To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.


Saturday, March 16, 2013

Conference 2013: Professor Mark Bellis on the ‘alcohol harm paradox’

Professor Mark Bellis sets out initial findings from Alcohol Research UK’s current  Flagship Research Grant – Understanding the ‘Alcohol Harm Paradox’.  He examines why the poorest 20% of people in Britain suffer up to twice the levels of alcohol related harm as the most affluent 20% – despite reporting similar, or lower, levels of consumption.  > > > > > >  Read More

Patterns of alcohol, tobacco and cannabis use and related harm in city, regional and remote areas of Australia



Prevalence of substance use and related harms
differs across geographic locations, with prevalence increasing with remoteness. This paper builds on previous research, investigating patterns of problematic use by remoteness.

Analysis of the National Drug Strategy Household Survey (NDSHS) data from 2007 by geographic location (in accordance with the Australian Standard Geographical Classification (ASGC) remoteness index).

Problematic cannabis use was predicted by demographics; older males with less education were more likely to report problematic cannabis use regardless of location. Younger, less educated males in inner regional and remote areas were more likely to report risky alcohol consumption for short term harms, while older, less educated males in outer regional and remote areas were more likely to report daily drinking. People from remote areas were significantly more likely to report driving under the influence of alcohol.

It is clear that men with lower levels of education were significantly more likely to report problematic alcohol and cannabis use patterns. An additional level of risk is associated with living in inner regional and remote areas, particularly in relation to risky drinking. Findings suggest a complex relationship between remoteness and substance use which requires further investigation.

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Health Consequences of Easier Access to Alcohol: New Zealand Evidence


We evaluate the health effects of a reduction in New Zealand's minimum legal purchase age for alcohol.

Difference-in-differences (DD) estimates show a substantial increase in alcohol-related hospitalizations among those newly eligible to purchase liquor, around 24.6% (s.e.=5.5%) for males and 22% (s.e.=8.1%) for females. There is less evidence of an effect among ineligible younger cohorts.

There is little evidence of alcohol either complementing or substituting for drugs. We do not find evidence that earlier access to alcohol is associated with learning from experience.

We also present regression discontinuity estimates, but emphasize DD estimates since in a simulation of a rational addiction model DD estimates are closer than regression dis
continuity estimates to the policy's true effect.

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Adenosine Transporter ENT1 Regulates the Acquisition of Goal-Directed Behavior and Ethanol Drinking through A2A Receptor in the Dorsomedial Striatum



Adenosine signaling has been implicated in the pathophysiology of many psychiatric disorders including alcoholism. Striatal adenosine A2A receptors (A2AR) play an essential role in both ethanol drinking and the shift from goal-directed action to habitual behavior. However, direct evidence for a role of striatal A2AR signaling in ethanol drinking and habit development has not been established.

In the present study, we found that decreased A2AR-mediated CREB activity in the dorsomedial striatum (DMS) enhanced initial behavioral acquisition of goal-directed behaviors and the vulnerability to progress to excessive ethanol drinking during operant conditioning in mice lacking ethanol-sensitive adenosine transporter ENT1 (ENT1−/−).

Using mice expressing β-galactosidase (lacZ) under the control of seven repeated CRE sites in both genotypes (CRE-lacZ/ENT1+/+ mice and CRE-lacZ/ENT1−/− mice) and the dominant-negative form of CREB, we found that reduced CREB activity in the DMS was causally associated with decreased A2AR signaling and increased goal-directed ethanol drinking.

Finally, we have demonstrated that the A2AR antagonist ZM241385 dampened protein kinase A activity–mediated signaling in the DMS and promoted excessive ethanol drinking in ENT1+/+ mice, but not in ENT1−/− mice.

Our results indicate that A2AR-mediated CREB signaling in the DMS is a key determinant in enhancing the development of goal-directed ethanol drinking in mice.

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Locomotor Sensitization to Ethanol Impairs NMDA Receptor-Dependent Synaptic Plasticity in the Nucleus Accumbens and Increases Ethanol Self-Administration

Although alcoholism is a worldwide problem resulting in millions of deaths, only a small percentage of alcohol users become addicted. The specific neural substrates responsible for individual differences in vulnerability to alcohol addiction are not known.

