Britain's alcohol problem: Our green and drunken land

Beneath the bucolic tranquillity lies a dark secret: the Surrey district of Runnymede contains the nation's biggest proportion of hazardous drinkers. Jonathan Brown reports

Published: 17 October 2007

"How much do I drink?" pondered Linda Withers as she took another sip of Foster's lager served, as usual, in an oversized wine glass in the lounge bar of her local pub, the Rose and Crown. "Well, I don't fall over every day," she laughs. "But I admit we are a boozy lot."

The drinkers of Virginia Water and their well-heeled neighbours in the prosperous Runnymede area of Surrey have been branded problem drinkers. In a study by Liverpool John Moores University, the area topped the table for Britain's most hazardous drinkers. To qualify in the study as a hazardous imbiber it seems you must consume between 22 and 50 units of alcohol per week. In other words: two bottles of wine for men and one and a half for women.

The study has given rise to the thesis that Britain's wealthiest areas contain its most determined recreational drinkers – raising the fear that Middle England is sitting astride an alcohol time bomb set to explode some time soon with an epidemic of liver problems, heart disease and cancer.
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Action on alcohol-related criminal behaviour

Tuesday 16 October 2007

Binge drinkers arrested for alcohol-related offences in four areas across the country may be compelled by police to face up to the consequences of their drinking after they have been arrested, Home Secretary Jacqui Smith announced today.

The Home Office has provided £330,000 of funding to Drug and Alcohol Action Teams in Manchester, Liverpool, Cheshire and Ealing to pilot Alcohol Arrest Referral Projects (AARP) until March next year. In Liverpool, offenders will be required to pay £30 each towards the cost of the counselling which will be ploughed back into the scheme. If they prove successful, further funding will be available until October 2008.
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Source: Daily Dose

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Effects of Early and Later Marriage on Women's Alcohol Use in Young Adulthood
A Prospective Analysis

Reprinted with permission from Journal of Studies on Alcohol, (now called Journal of Studies on Alcohol and Drugs),Vol. 66, No. 6, Nov. 2005, pp. 729-737. Copyright © 2005 Alcohol Research Documentation, Inc.

Previous research shows that marriage leads to reductions in alcohol use, especially for women. Because marriage prior to age 20 (early marriage) is a marker for deviance, the protective effects of marriage may not extend to those who marry in adolescence. We compared the effects of marriage in adolescence versus young adulthood on alcohol consumption, negative alcohol-related consequences and heavy episodic drinking at age 29.

Women who had not married, had married early or had married between ages 20 and 29 did not differ on alcohol use at age 18. Women who married as young adults were less likely than singles to engage in any alcohol use, heavy episodic drinking or experience negative consequences and reported less alcohol use at age 29. Women who married in adolescence reported fewer negative consequences at age 29 than did singles and (if they had not divorced) were less likely to engage in heavy episodic drinking or experience any negative consequences, reported fewer consequences and consumed less alcohol. The protective effects of marriage in young adulthood were observed whether or not women divorced. Parenthood and college attendance before age 23 did not explain the marriage effect.

Results support role theory, which posits that individuals who marry are socialized into conventional adult roles that discourage deviant behavior.

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Source: Daily Dose

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Mental Health and Substance Use: dual diagnosis

New Journal for 2008

Aims and Scope

Increased recognition of co-existing mental health and substance use issues over the past 20 years has led to a growing body of discussion and research into the efficacy of interventions, treatment, and service delivery. As knowledge and expertise advance, professionals at the forefront of the field need an effective and stimulating forum in which to share information, review strategies, and develop new concepts.

This international and interdisciplinary journal provides a single authoritative source of reference for clinicians, managers, service developers, researchers, educators, trainers, and students. The journal's primary aim is to explore the complex issues arising from co-existing mental health and substance use. The journal aims to inform, develop, and educate professionals by facilitating, sharing, and pooling knowledge, thus enhancing expertise in this fast developing field. It covers assessment, intervention, treatment, prevention, innovation, opinion, conceptual exploration and analysis, service delivery, service development, policy and procedure, research and debate.

