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, April 13, 2013

This is the Southern African Alcohol Policy Alliance

In November 2012, delegates from civil society organisations working in various capacities on alcohol met in Johannesburg to build a platform for collaboration on alcohol-related issues. The delegates represented civil society organizations from seven countries in the region, as well as NGOs from Kenya, Sierra Leone, Sweden and Norway.

The Forum allowed delegates to exchange experiences from policy and prevention work and to discuss a closer regional collaboration. These discussions led to the formation of the Southern African Alcohol Policy Alliance, which is affiliated to the Global Alcohol Policy Alliance (GAPA).    > > > >  Read More

Interoceptive Awareness, Tension Reduction Expectancies and Self-Reported Drinking Behavior

Recent accounts have suggested the involvement of interoceptive processes in consumption behavior for alcohol and other drugs. However, there is a paucity of empirical support for a direct association with physiologically assessed individual differences in interoceptive awareness (IA). The current research explored this postulated link and examined the interplay with positive outcome expectancies of alcohol consumption.

IA of alcohol-dependent adult in- and outpatients was measured with an objective electrocardiogram heart rate tracking task. Tension reduction expectancies (TRE) and drinking compulsions/obsessions were assessed with self-report questionnaires.

No direct associations of IA with drinking compulsions/obsessions were found. However, IA and TRE interacted as predictors of drinking compulsions and drinking obsessions.

The results corroborate the suggestion that neglect of bodily feedback might be a maintaining factor for drinking behavior.          

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Editorial - What neuroimaging has and has not yet added to our



Neuroscientists have collected valuable information on
neurofunctional and neurostructural characteristics accompanying addiction. This editorial argues for three
prerequisites to making neuroimaging practically relevant for addiction medicine: the integration of imaging findings, the identification of concrete neuroimaging risk factors for the individual and the ability to inform the development of treatment regimens.

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Characteristics, circumstances and toxicology of sudden or unnatural deaths involving very high range alcohol concentrations

To characterise sudden or unnatural deaths with very high range blood alcohol concentrations (BACs) presenting to the Department of Forensic Medicine (DOFM) in Sydney between 1/1/1997-31/12/2011.
Case series.
Sydney, Australia.
263 cases of sudden or unnatural death with a BAC of ≥0.300g/100ml.
Case characteristics, circumstances of death, quantitative toxicology, major autopsy findings and serology.
The mean age of decedents was 46.7 yrs and 74.5% were male. Pre-existing alcohol problems were noted in 78.7%. Deaths were due to alcohol toxicity/chronic alcoholism (34.6%), combined alcohol/other drug toxicity (14.8%), accidents (18.7%), natural disease (13.4%), suicide (11.0%), homicide (6.9%) and one case was undetermined. Alcohol was a direct, or contributory, cause of death in 84.4% of cases. The overwhelming majority (81.4%) occurred in a home environment, and deaths did not vary by day or month. The mean BAC was 0.371g/100ml (range 0.300-0.820g/100ml), being highest in alcohol toxicity/chronic alcoholism cases (0.410g/100ml). The most frequently detected substances, other than alcohol, were benzodiazepines (31.9%) and opioids (12.9%). Alcohol-related disease was diagnosed in 62.9% of cases. Alcohol-related pathology was prevalent across all categories of death: severe steatosis (35.3%), cirrhosis (22.5%), chronic pancreatitis (15.3%), cardiomyopathy (9.4%), cerebellar atrophy (9.0%).
Unnatural deaths with very high range alcohol concentrations extend well beyond direct toxicity, and alcohol is causal in most cases. Those at greatest risk are middle aged males, with long histories of alcohol problems.

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Brain-derived neurotrophic factor (BDNF) Val66Met polymorphism and its implication in executive functions in adult offspring of alcohol-dependent probands

Impairment of executive functions (EFs) mediated by the prefrontal lobe is regarded as a cognitive endophenotype of alcohol dependence, being observed both in probands and in healthy offspring. Given its impact on the anatomy of the prefrontal cortex, the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism may well be involved in this specific endophenotype.

Forty-six healthy adult children of alcoholics (HACA) and 82 healthy controls (HC) took part in the study. All the participants were assessed with the Diagnostic Interview for Genetic Studies, and their family histories of alcohol and substance use were assessed with the Family Informant Schedule and Criteria. The Trail Making Test, Arithmetic Switching Task, Stroop Color-Word Test and Wisconsin Card Sorting Test were administered to assess EFs. An overall executive factor score was calculated using factorial analyses. Genotyping of the BDNF Val66Met polymorphism was performed using the TaqMan® allelic discrimination assay.

