Requirement of central ghrelin signaling for alcohol reward

The stomach-derived hormone ghrelin interacts with key CNS circuits regulating energy balance and body weight. Here we provide evidence that the central ghrelin signaling system is required for alcohol reward.

Central ghrelin administration (to brain ventricles or to tegmental areas involved in reward) increased alcohol intake in a 2-bottle (alcohol/water) free choice limited access paradigm in mice.

By contrast, central or peripheral administration of ghrelin receptor (GHS-R1A) antagonists suppressed alcohol intake in this model.

Alcohol-induced locomotor stimulation, accumbal dopamine release and conditioned place preference were abolished in models of suppressed central ghrelin signaling: GHS-R1A knockout mice and mice treated with 2 different GHS-R1A antagonists.

Thus, central ghrelin signaling, via GHS-R1A, not only stimulates the reward system, but is also required for stimulation of that system by alcohol.

Our data suggest that central ghrelin signaling constitutes a potential target for treatment of alcohol-related disorders.


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A Cultural and Social Cognitive Model of Differences in Acculturation Orientations, Alcohol Expectancies, and Alcohol-Related Risk Behaviors Among His

The present study used a cultural and social cognitive conceptual framework to investigate whether alcohol expectancies and valuations would mediate the associations between specific acculturation orientations and alcohol-related risk behaviors.

The sample comprised 1,527 Hispanic students attending colleges and universities in diverse regions of the United States. Respondents completed self-report measures of Hispanic and American cultural practices; alcohol expectancies and valuations; and self-reported frequency of hazardous alcohol use, binge drinking, sexual activity under the influence of alcohol, driving under the influence of alcohol, and riding with a drunk driver. Latent class analysis was used to classify participants into acculturation orientations.

Results indicated that acculturation orientations were differentially associated with alcohol-related risk outcomes, with separated bicultural and low bicultural orientations inversely related to all of the alcohol-related risk behaviors except for riding with a drunk driver. Negative expectancy valuations were positively associated with endorsement of binge drinking and drunk driving and negative expectancies were negatively associated with binge drinking, drunk driving, and riding with a drunk driver. With the exception of sexual activity under the influence of alcohol, the associations between acculturation orientations and alcohol-related risk behaviors were partially mediated by positive alcohol expectancies.

Our findings provided relevant data that are informative for preventing alcohol and related risk behaviors among Hispanic college students.

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Request Reprint E-Mail: srosiers@med.miami.edu

Substance Misuse, October-December 2011

Statistics on Substance Misuse in Wales include data concerning people presenting to treatment services for substance misuse. The latest release updates the statistics previously released on 29 February 2012.

The key points from the latest release are:

• There were more than 6,800 referrals for treatment of alcohol or drug misuse notified to the database. During the quarter over 4,100 assessments were carried out by treatment services and over 3,300 treatments commenced.
• 51 per cent (3,500) of referrals related to misuse of alcohol, 41 per cent (2,800) related to misuse of drugs and 8 per cent (500) of referrals had no main substance reported.
• Of those where a main substance was reported 56 per cent of referrals were for alcohol and 44 per cent for drugs misuse. Heroin accounted for 46 per cent of all referrals for which drugs were specified as the main substance, with cannabis (17 per cent) and cocaine (10 per cent) the next most common drugs.
• Males accounted for the majority of all referrals for both alcohol (64 per cent) and drugs (75 per cent).
• 71 per cent of referrals for any substance were assessed within 10 working days of referral and 91 per cent of people were given treatment within 10 working days of assessment.

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Global Actions May 24, 2012

Key Recent Milestones:

· Colombia: Global Actions has been invited to participate as a key stakeholder in Colombia’s “Mesa por la Vida: Recuperación Integral de la Zona Rosa.” The project focuses on improving the safety of Bogota’s nightlife by promoting moderate alcohol consumption and working to reduce underage drinking, public drinking, drink driving, and noncommercial alcohol consumption.


Global Actions in Focus: Vietnam

Global Actions Vietnam held its first Noncommercial Alcohol workshop in April 2012 in Hanoi, “Production, Consumption, and Use of Noncommercial Alcohol in Vietnam.”

Co-sponsored by the Vietnam Beer Alcohol Beverage Association (VBA), the event featured a discussion of the state of unrecorded alcohol in Vietnam and remarks from experts in the research field, including VBA Chairman Dr. Nguyen Van Viet.

Institute for Population and Social Studies (IPSS) Vice Director Dr. Luu Bich spoke on findings from National Economic University (NEU) and ICAP’s 2011 qualitative survey in Bac Ninh, Quang Binh, and Tien Giang provinces. ICAP’s Brett Bivans remarked on the noncommercial alcohol issue globally, highlighting the need for continuing assessment and solutions.

In addition to the successful noncommercial alcohol workshop, Global Actions continues to see steady progress in the drink driving initiative.

“The Da Nang project team has well applied the combination of education and enforcement activities with the knowledge gained from our capacity-building workshops,” said Global Actions Country Manager Lan Huong Nguyen.


