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, May 25, 2013

Integration of self-guidance groups for relatives in a public program of alcoholism treatment

Interventions with relatives of alcohol-dependent patients have shown effictiveness in engaging unmotivated patients into treatment. The Federation of ex-alcoholics, in the Community of Madrid, has a network of self-help centers (Centers to Promote Psychosocial Alternatives against Addictions, CPAA) spread throughout the Madrid’s region where alcohol-dependent patients and their families receive attention.

The aim of this study was to demonstrate that the integration of these facilities could improve the psychological condition of the relatives and the outcome on the patients’ treatment.

188 patients attending the treatment program at "Hospital 12 de Octubre" and their relatives were randomized into two groups: Group A (n=94) (Standard program for patients and relatives delivered at our facility) and Group B (n=94) (where patients were treated with the standard program in our facilities and relatives attended a family group intervention at the CPAA)

After 12 weeks, the CPAA conditions were significantly more effective than our standard program in improving psychological distress of relatives and in engaging patients into treatment. Patients belonging to group B had fewer drinking days during the treatment period.

Our results support that psychological interventions delivered at CPAA centers are useful in improving psychological conditions of alcoholic patients’ relatives than when undertaking the public alcoholism program. This intervention also improves outcome of alcoholic patients.

The integration of these centers within public alcoholism treatment programs could provide a new way to treat alcoholism, based on collaboration of public facilities and patient associations.

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Mental health and substance abuse treatment in America

Curbside Consult Host Harold Pollack talks with Stanford University's Keith Humphreys, Professor of Psychiatry and Behavioral Sciences, about mental health and substance abuse coverage in the United States ... and how individuals can expect coverage of their treatment will change as the Affordable Care Act takes effect.
"In Part 1, Keith and I discuss common fallacies about who receives the lion’s share of mental health and substance abuse treatment in America. They also talk about the link between substance abuse and crime. The two researchers also compare notes on Alcoholics Anonymous and its efficacy.

In Part 2, I talk with Keith about the “pre-story” of mental health reform, including Humphreys’ involvement in a 12-year fight for mental health parity.

In Part 3, we discuss the impact and importance of Obamacare on mental health and substance abuse coverage for Medicare enrollees. They also discuss briefly whether the expansion of mental health services helps decrease the incidence of violent crime.

In Part 4, we look at challenges for states in delivery of mental health services. The two also talk about whether there’s capacity within the system to deal with expanded Medicaid coverage of treatment services."

Policy Statement - Intoxication and Motorized Recreational Vehicle and Watercraft Operation

The American College of Emergency Physicians (ACEP) supports efforts involving public education and legislation to ensure safe and responsible operation of motorized recreational vehicles* and watercraft. Operators and passengers should be educated about the dangers of intoxication with drugs or alcohol while engaged in motor vehicle or watercraft operation. Legislation should be enacted enabling the use of reasonable actions, including impoundment of property to ensure safe operation of motorized vehicles and watercraft.

*Motorized recreational vehicles and watercraft can include mopeds, mini-bikes, all-terrain vehicles (ATV), go-karts, snowmobiles, ultralight aircraft, boats, jet skis, and other such vehicles.
ACEP supports the adoption and enforcement of legislation prohibiting drug- or alcohol-impaired operation of motorized vehicles and watercraft. Such legislation should mandate that a blood alcohol concentration (BAC) of 0.08 g/dL or greater be per se evidence of operating a motorized vehicle or watercraft while impaired and that any measurable level of BAC while operating a motorized vehicle or watercraft shall be illegal in persons younger than the legal drinking age in each state.

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Role of Alcohol in Hospitalized Road Trauma in Viet Nam

To assess the blood alcohol concentration (BAC; dependent variable) of patients with road traffic injuries (RTIs) presenting at 3 provincial and central hospitals in the Socialist Republic of Viet Nam by age, sex, and road user type (independent variables). This survey formed part of the Viet Nam Road Traffic Injury Prevention Project, funded by Bloomberg Philanthropies.

RTIs are a leading cause of death and disability in Viet Nam, with 14,690 deaths and 143,940 injuries reported by the Ministry of Health (MOH) in 2010. Research estimates suggest that motorcycle riders and passengers account for 60 percent of fatalities. Alcohol has long been suspected of being a leading cause of road traffic collisions and injuries. However, until now data on this relationship have been limited.

A descriptive cross-sectional study measuring BAC in all consenting patients with RTIs presenting at 3 provincial or central hospitals between July 2009 and September 2010. All results were anonymous and summary information on key variables was sent to MOH and the World Health Organization (WHO) on a monthly basis.