HACA had significantly lower EFs performance than HC. Genetic analysis showed that BDNF genotype distributions were in Hardy–Weinberg equilibrium in the HACA and HC. Genotype and allele distributions did not differ significantly between the two groups. Participants with the Met allele performed significantly more poorly than participants with the Val allele, and a group by allele interaction was observed, the BDNF Met allele being associated with a poorer executive factor score in the HACA group.

These results suggest that the BDNF Val66Met polymorphism may contribute to alcohol dependence vulnerability via lower EFs performance.

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Extending the Treatment Options in Alcohol Dependence: A Randomized Controlled Study of As-Needed Nalmefene

There is a large treatment gap in alcohol dependence, and current treatments are only moderately effective in preventing relapse. New treatment modalities, allowing for reduction of alcohol consumption as a treatment goal are needed. This study evaluated the efficacy of as-needed use of the opioid system modulator nalmefene in reducing alcohol consumption in patients with alcohol dependence.

Six hundred and four patients (placebo = 298; nalmefene = 306),≥18 years of age, with a diagnosis of alcohol dependence,≥6 heavy drinking days, and average alcohol consumption≥World Health Organization medium drinking risk level in the 4 weeks preceding screening, were randomized (1:1) to 24 weeks of as-needed placebo or nalmefene 18 mg.

Patients taking placebo (n = 289) and patients taking nalmefene (n = 290) were included in the efficacy analyses. At Month 6, there was a significant effect of nalmefene compared with placebo in reducing the number of heavy drinking days (−2.3 days [95% confidence interval:−3.8 to−.8]; p = .0021) and total alcohol consumption (−11.0 g/day [95% confidence interval:−16.8 to−5.1]; p = .0003). Improvements in Clinical Global Impression and liver enzymes were larger in the nalmefene group compared with placebo at Week 24. Adverse events (most mild or moderate) and dropouts due to adverse events were more common with nalmefene than placebo. The number of patients with serious adverse events was similar in the two groups.

Nalmefene provides clinical benefit, constitutes a potential new pharmacological treatment paradigm in terms of the treatment goal and dosing regimen, and provides a method to address the unmet medical need in patients with alcohol dependence that need to reduce their alcohol consumption.

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Friday, April 12, 2013

Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets

Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets — the number of physical locations in which alcoholic beverages are available for purchase either per area or per population — through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms.

We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska.
Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems.

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Effects of naltrexone plus topiramate on ethanol self-administration and tyrosine hydroxylase gene expression changes

The purpose of this study was to evaluate the effects of naltrexone (0.7 mg/kg) and/or topiramate (25 mg/kg) on ethanol consumption and the motivation to drink in an oral-operant conditioning paradigm in C57BL/6 mice. Subsequent real-time polymerase chain reaction (PCR) experiments were performed to analyze gene expression changes in tyrosine hydroxylase (TH) in the ventral tegmental area (VTA).

The administration of naltrexone significantly reduced ethanol consumption and the motivation to drink during the different stages of the experiment, whereas the treatment with topiramate resulted in a much lower effect. Interestingly, the administration of naltrexone plus topiramate reduced ethanol consumption markedly compared with single-drug treatment.

The water self-administration paradigm was also performed using the same drugs and no differences were found between treatment groups. Real-time PCR analyses revealed that naltrexone significantly normalized the increase of TH gene expression in the VTA induced by ethanol, whereas the administration of topiramate did not produce any significant effect. In the ethanol self-administration procedure, the combination of both drugs further reduced TH gene expression, reaching statistical significance compared with the vehicle, naltrexone or topiramate groups.

Taken together, these findings indicate that the administration of naltrexone plus topiramate further reduced ethanol consumption and the motivation to drink in comparison with single-drug treatment. This action may be due, at least in part, to a greater decrease in TH gene expression in the VTA.

These results suggest that the combination of both drugs deserves further exploration for the treatment of problems related to alcohol consumption.

