College Drinking

Abusive and underage college drinking are significant public health problems, and they exact an enormous toll on the intellectual and social lives of students on campuses across the United States.

Drinking at college has become a ritual that students often see as an integral part of their highereducation experience. Many students come to college with established drinking habits, and the college environment can exacerbate the problem. Research shows that more than 80 percent of college students drink alcohol, and almost half report binge drinking in the past 2 weeks.

Virtually all college students experience the effects of college drinking—whether they drink or not. > > > > Read More

Special Announcement: The Points Online Library Project

Points‘ mission, in addition to providing readers with a regular opportunity to read new, insightful, and provocative content on the history of drugs and alcohol, is to help further develop online research and publishing in general. In an age in which WordPress, Facebook, Twitter, and Tumblr are fundamentally altering the nature of academia – in both positive and negative ways – it is incumbent for sites like Points to play whatever small role they can in negotiating a working relationship between newer and older forms of research. To that end, we are delighted to announce an exciting new project that will bring the best online research material to current and future readers.

Over the next month, we will be developing the Points Online Library, a virtual repository for links to all manner of open source drug- and alcohol-related materials on the Web. The library will provide links to readily-available studies, one-off articles, periodical archives, PDF-format eBooks, all manner of video, and even pre-existing drug resource databases, all in an easily-searchable format for both casual exploration or serious perusal. Our goal is to facilitate online research by creating, promoting, and maintaining a centralized location for relevant and trustworthy academic resources. > > > > Read More

Alcohol Exposure Rate Control Through Physiologically Based Pharmacokinetic Modeling

The instantaneous rate of change of alcohol exposure (slope) may contribute to changes in measures of brain function following administration of alcohol that are usually attributed to breath alcohol concentration (BrAC) acting alone. To test this proposition, a 2-session experiment was designed in which carefully prescribed, constant-slope trajectories of BrAC intersected at the same exposure level and time since the exposure began. This paper presents the methods and limitations of the experimental design.

Individualized intravenous infusion rate profiles of 6% ethanol (EtOH) that achieved the constant-slope trajectories for an individual were precomputed using a physiologically based pharmacokinetic model. Adjusting the parameters of the model allowed each infusion profile to account for the subject's EtOH distribution and elimination kinetics. Sessions were conducted in randomized order and made no use of feedback of BrAC measurements obtained during the session to modify the precalculated infusion profiles. In one session, an individual's time course of exposure, BrAC(t), was prescribed to rise at a constant rate of 6.0 mg% per minute until it reached 68 mg% and then descend at −1.0 mg% per minute; in the other, to rise at a rate of 3.0 mg% per minute. The 2 exposure trajectories were designed to intersect at a BrAC (t = 20 minutes) = 60 mg% at an experimental time of 20 minutes.

Intersection points for 54 of 61 subjects were within prescribed deviations (range of ±3 mg% and ±4 minutes from the nominal intersection point).

Results confirmed the feasibility of applying the novel methods for achieving the intended time courses of the BrAC, with technical problems limiting success to 90% of the individuals tested.

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Request Reprint E-Mail: oconnor1@iupui.edu

Hazardous Drinking and Dimensions of Impulsivity, Behavioral Approach, and Inhibition in Adult Men and Women

Hazardous drinking is characterized by decisions to engage in excessive or risky patterns of alcohol consumption. Levels of impulsivity and behavioral approach and inhibition may differ in hazardous drinkers and nonhazardous drinkers. A comparison of the relative levels of dimensions of impulsivity and behavioral inhibition and approach in adult men and women hazardous and nonhazardous drinkers may inform treatment and prevention efforts.

In the present research, 466 men and women from a community sample were administered the Alcohol Use Disorders Identification Test (AUDIT), the Behavioral Inhibition System/Behavioral Approach System (BIS/BAS) scale, and the Barratt Impulsiveness Scale, version 11 (BIS-11). Relations among the dimensions of these constructs were examined using multivariate analysis of covariance (MANCOVA), with age and race as covariates.

There were main effects of hazardous drinking on all 3 dimensions of impulsivity, the behavioral inhibition system, and the behavioral activation system Reward Responsiveness, and Fun-Seeking components, with hazardous drinkers scoring higher than nonhazardous drinkers.

This research provides a better understanding of the manner in which impulsivity and behavioral inhibition and approach tendencies relate to hazardous alcohol use in men and women. The present results have implications for alcohol-related prevention and treatment strategies for adult men and women.

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Request Reprint E-Mail: kristen.hamilton@yale.edu

KCa2 channels: Novel therapeutic targets for treating alcohol withdrawal and escalation of alcohol consumption

Small-conductance, calcium-activated potassium (K_Ca2) channels influence neuronal firing properties, intrinsic excitability, and NMDA receptor-dependent synaptic responses and plasticity.

In this mini-review, we discuss new evidence that chronic alcohol-associated plasticity critically involves K_Ca2 channels in hippocampus, ventral tegmental area, and nucleus accumbens.

K_Ca2 channel activity can modulate the magnitude of excitation of midbrain dopamine neurons induced by acute alcohol exposure.

Emerging evidence indicates that K_Ca2 channels regulate neuroadaptations to chronic alcohol that contribute to withdrawal hyperexcitability and escalation of voluntary alcohol consumption. Restoring K_Ca2 channel activity can attenuate the severity of the alcohol withdrawal syndrome in vivo and withdrawal-associated neurotoxicity in vitro. Pharmacological modulation of K_Ca2 channels can bi-directionally influence drinking behavior in rat and mouse models of voluntary alcohol consumption.

Collectively, these studies using various rodent models have clearly indicated a central role for K_Ca2 channels in the neuroplasticity of chronic alcohol exposure

In addition, accumulating evidence suggests that K_Ca2 channels are a novel therapeutic target to alleviate the symptoms of alcohol withdrawal and reduce high amounts of alcohol drinking.