Of the 36,418 patients with RTIs presenting to these 3 hospitals between July 2009 and September 2010, BAC analysis was completed on 14,990 patients (41.2%), representing all patients with RTIs 15 years of age and above who consented to anonymous testing. BAC results ranged from 0 to 0.589 g/dL blood, with a mean of 0.0441 g/dL being the average concentration among all tested patients. Of all patients tested, 56.8 percent had no detectable alcohol in their system. Motorcycle riders were most commonly represented in the tested sample (70.7%), with 27.8 percent having a BAC above the legal limit (0.05 g/dL). Car or other vehicle drivers represented 2.7 percent of the sample, with 63.4 percent tested having a BAC above 0 g/dL, the legal limit for these road users.
The results of this preliminary study indicate that 29.1 percent of all car drivers and motorcycle riders presenting at hospitals with RTIs exceeded the legal BAC limit for operating a motor vehicle. Though further study is required, this is suggestive that strengthening the enforcement of drink-driving laws is an urgent national road safety priority.
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Police Documentation of Alcohol Involvement in Hospitalized Injured Drivers

Injured drivers with blood alcohol concentration (BAC) above the legal limit are rarely convicted of impaired driving. One explanation is that police may have difficulty recognizing alcohol intoxication in injured drivers. In this study, we compare police documentation of alcohol involvement with BAC measured on arrival at a hospital. Our objectives were to determine how often police document alcohol involvement in injured drivers with BAC ≥ 0.05 percent and identify factors that influence police documentation of alcohol involvement.

We included injured drivers (1999–2003) who were admitted to a British Columbia trauma center or treated in the Vancouver General Hospital emergency department. We used probabilistic linkage to obtain police collision reports. Police were considered to have indicated alcohol involvement if (1) police documented that alcohol contributed to the crash, (2) the driver received an administrative sanction for impaired driving, or (3) the driver was criminally convicted of impaired driving. The proportion of drivers for whom police indicated alcohol involvement was determined relative to age, gender, BAC levels, crash severity, and crash characteristics. Multivariate logistic regression was used to identify factors independently associated with police indication of alcohol involvement.
Two thousand four hundred and ten injured drivers (73.5% male) were matched to a police report. Overall, 857 (35.6%) drivers tested positive for alcohol (BAC ≥ 0) and 736/857 (85.9%) of alcohol-positive drivers had a BAC ≥ 0.05 percent (the legal limit in British Columbia). Of the 736 drivers with a BAC > 0.05 percent at time of admission, police indicated alcohol involvement in 530 (72.0%). The criminal code conviction rate for impaired driving was 4.7 percent for drivers with 0.08 percent ≤ BAC < 0.16 percent and 13.6 percent for drivers with BAC > 0.16 percent. The following factors were associated with higher odds of police indicating alcohol involvement: (1) increasing blood alcohol levels, (2) a prior record of impaired driving, (3) involvement in a single-vehicle crash, (4) involvement in a nighttime crash, and (5) traffic violations or unsafe driving actions recorded by police.
Police recognized and documented alcohol involvement in 72 percent of injured drivers with BAC ≥ 0.05 percent. Police
documentation of alcohol involvement was more common at higher BAC levels, in nighttime or single-vehicle crashes, for drivers who committed traffic violations or drove unsafely, and for drivers with a prior record of impaired driving. The low conviction rate of injured impaired drivers does not appear to be due to police inability to recognize alcohol involvement.
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Norwegian Roadside Survey of Alcohol and Drug Use by Drivers (2008–2009)

To examine alcohol and drug use among random drivers in different regions of Norway by analyzing oral fluid, compare drivers in urban and rural areas, compare with results from the roadside survey in southeastern Norway in 2005–2006, and roughly estimate the prevalence of driving with blood drug concentrations above the new Norwegian legislative limits among random drivers. This roadside survey was part of the European DRUID (Driving Under the Influence of Drugs, Alcohol and Medicines) Project.

