Destigmatizing Alcohol Dependence: The Requirement for an Ethical (Not Only Medical) Remedy

The disease model of alcohol dependence or “alcoholism” is often presented as the linchpin in addressing the condition successfully. It has been argued, for example, that adopting a medical approach will reduce the stigma that impedes the provision and acceptance of treatment. However, the medical paradigm has existed for many years without significantly affecting the negative social attitudes that surround dependence.

I argue that a reductive scientific approach is not equipped to address the socioethical tensions that dependence creates.

To lessen the stigmatization of dependence, it is important to integrate ethical analysis into policy debates on the condition.

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Request Reprint E-Mail: Laura.Williamson@gcu.ac.uk

Treating Alcohol Problems With Couple Therapy

Couple therapy for treating alcohol use disorders (AUDs) results in less drinking and greater relationship stability and satisfaction in both men and women with AUDs.

The theoretical tenets, treatment methods, and research evidence for Alcohol Behavioral Couple Therapy (ABCT) are summarized.

The application of ABCT is illustrated through the treatment of a 42-year-old woman with an AUD and her 56-year-old husband.

During 12 sessions over a 6-month period, the woman attained abstinence from alcohol and learned cognitive and behavioral coping skills to deal with drinking antecedents. Her husband learned to support her abstinence by stopping drinking himself, helping her cope with drinking urges, and reinforcing her successes. The couple increased positive pleasurable activities that did not involve alcohol and improved their communication skills.

Challenges in the treatment included her ambivalence about abstaining, their complicated work and travel schedules, and other life stressors.


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Request Reprint E-Mail: bmccrady@unm.edu

Application of a Novel Hybrid Study Design to Explore Gene-Environment Interactions in Orofacial Clefts

Orofacial clefts are common birth defects with strong evidence for both genetic and environmental causal factors. Candidate gene studies combined with exposures known to influence the outcome provide a highly targeted approach to detecting GxE interactions.

We developed a new statistical approach that combines the case-control and offspring-parent triad designs into a “hybrid design” to search for GxE interactions among 334 autosomal cleft candidate genes and maternal first-trimester exposure to smoking, alcohol, coffee, folic acid supplements, dietary folate and vitamin A.

The study population comprised 425 case-parent triads of isolated clefts and 562 control-parent triads derived from a nationwide study of orofacial clefts in Norway (1996–2001). A full maximum-likelihood model was used in combination with a Wald test statistic to screen for statistically significant GxE interaction between strata of exposed and unexposed mothers. In addition, we performed pathway-based analyses on 28 detoxification genes and 21 genes involved in folic acid metabolism.

With the possible exception of the T-box 4 gene (TBX4) and dietary folate interaction in isolated CPO, there was little evidence overall of GxE interaction in our data.

This study is the largest to date aimed at detecting interactions between orofacial clefts candidate genes and well-established risk exposures.

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Request Reprint E-Mail: oivind.skare@medisin.uio.no

Binge-like ethanol consumption increases corticosterone levels and neurodegneration whereas occupancy of type II glucocorticoid receptors with mifepri

Excessive ethanol (EtOH) use leads to impaired memory and cognition. Using a rat model of binge-like intoxication, we tested whether elevated corticosterone (Cort) levels contribute to the neurotoxic consequences of EtOH exposure.

Rats were adrenalectomized (Adx) and implanted with cholesterol pellets, or cholesterol pellets containing Cort in order to achieve basal, medium, or high blood concentrations of Cort. Intragastric EtOH or an isocaloric control solution was given three times daily for 4 days to achieve blood alcohol levels ranging between 200 and 350 mg/dl. Mean 24-hour plasma levels of Cort were ∼110 and ∼40 ng/ml in intact EtOH-treated and intact control animals, respectively.

Basal Cort replacement concentrations in EtOH-treated Adx animals did not exacerbate alcohol-induced neurodegeneration in the hippocampal dentate gyrus (DG) or the entorhinal cortex (EC) as observed by amino-cupric silver staining.

In contrast, Cort replacement pellets resulting in plasma Cort levels twofold higher (medium) than normal, or greater than twofold higher (high) in Adx-Cort-EtOH animals increased neurodegeneration.

In separate experiments, pharmacological blockade of the Type II glucocorticoid (GC) receptor was initiated with mifepristone (RU38486; 0, 5, 15 mg/kg/day, i.p.). At the higher dose, mifepristone decreased the number of degenerating hippocampal DG cells in binge-EtOH–treated intact animals, whereas, only a trend for reduction was observed in 15 mg/kg/day mifepristone-treated animals in the EC, as determined by fluoro-jade B staining.

These results suggest that elevated circulating Cort in part mediates EtOH-induced neurotoxicity in the brain through activation of Type II GC receptors.

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Request Reprint E-Mail: bobsk@mail.nih.gov

GABRA2 markers moderate the subjective effects of alcohol

Individual differences in subjective responses (SRs) to alcohol are moderated by genetic variants and may be risk factors for the development of alcohol use disorders. Variation in the GABA_Aα2 receptor subunit gene (GABRA2) has been associated with alcohol dependence (AD).

Therefore, we examined whether individual differences in SRs, which reflect sensitivity to the effects of alcohol, are associated with variation in GABRA2.