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Request Reprint E-Mail: mulholl@musc.edu

News Advisory - Dr. Edward P. Riley to deliver 4th Annual Jack Mendelson Honorary Lecture at National Institutes of Health

What:	The National Institute on Alcohol Abuse and Alcoholism (NIAAA), part of the National Institutes of Health, announces that Edward P. Riley, Ph.D. will deliver the 4th Annual Jack Mendelson Honorary Lecture. Riley is a world-renowned expert on Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Spectrum Disorders (FASD). His presentation is called “FASD: It’s What’s Behind the Face that Matters – Effects of Prenatal Alcohol on Brain and Behavior.”
Who:	Edward P. Riley, Ph.D., is Distinguished Professor of Psychology at San Diego State University (SDSU), and serves as the Director of SDSU’s Center for Behavioral Teratology. He also leads the NIAAA-funded Collaborative Initiative on FASD, which is a multi-site international consortium studying FASD. During his more than 35 years as a psychologist and researcher, Riley has significantly enhanced our understanding of how prenatal exposure to alcohol can affect the developing embryo and fetus.
When:	Thursday, April 19, 2012, 1:30 p.m. EDT
Where:	Lipsett Amphitheater, NIH Building 10, Bethesda, MD

Background: NIAAA established the Jack Mendelson Honorary Lecture Series as a tribute to Dr. Jack Mendelson, who made remarkable scientific contributions to the field of clinical alcohol research. The purpose of this honorary lecture series is to highlight clinical/human research in the alcohol field by 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 pleased to present this series of scientific lectures to acknowledge the advances researchers are making in a wide range of alcohol-related areas of clinical research, and to honor the memory of an individual whose exciting and pioneering research with human alcoholics remains relevant today.> > > > Read More

Hyperactivation of Right Inferior Frontal Cortex in Young Binge Drinkers During Response Inhibition: a Follow-Up Study

The objective of this study was to examine brain activity, with particular attention to prefrontal function, during response execution and inhibition in youths who have engaged in Binge Drinking (BD) for at least two years. Design: Event-Related Potentials (ERPs) were recorded twice within three years, during performance of a Go/NoGo task.

The study was part of a longitudinal study of the neurocognitive effects of BD.

48 undergraduate students, 25 controls (14 females) and 23 binge drinkers (10 females), with no personal or family history of alcoholism or psychopathological disorders.

The Go-P3 and NoGo-P3 components of the ERPs were examined by Principal Component Analysis and exact Low-Resolution Tomography Analysis (eLORETA).

Binge drinkers showed larger Go-P3 amplitudes than controls in the first and second evaluations (p = .019). They also showed larger NoGo-P3 amplitude in the second evaluation (p = .002). eLORETA analyses in the second evaluation revealed significantly greater activation of the right Inferior Frontal Cortex (rIFC) in binge drinkers than in controls during successful inhibition (p < .05).

Young binge drinkers appear to show abnormal brain activity as measured by Event-Related Potentials during response execution and inhibition which may represent a neural antecedent of difficulties in impulse control.


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Request Reprint E-Mail: eduardo.lopez@usc.es

Motivation to Change as a Mediator for the Longitudinal Relationships of Gender and Alcohol Severity With One-Year Drinking Outcome

We examined whether motivation to change mediated the relationships between gender and baseline alcohol severity with drinking outcome at 12-month follow-up in a longitudinal community sample.

Data were from baseline and 12-month interviews from the Rural Alcohol Study, a probability sample of rural and urban at-risk drinkers (N = 733) from six southern states. At-risk drinkers were identified through a telephone-screening interview. Measures of motivation (problem recognition and taking action) were the resultant two factors derived from the Stages of Change Readiness and Treatment Eagerness Scale. Items on social consequences of drinking measured alcohol severity. Structural equation models examined relationships between baseline alcohol severity and motivation with drinks per drinking day at 12 months.

We identified significant, direct paths between drinking at 12 months and alcohol severity and taking action with an unstandardized estimate of 0.116 (p < .05), alcohol severity and problem recognition (0.423, p < .01), and each of the two "motivation" latent constructs—problem recognition (1.846, p < .01) and taking action (-0.660, p < .01). Finally, the combined direct and negative effect of gender on alcohol consumption at 12-month follow-up was statistically significant, with an unstandardized estimate of -0.970 (p < .01).

The current study offers evidence for motivation to change as a viable mechanism through which alcohol severity is associated with subsequent drinking outcomes. More research is needed to further explore the persistence of motivation to change on drinking outcomes over time.



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Request Reprint E-Mail: jsmall@uams.edu

Do Protective Behavioral Strategies Moderate the Relationship Between Negative Urgency and Alcohol-Related Outcomes Among Intercollegiate Athletes?

The purpose of this study was to examine the moderating effect of protective behavioral strategies on the relationship between negative urgency and alcohol outcomes.

Participants were college students who endorsed participating in club/intramural or varsity athletics. The students (N = 234; 73.9% female) completed measures of negative urgency, protective behavioral strategies, alcohol use, and alcohol-related problems. Separate hierarchical multiple regression analyses were conducted for each subscale of the Protective Behavioral Strategies Scale to test for moderation.

Results indicated that protective behavioral strategies aimed at serious harm reduction moderated the relationship between negative urgency and alcohol use, whereas strategies aimed at avoiding excessive or rapid drinking moderated the relationship between negative urgency and alcohol-related problems. Strategies that involved planning drinking activities in advance did not moderate the relationship between negative urgency and alcohol outcomes.

The current investigation provides further evidence for the role of protective behavioral strategies against known risk factors for alcohol use and related problems. Further, the paper suggests that type of strategy used matters when attempting to mitigate the relationship between negative urgency and alcohol outcomes.
Limitations and future directions are discussed.



