor of alcohol abuse. Previous studies have shown that the C57BL/6J (B6) and 129S1/SvImJ (S1) inbred mouse strains differ in responses on certain measures of acute EtOH intoxication.

To gain insight into genetic factors contributing to these differences, we performed quantitative trait locus (QTL) analysis of measures of EtOH-induced ataxia (accelerating rotarod), hypothermia,and loss of righting reflex (LORR) duration in a B6 9 S1 F2 population.

We confirmed that S1 showed greater EtOH-induced hypothermia (specifically at a high
dose) and longer LORR compared to B6. QTL analysis revealed several additive and interacting loci for various phenotypes, as well as examples of genotype interactions with sex.

QTLs for different EtOH phenotypes were largely non-overlapping, suggesting separable genetic influences on these behaviors. The most compelling main-effect QTLs were for hypothermia on chromosome 16 and for LORR on
chromosomes 4 and 6. Several QTLs overlapped with loci repeatedly linked to EtOH drinking in previous mouse studies.

The architecture of the traits we examined was complex but clearly amenable to dissection in future studies. Using integrative genomics strategies, plausible functional and positional candidates may be found.

Uncovering candidate genes associated with variation in these phenotypes in this population could ultimately shed light on genetic factors underlying sensitivity to EtOH intoxication and risk for alcoholism in humans.


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Biological Markers for Alcohol Withdrawal Seizures: A Retrospective Analysis

Alcohol withdrawal seizures (AWS) are among the most important possible complications during the detoxification treatment of alcohol-dependent patients. Pharmacological therapy is often used during detoxification, but can cause dangerous side effects [Eur Addict Res 2010;16:179–184]. In separate studies several biological markers have been described as being associated with AWS risk. We investigated the role of homocysteine (HCT), carbohydrate-deficient transferrin (CDT) and prolactin (PRL) as biological markers for the risk of developing AWS.

The present study included 189 alcohol-dependent patients of whom 51 had a history of AWS. We investigated the HCT, CDT and PRL levels of all patients and calculated sensitivity and specificity. Bayes’ theorem was used to calculate positive (PPV) and negative (NPV) predictive values.

The highest combined sensitivity and specificity for %CDT was reached at a plasma cutoff value of 3.75%. The combination of HCT at a cutoff value of 23.9 µmol/l and %CDT at a cutoff value of 3.75% showed the best predictive values (sensitivity 47.1%, specificity 88.4%, PPV 0.504, NPV 0.870).

A combined assessment of HCT and CDT levels can be a useful method to identify patients at a higher risk of AWS, which may lead to a more individualized therapy.


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Request Reprint E-Mail: karaguelle.deniz@mh-hannover.de

How Important Is the Context of an Adolescent’s First Alcoholic Drink? Evidence that Parental Provision May Reduce Later Heavy Episodic Drinking

This study examined the extent to which a retrospective measure of parental provision of the first alcoholic beverage was related to current heavy episodic drinking and current responsible drinking practices.

608 14- to 17-year-olds from the 2007 Australian National Drug Strategy Household Survey. Measures: Source of first alcoholic beverage (friends/parents/others), source of current alcohol, age of onset of alcohol use, current responsible drinking practices, and proportion of current friends who drink.

Binary logistic and multiple regression procedures revealed that parental provision of an adolescent’s first alcoholic beverage predicted lower current heavy episodic drinking, and responsible drinking mediated this association.

The results suggested that for adolescents who become alcohol users, parental provision of the first drink may reduce subsequent alcohol-related risks compared to introduction to alcohol by friends and other sources. Alcohol-related risks remain significant for adolescents who consume alcohol, independent of who is the provider.



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Request Reprint E-Mail: a.kelly@uq.edu.au

Associations between self-reported illness and non-drinking in young adults

This study investigated associations between self-reported illness, social factors and health behaviours and non-drinking among young people aged 18 to 34 years.

Logistic regression analysis of cross-sectional national survey data, collected from The Health Survey for England 2006 and 2008. Data was collected through face to face interviews and is self-reported.

2,826 male and 3,618 females aged 18 to 34 years drawn from a nationally representative multi-stage stratified probability sampling design across England.

Non-drinkers were based on those who reported no to drinking alcohol nowadays. Exposure measures included self-reports of having a limiting longstanding illness, longstanding illness, or self-reported poor health. We adjusted for ethnicity, income, education, general physical activity and other factors.

Having a limiting longstanding illness during early adulthood increased the odds of being a non-drinker 1.74 times for men (p<0.01), and 1.45 times for women (p<0.01). In both men and women belonging to the lowest income quintile or having no qualifications was associated with increased odds of being a non-drinker (p<0.001) indicating that the social gradient in non-drinking begins at an early age. Men and women aged 18 to 34 years with the lowest activity levels were also more likely to be non-drinkers (p<0.01).