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Thursday, April 11, 2013

An infernal spark: drink, addiction and disease

Our Research Manager, James Nicholls, recently gave a public lecture at the Museum of London on the history of alcohol and addiction in the UK. The full presentation (45 minutes) can now be viewed

Peri-Adolescent Ethanol Vapor Exposure Produces Reductions in Hippocampal Volume that are Correlated with Deficits in Prepulse Inhibition of the Startle

Epidemiological studies suggest that excessive alcohol consumption is prevalent among adolescents and may have lasting neurobehavioral consequences. The use of animal models allows for the separation of the effects of adolescent ethanol (EtOH) exposure from genetic background and other environmental insults. In this study, the effects of moderate EtOH vapor exposure, during adolescence, on structural diffusion tensor imaging (DTI) and behavioral measures were evaluated in adulthood.
A total of 53 Wistar rats were received at postnatal day (PD) 21 and were randomly assigned to EtOH vapor (14 hours on/10 hours off/day) or air exposure for 35 days from PD 23 to 58 (average blood ethanol concentration: 169 mg%). Animals were received in 2 groups that were subsequently sacrificed at 2 time points following withdrawal from EtOH vapor: (i) at 72 days of age, 2 weeks following withdrawal or (ii) at day 128, 10 weeks following withdrawal. In the second group, behavior in the light/dark box and prepulse inhibition (PPI) of the startle was also evaluated. Fifteen animals in each group were scanned, postmortem, for structural DTI.
There were no significant differences in body weight between EtOH and control animals. Volumetric data demonstrated that total brain, hippocampal, corpus callosum but not ventricular volume were significantly larger in the 128-day-sacrificed animals as compared to the 72 day animals. The hippocampus was smaller and the ventricles larger at 128 days as compared to 72 days, in the EtOH-exposed animals, leading to a significant group × time effect. EtOH-exposed animals sacrificed at 128 days also had diminished PPI, and more rears in the light box were significantly correlated with hippocampal size.
These studies demonstrate that DTI volumetric measures of hippocampus are significantly impacted by age and peri-adolescent EtOH exposure and withdrawal in Wistar rats.

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Multidimensionality in Impulsivity and Alcohol Use: A Meta-Analysis Using the UPPS Model of Impulsivity

Although there is considerable support for the relationship between impulsivity and alcohol use, the use of multidimensional conceptualizations of impulsivity and alcohol use has lead to varying relationship sizes across studies. The aims of the current meta-analysis are to (i) examine variability in the magnitude of the bivariate relationship between impulsivity and alcohol use across studies and (ii) describe the pattern of effects between specific impulsivity traits and alcohol use variables, using the UPPS model of impulsivity.

Ninety-six studies were meta-analyzed using a random effects model to examine the relationship between general impulsivity and alcohol use, as well as the relationships among separate impulsivity traits based in the UPPS model of impulsivity and specific alcohol use outcomes.
Results indicate that, in general, impulsivity and alcohol use are related (r = 0.28); however, this effect size varied significantly across studies (from −0.05 to 1.02). Drinking quantity was most strongly predicted by lack of perseverance (r = 0.32), whereas all traits equally predicted drinking frequency. Drinking problems were most highly related to negative (r = 0.35) and positive (r = 0.34) urgency, and alcohol dependence was most highly related to negative urgency (r = 0.38) and lack of planning (r = 0.37).
Effect sizes between impulsivity and alcohol use vary significantly by UPPS trait used in each study; thus, findings suggest and further reinforce the view in the literature that specific impulsivity-related constructs differentially relate to specific alcohol use outcomes.

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Mice Bred for Severity of Acute Alcohol Withdrawal Respond Differently in a Go/No-Go Task

Mice selectively bred for high or low withdrawal to acute alcohol differ on a number of traits, including consumption of alcohol, conditioned place preference for alcohol, and sensitivity to alcohol-induced locomotor activity. One trait that has not been examined in these mice is behavioral inhibition.
High and low alcohol withdrawal mice (second replicate: high and low acute alcohol withdrawal [HAW-2/LAW-2]) were trained and tested in a Go/No-go task. Mice were administered 0.0, 0.5, 1.0, and 1.5 g/kg ethanol (EtOH) on 3 occasions according to an incomplete Latin Square. A separate cohort of C57BL/6J (B6) and DBA/2J (D2) mice (the progenitor strains for HAW-2/LAW-2 mice) underwent the same protocol, using the same EtOH doses.
HAW-2 and LAW-2 mice did not differ in behavioral inhibition at baseline, although LAW-2 mice did have higher overall levels of responding in the task. EtOH did not alter behavioral inhibition in these mice. However, it did decrease responses to the Go cue, and this effect was greater in HAW-2 mice than in LAW-2 mice. D2 mice had lower behavioral inhibition than B6 mice at baseline, and EtOH slightly decreased behavioral inhibition in both strains.
The findings with D2 and B6 mice generally fit with the existing literature. However, the lack of a difference in behavioral inhibition between HAW-2 and LAW-2 mice was unexpected, as well as the absence of any effect of these doses of EtOH on behavioral inhibition in these mice. Nonetheless, the findings do suggest that selectively breeding for high or low withdrawal to acute alcohol can lead to differences in operant behavior in the Go/No-go task.