Drivers were selected for a voluntary and anonymous study using a stratified multistage cluster sampling procedure in collaboration with the Mobile Police Service. Samples of oral fluid were taken using the Statsure Saliva Sample (Statsure Diagnostic Systems, Framingham, MA), and the drivers’ gender, age, and nationality were recorded. Samples of oral fluid were analyzed for alcohol or drugs, for a total 28 psychoactive substances.
One hundred eighty-four roadside survey sessions were conducted and 10,004 drivers were asked to participate. The refusal rate was 5.8 percent. Psychoactive substances were found in 4.8 percent of the 9410 oral fluid samples analyzed. Alcohol was detected in 0.3 percent, medicinal drugs in 3.2 percent, and illegal drugs in 1.5 percent of the samples. Illegal drugs were significantly more frequently detected in samples from southeastern Norway including the capital Oslo, whereas medicinal drugs were more frequently detected in samples from southeastern Norway excluding Oslo. Illegal drugs were significantly more frequently detected in samples from drivers in urban areas than in rural areas, though there were no significant differences for alcohol and medicinal drugs. Medicinal drugs were most commonly found in samples collected during the daytime on weekdays (3.8%), and illegal drugs were most commonly found in samples collected during late night on weekdays or weekends (2.8%–3.2%). The most commonly found substances were the sleeping agent zopiclone (1.4%), the main active substance in cannabis tetrahydrocannabinol (1.1%), and the sedative drug diazepam (0.7%). The prevalence of driving with drug concentrations above the Norwegian legislative limits for blood was estimated to be about 0.2 percent for alcohol, 0.6 percent for illegal drugs, and about 1.3 percent for medicinal drugs.

The incidence of drink driving was very low, though driving after using psychoactive illegal or medicinal drugs was more frequent.

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Friday, May 24, 2013

Consumption of alcohol and risk of cancer among men: a 30 year cohort study in Lithuania

Studies have indicated hazardous consumption of large quantities of alcohol among adults in Lithuania.
We assessed the associations of alcohol consumption at baseline with cancer incidence among men in a population-based cohort study, using Cox models adjusted for smoking, education and body mass index. Attained age was used as a time-scale. During follow-up (1978–2008) 1,698 men developed cancer.

A higher amount of alcohol consumption (≥140.1 g/week vs. 0.1–10.0 g/week) was positively associated with increased risk of total cancer [hazard ratio (HR) = 1.36, 95 % confidence interval (95 % CI) 1.11, 1.65], upper aerodigestive tract cancer (HR = 2.79, 95 % CI 1.23, 6.34) and alcohol-related cancers (i.e. oral cavity, pharynx, larynx, oesophagus, colorectal and liver cancer) (HR = 1.88, 95 % CI 1.25, 2.85).

Compared to occasional drinkers (a few times/year), drinkers 2–7 times/week showed an increased risk of total (HR = 1.45, 95 % CI 1.16, 1.83), alcohol-related (HR = 1.83 95 % CI 1.14, 2.93) and other cancers (HR = 1.35, 95 % CI 1.04, 1.76).

Our results showed no statistically significant associations between quantity of alcohol intake per one occasion and risk of cancer.

About 13 % of total, 35 % of upper aerodigestive tract, 22 % of alcohol-related and 10 % of other cancer cases were due to alcohol consumption in this cohort of men.

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Tax Policy, Adult Binge Drinking, and Youth Alcohol Consumption in the United States

Prior research attributed youth alcohol consumption to the attitudes and drinking patterns among adults. Yet at a population level, few have examined the relationship between state-level adult binge drinking prevalence and youth drinking behaviors, or whether tax policy plays a role in this relationship.
We analyzed 6 biennial surveys (1999 to 2009) of individual-level youth alcohol use and related behaviors from state-based Youth Risk Behavior Surveys and corresponding years of state-level adult binge drinking prevalence from the Behavioral Risk Factor Surveillance System. We employed logistic regression with generalized estimating equations method to assess the extent to which state adult binge drinking predicted individual-level youth drinking outcomes and examined the role of alcohol taxes in that relationship.
Population-aggregate analyses based on 194 state-year strata showed a positive correlation between state adult binge drinking and youth binge drinking (Pearson r = 0.40, p < 0.01). For individual-level youth drinking outcomes, a 5 percentage point increase in binge drinking prevalence among adults was associated with a 12% relative increase in the odds of alcohol use (adjusted OR = 1.12, 95% CI: 1.08, 1.16). Taxes were strongly inversely related with adult and youth drinking measures, and the effect of tax on youth drinking was attenuated after controlling for adult binge drinking
Both tax and adult binge drinking are strong predictors of youth drinking. Tax may affect youth drinking through its effect on adult alcohol consumption. Implementing effective alcohol policies to reduce excessive drinking in the general population is an important strategy to reduce youth drinking.

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

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

Two-bottle free-choice alcohol consumption increased following 7-week exposure to intermittent alcohol intoxication. A bioinformatic approach using microarray analysis, quantitative PCR (qPCR), bioinformatic analysis and microRNA–messenger RNA (mRNA) integrative analysis identified expression patterns indicative of a disruption in synaptic processes and neuroplasticity.