Young adults who have a limiting longstanding illness are more likely not to drink alcohol even after adjusting for a range of social and demographic measures. Studies on the putative health benefits of moderate alcohol consumption later in life need to take account of early life history.

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Request Reprint E-Mail: l.ngfat.10@ucl.ac.uk

Alcohol Consumption and Risk of Stroke in Women

Light-to-moderate alcohol consumption has been consistently associated with lower risk of heart disease, but data for stroke are less certain. A lower risk of stroke with light-to-moderate alcohol intake has been suggested, but the dose response among women remains uncertain and the data in this subgroup have been sparse.

A total of 83 578 female participants of the Nurses' Health Study who were free of diagnosed cardiovascular disease and cancer at baseline were followed-up from 1980 to 2006. Data on self-reported alcohol consumption were assessed at baseline and updated approximately every 4 years, whereas stroke and potential confounder data were updated at baseline and biennially. Strokes were classified according to the National Survey of Stroke criteria.

We observed 2171 incident strokes over 1 695 324 person-years. In multivariable adjusted analyses, compared to abstainers, the relative risks of stroke were 0.83 (95% CI, 0.75–0.92) for <5 g/d, 0.79 (95% CI, 0.70–0.90) for 5 to 14.9 g/d, 0.87 (0.72–1.05) for 15 to 29.9 g/d, and 1.06 (95% CI, 0.86–1.30) for 30 to 45 g/d. Results were similar for ischemic and hemorrhagic stroke.

Light-to-moderate alcohol consumption was associated with a lower risk of total stroke. In this population of women with modest alcohol consumption, an elevated risk of total stroke related to alcohol was not observed.

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Request Reprint E-Mail: krexrode@partners.org

General Lifestyle Survey Overview A report on the 2010 General Lifestyle Survey

This report presents the latest information from the General Lifestyle Survey (GLF) for the 2010 calendar year (January to December). The report covers the main topics of the survey, which are presented as seven chapters: Smoking; Drinking; Households, families and people; Housing and consumer durables; Marriage and cohabitation; Pensions; and General health. The chapters provide overviews of each topic area, which are also supported by tabular output. The tabular output is provided in the form of Microsoft Excel tables that can be downloaded by clicking on the table references within the report.

Drinking
The General Household Survey (GHS) and the General Lifestyle Survey (GLF) have, between them, been measuring drinking behaviour for over 30 years. This chapter presents information on recent trends over time in drinking behaviour and detailed data for the 2010 survey year.

How the data are used and their importance..
Measuring alcohol consumption
Recent changes in methodology
Trends in average weekly alcohol consumption.
Trends in last week’s drinking
Frequency of alcohol consumption
Awareness of level of alcohol consumption.
Weekly alcohol consumption by sex and age
Weekly alcohol consumption and household socio-economic status
Weekly alcohol consumption and smoking.
Weekly alcohol consumption in urban and rural areas
Drinking in the week before interview in 2010.
Frequency of drinking during the last week.
Maximum daily amount drunk last week
characteristics
Drinking last week and smoking status
Drinking last week in urban and rural areas.
Drinking last week and household income.
Drinking last week, economic activity and earnings from employment.
Variation in drinking last week between countries and regions..
Drinking during pregnancy.
Notes and references.


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The Influence of Gene–Environment Interactions on the Development of Alcoholism and Drug Dependence

Alcoholism and drug dependence are common psychiatric disorders with a heritability of about 50%; therefore genetic and environmental influences are equally important.

Early-life stress is a predictor of adolescent problem drinking/drug use and alcohol/drug dependence in adulthood, but moderating factors governing the availability of alcohol/drug are important.

The risk–resilience balance for addiction may be due in part to the interaction between genetic variation and environment stressors (G × E); this has been confirmed by twin studies of inferred genetic risk.

Measured genotype studies to detect G × E effects have used a range of alcohol consumption and diagnostic phenotypes and stressors ranging from early-life to adulthood past year life events.

In this article, the current state of the field is critically reviewed and suggestions are put forth for future research.



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Request Reprint E-Mail: maenoch@niaaa.nih.gov

New Pharmacological Treatment Strategies for Relapse Prevention.

Here we discuss treatment strategies that are based on pharmacological interventions to reduce craving and relapse in alcohol-dependent patients.

We will first provide a historical overview about relapse prevention strategies. We will then review the development of disulfiram, naltrexone, acamprosate, and nalmefene and discuss their neurobiological modes of action. Then the concept of convergent genomic analysis will be introduced for the discovery of new molecular treatment targets.

Finally, we will provide convincing evidence for the use of N-methyl-D-aspartate (NMDA) receptor channel blockers as substitution drugs.

