Substance Use Disorders in the U.S. Armed Forces

Problems stemming from the misuse and abuse of alcohol and other drugs are by no
means a new phenomenon, although the face of the issue has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are
particularly prominent within the military, a population that also continues to experience longstanding
issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade—in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a
significant public health problem for the Department of Defense (DoD).

To better understand this problem, DoD requested that the Institute of Medicine (IOM assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening and diagnosis, and treatment of substance use disorders (SUDs). The IOM committee charged with conducting this study was also tasked with assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and with offering specific  ecommendations to DoD on where and how improvements
in these areas could be made.


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Harold A. Mulford, Jr. — In Memoriam

This memorial for Harold A. Mulford, Jr. will neither begin nor end with the standard statement about how much we have lost with Hal’s passing on June 28, 2012 just short of “four score and ten” at age 89. Tapping a perhaps less common tradition, let us celebrate some of the unique gifts that alcohol social science gained by his travels with us.

Hal Mulford’s life has both storybook qualities but as a scholar, features that are absolutely unique. Born on an Iowa farm and growing into a strapping handsome man, Hal was a hero in the Good War, with a medal-producing record of laying down the enemy with major artillery during D-Day and then fighting on through the Pacific Theater to nearly the end of the War. After marriage and the beginning of his family, and a GI Bill bachelor’s degree from Morningside College in 1947, his eventual education at the University of Iowa led him to a doctorate in sociology in 1955. Here he was substantially influenced by Manfred Kuhn, founder of what is known as “The Iowa School of Symbolic Interaction” wherein the somewhat elusive tenets of this perspective are put to hard-nosed empirical test. Hal’s work continually reflected this perspective; my attempted summary of the core of his life’s work would center on his efforts to construct the symbolic and interactional world of the deviant drinker and alcoholic through scale construction.

Following a brief stint as an apparently overloaded sociology instructor at Northwest Missouri State College, Hal received a surprise invitation to return to his Alma Mater, where he ended up spending the remainder of his career. His appointment started and remained in the Medical School’s Department of Psychiatry where he quickly earned a full professorship. Others often joked about his “garret” in the State Psychopathic Hospital, describing both a sort of ivory tower and the splendid isolation of having a full time tenured assignment as a research professor.  > > > >  Read More

Exposure of African-American Youth to Alcohol Advertising, 2008 and 2009

Excessive alcohol consumption contributes to approximately 4,700 deaths among underage youth each year, and in 2006 resulted in approximately $27 billion in economic costs.1,2 Among African-American high school students nearly 65 percent report having had at least a sip of alcohol and an estimated 25 percent report drinking alcohol for the first time before age 13.3 Alcohol is the most widely used drug among African-American youth3 and contributes to many health and social problems, including violence, motor vehicle crashes, and the spread of sexually transmitted diseases.4,5 The relationship between alcohol use and violence in African-American youth is bidirectional: Early alcohol use predicts later violent behavior,6 and early violent behavior predicts later alcohol use.7

According to the Youth Risk Behavior Survey (YRBS), about one in three African-American high school students in the U.S. are current drinkers, and about 40 percent of those who drink report binge drinking (≥ 5 drinks in a row).3 Alcohol use by youth is also known to be strongly related to alcohol use in adulthood. While current alcohol use and binge drinking tend to be less common among African-American adults than among other racial and ethnic groups, African-American adults who binge drink (≥ 4 drinks per occasion for women and ≥ 5 per occasion for men) tend to do so frequently (4.7 episodes per month) and with high intensity (number of drinks, 6.8 drinks per occasion).8 African-American adults also report higher levels of alcohol-related social consequences (relationship, employment, financial, and legal problems),9 with no evidence of any protective effect from light or moderate alcohol consumption,10,11 and a high prevalence of alcohol-related disease morbidity and mortality, including cardiovascular disease and hypertension.12   > > > >  Read More

Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample

Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.

Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001–2002) and II (2004–2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).

Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.

These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.

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Request Reprint E-Mail:   sherry.mckee@yale.edu

Global Actions September 26, 2012

Key Recent Milestones:

· Mexico: Following the launch of the “Train the Trainers” drink driving workshops, Global Actions carried out training in 34 schools and universities in Puebla. View photos from the education campaign.

