Your chance to contribute to an independent review of the Drinkaware Trust

Individuals and organisations are invited to contribute documents towards a review of the activities and effectiveness of the Drinkaware Trust.

An independent review panel, established at the request of Drinkaware trustees, has appointed 23red, an independent consultancy to conduct the review of the Drinkaware Trust. The review panel is chaired by Sir Hugh Taylor, Chairman of the Guy’s and St Thomas’ NHS Foundation Trust.  > > > >  Read More

Young adults and ‘binge’ drinking: A Bakhtinian analysis

In this paper, we use Bakhtin's theory of carnival in a literary analysis of young people's accounts of the role of alcohol in their social lives.

Bakhtinian themes in the focus-group transcripts included the dialogic character of drinking stories, the focus on parodic grotesquery, ribald and satiric laughter, and the temporary subversion and reversal of social norms and roles in a world turned ‘inside out’. 

We suggest that our analysis of the UK's drinking ‘culture’ hints at a previously untheorised complexity and force, and points to a deep contradiction between young people's lived experience of alcohol and government policy discourses based on appeals to individual moral responsibility. 

We conclude that the carnivalesque resonance of drinking is such that the UK's alcohol problem will continue to worsen until the availability and cultural presence of alcohol is subject to stricter controls.


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Global Actions January 16, 2013

Key Recent Milestones:

· United States: The Transportation Research Board (TRB) held its Annual Meeting this week in Washington, D.C. Over 11,000 transportation professionals from around the world attended the meeting which included a workshop that provided an update on activities for the UN Decade of Action for Road Safety. The meeting was a chance for ICAP to meet with road safety officials, including Senior Advisory Group members Kathy Stewart and Fred Wegman, on issues related to drink driving. ICAP’s Shushanna Mignott attended several sessions on road safety and impaired driving.

Global Actions in Focus: Pune, India Traffic Police Workshops

As part of ICAP’s support for industry actions to reduce harmful drinking in India, ICAP completed a series of training workshops with Pune traffic police

 in December 2012.

Approximately 150 traffic police officials participated in the workshops that trained attendees on Diageo’s DRINKiQ resources and international blood alcohol concentration (BAC) levels.

“The objective of the capacity-building workshops is to equip traffic police with the tools to share the principles of responsible drinking,” said ICAP’s India Country Coordinator Hetal Ghandi. The workshop was completed in time for Pune’s Road Safety Fortnight from January 1 to 15, 2013.

Sponsored by Diageo, DRINKiQ provides a comprehensive resource on alcohol-related topics for consumers, parents, retailers, teachers, community officials, and others with an interest in responsible drinking. Read more about DRINKiQ here.

What’s Happening Next:

· Vietnam: Global Actions Vietnam Country Manager Lan Huong Nguyen will be attending the Vietnam Beer Alcohol Beverage Association (VBA) annual review seminar on January 18, 2013. VBA is a partner for Global Actions drink driving initiatives in Vietnam.  

A Corticotropin Releasing Factor Pathway for Ethanol Regulation of the Ventral Tegmental Area in the Bed Nucleus of the Stria Terminalis

A growing literature suggests that catecholamines and corticotropin-releasing factor (CRF) interact in a serial manner to activate the bed nucleus of the stria terminalis (BNST) to drive stress- or cue-induced drug- and alcohol-seeking behaviors. 

 Data suggest that these behaviors are driven in part by BNST projections to the ventral tegmental area (VTA). Together, these findings suggest the existence of a CRF-signaling pathway within the BNST that is engaged by catecholamines and regulates the activity of BNST neurons projecting to the VTA. 

Here we test three aspects of this model to determine: (1) whether catecholamines modify CRF neuron activity in the BNST; (2) whether CRF regulates excitatory drive onto VTA-projecting BNST neurons; and (3) whether this system is altered by ethanol exposure and withdrawal. 

A CRF neuron fluorescent reporter strategy was used to identify BNST CRF neurons for whole-cell patch-clamp analysis in acutely prepared slices. Using this approach, we found that both dopamine and isoproterenol significantly depolarized BNST CRF neurons. Furthermore, using a fluorescent microsphere-based identification strategy we found that CRF enhances the frequency of spontaneous EPSCs onto VTA-projecting BNST neurons in naive mice. This action of CRF was occluded during acute withdrawal from chronic intermittent ethanol exposure. 