Important conclusions of this review are: (i) learning from other addictive substances is very helpful—e.g., substitution therapies as applied to opiate addiction for decades could also be translated to alcoholics, (ii) the glutamate theory of alcohol addiction provides a convincing framework for the use of NMDA receptor antagonists as substitution drugs for alcohol-dependent patients, (iii) a combination of behavioral and pharmacological therapies may be the optimal approach for future treatment strategies—one promising example concerns the pharmacological disruption of reconsolidation processes of alcohol cue memories, (iv) given that many neurotransmitter systems are affected by chronic alcohol consumption, numerous druggable targets have been identified; consequently, a “cocktail” of different compounds will further improve the treatment situation, (v) in silico psychopharmacology, such as drug repurposing will yield new medications, and finally, (vi) the whole organism has to be taken into consideration to provide the best therapy for our patients.

In summary, there is no other field in psychiatric research that has, in recent years, yielded so many novel, druggable targets and innovative treatment strategies than for alcohol addiction. However, it will still be several years before the majority of the “treatment-seeking population” will benefit from those developments.

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Modeling Relapse in Animals

Alcohol addiction is a chronically relapsing disorder characterized by compulsive alcohol seeking and use. Alcohol craving and long-lasting vulnerability to relapse present a great challenge for the successful treatment of alcohol addiction. Therefore, relapse prevention has emerged as a critically important area of research, with the need for effective and valid animal models of relapse.

This chapter provides an overview of the repertoire of animal models of craving
and relapse presently available and employed in alcoholism research. These models include conditioned reinstatement, stress-induced reinstatement, ethanol priming-induced reinstatement, conditioned place preference, Pavlovian spontaneous recovery, the alcohol deprivation effect, and seeking-taking chained
schedules.

Thus, a wide array of animal models is available that permit investigation of behaviors directed at obtaining access to alcohol, as well as neurobehavioral mechanisms and genetic factors that regulate these behaviors. These models also are instrumental for identifying pharmacological treatment targets and as tools for evaluating the efficacy of potential medications for the prevention
of alcohol craving and relapse.


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Advanced Transgenic Approaches to Understand Alcohol-Related Phenotypes in Animals

During the past two decades, the use of genetically manipulated animal models in alcohol research has greatly improved the understanding of the mechanisms underlying alcohol addiction.

In this chapter, we present an overview of the progress made in this field by summarizing findings obtained from studies of mice harboring global and conditional mutations in genes that influence alcohol-related phenotypes.

The first part reviews behavioral paradigms for modeling the different phases of the alcohol addiction cycle and other alocohol-induced behavioral phenotypes in mice.

The second part reviews the current data available using genetic models targeting the main neurotransmitter and neuropeptide systems involved in the reinforcement and stress pathways, focusing on the phenotypes modeling the alcohol addiction cycle.

Finally, the third part will discuss the current findings and future directions, and proposes advanced transgenic mouse models for their potential use in alcohol research.


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Increased sensitivity to alcohol induced changes in ERK Map kinase phosphorylation and memory disruption in adolescent as compared to adult C57BL/6J m

Adolescence is a critical period of brain development that is accompanied by increased probability of risky behavior, such as alcohol use. Emerging research indicates that adolescents are differentially sensitive to the behavioral effects of acute ethanol as compared to adults but the neurobiological mechanisms of this effect remain to be fully elucidated.

This study was designed to evaluate effects of acute ethanol on extracellular signal-regulated kinase phosphorylation (p-ERK1/2) in mesocorticolimbic brain regions. We also sought to determine if age-specific effects of ethanol on p-ERK1/2 are associated with ethanol-induced behavioral deficits on acquisition of the hippocampal-dependent novel object recognition (NOR) test.

Adolescent and adult C57BL/6J mice were administered acute ethanol (0 0.5, 1, or 3g/kg, i.p.). Brains were removed 30-min post injection and processed for analysis of p-ERK1/2 immunoreactivity (IR). Additional groups of mice were administered ethanol (0 or 1g/kg) prior to the NOR test. Analysis of p-ERK1/2 IR showed that untreated adolescent mice had significantly higher levels of p-ERK1/2 IR in the nucleus accumbens shell, basolateral amygdala (BLA), central amygdala (CeA), and medial prefrontal cortex (mPFC) as compared to adults. Ethanol (1g/kg) selectively reduced p-ERK1/2 IR in the dentate gyrus and increased p-ERK1/2 IR in the BLA only in adolescent mice. Ethanol (3g/kg) produced the same effects on p-ERK1/2 IR in both age groups with increases in CeA and mPFC, but a decrease in the dentate gyrus, as compared to age-matched saline controls.

Pretreatment with ethanol (1g/kg) disrupted performance on the NOR test specifically in adolescents, which corresponds with the ethanol-induced inhibition of p-ERK1/2 IR in the hippocampus.