Sixty-nine healthy subjects (21–30 years) underwent a laboratory-based within-session cumulative oral alcohol dosing procedure, achieving a mean peak blood alcohol level of 100.4 mg/dl (standard error = 2.5). Subjective assessments were obtained throughout the session, including ascending and descending limbs of the alcohol curve. We genotyped single nucleotide polymorphisms (SNPs) across the chromosome 4 region spanning GABRA2 and analyzed the effect of genotype and haplotypes on subjective responses to alcohol. Population substructure was characterized through the use of ancestry informative markers.

Individual SNP analysis demonstrated that carriers of the minor alleles for SNPs rs279858, rs279844, rs279845, rs279826, rs279828 and rs279836 had lower ‘Negative’ alcohol effects scores than individuals homozygous for the common allele at each SNP (P = 0.0060, P = 0.0035, P = 0.0045, P = 0.0043, P = 0.0037 and P = 0.0061, respectively).

Haplotype effects of block 1 showed concordant results with SNPs in this block (P = 0.0492 and P = 0.0150 for haplotypes 1 and 4, respectively). The minor alleles for several of these SNPs have previously been associated with AD.

Our findings provide further evidence that variation within GABRA2 is associated with attenuated negative responses to alcohol, a known risk factor for vulnerability to alcohol use disorders.

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Request Reprint E-Mail: Magdalena.Uhart@cshs.org

Reflections on the Scheduled NIAAA/NIDA Merger

Editor’s Note: Ready or not – and like it or not! — the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA) are scheduled for merger in less than 18 months. Points contributing editor Ron Roizen offers a two-part post on the history of the two institutes, the recent push toward merger, and the merger’s possible effects. This signal change in the organization of federally funded alcohol and drug research in the U.S. compels the attention of readers from across Points’ spectrum of history, policy, and advocacy. In addition to welcoming comments, we invite research and policy professionals with an interest in post-length comments on the merger– or on Roizen’s take on the merger– to contact Managing Editor Trysh Travis (ttravis@ufl.edu) to discuss future stints as guest bloggers.


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Dentists urged to ask about alcohol

Dentists are being urged to ask patients about their alcohol consumption, in an article in the Royal College of Surgeons' Dental Journal. Professor Jonathan Shepherd, the main author of the paper, states that asking about alcohol consumption should be routine, and that there is a "need to introduce a screening tool" to support this process.

Alcohol is linked to problems with oral health, including oral cancers, which have doubled in males aged 40-49 years over the past 20 years. Alcohol can also cause dental erosion in young people, increased tooth decay due to the sugars and acids in alcoholic drinks, poor oral hygiene and slower recovery from dental surgery. > > > > Read More

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

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

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

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

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


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Request Reprint E-Mail: rosie.lees@bristol.ac.uk

Developing an Accreditation System for Organizations and Programs Providing Peer Recovery Support Services

Faces & Voices is pleased to release Developing an Accreditation System for Organizations and Programs Providing Peer Recovery Support Services. The concept paper was developed over the last 14 months as we've worked with an Advisory Council that includes recovery community organization (RCO) leaders and allies to develop an accreditation system for organizations and programs providing peer recovery support services.

The objective is to accredit organizations and programs to support the wider purpose of supporting the development of recovery-oriented, community-based institutions and programs where peer services are delivered and a commitment to quality assurance and integrity of those services. An accreditation system will allow organizations and programs to oversee an expanding menu of peer support services and activities, as many already do today, providing a broader array of support to meet the needs of people seeking or in recovery. We would appreciate your thoughts and comments as we move forward.

Uncorking the muse: Alcohol intoxication facilitates creative problem solving

That alcohol provides a benefit to creative processes has long been assumed by popular culture, but to date has not been tested.

The current experiment tested the effects of moderate alcohol intoxication on a common creative problem solving task, the Remote Associates Test (RAT). Individuals were brought to a blood alcohol content of approximately .075, and, after reaching peak intoxication, completed a battery of RAT items.

Intoxicated individuals solved more RAT items, in less time, and were more likely to perceive their solutions as the result of a sudden insight.

Results are interpreted from an attentional control perspective.


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Global Actions on Harmful Drinking April 11, 2012

Key Recent Milestones:

· Worldwide: The International Center for Alcohol Policies has announced that registration is now available for the international conference Global Actions: Initiatives to Reduce Harmful Drinking in Washington, D.C. on October 8 and 9, 2012. The event will feature presentations of industry-sponsored initiatives from around the world in support of reducing harmful drinking. Register online at event.global-actions.org.

· Mexico: Global Actions participated in a health fair at Universidad de las Americas de Puebla. View photos from the event on our Facebook page.

Global Actions in Focus: Progress in Vietnam

Global Actions made significant progress in Vietnam with self-regulation and drink driving initiatives in March 2012.



Self-Regulation Code

Global Actions and the Vietnam Beer Alcohol Beverage Association (VBA) announced the establishment of an marketing code for wine and spirits with a workshop in Hanoi on March 20. This follows the launch of a marketing code for the beer sector in May 2010. These codes are meant to serve to reinforce responsible brand communications for members of VBA.