These findings suggest that dopamine and isoproterenol may enhance CRF release from local BNST sources, leading to enhancement of excitatory neurotransmission on VTA-projecting neurons, and that this pathway is engaged by patterns of alcohol exposure and withdrawal known to drive excessive alcohol intake.


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Request Reprint E-Mail:   danny.winder@vanderbilt.edu

Decreased injecting is associated with increased alcohol consumption among injecting drug users in northern Vietnam

Reducing injecting frequency may reduce the risk of HIV infection and improve health outcomes among injection drug users (IDUs). However, the reduction of one risk behavior may be associated with an increase in other risk behaviors, including the use of other risk-associated substances. Our objective was to determine if an association exists between a reduction in injecting and level of alcohol use among IDU.

We conducted a longitudinal analysis of data collected for a randomized controlled trial examining the efficacy of a peer education intervention in reducing HIV risk among IDU and their network members in Thai Nguyen, Vietnam. Our analysis included active male injectors (n = 629) who were study participants and attended both baseline and 3-month visits. Frequency of alcohol consumption was assessed as the number of alcoholic drinks in the past 30 days. Change in risk and outcome behaviors was calculated as the difference in frequencies of behaviors between baseline and 3-month follow-up visits. The outcome of interest was concurrent decreased drug injection and increased alcohol consumption.

The mean difference between baseline and 3-month follow-up of alcohol consumption and injection frequency in the past 30 days was 19.03 drinks (93.68 SD) and 20.22 injections (35.66 SD), respectively. Participants who reported reduced injection frequency were almost three times as likely to report increased alcohol consumption (OR 2.8; 95% CI, 2.0, 4.0). The proportion that both decreased injecting and increased alcohol by any amount in the past 30 days was 35.6%. In multivariate analysis higher education was significantly associated with an increase in alcohol and decrease in injecting of any amount.

Male IDU may be at risk for increasing alcohol consumption when they reduce injection frequency. Interventions with male IDU that encourage reduction of injection may need to review specific strategies to limit alcohol consumption

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Request Reprint E-Mail:   vgo@jhsph.edu

Ethnicity and Gender Comparisons of Health Consequences in Adults with Alcohol Dependence

The moderating effects of ethnicity and gender on factors associated with physical health consequences in adults manifesting alcohol dependence were examined using data from the 2001–2002 US National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). 

Black and white respondents with a lifetime diagnosis of DSM-IV alcohol dependence were selected for the study (n = 3,852). A multiple-group structural equation model tested ethnicity, gender, and intervening variables as predictors of physical health status in alcohol-dependent men and women.

Study findings offer implications for clinical practice with alcohol-dependent individuals by identifying likely target groups and problems for intervention.

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Request Reprint E-Mail:  karen.chartier@utsouthwestern.edu 

Effects of Parental Alcoholism, Sense of Belonging, and Resilience on Depressive Symptoms: A Path Model

This paper explored the relationships between parental alcoholism, sense of belonging, resilience, and depressive symptoms among Koreans in the U.S. 

Data from 206 Koreans (Mean age = 28.4 years; 59.8% females) living in a Midwestern state were collected in 2009, using a web-based survey, which included Children of Alcoholic Screening Test, Sense of Belonging Instrument, Connor-Davidson Resilience Scale, and Beck Depression Inventory-II. 

Path analysis results revealed sense of belonging as the most powerful, and resilience as the second important factor, resisting depressive symptoms associated with parental alcoholism. Implications for practice and research and study limitations are discussed. 

The study's limitations are noted.


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Request Reprint E-Mail:   leeh9@mail.nih.gov

Examining a curvilinear model of readiness to change and alcohol consumption

Research examining the relationship between readiness to change and alcohol consumption among college students is inconsistent. 

The purpose of the present study was to extend these findings, using two different measures of readiness to change. We hypothesized a curvilinear effect would occur such that the relationship between readiness to change and alcohol use would be relatively low for students low and high on readiness to change, whereas the relationship would be relatively high for those with moderate levels of readiness to change.