About 41 rat miRNAs and 165 mRNAs in the mPFC were significantly altered after chronic alcohol exposure. A subset of the miRNAs and mRNAs was confirmed by qPCR. Gene ontology categories of differential expression pointed to functional processes commonly associated with neurotransmission, neuroadaptation and synaptic plasticity. microRNA–mRNA expression pairing identified 33 miRNAs putatively targeting 89 mRNAs suggesting transcriptional networks involved in axonal guidance and neurotransmitter signaling.

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

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Critique 112: Relation of alcohol intake to risk of dying from cancer — 23 May 2013

There have been many papers relating alcohol intake to specific types of cancer. It is clear that heavy drinking is associated with an increase in the risk of most upper aero-digestive cancers (e.g., cancer of the mouth, pharynx, larynx), and even moderate drinking has been associated with a slight increase in the risk of breast cancer. On the other hand, the risk of thyroid cancer, lymphoma, renal cancer, and certain other cancers has been shown to be lower among moderate drinkers than among abstainers.
There have been few studies describing the relation between varying levels of alcohol consumption and the total risk of cancer. The present paper presents a meta-analysis relating alcohol intake to all cancer mortality, with data on more than 48,000 cancer deaths reported in 18 prospective cohort studies.
Surprisingly, the analyses demonstrated a J-shaped curve for alcohol and cancer. Light drinkers showed a statistically significant 9% lower risk, moderate drinkers showed no effect, and heavier drinkers showed a 32% increased risk of all cancer mortality.  > > > >  Read More

How Phenotype and Developmental Stage Affect the Genes We Find: GABRA2 and Impulsivity

The detection and replication of genes involved in psychiatric outcome has been notoriously difficult. Phenotypic measurement has been offered as one explanation, although most of this discussion has focused on problems with binary diagnoses.

This article focuses on two additional components of phenotypic measurement that deserve further consideration in evaluating genetic associations: (1) the measure used to reflect the outcome of interest, and (2) the developmental stage of the study population. We focus our discussion of these issues around the construct of impulsivity and externalizing disorders, and the association of these measures with a specific gene, GABRA2.

Data were analyzed from the Collaborative Study on the Genetics of Alcoholism Phase IV assessment of adolescents and young adults (ages 12–26; N = 2,128).

Alcohol dependence, illicit drug dependence, childhood conduct disorder, and adult antisocial personality disorder symptoms were measured by psychiatric interview; Achenbach youth/adult self-report externalizing scale; Zuckerman Sensation-Seeking scale; Barratt Impulsivity scale; NEO extraversion and consciousness.

GABRA2 was associated with subclinical levels of externalizing behavior as measured by the Achenbach in both the adolescent and young adult samples. Contrary to previous associations in adult samples, it was not associated with clinical-level DSM symptom counts of any externalizing disorders in these younger samples. There was also association with sensation-seeking and extraversion, but only in the adolescent sample. There was no association with the Barratt impulsivity scale or conscientiousness.

Our results suggest that the pathway by which GABRA2 initially confers risk for eventual alcohol problems begins with a predisposition to sensation-seeking early in adolescence. The findings support the heterogeneous nature of impulsivity and demonstrate that both the measure used to assess a construct of interest and the age of the participants can have profound implications for the detection of genetic associations.

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Blood thiamine, zinc, selenium, lead and oxidative stress in a population of male and female alcoholics: clinical evidence and gender differences.

Long term alcohol abuse is associated with deficiencies in essential nutrients and minerals that can cause a variety of medical consequences including accumulation of toxic metals. Aim. The aim of this research is to get evidence-based data to evaluate alcohol damage and to optimize treatment. Thiamine and thiamine diphosphate (T/TDP), zinc (Zn), selenium (Se), lead (Pb) and oxidative stress in terms of reactive oxygen metabolites (ROMs) were examined in blood samples from 58 alcohol dependent patients (17 females and 41 males).

T/TDP concentration in alcoholics resulted significantly lower than controls (p < 0.005) for both sexes. Serum Zn and Se did not significantly differ from reference values. Levels of blood Pb in alcoholics resulted significantly higher (p < 0.0001) than Italian reference values and were higher in females than in males. ROMs concentration was significantly higher than healthy population only in female abusers (p = 0.005).

Alcoholics show a significant increase in blood oxidative stress and Pb and decrease in thiamine. Impairment occurs mainly in female abusers confirming a gender specific vulnerability.