In this study, we used rodent models to study behavioral and synaptic correlates related to individual differences in the development of ethanol locomotor sensitization, a form of drug-dependent behavioral plasticity associated with addiction vulnerability.

Male Swiss Webster mice were treated daily with saline or 1.8 g/kg ethanol for 21 d. Locomotor activity tests were performed once a week for 15 min immediately after saline or ethanol injections. After at least 11 d of withdrawal, cohorts of saline- or ethanol-treated mice were used to characterize the relationships between locomotor sensitization, ethanol drinking, and glutamatergic synaptic transmission in the nucleus accumbens.

Ethanol-treated mice that expressed locomotor sensitization to ethanol drank significantly more ethanol than saline-treated subjects and ethanol-treated animals resilient to this form of behavioral plasticity. Moreover, ethanol-sensitized mice also had reduced accumbal NMDA receptor function and expression, as well as deficits in NMDA receptor-dependent long-term depression in the nucleus accumbens core after a protracted withdrawal.                       

These findings suggest that disruption of accumbal core NMDA receptor-dependent plasticity may represent a synaptic correlate associated with ethanol-induced locomotor sensitization and increased propensity to consume ethanol.


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The Case-Only Test for Gene–Environment Interaction is Not Uniformly Powerful: An Empirical Example

The case-only test has been proposed as a more powerful approach to detect gene–environment (G × E) interactions. This approach assumes that the genetic and environmental factors are independent. Although it is well known that Type I error rate will increase if this assumption is violated, it is less widely appreciated that G × E correlation can also lead to power loss.

We illustrate this phenomenon by comparing the performance of the case-only test to other approaches to detect G × E interactions in a genome-wide association study (GWAS) of esophageal squamous-cell carcinoma (ESCC) in Chinese populations.

Some of these approaches do not use information on the correlation between exposure and genotype (standard logistic regression), whereas others seek to use this information in a robust fashion to boost power without increasing Type I error (two-step, empirical Bayes, and cocktail methods).

G × E interactions were identified involving drinking status and two regions containing genes in the alcohol metabolism pathway, 4q23 and 12q24.

Although the case-only test yielded the most significant tests of G × E interaction in the 4q23 region, the case-only test failed to identify significant interactions in the 12q24 region which were readily identified using other approaches. The low power of the case-only test in the 12q24 region is likely due to the strong inverse association between the single nucleotide polymorphism (SNPs) in this region and drinking status.

This example underscores the need to consider multiple approaches to detect G × E interactions, as different tests are more or less sensitive to different alternative hypotheses and violations of the G × E independence assumption.

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Dose- and Gender-dependent Interactions between Coffee Consumption and Serum GGT Activity in Alcohol Consumers

Coffee consumption has been recently linked with decreased blood gamma-glutamyltransferase (GGT) activities and protection from alcoholic liver disease. To explore the relationship and dose response, we assessed the impacts of coffee and alcohol intake on serum GGT activity in apparently healthy men and women with varying levels of coffee and alcohol consumption.

Data on coffee, alcohol consumption and serum GGT activities were collected from 18,899 individuals (8807 men and 10,092 women), mean age 48 years, range 25–74 years, who participated in a large national cross-sectional health survey. Body mass index, smoking index and age were used as covariates in all analyses.
Among the study population, 89.8% reported varying levels of coffee consumption; 6.9% were abstainers from alcohol, 86.1% moderate drinkers, 3.7% heavy drinkers and 3.3% former drinkers. In men, the elevation of GGT induced by heavy drinking (>280 g/week) was found to be significantly reduced by coffee consumption exceeding 4 cups per day. A similar trend was also observed among women, which however, did not reach statistical significance. 
Coffe modulates the effect of ethanol on serum GGT activities in a dose- and gender-dependent manner. These
observations should be implicated in studies on the possible hepatoprotective effects of coffee in alcohol consumers.

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Friday, March 15, 2013

Under-reporting: media, myths, and policy implications?

