NIH statement on International Fetal Alcohol Spectrum Disorders Awareness Day

International Fetal Alcohol Spectrum Disorders Awareness Day, recognized every year on the ninth day of the ninth month, is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States. Almost 40 years have passed since we recognized that drinking during pregnancy can result in a wide range of disabilities for children, of which fetal alcohol syndrome is the most severe. Yet up to 30 percent of women report drinking alcohol during pregnancy.

The disabilities associated with fetal alcohol spectrum disorders can persist throughout life and place heavy emotional and financial burdens on people with the condition, their families, and society. Fetal alcohol spectrum disorders often bring to mind the distinct pattern of facial features associated with fetal alcohol syndrome, such as wide-set and narrow eyes, a smooth ridge on the upper lip, and a thin upper lip border. We now understand, however, that the neurobehavioral effects associated with fetal alcohol spectrum disorders, such as intellectual disabilities, speech and language delays, and poor social skills, can exist without the classic defining facial characteristics.

For many years, the National Institute on Alcohol Abuse and Alcoholism has supported research to understand how alcohol exposure during pregnancy interferes with fetal development and how fetal alcohol spectrum disorders can be identified and prevented. Scientists continue to make tremendous strides, providing important new insights into the nature of fetal alcohol spectrum disorders and potential intervention and treatment strategies.

The message is simple, not just on September 9, but every day. There is no known safe level of drinking while pregnant. Women who are, who may be, or who are trying to become pregnant, should not drink alcohol.

Watch a video on the importance of International FASD Awareness Day from NIAAA Acting Director Kenneth R. Warren, Ph.D., a leading expert on fetal alcohol spectrum disorders

 
Learn more about alcohol and pregnancy here and here.

Neural Correlates of Impulsivity in Healthy Males and Females with Family Histories of Alcoholism

Individuals family-history positive (FHP) for alcoholism have increased risk for the disorder, which may be mediated by intermediate behavioral traits such as impulsivity. Given the sex differences in the risk for and clinical presentation of addictive disorders, risk for addiction may be differentially mediated by impulsivity within FHP males and females.

FHP (N=28) and family-history negative (FHN, N=31) healthy, non-substance-abusing adults completed an fMRI Go/No-Go task and were assessed on impulsivity and alcohol use. Effects of family history and sex were investigated as were associations between neural correlates of impulse control and out-of-scanner measures of impulsivity and alcohol use.

FHP individuals showed greater activation in the left anterior insula and inferior frontal gyrus during successful inhibitions, an effect that was driven primarily by FHP males. Higher self-reported impulsivity and behavioral discounting impulsivity, but not alcohol use measures, were associated with greater BOLD signal in the region that differentiated the FHP and FHN groups. Impulsivity factors were associated with alcohol use measures across the FHP and FHN groups.

These findings are consistent with increased risk for addiction among FHP individuals being conferred through disrupted function within neural systems important for impulse control.


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A Phase 2, Placebo-Controlled Study of the Opioid Receptor Antagonist LY2196044 for the Treatment of Alcohol Dependence

 


Endogenous opioid-mediated reward pathways may play a role in the development and maintenance of alcohol dependence. This study tested whether LY2196044, an opioid receptor antagonist, in combination with medical management would reduce drinking in alcohol-dependent patients.
 

This was a multicenter, outpatient, randomized, double-blind, parallel, and placebo-controlled trial with a 16-week treatment period. Patients (N = 375) were alcohol-dependent, treatment-seeking adults. Patients were randomly assigned to once-daily LY2196044 (final doses of 125 or 250 mg/d) or placebo. DNA samples were collected at baseline. At each visit, patients underwent safety assessments, laboratory testing, efficacy measures, and medical management. Blood samples were also obtained for pharmacokinetic testing. The primary measure was the change from baseline in the percent heavy drinking days (HDD). Secondary efficacy measures were percent days abstinent per month and number of drinks per day.
 

The treatment difference in change from baseline in % HDD between LY2196044 and placebo was not statistically significant (−43.02 vs. −38.72%, respectively; p = 0.12). There was a trend toward greater change from baseline in the percent days abstinent per month for the LY2196044 group compared with the placebo group (33.49 vs. 28.12%, respectively; p = 0.051). The decrease from baseline for mean number of drinks per day was statistically significantly greater in the LY2196044 group compared with the placebo group (−5.37 vs. −4.66 drinks per day, respectively; p = 0.013). LY2196044-treated patients who were dopamine receptor type 4–variable number tandem repeat L carriers had greater reductions in % HDD (p = 0.0565), increased percent days abstinent (p = 0.0496), and reduced drinks per day (p = 0.0069) than placebo-treated L carriers. The safety profile for LY2196044 appeared similar to that of other opioid antagonists.
 

