Co-Occurring Mental Illness, Alcohol and/or Drug Abuse & Medical Conditions (R01)


Executive Summary

• Purpose. The NIDA, NIAAA, and the NIMH invite research grant applications to services research on co-occurring mental illness, alcohol and/or drug abuse, and commonly co-occurring medical conditions.
• Mechanism of Support. This FOA will utilize the NIH Research Project Grant (R01) award mechanism, but applications under the NIH Small Research Grant Program (R03) and the NIH Exploratory/Developmental Research Grant Program (R21) are also sought. Applicants for the R03 should respond to PA-06-180 and applicants for the R21 should respond to PA-06-181.
• Funds Available and Anticipated Number of Awards. Awards issued under this FOA are contingent upon the availability of funds and the submission of a sufficient number of meritorious applications.
• Eligible Institutions/Organizations. Public/State Controlled Institution of Higher Education; Private Institution of Higher Education; Nonprofit with 501(c)(3) IRS Status (Other than Institution of Higher Education); Nonprofit without 501(c)(3) IRS Status (Other than Institution of Higher Education); Small Business; For-Profit Organization (Other than Small Business); State Government; U.S. Territory or Possession; Indian/Native American Tribal Government (Federally Recognized); Indian/Native American Tribal Government (Other than Federally Recognized); Indian/Native American Tribally Designated Organization; Non-domestic (non-U.S.) Entity (Foreign Organization); Hispanic-serving Institution; Historically Black Colleges and Universities (HBCUs); Tribally Controlled Colleges and Universities (TCCUs); Alaska Native and Native Hawaiian Serving Institutions; Regional Organization; Other(s): Eligible agencies of the Federal government; Faith-based or community based organizations.
• Eligible Project Directors/Principal Investigators (PDs/PIs). Individuals with the skills, knowledge, and resources necessary to carry out the proposed research are invited to work with their institution/organization to develop an application for support. Individuals from underrepresented racial and ethnic groups as well as individuals with disabilities are always encouraged to apply for NIH support.
• Number of Applications. Applicants may submit more than one application, provided each application is scientifically distinct.
• Renewals and Resubmissions. Applications can be renewed by competing for additional project periods. Applicants may submit a “resubmission” application, but such application must include an “Introduction” addressing the previous peer review critique (Summary Statement).
• Number of PDs/PIs. More than one PD/PI, or multiple PDs/PIs, may be designated on the application.
• Application Materials. See Section IV.1 for application materials.
• General Information. For general information on SF424 (R&R) Application and Electronic Submission, see these Web sites:
  • SF424 (R&R) Application and Electronic Submission Information: http://grants.nih.gov/grants/funding/424/index.htm
  • General information on Electronic Submission of Grant Applications: http://era.nih.gov/ElectronicReceipt/
• Hearing Impaired. Telecommunications for the hearing impaired is available at: TTY 301-451-0088.

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Support for social norms programming to reduce alcohol consumption in pregnant women
Addiction Research & Theory, Volume 15, Issue 4 2007 , pages 383 - 396




This investigation examined the difference between the amount of alcohol consumed by pregnant Montana women (actual norms) and the amount they perceived was consumed by other Montana women of their same age (peer norms).

On the basis of a stratified cluster sampling, 712 women completed a survey based on social norms theory.

Results revealed that prior to the pregnancy women perceived that other women of their same age normally drank more than four times as much alcohol as they actually consumed. However, during their pregnancy women perceived that other women of their same age normally drank over 102 times as much alcohol as they actually consumed. Similar patterns were seen for the more than usual consumption.

The results of the investigation showed a consistent and dramatic pattern of overestimation of peer alcohol use norms compared to actual norms.

These findings support the application of intervention strategies designed to correct misperceptions of drinking norms in pregnant women as a way to reduce actual drinking rates.