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Comparative performance of biomarkers of alcohol consumption in a population sample of working-aged men in Russia: the Izhevsk Family Study


To assess the performance of a range of biomarkers of alcohol consumption in a heavy-drinking population of working-aged Russian men.

Cross-sectional study of men originally sampled at random from a population register.
Izhevsk, a Russian city with a population of 650,000 people
1,023 men aged 27–59 years living in Izhevsk who took part in a health check examination in 2008–2009.
Self-reported alcohol consumption, hazardous drinking behaviours, socio-economic position, anthropometric measurements plus blood levels of alcohol biomarkers (CDT, GGT, ALT, AST and MCV) and hepatitis B and C status.
In the year before interview there was a high prevalence of high-risk alcohol consumption indicated by consumption of non-beverage alcohols (5.0%), problem drinking behaviours (4.4%), and alcohol consumption exceeding an average 40 g per day (12.6%). All biomarkers were strongly associated with total beverage alcohol consumption even after adjustment for confounders. CDT performed best as an alcohol biomarker, with a sensitivity of 67% and specificity of 71% for detecting an average consumption of over 40 g per day vs. less. For all biomarkers sensitivity was considerably lower than specificity. Hazardous drinking patterns per se were not well detected by any of the biomarkers, all with sensitivity below 60%.
In a Russian population with high levels of alcohol consumption, carbohydrate deficient transferrin (CDT) may be the most sensitive and specific biomarker for detecting ethanol consumption above 40g/day. A biomarker reflecting hazardous drinking patterns has yet to be established.

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Drinking motives moderate the impact of predrinking on heavy drinking on a given evening and related adverse consequences - An event-level study

To test whether (a) drinking motives predict the frequency of predrinking (i.e. alcohol consumption before going out); (b) drinking motives predict HDGE (heavy drinking on a given evening: 4+ for women, 5+ for men) and related adverse consequences (hangover, injuries, blackouts etc.) even when predrinking is accounted for, and (c) drinking motives moderate the impact of predrinking on HDGE and consequences.

Using the Internet-based cell phone-optimised assessment technique (ICAT), participants completed a series of cell phone questionnaires every Thursday, Friday and Saturday evening over five weeks.
French-speaking Switzerland.
183 young adults (53.0% female, mean age [SD] = 23.1 [3.1]) who completed 7,828 questionnaires on 1,441 evenings.
Drinking motives assessed at baseline, alcohol consumption assessed at 8 p.m., 9 p.m., 10 p.m., 11 p.m. and midnight and consequences assessed at 11 a.m. the next day.
Gender-separate multilevel models revealed that predrinking predicted HDGE (men: B = 2.17, p < .001; women: B = 2.12, p < .001) and alcohol-related consequences (men: B = 0.24, p < .01; women: B = 0.29, p < .001). Enhancement motives were found to predict HDGE (B = 0.48, p < .05) and related consequences (B = 0.09, p < .05) among men, while among women coping motives had the same effect (HDGE: B = 0.73, p < .001; consequences: B = 0.13, p < .01). With the exception of conformity motives among women (B = 0.54, p < .05), however, no drinking motive dimension predicted the frequency of predrinking, while coping and conformity motives moderated the impact of predrinking on HDGE (Men, conformity: B = -1.57, p < .05) and its consequences (Men, coping: B = -0.46, p < .01; women, coping: B = 0.76, p < .05).
Among young adults in Switzerland, heavy weekend drinking and the related consequences seem to result from the combination of predrinking, level of negative reinforcement drinking for women and positive reinforcement drinking for men.

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Alcohol-Related Biases in Selective Attention and Action Tendency Make Distinct Contributions to Dysregulated Drinking Behaviour

There is increasing evidence that alcohol-related biases in selective attention and action tendency contribute to the eitiology of dysregulated drinking. However, previous research has been equivocal about whether these biases are concurrent manifestations of the same underlying selectivity in a common mechanism, or whether each bias is due to selectivity in a distinct mechanism. Our aim was to distinguish between these positions by assessing whether alcohol-related biases in selective-attention and action tendency uniquely predict the ability to regulate alcohol consumption.
Two groups of undergraduate social drinkers (total N=55) who differed in their ability to regulate their alcohol consumption completed a novel Selective-Attention/Action-Tendency Task (SA/ATT), which separately assessed alcohol-related biases in selective attention and action tendency.
University of Western Australia, Australia.