Global Actions in Focus: Embassy Briefing

In time to coincide with preparation for the international conference Global Actions: Initiatives to Reduce Harmful Drinking, ICAP held an embassy briefing on September 21, 2012 for the diplomatic community in Washington, DC. Diplomats from approximately 26 countries, including Global Actions focus countries Mexico, Nigeria, and Russia, were in attendance.

The briefing addressed the actions global producers of beer, wine, and spirits have taken in recognition that the harmful use of alcohol has a serious effect on public health and is a risk factor for non‐communicable diseases.

ICAP Senior Vice President Brett Bivans spoke about the role of ICAP in promoting coordination the implementation of the Global Actions at local level in 18 low- and middle-income countries—programs that are engaging the drinks industry, the research and public health communities, government, and civil society to contribute to the goals of the WHO Global Strategy to Reduce Harmful Use of Alcohol.

“Global Actions initiatives are contributing in a substantial way to the active engagement of local stakeholders to address harmful drinking by working together across sectors and innovative ways. With a focus on building capabilities at jurisdiction level and within partner organizations, ICAP has been able to expand access, use and adaptation of recognized international expertise and good practice,” Bivans explained to briefing participants.

ICAP President Marcus Grant (with Bivans in photo) gave an overview of the findings contained in an ICAP report to the international community which will be released at the conference in October. The Report highlights ICAP’s analysis of action submitted by industry members which are supportive of the objectives of the WHO Strategy to reduce harmful drinking. The conference will provide an important forum to discuss future industry actions to extend the scope and duration of the initial phase of the Global Actions program.

“The adoption in May 2010 of the Global Strategy by WHO Member States is a milestone for all stakeholders to assess their contributions to reducing harmful drinking,” Grant noted.  

“The conference, the Report, and the future actions of beverage alcohol industry members provides a further opportunity to take stock and reinvigorate the shared commitment to working together to reduce harmful drinking.”

An additional diplomatic briefing is planned for Geneva in November.

What’s Happening Next:

· Brazil: Global Actions is holding a Latin America regional meeting “Working Together: Research, Education, and Prevention” on October 30, 2012 in Sao Paulo with the Center for Information on Health and Alcohol (CISA). 

Age-based differences in treatment outcome among alcohol-dependent women.

The literature suggests that women are at higher risk for negative consequences from alcohol use than men and that these risks are compounded by age. 

The current study investigated how alcohol-dependent women from different age groups might differ in terms of baseline functioning and treatment response. The sample consisted of 181 participants drawn from two randomized clinical trials of cognitive–behavioral treatments for alcohol-dependent women. Demographic and psychopathology data were obtained at baseline using the SCID (Structured Clinical Interview for DSM disorders) I for Axis I disorders and the SCID II or Personality Disorders Questionnaire for Axis II disorders. Social networks data were collected using the Important People and Activities Interview. Drinking data were collected at baseline and follow-up using the Timeline Follow Back Interview. 

ANOVAs revealed that older women had better psychosocial functioning in terms of being better educated and reporting fewer Axis I disorders. Also, older women had more supportive social networks in terms of more people, a smaller percentage of heavy drinkers, and a nondrinking spouse.

Older women reported a less severe lifetime substance use history with a later age of first drink, later onset of alcohol use disorders, fewer lifetime abuse/dependence items, and less drug use. However, they reported drinking more frequently and more heavily over the 90 days prior to treatment. Finally, older women were more compliant with treatment and responded better by reducing drinking frequency and percentage of heavy drinking days. 

Suggestions to enhance treatment efficacy for younger women are made as well as suggestions for future research. 

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Request Reprint E-Mail:   zotaiba@eden.rutgers.edu

What do you mean “drunk”? Convergent validation of multiple methods of mapping alcohol expectancy memory networks.

The configuration and activation of memory networks have been theorized as mechanisms that underlie the often observed link between alcohol expectancies and drinking. A key component of this network is the expectancy “drunk.” 

The memory network configuration of “drunk” was mapped by using cluster analysis of data gathered from the paired-similarities task (PST) and the Alcohol Expectancy Multi-Axial Assessment (AEMAX). A third task, the free associates task (FA), assessed participants' strongest alcohol expectancy associates and was used as a validity check for the cluster analyses. Six hundred forty-seven 18–19-year-olds completed these measures and a measure of alcohol consumption at baseline assessment for a 5-year longitudinal study.