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Request Reprint E-mail: uhdtd@montana.edu
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Alcohol consumption, TaqIB polymorphism of cholesteryl ester transfer protein, high-density lipoprotein cholesterol, and risk of coronary heart disease in men and women
European Heart Journal Advance Access published online on December 6, 2007

To investigate whether a common polymorphism in the cholesteryl ester transfer protein (CETP) gene modifies the relationship of alcohol intake with high-density lipoprotein cholesterol (HDL-C) and risk of coronary heart disease (CHD).

Parallel nested case-control studies among women [Nurses’ Health Study (NHS)] and men [Health Professionals Follow-up Study (HPFS)] where 246 women and 259 men who developed incident CHD were matched to controls (1:2) on age and smoking.

The TaqIB variant and alcohol consumption were associated with higher HDL-C, with the most pronounced effects of alcohol among B2 carriers.

In the NHS we did not find an inverse association between alcohol and CHD in B2 non-carriers (P trend: 0.5), but did among B2 carriers (P trend <0.01).> the odds ratio (OR) for CHD among women with an intake of 5–14 g/day was 1.4 (95% CI: 0.6–3.7) compared with non-drinkers, whereas among B2 carriers the OR was 0.4 (0.2–0.8). Results in men were less suggestive of an interaction; corresponding OR’s were 1.9 (0.8–4.5) and 0.9 (0.5–1.6), for B2 non-carriers and carriers, respectively.

The association of alcohol with HDL-C levels was modified by CETP TaqIB2 carrier status, and there was also a suggestion of a gene–environment interaction on the risk of CHD.

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Request Reprint E-Mail: mkj@dce.au.dk

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What's New: September 19, 2007

Addition of Policy Change Summary page - On August 29, 2007, the information on the APIS Web site was updated to include legislative and regulatory changes that went into effect on or before 1/1/2007. The results of this update are summarized on a new Policy Changes at a Glance summary page. The summary covers the period 1/2/2006 through 1/1/2007 and includes a table showing which APIS policies changed in which States during this period, as well as text summarizing the changes for each State.

For additional details, see the Change Log.

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Engaging States and Local Communities in Prevention Policies
The 14th in a series of national conferences on the avoidance of alcohol-related problems using public policy strategies

Sunday - Wednesday, January 27 - 30, 2008

The Bahia Resort Hotel, Mission Bay, San Diego, California
Sponsored by the California Council on Alcohol Policy

The California Council on Alcohol Policy (Cal Council), a statewide non-profit educational and training corporation, is pleased to sponsor the January 2008 conference, Engaging States and Local Communities in Prevention Policies. This conference will be the 14th in a series of national and regional meetings that have addressed research, policy, and prevention issues related to alcohol. We welcome an anticipated attendance of up to 300 participants to Southern California - community-based practitioners, public officials, and researchers from across the North America and beyond.

Conference Goal and Objectives

This 14th conference in the Alcohol Policy series will explore, develop, and advance public policy approaches to the prevention of alcohol problems in order to promote evidence-based strategies and to bring public focus to the need for alcohol policy reform at all levels. Specific objectives are to:

• Influence international, national, regional, state and local agendas to consider alcohol policy, with an emphasis on communities.
• Strengthen the understanding of sound, evidence-based public policy in preventing and reducing alcohol-related problems.
• Illuminate the policy-making process at local, state, regional and national levels.
• Expand the coalition of individuals, organizations and agencies committed to public policy approaches to the prevention of alcohol problems.
• Promote public discussion on alcohol policy issues.

Alcohol Policy 14 Website
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Press Release - "Overall, illicit drug use by American teens continues gradual decline in 2007."

December 11, 2007



. . . . .

Trends in Alcohol Use

The use of alcohol by teens, like their use of many of the illicit drugs, has declined since the mid-1990s. The 30-day prevalence of alcohol use (reporting drinking an alcoholic beverage at least once in the 30 days prior to the survey) has fallen by 40 percent among 8th graders since their peak level in 1996. The proportional declines since recent peak rates are smaller for the older students, however: about a one-fifth decline for 10th graders and about one sixth for 12th graders. All three grades showed small declines in use this year—none reaching statistical significance. Thirty-day prevalence of alcohol use now stands at 16 percent, 33 percent, and 44 percent for grades 8, 10, and 12.