Data were collected from two studies: Study 1 consisted of 263 undergraduate students and Study 2 consisted of 245 undergraduates participating in either intercollegiate or recreational athletics at three US universities. In Study 1, we examined the association between both linear and quadratic scores on a readiness to change measure and alcohol use. In Study 2, we examined the relationship between scores on a stage of change measure that included subscales indicative of different levels of readiness to change and alcohol use. 

The pattern of relationships supported the existence of an effect where the highest levels of alcohol use occurred among those with scores representing moderate levels of readiness to change.


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Request Reprint E-Mail:     Jennifer.Cadigan@mail.missouri.edu

Industrialization Stresses, Alcohol Abuse & Substance Dependence: Differential Gender Effects in a Kenyan Rural Farming Community

Developing countries’ industrialization and urbanization attempts have been linked to psychological distress and alcohol abuse. 

We used Hobfoll’s COR theory to examine the relationship between gender, perceived resource loss (an indicator of industrialization stress), and alcohol abuse and dependence in a sample of Kenyan rural village men and women (N = 186).

Regression analyses indicated that both gender and COR loss predicted alcohol abuse and dependence. Additionally, results suggested that gender moderated the relationship between COR loss and alcohol dependence; such that higher COR loss scores predicted higher alcohol dependence for men, but COR loss scores did not predict alcohol dependence for women. 

Thus, we suggest that gender differences in substance abuse may be due less to actual differences in resource loss, but rather to gender differences in the response to resource loss. 

Limitations and opportunities for future research are discussed.


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Request Reprint E-Mail:  lwalt9@gmail.com

A Bivariate Mann-Whitney Approach for Unraveling Genetic Variants and Interactions Contributing to Comorbidity

Although comorbidity among complex diseases (e.g., drug dependence syndromes) is well documented, genetic variants contributing to the comorbidity are still largely unknown. The discovery of genetic variants and their interactions contributing to comorbidity will likely shed light on underlying pathophysiological and etiological processes, and promote effective treatments for comorbid conditions.

For this reason, studies to discover genetic variants that foster the development of comorbidity represent high-priority research projects, as manifested in the behavioral genetics studies now underway. The yield from these studies can be enhanced by adopting novel statistical approaches, with the capacity of considering multiple genetic variants and possible interactions. 

For this purpose, we propose a bivariate Mann-Whitney (BMW) approach to unravel genetic variants and interactions contributing to comorbidity, as well as those unique to each comorbid condition. Through simulations, we found BMW outperformed two commonly adopted approaches in a variety of underlying disease and comorbidity models. 

We further applied BMW to datasets from the Study of Addiction: Genetics and Environment, investigating the contribution of 184 known nicotine dependence (ND) and alcohol dependence (AD) single nucleotide polymorphisms (SNPs) to the comorbidity of ND and AD. 

The analysis revealed a candidate SNP from CHRNA5, rs16969968, associated with both ND and AD, and replicated the findings in an independent dataset with a P-value of 1.06 × 10^–03.


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Request Reprint E-Mail:   qlu@epi.msu.edu

Interactive effects of ApoE polymorphism, alcohol and smoking on age-related trends of blood pressure levels in elderly men: the Bambuì Cohort Study of Ageing (1997–2008)

Data from a population-based prospective study were used to examine longitudinal changes in blood pressure (BP) and seek interactions between apolipoprotein E (ApoE) genotypes, smoking and alcohol in a cohort of 557 elderly Brazilian men.

Repeated BP measurements were obtained in four waves, and multi-level random-effects pattern-mixture models were used to evaluate age-related BP trajectories while accounting for non-ignorable dropouts/deaths and handling heterogeneities as random parameter variations.

Alcohol was associated with high systolic BP in ε2 carriers and those with the ε3/3 genotype, but not in ε4 carriers. This was dependent on age and smoking habits: at the age of 60, expected systolic BP in alcohol drinking ε2 carriers was 16.5 mm Hg higher than in the reference group of non-smokers/non-drinkers if they were not smokers (P=0.049), and 28.6 mm Hg higher if they were also smokers (P=0.004). The youngest smoking/non-drinking ε2 carriers had lower systolic BP, but it increased rapidly and led to higher expected levels among older carriers. 

Alcohol consumption, alone or together with smoking, interacts with the effects of ApoE genotype on systolic BP, probably nullifying the more favourable lipid profile of ε2 carriers. The interactions of gene-modifiable risk factors have major public health implications.


