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, August 31, 2013

Alcohol intake, wine consumption and the development of depression: the PREDIMED study

Alcoholic beverages are widely consumed. Depression, the most prevalent mental disorder worldwide, has been related to alcohol intake. We aimed to prospectively assess the association between alcohol intake and incident depression using repeated measurements of alcohol intake.     
We followed-up 5,505 high-risk men and women (55 to 80 y) of the PREDIMED Trial for up to seven years. Participants were initially free of depression or a history of depression, and did not have any history of alcohol-related problems. A 137-item validated food frequency questionnaire administered by a dietician was repeated annually to assess alcohol intake. Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression, and/or initiated the use of antidepressant drugs. Cox regression analyses were fitted over 23,655 person-years.     
Moderate alcohol intake within the range of 5 to 15 g/day was significantly associated with lower risk of incident depression (hazard ratio (HR) and 95% confidence interval (95% CI) = 0.72 (0.53 to 0.98) versus abstainers). Specifically, wine consumption in the range of two to seven drinks/week was significantly associated with lower rates of depression (HR (95% CI) = 0.68 (0.47 to 0.98)).     
Moderate consumption of wine may reduce the incidence of depression, while heavy drinkers seem to be at higher risk.

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What is the purpose of BC’s liquor laws in 2013?

Almost 100 years ago Canadian provinces other than Québec voted for the total prohibition of alcohol. In BC this occurred in 1917 following a referendum but was soon repealed in 1921, overwhelmed by a tide of organized crime, official corruption and political scandal. Prohibition was imposed on the aboriginal people of Canada for over a century ending only in 1962.

Key elements of our present system of liquor control in BC emerged out of those prohibition years. In 1921, social concerns were addressed through a government owned sales and distribution system. There were few liquor outlets, operating for limited hours and drinkers had to purchase a license.

This month the BC government announced a review of its liquor policies, the first comprehensive review since 1999. The conditions that led to prohibition are largely no longer with us: a world war, disenfranchised women and sky high alcohol consumption, mostly by men. But the “social concerns” about alcohol have not disappeared. What can we learn from that the prohibition era? What have we learned about alcohol problems and how best to address them at this time in our history?  > > >   Read More

Friday, August 30, 2013

An Examination of the Social Determinants of Health as Factors Related to Health, Healing and Prevention of Fetal Alcohol Spectrum Disorder in a Northern Context – The Brightening Our Home Fires Project, Northwest Territories, Canada

The Brightening Our Home Fires (BOHF) project was conceptualized as an exploratory project to examine the issue of the prevention of foetal alcohol spectrum disorder (FASD) from a women’s health perspective in the Northwest Territories (NT). While dominant discourse suggests that FASD is preventable by abstention from alcohol during pregnancy, a broader perspective would indicate that alcohol and pregnancy is a far more complex issue, that is, bound in location, economics, social and cultural views of health. This project was prevention focused and a social determinant of health (SDH) perspective informed this research.

The BOHF project was a qualitative research project using a participatory action research framework to examine women’s health and healing in the north. The methodology utilized was Photovoice. Women were provided training in digital photography and given cameras to use and keep. The primary research question utilized was: What does health and healing look like for you in your community? Women described their photos, individually or in groups around this central topic. This research was FASD informed, and women participants were aware this was an FASD prevention funded project whose approach focused on a broader context of health and lived experience.

This project drew 30 participants from: Yellowknife, Lutsel ‘ke, Behchoko¨ and Ulukhaktok. These four different communities across the NT represented Dene and Inuit culture. The qualitative data analysis offered themes of importance to women’s health in the north including: land and tradition; housing; poverty; food; family; health, mental health and trauma, and travel. Photovoice provides a non-threatening way to engage in dialogue on complex health and social issues.