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Utility of established cardiovascular disease risk score models for the 10-year prediction of disease outcomes in women


Cardiovascular disease (CVD) is a major cause of mortality globally. In absolute numbers, more women die from CVD than men do. CVD mortality risk differs between genders, reflecting the different distribution of modifiable risk factors and severity of CVD outcomes.

This study reviews six established risk score models and their applicability to the female population. These models are assessed against two criteria: discrimination and calibration. Sensitivity, specificity and positive- and negative-predictive values are also examined.

The risk score models are found to be limited in applicability, requiring recalibration beyond their study population.

Relevant risk factors to predict CVD mortality for women, such as measures of obesity, physical activity, alcohol consumption, use of antihypertensive medication, chronic kidney disease and coronary artery calcium are generally not incorporated in these models.

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Liver Transplantation in Alcoholic Patients: Impact of an Alcohol Addiction Unit Within a Liver Transplant Center

Many concerns about liver transplantation in alcoholic patients are related to the risk of alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit (AAU) was formed within the liver transplant center for the management of alcoholic patients affected by end-stage liver disease and included in the waiting list for transplantation. We evaluated retrospectively the impact of the AAU on alcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration of alcohol abstinence before transplant was evaluated as well.
Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation. Clinical evaluation and management of alcohol use in these patients was provided by psychiatrists with expertise in addiction medicine not affiliated to the liver transplant center before 2002; group A), or by the clinical staff of the AAU within the liver transplant center starting from 2002 .
Group B, as compared with group A, showed a significantly lower prevalence of alcohol recidivism  and a significantly lower mortality  Furthermore, an analysis of group B patients with either greater than 6 or less than 6 months of alcohol abstinence before transplantation showed no difference in the rate of alcohol recidivism. 
The presence of an AAU within a liver transplant center reduces the risk of alcohol recidivism after transplantation. A pretransplant abstinence period greater than 6 months might be considered, at least in selected patients managed by an AAU.

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Alcohol Tax Policy in Relation to Hospitalization from Alcohol-Attributed Diseases in Taiwan: A Nationwide Population Analysis of Data from 1996 to 2010

The effects of alcohol taxes and prices on drinking and mortality are well established, but the effects of alcohol taxes on measures of alcohol-related morbidity from noninjury health outcomes have not been fully elucidated. We assess the 2 opposing effects of alcohol tax policy interventions (tax rate increase in 2002 and decrease in 2009) on alcohol-attributed diseases (AADs) in Taiwan.

Admissions data from 1996 to 2010 were retrieved from the National Health Insurance Research Database (NHIRD) claims file and analyzed in this study. Data on 430,388 men and 34,874 women aged 15 or above who had an admission due to an AAD were collected. An interrupted time series analysis examining the effects of the implementation of alcohol tax policy on quarterly age- and sex-specific incidence rates of hospitalization for AADs was employed. The same method was also used to analyze hospitalizations for alcoholic liver disease.

The teen/adult groups all showed significant (p < 0.05) changes in the adjusted incidence rate of hospitalization (AIRH) for AADs and alcoholic liver disease in 2002. Men aged 15 to 64 years showed an abrupt decline in the rate of AADs (9.1%) and in the rate of alcoholic liver disease (10.3%). A 16% reduction in the AAD rate was found in teen/adult women after the alcohol tax increase. In contrast, a 17.4% increase in the same rate was seen in the first quarter of 2010 for this group. A similar pattern was presented for the AIRH for alcoholic liver disease among women. The effect of tax intervention was not significant among the elderly.

This study provides evidence that alcohol taxation in
response to international trade liberalization has resulted in an immediate reduction of AADs in Taiwan. The policy of increasing alcohol tax rates may have favorable influences on the time trend for the rate of AADs, most notably among young and middle-aged men and women.

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Long-term ethanol exposure-induced hepatocellular carcinoma cell migration and invasion through lysyl oxidase activation are attenuated by combined treatment with pterostilbene and curcumin analogs

Ethanol consumption induces hepatocellular carcinoma (HCC) cell metastasis by changing the extracellular matrix (ECM). Lysyl oxidase (LOX) catalyzes the cross-linkage of collagen or elastin in the ECM.