In April 2012, Global Actions worked with the Da Nang Traffic Police Department to implement the most recent drink driving education campaign. We also worked with the Traffic Safety Committee to produce leaflets, panels, and a manual of traffic safety named “Prevention of Harmful Drinking While Driving” that will be distributed to the Da Nang public.

What’s Happening Next:

· Mexico: ICAP’s Brett Bivans is speaking on the topic of responsible marketing of beverage alcohol through compliance monitoring at the CONAR-CIVyL Signing Ceremony on May 24. ICAP is also set to launch the Global Actions campaign “Towards zero drink- driving deaths in Puebla” on May 30.

Caffeinated alcoholic beverages: report, policy recommendations and fact sheets

A new report from the Canadian Centre on Substance Abuse (CCSA) and the Centre for Addictions Research of British Columbia (CARBC) examines the trends and risks of alcohol and caffeine consumption, and provides targeted recommendations for policy makers, public health organizations, healthcare providers and researchers.

View the recommendations in the full report, Caffeinated Alcoholic Beverages in Canada: Prevalence of Use, Risks and Recommended Policy Responses.

Read the accompanying Policy Brief on Alcohol and Caffeine.

CCSA and CARBC have also developed alcohol and caffeine fact sheets for parents and youth:

Youth – Alcohol and Caffeine: a Bad Buzz
Parents – Alcohol and Caffeine: a Bad Buzz

Does Staying in school (AND NOT WORKING) Prevent Teen Smoking and Drinking?

Previous work suggests but cannot prove that education improves health behaviors. We exploit a randomized intervention that increased schooling (and reduced working) among male students in the Dominican Republic, by providing information on the returns to schooling.

We find that treated youths were much less likely to smoke at age 18 and had delayed onset of daily or regular drinking. The effects appear to be due to changes in peer networks and disposable income.

We find no evidence of a direct impact of schooling on rates of time preference, attitudes towards risk or perceptions that drinking or smoking are harmful to health, though our measures of these factors are more limited.


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Request Reprint E-Mail: robertjensen@ucla.edu

Scotland passes minimum pricing bill; Irish health minister announces ban on alcohol sports sponsorship

The Scottish Government has passed the Alcohol Minimum Pricing Bill, meaning a 50 pence minimum unit price (MUP) could be in place north of the border by April next year. The Bill requires Royal Assent and still faces the threat of potential legal challenges as warned of by sections of the alcohol industry.

A 50 pence MUP would set a minimum floor price for an average strength bottle of wine at £4.69, vodka at £13.13 a bottle (70cl) and a standard four-pack of lager would need to cost at least £3.52. The Bill sets a minimum price for a unit of alcohol as a condition of licence.

However most drinks would be unaffected, especially those sold in pubs and restaurants. The minimum price would not be raised for at least two years and is reported to include a "sunset clause". The move is expected to save lives and reduce crime based on evidence linking price and consumption and modelling work by the University of Sheffield. > > > > Read More

The propensity for consuming ethanol in Drosophila requiresrutabagaadenylyl cyclase expression within mushroom body neurons

Alcohol activates reward systems through an unknown mechanism, in some cases leading to alcohol abuse and dependence. Herein, we utilized a two-choice Capillary Feeding assay to address the neural and molecular basis for ethanol self-administration in Drosophila melanogaster.

Wild-type Drosophila demonstrates a significant preference for food containing between 5 and 15% ethanol.

Preferred ethanol self-administration does not appear to be due to caloric advantage, nor due to perceptual biases, suggesting a hedonic bias for ethanol exists in Drosophila.

Interestingly, rutabaga adenylyl cyclase expression within intrinsic mushroom body neurons is necessary for robust ethanol self-administration. The expression of rutabaga in mushroom bodies is also required for both appetitive and aversive olfactory associative memories, suggesting that reinforced behavior has an important role in the ethanol self-administration in Drosophila. However, rutabaga expression is required more broadly within the mushroom bodies for the preference for ethanol-containing food than for olfactory memories reinforced by sugar reward.

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gwroman@uh.edu

Further study on the affordability of alcoholic beverages in the EU

Policies related to alcohol pricing, promotion and discounts provide opportunities to address harms associated with alcohol consumption. However, there are important gaps in information and knowledge about various policy-relevant aspects of alcohol retail and pricing. This information could help governments to plan their alcohol strategies better and develop evidence-based policies.

To address these knowledge gaps, this report presents findings from our research, which focused on the following four areas of inquiry:

· the link between changes in excise duties and changes in alcohol consumer prices

· the trends in the ratio of on-trade to off-trade consumption of alcohol, and their drivers

· the scale of alcohol price promotions and discounts in the on- and off-trade across the EU

· regulations in Member States on price promotions and discounts, their compliance and effectiveness.