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Love and faith

The field of addiction treatment was flawed in 1973, but not nearly as flawed as some would have you believe.
The following is from Marty Mann in 1973 and I could not do a better job of summarizing Dawn Farm’s approach
Para-professionals working in the field of alcoholism are overwhelmingly recovered alcoholics. Most of them credit their recovery to AA, some to the facility where they are currently working, an increasing number to a combination of both, and a few to still other forms of therapy. One thing they all share is their attitude toward sick alcoholics, whether those alcoholics are in treatment, approaching treatment, or in and out of treatment with their motivation barely showing. Their attitude even encompasses all those sick alcoholics out there, who have not yet appeared anywhere at all seeking help, some of whom are known to the recovered alcoholics, but who cannot yet be reached. What is this attitude that I call the key to successful treatment?   > > > >  Read More

Multiple fruit-flavored alcoholic drinks in a can (MFAC): an overlooked class of potentially harmful alcohol products.


This article examines an overlooked class of alcohol products, described herein as multiple fruit-flavored alcoholic drinks in a can (MFAC). The article describes how characteristics of these products likely contribute to hazardous alcohol consumption among youth.

Government regulation of these products may be needed to protect adolescent and young adult populations.

National substance abuse surveillance systems should consider immediate adoption of MFAC use indicators to determine use and harm associated with these products, and to assess the effectiveness of future regulatory actions.

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The effects of acute alcohol administration on the human brain: Insights from neuroimaging

Over the last quarter century, researchers have peered into the living human brain to develop and refine mechanistic accounts of alcohol-induced behavior, as well as neurobiological mechanisms for development and maintenance of addiction. These in vivo neuroimaging studies generally show that acute alcohol administration affects brain structures implicated in motivation and behavior control, and that chronic intoxication is correlated with structural and functional abnormalities in these same structures, where some elements of these decrements normalize with extended sobriety.

In this review, we will summarize recent findings about acute human brain responses to alcohol using neuroimaging techniques, and how they might explain behavioral effects of alcohol intoxication.

We then briefly address how chronic alcohol intoxication (as inferred from cross-sectional differences between various drinking populations and controls) may yield individual brain differences between drinking subjects that may confound interpretation of acute alcohol administration effects.

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Trends in the prevalence of multiple substance use in adolescents in England, 1998–2009

This study examines demographic risk factors and trends from 1998 to 2009 for concurrent multiple substance use in adolescence in England.
We used data from the ‘Smoking, Drinking and Drug Use among Young People in England’ survey, a nationally representative annual survey of 11–15 year olds. Measures of smoking, drinking and illicit drug use frequency and weekly alcohol consumption were combined to create variables representing concurrent substance use.

All forms of substance use were strongly related. The prevalence of multiple substance use decreased significantly across time in line with decreases in individual substance use. The prevalence of individual and multiple substance use across years is higher amongst white young people. Males are more likely to engage in risky drinking behaviour with females more likely to smoke regularly but females were at increased risk for multiple substance use. Deprivation was unrelated to drinking behaviour but was associated with increases in smoking and illicit drug use and all forms of multiple substance use.

These findings affirm the importance of continued prevention efforts targeting individual substance uses while highlighting the policy relevance of multiple substance use and interventions which target it. These interventions should be tailored for at-risk groups including deprived adolescents and young women.

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Oxidation of ethanol in the rat brain and effects associated with chronic ethanol exposure

It has been reported that chronic and acute alcohol exposure
decreases cerebral glucose metabolism and increases acetate oxidation. However, it remains unknown how much ethanol the living brain can oxidize directly and whether such a process would be affected by alcohol exposure. The questions have implications for reward, oxidative damage, and long-term adaptation to drinking.

One group of adult male Sprague–Dawley rats was treated with ethanol vapor and the other given room air. After 3 wk the rats received i.v. [2-
13C]ethanol and [1, 2-13C2]acetate for 2 h, and then the brain was fixed, removed, and divided into neocortex and subcortical tissues for measurement of 13C isotopic labeling of glutamate and glutamine by magnetic resonance spectroscopy.

Ethanol oxidation was seen to occur both in the cortex and the subcortex. In ethanol-naïve rats, cortical oxidation of ethanol occurred at rates of 0.017 ± 0.002 µmol/min/g in astroglia and 0.014 ± 0.003 µmol/min/g in neurons, and chronic alcohol exposure increased the astroglial ethanol oxidation to 0.028 ± 0.002 µmol/min/g (P = 0.001) with an insignificant effect on neuronal ethanol oxidation.