For both the PST and AEMAX, “drunk” clustered with mainly negative and sedating effects (e.g., “sick,” “dizzy,” “sleepy”) in lighter drinkers and with more positive and arousing effects (e.g., “happy,” “horny,” “outgoing”) in heavier drinkers, showing that the cognitive organization of expectancies reflected drinker type (and might influence the choice to drink). 

Consistent with the cluster analyses, in participants who gave “drunk” as an FA response, heavier drinkers rated the word as more positive and arousing than lighter drinkers. 

Additionally, gender did not account for the observed drinker-type differences. 

These results support the notion that for some emerging adults, drinking may be linked to what they mean by the word “drunk.”  


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Request Reprint E-Mail:    rreich@usf.edu

Event-level associations between objective and subjective alcohol intoxication and driving after drinking across the college years.

Heavy episodic drinking is strongly associated with driving after drinking, yet there has been mixed evidence regarding whether the disinhibiting effects of alcohol intoxication contribute to the decision to drive after drinking.

This investigation tested whether greater alcohol intoxication increased the probability of driving after drinking particularly during drinking episodes in which students experienced reduced subjective feelings of intoxication. A sample of 1,350 college students completed up to 30 days of web-based daily diary monitoring in each of 4 consecutive years. Participants reported daily on their alcohol consumption, subjective intoxication, and whether they drove after drinking on the previous day or night. 

In generalized estimating equation models, daily estimated blood alcohol concentration (eBAC) was more strongly associated with driving after drinking during episodes in which subjective intoxication was lower. That is, students were most likely to drive after drinking when they were objectively more intoxicated but perceived themselves as less intoxicated.

These event-level associations did not change over time nor did they differ as a function of gender. Further, the effects persisted when predicting driving at eBACs above the legal limit for operating a motor vehicle.

Greater subjective intoxication may serve to inhibit driving after drinking, particularly when students are objectively more intoxicated. In the absence of subjective intoxication, however, other salient pressures might impel driving after drinking. Prevention efforts should incorporate the importance of variability in subjective intoxication.


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

'Getting into the spirit': Alcohol-related interpretation bias in heavy-drinking students.

Alcohol misuse is characterized by patterns of selective information processing. The present study investigated whether heavy- compared with light-drinking students, show evidence of an alcohol-related interpretation bias to ambiguous, alcohol-related cues.

Toward this aim, participants were asked to create continuations for ambiguous, open-ended scenarios that provided either an alcohol-related or neutral context. 

Results showed that heavy-drinking students generated more alcohol continuations for ambiguous alcohol-related scenarios than light-drinking students. 

This result was independent of the coding method used, with an interpretation bias found when continuations were coded by either participants themselves or by two independent raters.


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Request Reprint E-Mail:   M.Woud@psych.ru.nl 

Treating alcoholism reduces financial burden on care-givers and increases quality-adjusted life years

The study assessed the alcoholism-related financial burden borne by informal care-givers and relatives of German alcoholic patients.

By using an exploratory approach, care-giver burden was assessed both prior to and 12 months after detoxification and withdrawal. Quality-of-life data for care-givers collected during follow-up were used to calculate the number of quality-adjusted life years (QALYs) gained by alcoholics’ family members while their relatives are undergoing treatment.

Forty-eight informal care-givers and relatives of alcoholic patients.

In-patient and out-patient departments of three psychiatric university hospitals in Germany.

Measurements

Expenditures of families related directly to the addiction disorder of alcoholic patients, quality of life of care-givers, relapses of patients.

Findings

Families’ expenditures related directly to their addicted member's alcoholism decreased from an average of €676.44 per month (or 20.2% of the total pre-tax family income) at baseline to an average of €145.40 per month at 12 months after the beginning of treatment. The average time spent caring for the affected family member was reduced from 32.3 hours per month to 8.2 hours per month (P = 0.0109), and quality-of-life total scores increased from 60.6 to 68.0. The total gain in QALYs for family members was 0.108. When weighed against the average cost of the alcoholism treatment, the cost of one QALY for care-giving family members was €20 398 on average.