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Alcohol-Related Context Modulates Performance of Social Drinkers in a Visual Go/No-Go Task: A Preliminary Assessment of Event-Related Potentials

Increased alcohol cue-reactivity and altered inhibitory processing have been reported in heavy social drinkers and alcohol-dependent patients, and are associated with relapse. In social drinkers, these two processes have been usually studied separately by recording event-related potentials (ERPs) during rapid picture presentation. The aim of our study was to confront social drinkers to a task triggering high alcohol cue-reactivity, to verify whether it specifically altered inhibitory performance, by using long-lasting background picture presentation.

ERP were recorded during visual Go/No-Go tasks performed by social drinkers, in which a frequent Go signal (letter ‘‘M’’), and a rare No-Go signal (letter ‘‘W’’) were superimposed on three different types of background pictures: neutral
(black background), alcohol-related and non alcohol-related.

Our data suggested that heavy social drinkers made more commission errors than light drinkers, but only in the alcohol-related context. Neurophysiologically, this was reflected by a delayed No-Go P3 component.

Elevated alcohol cue-reactivity may lead to poorer inhibitory performance in heavy social drinkers, and may be considered as an important vulnerability factor in developing alcohol misuse. Prevention programs should be designed to decrease the high arousal of alcohol stimuli and strengthen cognitive control in young, at-risk individuals.


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Withdrawal-Associated Increases and Decreases in Functional Neural Connectivity Associated with Altered Emotional Regulation in Alcoholism

Alcoholic patients who have undergone multiple detoxifications/relapses show altered processing of emotional signals.

We performed functional magnetic resonance imaging during performance of implicit and explicit versions of a task in which subjects were presented with morphs of fearful facial emotional expressions.

Participants were abstaining, multiply detoxified (MDTx; n=12) or singly detoxified patients (SDTx; n=17), and social drinker controls (n=31).

Alcoholic patients were less able than controls to recognize fearful expressions, and showed lower activation in prefrontal areas, including orbitofrontal cortex and insula, which mediate emotional processing.

The decrease in activation was greater in MDTx patients who also showed decreased connectivity between insula and prefrontal areas, and between amygdala and globus pallidus.

In the explicit condition, the strength of connectivity between insula and areas involved in regulation of emotion (inferior frontal cortex and frontal pole) was negatively correlated with both the number of detoxifications and dependency (measured by the severity of alcohol dependency (SADQ) and control over drinking score (Impaired Control questionnaire, ICQ)). In contrast, increased connectivity was found between insula and the colliculus neuronal cluster, and between amygdala and stria terminalis bed nucleus.

In the implicit condition, number of detoxifications and ICQ score correlated positively with connectivity between amygdala and prefrontal cortical areas involved in attentional and executive processes.

Repeated episodes of detoxification from alcohol are associated with altered function both in fear perception pathways and in cortical modulation of emotions. Such changes may confer increased sensitivity to emotional stress and impaired social competence, contributing to relapse.


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Risk factor burden predicts long-term mortality in young patients with arterial cerebral infarction

The aim was to investigate risk factors separately and in sum in relation to long-term mortality after arterial cerebral infarction in young adults.

Mortality in relation to the number of risk factors (smoking, hypertension, hypercholesterolemia, diabetes mellitus, myocardial infarction, angina pectoris, and intermittent claudication known at the time of the index stroke) and etiology was studied in a population of young adults with first-ever arterial ischemic stroke at an age < 50 years. Cox regression analyses were performed.

After a mean follow-up time of 18 years (the longest follow-up study after cerebral infarction in young adults), 12.5% with no risk factor had died while the corresponding frequencies in patients with 1–3 or more risk factors were 18.5%, 25.4%, and 53.1%, respectively (P < 0.001). The number of risk factors was associated with mortality on Cox regression analysis [hazard ratio (HR) = 1.6, P = 0.001]. A separate Cox regression analysis showed mortality to be associated with diabetes mellitus (HR = 3.0, P = 0.001), myocardial infarction (HR = 3.1, P = 0.001), and alcoholism (HR = 6.3, P < 0.001).

Increasing number of traditional risk factors is associated with long-term mortality in young adults with cerebral infarction indicating aggressive long-term secondary preventive treatment in selected patients.

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Request Reprint E-Mail: haln@haukeland.no

Media Release – Lies Exposed as Industry Fronts FASD Inquiry

A detailed analysis of the alcohol industry’s submissions to a Parliamentary Inquiry has exposed a raft of false, misleading and unfounded claims.

The damning finding comes as alcohol industry representatives meet in Canberra today to present to the House of Representatives Inquiry into Fetal Alcohol Spectrum Disorders (FASD), and calls into doubt the veracity of the industry claims.

The Foundation for Alcohol Research and Education (FARE) analysed four alcohol industry submissions from the Winemakers Federation of Australia (WFA), the Brewers Association of Australia and New Zealand Inc (Brewers), the Distilled Spirits Industry Council of Australia (DSICA) and the Australian Wine Research Institute (AWRI).