Sadie Boniface, who is currently writing up her PhD in UCL’s
Department of Epidemiology & Public Health, has contributed the following guest post. It explores some of the key issues that were neglected in recent media reports of this paper about under-reporting of alcohol consumption, the NHS Choices Behind the Headlines summary of which appears here.  > > >  > > > >  Read More

Faces and Voices of Recovery - Issue Briefing No. 1

It’s been said that “recovery is a process, not an event.” Many of us know that the growth and transformation that happens after we eliminate use of alcohol and other drugs is a lifelong process. As we move forward in our recovery journey, we experience new opportunities, achievements, and lessons. Along with these come challenges and setbacks. During these times, we may need to seek out extra help and support. This often helps to secure our recovery and prevent relapse. Sustaining our recovery requires cultivation, so that we don’t fall back into old ways or active addiction.  Over the years, scientists have confirmed what many of us knew all along: addiction is a chronic condition. This means that, just like with other chronic conditions including heart disease, hypertension, and diabetes, there is not a cure that will make our addiction go away completely. This is why many of us say that we are “in recovery,” rather than “recovered.” We manage our condition through a process of changing how we think, behave, and (re)assemble our lives. Most of us cannot do it alone, so we seek out others to help support and cultivate our recovery journey. Recovery doesn’t just automatically happen, it evolves and changes over time as we grow and mature.

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Addiction Recovery Communities as Indigenous Cultures:

This commentary conceptualizes recovery mutual aid organizations and other grassroots, non-professional recovery support institutions as indigenous cultures, identifies ethical issues that can arise in professional and scientific collaboration with such cultures, and provides a checklist that can guide professional and scientific collaborations with grassroots recovery support organizations.

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Toward a Core Recovery-focused Knowledge Base

Recovery is emerging as a new organizing construct within the alcohol and drug problems arena. Government policymakers are reframing policy goals beyond those of supply reduction, harm minimization, and demand reduction. Discussions of primary prevention, early intervention, and clinical treatment are being reframed within a larger rubric of personal, family, and community recovery; wellness; and quality of life. Acute and palliative care models of addiction treatment are giving way to models of sustained recovery management nested within larger recovery-oriented systems of care. Clinical assessment and service planning are being revolutionized via the constructs of recovery capital and recovery planning. Multiple pathways of long-term recovery are being mapped within and across an ever-growing network of religious, spiritual, and secular recovery mutual aid societies and a greater understanding of processes of natural recovery. Grassroots recovery community organizations are springing up across the globe in an unprecedented level of cultural and political mobilization of individuals and families in recovery. New service institutions are emerging—recovery homes, recovery schools, recovery industries, recovery ministries, recovery cafes—that do not fit the traditional categories of addiction treatment and recovery mutual aid. Internet-based and other technology-based mutual aid and social networking are challenging traditional mechanisms for delivering both treatment and recovery support. New recovery-focused service roles are rapidly spreading, e.g., recovery support specialists, recovery coaches, peer specialists. And calls for pursuit of a recovery-focused research agenda are challenging the historical addiction pathology preoccupations of the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism.  > > > >  Read More

Federalizing Medical Campaigns against Alcoholism and Drug Abuse

The formation of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Special Action Office for Drug Abuse Prevention (SAODAP) in the early 1970s dramatically expanded scientific and medical efforts to control alcoholism and drug abuse in the United States.
Drawing on a variety of primary, secondary, and archival sources, this article describes the creation and early years of these agencies.
I show that while the agencies appeared at roughly the same time, their creation involved separate sets of issues and actors. In addition, I show that SAODAP received more money and resources, even though advocates for alcoholics mobilized a stronger lobbying campaign.

Two factors explain this discrepancy in money and resources: (1) alcoholism was framed as a public health problem, whereas drug abuse was drawn into broader debates about crime and social decline; and (2) alcohol programs relied on congressional support, whereas drug programs found champions at high levels of the Nixon administration. These political and cultural factors help explain why current programs for illegal drugs receive more federal support, despite alcohol's greater public health burden.

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Thursday, March 14, 2013

Lifestyle Factors and the Risk of a Second Breast Diagnosis after DCIS in the Wisconsin In Situ Cohort


Certain tumor factors have been associated with increased likelihood of a second breast diagnosis after treatment for ductal carcinoma in situ (DCIS) breast cancer. However, little information exists on modifiable lifestyle factors that affect prognosis after DCIS and may be useful for survivors in reducing their risk of a second breast cancer event.