Road Safety & Bus Drivers

Six months have passed since Global Actions launched the bus driver project to educate inter-city bus drivers about the risk of drink driving. The pilot project included training of transit safety officers and breath testing of bus drivers for alcohol. At the March meeting in Nha Trang, stakeholders met to discuss the direction, implementation, and plans to expand inspection of drivers. Representatives from government agencies, research institutions, transport companies, and the beverage alcohol industry were there to exchange ideas.

"This project is designed in accordance with the focus on traffic safety outlined in Resolution 88/NQ-CP” said deputy general director of Directorate for Roads of Vietnam (DRVN) Mr. Nguyen Van Quyen. “Practical solutions are being implemented to ensure traffic safety in Vietnam.”

“Based on performance evaluation and criteria for expanding projects, ICAP is cooperating with the Ministry of Transport to develop phase 2 of the bus driver project,” said Global Actions country manager Lan Huong Nguyen. “Implementation is expected to begin in the third quarter of 2012.”


Situation Assessments: Traffic Injury Prevention

In addition to worldwide press coverage of Global Actions projects in Vietnam, a series of papers associated with the drink driving initiative was published in the March issue of Traffic Injury Prevention. The papers describe and analyze the drink driving situations in China, Colombia, Nigeria, and Vietnam. Read more of the announcement from ICAP.

What’s Happening Next:

· Vietnam: The findings of a qualitative survey on noncommercial alcohol in Vietnam will be presented at a workshop to be held on April 27 in Hanoi.

Don't Bottle It Up - HAGA launches online self assessment and referral resource

HAGA has launched DontBottleItUp, a website that allows visitors to work out the level of risk they are at as a result of their drinking and access personalised advice online. For areas such as Haringey where it is commissioned locally, users can find out where to get face-to-face support.

DontBottleItUp was developed with support from the Department of Health and aims to improve local best practice in prevention and early intervention, whilst also building clear pathways into treatment. The site aims to add value to existing Identification and Brief Advice (IBA) activity, such as the alcohol Direct Enhanced Service and NHS Health Checks and uses the validated AUDIT alcohol screening questions. > > > > Read More

Reduced Subjective Response to Acute Ethanol Administration Among Young Men with a Broad Bipolar Phenotype

Elevated lifetime prevalence rates of alcohol use disorders (AUDs) are a feature of bipolar disorder (BD). Individuals at-risk for AUDs exhibit blunted subjective responses to alcohol (low levels of response), which may represent a biomarker for AUDs. Thus, individuals at-risk for BD may exhibit low responses to alcohol.

Participants were 20 unmedicated adult males who reported high rates of hypomanic experiences (bipolar phenotype participants; BPPs), aged 18 to 21 years, and 20 healthy controls matched on age, gender, IQ, BMI, and weekly alcohol intake. Subjective and pharmacokinetic responses to acute alcohol (0.8 g/kg) vs placebo administration were collected in a randomized, double-blind, cross-over, placebo-controlled, within-subjects design.

BPP participants reported significantly lower subjective intoxication effects (‘feel high’: F=14.2, p=0.001; ‘feel effects’: F=8.1, p=0.008) across time, but did not differ in their pharmacokinetic, stimulant, or sedative responses.

Paradoxically, however, the BPP participants reported significantly higher expectations of the positive effects of alcohol than controls.

Our results suggest that unmedicated young males with previous hypomanic experiences exhibit diminished subjective responses to alcohol. These blunted alcohol responses are not attributable to differences in weekly alcohol intake, pharmacokinetic effects (eg, absorption rates), or familial risk of AUDs.

These observations suggest that the dampened intoxication may contribute to the increased rates of alcohol misuse in young people at-risk for BD, and suggest possible shared etiological factors in the development of AUDs and BD.



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Request Reprint E-Mail: sarah.yip@yale.edu

Caenorhabditis elegans Battling Starvation Stress: Low Levels of Ethanol Prolong Lifespan in L1 Larvae

The nematode Caenorhabditis elegans arrests development at the first larval stage if food is not present upon hatching. Larvae in this stage provide an excellent model for studying stress responses during development.

We found that supplementing starved larvae with ethanol markedly extends their lifespan within this L1 diapause.

The effects of ethanol-induced lifespan extension can be observed when the ethanol is added to the medium at any time between 0 and 10 days after hatching.

The lowest ethanol concentration that extended lifespan was 1 mM (0.005%); higher concentrations to 68 mM (0.4%) did not result in increased survival.

In spite of their extended survival, larvae did not progress to the L2 stage.

Supplementing starved cultures with n-propanol and n-butanol also extended lifespan, but methanol and isopropanol had no measurable effect.

Mass spectrometry analysis of nematode fatty acids and amino acids revealed that L1 larvae can incorporate atoms from ethanol into both types of molecules.

Based on these data, we suggest that ethanol supplementation may extend the lifespan of L1 larvae by either serving as a carbon and energy source and/or by inducing a stress response.


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Determining the best population-level alcohol consumption model and its impact on estimates of alcohol-attributable harms

The goals of or study are to determine the most appropriate model for alcohol consumption as an exposure for burden of disease, to analyze the effect of the chosen alcohol consumption distribution on the estimation of the alcohol Population- Attributable Fractions (PAFs), and to characterize the chosen alcohol consumption distribution by exploring if there is a global relationship within the distribution.