The analysis found that between them, the alcohol industry bodies made a total of ten false or misleading claims regarding FASD, and the effectiveness of interventions to prevent FASD. > > > > Read More

Evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management.

They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants.

The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.


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Event-Related Oscillations in Alcoholism Research: A Review

Alcohol dependence is characterized as a multi-factorial disorder caused by a complex interaction between genetic and environmental liabilities across development.

A variety of neurocognitive deficits/dysfunctions involving impairments in different brain regions and/or neural circuitries have been associated with chronic alcoholism, as well as with a predisposition to develop alcoholism.

Several neurobiological and neurobehavioral approaches and methods of analyses have been used to understand the nature of these neurocognitive impairments/deficits in alcoholism.

In the present review, we have examined relatively novel methods of analyses of the brain signals that are collectively referred to as event-related oscillations (EROs) and show promise to further our understanding of human brain dynamics while performing various tasks. These new measures of dynamic brain processes have exquisite temporal resolution and allow the study of neural networks underlying responses to sensory and cognitive events, thus providing a closer link to the physiology underlying them.

Here, we have reviewed EROs in the study of alcoholism, their usefulness in understanding dynamical brain functions/dysfunctions associated with alcoholism as well as their utility as effective
endophenotypes to identify and understand genes associated with both brain oscillations and alcoholism.


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Gender differences in factors associated with alcohol drinking: Delay discounting and perception of others’ drinking

Excessive alcohol consumption in college students is associated with impulsivity and with overestimating levels of others’ drinking; however, females’ and males’ drinking may be differently impacted by their overestimations. We examined whether moderate drinkers discount alcohol rewards differently from money rewards and whether their estimate of others’ drinking is more closely associated with own-drinking for males than females.

College students completed two delay discounting tasks in which they chose between money rewards and between alcohol rewards, varying in amount and delay to receipt. Participants also completed questionnaires about their own and others’ drinking.

Area under the curve (AUC) relating delay to subjective value was smaller for alcohol than money rewards, implying steeper discounting of alcohol rewards. Regression analyses showed that females’ number of drinks per sitting was related only to AUC for money, while males’ drinks per sitting was related to their estimates of others’ drinks.

The relationship between alcohol consumption and discounting was replicated. This study also indicated that social norms play a larger role in determining males’ drinking than females’.

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Request Reprint E-Mail: yankelevitz@gmail.com

Two-part random effects growth modeling to identify risks associated with alcohol and cannabis initiation, initial average use and changes in drug con

Our aim was to profile alcohol and cannabis initiation and to characterize the effects of developmental and environmental risk factors on changes in average drug use over time.

We fitted a two-part random effects growth model to identify developmental and environmental risks associated with alcohol and cannabis initiation, initial average use and changes in average use.

1796 males aged 24–63 from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders.

Data from three interview waves included self-report measures of average alcohol and cannabis use between ages 15 and 24, genetic risk of problem drug use, childhood environmental risks, personality, psychiatric symptoms, as well as personal, family and social risk factors.

Average alcohol and cannabis use were correlated at all ages. Genetic risk of drug use based on family history, higher sensation seeking, and peer group deviance predicted both alcohol and cannabis initiation. Higher drug availability predicted cannabis initiation while less parental monitoring and drug availability were the best predictors of how much cannabis individuals consumed over time.

The liability to initiate alcohol and cannabis, average drug use as well as changes in drug use during teenage years and young adulthood is associated with known risk factors.

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Request Reprint E-Mail: ngillespie@vcu.edu

Lifetime victimization and past year alcohol use in a U.S. population sample of men and women drinkers

Research on alcohol use among victims of physical and sexual violence has focused mostly on women and alcohol use disorders. It is also limited by the relative lack of consideration of victimization over the lifetime and of population data on both men and women. We critically examined associations between lifetime victimization and diverse past year alcohol use patterns and problems and whether these associations differ for men and women.

Population data from the 2005 U.S. National Alcohol Survey (NAS11, n=6919) are reported for 4256 adult men and women drinkers. Logistic regressions assessed associations between physical only or any sexual victimization experienced over the lifetime and past year heavy episodic drinking, drinking to intoxication, alcohol-related consequences and any alcohol use disorder. Models controlled for demographics and parental history of alcohol abuse and examined interactions of gender with victimization.

Associations between victimization experienced over the lifetime and all past year alcohol measures were significant for both men and women. These associations did not differ by type of lifetime victimization (physical only vs any sexual). The association of physical only victimization with drinking to intoxication was stronger for victimized vs non-victimized women compared to victimized vs non-victimized men. This gender difference ceased to be significant when specific victimization characteristics were controlled for.

Lifetime victimization is associated with increased risk for diverse alcohol use problems for both men and women. All prevention and treatment programs should screen men and women for lifetime victimization and diverse alcohol use problems.