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Request Reprint E-Mail: weavercc@missouri.edu

Association Between Social Influences and Drinking Outcomes Across Three Years

Multiple studies have shown social network variables to mediate and predict drinking outcome, but, because of self-selection biases, these studies cannot reliably determine whether the influence is causal or correlational. The goal of this study was to evaluate evidence for a causal role for social network characteristics in determining long-term outcomes using state-of-the-art statistical methods.

Outpatient and aftercare clients enrolled in Project MATCH (N = 1,726) were assessed at intake and at 3, 6, 9, 12, and 15 months; the outpatient sample was also followed to 39 months. Generalized linear modeling with propensity stratification tested whether changes in social network ties (i.e., number of pro-abstainers and pro-drinkers) at Month 9 predicted percentage of days abstinent and drinks per drinking day at 15 and 39 months, covarying for Alcoholics Anonymous (AA) attendance at Month 9.

An increase in the number of pro-drinkers predicted worse drinking outcomes, measured by percentage of days abstinent and drinks per drinking day, at Months 15 and 39 (p < .0001). An increase in the number of pro-abstainers predicted more percentage of days abstinent for both time periods (p < .01). The social network variables uniquely predicted 5%–12% of the outcome variance; AA attendance predicted an additional 1%–6%.

Network composition following treatment is an important and plausibly causal predictor of alcohol outcome across 3 years, adjusting for multiple confounders. The effects are consistent across patients exhibiting a broad range of alcohol-related impairment. Results support the further development of treatments that promote positive social changes and highlight the need for additional research on the determinants of social network changes.

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Request Reprint E-Mail: stout@pire.org

A Systematic Review of Family-Based Interventions Targeting Alcohol Misuse and Their Potential to Reduce Alcohol-Related Harm in Indigenous Communitie

Alcohol misuse is a major risk factor for harm in indigenous communities. The indigenous family unit is often the setting for, and is most adversely affected by, alcohol-related harm. Therefore, family-based alcohol interventions offer great potential to reduce alcohol-related harm in indigenous communities. This systematic review aims to identify peer-reviewed published evaluations of family-based alcohol interventions, critique the methodological quality of those studies, describe their intervention characteristics, and identify which interventions appear most promising to reduce alcohol-related harm in indigenous communities.

Eleven electronic databases were searched. The reference lists of reviews of family-based approaches focused on alcohol interventions were hand-searched for additional relevant studies not identified by the electronic database search.

Initially, 1,369 studies were identified, of which 21% (n = 142) were classified as intervention studies. Nineteen intervention studies were family-based alcohol interventions. Eleven of these studies included family members in the treatment of problem drinkers, and eight studies specifically targeted family members of problem drinkers. Methodological quality of studies varied, particularly in relation to study design, including confounding variables in the analyses, and follow-up rates.

The evidence for the effectiveness of family-based alcohol interventions is less than optimal, although the reviewed studies did show improved outcomes. Given the important role of family in indigenous communities, there is merit in exploring family-based approaches to reduce alcohol-related harms. Tailored family-based approaches should be developed that include direct consultation with targeted indigenous communities.



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Request Reprint E-Mail: b.calabria@unsw.edu.au

Effects of Age and Life Transitions on Alcohol and Drug Treatment Outcome Over Nine Years

The purpose of this study was to examine the effects of age, common life transitions, treatment, and social support on outcomes 5–9 years after alcohol and other drug (AOD) treatment intake.

Participants were patients from a large outpatient AOD treatment program in an integrated health plan. There were 1,951 participants interviewed at intake, of whom 1,646 (84%) completed one or more telephone follow-up interviews at 5, 7, and 9 years. Measures included AOD use based on the Addiction Severity Index; treatment; and changes in marital, employment, and health status in the years between each follow-up. We compared participants by age group (18–39, 40–54, and ≥55 years old at intake) and examined factors (time invariant and time varying) associated with outcomes at 5, 7, and 9 years by fitting mixed-effects logistic random intercept models.

Changes in marital, employment, and health status varied significantly by age. Factors associated with remission across Years 5–9 included being in the middle-aged versus younger group (p < .001); female gender (p < .001); not losing a partner to separation, divorce, or death (p < .001); not experiencing a decline in health (p = .021); having any close friends supportive of recovery (p < .001); and not having any close friends who encourage AOD use (p < .001). Additional predictors, including employment changes, varied by drug versus alcohol abstinence outcome measures.

Negative life transitions vary by age and are associated with worse outcomes. Older age and social support are associated with long-term AOD remission and abstinence. Findings inform treatment strategies to enhance recovery across the life span.



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Request Reprint E-Mail: dereks@lppi.ucsf.edu

Trends in Alcohol- and Drug-Related Emergency Department and Primary Care Visits: Data From Four U.S. National Surveys (1995–2010)

The purpose of this study was to update trends in alcohol- and drug-related emergency department and primary care visits over the last 15 years in the United States.

A trend analysis was conducted on substance-related health services visits, based on self-reported alcohol or other drug use within 6 hours before an injury and/or illness event, from four National Alcohol Surveys: 1995, 2000, 2005, and 2010.

A significant upward trend was found from 1995 to 2010 in alcohol-related emergency department visits but not in alcohol-related primary care visits. The odds of an alcohol-related emergency department visit doubled between 1995 and 2010 (odds ratio = 2.36). No significant trend was found in either drug-related emergency department or drug-related primary care visits between 1995 and 2010.

These data suggest that alcohol-related emergency department visits have increased significantly over the past 15 years, whereas drug-related emergency department visits may have stabilized. These findings underscore the opportunity provided by the emergency department for screening and brief intervention for alcohol-related problems and suggest that Healthy People 2010 objectives calling for a reduction in substance-related emergency department visits were not realized. Thus, it might be prudent to adjust Healthy People 2020 objectives accordingly.