LOX protein and mRNA overexpression (>21-fold compared with controls, n=6) was detected in cirrhotic HCC patients with a history of alcoholism. LOX protein expression was induced in HCC cells after long-term treatment with ethanol (10 mM) for 20 to 40 passages (denoted as E20-E40 cells). Pterostilbene (PSB, 1 υM) displayed significant potency to reduce LOX-mediated activity in E40 cells when combined with curcumin and its analogs. The ability of E40 cells to form colonies in soft agar was reduced by both genetic depletion of LOX and by chemical inhibitors of LOX expression.
This study suggests that targeting LOX expression with food components such as PSB and curcumin may be a novel strategy to overcome ethanol-induced HCC cell metastasis in liver cancer patients.

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Chronic tolerance to ethanol-induced sedation: Implication for age-related differences in locomotor sensitization

The adolescent brain has been suggested to be particularly sensitive to ethanol-induced neuroadaptations, which in turn could increase the risk of youths for alcohol abuse and dependence. Sensitization to the locomotor stimulant effects of ethanol has often been used as an animal model of ethanol-induced neuroadaptations. Previously, we showed that young mice were more sensitive than adults to the locomotor sensitization induced by high ethanol doses. However, this effect could be due to age-related differences in chronic tolerance to the sedative effects of ethanol.

The aim of the present study is to assess chronic tolerance to the sedative effects of ethanol in weaning 21-day-old (P21), adolescent 35-day-old (P35) and adult 63-day-old (P63) female Swiss mice.

After a daily injection of saline or 4 g/kg ethanol during 6 consecutive days, all P21, P35 and P63 mice were injected with 4 g/kg ethanol and submitted to the loss of righting reflex procedure.

Our results confirm that the sensitivity to the acute sedative effects of ethanol gradually increases with age. Although this schedule of ethanol injections induces significant age-related differences in ethanol sensitization, it did not reveal significant differences between P21, P35 and P63 mice in the development of a chronic ethanol tolerance to its sedative effects.
The present results show that age-related differences in the development of ethanol sensitization cannot be explained by differences in chronic ethanol tolerance to its sedative effects. More broadly, they do not support the idea that ethanol-induced sensitization is a by-product of chronic ethanol tolerance.

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Diffusion Tensor Imaging Correlates of Saccadic Reaction Time in Children with Fetal Alcohol Spectrum Disorder

Eye movement tasks provide a simple method for inferring structural or functional brain deficits in neurodevelopmental disorders. Oculomotor control is impaired in children with fetal alcohol spectrum disorder (FASD), yet the neuroanatomical substrates underlying this are not known. Regions of white matter have been shown by diffusion tensor imaging (DTI) to be different in FASD and thus may play a role in the delayed saccadic eye movements. The objective of this study was to correlate oculomotor performance with regional measures of DTI-derived white matter anisotropy in children with FASD.
Fourteen children (8 to 13 years) with FASD were recruited for oculomotor assessment and DTI. Eye movement control was evaluated using the pro- and antisaccade tasks, in which subjects look at (prosaccade) or away from (antisaccade) a peripheral target. Saccadic reaction time (SRT; time for subjects to move their eyes after the target appears) and direction errors (saccades made in the incorrect direction relative to the instruction) were measured and correlated to fractional anisotropy (FA) on a voxel-by-voxel basis across the whole brain white matter.
A significant positive correlation was observed between antisaccade SRT and FA in a large cluster containing anterior and posterior sections of the corpus callosum just to the right of the midline; prosaccade SRT and FA correlated positively in the genu of the corpus callosum and the right inferior longitudinal fasciculus (ILF), and correlated negatively in the left cerebellum.
The negative correlation for prosaccade SRT and cerebellum demonstrated that individuals with slower reaction times had lower FA values relative to their faster responding counterparts, a finding that implicates cerebellar dysfunction as a significant contributor to deficits in oculomotor control. The higher FA in the corpus callosum and ILF corresponding to longer reaction times for both pro- and antisaccade was opposite to what was expected, but nonetheless implies that altered brain structure in these regions underlies deficits in oculomotor control.

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Moderation of a Parent-Based Intervention on Transitions in Drinking: Examining the Role of Normative Perceptions and Attitudes Among High- and Low-Risk First-Year College Students