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Read Call for Papers Flyer (PDF)

Contributor: David B. Cooper

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Alcohol Industry News and Analysis for October 2007

Underage Alcopop Consumption: Cost Data for 27 States

Here in California, Marin Institute estimated the enormous costs of underage alcopop consumption; we used this data to educate policymakers, the media, and others. Now we've made similar estimates for the other 27 states where current law indicates that alcopops should be classified as distilled spirits. Doing so would make these products less available to youth (depending on the state law), either by removing them from grocery and convenience stores, raising the taxes (and hence prices), or both. Look up your state here.


Shining a Light on Alcopops in Two More States

Ads like the above, for Mike's Hard Lemonade depict young women empowering themselves while drinking alcopops.

Utah, a state already known for strong alcohol policies, could be the next to make alcopops less accessible to youth. The state's Alcoholic Beverage Control Commission recently voted unanimously to consider limiting the sales of all alcopops or "flavored malt beverages" to state liquor stores. The decision could mean removing the products from hundreds of grocery stores and convenience stores. The state's attorney general, Mark Shurtleff, was a strong voice in support of the decision. He said in a statement: "These drinks are not beer and should not be sold like beer.'' Final regulations are expected in early 2008.

Meanwhile, Illinois has become the first state to pass a law prohibiting alcohol companies from advertising, promoting, or marketing alcopops to youth. State policymakers likened the marketing of alcopops to using the cartoon character Joe Camel to sell cigarettes. State Representative Greg Harris explained: "Alcopop advertisers use the lure of youth and popularity to attract teenagers, especially the females, to their alcoholic products. We must protect children from the dangers of underage drinking by putting a stop to ads that make it look 'cool'."

Sources:

Alcoholic Drinks May Be Pulled From Utah Stores
Associated Press October 3, 2007

Legislation Prohibits Marketing of Flavored Alcoholic Beverages to Minors
Illinois Department of Health Services, September 19, 2007


Fewer Beer Giants Bring More Layoffs, Bigger Profits

When the second and third largest brewers, (behind Anheuser-Busch) SABMiller and Molson Coors, announced their intent to combine their U.S. operations last week, the motivation was clear: to better compete with the King of Beer. The new "MillerCoors" is expected to sell 69 million U.S. barrels annually, cut as much as $500 million in costs, and bring their net revenue to approximately $6.6 billion.

Isn't it funny how beer companies complain that raising taxes will result in job losses, but won't hesitate to lay off workers just to boost profits?

Source:

SABMiller and Molson Coors to Merge U.S. Units
International Tribune Herald, October 10, 2007


Budweiser Contaminated With Science Experiment

Did you know that Anheuser-Busch is the largest buyer of rice in this country, purchasing between six and ten percent of the entire annual U.S. rice harvest? The company uses rice in the beer manufacturing process, they say, for flavor.

Recently, Greenpeace International conducted a series of independent laboratory tests at an Arkansas-based Anheuser-Busch rice mill that showed the presence of an experimental genetically-engineered (GE) strain of rice. Back in 2006, this same strain was the source of a major contamination of at least 30 percent of the rice stocks in the United States. The contamination had a massive negative economic impact on the U.S. rice industry as many countries subsequently stopped or significantly restricted the import of U.S. rice.

Send a letter to Anheuser-Busch demanding that the company commit to
barring all GE ingredients from their products

Source:

Budweiser Rice Contamination Exposed
Greenpeace International, October 8, 2007

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Middle class are biggest abusers of alcohol


By Rebecca Smith and Sarah Womack

16/10/2007

Middle-class drinkers who unwind with a bottle of wine are putting themselves in danger, with figures out today showing one in four couples in some affluent areas are regularly consuming "hazardous" levels of alcohol.

The geography of alcohol abuse Your view: Should we be worried about middle-class wine drinking?

A study involving every local authority in the country found the worst rates of dangerous weekly drinking are in some of the country's most attractive suburbs.