These data show that adolescent mice have differential expression of basal p-ERK1/2 IR in mesocorticolimbic brain regions. Acute ethanol produces a unique set of changes in ERK1/2 phosphorylation in the adolescent brain that are associated with disruption of hippocampal-dependent memory acquisition.



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Request Reprint E-Mail: mspanos@unity.ncsu.edu

Variation in Documented Care for Unhealthy Alcohol Consumption Across Race/Ethnicity in the Department of Veterans Affairs Healthcare System

The VA Healthcare System has made progress implementing evidence-based care for unhealthy alcohol use, but whether there are differences in care across race/ethnicity is unclear.

We describe alcohol-related care for 3 racial/ethnic groups among VA outpatients with unhealthy alcohol use.

This cross-sectional study utilized secondary quality improvement data collected for the VA Office of Quality and Performance (July 2006 to June 2007) to identify a sample of 9,194 black (n = 1,436), Hispanic (n = 500), and white (n = 7,258) VA outpatients who screened positive for unhealthy alcohol use (AUDIT-C score ≥4 men; ≥3 women). Alcohol-related care was defined as medical record documentation of brief intervention (advice or feedback) and/or referral (discussion of or scheduled). Logistic regression models estimated the prevalence of alcohol-related care among black, Hispanic, and white patients after adjustment for sociodemographic characteristics, alcohol use severity, other substance use, and mental health comorbidity.

Among all eligible patients, 2,903 (32%) had documented alcohol-related care. Adjusted prevalences were 35.3% (95% CI 30.0 to 40.5) for black, 27.3% (95% CI 21.1 to 33.5) for Hispanic, and 28.9% (95% CI 25.5 to 32.3) for white patients. Differences in documented alcohol-related care between all racial/ethnic groups were significant (p-values all < 0.05).

Among VA patients with unhealthy alcohol use, black patients had the highest, and Hispanic the lowest, prevalence of documented alcohol-related care. Future research should evaluate contextual and system-, provider-, or patient-level factors that may attenuate racial/ethnic differences in documented alcohol-related care, as well as whether differences in documented care are associated with differences in outcomes.

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Request Reprint E-Mail: emily.williams3@va.gov

Relation Over Time Between Facial Measurements and Cognitive Outcomes in Fetal Alcohol-Exposed Children

The identification of individuals exposed prenatally to alcohol can be challenging, with only those having the characteristic pattern of facial features, central nervous system abnormality, and growth retardation receiving a clinical diagnosis of fetal alcohol syndrome (FAS).

Seventeen anthropometric measurements were obtained at 5 and 9 years from 125 Cape Town, South African children, studied since birth. The children were divided into 3 groups: FAS or partial FAS (PFAS), heavily exposed nonsyndromal (HE), and non-alcohol-exposed controls (C). Anthropometric measurements were evaluated for mean group differences. Logistic regression models were used to identify the subset of anthropometric measures that best predicted group membership. Anthropometric measurements were examined at the 2 ages in relation to prenatal alcohol exposure obtained prospectively from the mothers during pregnancy. Correlation of these facial measurements with key neurobehavioral outcomes including Wechsler Intelligence Scales for Children-IV IQ and eyeblink conditioning was used to assess their utility as indicators of alcohol-related central nervous system impairment.

Significant group differences were found for the majority of the anthropometric measures, with means of these measures smaller in the FAS/PFAS compared with HE or C. Upper facial widths, ear length, lower facial depth, and eye widths were consistent predictors distinguishing those exposed to alcohol from those who were not. Using longitudinal data, unique measures were identified that predicted facial anomalies at one age but not the other, suggesting the face changes as the individual matures. And 41% of the FAS/PFAS group met criteria for microtia at both ages. Three of the predictive anthropometric measures were negatively related to measures of prenatal alcohol consumption, and all were positively related to at least 1 neurobehavioral outcome.

The analysis of longitudinal data identified a common set of predictors, as well as some that are unique at each age. Prenatal alcohol exposure appears to have its primary effect on brain growth, reflected by smaller forehead widths, and may suppress neural crest migration to the branchial arches, reflected by deficits in ear length and mandibular dimensions. These results may improve diagnostic resolution and enhance our understanding of the relation between the face and the neuropsychological deficits that occur.

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Request Reprint E-Mail: tforoud@iupui.edu

Institutionalization of Brief Alcohol Intervention in Primary Health Care—The Finnish Case

There have been several research and practical projects to promote alcohol brief interventions (BIs) in healthcare settings, but no reports of nationwide outcome have so far been published. In Finland, these activities started in the early 1990s, and in the past years, the focus has been mainly on primary and occupational health care.

The aim of the present study was to ascertain whether the extensive and long-lasting implementation efforts have led to the institutionalization of this activity among primary healthcare physicians and to the identification of factors that may be associated with it.