We examined the longitudinal association between body mass index (BMI), physical activity, and alcohol intake and risk of a second breast diagnosis among 1,925 DCIS survivors first diagnosed in 1997–2006 and enrolled in the Wisconsin In Situ Cohort. Data were collected during biennial patient interviews and diagnosis information was validated via pathology report. BMI, physical activity, and alcohol intake were examined over time using Chi-square and ANOVA methods. Cox proportional hazards regression was used to estimate the risk of a second diagnosis after adjustment for patient, tumor, and treatment factors. Repeated measures were incorporated to make use of exposure measurements taken at each post-diagnosis interview.

Over an average of 6.6 years of follow-up, 162 second breast cancer diagnoses were reported. Significant trends of increasing BMI and decreasing physical activity were observed over time since diagnosis (p < 0.001). For all women, a significant linear trend of increasing risk of a second diagnosis was found over increasing categories of post-diagnosis alcohol intake (p-trend 0.02). Among women treated with ipsilateral mastectomy, a reduction in risk was suggested with increasing post-diagnosis physical activity (HR 0.67, 95% CI 0.45, 1.02 for each additional hour/week). Among postmenopausal women, higher categories of post-diagnosis BMI were associated with increasing risk, although these results were of borderline significance (p-trend 0.09).

 This study is the first to examine the association of physical activity and alcohol intake with second breast diagnoses in an exclusively DCIS population. Our results suggest that DCIS survivors may reduce their risk of a second diagnosis by engaging in physical activity and reducing their alcohol consumption.

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Less Drinking, Yet More Problems: Understanding African American Drinking and Related Problems.


Researchers have found that, compared to European Americans, African Americans report later initiation of drinking, lower rates of use, and lower levels of use across almost all age groups. Nevertheless, African Americans also have higher levels of alcohol problems than European Americans.
After reviewing current data regarding these trends, we provide a theory to understand this apparent paradox as well as to understand variability in risk among African Americans. 
Certain factors appear to operate as both protective factors against heavy use and risk factors for negative consequences from use. For example, African American culture is characterized by norms against heavy alcohol use or intoxication, which protects against heavy use but also provides within-group social disapproval when use does occur. African Americans are more likely to encounter legal problems from drinking than European Americans, even at the same levels of consumption, perhaps thus resulting in reduced consumption but more problems from consumption.

There appears to be one particular group of African Americans, low-income African American men, who are at the highest risk for alcoholism and related problems. 
We theorize that this effect is due to the complex interaction of residential discrimination, racism, age of drinking, and lack of available standard life reinforcers (e.g., stable employment and financial stability).

Further empirical research will be needed to test our theories and otherwise move this important field forward. A focus on within-group variation in drinking patterns and problems is necessary. We suggest several new avenues of inquiry.

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Wednesday, March 13, 2013

ALCOHOL POLICY, UNDERAGE DRINKING PREVENTION, AND SOCIAL CHANGE: Rebalancing the Public Good and Industry Profitability

James F. Mosher, JD Alcohol Policy Specialist Alcohol Policy Consultations - Felton California

According to the latest estimates of the global burden of disease study, alcohol is the leading risk factor in most countries of the Americas Region. Implementing effective alcohol policies that would reduce the burden of non communicable diseases, injuries, underage drinking, at the same time that they would make economic sense, remain both a challenge and a priority for PAHO/WHO and MemberStates. Such policies need also to counter balancing the influence of the alcohol industry, which is rapidly expanding in the Region.

Jim Mosher’s presentation will focus on preventing underage drinking: alcohol policies shown to be effective, the alcohol industry’s role and economic stake in the policy debate, and community-based implementation strategies.

James Mosher's pioneering work in alcohol policy has brought him international acclaim. His expertise spans numerous topics, including underage drinking prevention, alcohol marketing, community prevention strategies, alcohol law, dram shop liability, and social host liability. His services include consulting, keynote presentations, workshops and trainings, policy analysis, and advocacy in media and policy. He has also served as a WHO consultant on numerous occasions, an expert witness and consultant in alcohol litigation cases. 