Harrogate, North Yorks, and Runnymede, Surrey Heath, Guildford and Mole Valley, all in Surrey, are the worst culprits – with up to one in four residents consuming more than three bottles of wine a week.

This is enough to put their health at serious risk, experts warn.

The Government's approach to tackling problem drinking has focused mainly on teenage binge drinkers, but this research found there is an epidemic of excessive drinking among the middle classes.
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Read Full Article
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Paper P.6.e.001:

Oxcarbazepine in treatment of alcohol and heroin

Citation: European Neuropsychopharmacology The Journal of the European College of Neuropsychopharmacology, Volume 17 Supplement 4, Page S558

Substance use disorders (SUD) are both very common and the most severe psychiatric disorders, with highest prevalence among others. According to neuroadaptive model, prolonged presence of alcohol and other drugs (AOD) induces changes in brain-cell functioning (sensitization) expetially in midbrain dopaminergic system, glutaminergic, GABA-ergic, and endogenous opioids, which in the absence of AOD induces imbalance in brain activity that results in craving.

Oxcarbazepine (OXC) is beleived to inhibit voltage-sensitive sodium channels, and MHD reduces high-voltage activated calcium currents in striatal and cortical neurons, which finally reduces glutaminergic neurotransmission in corticostriatal synapses. OXC has no interactions with AOD, any addiction potential, and OXC and MHD has no capacity for inhibition of the most P 450 cytochrom enzyme systems.

Aim of this study was to ascertain the efficiency of the OXC therapy in the treatment of alcohol and heroin induced craving.

Patients were monitored for 6 months in hospital and outpatient conditions, according to specially designed protocol, which included Alcohol Craving Scale (ACS score) and Drug Craving Scale (DCS score).

ACS and DCS scores are significantly lower in OXS groups from tenth day of treatment. OXC has statistically significant anticraving effect in both alcohol and heroin addicts, and significant efficacy in prevention of relapse without unwanted therapy side effects.

Read Full Information on Paper P.6.e.001
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Predicting the effect of different anti-craving drugs on relapse


Citation: European Neuropsychopharmacology The Journal of the European College of Neuropsychopharmacology, Volume 17 Supplement 4, Page S214

Alcohol addiction is a chronic disorder that develops on a genetic, psychosocial and environmental background. Whereas alcohol withdrawal treatment is widely accepted as a pharmacotherapeutic domain, anti-craving and relapse prevention treatment in clinical practice up to now is mainly based on psychosocial and psychotherapeutic interventions. However, there is growing interest in the interaction of psychotherapy with drug therapy since it has been shown repeatedly that pharmacological treatment is efficacious in the reduction of craving and risk of relapse in abstinent alcohol dependent patients.

Considerable efforts have been achieved in the development and the clinical implementation of relapse preventing medications. Especially acamprosate and naltrexone have demonstrated consistent efficacy in reducing the probability or severity of relapse in subjects treated for alcohol. Nonetheless, not all patients treated with such drugs respond adequately to treatment.

Understanding this suboptimal response, and being able to predict likely outcomes to treatment with individual drugs, represents a major challenge fo alcohol research. The hypothesis that there exist different modes of alcohol craving providing multiple pathways to relapse provides a stimulating theorethical framework for understanding this heterogeneity in response.

Data from psychometric studies, imaging studies and neurophysiological observations suggest that mainly endophenotypic and pharmacogenomic predictors may support both a more efficacious treatment and a closer understanding of the pathophysiology of craving and relapse.

The definition of subgroups of patients that respond preferably to a specific anticraving compound would represent a major progress in the treatment of alcohol addiction.



Read Information on Paper: S.25.03

Annual Symposium 2007

Thursday 15 – Friday 16 November

The Park Inn Hotel, North Street, York, UK.

Click here for the application form for the 2007 Symposium and click here to download the programme.

THEME: Theory, policy and practice in addictions: how are they related?