Compared with published rates of overall oxidative metabolism in astroglia and neurons, ethanol provided 12.3 ± 1.4% of cortical astroglial oxidation in ethanol-naïve rats and 20.2 ± 1.5% in ethanol-treated rats. For cortical astroglia and neurons combined, the ethanol oxidation for naïve and treated rats was 3.2 ± 0.3% and 3.8 ± 0.2% of total oxidation, respectively. 
13C labeling from subcortical oxidation of ethanol was similar to that seen in cortex but was not affected by chronic ethanol exposure.

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Thursday, August 29, 2013

The impact of twelve-step program familiarity and its in-session discussion on counselor credibility.

The therapeutic relationship is an important factor in substance abuse treatment. Because Twelve-Step Program (TSP) concepts and principles are often incorporated into substance abuse treatment, we investigated whether counselor familiarity and time spent on TSPs impact counselor credibility.
 A sample of 180 clients receiving residential treatment in the capital region of a northeastern state in 2009 completed a Client Demographic Questionnaire and the Counselor Rating Form - Short Version. Their counselors (N = 31) completed a corresponding Counselor Demographic Questionnaire.
The effect of the estimated percentage of in-session time discussing TSPs (p = .010) and the effect of TSP familiarity for counselors in recovery (p = .017) had significant effects on counselor credibility.
The credibility of counselors is important for a working relationship with clients. These results highlight counselor influence stemming from a TSP presence in treatment, indicating positive ramifications for the therapeutic relationship.

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Validating the ability of a single-item assessing drunkenness to detect hazardous drinking.


o simplify the screening process to identify problem drinking, researchers have developed single-item, quantity-based instruments. Quantity-based items, however, suffer from several limitations.
Determine whether a non-quantity-based single item assessing drunkenness would be able to identify those who exhibited signs of hazardous alcohol use, as determined by Alcohol Use Disorders Identification Test (AUDIT)-C scores.

Between September and November of 2011, the alcohol-related behaviors of 1062 self-identified current drinkers were assessed with self-report measures (i.e. AUDIT-C and one item assessing frequency of drunkenness) in addition to corresponding biologic samples (i.e. breath alcohol concentration (BrAC) samples). We assessed the concurrent validity of the single item to identify hazardous alcohol use established via gender-based AUDIT-C thresholds. Convergent validity of the single-item was assessed by determining its relationship to BrAC levels.
The single item accounted for 0.791 of the area under the received operating characteristics curve for hazardous alcohol use (p < 0.001). When employing a cut-off of 1, the single-item question was 95.9% sensitive in identifying hazardous alcohol use.
The results reported herein highlight the validity (both concurrent and convergent) and potential utility of a non-quantity-based single-item alcohol screen for assessing drunkenness. Additional research is warranted to confirm the utility of this one-item drunkenness measure to capture risk of injury and hazardous drinking.
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Drinking and Swimming: Investigating Young Australian Males' Intentions to Engage in Recreational Swimming While Under the Influence of Alcohol.

Drowning, a largely preventable problem, continues to be a serious issue worldwide, with young men particularly at risk. Alcohol and drugs are often present among young males and, particularly for males aged 18–34 years, alcohol is considered to be a significant risk factor for drowning.

The current study aimed to understand the motivations guiding the intentions of young Australian men to engage in drinking and swimming, a behaviour not yet examined systematically.

A cross-sectional correlational design was adopted to investigate the ability of the theory of planned behaviour (TPB) and additional variables to predict males’ intentions to drink and swim. Males (N = 211) aged 18–34 years (Mage = 23.93, SD = 4.01) completed a survey either on-line or paper-based. The survey assessed the TPB constructs of attitude, subjective norm, and perceived behavioural control (PBC); and additional variables of group norms, anticipated regret, objective (i.e. swimming ability) and perceived (i.e. perceived severity and perceived susceptibility) risk perceptions, and past behaviour.

Support was found for the TPB constructs of attitude and subjective norm, but not PBC, as well as the additional constructs of group norm, anticipated regret, objective risk, and past behaviour in predicting males’ intentions to drink and swim; explaining an overall 76 % of variance.

Knowledge gained from this study will help to inform resultant interventions designed to discourage alcohol use in, on, or around water and, thus, prevent drownings in this at risk group.