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Request Reprint E-Mail: ccherpitel@arg.org

Developmental Consistency in Associations Between Depressive Symptoms and Alcohol Use in Early Adolescence

Despite frequent theorizing, prior literature on the association between depressive symptoms and alcohol use in adolescence has been inconsistent. Yet studies have varied widely with respect to age at assessments, time frame of prediction, and controls for comorbid conditions and demographic factors. The current study examined whether the associations between depressive symptoms and alcohol use were similar in valence and magnitude over a 4-year period in early adolescence.

A sample of 521 young adolescents and their parents were interviewed every year from sixth (mean age = 12.0 years) through ninth grades. At each interview, symptom counts on depressive and conduct disorders were generated from the Diagnostic Interview Schedule for Children. Adolescents also reported on their alcohol use, which was converted to a binary variable. Autoregressive, cross-lagged panel models specifying depressive and conduct disorder symptoms as predictors of alcohol use 1 year later with equality constraints were tested and compared with models allowing path coefficients to vary over time.

For youth self-report, depressive symptoms were positively associated with alcohol use 1 year later over and above conduct problems and earlier alcohol use throughout early adolescence. By parental report, only very early adolescent depressive symptoms (sixth to seventh grades) were associated with alcohol use. Gender did not moderate findings for analyses with self- or parental-report data.

These results indicate that, even in the context of conduct disorder symptoms, depressive symptoms are important indicators of risk for use of alcohol across early adolescence.


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Request Reprint E-Mail: . cmccarty@u.washington.edu

Enhancing the ICD System in Recording Alcohol's Involvement in Disease and Injury

Among the tasks facing those who code alcohol-related disorders in an international classification of disease are an examination of the multiple places in which the involvement of alcohol and other psychoactive substances (and their associated disorders) are captured and finding out how this can be optimized for clinical and epidemiological purposes.

It is important to adjust the current coding system so that the involvement of alcohol in injuries is routinely recorded.

The suggestions by Touquet and Harris (2012) for enhancing the International Classification of Diseases (ICD) system are valuable input for this process, pointing to the importance of codes that can be used in the emergency-department environment both for capturing alcohol's involvement and to point to the necessary therapeutic response.


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Request Reprint E-Mail: mail@jbsaunders.net

Genome-wide search for replicable risk gene regions in alcohol and nicotine co-dependence

The present study searched for replicable risk genomic regions for alcohol and nicotine co-dependence using a genome-wide association strategy. The data contained a total of 3,143 subjects including 818 European-American (EA) cases with alcohol and nicotine co-dependence, 1,396 EA controls, 449 African-American (AA) cases, and 480 AA controls.

We performed separate genome-wide association analyses in EAs and AAs and a meta-analysis to derive combined P-values, and calculated the genome-wide false discovery rate (FDR) for each SNP. Regions with P < 5 × 10⁻⁷ together with FDR < 0.05 in the meta-analysis were examined to detect all replicable risk SNPs across EAs, AAs, and meta-analysis. These SNPs were followed with a series of functional expression quantitative trait locus (eQTL) analyses.

We found a unique genome-wide significant gene region—SH3BP5-NR2C2—that was enriched with 11 replicable risk SNPs for alcohol and nicotine co-dependence. The distributions of −log(P) values for all SNP-disease associations within this region were consistent across EAs, AAs, and meta-analysis (0.315 ≤ r ≤ 0.868; 8.1 × 10⁻⁵² ≤ P ≤ 3.6 × 10⁻⁵).

In the meta-analysis, this region was the only association peak throughout chromosome 3 at P < 0.0001. All replicable risk markers available for eQTL analysis had nominal cis- and trans-acting regulatory effects on gene expression.

The transcript expression of the genes in this region was regulated partly by several nicotine dependence (ND)-related genes and significantly correlated with transcript expression of many alcohol dependence- and ND-related genes.

We concluded that the SH3BP5-NR2C2 region on Chromosome 3 might harbor causal loci for alcohol and nicotine co-dependence.


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Request Reprint E-Mail: lingjun.zuo@yale.edu

Using Parental Profiles to Predict Membership in a Subset of College Students Experiencing Excessive Alcohol Consequences: Findings From a Longitudina

Previous research identified a high-risk subset of college students experiencing a disproportionate number of alcohol-related consequences at the end of their first year. With the goal of identifying pre-college predictors of membership in this high-risk subset, the present study used a prospective design to identify latent profiles of student-reported maternal and paternal parenting styles and alcohol-specific behaviors and to determine whether these profiles were associated with membership in the high-risk consequences subset.

A sample of randomly selected 370 incoming first-year students at a large public university reported on their mothers' and fathers' communication quality, monitoring, approval of alcohol use, and modeling of drinking behaviors and on consequences experienced across the first year of college.

Students in the high-risk subset comprised 15.5% of the sample but accounted for almost half (46.6%) of the total consequences reported by the entire sample. Latent profile analyses identified four parental profiles: positive pro-alcohol, positive anti-alcohol, negative mother, and negative father. Logistic regression analyses revealed that students in the negative-father profile were at greatest odds of being in the high-risk consequences subset at a follow-up assessment 1 year later, even after drinking at baseline was controlled for. Students in the positive pro-alcohol profile also were at increased odds of being in the high-risk subset, although this association was attenuated after baseline drinking was controlled for.

These findings have important implications for the improvement of existing parent- and individual-based college student drinking interventions designed to reduce alcohol-related consequences.