Source: Rowdy Yates

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Confrontation in Addiction Treatment

Written by William R. Miller, PhD and William White, MA

Thursday, 04 October 2007

The use of confrontational strategies in individual, group and family substance abuse counseling emerged through a confluence of cultural factors in U.S. history, pre-dating the development of methods for reliably evaluating the effects of such treatment. Originally practiced within voluntary peer-based communities, confrontational approaches soon extended to authority-based professional relationships where the potential for abuse and harm greatly increased. Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. There are now numerous evidence-based alternatives to confrontational counseling, and clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. It is time to accept that the harsh confrontational practices of the past are generally ineffective, potentially harmful, and professionally inappropriate. . . . . . . . Read Full Article Contributor: Don Phillips ___________________________________________________________________ ______________________________________________

eNewsletter: October 15, 2007

Mark your Calendar! October 16: The House Energy and Commerce committee will consider H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act at 10:00 am. The bill has now made it through five committee/subcommittee mark-ups!!! This is the last step before it can come before the full House for a vote. You can watch the mark-up live. Learn more… November 9 and 10: “Our Stories Have Power...A Media Workshop for Recovery Advocates” will be in Boston, MA. We are collaborating with Massachusetts Organization for Addiction Recovery (MOAR) and the Addiction Technology Transfer Center of New England. Register online today, space is very limited! December 2: Presidential Town Hall meeting on addiction prevention, treatment and recovery, Timberlane High School, Plaistow, NH from 3:00-6:00 pm, details coming soon! Sign-on letter supporting H.R. 1424 Has your organization signed-on in support of The Paul Wellstone Mental Health and Addiction Equity Act? If you’d like to join the over 200 organizations who have indicated their support, email Holly Merbaum today. Rally for Recovery! People Advocating Recovery registered 250 voters at its Louisville, Kentucky event. If you haven’t sent us your pictures and information yet, we’d love to hear from you so that we can post your events online! SAMHSA Hosts Regional Meetings Recovery advocates have been participating in regional meetings being hosted by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) on developing, strengthening and implementing recovery-oriented systems of care. Learn more… ACTION Campaign launched Does your organization provide peer recovery support services? Are there treatment providers in your community that could benefit from tools to improve services? Faces & Voices of Recovery is partnering with other organizations in the ACTION Campaign to reduce the barriers to access and engagement in treatment. Learn more… Resources Faces & Voices board member, author of “Broken,” and addiction recovery advocate William C. Moyers has launched a nationally syndicated column called "Beyond Addiction," that is being distributed by Creators Syndicate. If you’d like to read “Beyond Addiction” in your local paper, call or write the editor/news desk and ask them to carry the weekly column. The White House’s September 20, 2007 Compassion in Action Roundtable featured presentations by Institute for Research, Education and Trainings in Addictions (IRETA)’s Michael Flaherty on “ Building a Common Vision for Recovery in America” (PowerPoint presentation and remarks) and Recovery Consultants of Atlanta and RCSP grantee David Whiters on “A Faith-based Approach to Providing Peer-led Addiction Recovery Support Services.” Connecticut Community for Addiction Recovery (CCAR) is providing Telephone Peer Recovery Support Services under a contract with the Connecticut Department of Mental Health and Addiction Services. This flyer documents the program’s success in helping people in Connecticut sustain their recovery. November 7 is the deadline for The Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program’s final round of funding. There’s up to $5 million available and applications must be completed online. The US Centers for Medicare and Medicaid Services (CMS) has issued a letter of guidance to states interested in peer support services under the Medicaid program for mental health and substance use disorders services. The letter reaffirms CMS’ commitment to state flexibility and consumer protection in peer support. The National Quality Forum has published voluntary national consensus standards for addiction identification, treatment and continuing care management. The standards include four domains: identification of substance use conditions; initiation and engagement in treatment; therapeutic interventions to treat substance use illness; and continuing care management of substance use illness. These four domains are divided into eleven endorsed treatment practices. Announcements The Robert Wood Johnson Foundation (RWJF) has set an October 19 deadline for nominees for its Community Health Leaders awards program that will honor 10 outstanding community leaders who work to expand access to healthcare and social services. Learn more… Congratulations to Henry Lozano on his appointment by President George W. Bush as Director of the USA Freedom Corps. Henry, a person in long-term recovery from addiction, is a member of the Recovery Month Planning Partners and a member of the Community Anti-Drug Coalition (CADCA) board of directors. He was the President and Chief Executive Officer of Californians for Drug-Free Youth, a non-profit organization working to bring parents, youth, schools, and communities together to create and support safe and healthy communities.