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Request Reprint E-Mail:      emoriguchi@pucrs.br   

Urge-specific and lifestyle coping strategies of alcoholics: Relationships of specific strategies to treatment outcome

The present study examined the efficacy of various specific lifestyle and situation-specific coping skills by determining the relationship of each of these strategies to drinking outcomes.


Patients with alcohol dependence in intensive day treatment (n=165) were participating in a randomized trial of naltrexone versus placebo and adjunctive communication and coping skills training or a control treatment. The alcohol version of the Urge-Specific Strategies (USS) questionnaire and the General Strategies for Alcoholics (GSA) were administered early in treatment. The USS assesses 16 situation-specific strategies taught in cue exposure treatment, communication skills training, or relaxation/meditation training to cope with experiencing an urge to drink (e.g., think of positive and negative consequences of drinking, use mastery messages, engage in an alternative behavior); the 21-item GSA assesses lifestyle change strategies taught in communication skills training and in the general treatment program (e.g., keep busy, exercise regularly, attend 12-Step meetings, avoid high-risk situations). Alcohol use and frequency of use of the skills were assessed 6 and 12 months following treatment.

Many specific behavioral and cognitive coping strategies were significantly related to drinking outcomes, including 13 urge-specific and 18 general lifestyle strategies, while other strategies were unrelated.

Since some strategies taught in treatment are more effective in preventing relapse than others; treatment may be improved by focusing on these specific strategies. Since results may be limited to this population, replication is needed in more diverse settings and without medication.


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Request Reprint E-Mail:   Damaris_Rohsenow@brown.edu

Associations of the 5-hydroxytryptamine (serotonin) Receptor 1B gene (HTR1B) with alcohol, cocaine, and heroin abuse†‡

Abnormal serotonergic pathways are implicated in numerous neuropsychiatric disorders including alcohol and drug dependence (abuse). The human 5-hydroxytryptamine (serotonin) receptor 1B, encoded by the HTR1B (5-HT1B) gene, is a presynaptic serotonin autoreceptor that plays an important role in regulating serotonin synthesis and release.

Although there was evidence of associations of the HTR1B gene variants in the etiologies of substance use disorders, negative findings were also reported. To clarify the roles of commonly reported single nucleotide polymorphisms (SNPs) of the HTR1B gene underlying alcohol and drug dependence (abuse), we performed a meta-analysis based on the available genotype data from individual candidate gene-based association studies.

Evidence of association was found between the functional SNP −161A>T (rs130058) and alcohol, cocaine, and heroin dependence (e.g., P = 0.03 and odds ratio (OR) = 1.2 (1.02, 1.42) in the combined European, Asian, African, and Hispanic populations).

SNP −261T>G (rs11568817) also showed evidence of association but with different directions in Europeans and non-Europeans (e.g., P = 0.0018 with OR = 1.42 (1.14, 1.76) and P = 0.01 with ORs = 0.5 (0.3, 0.85), respectively). 

This meta-analysis supports the associations of HTR1B −261T>G and −161A>T with alcohol and drug abuse and further investigations are warranted in larger samples


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Request Reprint E-Mail:  dawei.li@uvm.edu 

Population pharmacokinetics of multiple alcohol intake in humans

The objective of this study was to determine population-based pharmacokinetics parameters for ethanol following multiple intake and to identify the factors influencing the pharmacokinetics.

Three different solutions of alcoholic liquor (ethanol 55.39 ± 0.45 g) with different dissolved oxygen concentrations were administered, and blood alcohol concentration was determined in 59 healthy subjects using a breath analyzer. Samples (n = 2955) were collected at various time points. Population pharmacokinetic modeling was performed to describe the pharmacokinetics of ethanol. The influence of individuals' demography and dissolved oxygen concentration was investigated, and Visual Predictive Check and bootstrapping were conducted for internal evaluation. The developed model was used to perform simulations to visualize the effects of covariates on individuals.

A one-compartment model with Michaelis–Menten elimination kinetics described the multiple ethanol intake data. Population pharmacokinetic estimates of V_max and K_m were 3.256 mmol min⁻¹ and 0.8183 mmol L⁻¹, respectively. V_d/F was estimated to be 77.0 L, and K_a was 0.0767 min⁻¹. 