To identify the best model, the Log-Normal, Gamma, and Weibull prevalence distributions were examined using data from 41 surveys from Gender, Alcohol and Culture: An International Study (GENACIS) and from the European Comparative Alcohol Study. To assess the effect of these distributions on the estimated alcohol PAFs, we calculated the alcohol PAF for diabetes, breast cancer, and pancreatitis using the three above-named distributions and using the more traditional approach based on categories. The relationship between the mean and the standard deviation from the Gamma distribution was estimated using data from 851 datasets for 66 countries from GENACIS and from the STEPwise approach to Surveillance from the World Health Organization.

The Log-Normal distribution provided a poor fit for the survey data, with Gamma and Weibull distributions providing better fits. Additionally, our analyses showed that there were no marked differences for the alcohol PAF estimates based on the Gamma or Weibull distributions compared to PAFs based on categorical alcohol consumption estimates. The standard deviation of the alcohol distribution was highly dependent on the mean, with a unit increase in alcohol consumption associated with a unit increase in the mean of 1.258 (95% CI: 1.223 to 1.293) (R2 = 0.9207) for women and 1.171 (95% CI: 1.144 to 1.197) (R2 = 0. 9474) for men.

Although the Gamma distribution and the Weibull distribution provided similar results, the Gamma distribution is recommended to model alcohol consumption from population surveys due to its fit, flexibility, and the ease with which it can be modified. The results showed that a large degree of variance of the standard deviation of the alcohol consumption Gamma distribution was explained by the mean alcohol consumption, allowing for alcohol consumption to be modeled through a Gamma distribution using only average consumption.

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Genetic dissection of a model complex trait using the Drosophila Synthetic Population Resource

Genetic dissection of complex, polygenic trait variation is a key goal of medical and evolutionary genetics. Attempts to identify genetic variants underlying complex traits have been plagued by low mapping resolution in traditional linkage studies, and an inability to identify variants that cumulatively explain the bulk of standing genetic
variation in genome-wide association studies (GWAS). Thus, much of the heritability remains unexplained for most complex traits.

Here we describe a novel, freely-available resource for the Drosophila community consisting of two sets of recombinant inbred lines (RILs), each derived from an advanced generation cross between a different set of eight highly-inbred, completely resequenced founders.

The Drosophila Synthetic Population Resource (DSPR) has been designed to combine the high mapping resolution offered by multiple generations of recombination, with the high statistical power afforded by a linkage-based design.

Here, we detail the properties of the mapping panel of >1,600 genotyped RILs, and provide an empirical demonstration of the utility of the approach by genetically dissecting alcohol dehydrogenase (ADH) enzyme activity.

We confirm that a large fraction of the variation in this classicquantitative trait is due to allelic variation at the Adh locus, and additionally identify
several previously unknown modest-effect trans-acting QTL (quantitative trait loci). Using a unique property of multiparental linkage mapping designs, for each QTL we highlight a relatively small set of candidate causative variants for follow-up work.

The DSPR represents an important step toward the ultimate goal of a complete understanding of the genetics of complex traits in the Drosophila model system.


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Press Release - Friends Don't Let Problem Drinkers Drink

"Friends don't let friends drive drunk!" We all know that campaign, but researchers have given us a new message about the role of friends and drinking: Friends don't let problem drinkers drink. The attitude of friends, and family, makes a difference for people trying to sustain recovery from addiction to alcohol. That is the message of recent research, which demonstrates that people who make positive changes in their social relationships can improve their chances of success following treatment.

Using innovative statistical techniques to overcome some of the methodological flaws of previous research, this study, published in the May edition of the Journal of Studies on Alcohol and Drugs, shows that social networks can have a powerful and lasting effect on how well people are able to cope following treatment for alcohol abuse. These effects can last for at least three years after treatment. > > > > Read More

Physicians' Beliefs About Faith-Based Treatments for Alcoholism.

The study examined physicians' beliefs about faith-based alcohol treatments vis-à-vis Alcoholics Anonymous, pharmacologic treatment, and residential treatment.

A survey was mailed to a national sample of U.S. primary care physicians and psychiatrists. It included a brief vignette of a nominally religious 47-year-old man hospitalized for acute alcohol poisoning who requested addiction treatment. Physicians rated the likely effectiveness of three treatment methods: Alcoholics Anonymous, pharmacological therapy by an addiction specialist, and a residential program. Physicians were asked whether they would refer the patient to a faith-based program (beyond Alcoholics Anonymous) and whether an emphasis on spirituality is critical to 12-step program success.

The response rate was 896 of 1,427 (63%) for primary care physicians and 312 of 487 (64%) for psychiatrists. Psychiatrists were more likely to rate Alcoholics Anonymous as very effective (64% versus 57% of primary care physicians), more likely to rate residential treatment as very effective (47% versus 38% of primary care physicians), and more likely to rate pharmacologic therapy as very effective (31% versus 22% of primary care physicians). Psychiatrists and primary care physicians were equally likely to consider referring the patient to a faith-based program (71% and 79%) and equally likely to believe that “an emphasis on spirituality is critical to the success of 12-step programs” (81% and 85%).

Psychiatrists were more optimistic than primary care physicians about all three treatments. Physicians in both specialties would refer even nominally religious patients to explicitly faith-based programs (beyond Alcoholics Anonymous). Physicians' enthusiasm for faith-based treatments highlights the need for scientific study of these treatments to determine which elements are most helpful for patients seeking recovery.