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Reward-Related Ventral Striatum Reactivity Mediates Gender-Specific Effects Of A Galanin Remote Enhancer Haplotype On Problem Drinking

The neuropeptide galanin has been implicated in the regulation of appetitive and consummatory behaviors. Prior studies have shown that direct injection of galanin into the hypothalamus results in increased release of dopamine (DA) in the nucleus accumbens (NAcc), and parallel increases in food and alcohol consumption. These studies are consistent with a role of hypothalamic galanin in regulating reward system reactivity. In humans, a common functional haplotype (GAL5.1) within a remote enhancer region upstream of the galanin gene (GAL) affects promoter activity and galanin expression in hypothalamic neurons in vitro. 

Given the effects of hypothalamic galanin on NAcc DA release and the effects of the GAL5.1 haplotype on GAL expression, we examined the impact of this functional genetic variation on human reward-related ventral striatum (VS) reactivity.

 Using an imaging genetics strategy in Caucasian individuals (N=138, 72 women) participating in the ongoing Duke Neurogenetics Study, we report a significant gender-by-genotype interaction (right hemisphere: F(1,134)=8.08, p=0.005; left hemisphere: F(1,134)=5.39, p=0.022), such that homozygosity for the GG haplotype, which predicts greater GAL expression, is associated with relatively increased VS reactivity in women (n=50, right hemisphere: p=0.015; left hemisphere: p=0.060), but not in men (n=49, p values>0.10).

 Furthermore, these differences in VS reactivity correlated positively with differences in alcohol use, such that VS reactivity mediated a gender-specific association between GAL5.1 haplotype and problem drinking. 

Our current results support those in animal models implicating galanin signaling in neural pathways associated with appetitive and consummatory behaviors of relevance for understanding risk for substance use and abuse.

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Minimum alcohol pricing reportedly dropped after cabinet revolt

Home Secretary Theresa May appears to have scored a victory by leading a cabinet revolt against minimum alcohol prices.

The government has been consulting on a price of 45p per unit, and the proposal appeared to have the support of David Cameron.

The government has argued that introducing a minimum unit price would help reduce the levels of ill-health and crime related to alcohol and prevent practices such as "pre-loading", where people binge-drink before going out.

May, the former health secretary Andrew Lansley, and the education secretary, Michael Gove, have all opposed the proposals on grounds that the impact on living standards would be unacceptable.

The proposals have also been rejected by the Mayor of London, Boris Johnson, as regressive.

The news of a likely retreat sparked anger among some Tory MPs such as Tracey Crouch and Dr Sarah Wollaston.

The consultation has been led by the Home Office, although the Department of Health was closely involved.   > > > >  Read More