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Request Reprint E-Mail: mnayak@arg.org

Time based prospective memory deficits associated with binge drinking: Evidence from the Cambridge Prospective Memory Test (CAMPROMPT)

To examine whether ‘binge drinking’ (BD) in young adults adversely affects prospective memory (PM). BD was defined as males drinking 8/more units and females 6/more units on at least one session per-week. BDs and non-binge drinkers (NBDs) were compared on self-reported and objective PM.

An existing-groups design compared BDs with NBDs as the independent factor. Scores on the PM and retrospective memory (RM) subscales of the Prospective and Retrospective Memory Questionnaire (PRMQ) and scores on the Cambridge Prospective Memory Task (CAMPROMPT) were the dependent factors. Age, total years spent drinking, time since last drink consumed (hours), mood, strategy-use and pre-morbid IQ were measured as covariates.

Each participant was tested in a laboratory setting.

An opportunity sample of 28 BDs and 28 NBDs were compared.

Self-reported PM and RM lapses were measured using the PRMQ and the CAMPROMPT measured objective PM. Drug use was assessed using a Recreational Drug Use Questionnaire. The Hospital Anxiety and Depression Scale measured mood. The strategy-scale from the Prospective Memory Questionnaire measured strategy use. The National Adult Reading Test measured pre-morbid IQ.

BDs and NBDs did not differ in terms of gender makeup and a series of ANCOVAs (controlling for the covariates) revealed no significant between-groups differences on self-reported PM/RM lapses; but BDs exhibited reduced function on time-based PM, but not event-based PM, when compared with NBDs.

BDs exhibit selective impairments on time-based PM; this deficit is a new finding in terms of the neuropsychological sequelae associated with BD.

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Request Reprint E-Mail: tom.heffernan@northumbria.ac.uk

Associations between energy drink consumption and alcohol use behaviors among college students

To explore associations between energy drink consumption and alcohol use among college students.

Participants included 585 students (m age=18.7; 47.0% White, 21% Hispanic, 25% Asian, 7% other race/ethnicity; 56.0% female). Energy drink behaviors included past month and past week consumption. Alcohol use behaviors included past month and past two week consumption, as well as heavy drinking and quantity of alcohol consumed. Consumption of energy drinks mixed with alcohol was also measured. Linear and logistic regression analyses between energy drink consumption and alcohol use were run controlling for gender, age, and race/ethnicity.

For each one unit increase in past month (i.e., additional day used) energy drink use, the likelihood of past month alcohol use increased by 80%, heavy drinking by 80% and past month energy drinks mixed with alcohol use by 90%. Similar results were found for past week energy drink use. A positive relationship between energy drink use and quantity of alcohol consumed during a single episode of drinking was also found (p<0.001). Significant gender interactions between energy drink consumption and alcohol use as well as quantity of alcohol consumed were found, with relationships stronger among males than females. There were no significant interactions by race/ethnicity.

Energy drinks are readily available to students and pose potential health risks. Students who report greater energy drink consumption also consume more alcohol, are more likely to mix energy drinks and alcohol, and experience heavy episodes of drinking, which is problematic given the potential negative consequences of these drinks.

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

Atypical frontal lobe activity during verbal working memory in youth with a family history of alcoholism

Abnormal brain functioning during verbal working memory (VWM) tasks has been shown in individuals with alcohol use disorders (AUDs). Since adolescents with a familial history of alcoholism (FHP) are at high risk for developing an AUD, it is important to consider whether atypical brain activity during VWM may help to explain FHP vulnerability toward developing alcoholism.

To that end, using functional magnetic resonance imaging, we examined brain response during a VWM 2-back task in 19 FHP adolescents and 16 age and gender-matched family history negative (FHN) controls.

Despite no group differences in task accuracy, FHP youth had significantly slower average reaction time when making correct responses during the 2-back condition than FHN youth. In contrast to a vigilance control condition, while covarying for reaction time, FHP adolescents showed less activation during VWM than FHN youth in multiple areas of the prefrontal cortex (PFC) – a brain region crucial to intact working memory skills.

These results suggest that even prior to heavy alcohol use, FHP adolescents show atypical executive brain functioning during VWM, and that these differences are independent of slower working memory reaction time in FHP youth. Given the importance of working memory in numerous areas of day-to-day functioning, such as adaptive decision-making, these abnormalities may contribute to FHP youth vulnerability toward developing AUDs.

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Request Reprint E-Mail: nagelb@ohsu.edu

Ethnic-specific meta-analyses of association between the OPRM1 A118G polymorphism and alcohol dependence among Asians and Caucasians

Many studies have investigated the association between the OPRM1 A118G polymorphism (rs1799971) and alcohol dependence, but the results were inconsistent. To better understand this relationship, ethnicity-specific meta-analyses were conducted.

We retrieved all eligible studies published up to April 12, 2011 from the PubMed/MEDLINE, EMBASE, and ISI Web of Science databases. Ethnicity-specific meta-analyses were performed using either fixed- or random-effect models as appropriate.