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Request Reprint E-Mail: rlawrence@uchicago.edu

Military Addresses Alcohol Use with Online Screening Tool

The rate of heavy alcohol use among young military men is about twice that of their civilian counterparts. Taking the first step to getting help is as easy as visiting http://www.DrinkingIQ.org. The anonymous online alcohol screening tool, provided by Military Pathways, is visited by many users during Alcohol Awareness Month in April and on National Alcohol Screening Day which is today, Thursday, April 5. > > > > Read More

Alcohol in the European Union: WHO releases updated report on data and policy for EU

A new report from the World Health Organization (WHO) updates data on alcohol in the European Union (EU) and effective policies to address related harm.

Download Alcohol in the European Union. Consumption, harm and policy approaches

The report uses information gathered in 2011 to update key indicators on alcohol consumption, health outcomes and gives an overview of the latest research on effective alcohol policies. It includes data from the EU, Norway and Switzerland on alcohol consumption, harm and policy approaches. > > > > > Read More

Categorical 12-step involvement and continuous abstinence at 2 years

A longitudinal analysis of 12-step involvement was conducted among a U.S. sample of patients exiting treatment for substance dependence. Categorical involvement in a set of 12-step activities and summary scores of involvement from the Alcoholics Anonymous Affiliation Scale were examined in relation to continuous abstinence and aftercare (Oxford House or usual care) condition.

Participants who were categorically involved in 12-step activities were significantly more likely to maintain continuous abstinence at 2 years compared with those who were less involved, predicting a greater likelihood of complete abstinence than summary scores of involvement.

In addition, participants in the Oxford House condition were significantly more likely to remain continuously abstinent throughout the course of this randomized clinical trial.

Findings suggest that categorical involvement in a set of 12-step activities and communal-living settings such as Oxford Houses are independent factors associated with continuous abstinence from both alcohol and illicit drugs among substance dependent persons.


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Request Reprint E-Mail: jmajer@ccc.edu

The Drink Driving Situation in China

China has been concerned about the serious problem of drinking and driving road crashes, and it has made good progress by establishing strict laws, imposing serious penalties, and initiating a rigorous enforcement program since 2008. This study has assessed the magnitude and nature of the problem and reviewed the legislation, current practices, and institutional capacities for preventing drinking and driving.

Data and information were collected using existing reports and by consulting officials and experts from a number of agencies.

Although there were no national statistics on levels of drinking and driving, random breath test surveys in 2 southern cities showed that between 4.5 and 4.6 percent of drivers were driving over the minimum legal blood alcohol concentration (BAC) limit of 20 mg/100 mL. Preliminary results from crash data also showed that at least 20 percent of serious road crashes were alcohol related in these cities. The national published figure for fatal crashes caused by drinking and driving was much lower, only 4 percent, but alcohol was not often identified as the main cause because of measurement difficulties. China's legislation sets 2 BAC limits that are comparable with international norms. It has recently increased the penalties for drunk driving, the more serious of the 2 offenses, with a minimum driving ban of 5 years. The police are actively enforcing the laws through frequent roadside checking but they need more resources. Alcohol breath tests before and after a combined publicity and enforcement campaign indicated reductions of 87 and 68 percent of drivers over the legal limit in 2 southern cities.

China has made progress in strengthening its approach to preventing drinking and driving, particularly in the area of law enforcement. However, it is not possible to evaluate the potential benefits because of data issues. Recommendations for the future include the need to improve the national road crash and injury database, strengthen the coordination of key agencies, and provide more effective and sustained public information campaigns that target vulnerable drivers and are integrated with enforcement strategies. Evaluation and research are important to improve future prevention programs.

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The Drink Driving Situation in Nigeria

This study was carried out to assess the magnitude and nature of the drink-drive problem in Nigeria and evaluate the institutional capacities for preventing drinking and driving, using the methodology developed by the International Center for Alcohol Policies (ICAP) described in the overview article in this issue (Johnson 2012).

Data and information were collected using existing reports and by consulting officials and experts from a number of key agencies.

In 2008, 9572 people died in road crashes according to police statistics. However, according to World Health Organization statistical modeling, this figure is likely to be much higher, with deaths ranging from 34,000 to 78,000 in 2007 and a mortality rate of 32.3 percent. Not only is it likely that the police data underestimate the road crash problem but it was also found that the data from the police and the Federal Road Safety Commission (FRSC) were inadequate for estimating the extent of the drink-drive problem mainly because of the lack of alcohol testing equipment. One research study highlighted the problem of drivers of commercial vehicles; 67.2 percent of drivers admitting to drinking alcohol during the working day. Nigeria sets a legal limit of 0.05 g/100 mL blood alcohol concentration (BAC), but enforcement of the law is weak because alcohol testing equipment is unavailable. The FRSC is a federal agency dedicated to improving road safety and the clear lead agency in Nigeria. It runs publicity campaigns against drinking and driving with private sector support, especially toward the end of the year when there is increased vehicular traffic due to people travelling to celebrate the Christmas and New Year holidays, but these have not been evaluated. However, its combined enforcement and public education roles give it considerable potential for tackling the drink-drive problem in the future.