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Request Reprint E-Mail: kam54@psu.edu

Do Peers' Parents Matter? A New Link Between Positive Parenting and Adolescent Substance Use

Although studies have demonstrated that an adolescent's parents and friends both influence adolescent substance use, it is not known whether the parenting experienced by one's friends also affects one's own use. Drawing on conceptions of shared parenting and the tenets of coercion theory, we investigated the extent to which three domains of parenting behaviors (parental knowledge, inductive reasoning, and consistent discipline) influenced the alcohol, cigarette, and marijuana use of not only their own adolescent children but also of members of their adolescents' friendship groups.

Analyses of friendship nominations within each of two successive ninth-grade cohorts in 27 Iowa and Pennsylvania schools (N = 7,439 students, 53.6% female) were used to identify 897 friendship groups. Hierarchical logistic regression models were used to examine prospective associations between 9th-grade friendship group–level parenting behaviors and adolescent self-reported alcohol, cigarette, and marijuana use in 10th grade.

Adolescent substance use in 10th grade was significantly related to parenting behaviors of friends' parents, after controlling for adolescents' reports of their own substance use and their own parents' behaviors at the 9th grade level. These associations were particularly strong for parents' knowledge about their children and use of inconsistent discipline strategies. Significant interaction effects indicated that these relationships were strongest when adolescents received positive parenting at home. Some, but not all, of the main effects of friends' parents' parenting became nonsignificant after friends' substance use in ninth grade was included in the model.

The findings suggest that the parenting style in adolescents' friends' homes plays an important role in determining adolescent substance use. Implications of the joint contribution of parents and peers for prevention and intervention are discussed.

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Request Reprint E-Mail: mcleveland@psu.edu

Responses to the Government Alcohol Strategy: statements, press and comments

Following the recent release of the Government Alcohol Strategy, here's a selection of some of the comments and reaction. > > > > Read More

Advancing Recovery: Implementing Evidence-Based Treatment for Substance Use Disorders at the Systems Level

A multisite evaluation examined the process and outcomes of Advancing Recovery, a Robert Wood Johnson Foundation initiative to overcome barriers to implementing evidence-based treatments within alcohol and drug treatment systems.

We report findings from a 3-year, mixed-method study of how treatment systems promoted two evidence-based practices: medication-assisted treatment and continuing care management. We compared outcomes and implementation strategies across 12 state/county agencies responsible for alcohol and drug treatment and their selected treatment centers. Each partnership received 2 years of financial and technical support to increase adoption of evidence-based treatments.

Partnerships flexibly applied the Advancing Recovery model to promote the adoption of evidence-based treatments. Most sites achieved a measurable increase in the numbers of patients served with evidence-based practices, up from a baseline of virtually no use. Rates of adopting medication-based treatments were higher than those for continuing care management. Partnerships used a menu of top-down and bottom-up strategies that varied in specifics across sites but shared a general process of incremental testing and piecemeal adaptation.

Supported partnerships between providers and policymakers can achieve wider adoption of evidence-based treatment practices. Systems change unfolds through a trial-and-error process of adaptation and political learning that is unique to each treatment system. This leads to considerable state and local variation in implementation strategies and outcomes.

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Request Reprint E-Mail: laura.schmidt@ucsf.edu

Impact of Sexual Orientation and Co-Occurring Disorders on Chemical Dependency Treatment Outcomes

The aims of this study were to compare client characteristics at admission to chemical dependency (CD) treatment by sexual orientation, examine sexual orientation as a predictor of co-occurring CD and mental health problems (hereafter referred to as co-occurring disorders [COD]), and to examine the effect of sexual orientation and COD on 1-year CD treatment outcomes (treatment completion, treatment reentry, and arrest) among men and women.

This retrospective cohort study used 2004–2008 data from publicly funded CD treatment programs in Washington State (n = 69,525 clients). Bivariate comparisons were made using chi-square tests; logistic and Cox regressions were to estimate risk in multivariate analyses.

Risk factors associated with sexual minority status (lesbian/gay/bisexual) included COD, primary drug (vs. alcohol) use, and greater substance use. In multivariate analyses, sexual minority clients were more than twice as likely as their heterosexual counterparts to have COD. COD, but not sexual orientation, negatively predicted treatment completion and arrest overall in the year following treatment among male and female clients and positively predicted treatment reentry and intimate partner violence–related arrest among women. COD moderated the effect of sexual orientation on arrest; gay men with COD were less likely to be arrested, particularly for substance use and other violence–related crimes.

These findings highlight the importance of assessing mental health among sexual minority clients in treatment settings and addressing issues specific to both female and male sexual minorities.


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Request Reprint E-Mail: Lipsky@u.washington.edu

Association Between Alcohol Screening Scores and Alcohol-Related Risks Among Female Veterans Affairs Patients

Evidence-based brief interventions for primary care patients with at-risk drinking include personalized feedback on alcohol-related risks, yet little is known about associations between alcohol screening scores and outcomes among women. This study evaluated associations between scores on the three-item Alcohol Use Disorders Identification Test–consumption (AUDIT-C) questionnaire and self-reported alcohol-related risks and consequences among veteran women.

Female outpatients from an urban Veterans Affairs facility were mailed annual surveys (1998-2000) (response rates: 65% Years 1 and 2, 55% Year 3). Measures were obtained from each respondent's first completed survey and included a gender-specific AUDIT-C (0–12 points), self-reported alcohol-related consequences, problem drinking or other drug use, and health risks. The prevalence of each outcome across AUDIT-C score groups (0, 1–2, 3, 4, 5–7, 8–12) was estimated using logistic regression, adjusting for age, race, and marital status.