The greater decline in use among 8th graders may well reflect the greater decline in their reported availability of alcohol. While there has been some decline in reported availability among the upper grades, the 8th graders have shown by far the greatest decline. In 1996, 75 percent of them thought that they could get alcohol if they wanted some, whereas by 2007 the number had fallen to 62 percent.

Self-reports of being drunk continued a long slow decline into 2007 (though one-year changes were not statistically significant this year). Again, the long-term decline was most pronounced among 8th graders—the youngest teens being surveyed.

The proportions saying that they got drunk in the prior 30 days was 5.5 percent in the 2007 survey, down by more than four tenths from what it was in 1996 (9.6 percent). The proportional declines are much smaller for the older students, with 18 percent of the 10th graders admitting to drunkenness within the month, down almost one quarter from their recent peak rate, and 29 percent of 12th graders admitting drunkenness, down only about one sixth from their peak rate in 1997. Here also, none of the one-year declines in 2007 reached significance, but all three grades showed some decline
. . . . . .


Read Full 2007 Press Release (PDF)
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Media Release - THE BATTLE OF THE BEERS
UVic Study Reveals Drinkers Can’t Tell the Difference
10 Dec 2007

When it comes to drinking, young males can’t tell the difference between low alcohol and regular strength beer. That’s according to a study the University of Victoria’s Centre for Addictions Research (CARBC). The results of the study, which took place at UVic between August and October 2006, were released in Victoria today.
. . . . . .

Read Full Media Release (PDF)
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Alcohol Consumption in British Columbia and Canada: A Case for Liquor Taxes that Reduce Harm
Bulletin 3 - December 2007


Overview
• Alcohol consumption in Canada has increased by over 11% in the past decade.
• Per adult absolute alcohol consumption in British Columbia has increased from 8.18 litres in 2002 to 8.53 litres in 2005.
• Since 2002 the numbers of hospitalizations and neuro-psychiatric deaths attributable to alcohol in BC have increased by 11.7% and 18%, respectively.
• In 2005 there were an estimated 25,194 alcohol-related injuries and illnesses in BC requiring hospitalization compared with 4,817 related to illicit drug use.
• There is extensive scientific evidence to support the use of pricing and taxation strategies as effective means of reducing alcohol consumption and related harms.
• In British Columbia such strategies are readily achievable because the government alcohol monopoly directly controls liquor prices.
• 65% of the coolers now sold in BC contain 7% alcohol content and have an average price of $5.41 per litre, compared with $8.07 for coolers with a 5-5.9% alcohol content.
• We recommend that liquor prices more closely reflect alcohol content and that these are regularly updated with the cost of living.
• Beers and coolers with low alcohol content should have significantly lower price ‘mark-ups’ applied to give manufacturers, retailers and consumers incentives to produce, market and consume these products.
• Minimum prices also need to be set and updated regularly to ensure there are no cheap high strength products available.
• We also recommend that a “nickel a drink” tax be introduced to generate $95.7 million per annum for treatment and prevention programs.

Read Full Bulletin (PDF)
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Low Alcohol Alternatives: A Promising Strategy for Reducing Alcohol Related Harm



Centre for Addictions Research of BC
December 2007
Research and Policy Papers: 5/2007
First published: December 2007


The aim of this study was to provide an empirical test of whether a sample of young beer drinkers report differences in subjective levels of enjoyment and intoxication when given moderate amounts of unmarked low alcohol beer (3.8%) compared with regular strength beer (5.3%).

The 34 participants were volunteer male students from the University of Victoria who reported drinking 5 or more beers in one day at least once in the last month. In each drinking session, small groups of between 6 and 10 students consumed two glasses of beer while playing a pub game. Each subject was his own control in the experiment by attending two group drinking sessions, drinking a different beverage each time. The different strength beers were given in balanced order, with half the subjects in each group drinking one beer and the rest the other beer. Standard instruments employed in previous studies were used to measure subjective intoxication, enjoyment and mood. Blood alcohol levels were tested before, during and after drinking with a hand-held breathalyser.