This study recommended that priority should be given to strengthening the road crash and injury database and drink-drive enforcement, especially for drivers of commercial vehicles, and that the opportunities provided by the World Bank project supporting safe road corridors should be maximized.

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The Drink Driving Situation in Vietnam

To identify the extent and nature of the problem and the main contributing factors to drink driving crashes; determine the current mechanisms in place, particularly in terms of legislation and its enforcement; and identify baseline data and relevant stakeholders.

The situational assessment was based on the collection of secondary data from available reports and documents, in-depth interviews with key representatives at a central level, and field surveys in provinces.

Vietnam has experienced phenomenal growth in motor vehicles, especially motorcycles, in the last decade (400%). This initially led to an increase in deaths from road crashes, but since 2006 the number has stayed fairly level according to police statistics. However, comparisons with health data suggest that the number of deaths is much higher and there are clearly a number of problems with the relevant data systems. Data on the percentage of drivers exceeding legal limits are not available, but police statistics indicated that drinking alcohol was a contributory factor in 7 percent of motor vehicle crashes. This is likely to be an underestimate, because the police and health services do not have the equipment to measure the blood alcohol concentration (BAC) levels of all drivers in crashes. Motorcycle riders and young people are in the high-risk groups. There are strict BAC limits starting at over zero and severe punishments for drunk drivers involved in serious crashes. However, the police do not have adequate manpower or equipment to conduct regular and frequent roadside checking for drivers who have been drinking. There have also been a number of education programs on road safety including drinking and driving, but these have not included sustained and intensive campaigns targeting the high-risk groups. The National Traffic Safety Committee (NTSC) is responsible for coordinating the relevant agencies but there is still a problem with lack of information sharing between agencies.

This study completed a comprehensive situational assessment that examined the problem of drinking and driving and identified some of the weaknesses in the current prevention system. Vietnam currently has 2 international projects on road safety and it is hoped that these together with support from the International Center for Alcohol Policies (ICAP) Global Actions program will provide opportunities for strengthening drinking and drive prevention initiatives by improving the road crash and injury database, building the capacity of the key organizations, strengthening the coordination mechanisms, and implementing and evaluating trial drink-drive interventions.

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The Drink Driving Situation in Colombia

To describe and analyze the drink driving situation in Colombia.

Methods: The assessment was based on semistructured interviews of key stakeholders and analysis of secondary data.

Results: Road traffic crashes caused 5704 deaths and injured 39,318 people in 2010. The 3 main sources of crash data—forensic authorities, traffic authorities, and motor vehicle insurance agencies—provide different information about crashes, drivers, and victims, but they cannot be routinely merged. This together with the problem of identifying alcohol as the cause of a crash makes it difficult to estimate the role of drink driving in road crashes. In addition, reliable figures for the incidence of drink driving are not available from the random breath test programs because of sampling issues, underreporting, and missing data on negative results. However, it can be argued that alcohol plays a role in fatalities, because the proportion of crashes involving fatalities rises on weekends and between 12:00 a.m. and 05:59 a.m. when drink driving is likely to occur. Colombia has strict drink-drive laws that specify 3 levels of offense and sanctions (level I: 40– 99 mg/100 mL, level II: 100–149 mg/100 mL, and level III: 150 mg/100 mL or above). Drivers responsible for causing crashes with fatalities and injuries can be imprisoned under criminal law and sentences are increased by 50 to 100 percent if they test positive for alcohol. Enforcement includes random breath testing for alcohol, but its impact is weakened by the lack of a legal requirement to submit to a test and poor implementation of sanctions. There have been mass media campaigns against drink driving including one linked to a major enforcement initiative in 2008. However, there was a consensus that most campaigns were not focused sufficiently on increasing drivers’ perceived risk of being caught. According to those interviewed, campaigns aimed at responsible consumption and the use of designated drivers appear to have had a growing positive effect, but these impacts have not been empirically assessed. The Road Prevention Fund is a Sui Generis institution in Colombia that has played a key role in tackling the drink driving problem.

Legal blood alcohol concentration (BAC) limits are on a par with international standards and the traffic authorities carry out regular roadside sobriety checks. However, the enforcement is weakened by poor implementation of sanctions. In addition, issues with data mean that the nature and extent of drink driving in Colombia cannot be accurately monitored.

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Assessing a Country's Drink Driving Situation: An Overview of the Method Used in 6 Low- and Middle-Income Countries

The International Center for Alcohol Policies (ICAP) has developed an international program to reduce drink driving as part of its strategy for Global Actions on Harmful Drinking.

The program focuses on capacity building, training, and the implementation, monitoring, and evaluation of regional and local pilot projects in 6 participating low- and middle-income countries.

The first step in developing an effective program that addresses specific problems in a region or country is to assess the current drink driving situation.

In order to meet this key requirement, ICAP developed a situation assessment approach based largely on the recommendations of Chapter 2 of the good practice manual on drinking and driving produced by the Global Road Safety Partnership (GRSP) under the auspices of the United Nations (UN) Road Safety Collaboration. The aim of the assessment was to provide the foundation for preparing a prioritized and effective suite of projects using the good practice recommended by the GRSP/UN manual. Its output is intended to assist with determining program objectives, design, and evaluation so that the benefits from the investments in drink driving programs can be maximized and data led, focusing on the priorities identified by the assessment.