Among 2,670 respondents, 23.7% screened positive for alcohol misuse (AUDIT-C ≥ 3). For three out of the five alcohol-related consequences (tolerance, blackouts, felt needed to cut down), adjusted prevalence increased at AUDIT-C scores of 3 or more. The remaining alcohol-related consequences (morning eye openers, family/friends worried) increased at scores of 4 or more, as did self-reported problem drinking or other drug use. Associations between health risks (two or more sexual partners, sexually transmitted diseases, injuries, domestic violence, hepatitis/cirrhosis) and AUDIT-C scores were less consistent, but prevalence generally increased at scores of 5 or more.

Increasing scores on the AUDIT-C reflect increasing prevalence of self-reported alcohol-related risks and consequences among women. These results provide clinicians with gender-specific information on alcohol-related risks that could be incorporated into brief interventions.



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

Examining Explanatory Mechanisms of the Effects of Early Alcohol Use on Young Adult Alcohol Dependence

This study examined potential explanatory mechanisms linking childhood alcohol use onset and chronicity of adult alcohol dependence by testing the following three competing hypotheses: (1) a marker hypothesis, where early onset of alcohol use may be simply a marker for other factors that have been linked to both age at initiation and adult alcohol problems; (2) a compromised development hypothesis, where early alcohol initiation may interfere with adolescent development, which can lead to later alcohol problems; and (3) an increased substance use hypothesis, where early onset of alcohol use may lead to increased substance use in adolescence and, in turn, chronic alcohol dependence.

Data came from a longitudinal community sample of 808 participants recruited at age 10 in 1985. Participants were followed through age 33 in 2008 with 92% retention.

Childhood onset of alcohol use (before age 11), when compared with initiation during adolescence, predicted an increased chronicity of adult alcohol dependence, even after accounting for the hypothesized confounds from the marker hypothesis. In addition, adolescent compromised functioning did not mediate this relationship between early alcohol use and chronicity of adult dependence (Hypothesis 2), nor did adolescent substance use (Hypothesis 3). However, compromised functioning and substance use in adolescence predicted increased chronicity of alcohol dependence in young adulthood.

Prevention efforts as early as the elementary grades should focus on delaying the onset of alcohol use and reducing substance use in adolescence as well as improving school functioning, reducing adolescent problem behaviors, and targeting adolescent peer networks.

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Request Reprint E-Mail: kg27@u.washington.edu

Alcohol Policies and Practices Among Four-Year Colleges in the United States: Prevalence and Patterns

The purpose of this study was to assess the prevalence of college alcohol policies and practices and to identify patterns of policies/practices across colleges.

An online survey of administrators at a random sample of 351 4-year U.S. colleges was conducted in 2008. The prevalence of 31 alcohol policies and practices was assessed as well as differences across size and type of colleges. Latent class analyses identified classes of colleges based on their alcohol policies/practices.

The majority of colleges prohibit alcohol use at sporting events, whereas less than half prohibit alcohol use at fraternity and sorority events. Less than half of the colleges also prohibit alcohol advertising in/on campus newspapers and radio stations. Small colleges are more likely than large colleges to prohibit alcohol use at tailgating events and to prohibit newspaper alcohol advertising. Public colleges are more likely than private colleges to prohibit alcohol use in dorms but less likely to prohibit alcohol advertising. We identified four classes of colleges—the largest class (38%) was characterized by having many alcohol policies/practices, the smallest class (13%) had none or few alcohol policies/practices, and the remainder fit into two middle classes that had certain policies/practices in place but lacked others.

Most colleges report implementing some alcohol policies/ practices but are lacking others. Only two of every five colleges fit into a class that has many alcohol policies. More studies are needed to validate our findings and assess whether certain policies/practices and patterns of policies are associated with reducing student alcohol consumption and related problems.



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Request Reprint E-Mail: lenk@umn.edu

Intimate Partner Violence and Patterns of Alcohol Abuse and Dependence Criteria Among Women: A Latent Class Analysis

Intimate partner violence (IPV) is a major public health issue, yet little is known about the association between IPV victimization and problem drinking among women. Study objectives were to (a) identify subtypes of problem drinking among women according to abuse and dependence criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV); (b) examine the association between recent IPV and the problem drinking classes; and (c) evaluate major depressive disorder (MDD) as a mediator of the IPV-alcohol relationship.

Data come from a cohort of 11,782 female current drinkers participating in Wave 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analysis was used to group participants into problem drinking classes according to 11 DSM-IV abuse and dependence criteria. The IPV measure was derived from six questions regarding abusive behaviors perpetrated by a romantic partner in the past year. Past-year MDD was assessed according to DSM-IV criteria. Latent class regression was used to test the association between drinking class and IPV.

Three classes of problem drinkers were identified: Severe (Class 1: 1.9%; n = 224), moderate (Class 2: 14.2%; n = 1,676), and nonsymptomatic (Class 3: 83.9%; n = 9,882). Past-year IPV was associated with severe and moderate classes (severe: adjusted odds ratio [aOR] = 5.70, 95% CI [3.70, 8.77]; moderate: aOR = 1.92, 95% CI [1.43, 2.57]). Past-year MDD was a possible mediator of the IPV–drinking class relationship.

Results indicate a strong association between recent IPV and problem drinking class membership. This study offers preliminary evidence that programs aimed at preventing problem drinking among women should take IPV and MDD into consideration.



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Request Reprint E-Mail: llaflair@jhsph.edu

Alcohol-Related Risk of Driver Fatalities: An Update Using 2007 Data

The purpose of this study was to determine whether the relative risk of being involved in an alcohol-related crash has changed over the decade from 1996 to 2007, a period during which there has been little evidence of a reduction in the percentage of all fatal crashes involving alcohol.

We compared blood-alcohol information for the 2006 and 2007 crash cases (N = 6,863, 22.8% of them women) drawn from the U.S. Fatality Analysis Reporting System (FARS) with control blood-alcohol data from participants in the 2007 U.S. National Roadside Survey (N = 6,823). Risk estimates were computed and compared with those previously obtained from the 1996 FARS and roadside survey data.