Parent-based interventions (PBIs) are an effective strategy to reduce problematic drinking among first-year college students. The current study examined the extent to which student-based characteristics, derived from the Theory of Planned Behavior, moderated 3 PBI conditions: (i) prior to college matriculation (PCM); (ii) PCM with a booster during the fall semester; and (iii) after college matriculation. The moderator variables included injunctive and descriptive peer norms about alcohol use and attitudes toward alcohol use.
Using data from a randomized control trial delivered to 1,900 incoming college students, we examined differential treatment effects within 4 types of baseline student drinkers: (i) nondrinkers; (ii) weekend light drinkers (WLD); (iii) weekend heavy episodic drinkers; and (iv) heavy drinkers. The outcome variable was based on the transitions in drinking that occurred between the summer prior to college enrollment and the end of the first fall semester and distinguished between students who transitioned to 1 of the 2 risky drinking classes.
The results indicated that injunctive norms (but not descriptive norms or attitudes) moderated the differential effects of the PBI with strongest effects for students whose parents received the booster. Differential effects also depended on baseline drinking class and were most pronounced among WLDs who were deemed “high-risk” in terms of injunctive peer norms.
Parental influence can remain strong for young adults who are transitioning to college environments, even among students with relatively high peer influence to drink alcohol. Thus, the PBI represents an effective tool to prevent escalation of alcohol use during the first year of college, when risk is highest and patterns of alcohol use are e

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Comments and Reflections on Ethics in Screening for Biomarkers of Prenatal Alcohol Exposure

Early identification of and intervention for fetal alcohol spectrum disorder (FASD) has been shown to optimize outcomes for affected individuals. Detecting biomarkers of prenatal alcohol exposure (PAE) in neonates may assist in the identification of children at risk of FASD enabling targeted early interventions. Despite these potential benefits, complicated ethical issues arise in screening for biomarkers of PAE and these must be addressed prior to the implementation of screening programs.

Here, we identify and comment, based on a North American perspective, on concerns raised in the current ethical, social, and legal literature related to meconium screening for PAE.

Major ethical concerns revolve around the targeting of populations for PAE screening, consent and respect for persons, stigma and participation rates, the cost—benefit analysis of a screening program, consequences of false-positive and false-negative test results, confidentiality and appropriate follow-up to positive screen results, and the use of screen results for criminal prosecution.

We identify gaps in the literature on screening for PAE, most notably related to a lack of stakeholder perspectives (e.g., parents, healthcare providers) about screening and the ethical challenges it presents.

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Wednesday, April 10, 2013

Technical Assistance Impact Fact Sheet Series

The SAMHSA FASD Center for Excellence is proud to announce the release of the second and third Fact Sheets in a new series of Technical Assistance (TA) Impact Fact Sheets. These products are designed to help agencies enhance their capacity to prevent and address FASD.

The Addressing Fetal Alcohol Spectrum Disorders (FASD) In Women’s Residential Substance Abuse Treatment Fact Sheet PDF icon provides vital information for women’s residential substance abuse treatment centers seeking to expand their capacity to address FASD, and describes the value of these services for systems, clients, and their families.

The Integrating Sustainable Fetal Alcohol Spectrum Disorders (FASD) Services in Your Existing Service Setting Fact Sheet PDF icon addresses four key components of adding FASD services to already-established service settings: designing and implementing program components; developing Task Forces; expanding staff knowledge and skills around FASD; and collecting data to measure and report outcomes.

These free, downloadable documents compile key lessons learned from agencies that have successfully expanded and sustained their ability to address FASD.

To access these TA Impact Fact Sheets, visit our "Fact Sheets and Brochures" page or our "Training, TA, and Conference/Event Speaking" page.

Measuring Alcohol Consumption Using Timeline Followback in Non-Treatment-Seeking Medical Clinic Patients With and Without HIV Infection: 7-, 14-, or 30-day Recall


The measurement of alcohol consumption is an essential component of research in patients at risk for or infected with HIV. Daily estimation measures such as the Timeline Followback (TLFB) have been validated, yet the optimal time window and its performance in non-treatment-seeking medical clinic subjects and among those with HIV are not known.

 In 1,519 HIV-infected and 1,612 uninfected men receiving medical care in general medical or infectious disease clinics, we compared the association between 7-, 14-, and 30-day TLFB reports, obtained via telephone, of alcohol consumption using Spearman's correlation coefficients. To evaluate agreement between 7-, 14-, and 30-day reports of heavy episodic drinking, we evaluated percent agreement, sensitivity, and kappa statistics, considering 30-day report as the gold standard.

The estimated prevalence of heavy episodic drinking was progressively higher for longer TLFB intervals (7 days: 6.3%; 14 days: 8.0%; 30 days: 9.5%). Correlation coefficients with 30-day TLFB were higher for 14 days (.94) than for 7 days (.86) overall (p < .001) and among HIV-infected (.94 vs. .86, p < .001) and uninfected (.95 vs. .87, p < 001). Correlations were similar by HIV status. When considered overall and by HIV status, the sensitivity, percent agreement, and kappa statistics are better for heavy episodic drinking based on 14 days compared with 7 days.