The data were gathered by a questionnaire sent to all Finnish primary healthcare physicians in 2002 and 2007. In both years, the questionnaire contained questions on demographics, professional background and the physicians' own BI activity (regular, occasional, or none). In 2007, a question eliciting information about the change in BI activity during the past 5 years was added. The response rate was 67.1% (95% CI 65.4 to 68.8) (2,001/2,980) in 2002 and 50.9% (95% CI 49.2 to 52.6) (1,610/3,163) in 2007.

The number of physicians offering BI had increased during the study years from 59.2 to 78.5%. Regular activity was reported in 2002 by 9.3% of physicians and in 2007 by 17.2% and occasional activity correspondingly by 49.9 and 61.3%. Of the physicians who offered BI in 2007, 52.4% reported increased activity and 42.6% similar activity to that reported 5 years earlier. Having a specialist's license in general practice or occupational health care or long experience as a primary healthcare physician predicted high activity.

The BI activity of Finnish primary healthcare physicians is reasonably high and rising. Training and motivating those with low BI activity remains future challenge.

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kati.seppanen@uta.fi

Acute and Long-Term Purkinje Cell Loss Following a Single Ethanol Binge During the Early Third Trimester Equivalent in the Rat

In the rat, binge-like ethanol (EtOH) exposure during the early neonatal period (a developmental period equivalent to the human third trimester) can result in a permanent deficit of cerebellar Purkinje cells (Pcells). However, the consequences of a moderate binge alcohol exposure on a single day during this postnatal period have not been established. This is an issue of importance as many pregnant women binge drink periodically at social drinking levels.

This study aimed to identify both the acute and long-term effects of exposure to a single alcohol binge that achieved a mean peak blood EtOH concentration of approximately 250 mg/dl during early postnatal life using a rat model of fetal alcohol spectrum disorders.

Acute apoptotic Pcell death 10 hours after a moderate dose binge EtOH exposure from postnatal days (PDs) 0 to 10 was assessed using active caspase-3 immunolabeling. Acute Pcell apoptosis was quantified in cerebellar vermal lobules I–X using the physical disector method. Long-term effects were assessed at PD 60 using stereological methods to determine total Pcell numbers in the vermis, lobule III, and lobule IX, following a moderate dose binge EtOH exposure at PDs 0, 2, or 4.

Acute apoptosis was induced by EtOH on PDs 1 to 8 in a time and lobular-dependent manner. For EtOH exposure on PD 2, significant long-term Pcell loss occurred in lobule III. EtOH exposure on PD 4 resulted in significant long-term Pcell loss throughout the entire vermis.

These results indicate that a single, early EtOH episode of moderate dose can create significant and permanent Pcell loss in the developing cerebellum.

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Request Reprint E-Mail: ruth.napper@anatomy.otago.ac.nz

The International Alcohol Control (IAC) Study—Evaluating the Impact of Alcohol Policies

This paper describes a new multicountry collaborative project to assess the impact of alcohol control policy. Longitudinal surveys of drinkers in a number of participating countries and analysis of the policy context allow for the assessment of change over time within countries and comparison between countries. The design of the study is modeled on the International Tobacco Control study and aims to assess the impact of alcohol policies in different cultural contexts on policy-related behaviors and alcohol consumption. A survey instrument and protocol for policy analysis have been developed by the initial participating countries: England, Scotland, Thailand, South Korea, and New Zealand. The first round of data collection is scheduled for 2011–2012.

The survey instrument (International Alcohol Control [IAC] survey) measures key policy relevant behaviors: place and time of purchase, amounts purchased and price paid; ease of access to alcohol purchase; alcohol marketing measures; social supply; perceptions of alcohol affordability and availability and salience of price; perceptions of enforcement; people's experiences with specific alcohol restrictions; support for policy and consumption (typical quantity, frequency using beverage and location-specific measures). The Policy Analysis Protocol (PoLAP) assesses relevant aspects of the policy environment including regulation and implementation.

It has proved feasible to design instruments to collect detailed data on behaviors relevant to alcohol policy change and to assess the policy environment in different cultural settings.

In a policy arena in which the interest groups and stakeholders have different perceptions of appropriate policy responses to alcohol-related harm, a robust methodology to assess the impact of policy will contribute to the debate.

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

Rapid Decline of Liver Stiffness Following Alcohol Withdrawal in Heavy Drinkers

Measurement of liver stiffness (LS) using real-time elastography appears as a promising tool to evaluate the severity of chronic liver diseases. Previous studies in patients with alcoholic liver disease have suggested that fibrosis was the only histological parameter to influence LS. To challenge this hypothesis, we have prospectively tested the short-term impact of alcohol withdrawal on LS value.