Twelve independent studies with 1900 cases and 2382 controls were included. Five studies were conducted in Asians and seven in Caucasians. Ethnicity-specific meta-analyses revealed that the A118G polymorphism was significantly associated with alcohol dependence risk in Asians (GA vs. AA: odds ratio [OR], 1.73; 95% confidence interval [CI], 1.33–2.25; GA+GG vs. AA: OR, 1.57; 95% CI, 1.22–2.02), but not in Caucasians (GA vs. AA: OR, 1.05; 95% CI, 0.75–1.49; GA+GG vs. AA: OR, 1.11; 95% CI, 0.79–1.55).

The OPRM1 A118G polymorphism may contribute to the susceptibility of alcohol dependence in Asians but not in Caucasians.

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Request Reprint E-Mail: wzzh@mails.tjmu.edu.cn

The temporal relationship between per capita alcohol consumption and harm: A systematic review of time lag specifications in aggregate time series ana

Changes in per capita alcohol consumption are temporally linked to changes in rates of alcohol-related harm. Methodological approaches for analysing this relationship have been suggested, however, the problem of time lags is not well-addressed. This study provides a review of time lag specifications, looking at (a) time to first effect on harm, (b) time to full effect and (c) the functional form of the effect accumulation from first to full effect to inform modelling of the relationship between changes in aggregate alcohol consumption and changes in rates of harm.

Bibliographic databases were searched and citation and reference checking was used to identify studies. Included studies were time series analyses of the relationship between aggregated population alcohol consumption and rates of alcohol-related harms where time lag specifications had been derived or tested.

36 studies were included with liver cirrhosis, heart disease and suicide dominating the evidence base. For a large number of alcohol-related harms, no literature was identified. There was strong evidence of an immediate first effect following a change in consumption for most harms. Recommended lag specifications are proposed for a set of alcohol-attributable harms.

Research on time lag specifications is under-developed for most harms although we provide suggested specifications based on the findings of the review. Greater methodological attention needs to be given to the rationale for choosing or applying lag specifications and the inherent complexity of the time lag process. More consistent and transparent reporting of methodological decisions would aide progress in the field.

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Request Reprint E-Mail: john.holmes@sheffield.ac.uk

'Responsible Marketing Pact' aims to protect children from alcohol marketing

The European Centre for Monitoring Alcohol Monitoring (EUCAM) has delivered a luke warm response to the Responsible Marketing Pact. The pact was trumpeted to be the first time that common standards would be implemented throughout the EU. The standards would protect young people from undue exposure to alcohol and prohibit marketing being directed at minors. The alcohol industry had claimed that self-regulation is working, and should be expanded.

However AMMIE (Alcohol Marketing Monitoring in Europe) at the EUCAM conference in March, warned against mere "window dressing" and called for an outright ban on advertising. Their research showed that on average each minor in the 5 countries they researched (Germany, the Netherlands, Italy, Bulgaria and Denmark) were exposed to 44 alcohol commercials in 2 months. They noted numerous violations of the 30% rule, whereby advertising should only be allowed where under 30% of the population are minors. In practice, they insist, there is nowhere in Europe where there is a population group consisting of more than 30% minors, meaning that alcohol advertising can go unchecked. > > > > Read More

Critique 081: Alcohol intake in the elderly affects risk of cognitive decline and dementia — 22 May 2012

Kim JW, Lee DY, Lee BC, Jung MH, Kim H, Choi YS, Choi I-G. Alcohol and Cognition in the Elderly: A Review. Psychiatry Investig 2012;9:8-16; On-line: http://dx.doi.org/10.4306/pi.2012.9.1.8

Forum Comments

Alzheimer’s disease (AD) and other types of dementia are most common in the very elderly, and are associated with huge health costs. With a rapidly ageing population throughout the world, factors that affect the risk of cognitive decline and dementia are of great importance. At present, there are no proven agents to prevent cognitive decline or dementia, although a number of prospective epidemiologic studies have shown a lower risk of such conditions among light to moderate drinkers in comparison with non-drinkers.^1-4 (Other studies have found that beneficial effects are seen only among certain sub-groups of subjects.^5-6) A recent meta-analysis by Peters et al⁷ of subjects over the age of 65 in longitudinal studies concluded that light-to-moderate alcohol consumption, in comparison with abstinence, was associated with approximately 35-45% lower risk of cognitive decline or dementia.⁷

This paper provides a summary of what is known about the mechanisms by which alcohol consumption, especially heavy drinking, can be neurotoxic, and how light-to-moderate drinking may help protect against cognitive decline and dementia. The authors state that their intent is to determine if there is an “optimal pattern of drinking” that may protect the elderly against such conditions. > > > > Read More

Coordinated dysregulation of mRNAs and microRNAs in the rat medial prefrontal cortex following a history of alcohol dependence

Long-term changes in brain gene expression have been identified in alcohol dependence, but underlying mechanisms remain unknown. Here, we examined the potential role of microRNAs (miRNAs) for persistent gene expression changes in the rat medial prefrontal cortex (mPFC) after a history of alcohol dependence.