The results from this proof-of-concept clinical trial warrant further evaluation of LY2196044 for the treatment of alcohol dependence.



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The Association Between Problematic Parental Substance Use and Adolescent Substance Use in an Ethnically Diverse Sample of 9th and 10th Graders

Adolescents of parents who use substances are at an increased risk for substance use themselves. Both parental monitoring and closeness have been shown to mediate the relationship between parents’ and their adolescents’ substance use. However, we know little about whether these relationships vary across different substances used by adolescents.

Using structural equation modeling, we examined these associations within a racially and ethnically diverse sample of 9th and 10th graders (N = 927).

Path analyses indicated that maternal closeness partially mediated the association between maternal problematic substance use and adolescent alcohol use. Parental monitoring partially mediated the relationship between paternal problematic substance use and adolescent alcohol, cigarette, marijuana, inhalant, and illicit prescription drug use.

These results were consistent across gender and race/ethnicity. These findings suggest that parental interventions designed to increase closeness and monitoring may help to reduce adolescent substance use.


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Alcohol Research UK announce new funding opportunities

 

Alcohol Research UK have announced its 2014/15 studentship scheme and a new flagship initiative on linking harms caused by alcohol to drinking behaviours. The research charity offers a number of grants, and previously funded work can be accessed via the alcohol library.

For the new flagship scheme, a call for proposals has been made to investigate the link between specific harms caused directly by a distinct pattern, level and duration of alcohol drinking at key stages in the life-course. It is co-funded by the MRC and ESRC and aims to inform public health policy and the design of interventions.

Between £200,000 and £500,000 is available for each flagship project. Full information, including how applications may be made, can be found on theMedical Research Council's website.  > > > >   Read More

“Preventing Alcohol Use during Pregnancy – Applying New Solutions to Ongoing Needs”: An International FASD Awareness Day Webinar Hosted by the SAMHSA FASD Center for Excellence

 

In our continuing effort to raise awareness of the dangers of consuming alcohol during pregnancy, the SAMHSA FASD Center for Excellence will host a Webinar on September 09, 2013, International FASD Awareness Day. 
 
“Preventing Alcohol Use during Pregnancy – Applying New Solutions to Ongoing Needs” will highlight valuable information for our audience and also for individuals who may be new to the topic of FASD, but who are interested in preventing drinking during pregnancy.

The program will feature:

• Dr. Susan Astley, University of Washington, who will serve as facilitator as well as provide background information on FASD and reflect on the 40th anniversary of the coining of the term, Fetal Alcohol Syndrome (FAS).
• A presentation from Dr. Margaret Ellen Mattson, SAMHSA’s Center for Behavioral Health Statistics and Quality (CBHSQ), on incidences of women drinking during pregnancy from SAMHSA’s National Survey on Drug Use and Health (NSDUH), and Jamie Reinebold, Memorial Hospital of South Bend, presenting Screening and Brief Intervention (SBI) data (by trimesters).
• Strategies to prevent alcohol consumption during pregnancy in public health and community settings presented by Paulette Romashko, ARC Community Services; Helen Weinstein, The Erie County Council for the Prevention of Alcohol and Substance Abuse, Inc.; Laura Nagle, Kentucky State FASD Coordinator; and Jamie Reinebold, Memorial Hospital of South Bend (Indiana).
• A question and answer session following the formal presentations.  > > > >   Read More

Ask the Expert

Welcome to the “Ask the Expert” page of the Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence Web site.       
Every month, Dan Dubovsky, M.S.W., the Center’s FASD Specialist, or a special guest will use this space to write about an aspect of FASD in response to questions from the Center’s audience. (For more information about Mr. Dubovsky’s background and his thoughts on the word “expert,” please see our About the Expert section below.)