Selective attention and action tendency were assessed using the SA/ATT, working memory was assessed using the operation-span task, and participant characteristics were assessed using the AUDIT and SOCRATES.
Results indicated that a) there was no significant association between alcohol-related biases in selective attention and action tendency, r = 0.16, p =.274, and b) biases towards alcohol, in both selective attention, β=1.01, odds ratio = 2.74, p = .022, and action tendency, β=1.24, odds ratio = 3.45, p = .015, predicted independent variance in dysregulated-drinker status.
Biases in selective attention and action tendency appear to be distinct mechanisms that independently contribute to difficulty regulating alcohol consumption. Treatment components that could be combined to target both mechanisms may enhance treatment outcomes for alcohol-use disorders.

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Alcohol consumption and self-reported (SF12) physical and mental health among working aged-men in a typical Russian city: A cross sectional study

To investigate the association between patterns of alcohol consumption and self-reported physical and mental health in a population with a high prevalence of hazardous drinking.

Cross-sectional study of an age-stratified random sample of a population register.
The city of Izhevsk, The Russian Federation, 2008-9.

1031 men aged 25 to 60 years (68% response rate).
Self-reported health was evaluated with the SF12 physical (PCS) and mental (MCS) component summaries. Measures of hazardous drinking (based on frequency of adverse effects of alcohol intake including hangover, excessive drunkenness and extended episodes of intoxication lasting two or more days) were used in addition to frequency of alcohol consumption and total volume of beverage ethanol per year. Information on smoking, and socio-demographic factors were obtained.
Compared with abstainers, those drinking 10-19 L of beverage ethanol per year had a PCS score 2.66 (95%CI = 0.76; 4.56) higher. Hazardous beverage drinking was associated with a lower PCS score (mean diff: -2.95 (95%CI = -5.28; -0.62)) and even more strongly with a lower MCS score (mean diff: -4.29 (95%CI = -6.87; -1.70)), with frequent non-beverage alcohol drinking being associated with a particularly low MCS score (-7.23 (95%CI = -11.16; -3.29)). Adjustment for smoking and socio-demographic factors slightly attenuated these associations, but the same patterns persisted. Adjustment for employment status attenuated the associations with PCS considerably.
Among working age male adults in Russia, hazardous patterns of alcohol drinking are associated with poorer self-reported physical health, and even more strongly with poorer self-reported mental health. Physical health appears to be lower in those reporting complete abstinence from alcohol compared with those drinking 10-19 L per year.

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Decision making in the pathway from genes to psychiatric and substance use disorders

In influencing risk for psychiatric and substance use disorders, genes are typically conceptualized as working in silent physiological pathways in the bowels of our biology, far from the influences of human desires. I here argue that this model of gene action is too restricted.

At the individual, family and societal level, humans can, through their decision-making capacity, intervene in causal pathways from genes to behavior. At the individual level, I present four paradigmatic cases involving alcohol dependence, major depression, general externalizing behaviors and animal phobia showing how human decisions can inhibit the expression of risk genes.

I review the literatures demonstrating that parental behaviors can suppress or augment the heritability of traits in their children, and social attitudes can alter and even create causal pathways from genes to phenotypes.

We evolved from organisms whose nervous systems were networks of reflexes that then developed simple cognitive systems and finally self-reflection. Just as our cognitions have gone ‘meta,’ we are now nearing a time when we can go ‘meta’ about our genetic risk. For many psychiatric disorders, our risk genes are not entirely cordoned off in our silent, purposeless biological substrate. Rather, we are able to make decisions that impact on the expression of our own genomes, those of our loved ones and those of our friends and neighbors. Our actions and our genes are often weaved together, integrated into the fabric of our lives.

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Thursday, May 23, 2013

Scotland's multi-buy promotions ban sees decrease in off-trade alcohol sales

NHS Health Scotland have published a report that evaluates the impact of the Alcohol etc (Scotland) Act on off-trade alcohol sales in Scotland.

The report found the introduction of the Act, which included a ban on multi-buy promotions, was associated with an overall 2.6% decrease in off-trade alcohol sales, largely driven by a 4% decline in off-trade wine sales.