Among the families of German alcoholics who receive detoxification, there is a substantial reduction in family expenditures, time spent caring and an increase in quality of life at 1 year. These are important but often neglected additional measures of the burden on family members and also treatment benefits.


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Request Reprint E-Mail:   hans-joachim.salize@zi-mannheim.de

A public communication campaign to promote healthy lifestyles among European teenagers

The project aims to produce a webseries to reach and sensitize young people to some of today most pressing public health concerns including nutrition, alcohol and drug abuse, and sexual health. 



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1 in 5 people don’t know that alcohol can cause cancer

Based on scientific evidence, the International Agency for Research on Cancer of the World Health Organisation has classified alcohol as ‘carcinogenic to humans’. According to their research, there are no safe levels of consumption. In order to have no risk of cancer from alcohol it is best not to drink at all, however, if you would still like to enjoy a drink with just a minimum risk, one drink per day for women and two for men is the IARC advised maximum.   > > > >   Read More

Development and process evaluation of a web-based responsible beverage service training program

Responsible beverage service (RBS) training designed to improve the appropriate service of alcohol in commercial establishments is typically delivered in workshops. Recently, Web-based RBS training programs have emerged. This report describes the formative development and subsequent design of an innovative Web-delivered RBS program, and evaluation of the impact of the program on servers' knowledge, attitudes, and self-efficacy.

Formative procedures using focus groups and usability testing were used to develop a Web-based RBS training program. Professional alcohol servers (N = 112) who worked as servers and/or mangers in alcohol service settings were recruited to participate. A pre-post assessment design was used to assess changes associated with using the program.

Participants who used the program showed significant improvements in their RBS knowledge, attitudes, and self-efficacy.

Although the current study did not directly observe and determine impact of the intervention on server behaviors, it demonstrated that the development process incorporating input from a multidisciplinary team in conjunction with feedback from end-users resulted in creation of a Web-based RBS program that was well-received by servers and that changed relevant knowledge, attitudes, and self-efficacy. The results also help to establish a needed evidence base in support of the use of online RBS training, which has been afforded little research attention.



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Assessment of the interoceptive effects of alcohol in rats using short-term training procedures

In the present study, we sought to determine whether the interoceptive effects of alcohol (1 g/kg, IG) could be assessed using a Pavlovian discrimination method, in which the alcohol drug state sets the occasion for which an environmental stimulus (e.g., light) will be followed by a sucrose reward. 

This procedure takes advantage of a naturally occurring behavior (i.e., food-seeking) which can be trained rapidly prior to the initiation of discrimination training. Given that the interoceptive effects of alcohol are routinely assessed using operant drug discrimination methods, another group of rats was trained using standard two-lever operant drug discrimination procedures in an effort to compare the Pavlovian procedure to a known behavioral benchmark.

The results from this work show that, in addition to operant discrimination procedures, a Pavlovian discrimination task can be used to evaluate the interoceptive effects of alcohol. In addition to the brief behavioral sucrose access training (3 days) required prior to the initiation of the Pavlovian discrimination, the alcohol discrimination was acquired relatively rapidly (i.e., 8 training sessions), shortening the overall duration of the experiment. 

These features of the Pavlovian procedure make it a valuable method by which to assess the interoceptive effects of alcohol if a short experimental time frame is required, such as assessing the interoceptive effects of alcohol during a brief developmental window (e.g., adolescence) or determining the effects of a pretreatment (i.e., chronic stress, chronic drug pretreatment) on the acquisition of the alcohol discrimination. 

As such, this initial characterization confirms the feasibility of using this Pavlovian discrimination training method as an additional tool by which to assess the interoceptive effects of alcohol, as there may be experimental situations that necessitate short term discrimination training.



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Request Reprint E-Mail:    jbesheer@med.unc.edu

Acute and chronic ethanol intake: Effects on spatial and non-spatial memory in rats

Abusive alcohol consumption produces neuronal damage and biochemical alterations in the mammal brain followed by cognitive disturbances. 

In this work rats receiving chronic and acute alcohol intake were evaluated in a spontaneous delayed non-matching to sample/position test. Chronic alcohol-treated rats had free access to an aqueous ethanol solution as the only available liquid source from the postnatal day 21 to the end of experiment (postnatal day 90). Acute alcoholic animals received an injection of 2 g/kg ethanol solution once per week. Subjects were evaluated in two tests (object recognition and spatial recognition) based on the spontaneous delayed non-matching to sample or to position paradigm using delays of 1 min, 15 min and 60 min.