Body weight, age, and the dissolved oxygen concentration were confirmed to be significant covariates. The mean estimates from the developed population pharmacokinetic model were very similar to those from 500 bootstrap samples, and Visual Predictive Check showed that approximately 94% of the observed data fit well within the 5th–95th percentile.

 A one-compartment model with nonlinear elimination kinetics for multiple ethanol intake was developed and the significant covariates were determined. The robustness of the developed model was evaluated by bootstrap and Visual Predictive Check. The final model and implanted covariates explained well the variability and underlying mechanism of ethanol PK.


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Request Reprint E-Mail:   kwon@cnu.ac.kr

Growth and empowerment for Indigenous Australians in substance abuse treatment-

This paper describes psychosocial outcomes of an Indigenous residential substance abuse rehabilitation centre in Australia, examines the sensitivity to change of the new Growth and Empowerment Measure (GEM), and explores the degree to which service users value cultural components of the treatment program. 

Participants were 57 Indigenous and 46 non-Indigenous male clients from Oolong House. Intake, 8-weeks, and 16-weeks (program completion) measures of Kessler 10 Psychological Distress Scale (K10), Drug Taking Confidence Questionnaire (DTCQ-8), and GEM were completed. The Treatment Component Evaluation (TCE) was completed at 16-weeks.

 There were significant improvements for participants, with a decrease in psychological distress and increases in refusal self-efficacy and empowerment. Effect sizes for GEM were medium to large across the time-points (r = 0.61 to 0.70 for all four subscales from baseline to 8-weeks; r = 0.44 to 0.70 for three subscales from 8-weeks to 16-weeks), indicating sensitivity to change. Indigenous participants rated cultural components of treatment significantly more helpful than did non-Indigenous participants. 

Implications for future research and substance abuse interventions for Indigenous Australians are discussed.

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Request Reprint E-Mail:  slb775@uowmail.edu.au

Moderate Prenatal Alcohol Exposure Reduces Plasticity and Alters NMDA Receptor Subunit Composition in the Dentate Gyrus

Although it is well documented that heavy consumption of alcohol during pregnancy impairs brain development, it remains controversial whether moderate consumption causes significant damage. Using a limited access, voluntary consumption paradigm, we recently demonstrated that moderate prenatal alcohol exposure (MPAE) is associated with dentate gyrus-dependent learning and memory deficits that are manifested in adulthood.

Here, we identified a novel mechanism that may underlie this effect of MPAE. We found that MPAE mice exhibit deficits in NMDA receptor (NMDAR)-dependent long-term potentiation (LTP) in the dentate gyrus. Further, using semiquantitative immunoblotting techniques, we found that the levels of GluN2B subunits were decreased in the synaptic membrane, while levels of C2′-containing GluN1 and GluN3A subunits were increased, in the dentate gyrus of MPAE mice.

These data suggest that MPAE alters the subunit composition of synaptic NMDARs, leading to impaired NMDAR-dependent LTP in the dentate gyrus.


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Request Reprint E-Mail:    kcaldwell@salud.unm.edu 

Alcohol: a key determinant for ill health and an obstacle to development

In 2000, world leaders promised to halve extreme poverty by 2015 with a global plan called the Millennium Development Goals (MDGs). The MDGs set clear targets for the development agenda, but 2015 is coming closer. Yet, 1.4 billion people still live in extreme poverty. New development targets are needed. Already there are formal and informal processes running in this process. A platform for consultation on the role of health in the post-2015 development agenda is co-convened by WHO and UNICEF, in collaboration with the Government of Sweden and the Government of Botswana.

In a paper contributed to the consultation the Global Alcohol Policy Alliance (GAPA) point out that alcohol is a risk factor for ill-health and should be included in the development agenda.The MDGs state that health is critical to the economic, political and social development of all countries. The health-related MDGs focus on reducing child mortality (no. 4), improving maternal health (no. 5), and combatting HIV/AIDS, malaria and other diseases (no. 6), but do not capture the increasing burden of non-communicable diseases (NCDs). Substantial progress has been made in addressing MDGs 4-6; however, there are still important challenges remaining with regard to addressing these MDGs in some regions of the world. The reformulation of globally agreed development goals for the post 2015 period nevertheless is an opportunity to address the lack of a NCD focus. This reformulation needs to be informed by the recognition of emerging challenges as expressed by the UN High Level Meeting on NCDs in 2011 as well as by new knowledge from the recently released Global Burden of Disease Study 2010. > > > >  Read More

Where the Individual Meets the Ecological: A Study of Parent Drinking Patterns, Alcohol Outlets, and Child Physical Abuse

Despite well-known associations between heavy drinking and child physical abuse, little is known about specific risks related to drinking different amounts of alcohol in different drinking venues. This study uses a context-specific dose–response model to examine how drinking in various venues (e.g., at bars or parties) is related to physically abusive parenting practices while controlling for individual and psychosocial characteristics.