Two-bottle free-choice alcohol consumption increased following 7-week exposure to intermittent alcohol intoxication.

A bioinformatic approach using microarray analysis, quantitative PCR (qPCR), bioinformatic analysis and microRNA–messenger RNA (mRNA) integrative analysis identified expression patterns indicative of a disruption in synaptic processes and neuroplasticity. About 41 rat miRNAs and 165 mRNAs in the mPFC were significantly altered after chronic alcohol exposure.

A subset of the miRNAs and mRNAs was confirmed by qPCR. Gene ontology categories of differential expression pointed to functional processes commonly associated with neurotransmission, neuroadaptation and synaptic plasticity. microRNA–mRNA expression pairing identified 33 miRNAs putatively targeting 89 mRNAs suggesting transcriptional networks involved in axonal guidance and neurotransmitter signaling.

Our results demonstrate a significant shift in microRNA expression patterns in the mPFC following a history of dependence. Owing to their global regulation of multiple downstream target transcripts, miRNAs may have a pivotal role in the reorganization of synaptic connections and long-term neuroadaptations in alcohol dependence. MicroRNA-mediated alterations of transcriptional networks may be involved in disrupted prefrontal control over alcohol drinking observed in alcoholic patients.



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Request Reprint E-Mail: markus.heilig@mail.nih.gov

Alcohol and Cognition in the Elderly: A Review

Consumption of large amounts of alcohol is known to have negative effects, but consumption in smaller amounts may be protective. The effect of alcohol may be greater in the elderly than in younger adults, particularly with regard to cognition. However, the drinking pattern that will provide optimal protection against dementia and cognitive decline in the elderly has not been systematically investigated.

The present paper is a critical review of research on the effect of alcohol on cognitive function and dementia in the elderly. Studies published from 1971 to 2011 related to alcohol and cognition in the elderly were reviewed using a PubMed search.

Alcohol may have both a neurotoxic and neuroprotective effect. Longitudinal and brain imaging studies in the elderly show that excessive alcohol consumption may increase the risk of cognitive dysfunction and dementia, but low to moderate alcohol intake may protect against cognitive decline and dementia and provide cardiovascular benefits.

Evidence suggesting that low to moderate alcohol consumption in the elderly protects against cognitive decline and dementia exists; however, because of varying methodology and a lack of standardized definitions, these findings should be interpreted with caution.

It is important to conduct more, well-designed studies to identify the alcohol drinking pattern that will optimally protect the elderly against cognitive decline and dementia.

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Are the stages of change relevant for the development and implementation of a web-based tailored alcohol intervention? A cross-sectional study

Computer-tailored programs are a promising tool to stimulate health behavior change, such as reducing alcohol intake. Yet more research is needed to assess whether groups differing in their motivational level to change may need different types of feedback. Furthermore, it is unknown whether motivational level may also determine reactions to computer-tailored interventions. Our aim is to identify the potential relevance of the application of the stages of change concept in the development and implementation of alcohol interventions.

A web-based instrument was used to disseminate a questionnaire and to provide tailored feedback messages among adults in the Netherlands (N=170; 96 females). Motivational level was assessed by the stage of change construct. The survey furthermore assessed alcohol consumption, attitude, social influence, self-efficacy, and program evaluation (i.e., survey items, tailored advice, layout and functionality of the program). The Least Significant Difference method was used to compare people in different stages of change with regard to psychosocial determinants of drinking behavior and program evaluation.

Of the respondents, 34.1% (n=58) reported no intention to drink healthily in the foreseeable future (precontemplation), 22.9% (n=39) intended to improve their drinking behavior in the near future (contemplation/preparation) and 42.9% (n=73) reported to currently adhere to the Dutch alcohol consumption guidelines (action/maintenance). When comparing the three groups, people in the action or maintenance stage reported the lowest number of pros of drinking alcohol, having most healthy drinking role models and the highest levels of self-efficacy regarding healthy drinking in difficult situations, whereas precontemplators reported to receive the least social support regarding healthy drinking. In general, the intervention was positively evaluated, but it seemed to be most appreciated by contemplators and preparators.

Stage-matched interventions may be useful to encourage people to reduce their alcohol intake. Different factors seem to be important for people in different motivational stages. Longitudinal studies are needed to determine whether these factors also predict stage transition. The intervention could be optimized by tailoring the feedback messages more precisely to the needs of people in different motivational stages, for example by applying the different processes of change.

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Present orientation, future orientation and alcohol use in Northern Irish adolescents

Earlier initiation into more problematic drinking behaviour has been found to be associated with more problematic drinking later in life. Research has suggested that a lower future time perspective (and higher present time perspective) is associated with health-compromising behaviours such as problematic alcohol use in college student, University undergraduate and general population samples.

This study used a cross-sectional design to examine whether consideration of future consequences (CFC), assessed by the Consideration of Future Consequences Scale, was significantly related to drinking behaviour in a large sample (n = 707) of Northern Irish adolescents.