A TLFB for alcohol consumption of 14 days is preferable to 7 days for non-treatment-seeking patients in medical clinics with and without HIV infection when compared with 30 days.

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The Reinforcing Efficacy of Alcohol Mediates Associations Between Impulsivity and Negative Drinking Outcomes

One predictor of negative drinking outcomes in college populations is impulsivity. Individual differences in the reinforcing efficacy of alcohol, which reflects willingness to drink despite potential costs, may serve as a mechanism by which impulsivity is associated with alcohol-related problems. The purpose of this study was to determine whether two measures of the reinforcing efficacy of alcohol—demand intensity (consumption when drinks are free) and Omax (maximum expenditure on alcohol)—statistically mediated the associations between four facets of impulsivity and negative drinking outcomes.

We gave 202 undergraduate social drinkers a hypothetical task in which they indicated how many drinks they would consume across a range of prices. They also completed measures of impulsivity, alcohol use, and alcohol-related problems.

Path models revealed that two facets of impulsivity—sensation seeking and urgency—were associated with higher reinforcing efficacy and worse alcohol problems. Moreover, the associations between both of these impulsivity facets and alcohol-related problems were sequentially mediated by reinforcing efficacy and alcohol use.

Individuals who respond impulsively to negative emotions or have sensation-seeking tendencies may exhibit greater willingness to consume and purchase alcohol. As a result, they may in fact drink more, leading to worse drinking-related problems. These findings suggest a need for more research into the mechanisms of interventions that successfully reduce problem drinking. They also indicate that more study is needed on whether decreasing the availability of low-cost alcohol reduces alcohol-related problems in impulsive individuals.

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Patient Characteristics and Patterns of Intoxication: One-Time and Repeated Use of Emergency Ambulance Services

The aim of this study was to investigate the utilization of ambulance services that resulted from alcohol and drug intoxication over a period of 1 year in a metropolitan area, with an emphasis on characteristic differences between patients with one-time versus repeated use.

All ambulance-service report forms filed in 2010 were systematically screened for utilizations in which alcohol intoxication or intoxication resulting from consumption of illicit or legal drugs other than alcohol was the chief complaint (N = 2,341 patients; 65% male).

Repeat users differed from persons with one-time use in their characteristics and patterns of intoxication. On average, patients with repeated ambulance use were almost 8 years older and had a different pattern of ambulance use over the course of the week with no clear peak on any specific day. The mean number of ambulance services in patients with repeated use was 2.8 (SD = 1.517) in the 1-year study period. Repeat users were less likely to be injured than patients with one-time ambulance-service use and more often showed aggression or uncooperative behavior toward paramedics. All cases of death associated with intoxication involved patients with one-time ambulance use. 
The ambulance-service users' generally slight impairment of consciousness and the high proportion of intoxicated patients without any injuries raise the question of how many of these patients could be adequately cared for in a sobering center. Sobering centers might relieve hospital emergency departments of patients not requiring acute emergency care and, in addition, could provide intervention services to prevent relapses.

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Convergence of Drinking Patterns of Young Russian Immigrants and Veteran Israelis Decades After Mass Immigration: Results From a Bidirectional Acculturation Model

Studying drinking patterns in relation to immigration processes is important for reaching a better understanding of changes in drinking habits in host as well as immigrant populations. Research based on assimilation models has previously noted that immigration may affect minority drinking patterns but has failed to acknowledge the possibility that immigration may change the host drinking patterns. The current study applies a bidirectional acculturation model to analyze if, and in what ways, mass emigration from the former Soviet Union (fSU) to Israel may have influenced immigrant drinking habits as well as the drinking patterns of veteran Israelis.

A cross-sectional pooled nationally representative stratified simple random sample of the young Israeli Jewish adult population (ages 21–40 years) from 2004 and 2009 was used (n = 1,357; women = 52.7%). Logistic regression examined differences in drinking patterns and differences over time between fSU immigrants and veteran Israelis.

There has been a convergence in moderate drinking habits between the two populations, and this convergence is attributed to increases in veteran Israeli moderate drinking over time but not to decreases in fSU immigrant drinking habits. Results also show that heavy drinking is increasing among veteran Israelis but that fSU immigrants continue to drink more heavily and to be more likely to prefer distilled spirits than veteran Israelis.

A bidirectional acculturation model may be more appropriate than assimilation models for the study of immigrant drinking patterns because it acknowledges the possibility of changes in immigrant as well as host drinking customs.