It is our hope that this column will provide vital, up-to-date information on FASD for a variety of stakeholders. We are particularly excited for this first edition since it gave us the privilege of interviewing Dr. Kenneth Lyons Jones and Dr. Ann Streissguth, two of the seminal early researchers in the field. Most of the breakthroughs in FAS and FASD over the last 40 years may not have been possible without their groundbreaking work, and we appreciate them taking the time to provide their perspectives.  > > > >  Read More

Global Actions: Commitments to Reduce Harmful Drinking. Sep 5,2013

 

Global Actions in Focus

The 20^th International council on alcohol, drugs and traffic safety conference

brisbane, australia

Kathryn Stewart of Safety and Policy Analysis International hosted a seminar at the 20^th International Council on Alcohol, Drugs and Traffic Safety Conference (T2013) in Brisbane, Australia. Stewart’s presentation focused on drink driving initiatives in low- and middle-income countries, concentrating on the progress of initiatives in Nigeria and Vietnam. Stewart is a senior advisor to the Global Actions drink driving initiatives.

Stewart emphasized that while a majority of high-income countries have adopted technologically sophisticated strategies to address drink driving, many low- and middle- income countries have not fully developed basic public education, legal, or enforcement approaches. “ICAP made a significant contribution to T2013 by sharing the promising strategies and results of the drink drive initiatives with researchers and policy makers from the 37 countries represented at the conference,” said Stewart.

Global Actions currently has drink driving campaigns in six low- and middle-income countries: China, Colombia, Mexico, Nigeria, Russia, and Vietnam. During the seminar, Stewart shared overviews of the drink driving initiatives coordinated by ICAP in Nigeria and Vietnam.

In Nigeria, the initiatives mainly focus on educating bus drivers and commercial tanker drivers. These are two groups with some of the highest rates of drink driving road crashes in the country. Education classes for these drivers are complemented by additional distribution of materials on the dangers of drink driving and the intensification of roadside breath tests.

In Vietnam, the main goals are to educate local police officers on road safety awareness issues and train them on equipment to conduct effective road side checkpoints for drink drivers. Through government and local collaborations in the country, ICAP has co-hosted numerous capacity building training courses for health workers, police officials, and community leaders.

Key Recent Milestones

· India: Global Actions hosted a capacity building workshop for 11 state police officials from Madhya Pradesh and Haryana on September 2, 2013.

What's Happening Next

· Netherlands: ICAP Country Managers Mariana Guerra Rendon, Mario Lleras, and Hetal Gandhi will attend the International Road Safety Course at the Delft University of Technology in the Netherlands from September 15 to 27, 2013. Professor Fred Wegman, a Global Actions senior advisor, will lead the course.

News Release - Increase in heavy drinkers leading to more harm, new Australian analysis shows

 

Very heavy drinking among the nation’s top 10% of drinkers has increased in the past decade while lighter drinkers have cut back further, according to a new analysis of Australian drinking habits since 2001.

Dr Michael Livingston, who will present the results at the National Drug and Alcohol Research Centre Annual Symposium, analysed data from four successive National Drug Strategy Household Surveys since 2001. Each survey involved more than 20,000 Australians aged 14 and over. The top 10% of drinkers are drinking between four and five per cent more than a decade ago. At the other end of the scale more people were abstaining altogether and lighter drinkers were drinking even less.

On average Australians drink 10 litres of pure alcohol a year per head. The top 10% of drinkers now account for 52% of total alcohol consumed, compared with 49% a decade ago. On average the top five per cent of drinkers are drinking 140 more standard drinks a year compared with a decade ago. > > > >  Read More

Maintaining Sobriety and Recovery

Recovery is a continuous, progressive process of improvement whereby a person with a substance use disorder first becomes sober and then begins a lifelong commitment to improve his or her health, live a self-directed life, and strive to reach full potential.

The nurse plays an important role in the beginning stages of this process by helping the patient identify relapse risk factors along with providing psychoeducational, psychotherapeutic, and psychopharmacologic interventions to decrease the risk of relapse and direct the patient down a path of self-efficacy, personal health, and productive citizenship.


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Underage Drinking: An Evolutionary Concept Analysis

Underage drinking is a major cause of morbidity and mortality for American youths and young adults.

The negative consequences of underage drinking range from academic problems to intentional and unintentional injuries, acts directed toward self or others, and death.

Nurses, regardless of practice settings, are on the frontline of defense. The take-home message is to delay/deter the first drink of alcohol.


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Providing Information About the Neurobiology of Alcohol Use Disorders to Close the ‘Referral to Treatment Gap’

Only a small proportion of the 18 million Americans who could benefit from alcohol treatment actually receive it.

Disseminating information on the neurobiological base of alcohol disorders may be useful in removing the prevailing barriers to accepting a referral to alcohol treatment.

Nurses, guided by a set of clinical strategies known as screening, brief intervention, and referral to treatment, can be instrumental in closing this treatment gap.