Tuesday, March 12, 2013

Alcohol News - 10/2013

Science Nordic (Sweden) - Swedish teens now toe the line
The behaviour of Swedish 15-year-olds has improved since the mid-1990s – they're less likely now to skip school, steal or drink than they were in the past.
Expatindenmark (Denmark) - Alcohol and unhealthy food brings Denmark at the bottom of the life expectancy list
A large number of smokers, lots of alcohol, unhealthy and high calorie diet are some of the causes for the Dane's poor health.
The Research Council of Norway (Norway) - Women who over-imbibe pose greatest risk to marriage
A high level of alcohol consumption increases the risk of divorce. However, research shows that if both partners are heavy drinkers it may actually protect the marriage.
Postimees (Estonia) - Survey: 1/3 of Estonian residents say illegal goods gained market share in 2012
Nearly one-third of residents in Estonia find that consumption of illegal goods increased in the country in 2012, it appears from a survey carried out in the three Baltic countries at the initiative of the Lithuanian Free Market Institute (LFMI). (Latvia) - Alcohol availability for young people to be reduced
Latvia may be a good example for the Baltic Sea Area to establish rules that will reduce alcohol availability and consumption rates among young people. The Latvian Parliamentary Judicial Commission has decided to submit to the Saeima (Parliament) amendments to the Latvian administrative rules to that purpose.
Sydney Morning Herald (Australia) - Call for zero blood alcohol for under 25s
All drivers aged under 25 should be restricted to a zero blood alcohol limit, a public health group says.
New York Times (Mexico) - New Mexico Confronts Drunken Driving
For years, New Mexico has had one of the highest rates of alcohol-related traffic deaths in the nation. And during each legislative session, it seems, lawmakers wrestle with how to make the state’s highways and rural roads safer, usually spurred by the latest horrific accident.
TopNews United States (Canada) - Alcohol Consumption among Women on Rise, Says Study
According to experts, alcohol consumption among women has sought a rise compared to their male peers. A group of researchers discussed the rising problem of alcohol consumption among women in Toronto on Friday.
IBTimes Canada (Canada) - Canadians Drink 50 Percent More Than Global Average: Study
Canadians drink 50 percent more than the global average, a recent study by the Centre for Addiction and Mental Health (CAMH) has stated.
Irish Times (Ireland) - Irish alcohol consumption drops
Alcohol consumption in Ireland is down 19 per cent since 2001, new figures show. Analysis of figures from the Revenue Commissioners and the CSO show that Irish people are drinking 2.7 litres of alcohol less than they did 11 years ago.
Otago Daily Times (New Zealand) - Alcohol policy subject to residents' influence
Dunedin residents will have their chance later this year to influence when and where licensed premises can operate in the city in the future.
Times of India (India) - Nagpurians to fight the war against alcohol
Showing their commitment for the benefit of the society at large were young Nagpurians of a city-based NGO, who had gathered to fight the war against alcohol.
New Vision (Uganda) - 45% of Ugandan youth take drugs and alcohol
Forty-five percent of the youths have confessed that they have taken drugs and alcohol, according to the data collected by Uganda Youth Development Link (UYDEL).
The Age (Australia) - Call to ban alcohol ads in TV sports
A Greens senator pushing for gambling advertising to be banned in the AFL, also wants the promotion of alcohol tbe outlawed in sports broadcasts.
BBC News (Isle of Man) - Changes to Isle of Man alcohol measurements scrapped
Plans to change the way alcohol is sold on the Isle of Man have been scrapped. Current regulations mean draught beer must be sold in pints (equivalent to 568ml), halves (284ml) or the little-known one-third measurement.
RedOrbit - A Look At Worldwide Alcohol Consumption
When examining the history of alcohol, we find it runs parallel to much of recorded human history. Throughout time, the use of alcohol has played an important role in religion and worship. Additionally, its use has provided nutrients and provided medicinal, antiseptic and analgesic properties. - Alcohol now third-leading cause of illness worldwide
Canada’s Centre for Addiction and Mental Health (CAMH) reports alcohol is now the third out of 67 leading causes of disease and injury worldwide. These findings were reached despite the fact most adults, 46 percent, actually were lifetime abstainers. The report appeared in a March 4 “early view” of an article for the journal Addiction. (Canada) - Halifax approves alcohol sponsorship with conditions
A debate on whether alcohol corporations should be able to sponsor city events has motivated Halifax Regional Council to consider implementing a municipal alcohol policy.
Herald Sun (Australia) - More women are getting drunk on Sydney streets than ever before
More than 80 per cent of all sexual offences, including rape and indecent assault, involve either the victim or the offender being affected by alcohol, an analysis of police data for Sydney shows.
Hurriyet Daily News (UN) - Let’s make alcohol-free budget talks, US tells UN diplomats
The United States has called for drunk diplomats to be barred from budget negotiations at the United Nations and warned of taking all appropriate steps to maintain more discipline in the wake of past, unpleasant incidents.
Irish Examiner (Ireland) - NEWS FEATURE: Teens and alcohol and how we compare
The Irish relationship with drink has come in for a lot of criticism, not least in Des Bishop’s recent TV series. But how do young people treat alcohol in other countries? We sent reporters out with teenagers in six different cities to talk about alcohol, clothes and the opposite sex.
The (France) - Alcohol report lays bare France's drink problem
The reputation of the French for drinking in moderation appears slightly misleading after a worrying report released on Monday revealed alcohol is responsible for around 49,000 deaths in France each year - around 134 each day.
The Local (France) - France introduces car breathalyser law – again
The confusion appears to be over. The French government confirmed on Friday that it will be compulsory for motorists to carry breathalyser kits in their cars. The move comes after the Interior Ministry has suspended legislation earlier this year.