The situation assessment approach was produced as a set of guidelines containing a detailed and structured list of questions. The questions are organized into 6 main groups or elements and they enable a comprehensive and systematic collection of existing information about the extent and nature of the drink driving problem, the strengths and weaknesses of the current prevention practices, and the capacity for improvements.

Situation assessments using these guidelines have been completed in the 6 focus countries and the resulting information is now being used for capacity building and developing appropriate and relevant pilot projects, taking into consideration the country's culture with respect to transportation, enforcement, health care, and alcohol consumption.

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Reducing Drink Driving in Low- and Middle-Income Countries: Challenges and Opportunities

A great deal of progress has been made in reducing alcohol-impaired driving crashes and the related injuries and deaths in countries around the world. Unfortunately, this progress has not been shared by many low- and middle-income countries.

In response to this disparity, a variety of international efforts have been undertaken, including the Drink Driving Initiative of Global Actions on Harmful Drinking, being carried out with a focus on 6 low- and middle-income countries where drink driving is a significant issue. These countries are China, Colombia, Mexico, Nigeria, Russia, and Vietnam.

This article provides an overview of situational assessments that describe the current drink driving problems in these countries and the laws, policies, enforcement efforts, and public attitudes related to drink driving.

These descriptions show clearly that there are particular challenges faced by the countries discussed here. Some, such as a lack of reliable traffic safety data, are common to most of the countries. This lack of data may be interrelated with the lack of well-developed drink driving policies. Other challenges vary depending on the particular geographic, economic, cultural, and social situations in each country.

The assessments indicate the need for a focus on capacity building at the organizational and individual level in the target countries. The assessments also indicate that a long-term commitment to strengthening policies, implementation, and evaluation will be needed.

This deeper understanding of the situations in each of these countries is already being put to use in what we hope is the beginning of an important and lifesaving process.


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Higher Serum Free Glycerol Levels in a Group of Alcoholics than in Controls

The biomarkers of excessive alcohol intake reported thus far have not always been reliable. We discovered the presence of free glycerol (FG) by high-performance liquid chromatography (HPLC) in the serum of alcoholic patients but not in healthy persons, and a higher percentage of the alcoholics were positive for serum FG than for gamma-glutamyl transpeptidase, mean corpuscular volume, or carbohydrate-deficient transferrin (%CDT). Therefore, in this study, we investigated whether the same results as with HPLC could be obtained by measuring FG with an easy-to-use autoanalyzer and whether the serum FG measured by this method would be useful as a biomarker of excessive alcohol intake.

First, the measurements of serum FG made by HPLC and by a biochemical method with an autoanalyzer were tested for a correlation, and then fasting serum FG was measured with the autoanalyzer in 3 groups: a group of Japanese male alcoholics who drank until just before admission, a group of Japanese male patients with chronic viral hepatitis, and a group of Japanese healthy male volunteers.

There was a strong positive correlation between the serum FG values measured by HPLC and by the autoanalyzer in the alcoholic group. The values in the alcoholic group were significantly higher than in the viral hepatitis group and healthy control group. We set the cutoff serum FG value for discriminating between the alcoholic group and the other 2 groups in the receiver operating characteristic analysis at 0.9 mg/dl, and that cutoff value provided a sensitivity of 80% for identifying the alcoholic group and a specificity of 84 and 94% in relation to the viral hepatitis group and the healthy volunteer group, respectively. Among various clinical tests in the alcoholic group, serum FG showed the highest rate of abnormally high value.

Measurement of serum FG with an autoanalyzer may be useful as a biomarker of excessive alcohol intake.

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Emergency Department Visits Due to Alcohol Intoxication: Characteristics of Patients and Impact on the Emergency Room

The aim of the study was to describe the epidemiology, management and cost of emergency department (ED) visits due to alcohol intoxication.

A retrospective review of medical records of all episodes of alcohol intoxication was made, excepting those where another diagnosis such as trauma or psychiatric illness was primary, in patients older than 16 years, who presented to the ED of a large university hospital in Belgium over a 12-month period from 1 January 2009.


A total of 635 such patients accounted for 1.2% of all ED visits; 429 were males and 48.3% were aged between 41 and 60 years; 63.8% of the patients had a history of alcohol use disorder and 60.3% had a history of psychiatric disorder; 74.3% of the patients received some form of medical treatment and 62% were seen by a psychiatrist. Of the total, 57.5% of the patients were admitted to the ED observation ward, with a mean length of stay of 8.4 h. The estimated total cost was €318 838.25, with an average of €541.32 per patient.

Alcohol intoxication leads to a financial burden on the community. In addition to imposing physical, social and psychological stress on the community, the often agitated or aggressive patient imposes stress on ED staff. Close surveillance of trends in alcohol abuse is warranted, and the ED should consider implementing a questionnaire method of screening for alcohol abuse.



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Alcohol Dependence, Consumption of Alcoholic Energy Drinks and Associated Work Characteristics in the Taiwan Working Population

To examine the association between work characteristics and the risk of alcohol dependence across different employment types and occupations, including the pattern of alcohol consumption in the form of energy drinks and its association with alcohol dependence.

A total of 13,501 men and 8584 women participated in a national survey in Taiwan. Alcohol dependence was defined as ≥2 points in the CAGE questionnaire. A self-administered questionnaire recorded drinking behaviors, consumption of alcoholic energy drinks, employment type, occupation and a number of psychosocial work stressors, namely job demands, job control, employment security and workplace justice.