The Act was also associated with an 8.5% decline in pre-mixed alcohol beverages, although these account for a very small proportion of the overall off-trade market. > > > >  Read More

Global Actions: Commitments to Reduce Harmful Drinking. May 22, 2013

Global Actions in Focus
Colombia Drink driving initiative
The Colombia Global Actions Drink Driving Initiative hosted a workshop for law enforcement officers and legal teams on May 8, 2013, in Chia, Colombia. Participants included 13 Chia transit police officers, members of the Cundinamarca Highway Police, transit lawyers, and the Chia Secretary of Mobility. The workshop provided attendees with a review of new drink driving procedures and court interpretations in the area. Police officers were shown how to use media to enhance the deterrent effect of sobriety checkpoints, how to conduct operations of short duration, and how to utilize consecutive checkpoints to improve efficiency.
Participants at the Drink Driving Initiative in Chia, Colombia listen to a presentation.
The drink driving enforcement project in Chia began with a collaboration with the Mayor of Chia and a checkpoint equipment grant from DIAGEO Colombia. In 2012, Global Actions conducted capacity building workshops with key city agencies to enhance both community engagement and police enforcement activities. Surveys conducted before and after the events indicate that officers retained information from previous seminars and maintained a 76% knowledge level regarding new drink driving laws in Colombia.
Expanding the methodology in other Colombian cities has been endorsed by Global Actions sponsor companies in Colombia. In April 2013, Global Actions visited officials in Yumbo, a satellite city of Cali, to arrange Phase One of the Patrullero Project. Phase One involves hosting one-day seminars for police and transit officials. The Yumbo seminar will be held on May 30 and 31, 2013. Representatives from Palmira, Tulua, and Candelaria will also attend the Yumbo seminar.
Following the May 2013 seminar, Global Actions held discussions with Chia Secretary of Mobility Clara Maritza Riveros to plan future cooperation on drink driving enforcement and prevention in conjunction with Phase Two of the Patrullero Project in Chia.
Key Recent Milestones
· Vietnam: The first site survey was conducted on May 14 through 18, 2013, as part of the Global Actions Drink Driving Initiative in Thanh Hoa Province and Nghe An Province in Vietnam. Provincial Traffic Safety Councils and the Project Steering Board, headed by National Transportation Safety Council Chief (NTSC) Nguyen Trong Thai, attended the event. The survey included a review of recent road traffic crashes and focused on inter-sector partnerships to implement traffic safety measures.
What's Happening Next
· Thailand: Conducted in two rural areas in Thailand, the Community Drink Driving Pilot Project (CDDPP) engaged local communities to empower them to address the risks associated with harmful drinking and drink driving. On May 28, 2013, the evaluation team will discuss CDDPP and review best practices, improvements that could be made, challenges that were encountered during the project, and recommendations made by research team members. Results of the CDDPP will be available in June 2013.

Internal medicine residents’ training in substance use disorders; a survey of the quality of instruction and resident self-perceived preparedness to diagnose and treat addiction

Resident physicians are the direct care providers for many patients with addiction. This study assesses residents’ self-perceived preparedness to diagnose and treat addiction, measures residents’ perceptions of the quality of addictions instruction, and evaluates basic knowledge of addiction.
A survey was e-mailed to 184 internal medicine residents at Massachusetts General Hospital in May, 2012.
Responses were obtained from 55% of residents. Residents estimated that 26% of inpatients they cared for met criteria for a SUD. 25% of residents felt unprepared to diagnose and 62% felt unprepared to treat addiction. Only 13% felt very prepared to diagnose addiction. No residents felt very prepared to treat addiction. Preparedness to diagnose or treat addiction did not differ significantly across PGY level. 55% rated the overall instruction in addictions as poor or fair. 72% of residents rated the quality of addictions training as poor or fair in the outpatient clinical setting, and 56% in the inpatient setting. No resident answered all six knowledge questions correctly. Slightly more than half correctly identified the mechanism of buprenorphine and 19% correctly answered a question about naltrexone. 9% of residents responded that someone had expressed concern about the respondent's substance use.
Despite providing care for a substantial population with addiction, the majority of internal medicine residents in this study feel unprepared to treat SUD. More than half rate the quality of addictions instruction as fair or poor. Structured and comprehensive addictions curriculum and faculty development are needed to address the deficiencies of the current training system.
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State-Specific Liquor Excise Taxes and Retail Prices in Eight U.S. States, 2012


We investigated the relationship between state excise taxes and liquor prices in eight states, using 2012 data for 45 brands. We made 6,042 price observations among 177 liquor stores with online prices.

Using a hierarchical model, we examined the relationship between excise taxes and product prices.

State excise taxes were significantly related to liquor prices, with an estimated pass-through rate of 0.93. The proportion of price accounted for by excise taxes averaged 7.0%.

We find that excise taxes do increase the price of alcohol, but states are not taking advantage of this opportunity to reduce alcohol-related morbidity and mortality.