Results showed that chronic and acute alcohol intake impairs the rats' performance in both tests. Moreover, chronic alcohol-treated rats were more altered than acute treated animals in both tasks. 

Our results support the idea that chronic and acute alcohol administration during postnatal development caused widespread brain damage resulting in behavioral disturbances and learning disabilities.


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Request Reprint E-Mail:   luismgm@edu.ucm.es

Maternal depressive symptoms as a predictor of alcohol use onset and heavy episodic drinking in youths.

 

The current study addressed a gap in the literature by investigating the association between maternal depressive symptoms and subsequent timing of their children's alcohol use onset and heavy episodic drinking (HED). Childhood depression/dysthymia symptoms, harsh discipline, and parental positive regard were examined as potential mediators of this relation. Longitudinal self- and parent-report data were collected annually from a community sample of 754 youths (50% male; 43% African American) from kindergarten to Grade 11 (ages 5–18 years). The measures administered were the Things That You Have Done scale (Conduct Problems Prevention Research Group [CPPRG], 1995a) and the Tobacco, Alcohol, and Drugs measure (CPPRG, 1995b), which assessed alcohol use behaviors; the Center for Epidemiological Studies–Depression Scale (Radloff, 1977); the Diagnostic Interview Schedule for Children (Costello, Edelbrock, & Costello, 1985); and the Parental Discipline Scale (CPPRG, 1994). Maternal depressive symptoms significantly predicted an earlier onset of alcohol use and HED in youths. Harsh parental discipline mediated the relation between maternal depressive symptoms and alcohol use onset as hypothesized; however, childhood depressive/dysthymia symptoms and parental positive regard did not. In the parallel analyses testing the 3 potential mediating variables in the prediction of HED, no significant mediation was found. These findings suggest the importance of intervening to prevent early and risky alcohol use among youths who have been identified as having a mother who is clinically depressed or is experiencing depressive symptoms; part of this intervention effort could involve working with depressed mothers to reduce their use of harsh discipline. These improved intervention and prevention strategies could have important implications for reducing the occurrence and early initiation of alcohol use and HED among at-risk youths.
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dalamis@gmail.com

Insulin Resistance, Ceramide Accumulation and Endoplasmic Reticulum Stress in Experimental Chronic Alcohol-Induced Steatohepatitis

Chronic alcohol abuse causes steatohepatitis with insulin resistance, which impairs hepatocellular growth, survival and metabolism. However, growing evidence supports the concept that progressive alcohol-related liver injury may be mediated by concurrent mal-signaling through other networks that promote insulin resistance, e.g. pro-inflammatory, pro-ceramide and endoplasmic reticulum (ER) stress cascades. 

Using the Long Evans rat model of chronic ethanol feeding, we characterized the histopathologic and ultrastructural features of steatohepatitis in relation to biochemical and molecular indices of tissue injury, inflammation, insulin resistance, dysregulated lipid metabolism and ER stress. 

Chronic steatohepatitis with early chicken-wire fibrosis was associated with enlargement of mitochondria and disruption of ER structure by electron microscopy, elevated indices of lipid storage, lipid peroxidation and DNA damage, increased activation of pro-inflammatory cytokines, impaired signaling through the insulin receptor (InR), InR substrate-1, Akt, ribosomal protein S6 kinase and proline-rich Akt substrate 40 kDa, glycogen synthase kinase 3β activation and constitutive up-regulation of ceramide and ER stress-related genes. Liquid chromatography coupled with tandem mass spectrometry demonstrated altered ceramide profiles with higher levels of C14 and C18, and reduced C16 species in ethanol-exposed livers. 

The histopathologic and ultrastructural abnormalities in chronic alcohol-related steatohepatitis are associated with persistent hepatic insulin resistance and pro-inflammatory cytokine activation, dysregulated lipid metabolism with altered ceramide profiles and both ER and oxidative stress. Corresponding increases in lipid peroxidation, DNA damage and protein carbonylation may have contributed to the chronicity and progression of disease. The findings herein suggest that multi-pronged therapeutic strategies may be needed for effective treatment of chronic alcoholic liver disease in humans.                  