Although the adult relative risk of being involved in a fatal alcohol-related crash apparently did not change from 1996 to 2007, the risk for involvement in an alcohol-related crash for underage women has increased to the point where it has become the same as that for underage men. Further, the risk that sober underage men will become involved in a fatal crash has doubled over the 1996–2007 period.

Compared with estimates obtained from a decade earlier, young women in this study are at an increased risk of involvement in alcohol-related crashes. Similarly, underage sober drivers in this study are more at risk of involvement in a crash
than they were a decade earlier.


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Guidelines on the management of co-occurring mental health conditions in alcohol and other drug treatment settings: how useful are they

There has been a growing literature documenting the high prevalence of co-occurring mental health disorders among clients of substance use treatment services and the challenges clinicians face when treating comorbid clients.

To assist alcohol and other drug (AOD) workers in working with these clients, the Australian Government Department of Health and Ageing funded the development of ‘Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.’ Too often guidelines are produced but not evaluated.

The present study aimed to examine the extent to which this resource is perceived to be relevant and useful to clinical practice.

Ninety-seven AOD workers from across Australia completed an online survey. A series of questions asked respondents to rate the relevance and usefulness of the Guidelines to their clinical practice.

Overall, the responses received were overwhelmingly positive. The vast majority of respondents perceived the Guidelines to be relevant and useful to their clinical practice. Almost all respondents (91%) indicated that they will use some of the things they learnt from the Guidelines in their work.

The findings indicate that the Guidelines are an acceptable resource to the AOD field, and have broad applicability across AOD workers representing a range of occupations, from various service types in different geographic locations, who service a variety of client groups.

The findings are encouraging, and suggest that the Guidelines may have the potential to lead to improvements in a treatment provision.


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Request Reprint E-Mail: k.mills@unsw.edu.au

Attachment styles and alcohol problems in emerging adulthood: a pilot test of an integrative model

A pilot study tested a model of alcohol problems based on attachment theory. It was hypothesised that insecure attachment, particularly the fearful-avoidant attachment style, may be manifested in low levels of social support, which in turn might lead to alcohol problems in young adulthood.
Problematic alcohol use is a key area of concern for individuals with a mental health disorder.

Ninety university students completed self-report measures of attachment, perceived social support, parent/peer attachment and the Alcohol Use Disorders Identification Tool.

Analyses for males indicated that attachment styles were associated in the expected direction with alcohol problem. Secure attachment was negatively associated with alcohol consumption, alcohol dependence and having experienced adverse consequences resulting from alcohol use, while fearful-avoidant adult attachment was positively correlated with alcohol dependence.

While fearful-avoidant attachment was related to lower perceptions of social support, the pathway model was not supported.

Results for females, in contrast, showed no association between adult attachment style and alcohol problems, but perceived social support was again positively associated with secure attachment and negatively related to fearful and preoccupied attachment styles.

Although results were limited by the small number of male participants, future testing of the proposed model may show promise.

Results are discussed in terms of gender differences in the experience of alcohol problems, and implications for the advancement of therapeutic interventions.



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

Order of age at onset for substance use, substance use disorder, conduct disorder and psychiatric illness

This study aimed to assess the number of patients who reported earlier age at onset for psychiatric illness versus those with an earlier age at onset for substance use.

Subjects were 194 patients from substance use disorder (SUD) treatment services in the Municipality of Fredericia who accepted an offer of psychological assessment.

Patients were administered the Mini International Neuropsychiatric Interview (MINI), and when diagnoses were indicated, queried about the age at onset for each disorder. Additionally, subjects were administered the WAIS-III vocabulary scale, the Structured Assessment of Personality – Abbreviated Scale (SAPAS), completed the MCMI-III, the Beck Anxiety Inventory (BAI), and were rated with the Montgomery Åsberg Depression Rating Scale.

Age at onset was lowest for conduct disorder/antisocial behaviour, followed by tasting alcohol, trying drugs, post-traumatic stress disorder and social phobia.

Of patients reporting an age at onset for SUD and conduct disorder, 84% reported that age at onset was earliest for conduct disorder.

Of patients reporting an age at onset for both any non-substance related axis I disorder and any substance related disorder, age at onset was earliest for non-substance related disorder in 72%.

Patients reporting that their axis I disorder predated their SUD reported more severe problems currently on the BAI and the SAPAS.

Patients reporting that their conduct disorder/antisocial personality disorder criteria predated their SUD reported more aggressive-sadistic personality traits than patients reporting that SUD predated conduct disorder/antisocial personality, but did not differ in terms of antisocial personality disorder traits.

The findings are discussed in terms of their clinical implications.



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Request Reprint E-Mail: mh@crf.au.dk

CHRONIC ALCOHOL NEUROADAPTATION AND STRESS CONTRIBUTE TO SUSCEPTIBILITY FOR ALCOHOL CRAVING AND RELAPSE

Alcoholism is a chronic relapsing disorder. Major characteristics observed in alcoholics during an initial period of alcohol abstinence are altered physiological functions and a negative emotional state. Evidence suggests that a persistent, cumulative adaptation involving a kindling/allostasis-like process occurs during the course of repeated chronic alcohol exposures that is critical for the negative symptoms observed during alcohol withdrawal.

Basic studies have provided evidence for specific neurotransmitters within identified brain sites being responsible for the negative emotion induced by the persistent cumulative adaptation following intermittent-alcohol exposures. After an extended period of abstinence, the cumulative alcohol adaptation increases susceptibility to stress- and alcohol cue-induced negative symptoms and alcohol seeking, both of which can facilitate excessive ingestion of alcohol. In the alcoholic, stressful imagery and alcohol cues alter physiological responses, enhance negative emotion, and induce craving.