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Alcohol Intake Between Menarche and First Pregnancy: A Prospective Study of Breast Cancer Risk

Adult alcohol consumption during the previous year is related to breast cancer risk. Breast tissue is particularly susceptible to carcinogens between menarche and first-term pregnancy. No study has characterized the contribution of alcohol consumption during this interval to risks of proliferative benign breast disease (BBD) and breast cancer.

We used data from 91005 parous women in the Nurses’ Health Study II who had no cancer history, completed questions on early alcohol consumption in 1989, and were followed through June 30, 2009, to analyze breast cancer risk. A subset of 60093 women who had no history of BBD or cancer in 1991 and were followed through June 30, 2001, were included in the analysis of proliferative BBD. Relative risks (RRs) were estimated using Cox proportional hazard regression.

We identified 1609 breast cancer cases and 970 proliferative BBD cases confirmed by central histology review. Alcohol consumption between menarche and first pregnancy, adjusted for drinking after first pregnancy, was associated with risks of breast cancer (RR = 1.11 per 10g/day intake; 95% confidence interval [CI] = 1.00 to 1.23) and proliferative BBD (RR = 1.16 per 10g/day intake; 95% CI = 1.02 to 1.32). Drinking after first pregnancy had a similar risk for breast cancer (RR = 1.09 per 10g/day intake; 95% CI = 0.96 to 1.23) but not for BBD. The association between drinking before first pregnancy and breast neoplasia appeared to be stronger with longer menarche to first pregnancy intervals.
Alcohol consumption before first pregnancy was consistently associated with increased risks of proliferative BBD and breast cancer.

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Alcoholics anonymous and twelve-step recovery: A model based on social and cognitive neuroscience

In the course of achieving abstinence from alcohol, longstanding members of Alcoholics Anonymous (AA) typically experience a change in their addiction-related attitudes and behaviors. These changes are reflective of physiologically grounded mechanisms which can be investigated within the disciplines of social and cognitive neuroscience.
This article is designed to examine recent findings associated with these disciplines that may shed light on the mechanisms underlying this change.
Literature review and hypothesis development.
Pertinent aspects of the neural impact of drugs of abuse are summarized. After this, research regarding specific brain sites, elucidated primarily by imaging techniques, is reviewed relative to the following: Mirroring and mentalizing are described in relation to experimentally modeled studies on empathy and mutuality, which may parallel the experiences of social interaction and influence on AA members. Integration and retrieval of memories acquired in a setting like AA are described, and are related to studies on storytelling, models of self-schema development, and value formation. A model for ascription to a Higher Power is presented.
The phenomena associated with AA reflect greater complexity than the empirical studies on which this article is based, and certainly require further elucidation. Despite this substantial limitation in currently available findings, there is heuristic value in considering the relationship between the brain-based and clinical phenomena described here.

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A retrospective study of gender differences in depressive symptoms and risk of relapse in patients with alcohol dependence

The aim of this study was to investigate potential gender differences in situations associated with heavy alcohol drinking.
Data from 395 alcohol dependent patients participating in the Mayo Clinic Intensive Addiction Program were evaluated. Each participant completed the inventory of drug taking situations (IDTS), Penn alcohol craving scale (PACS), patient health questionnaire (PHQ-9), and/or Beck depression inventory (BDI). Gender differences in IDTS scores representing three domains (negative, positive, and temptation) of situations associated with heavy alcohol use were examined.
Women with alcohol dependence report a higher frequency of heavy drinking in unpleasant emotional (IDTS negative scores mean ± SD women vs. men: 52.3 ± 22.1 vs. 43.8 ± 21.8; p = .0006), and as a result of temptation (IDTS temptation scores mean ± SD women vs. men: 40.4 ± 23.0 vs. 35.3 ± 20.8; p = .035). Upon admission, women also scored significantly higher on depressive symptoms as measured by the BDI (23.4 ± 11.4 vs. 18.2 ± 9.8, p < .001). After controlling for depressive symptom severity as a covariate, the IDTS gender differences were no longer significant.
Our results suggest that unpleasant or temptation based emotional situations are a vulnerability risk factor for heavy drinking particularly in females. This risk appears to be at least partially driven by depressive symptom burden. Future research is needed to further investigate this finding.