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A Randomized Controlled Trial of a Web-Delivered Brief Alcohol Intervention in Veterans Affairs Primary Care


This study sought to examine whether a web-delivered brief alcohol intervention (BAI) is effective for reducing alcohol misuse in U.S. military veterans presenting to primary care.
 Veterans (N = 167) screening positive for alcohol misuse during a routine primary care visit were randomized to receive a BAI plus treatment as usual (TAU) or TAU alone. An assessment of alcohol-related outcomes was conducted at baseline and 3 and 6 months after treatment.

Veterans in both study conditions showed a significant reduction in alcohol quantity and frequency and alcohol-related problems at 6-month follow-up. No differential treatment effects on outcomes were observed between the two treatment groups.

This study is the first to explore whether a web-delivered BAI using normative feedback is effective for veterans with alcohol misuse. Our findings suggest that BAIs using normative feedback may not have any additional benefit beyond TAU for older veterans with high rates of comorbid mental health concerns.

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Underage Alcohol Sales—It Only Takes a Minute: A New Approach to Underage Alcohol Availability

Because minors generally report higher accessibility than one would expect on the basis of the "compliance rates" established by researchers (the percentage of stores that comply with age limits for sales of age-restricted products such as alcoholic beverages), we propose a new method to better depict the availability of age-restricted products for minors as an alternative to the compliance approach, which in our view is too narrow.

Underage mystery shoppers were assigned to buy alcohol in a store of their preference, using any (legally allowed) purchase method. The time required to buy alcohol was the main outcome variable. As a benchmark, the time required to buy soft drinks was recorded.

All underage mystery shoppers succeeded in buying alcohol, which means 100% availability. On average, buying alcohol took less than 10 minutes (including travel and shopping time), which was 2 minutes more than when purchasing soft drinks.

Compliance at an outlet level can misrepresent the actual availability to minors. Both the proposed approach to availability and a new approach to age validation indicate that the general assumption that the traditional methods of age validation can effectively prevent the commercial availability of age-restricted products to minors should be seriously questioned.

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The Role of Protective Behavioral Strategies and Anxiety in Problematic Drinking Among College Students

The use of protective behavioral strategies (PBS) has been shown to reduce heavy alcohol consumption and alcohol-related problems among college students. Limited research has examined how mental health is related to PBS use in the prediction of alcohol outcomes. Consequently, the aims of the present study were to (a) examine the relationship between anxiety symptoms and the use of PBS, (b) examine PBS as a mediator of the association between anxiety and alcohol-related problems, and (c) test anxiety as a moderator of the relationship between the use of PBS and alcohol-related problems.

Participants were college students (N = 199, 67% women) who completed self-report measures of typical anxiety symptoms, use of PBS, and alcohol-related problems.

Results indicated that anxiety was significantly negatively related to PBS use. Additionally, the association between anxiety and alcohol-related consequences was mediated by the use of PBS. The association between PBS use and alcohol-related problems was also contingent on one's level of anxiety. That is, although the relationship between the use of PBS and problems was negative regardless of anxiety level, those with higher anxiety exhibited a stronger, negative relationship between PBS and problems.

These findings suggest that PBS is both a mediator in the anxiety and alcohol-related problems association as well as an important factor in reducing negative consequences for college students higher in anxiety. Results indicate that college students with anxiety would be ideal candidates for harm-reduction interventions that emphasize the use of PBS in drinking contexts.

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Characterizing Alcohol Use Disorders and Suicidal Ideation in Young Women

Alcohol use disorders (AUDs) and suicidal ideation (SI) co-occur, yet few studies have investigated the risk and protective factors that influence their comorbidity.

 Data from 3,787 twin women ages 18–27 years were analyzed. AUD was defined as a lifetime history of alcohol abuse or dependence as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. SI was coded as a lifetime report of any SI, and all subjects were queried about SI. Subjects were divided into those with neither AUD nor SI (AUD-SI-), those with AUD but no SI (AUD+SI-), those with SI but no AUD (AUD-SI+), and those with comorbid AUD and SI (AUD+SI+). Association with multiple measures of psychopathology, negative life events, personality, and family history was assessed using multinomial logistic regression.

 Women with AUD were at 3.1 (95% confidence interval [2.5, 3.8]) odds of also reporting a lifetime history of SI. Psychopathology and negative life events were consistently high in the AUD+SI+ group. AUD+SI+ women also were more likely to report drinking to cope. Substance use was more common in the AUD+SI- versus the AUD-SI+ women, whereas major depressive disorder, social phobia, and panic attacks were more commonly reported by the AUD-SI+ versus the AUD+SI- women.

The comorbidity between AUD and SI is characterized in young women by co-occurring psychopathology, drinking to cope, and negative life events.

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