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Request Reprint E-Mail:    dfinnel1@jhu.edu

Implementing an Evidence-Based Detoxification Protocol for Alcoholism in a Residential Addictions Treatment Facility

Chemical dependency, commonly known as substance abuse and use disorders, continues to plague residents of the United States. Because treatment has expanded beyond the walls of the acute care hospital, advanced practice nurses play a pivotal role in caring for clients addicted to various substances.

This article describes how an advanced practice nurse in collaboration with the medical director and a director of nursing at a residential treatment center in southern New Jersey oversaw the development of an evidence-based detoxification treatment protocol for alcohol dependency, emphasizing the critical role of nurses in assuring that clinical practice is rooted in current evidence.


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The Role of Intrapersonal Factors on Alcohol and Drug Use Among Latinos With Physical Disabilities

 


Persons with disabilities are disproportionately impacted by alcohol and drug use. Social work best practice approaches require an understanding of the effects of intrapersonal factors on alcohol and drug use, yet the theoretical and empirical literature remain underdeveloped, especially among ethnic minority populations.

We sought to obtain a detailed description of the role of intrapersonal factors, including perceptions and life experiences, on alcohol and drug use among Latinos with physical disabilities.

We employed community-based participatory research in conjunction with photovoice. A total of 17 focus group interviews were completed. Three rounds of photography and focus group interviews occurred with a total of 28 participants who participated in each round. Data analyses followed the tenets of descriptive phenomenology.

Results highlight intrapersonal risk and protective factors to inform social work practice and work toward developing and evaluating alcohol and drug use preventive interventions for this overlooked and vulnerable population.


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STIGMA AND RECOVERYISM

 

The suggestion that there are multiple and diverse pathways of long-term addiction recovery has evolved from a heretical statement to a central tenet of an international recovery advocacy movement. As tens of thousands of people representing diverse recovery experiences stand in unison in September's recovery celebration events, it is perhaps time to explore and then put aside past divisions within and between communities of recovery.

 In 2006, Tom Horvath, President of SMART Recovery, penned a brief article in which he coined the termrecoveryism.  He used the term to depict assertions that a particular approach to addiction recovery was superior to all others - that there really is only ONE effective approach to addiction recovery.  Horvath rightly called our attention to a special form of bigotry sometimes exhibited by people who are grateful for their own brand of recovery.  There are those in secular, spiritual, and religious pathways of recovery who have claimed ultimate eminence for their particular ideas and methods and viewed alternatives as inherently inferior.  Radical abstentionists and radical medicationists continue acrimonious debates marked by more heat than illumination.  Those who enter recovery with and without specialized addiction treatment have each claimed a form of superiority, as have those who maintain recovery with and without participation in recovery mutual aid groups.  Each of these approaches is in turn subject to internal dissension about how that approach should best be pursued.    > > >>  Read More

Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings and Detailed Tables

This report and the detailed tables present a first look at results from the 2012 National Survey on Drug Use and Health (NSDUH), an annual survey of the civilian, noninstitutionalized population of the United States aged 12 years old or older.

Both the report and detailed tables present national estimates of rates of use, numbers of users, and other measures related to illicit drugs, alcohol, and tobacco products, with a focus on trends between 2011 and 2012 and from 2002 to 2012, as well as differences across population subgroups in 2012.

NSDUH national estimates related to mental health and NSDUH State-level estimates related to both substance use and mental health will be published in separate releases in the fall of 2013.

The SAMHSA report also found that the rates of past month drinking, binge drinking and heavy drinking among underage adolescents aged 12 to 17 remained lower than their levels in 2002 and 2009. The percentage of people aged 12 and older who drove under the influence of alcohol at least once in the past year in 2012 was 11.2 percent, significantly lower than the level in 2002 (14.2 percent) but similar to the rate in 2011 (11.1 percent).

 

 

 

Read Summary National Findings        (PDF)

 

Read Detailed Tables    (PDF)

PHE release 'alcohol stocktake self assessment tool'

 

Public Health England have released an Alcohol stocktake self-assessment tool [doc]. It allows local areas to take a systematic review of their strategy for addressing alcohol-related harm in the adult population. See here for a slides overview [ppt] of the tool. 