Brain fMRI imaging following stress and alcohol cues has documented neural changes in specific brain regions of alcoholics not observed in social drinkers. Such altered activity in brain of abstinent alcoholics to stress and alcohol cues is consistent with a continuing ethanol adaptation being responsible.

Therapies in alcoholics found to block responses to stress and alcohol cues would presumably be potential treatments by which susceptibility for continued alcohol abuse can be reduced.

By continuing to define the neurobiological basis of the sustained alcohol adaptation critical for the increased susceptibility of alcoholics to stress and alcohol cues that facilitate craving, a new era is expected to evolve in which the high rate of relapse in alcoholism is minimized.


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Do Premorbid Predictors of Alcohol Dependence Also Predict the Failure to Recover From Alcoholism?*

In a search for viable endophenotypes of alcoholism, this longitudinal study attempted to identify premorbid predictors of alcohol dependence that also predicted the course of alcoholism.

The 202 male subjects who completed a 40-year follow-up were originally selected from a Danish birth cohort (N = 9,182). Two thirds of the subjects were high-risk biological sons of treated alcoholics. A large number of measures (361) were obtained at different periods before any subject had developed an alcohol-use disorder. At age 40, a psychiatrist provided mutually exclusive lifetime diagnoses of alcohol abuse or alcohol dependence that were characterized as currently active or currently in remission according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, course specifiers.

The majority of subjects with a diagnosis of alcohol abuse were in remission at age 40 compared with those with a diagnosis of alcohol dependence (88% vs. 58%). Treatment did not predict remission. Fourteen of the 18 predictors of remission that also predicted dependence were submitted to an exploratory factor analysis (varimax). Two premorbid dimensions were identified: cognitive efficiency and early behavioral dyscontrol in childhood. Both factors predicted the failure to remit (low cognitive efficiency and high behavioral dyscontrol) even when lifetime alcoholism severity was controlled.

This 4-decade study found a striking disconnect between measures that predicted alcohol dependence and measures that predicted remission from alcohol dependence. Reduced cognitive efficiency and increased behavioral dyscontrol may be basic to gaining a fuller understanding of the etiology of alcoholism.


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Alcohol Alert

The NIAAA Alcohol Alert is a quarterly bulletin that disseminates important research findings on a single aspect of alcohol abuse and alcoholism. Please click on the desired publication for full text. To order single copies of select Alcohol Alerts, see ordering Information.

• No. 82: Fetal Alcohol Spectrum Disorders [ PDF - 466K]
• No. 81: Exploring Treatment Options for Alcohol Use Disorders [ PDF - 539K]
• No. 80: Alcohol and HIV/AIDS: Intertwining Stories [ PDF - 708K]
• No. 79: NIAAA: 40 Years of Research Leadership [ PDF - 421K]
• No. 78: A Developmental Perspective on Underage Alcohol Use [ PDF - 1.52 MB]
• No. 77: Neuroscience: Pathways to Alcohol Dependence (2009) [ PDF-1.31 MB]
• No. 76: Alcohol and Other Drugs (2008) [ PDF-0.36 MB]
• No. 75: Systems Biology: The Solution to Understanding Alcohol-Induced Disorders? (2008) [ PDF-0.27 MB]
• No. 74: Alcohol Research: A Lifespan Perspective (2008) [ PDF-0.32 MB]
  
• No. 73: Underage Drinking--Highlights From The Surgeon General's Call to Action
  To Prevent and Reduce Underage Drinking (2007) [ PDF-0.39 MB]
• No. 72: Alcohol Metabolism: An Update (2007) [ PDF--0.2 MB]
• No. 71: Alcohol and Tobacco (2007) [ PDF--1.26 MB]
  
• No. 70: National Epidemiologic Survey on Alcohol and Related Conditions (2006) [ PDF--3.87 MB]
• No. 69: Health Services Research (2006) [ PDF--1.74 MB]
• No. 68: Young Adult Drinking (2006) [ PDF--1.20 MB]
• No. 67: Underage Drinking (2006) [ PDF--1.12 MB]
  
• No. 66: Brief Interventions (2005) [ PDF--0.9 MB]
• No. 65: Screening for Alcohol Use and Alcohol-Related Problems (2005) [ PDF--3.87 MB]
• No. 64: Alcohol and Liver (2005) [ PDF --0.2 MB]
  
• No. 63: Alcohol's Damaging Effects on the Brain (2004) [ PDF--0.6 MB]
• No. 62: Alcohol-An Important Women's Health Issue (2004) [ PDF--0.4 MB]
• No. 61: Neuroscience Research and Therapeutic Targets (2004) [ PDF--0.5 MB]
  
• No. 60:The Genetics of Alcoholism (2003) [ PDF--0.2 MB]
• No. 59: Underage Drinking: A Major Public Health Challenge (2003) [ PDF--0.1 MB]
  
• No. 58: Changing the Culture of Campus Drinking (2002) [ PDF--0.2 MB]
• No. 57: Alcohol and HIV/AIDS (2002)
• No. 56: Screening for Alcohol Problems - An Update (2002)
• No. 55: Alcohol and Minorities: An Update (2002)
  
• No. 54: Craving Research: Implications for Treatment (2001)
• No. 53: Cognitive Impairment and Recovery from Alcoholism (2001)
• No. 52: Alcohol and Transportation Safety (2001)
• No. 51: Economic Perspectives in Alcoholism Research (2001)
  
• No. 50: Fetal Alcohol Exposure and the Brain (2000)
• No. 49: New Advances in Alcoholism Treatment (2000)
• No. 48: From Genes to Geography: The Cutting Edge of Alcohol Research (2000)
• No. 47: Imaging and Alcoholism: A Window on the Brain (2000)