Letters - Alcohol And Drug Use: The Authors Reply

We agree with Dennis McCarty and colleagues that moving addiction treatment into the mainstream is a critical priority, and that includes better integration with physical and mental health care in outpatient settings (Jan 2013). This task is complex and important. We would like to add that hurdles to achieving this integration may be greater for racial or ethnic minorities, given that minority populations are less likely to have established relationships with primary care providers and are more likely to be uninsured than other populations. We feel strongly that overcoming these issues should be a priority with the implementation of the Affordable Care Act.

Residential treatment is clearly not a substitute for creating a more integrated system of outpatient addiction treatment, including greater emphasis on evidence-based treatments and culturally competent care. Nor did we imply that residential treatment would fix other structural problems in addiction treatment.  > > > >  Read More

Letters - Treating Alcohol And Drug Use Disorders

Brendan Saloner and Benjamin Lê Cook (Jan 2013) provide an important analysis showing poor completion rates in contemporary treatment services for alcohol and drug use disorders. To address racial and ethnic discrepancies in treatment completion, they note the Affordable Care Act’s expansion of Medicaid and recommend that Medicaid cover residential treatment so residential care can increase.

That expansion, unfortunately, would reinforce the stigma associated with treatment for alcohol and drug use disorders, further the segregation of addiction treatment from medical care, and fail to take advantage of emerging evidence-based treatments for these disorders. States should use the Affordable Care Act to build systems of care for the twenty-first century rather than relying on antiquated care models.

States need to improve systems of care for everyone. Addiction is a chronic disorder that requires ongoing ambulatory care management.1 When fully implemented, the Affordable Care Act can promote integrated treatment for alcohol and drug use disorders within primary care medical homes. The act will increase access to therapists with graduate training and physicians trained in the use of pharmacotherapy.  > > > >  Read More

Novel Oxytocin Gene Expression in the Hindbrain Is Induced by Alcohol Exposure: Transgenic Zebrafish Enable Visualization of Sensitive Neurons

Fetal Alcohol Spectrum Disorders (FASD) are a collection of disorders resulting from fetal ethanol exposure, which causes a wide range of physical, neurological and behavioral deficits including heightened susceptibility for alcoholism and addictive disorders. While a number of mechanisms have been proposed for how ethanol exposure disrupts brain development, with selective groups of neurons undergoing reduced proliferation, dysfunction and death, the induction of a new neurotransmitter phenotype by ethanol exposure has not yet been reported.

The effects of embryonic and larval ethanol exposure on brain development were visually monitored using transgenic zebrafish expressing cell-specific green fluorescent protein (GFP) marker genes. Specific subsets of GFP-expressing neurons were highly sensitive to ethanol exposure, but only during defined developmental windows. In the med12 mutant, which affects the Mediator co-activator complex component Med12, exposure to lower concentrations of ethanol was sufficient to reduce GFP expression in transgenic embryos. In transgenic embryos and larva containing GFP driven by an oxytocin-like (oxtl) promoter, ethanol exposure dramatically up-regulated GFP expression in a small group of hindbrain neurons, while having no effect on expression in the neuroendocrine preoptic area.

Alcohol exposure during limited embryonic periods impedes the development of specific, identifiable groups of neurons, and the med12 mutation sensitizes these neurons to the deleterious effects of ethanol. In contrast, ethanol exposure induces oxtl expression in the hindbrain, a finding with profound implications for understanding alcoholism and other addictive disorders.