The resource allows local areas to check activity against 7 key domains:

1. Needs assessment and Data
2. Finance
3. Pathways
4. Population Level Actions
5. Targeted Interventions
6. Hospital-based Alcohol Services
7. Specialist treatment

The tool aims to address the integration of activity by all local partners across all levels of prevention and covers interventions that are thought to be most effective. It is in line with NICE guidance, which previously produced detailed benchmarking tools. NICE also recently released Public Health Guidance for local authorities.  > > > >  Read More

Repeated Binge-Like Ethanol Drinking Alters Ethanol Drinking Patterns and Depresses Striatal GABAergic Transmission

Repeated cycles of binge alcohol drinking and abstinence are key components in the development of dependence. However, the precise behavioral mechanisms underlying binge-like drinking and its consequences on striatal synaptic physiology remain unclear.

In the present study, ethanol and water drinking patterns were recorded with high temporal resolution over 6 weeks of binge-like ethanol drinking using the ‘drinking in the dark’ (DID) protocol. The bottle exchange occurring at the beginning of each session prompted a transient increase in the drinking rate that might facilitate the acquisition of ethanol binge-like drinking.

Ethanol drinking mice also displayed a ‘frontloading’ behavior in which the highest rate of drinking was recorded during the first 15 min. This rate increased over weeks and paralleled the mild escalation of blood ethanol concentrations. GABAergic and glutamatergic transmission in the dorsal striatum were examined following DID.

Spontaneous glutamatergic transmission and the density of dendritic spines were unchanged after ethanol drinking. However, the frequency of GABA_A receptor-mediated inhibitory postsynaptic currents was depressed in medium spiny neurons of ethanol drinking mice.

A history of ethanol drinking also increased ethanol preference and altered the acute ethanol effects on GABAergic transmission differentially in dorsolateral and dorsomedial striatum.

Together, the study shows that the bottle exchange during DID promotes fast, voluntary ethanol drinking and that this intermittent pattern of ethanol drinking causes a depression of GABAergic transmission in the dorsal striatum.



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The effect of rumination on craving across the continuum of drinking behaviour

Rumination is an abstract, persistent, and repetitive thinking style that can be adopted to control negative affect. Recent studies have suggested the role of rumination as direct or indirect cognitive predictor of craving experience in alcohol-related problems.

 

The goal of this study was to explore the effect of rumination induction on craving across the continuum of drinking behaviour.

Participants of three groups of alcohol-dependent drinkers (N = 26), problem drinkers (N = 26) and social drinkers (N = 29) were randomly allocated to two thinking manipulation tasks: distraction versus rumination. Craving was measured before and after manipulation and after a resting phase.

Findings showed that rumination had a significant effect on increasing craving in alcohol-dependent drinkers, relative to distraction, but not in problem and social drinkers. This effect was independent of baseline depression and rumination and was maintained across the resting phase.

Rumination showed a direct causal impact on craving that is specific for a population of alcohol-dependent drinkers.


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P 11. Cortical inhibition within motor and frontal regions in alcohol dependence: A TMS–EEG study

Preclinical studies suggest that alterations within the frontal cortex play a critical role in the neurophysiology of alcohol dependence. The combination of transcranial magnetic stimulation and electroencephalography (TMS-EEG) allows a direct assessment of cortical excitability and inhibition within the frontal cortex in human subjects. We report the first application of TMS-EEG to measure these indices within the frontal cortices of patients with alcohol dependence.

Cortical inhibition was assessed in 12 patients with alcohol dependence and 14 healthy controls through single and paired-pulse transcranial magnetic stimulations (TMS) paradigms delivered to both the frontal and motor cortices. Long interval cortical inhibition (LICI) was used to index inhibition in the frontal cortex. Short intracortical inhibition (SICI) and cortical silent period (CSP) was used to index inhibition, while intracortical facilitation (ICF) measured facilitation, in the motor cortex. Cortical excitability was indexed by the resting motor threshold (RMT) and active motor threshold (AMT).

The alcohol dependent group demonstrated deficits in LICI across both the left and right dorsolateral prefrontal cortex relative to healthy controls. The alcohol dependent group also exhibited reduced RMT and AMT. In terms of motor cortex inhibition, there were no significant differences in SICI, ICF or CSP, although increased intra-trial-variability in SICI was observed in the alcohol dependent group.

The current study provides the first direct evidence of reduced cortical inhibition that is specific to the frontal cortex of patients with alcohol dependence. Our study also revealed evidence of altered cortical excitability in the motor cortex of patients with alcohol dependence; however, the utility of using the motor cortex to index cortical alterations related to alcohol dependence remains unclear. Although these findings are preliminary, they provide critical neurophysiological evidence of disrupted cortical excitability within the frontal cortex of alcohol dependent patients



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Request Reprint E-Mail:    paul.fitzgerald@med.monash.edu.au