Data were collected via a telephone survey of parents in 50 cities in California, resulting in 2,163 respondents who reported drinking in the past year. Child physical abuse and corporal punishment were measured using the Conflict Tactics Scale, Parent–Child version. Drinking behaviors were measured using continued drinking measures. Data were analyzed using zero-inflated Poisson models.

Drinking at homes, parties, or bars more frequently was related to greater frequencies of physically abusive parenting practices. The use of greater amounts of alcohol in association with drinking at bars appeared to increase risks of corporal punishment, a dose–response effect. Dose–response relationships were not found for drinking at homes or parties or drinking at bars for physical abuse nor for drinking at home and parties for corporal punishment.

Frequencies of using drinking venues, particularly bars and home or parties, are associated with greater use of abusive parenting practices. These findings suggest that a parent's routine drinking activities place children at different risks of being physically abused. They also suggest that interventions that take into account parents’ alcohol use at drinking venues are an important avenue for secondary prevention efforts.


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Request Reprint E-Mail:    freisthler@publicaffairs.ucla.edu

Alcohol Outlet Densities and Alcohol Price: The British Columbia Experiment in the Partial Privatization of Alcohol Sales Off-Premise

Alcohol beverage prices or taxes have been shown to be related to alcohol sales and use and related problems. What is not clear are the mechanisms underlying these relationships.

This study examines the relationship between alcohol outlet density under conditions of the partial privatization of off-premise consumption in British Columbia (BC) occurring over the past decade. Two hypotheses are tested. First, reflecting basic supply–demand principles, greater geographic densities of alcohol outlets will be directly related to reductions in beverage prices in response to greater competition. Second, reflecting the effects of niche marketing and resulting market stratification, increased densities of private liquor stores will be especially related to reductions in beverage prices within this outlet category. Data were collected from: (i) a survey of BC private store prices and practices, (ii) alcohol outlet location information, and (iii) data on demographic characteristics. Multilevel models examine the relationships between prices at individual private liquor stores and the densities of government liquor stores, private liquor stores, bars, and restaurants, controlling for background demographics and geographic unit level effects. Spatial dependencies were also examined.

Increased densities of private liquor stores were associated with lower mean prices of beer and all alcohol aggregated across brands at the store level. There appeared to be no outlet level effect on discounting patterns, however, with the mean price differences apparently reflecting differences in the quality of brands carried rather than unequal prices for any given brand.

Increased densities of private off-sale alcohol outlets appear to result in lower prices charged at said establishments independently of other types of alcohol outlets suggesting that they represent an emerging marketing niche in the context of off-sale outlet privatization.


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Request Reprint E-Mail:   andrew@prev.org

Critique 100: The effects of moderate drinking on cognitive function and dementia: An update — 15 January 2013

In several longitudinal studies, light-to-moderate drinking of alcoholic beverages has been proposed as being protective against the development of age-related changes in cognitive function, predementia syndromes, and cognitive decline of degenerative (Alzheimer’s disease, AD) or vascular origin (vascular dementia). However, contrasting findings also exist.

The English literature published in this area before September 2011 was evaluated, and information relating to the various factors that may impact upon the relationship between alcohol consumption and dementia or predementia syndromes is presented in the succeeding texts.

Light-to-moderate alcohol consumption may be associated with a reduced risk of incident overall dementia and AD; however, protective benefits afforded to vascular dementia, cognitive decline, and predementia syndromes are less clear. The equivocal findings may relate to many of the studies being limited to cross-sectional designs, restrictions by age or gender, or incomplete ascertainment. Different outcomes, beverages, drinking patterns, and study follow-up periods or possible interactions with other lifestyle-related (e.g., smoking) or genetic factors (e.g., apolipoprotein E gene variation) may all contribute to the variability of findings.