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Reduced Acute Recovery from Alcohol Impairment in Adults with ADHD

Prior research has found that adults with attention-deficit/hyperactivity disorder (ADHD) show  
increased sensitivity to the impairing effects of alcohol (Weafer et al., Exp Clin Psychopharmacol 17: 113–121, 2009). However, these studies have focused exclusively on the ascending limb of the blood alcohol concentration (BAC) curve, and it is unclear whether these adults continue to show increased sensitivity during the later phase of the dose as BAC is declining.
This study tested the hypothesis that those with ADHD would display increased response to alcohol during the ascending limb of the BAC curve and less recovery from the impairing effects during the descending limb.
Adult social drinkers with ADHD and control adults completed measures of motor coordination, reaction time (RT), and subjective intoxication twice following 0.64 g/kg alcohol and placebo. The measures were administered during the ascending limb of the BAC curve and again during the descending limb.
During the ascending limb, alcohol reduced motor coordination, slowed RT, and increased self-reports of subjective intoxication. Those with ADHD displayed greater impairment of motor coordination compared with controls. During the descending limb, controls reported diminished subjective intoxication and showed recovery from the impairing effects of alcohol on both their motor coordination and their RT. Those with ADHD showed reduced subjective intoxication and faster RT during this time, but they did not recover motor control.
The protracted time course of motor impairment in adults with ADHD despite reductions in subjective intoxication may contribute to poor decision making and diminished behavioral control in this group.

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Is alcoholism learned? Insights from the fruit fly


Alcohol addictionis a complex, unique human disease. Breaking addiction down into contributing endophenotypes enables its study in a variety of model systems. The Drosophila model system has been most often used to study alcohol sensitivity, tolerance, and physiological dependence. 

However, none of these endophenotypes can account for the near-permanent quality of the addicted state. It has been recently discussed that addictive drugs may hijack the learning-and-memory machinery to produce persistent behavioral changes.

Learning and memory is amenable to experimental study, and provides us with a window into how alcohol affects higher-order mental functions that are likely to contribute compulsive drug use. 

Here, we review the Drosophila literature that links alcohol-related behaviors to learning and memory.

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Vol 2, No 1 (2013) Special Issue: Global burden of alcohol consumption and policy implications: A focus on infectious diseases






Table of Contents


The comparative risk assessment for alcohol as part of the Global Burden of Disease 2010 Study: What changed from the last study?PDF
Jürgen Rehm, Ph.D., Guilherme Borges, Gerhard Gmel, Kate Graham, Bridget Grant, Charles Parry, Vladimir Poznyak, Robin Room


Alcohol as a public health risk: New evidence demands a stronger global responsePDF
Robin Room


Global burden of tuberculosis and lower respiratory infections attributable to alcohol consumption in 2004PDF
Kevin David Shield, Andriy V Samokhvalov, Jürgen Rehm
Global burden of HIV/AIDS in 2004 resulting from alcohol attributable non-adherence to medication regimesPDF
Kevin David Shield, Paul A Shuper, Gerrit Gmel, Jürgen Rehm
Elasticity of alcohol consumption, alcohol-related harms, and drinking initiation in low- and middle-income countries: A systematic review and meta-analysisPDF
Bundit Sornpaisarn, Kevin Shield, Joanna Cohen, Robert Schwartz, Jürgen Rehm

Other Papers

A comparison of alcohol measures as predictors of psychological distress in the New Zealand populationPDF
James Addison Foulds, J Elisabeth Wells, Cameron James Lacey, Simon J Adamson, J Douglas Sellman, Roger Tony Mulder
Patron offending and intoxication in night-time entertainment districts (POINTED): A study protocolPDF
Peter Miller, Amy Pennay, Rebecca Jenkinson, Nicolas Droste, Tanya Chikritzhs, Stephen Tomsen, Phillip Wadds, Sandra Jones, Darren Palmer, Lance Barrie, Dan Lubman
What happened to alcohol consumption and problems in the Nordic countries when alcohol taxes were decreased and borders opened?PDF
Robin Room, Kim Bloomfield, Gerhard Gmel, Ulrike Grittner, Nina-Katri Gustafsson, Pia Mäkelä, Esa Österberg, Mats Ramstedt, Jürgen Rehm, Matthias Wicki
Alcohol consumption among Chilean adolescents: Examining individual, peer, parenting and environmental factorsPDF
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An update on alcohol use and risk of HIV infection in sub-Saharan Africa: Meta-analysis and future research directionsPDF
Sarah E Woolf-King, Craig M Steinmaus, Arthur L Reingold, Judith A Hahn