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Reduction of excessive alcohol drinking by a novel GABAB receptor positive allosteric modulator ADX71441 in mice

A promising pharmacotherapy for alcohol use disorders has been positive allosteric modulators (PAMs) of the γ-aminobutyric acid receptor B (GABAB R) since GABAB R PAMs reduce ethanol drinking and self-administration in rodents.
The current studies investigated a novel, selective GABAB R PAM, ADX71441, in comparison to naltrexone in a protocol of ethanol binge-like drinking, drinking-in-the-dark (DID), and in a model of long-term, excessive drinking, intermittent access to ethanol (IA).
Male C57BL/6 J mice were given doses of ADX71441 (3, 10, 30 mg/kg, p.o.) before the fourth test day of repeated DID access to 20 % ethanol. Another group of mice had a history of 4 weeks of IA before ADX71441 (3, 10, 17 mg/kg, p.o.) treatment. The opioid antagonist, naltrexone (0.1, 1, 10 mg/kg, i.p.), was administered to different groups of mice in both protocols as a positive control.
In both DID and IA protocols, ADX71441 showed a selective and potent reduction of ethanol drinking, but not water drinking, while naltrexone had a more modest and transient effect on reducing ethanol drinking. The long-lasting effect of ADX71441 agrees with its plasma pharmacokinetics in showing peak concentrations at 2 h followed by a slow decay lasting well beyond 8 h.\
These findings support previous studies demonstrating that GABAB R PAMs decrease voluntary ethanol intake without altering water intake. ADX71441 may be a worthwhile candidate for developing a treatment of alcoholism, yet its site of action in the brain and long-term pharmacological effects require further exploration.

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Wednesday, August 28, 2013

The role of an Aboriginal women's group in meeting the high needs of clients attending outpatient alcohol and other drug treatment


Support groups are typically offered as part of specialist alcohol or other drug treatment. However, their usefulness with Indigenous Australians has not been examined. This paper provides a profile of Aboriginal women attending an inner city outpatient alcohol and other drug treatment service, insight into how effective women and staff perceive the support group to be at meeting their needs and suggestions for improvements.

Structured interviews were conducted with 24 Aboriginal female clients of an outpatient treatment service and with 21 staff from across that service and the local Aboriginal Medical Service. Client interviews also assessed alcohol consumption and mental health risk (Indigenous Risk Impact Screen).
Clients reported social and health indicators illustrating disadvantage and complex needs. Most clients and staff perceived the group to be useful and easily accessible. The participants discussed positive elements including opportunities for shared experience in a non-judgemental environment, practical support and health education. Staff reported how the safe, relaxed environment of the group helped with early identification of issues and user-friendly pathways for treatment access. Suggested improvements included greater involvement from Aboriginal staff and community members and enhanced communication with other staff.
Clients and staff recognised the usefulness of the group, including the opportunities it provided for socialisation and early intervention. Comprehensive research is needed to determine the types and sources of support that best assist Aboriginal women with substance use disorders

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Alcohol and other drug treatment services in Australia 2011-12

Almost 700 agencies provided over 150,000 treatment episodes for alcohol and other drug issues in Australia in 2011-12. Most of the closed episodes provided in 2011-12 were for clients receiving treatment for their own drug use, and these clients tended to be male and in their 20s and 30s. Alcohol was the most common principal drug of concern, accounting for almost half of these closed episodes, and counselling was the most common type of treatment.

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MRC, ESRC and Alcohol Research UK Call for research linking harms caused by alcohol to drinking behaviours

The MRC, ESRC and Alcohol Research UK wish to continue making key contributions to this field, in this case through providing authoritative evidence on the link between the specific harms caused directly by a distinct pattern, level and duration of alcohol drinking at key stages in the life-course. The hypothesis is that establishing such links will provide breakthroughs in this field and provide compelling evidence to inform public health policy and lay the groundwork for the design of interventions. The rationale for this comes in part from a MRC/ESRC workshop held in October 2012. The report of the workshop can be found at the following link.