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The Prevalence of Positive Drug and Alcohol Screens in Elderly Trauma Patients

Alcohol and drug abuse are recognized to be significantly prevalent in trauma patients, and are frequent harbingers of injury. The incidence of substance abuse in elderly trauma patients has however been limitedly examined. We sought to identify the spectrum of positive alcohol and drug toxicology screens in patients ≥65yrs admitted to a Level I Trauma Center.

Patients ≥65 years old admitted to an ACS Level I Trauma center over a 60 ­month period were identified from the trauma registry. Demographic data, blood alcohol content (BAC) and urine drug screens (UDS) results at admission were obtained and analyzed. The positive results were compared with individuals below 65 years in different substance categories using Fisher's exact test.

In 5 year period studied, of the 4139 patients ≥65 yrs, 1302 (31.5%) underwent toxicological substance screening. A Positive BAC was present in 11.1% of these patients and a positive UDS in 48.3%. The mean BAC level in those tested was 163mg/dL and 69% of patients had a level >80mg/dL.

Our data show that alcohol and drug abuse are an issue in patients ≥65yrs in our institution, though not as pervasive a problem as in younger populations. Admission toxicology screens, however, are important as an aid to identify geriatric individuals who may require intervention.

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Pilot test of twelve-step linkage for alcohol abusing women in leaving jail

More than a million U.S. women are detained in jails each year; many have alcohol use disorders (AUD). AUD intervention with pretrial jail detainees presents a logistical challenge due to limited jail stays and lack of resources for post release treatment. The availability, no-cost entry, and promise of anonymity of Alcoholics Anonymous (AA) make it a highly accessible resource for underserved populations. However, the outreach of AA volunteers into jails (as opposed to prisons) has been limited, and incarcerated women are unlikely to seek out strangers for help after release.

This study pilot tested an enhanced referral approach introducing a twelve-step volunteer to a woman in jail who would attend a meeting with her after release.
Methods: Participants were 14 unsentenced female pretrial jail detainees with AUD. Intervention consisted of introducing participants detained in jail to female AA volunteers who could accompany them to an AA meeting after release. Assessments took place at baseline and one month after release. This uncontrolled pilot study evaluated the feasibility and acceptability of this enhanced referral approach. We also report pre-post alcohol use, drug use, alcohol problems, and AA attendance.

 Enhanced referral was feasible and acceptable. Many (57%) of the 14 participants who met with AA volunteers in jail were in contact with those volunteers after release from jail. Participants had significantly fewer drinking days, heavy drinking days, alcohol problems, and drug-using days during the post-release follow-up than they did before jail detention.

Providing linkage between women in jail and female AA volunteers who can accompany them to post-release a meeting is achievable, and may be a disseminable and low-cost method to improve alcohol outcomes in this vulnerable population.
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Dissociable Effects of Kappa-Opioid Receptor Activation on Impulsive Phenotypes in Wistar Rats

The kappa-opioid receptor (KOR) is the primary target for the endogenous opioid peptide dynorphin (DYN) and KORs reside within brain circuitry underlying the complex integration of information related to different behavioral domains such as motivation, negative affect and decision-making.

Alterations in extended amygdala dynorphins (DYN) and kappa-opioid receptor (KOR) function following chronic alcohol exposure have been shown to mediate escalated alcohol self-administration during acute withdrawal. In addition to excessive alcohol consumption and increased negative affect, other symptoms of alcohol dependence include compromised impulse control.

Given that DYN and KOR expression are dysregulated within prefrontal brain circuitry associated with decision-making and impulse control in alcohol-dependent humans and rodents and have been shown to modify multiple neurotransmitter systems associated with impulse control disorders, we hypothesized that KOR activation could contribute to impulsive phenotypes.

To test this hypothesis, separate cohorts of male Wistar rats were trained in one of two animal models of impulsivity: delay discounting (DD) or stop-signal reaction time (SSRT) tasks and once stable responding was observed, received intracerebroventricular infusions of the KOR agonist U50,488 (0-50μg) according to a within-subject dosing regimen.

The results demonstrated a dissociable effect of U50488 on impulsive phenotypes related to intolerance to delay or response inhibition with selective effects in the SSRT. Furthermore, the pro-impulsive effects of KOR activation were rescued by pretreatment with the KOR antagonist nor-binaltorphimine (norBNI). Therefore, KOR activation was shown to induce an impulsive phenotype that was norBNI-sensitive.

Dysregulation of impulsive behavior by increased DYN/ KOR activity could serve to increase vulnerability for the initiation, or perpetuate existing patterns of excessive alcohol abuse and can enhance the probability of relapse in dependent individuals. Furthermore, KOR-mediated impulsivity has implications for numerous neuropsychiatric disorders.

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