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Request Reprint E-Mail:   suzanne_delamonte_md@brown.edu

Alcohol Exposure During Late Adolescence Increases Drinking in Adult Wistar Rats, an Effect that is not Reduced by Finasteride

We tested whether an exposure to alcohol in late adolescence, an age of rapid increase in neuroactive steroid precursors, would increase voluntary alcohol consumption in adult rats and whether this effect would be modulated by finasteride, an inhibitor of neuroactive steroid synthesis. 

In Experiment 1, we exposed male Wistar rats to 8% alcohol during the dark cycle for 1 week during late adolescence [postnatal days (PNDs) 51–58], and then measured voluntary alcohol consumption 1 month later in adulthood (PNDs 91–104). In Experiment 2, finasteride was administered during the forced alcohol exposure in late adolescence and, in Experiment 3, during voluntary alcohol consumption in adulthood. Plasma was collected at the end of each finasteride treatment to confirm the reduction of plasma neuroactive steroid levels. 

We found that a daily 12-h exposure to alcohol for 7 days in late adolescence significantly increased voluntary alcohol consumption (4-fold) a month later during adulthood. Finasteride administration in late adolescence increased group alcohol intake in late adolescence but did not block the effect of adolescent alcohol exposure on increasing alcohol preference in adulthood. There was no effect of finasteride treatment in adulthood on alcohol preference. 

A daily 12-h exposure to alcohol for 7 days in late adolescence was sufficient to induce chronically increased alcohol preference in adulthood, indicating that this age may be sensitive to the effects of alcohol.


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Request Reprint E-Mail:   jocovault@uchc.edu

Prognostic Factors During Outpatient Treatment for Alcohol Dependence: Cohort Study with 6 months of Treatment Follow-up

To identify prognostic factors to outpatient alcohol treatment on admission as well as during the treatment period. 

 A cohort study of n = 209 alcoholic patients (DSM-IV) during 6 months of outpatient treatment. Eight medical doctors from two hospitals were involved. Co-responsible participation in treatment was a necessary condition. At admission, we documented socio demographic factors, use of other drugs and severity of alcohol consumption. During the 6 months, we observed medication for prevention of alcohol relapse [disulfiram (DIS), acamprosate], number of sessions with the doctor, number of phases of the consultation and medication for depression. Primary outcome variables were time to first heavy relapse and abstinence of heavy alcohol consumption. These were measured with Timeline Followback. Five or more alcohol units of 10 g in one relapse day were considered heavy relapse. 

The patients were 84% males, with 41 years median age; the median alcohol consumption was 192 g per day with a median duration of 13 years of heavy consumption. The median education was 6 years with 61% of the patients from lower socio-economic levels. The Kaplan–Meier heavy relapse rate at 6 months was 23%. On admission to treatment, female gender, lower socio-economic levels, cocaine use, >20 years of consumption, gamma glutamyl transferase values above normal and five or more alcohol-related problems on the Alcohol-Related Problem Questionnaire predicted worse outcomes. Having a full-time job and shorter abstinence time before treatment (until 7 days) predicted better outcomes. During the 6 months, we found that DIS for <120 120="120" a="a" at="at" days="days" dis="dis" factor="factor" for="for" least="least" of="of" outcomes.="outcomes." prognostic="prognostic" was="was" worse="worse">50% of adherence to consultations and more than two phases on each consultation predicted better outcomes. The combined sensitivity and specificity for DIS for at least 120 days, >50% of adherence to consultations and more than two phases on consultation regarding abstinence from heavy relapse were respectively 100 and 71%. 

 During 6 months of outpatient treatment, longer adherence to DIS and consultations as well as more phases in a consultation involving necessarily a co-responsible predict a good outcome independently of the patient features at admission.                



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Request Reprint E-Mail:   pedroaguiar@ensp.unl.pt

Behavioral Counseling After Screening for Alcohol Misuse in Primary Care A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force

Alcohol misuse, which includes the full spectrum from risky drinking to alcohol dependence, is a leading cause of preventable death in the United States.

To evaluate the benefits and harms of behavioral counseling interventions for adolescents and adults who misuse alcohol.

MEDLINE, EMBASE, the Cochrane Library, CINAHL, PsycINFO, and reference lists of published literature (January 1985 through January 2012, limited to English-language articles).