This highlight notice focuses on research that will work towards the ultimate aim of defining harms caused by alcohol and linking these to each of the various drinking behaviours prevalent in the UK. Harm is defined broadly and comprehensively; it ranges from damage to the organs, to the health and mental wellbeing of the drinker; to social harms – for example, the impact on the psychological development of children in a family where there is a heavy drinker. As this objective is medium–term, this highlight notice seeks to provide research impetus to underpin these goals. We have therefore included a work-package approach to the research proposals so that underpinning research, scoping and methodology can be supported along-side hypothesis-driven and empirical study.  > > > >  Read More

Global Actions: Commitments to Reduce Harmful Drinking. August 28, 2013

Global Actions in Focus
Drink Driving events in Mexico
Throughout the month of August 2013, the Global Actions Drink Drive Initiative in Mexico has hosted several events to promote the campaign, “Toward Zero Deaths for Drinking and Driving in Puebla.” On August 5 through 9, Global Actions launched a pilot program to present drink driving awareness training to approximately 1,000 students at the Colegio Nacional de Educación Profesional Técnica (CONALEP). The Secretary of Education of Puebla announced that this training will be integrated into courses that are given to students each year as part of their commitment to raise awareness among youth concerning the possible consequences of drink driving and harmful drinking.
Experts, including ICAP Country Manager in Mexico Mariana Guerra Rendon, spoke at a drink driving seminar
In addition to targeting youth, Global Actions also coordinated drink driving training for law enforcement agencies in Puebla on August 17. Approximately 100 representatives from the state and municipal police departments attended the event, along with other first responder personnel. The training was conducted by Dr. Othon Sanchez Cruz, former Director of the Mexico City Police’s “Programa Conduce Sin Alcohol Project”; William Georges, retired Assistant Chief of Police from Albany, New York and road safety consultant; and Mariana Guerra Rendon, ICAP Country Manager in Mexico.
William Georges, retired Assistant Chief of Police from Albany, New York and road safety consultant, delivers training to law enforcement personnel in Puebla
The training seminar focused on how to develop and implement a self-sustaining STOP-DWI program, and also discussed the impacts of traffic enforcement on crime reduction, enforcement techniques, data collection strategies, and youth education efforts within the local area. After the training event, law enforcement officials and agencies were encouraged to strengthen inter-departmental relationships to increase coordination of drink driving interventions.
Key Recent Milestones
· Vietnam: In partnership with the National Traffic Safety Committee (NTSC) and the Thanh Hoa Provincial Traffic Safety Council (TSC), the Global Actions Drink Driving Initiative in Vietnam held the first capacity building workshop in Thanh Hoa City, Thanh Hoa Province, Vietnam on August 16 and 17, 2013.
What's Happening Next
· Colombia: Global Actions will host a drink driving training seminar as part of Phase One of the Patrullero Project in Palmira, Colombia on August 30, 2013.

Using Autopsy Brain Tissue to Study Alcohol-Related Brain Damage in the Genomic Age

The New South Wales Tissue Resource Centre at the University of Sydney, Australia, is one of the few human brain banks dedicated to the study of the effects of chronic alcoholism. The bank was affiliated in 1994 as a member of the National Network of Brain Banks and also focuses on schizophrenia and healthy control tissue.

Alcohol abuse is a major problem worldwide, manifesting in such conditions as fetal alcohol syndrome, adolescent binge drinking, alcohol dependency, and alcoholic neurodegeneration. The latter is also referred to as alcohol-related brain damage (ARBD).

The study of postmortem brain tissue is ideally suited to determining the effects of long-term alcohol abuse, but it also makes an important contribution to understanding pathogenesis across the spectrum of alcohol misuse disorders and potentially other neurodegenerative diseases.

Tissue from the bank has contributed to 330 peer-reviewed journal articles including 120 related to alcohol research. Using the results of these articles, this review chronicles advances in alcohol-related brain research since 2003, the so-called genomic age. In particular, it concentrates on transcriptomic approaches to the pathogenesis of ARBD and builds on earlier reviews of structural changes (Harper et al. Prog Neuropsychopharmacol Biol Psychiatry 2003;27:951) and proteomics (Matsumoto et al. Expert Rev Proteomics 2007;4:539).

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