Children of alcoholics in Spain: from risk to pathology

Results from the ALFIL program
Social Psychiatry and Psychiatric Epidemiology Online 12 octoher 2007

To identify the possible risk factors and negative outcomes associated with parental alcoholism. A secondary aim was to determine the influence of the family density of alcoholism on children of alcoholics’ (COAs) psychological functioning.

Children of alcoholics’ were twice as likely as controls to present subclinical symptoms and four times more likely than controls to have a definite diagnosis of any mental disorder. More specifically, COAs had a significantly higher risk than controls of attention deficit disorder/hyperactivity, depression, phobias, enuresis and tics. COAs also tended to have more symptoms of generalized anxiety disorder. COAs had worse results on all the cognitive tests used and their risk of low school achievement was nine times higher than that of controls. Family density of alcoholism was significantly related to several psychiatric disorders and to low academic and cognitive performance in these children.

Children of alcoholics’ whose parents are in contact with treatment centers in Spain constitute a target group for selective prevention, as they have a higher risk of different negative outcomes, which mainly include attention disorders and other cognitive deficits, depression and anxiety.

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Request Reprint E-Mail: diaz@clinic.ub.es
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AMERICAN SOCIETY OF ADDICTION MEDICINE

Public Policy Statement on the Establishment of a Framework Convention on Alcohol Control and the Exclusion of Tobacco and Alcohol from Trade Agreements

The statement re the Establishment of a Framework Convention on Alcohol Control and the Exclusion of Tobacco and Alcohol from Trade Agreements provided the appropriate policy foundation for ASAM to introduce 2 resolutions on this topic on 1) establishing a framework convention on alcohol control and 2) exclusion of tobacco and alcohol from trade agreements at the Annual Meeting of the American Medical Association in June 2007. ASAM had been invited to lead this effort, as a member of the AMA’s preventive medicine section, with which ASAM has long collaborated.

Read Full ASAM Public Policy Statement

APHA Approves Framework Convention on Alcohol Control

The American Public Health Association approved an important policy statement at the November Annual Meeting - "A Call for a Framework Convention on Alcohol Control." The APHA Governing Council adopted a statement submitted by our Alcohol, Tobacco and Other Drug Section with the endorsement of several other sections. The statement describes alcohol's global burden of disease and social harm, lessons from the tobacco movement and the Framework Convention on Tobacco Control (FCTC), rationale for an international treaty on alcohol, and how the current climate favors an international treaty. In conclusion "the American Public Health Association:

1. Calls on the World Health Organization to adopt and implement a binding international treaty, a Framework Convention on Alcohol Control, modeled after the Framework Convention on Tobacco Control;
2. Urges national public health organizations and other non-governmental organizations to support development of a Framework Convention on Alcohol Control; and
3. Solicits the U.S. government to support consideration of and planning for such Convention."
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Read Full Statement

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Editorial - A Framework Convention on Alcohol Control
The Lancet 2007; 370:1102, 29 September 2007

International conventions exist to control narcotics, psychotropic substances, tobacco, and doping in sport. But when it comes to alcohol—the drug that causes 4% of global deaths and disability—nearly as much as tobacco (4·1%) and five times the burden of illicit drugs—no similar legally binding agreement has been sought.

In many cultures, alcohol has long been considered in a more salubrious, socially acceptable light than other drugs. This attitude might be because of the putative health benefits associated with moderate drinking. Or perhaps it is due to the popularity of alcohol among higher socioeconomic groups, who, in many countries, are more likely to drink and more likely to drink regularly, while lower socioeconomic groups are more likely to smoke. Public-health advocates have also been lenient on the alcoholic beverage industry compared with big tobacco.