Protective effects of moderate alcohol consumption against cognitive decline are suggested to be more likely in the absence of the AD-associated apolipoprotein E e4 allele and where wine is the beverage. At present, there is no indication that light-to-moderate alcohol drinking would be harmful to cognition and dementia, and attempts to define what might be deemed beneficial levels of alcohol intake in terms of cognitive performance would be highly problematic and contentious.


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Global Actions

Key Recent Milestones:

· Mexico: Global Actions presented a drink driving awareness training to Erica Alonso, the wife of Puebla’s Governor. Mrs. Alonso signed a memorandum of understanding to expand the drink driving training program throughout the state.

Global Actions in Focus: Mexico Tequila Chamber Meeting

Global Actions recently met with the National Chamber for the Tequila Industry in Guadalajara, Jalisco.

Approximately 30 members of the tequila chamber attended the event that was chaired by the National Chamber’s Eduardo Orendain.

ICAP’s Regional Coordinator for Latin America Denise Bussio discussed the WHO Global Strategy to Reduce the Harmful Use of Alcohol. Her presentation included a step-by-step guide on best practices for developing an intervention program. Bussio addressed questions such as how to choose a target group, and showed samples and best practices from different intervention programs.

“Attendees showed interest and motivation to move forward,” said Global Actions Country Manager Mariana Guerra Rendon. Guerra Rendon presented Global Actions’ drink driving project in Puebla, followed by a question and answer session.

ICAP also met with Tequila Chamber director Franciso J. Soltero, who spoke about the history and goals of the chamber. Another round of Q&A gave Global Actions the opportunity to discuss ICAP’s expertise in developing intervention programs.

What’s Happening Next:

· Brussels: ICAP is planning the seminar Noncommercial Alcohol in Three EU Countries to be held February 20, 2013 at the European Parliament. The event will feature research findings from Poland, Latvia, and Estonia, and address policy implications of the unrecorded alcohol sector related to public health, trade, and state revenue.  

Striatal Adenosine Signaling Regulates EAAT2 and Astrocytic AQP4 Expression and Alcohol Drinking in Mice

Adenosine signaling is implicated in several neuropsychiatric disorders, including alcoholism. Among its diverse functions in the brain, adenosine regulates glutamate release and has an essential role in ethanol sensitivity and preference. However, the molecular mechanisms underlying adenosine-mediated glutamate signaling in neuroglial interaction remain elusive. 

We have previously shown that mice lacking the ethanol-sensitive adenosine transporter, type 1 equilibrative nucleoside transporter (ENT1), drink more ethanol compared with wild-type mice and have elevated striatal glutamate levels. In addition, ENT1 inhibition or knockdown reduces glutamate transporter expression in cultured astrocytes. 

Here, we examined how adenosine signaling in astrocytes contributes to ethanol drinking. 

Inhibition or deletion of ENT1 reduced the expression of type 2 excitatory amino-acid transporter (EAAT2) and the astrocyte-specific water channel, aquaporin 4 (AQP4). EAAT2 and AQP4 colocalization was also reduced in the striatum of ENT1 null mice.

Ceftriaxone, an antibiotic compound known to increase EAAT2 expression and function, elevated not only EAAT2 but also AQP4 expression in the striatum. Furthermore, ceftriaxone reduced ethanol drinking, suggesting that ENT1-mediated downregulation of EAAT2 and AQP4 expression contributes to excessive ethanol consumption in our mouse model.

Overall, our findings indicate that adenosine signaling regulates EAAT2 and astrocytic AQP4 expressions, which control ethanol drinking in mice.


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Request Reprint E-Mail:   choids@mayo.ed

How Patients Recovering From Alcoholism Use a Smartphone Intervention

 Mobile technology has the potential to radically improve addiction treatment and continuing care by offering emotional and instrumental support anywhere and just in time. This is particularly important in addiction because timing is critical to preventing relapse. 

Although most experts consider alcoholism to be a chronic disease, providers do not typically offer ongoing support for relapse prevention after patients complete treatment, even though a central characteristic of alcoholism and other addictive behaviors is their chronically relapsing nature. 