Patients hospitalized for alcohol withdrawal in our Liver and Addiction Unit between 2007 and 2010 had an LS determination at entry (D0) and 7 days after alcohol withdrawal (D7). LS value was given as the median of 10 measurements performed with a FibroScan^® device. For a given patient, variation of LS was considered as significant when the comparison of the 10 measurements at D0 and at D7 yielded a p-value under 0.05 (Wilcoxon test).

One hundred and thirty-seven patients were included in the study (median alcohol consumption: 150 g/d; hepatitis C: n = 21 [15.6%]). Considering all patients, median LS value decreased from 7.2 to 6.1 kPa between D0 and D7 (p = 0.00001, paired Wilcoxon test). LS decreased significantly in 62 patients (45.3%), and there was a reduction in the estimated stage of fibrosis in 32 (23.3%). LS increased significantly in 16 patients (11.7%). Subgroup analyses revealed that the decrease in LS was still significant in patients with or without hepatitis C infection, and aspartate transaminase level below or above 100 UI/l.

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Request Reprint E-Mail: jean-baptiste.trabut@cch.aphp.fr

Carbohydrate Deficient Transferrin in a Driver's License Regranting Program

Carbohydrate deficient transferrin (CDT) is a common diagnostic marker for detecting chronic alcohol abuse. For over 2.5 years, it has been used in traffic medicine among subjects applying for driver's license renewal or regranting in Belgium

We report on data collected during the program and provide an estimation of an applicable cut-off point in forensic situations. Using this cut-off, the success of the driver's license regranting program is evaluated.

CDT was assayed at Ghent University Hospital by capillary zone electrophoresis, measured on the Capillarys 2™ system, in 3977 subjects applying for driver's license regranting. Determination of a cut-off was done by using Bhattacharya statistics and by adding a measurement uncertainty interval. The outcome of the program was evaluated by monitoring CDT values for 163 subjects during one entire year.

In 3977 subjects (3481 males and 496 females), CDT values were significantly higher in men compared with women, but there is no need for a gender-specific cut-off value. Drunk drivers under the age of 30 have significantly lower CDT values than older subjects, and a separate cut-off could be calculated. A general cut-off of 2.3% CDT was calculated for the entire study population. Using this cut-off value for evaluating the outcome of the program for 163 subjects, the percentage offenders at the beginning (29%) decreased to 8% after 1 year.

Applying a marker for chronic alcohol abuse such as CDT for driver's license renewal or regranting is a powerful tool. Analysis of data collected over 2.5 years reveals a favorable outcome of the program and a useful cut-off point could be determined.


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Changing Parental Behaviour to Reduce Risky Drinking Among Adolescents: Current Evidence and Future Directions

Risky drinking among young people is an issue of public concern globally. In Australia and elsewhere, there has been a steady increase in alcohol-related harms among young people in recent years.

The aims of this study were to review the nature of parental supply of alcohol to adolescents aged 13–17 years, explore parental social networks as a potential avenue for intervention, and propose future directions for research with a view to informing public policy and the development of interventions to reduce risky drinking.

Narrative review.

While a large literature exists concerning parental influence on children's drinking, exploration of the volume of alcohol and context of parental supply is lacking. Results from cross-sectional and longitudinal studies on the impact of parental factors such as monitoring, rule setting, alcohol supply and supervision of drinking present an unclear picture. Consequently, translation of research findings into advice for parents is problematic.

We propose that future research seeks to (a) gain a better understanding of the volume and contexts of parental supply of alcohol, (b) explore the structure of social networks among adolescents and their parents, (c) determine the accuracy of parents' perceptions of other parents' behaviours and beliefs, (d) develop an analytic approach for quantifying aspects of parental networks an (e) evaluate low-intensity parental interventions including web programmes.


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

2nd Report, 2012 (Session 4): Stage 1 Report on the Alcohol (Minimum Pricing) (Scotland) Bill

2nd Report, 2012 (Session 4)

Stage 1 Report on the Alcohol (Minimum Pricing) (Scotland) Bill

CONTENTS

Remit and membership

Report
Introduction

Procedure
Purpose of the Bill
Scottish Government consultation
Previous legislation
Committee consideration

Minimum Pricing

Background
Evidence base
Health and social impact
Setting the price
Consequences
Evaluation
Legality

Financial implications of the Bill

Background
Section 1
Section 2
Estimated savings
Cost to Scottish Government
Costs to Local authorities
Costs to other bodies

Subordinate legislation

Background
Section 1 – minimum price of alcohol

Equalities
Overall conclusion

Annexe A: EXTRACT FROM MINUTES OF THE HEALTH AND SPORT COMMITTEE

Annexe B: ORAL EVIDENCE AND ASSOCIATED WRITTEN EVIDENCE

Annexe C: LIST OF OTHER WRITTEN EVIDENCE

Annexe D: REPORT BY THE FINANCE COMMITTEE

Annexe E: REPORT BY THE SUBORDINATE LEGISLATION COMMITTEE

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Call for Abstracts—Sixth Annual National Conference on Health Communication, Marketing, and Media

August 7–9, 2012 | Atlanta, Georgia | Abstract Submission Deadline: March 27, 2012

The National Conference on Health Communication, Marketing, and Media brings together academia, public health researchers and practitioners from all levels of government and private sectors, and provides a forum for cross-disciplinary dialogue. Come meet with colleagues and shape the practice of health communication, marketing, and media.