Of the total, 9.4% of men and 0.8% of women were CAGE-positive, and 6.0% of men and 0.7% of women regularly consumed alcoholic energy drinks. In male and female regular consumers of alcoholic energy drinks, 38.7 and 23.3%, respectively, were alcohol-dependent. Multivariate regression analyses showed that male employees in manual skilled occupations, with lower workplace justice, having weekly working hours <40 h and on piece-rated or time-based pay systems were at higher risks of alcohol dependence

Certain occupational groups and workers with adverse psychosocial work characteristics should be targets for prevention of alcohol dependence. Alcoholic energy drink consumption should be taken into consideration while studying alcohol dependence in the work population in Taiwan.


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Factors Predicting Change in Frequency of Heavy Drinking Days among Alcohol-Dependent Participants in the National Epidemiologic Survey on Alcohol and

To discover the predictors of change in the frequency of heavy drinking (HD) over a 4-year period in alcohol dependent (AD)-individuals identified in the general population, namely, among participants of the US National Epidemiologic Survey on Alcohol and Related Conditions interviewed at Wave 1 (2001–2002) and at Wave 2 (2004–2005).

The study cohort included subjects meeting DSM-IV criteria for AD in the past year at Wave 1 (n = 1484), who were present at Wave 2 (n = 1172) and had complete data on factors of interest (n = 1123). Frequency of HD was defined as the number of HD days (HDD) (≥5 drinks per day for men and ≥4 for women). Change in frequency of HDD from baseline (Wave 1) to ∼3 years later (Wave 2) was determined. An analysis of covariance model (ANCOVA), adjusting for baseline HDD, was used to examine individual factors associated with change in frequency of HDD, while a multivariable regression model was employed to assess factors associated with change in frequency of HDD simultaneously.

Overall, there was a decrease in mean standard errors (SE) HDD [from 119.4 (1.8) at Wave 1 to 82.5 (2.1) at Wave 2, P < 0.0001]. Compared with smokers, non-smokers had a mean (SE) HDD reduction of 13.4 (6.7), P < 0.05. AD criteria of tolerance was significantly associated (P < 0.05) with less reduction in HDD. Change in depression/dysthymia status was associated with greater reduction in HDD in the ANCOVA model, but not the fully adjusted multivariable model.

Findings from this study suggest that smoking and AD criteria of tolerance are important factors for long-term follow-up of AD patients and they should influence the selection of the kinds of interventions required for AD patients to achieve maximal therapeutic benefit.


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The Epidemiology of Alcohol Consumption and Misuse among Chinese College Students

To understand alcohol-related risk behaviours among Chinese college students.

As part of the first China National Youth Risk Behaviour Survey, undertaken in 2009, 52,150 students at 119 colleges were randomly sampled. Information was obtained from self-administered questionnaires.

Prevalences were: lifetime drinkers 80.8%, current drinkers 49.3% (drank alcohol in past 30 days) and binge drinkers 23.5% (‘binge drinkers’ reporting at least five alcoholic drinks on a single occasion at least six times during the past 30 days). Multinomial logistic analysis revealed the contribution of sociodemographic factors to three high-risk drinking behaviours: odds ratio (95% confidence interval) = 3.64 (2.69–4.60) with frequent drinking; 3.27 (1.82–4.72) with binge drinking; and 5.48 (3.20–7.77) with heavy binge drinking. These three rates were greater among males than females, in the Western more than the Eastern region, among students living off-campus and among those whose mothers had higher education. Heavy drinking was linked to lower academic self-rating.

There is a trend towards risky drinking among Chinese college students. Measures such as a minimum drinking age, advertisement restrictions, taxation, drunk-driving penalties and campaigns to heighten public awareness of alcohol-related health risks should be instituted in order to improve the situation on college campuses where
alcohol abuse is particularly prevalent.


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California Traffic Safety Report Card - Alcohol

Alcohol-impaired driving fatalities (fatalities in crashes involving a driver or motorcycle rider (operator) with a blood alcohol concentration (BAC) of 0.08 grams per deciliter (g/dL) or greater) dropped by 14.4 percent from 924 in 2009 to 791 in 2010. The 2010 figure is the lowest DUI death total ever.

California’s alcohol-impaired driving fatality rate dropped from 0.31 in 2008 to 0.28 in 2009. California’s rate is much better than the national average of 0.36. Of the five largest states in terms of total traffic fatalities, (CA, FL, TX, PA, and NC), California has the best rate.

As a percent of total fatalities, alcohol-impaired fatalities decreased from 30 percent in 2009 to 29 percent in 2010. This number has remained virtually unchanged in the past five years. California is better than the national average of 31 percent.

In 2010, the 21-24 age group had the highest percentage of drivers in fatal crashes with BAC levels of 0.08 or higher – 30 percent (down from 33 percent in 2009).

DUI arrests have dropped in 2010 to 195,879 as compared to 208,531 in 2009. Note: the 2010 DUI arrest figure represents more DUI arrests than any year between 1997-2005. (DMV)

California’s statewide DUI conviction rate for 2008 is 79 percent. (2011 Annual Report of the California DUI Management Information System)