A-CHESS is a smartphone-based system for preventing relapse to heavy drinking among people leaving active alcohol dependence treatment. A-CHESS is designed to improve competence, social relatedness, and motivation, the three tenets of self-determination theory. This paper reports on the relative impact and use of A-CHESS 4 months after patients entered the study and discusses implications of the results on treating addiction and chronic diseases generally. 

A total of 349 individuals with alcohol dependence leaving residential treatment were randomly assigned to either receive A-CHESS + Treatment as usual or treatment as usual (standard aftercare). Patients came from two treatment agencies, one in the Midwest and one in the Northeast. Patients assigned to A-CHESS received a smartphone for 8 months and were followed for 12. The authors analyzed use patterns during the first 4 months of use by those receiving A-CHESS. 

 Participants used A-CHESS heavily and sustained their use over time. Ninety-four percent of A-CHESS participants used the application during the first week after residential treatment. At week 16, almost 80% continued to access A-CHESS. Participants with alcohol and drug dependence showed higher levels of system use than those with alcohol dependence only. Participants with a mental health diagnosis had slightly lower levels of use at the end of the intervention period (week 16), although more than 70% still accessed the system. RR


These findings illustrate that patients with alcohol dependence, alcohol and drug dependence, and mental health issues will use smartphone applications such as A-CHESS for ongoing support, resources, and information, thus extending patient care if given the opportunity. Further analysis is needed to determine whether sustained A-CHESS use improves outcomes. 

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Attachment style, anxiety coping, and personality-styles in withdrawn alcohol addicted inpatients

Insecure early attachment experiences have been reported to play an important role in the manifestation in alcoholism. The purpose of this study was to investigate the relationship of attachment styles with anxiety, anxiety coping and dysfunctional personality styles, as well as with the prevalence of personality disorders, and adverse life-events in adolescence.

59 inpatient alcohol addicted male (n=43) and female (n=16) patients were characterized by an attachment style scale (Relationships-style-questionnaire-RSQ) and completed a questionnaire battery comprising the State-Trait-Anxiety-Inventory (STAI), the Anxiety-Coping-Inventory (ABI), Temperament-and-character-inventory (TCI), Personality-system-interaction-inventory (PSI), and gave information on sociodemography, alcohol history, and adolescent adverse events. A structured interview (SKID-II) was performed to diagnose personality disorders.

Only 33% of subjects had a secure attachment style. Insecure attachment was associated with significantly higher trait-anxiety, higher cognitive avoidance to control anxiety, and higher values on most personality style dimensions directed to the pathological pol

Despite the limitation due to a small sample size, the results of this study show that the consideration of attachment styles is of significance in the diagnosis and therapy of alcohol addiction. Attachment may characterize different styles to control emotional aspects, anxiety cues and interpersonal relationships in individuals suffering from alcohol addiction


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Alcohol education and training in pre-registration nursing: A national survey to determine curriculum content in the United Kingdom (UK)

Alcohol-related harm impacts significantly on the health of the population. Nurses are often among the first health professionals that many patients with alcohol-related problems come into contact with and have been identified as playing a key role but may be ill-prepared to respond. Future nurses need to have the skills, knowledge and clinical confidence to respond to patients suffering from alcohol-related harm. A pre-registration curriculum that ensures a nursing workforce fit for practice in responding to alcohol-related harm is necessary.

To determine the level of alcohol education and training content in the pre-registration curriculum for nursing in the United Kingdom (UK). To establish whether there are variations in the pre-registration curriculum content across the UK.

A descriptive study.

All 68 UK Higher Education Institutions offering a total of 111 pre-registration courses for nurses were invited to participate in the study.

Twenty nine completed questionnaires were returned, a response rate of 26%. The largest number of identified responders were from England (n=15), with 3 from Scotland and 1 each from Wales and Northern Ireland. Nine Universities chose not to identify themselves.

An online semi-structured questionnaire survey was used to collect the study data.

Teaching of alcohol and alcohol related harm was mainly delivered during the second year of a pre-registration nursing programme provided mainly to adult and mental health students. Overall, the majority of alcohol related content that is provided within the responding pre-registration nursing courses relates to biophysiology, aetiology, and pharmacological and non-pharmacological interventions.

This study highlights the need for a greater and more relevant focus of alcohol education to pre-registration nursing students of all fields of practice incorporating an integrated approach across all years of study.


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