Controlled trials at least 6 months in duration that enrolled persons with alcohol misuse identified by screening in primary care settings and evaluated behavioral counseling interventions.

One reviewer extracted data and a second checked accuracy. Two independent reviewers assigned quality ratings and graded the strength of the evidence.

The 23 included trials generally excluded persons with alcohol dependence. The best evidence was for brief (10- to 15-minute) multicontact interventions. Among adults receiving behavioral interventions, consumption decreased by 3.6 drinks per week from baseline (weighted mean difference, 3.6 drinks/wk [95% CI, 2.4 to 4.8 drinks/wk]; 10 trials; 4332 participants), 12% fewer adults reported heavy drinking episodes (risk difference, 0.12 [CI, 0.07 to 0.16]; 7 trials; 2737 participants), and 11% more adults reported drinking less than the recommended limits (risk difference, 0.11 [CI, 0.08 to 0.13]; 9 trials; 5973 participants) over 12 months compared with control participants (moderate strength of evidence). Evidence was insufficient to draw conclusions about accidents, injuries, or alcohol-related liver problems. Trials enrolling young adults or college students showed reduced consumption and fewer heavy drinking episodes (moderate strength of evidence). Little or no evidence of harms was found.

Results may be biased to the null because the behavior of control participants could have been affected by alcohol misuse assessments. In addition, evidence is probably inapplicable to persons with alcohol dependence and selective reporting may have occurred.

Behavioral counseling interventions improve behavioral outcomes for adults with risky drinking.


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Heavy alcohol intake and intracerebral hemorrhage Characteristics and effect on outcome

To identify associated factors and influence on long-term outcome of heavy alcohol intake in a large prospective cohort of consecutive patients with a spontaneous intracerebral hemorrhage (ICH).

Between November 2004 and March 2009, we prospectively recruited 562 consecutive adults with a spontaneous ICH. We excluded patients without information on drinking habit (n = 22). Heavy alcohol intake was defined as a regular consumption of more than 300 g alcohol/week. We performed bivariate and multivariate analyses (logistic regression) based on demographic and radiologic models. Survival analyses were performed using Kaplan-Meier statistics.

Among 540 patients with ICH, 137 (25) were heavy alcohol drinkers (median age 60 vs 74 years in nonabusers; p < 0.0001). In the multivariate demographic model, heavy alcohol drinkers were less likely to be older (odds ratio [OR] 0.97 per 1-year increase, 95% confidence interval [CI] 0.95−0.98) and to have a history of ischemic heart disease (OR 0.34, 95% CI 0.15−0.77) and more likely to be smokers (OR 3.96, 95% CI 2.43−6.46). In the radiologic model, independent factors were nonlobar location of ICH (OR 1.71, 95% CI 1.05−2.77) and less severe leukoaraiosis (OR 0.76 per 1-step increase, 95%CI 0.62−0.73). Platelet counts and prothrombin ratio were significantly lower among heavy alcohol drinkers (respectively, p = 0.01 and p = 0.017). Heavy alcohol intake was predictive of 2 years mortality only among patients younger than 60 years with nonlobar ICH (hazard ratio 1.96, 95% CI 1.06−3.63).

Heavy alcohol intake is associated with the occurrence of ICH at a young age. However, the underlying vasculopathy remains unexplored in these patients. Indirect markers suggest small-vessel disease at an early stage that might be enhanced by moderate hemostatic disorders.     

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Request Reprint E-Mail:       charlotte.cordonnier@chru-lille.fr

Appointment of Trustees, Autumn 2012

Alcohol Research UK is a new national charity that has taken over the work of the Alcohol Education and Research Council. Our vision is to reduce the harm caused by excessive alcohol consumption, by ensuring that policy and practice can always be developed on the basis of robust scientific evidence.

We do this by funding new research, either alone (using the income from our £13 million endowment fund) or in partnership with other organisations. We then disseminate the findings.

We have ambitious plans for the future, which include funding a lot more research, ensuring that our research is important to policy and practice, creating a practical evidence-base on research into alcohol harm and significantly raising our profile and influence. Ultimately, we want policymakers (e.g. the Government) and practioners (e.g. doctors) to regard us the UK’s foremost source of information on research into alcohol related harm.