Alcohol use was self-reported by means of a composite measure of drinking behaviour. Demographic data were also gathered.

After controlling for year in school (proxy for age), sex and for clustering at school level, lower future orientation and higher present orientation were found to be significantly associated with more problematic self-reported drinking behaviour.

These results extend recent findings of a significant relationship between a foreshortened future time perspective and more problematic self-reported drinking behaviour in a UK sample of University undergraduates, to a large UK sample of adolescents.

Given the relationship between early-onset drinking and more problematic use in later life, health promotion interventions might explore using the CFC construct in targeting adolescent drinkers.


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Request Reprint E-Mail: Michael.Mckay@liverpool.ac.uk

Alcohol: A Major Public Health Problem—South Asian Perspective

Over the years, use of alcohol, excessive and prolonged, has been associated with various health hazards. With increasing clinical experience and research in the area, the association has become stronger and progressively more alarming. The evidence from different treatment settings viz. the outpatient department, inpatient setup, emergency department, and the consultation liaison services has linked the use of alcohol with a wide array of hazards to the physical and the psychological health of the users. The impact on psychological health extends beyond the users of alcohol to involve caregivers and other family members of users.

Alcohol consumption is the leading risk factor for disease burden in low-mortality developing countries and the third largest risk factor in developed countries. Added to this is the fact that a significant proportion of those needing the help of deaddiction service providers and of mental health professionals present to various other departments including medicine, surgery, gastroenterology, nephrology, and cardiology, among others. We present here a comprehensive review of the impact of alcohol use on health.

We have reviewed the relevant literature from south Asian countries using Pubmed search. In addition, other information sources such as Cork Bibliography, published monographs, and study reports have been included in the review.



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Sobriety Tools That Fit in a Pocket

Medicine isn’t the only science paving new paths to sobriety. Thanks to a new mobile app from the Hazelden Foundation, alcoholics are now leaving rehab with an interactive version of the 12 Steps in their pocket.

When users log on to the app, the MORE Field Guide to Life, they are greeted with the number of days since their last drink. From there, they can find the nearest Alcoholics Anonymous meeting, make lists of their obstacles and accomplishments, watch testimonials from other recovered alcoholics, or, if they’re struggling, press an “S.O.S.” button to immediately contact a sponsor. > > > > Read More

Drugs Help Tailor Alcoholism Treatment

If alcoholism is a disease, is there hope of finding the cure in a pill?

Yes and no. Having mapped the physical changes the brain undergoes with years of habitual drinking, researchers in recent years have discovered a handful of promising — and some say underused — drugs that, combined with therapy, help alcoholics break the cycle of addiction.

To those for whom such remedies work, they certainly can feel like a cure.

“I felt like I had found something that finally helped me through the cravings,” said Patty Hendricks, 49, who used one such drug, naltrexone, to help control her drinking habit after four failed rehab attempts. “I don’t think I could have gotten sober without it.”

The problem is that alcoholics, like cancer patients, are not a homogeneous group. People drink compulsively for any number of reasons, from genetics to anxiety to post-traumatic stress disorder. The pill that helped Ms. Hendricks get sober might do nothing for, say, a veteran who drinks to ward off nightmares. > > > > Read More

Prenatal alcohol exposure, blood alcohol concentrations and alcohol elimination rates for the mother, fetus and newborn

Fetal alcohol spectrum disorders (FASDs) are a common cause of intellectual impairment and birth defects. More recently, prenatal alcohol exposure (PAE) has been found to be a risk factor for fetal mortality, stillbirth and infant and child mortality. This has led to increased concern about detection and management of PAE.

One to 2 h after maternal ingestion, fetal blood alcohol concentrations (BACs) reach levels nearly equivalent to maternal levels.

Ethanol elimination by the fetus is impaired because of reduced metabolic capacity. Fetal exposure time is prolonged owing to the reuptake of amniotic-fluid containing ethanol by the fetus.

Alcohol elimination from the fetus relies on the mother's metabolic capacity. Metabolic capacity among pregnant women varies eightfold (from 0.0025 to 0.02 g dl⁻¹ h⁻¹), which may help explain how similar amounts of ethanol consumption during pregnancy results in widely varying phenotypic presentations of FASD.

At birth physiological changes alter the neonate's metabolic capacity and it rapidly rises to a mean value of 83.5% of the mother's capacity.

FASDs are highly recurrent and younger siblings have increased risk. Detection of prenatal alcohol use offers an important opportunity for office-based interventions to decrease exposure for the remainder of pregnancy and identification of women who need substance abuse treatment.

Mothers of children with FAS have been found to drink faster, get drunk quicker and to have higher BACs.

A modest increase in the prevalence of a polymorphism of alcohol dehydrogenase, which increases susceptibility to adverse outcomes from PAE has been reported.

Lastly, detection of alcohol use and appropriate management would decrease risk from PAE for subsequent pregnancies.


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Request Reprint E-Mail: larry.burd@med.und.edu