The conference planning committee invites abstracts for both oral and poster presentations in addition to panel sessions focusing on the areas of health communication, social marketing, media, partnerships, public health policy communication, and other topic areas that relate to the multidisciplinary nature of this conference. A wide diversity of submissions is encouraged, addressing specific issues and approaches that range from research and evaluation, and theory/model development to practice/program-based foci.

Abstracts will be reviewed and considered for oral, poster, or panel presentations.

Learn More About the Conference | Submit an Abstract

National Liver Disease Strategy moves one step closer

The development of a National Liver Disease Strategy (NLDS) is moving closer after first being announced over 2 years ago.

With excessive alcohol consumption, obesity and hepatitis B and C infections as the main causes of liver disease, early identification and treatment is key to success. The strategy will seek to ensure improved partnership working in order to address the major lifestyle behaviours affecting liver disease rates.

To influence the development of the liver strategy, NHS Liver Care are hosting a number of workshops for health specialists around the country, and have revealed a new on-line newsletter called Liver Matters to kick-start discussions and interest in liver disease. > > > > Read More

Behavioral Actions of Alcohol: Phenotypic Relations from Multivariate Analysis of Mutant Mouse Data

Behavioral studies of genetically diverse mice have proven powerful for determining relationships between phenotypes and have been widely used in alcohol research. Most of these studies rely on naturally occurring genetic polymorphisms among inbred strains and selected lines. Another approach is to introduce variation by engineering single gene mutations in mice.

We have tested 37 different mutant mice and their wild type controls for a variety (31) of behaviors and have mined this dataset by K-means clustering and analysis of correlations.

We found a correlation between a stress-related response (activity in a novel environment) and alcohol consumption and preference for saccharin.

We confirmed several relationships detected in earlier genetic studies including positive correlation of alcohol consumption with saccharin consumption, and negative correlations with conditioned taste aversion and alcohol withdrawal severity. Introduction of single gene mutations either eliminated or greatly diminished these correlations. The three tests of alcohol consumption used (continuous two bottle choice, and two limited access tests: Drinking In the Dark and Sustained High Alcohol Consumption) share a relationship with saccharin consumption, but differ from each other in their correlation networks.

We suggest that alcohol consumption is controlled by multiple physiological systems where single gene mutations can disrupt the networks of such systems.

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Request Reprint E-Mail: harris@mail.utexas.edu

Global Actions March 7, 2012

Key Recent Milestones:

· China: Baseline surveys have been conducted in Xi’an and Wuhan for Global Actions drink drive initiative in China. Researchers interviewed 1,900 local people in Xi’an and 900 in Wuhan. Surveys will continue in Wuhan this week and begin in Nanjing on March 7. View photos on our Facebook page.


Global Actions in Focus: Drink Drive Summit in Puebla, Mexico

Global Actions Mexico made more progress in February with a drink drive capacity-building summit in Puebla. ICAP partnered with the Puebla State Road Safety Police to hold Working together towards zero alcohol deaths in Puebla.



With the goal of assisting states and municipalities to reduce drink driving throughout Mexico, the event drew attendees from Puebla state police forces, road safety organizations, elected officials, local media, Benemerita Universidad de Puebla, and Universidad de las Americas. Presenters encouraged discussion of strategies and action plans to most effectively address alcohol-related road safety issues.



“With an evidence-based approach, we sought to bring strategic resources and information to public health institutions, governments, and other entities concerned,” said Global Actions Mexico Country Manager Mariana Guerra Rendon.

ICAP consultant William Georges presented on traffic safety programs such as the STOP-DWI program that has been successfully implemented throughout the United States.



Edgar Sanchez Valencia of the Direccion de Vialidad del Estado gave a review of crash data in Puebla, and Diputado Hector Alonso Granadas, president of the Comision de Seguridad Publica y Proteccion Civil spoke on legislative issues.

“We are extremely pleased to be working with law enforcement and allied organizations in Puebla,” said Georges. “By everyone working together: law enforcement, education, legislators, and alcohol producers, we will strive to accomplish the life-saving goal of zero alcohol deaths.”

For more, read ICAP’s press release of the summit and view more photos.