These lax attitudes along with free trade and competition rules, which treat alcohol as any other commodity, have undermined effective alcohol control measures, such as increasing taxes or restricting the hours or days of sale. Instead, at country level, ineffective control strategies (warning labels, education in schools) have been adopted. Internationally, resolutions on alcohol control exist but are non-binding and easily flouted.

For alcohol-control measures to be taken more seriously by governments, an international treaty modelled on the Framework Convention on Tobacco Control (FCTC) is needed. One of WHO's greatest achievements, the FCTC aims to counter the increase in tobacco consumption by making it a legal requirement for countries to introduce certain tobacco-control strategies.

Momentum is already gathering for a Framework Convention on Alcohol Control (FCAC). In the past couple of years the World Medical Association and the American Public Health Association have been among those who have voiced their support for such a move.

From its initial inception, the FCTC took 10 years to become a reality. The road to an FCAC is likely to be similarly long. Next year's World Health Assembly provides a crucial opportunity for WHO and member states to make those first steps towards a global treaty to reduce alcohol-related harm.

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Hospital figures show rise in binge drinking


By Sophie Borland

15/10/2007

Binge drinking is pushing up the number of emergency admissions to hospital, new figures reveal.

Since the licensing laws were relaxed two years ago to allow 24-hour drinking, the number of patients with alcohol-related injuries or illness has risen in many accident and emergency departments.

NHS statistics show that the number of men admitted to hospital as a result of drink has risen by 27.3 per cent since the change in legislation — from 714 per 100,000 in 2001-2002 to 909 per 100,000 in 2005-06.

The number of female alcohol casualties has increased by 29 per cent over the same period — from 396 per 100,000 in 2001-02 to 510 per 100,000 in 2005-06.
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Alcohol label to warn of health risk during pregnancy
October 15, 2007


Paul Cullen, Consumer Affairs Correspondent

Mandatory labelling of alcohol containers with a health warning about the dangers of drinking alcohol during pregnancy is to be introduced.

Drinks Manufacturers Ireland (DMI), the umbrella body for the industry, confirmed yesterday it had agreed to the health warning, which will apply to all alcohol containers sold in the Republic.
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NHMRC releases revised draft—Australian alcohol guidelines for low-risk drinking
12 October 2007

“The National Health and Medical Research Council (NHMRC) have today released a revised draft of the Australian alcohol guidelines for low-risk drinking,” NHMRC CEO Professor Warwick Anderson said.

“We are inviting comment from a wide range of groups and individuals—including health professionals, community groups, professional and educational organisations, policy makers, the general public and those businesses responsible for providing alcohol.
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Read Full News Release

» View: the draft guideline

» Download: Frequently asked questions factsheet (PDF, 46kb)

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Substance abuse and quality of life among severely mentally ill consumers

A longitudinal modelling analysis
Social Psychiatry and Psychiatric Epidemiology Volume 42, Number 10 / October, 2007 pp. 810-818


Evidence suggests that substance abuse negatively affects both psychiatric symptom severity and quality of life (QOL) in people with severe mental illness (SMI). However, these relationships have not been examined simultaneously, nor have they been characterized over time. Thus, it is difficult to appreciate the extent to which substance abuse exerts an enduring effect on psychiatric symptoms and distress and/or QOL in this population.

The purpose of this study is to test a conceptual model linking these factors together.

The prevalence of substance abuse was 55.0%. The SEM analysis suggested that substance abuse at baseline was associated with elevated symptomatology and distress and lower QOL, and that these effects endured after 18 months of treatment. Psychiatric symptoms and distress mediated the negative relationship between substance abuse and QOL.

The mediating role played by symptom and distress levels in the relationship between substance abuse and QOL suggests the importance of closely monitoring changes in these factors among SMI patients with substance problems.

Tracking symptom severity and distress levels over time will allow service providers to intervene and potentially improve the QOL of individuals with SMI.

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Request Reprint E-Mail: karen_urbanoski@camh.net
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