We want to appoint up to four new trustees who can bring the skills and experience that will help us achieve those plans.   > > > >   Read More

Alcohol News - 39/2012

YLE News (Finland) - Finland moves to commit pregnant addicts

Doctors may soon be able to force expectant substance abusers into treatment if a bill under review is written into law.

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YLE Uutiset (Finland) - Finnish anti-drinking ad scares Americans sober

Alcoholic parents appear as monsters in a new Finnish anti-drinking campaign that captured the attention of the American news network CNN.

Read more

Huffington Post (USA) - Children Can Easily Buy Alcohol On eBay And Other Websites, Reports Show

The Internet can already seem like a dangerous place for a child. There are the persistent concerns of cyber bullies and sexual predators, as well as a child's potential exposure to inappropriate content like pornography.

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IPPmedia (Africa) - Global meeting on alcohol policy formulation kicks off

The third international conference on alcohol policy formulation in the East Africa region begins in Arusha tomorrow. The two-day conference will attract 80 participants from the region as well as Malawi, Sweden and Norway, who have a wealth of knowledge to share on the impact of irresponsible drinking and the role of alcohol policy can play in reducing the negative impact of drinking.

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CBC.ca - Letting kids sip alcohol may not stave off binge drinking

Some parents allow their children to sip alcohol, thinking it will help them to resist peer pressure later — but that might not be the best approach, the authors of an American study say.

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Sydney Morning Herald (Australia) - Social media condemned for alcohol marketing

AUSTRALIA'S peak medical body has censured the social media giant Facebook for allowing alcohol companies to target children.

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ABC Online (Australia) - Committee calls for action on fetal alcohol disorder

Parliamentary committee in Western Australia says fetal alcohol spectrum may be more prevalent than Down's Syndrome-- but a lack of data means no-one really knows how prevalent it is. The committee has found that the incidence of fetal alcohol spectrum disorder in Aboriginal communities could be higher than 25-percent.

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Guardian Express - Eight Weeks Abstinence from alcohol initiate healthier bones for alcoholics with Osteoporosis

To understand Osteoporosis and its effect on the body, breaking down the word (Osteoporosis) might be as good of a starting place as any.

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BBC News (UK) - Alcohol and obesity cause liver disease death rise

Alcohol abuse and obesity are to blame for a big rise in liver disease in the North West, says a report.

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RedOrbit - Symptoms Of Alcohol Abuse, Not Dependence, May Better Reflect Family Risk For Alcohol Use Disorders

Individuals with alcohol use disorders (AUDs) vary widely in their age of onset of use, patterns of drinking, and symptom profiles. AUDs are often ‘divided’ into two categories: alcohol abuse (AA) and alcohol dependence (AD), with AA perceived as a milder syndrome that might develop into AD over time.

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Times of India (India) - Alcohol linked to aggression: Experts

Alcoholism has long been linked to aggression. City psychiatrists and NGOs peg the percentage of domestic violence in households where men are alcohol addicts at 75% and say it cuts across all sections of the society.

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Malta Independent Online (Malta) - Campaign encourages alcohol-free pregnancy

An increase in binge drinking among young women has led the health authorities to launch a campaign urging women to avoid drinking during pregnancy.

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Berwick Today (UK) - Minimum alcohol pricing considered in Northumberland

COUNTY residents have been told by supporters of a minimum price for alcohol that supermarkets would be hit hardest and local pubs would not be affected.

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News-Medical.net - Light alcohol consumption may increase risk of certain cancers

The majority of observational studies have shown that alcohol intake, especially heavy drinking, increases a number of upper-aero-digestive tract (UADT) and other cancers, and even moderate drinking is associated with a slight increase in the risk of breast cancer.

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PsychCentral.com - Maternal Binge Drinking Slows Some Fetal Brain Functions

Fetuses exposed to heavy binge drinking required significantly more time to habituate, or adjust, to repeated stimulation in the womb and also showed greater variability in test performance, according to a new study.

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Nyasa Times (Malawi) - Malawi NGOs call for alcohol policy adoption

Alcohol Policy Alliance, a grouping of some Civil Society Organizations (CSOs) has started mobilizing support to push for quick adoption of Alcohol Policy by Malawi Parliament.

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