What’s Happening Next:

· Vietnam: A launch event will be held in Hanoi on March 20 for Global Actions self-regulation initiative in Vietnam. The Vietnam Beer Alcohol Beverage Association (VBA) has partnered in our efforts to develop a marketing code for wine and spirits.

Press Release - Data presented at the 2012 European Congress of Psychiatry on Selincro™ demonstrate that alcohol dependent patients were able to red

• Phase III clinical data showed that patients treated with Selincro (nalmefene) were able to reduce their total alcohol consumption by 66% on average after six months of treatment
• The effect is maintained and even improved after one year of treatment
• Selincro has been shown to be safe and well tolerated
• Selincro has a significant potential for helping individuals with alcohol dependence in reducing their alcohol consumption
• Selincro is the first medicine aimed for the reduction of alcohol consumption in patients with alcohol dependence and it is currently undergoing regulatory review in Europe
• Patients with alcohol dependence are currently both underdiagnosed and undertreated indicating a need for new treatment approaches
• Alcohol dependence is one of the most burdensome diseases ranked as number 9 according to WHO
• The risk for all types of harms is lessened, and for most conditions, reversed with a reduction of alcohol consumption, both the overall volume of consumption and consumption at any one time¹⁰

H. Lundbeck A/S (Lundbeck) today announced the results of the clinical phase III programme of Selincro™ (nalmefene), an investigational compound for the treatment of alcohol dependence, at the 20^th European Congress of Psychiatry (EPA) in Prague, Czech Republic. The symposium presentation included results from the three placebo-controlled clinical phase III studies (ESENSE 1, ESENSE 2 and SENSE). In addition, the ESENSE 1 study was presented as a poster (poster no. 710) by Prof. Dr. Karl Mann et al. Further details of the ESENSE 2 and SENSE studies will be presented at the Annual Research Society on Alcoholism (RSA) Scientific Meeting in San Francisco in June.

The results of the three studies support the efficacy and tolerability of Selincro in reducing alcohol consumption in patients with alcohol dependence. > > > > Read More

Survey: Ten Percent of American Adults Report Being in Recovery from Substance Abuse or Addiction

Survey data released today by The Partnership at Drugfree.org and The New York State Office of Alcoholism and Substance Abuse Services (OASAS) show that 10 percent of all American adults, ages 18 and older, consider themselves to be in recovery from drug or alcohol abuse problems. These nationally representative findings indicate that there are 23.5 million American adults who are overcoming an involvement with drugs or alcohol that they once considered to be problematic.

According to the new survey funded by OASAS, 10 percent of adults surveyed said yes to the question, “Did you once have a problem with drugs or alcohol, but no longer do?” – one simple way of describing recovery from drug and alcohol abuse or addiction. > > > > Read More

Special Issue: Low Risk Drinking Guidelines

EDITORIAL

Constructing and responding to low-risk drinking guidelines: Conceptualisation, evidence and reception (pages 121–125)

ORIGINAL ARTICLES

The basis for Canada's new low-risk drinking guidelines: A relative risk approach to estimating hazardous levels and patterns of alcohol use (pages 126–134)

Clear criteria based on absolute risk: Reforming the basis of guidelines on low-risk drinking (pages 135–140)

An empirical approach to evaluating the validity of alternative low-risk drinking guidelines (pages 141–150)

COMMENTARIES

Why have guidelines at all? A critical perspective (pages 151–152)

Drinking guidelines are essential in combating alcohol-related harm: Comments on the new Australian and Canadian guidelines (pages 153–155)

ORIGINAL ARTICLES

Different guidelines for different countries? On the scientific basis of low-risk drinking guidelines and their implications (pages 156–161)

Responses to risk: Public submissions on Australian alcohol guidelines for low-risk drinking (pages 162–169)

Guidelines for pregnancy: What's an acceptable risk, and how is the evidence (finally) shaping up? (pages 170–183)

Is there a ‘low-risk’ drinking level for youth? The risk of acute harm as a function of quantity and frequency of drinking (pages 184–193)

COMMENTARIES

What place, if any, does information on putative cardioprotective effects of moderate alcohol use have in safer drinking guidelines? (pages 194–197)

Cautioning against causal alcohol–cardiovascular assumptions (pages 198–199)

ORIGINAL ARTICLES

Understanding standard drinks and drinking guidelines (pages 200–205)

My cup runneth over: Young people's lack of knowledge of low-risk drinking guidelines (pages 206–212)

Know your limits: Awareness of the 2009 Australian alcohol guidelines among young people (pages 213–223)

Perceptions of low-risk drinking levels among Australians during a period of change in the official drinking guidelines (pages 224–230)

The marketing of responsible drinking: Competing voices and interests (pages 231–239)

An exploratory study of drinkers views of health information and warning labels on alcohol containers (pages 240–247)