Although significantly higher blood alcohol levels (BACs) were obtained with the higher strength beer (means of 0.026 versus 0.033mg/100ml at the end of the study, p<0.001), when a sub-group of 22 participants were debriefed, (i) most reported enjoying the two sessions equally or preferred the low alcohol beer session; (ii) most did not report feeling different between the two sessions; and (iii) only about half (12/22) correctly guessed which was the higher alcohol content beer. There was a small difference, however, in terms of preferring the taste of the 5.3% beer.

While the sample size was relatively small, the experimental design with each subject as their own control had adequate statistical power to detect practically significant changes in the outcome measures.

We recommend these findings be used in devising alcohol taxation policy and other strategies that might create incentives for the manufacture, marketing and consumption of low alcohol alternatives.

Read Full Abstract
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GABA_Aα4 Receptor Subunits and Ethanol: A Knockout Punch?
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 7 Dec 2007

DEFINING THE MOLECULAR sites of action that account for the neurobehavioral effects of ethanol has been an especially difficult task. Both membrane lipids and the proteins that reside there have been examined as targets for the modest and unassuming ethyl alcohol molecule. Over the last 20 years, a great deal of this attention has focused on the widely expressed GABAA family of chloride-conducting ion channels that mediate much of the inhibitory neurotransmission in the adult brain. This is due in large part to the similarities observed between the behavioral actions of ethanol and compounds such as benzodiazepines and barbiturates that are known modulators of GABAA receptor function.m Following the discovery and cloning of the genes that encode members of the GABAA receptor family, a steady and systematic search for ethanol-sensitive GABAA receptors was initiated. To date, there are numerous reports demonstrating that ethanol potentiates the function of various GABAA subunit combinations including those containing the c subunit, a subunit required for sensitivity to benzodiazepines. Yet, in many of these studies, ethanol concentrations required to produce reliable potentiation are uncomfortably high (>50 mM) and are associated with gross intoxication and even death in nontolerant individuals. In contrast to these findings, a recent spate of reports has suggested that a special class of GABAA receptors may be exquisitely sensitive to concentrations of ethanol that are achieved following 1 drink or less. One such member of this family of receptors is thought to be composed of a4 subunits in combination with b and d subunits. These receptors reside outside the gates of the GABAergic synapse where they are exposed to very low ambient levels of GABA. These so-called ‘‘extra’’ synaptic receptors possess a high sensitivity to GABA and a low rate of desensitization allowing them to contribute to the background or tonic level of chloride conductance found in many neurons. This buzz of inhibitory ion flow can be likened to the residual cosmic radiation leftover from the Big Bang and has an important role in regulating neuronal excitability in many brain areas. Interestingly, tonic GABA-mediated currents are enhanced by the action of specific endogenous neurosteroids as well as exogenous pharmacological agents such as Gaboxadol (7-tetra hydroisoxazolo[ 5, 4-c]pyridin-3-ol; THIP) that has been under consideration for use as a sleep aid.

In this issue of ACER, 2 papers appear that examine the effects of ethanol in animals that lack the a4 gene.
. . . . . . .
Despite the unexpected findings of Liang et al. (2008) and Chandra et al. (2008), the results of these studies underscore the incredible advances and opportunities that are now available in the alcohol research field. They also stress the importance of combining multiple experimental approaches to better link changes in neurotransmitter signaling pathways to complex ethanol-related behaviors. Finally, they demonstrate the critical need for continued funding of innovative and sophisticated research focused on clearly defining elements that mediate ethanol’s effects on brain and behavior.

Read Summary

Request Reprint E-Mail: woodward@musc.edu ________________________________________________________________

Diageo: solve Kenya's drink problem with cheap beer

Simon Bowers
The Guardian,
Tuesday December 11 2007

The solution to problem drinking in some of the poorest parts of Africa is to flood troublesome districts with ultra-low-cost beer, according to the world's biggest alcoholic drinks group Diageo.

The counter-intuitive proposal offers an affordable alternative to the high-strength and often toxic moonshine prevalent in many slums and rural communities.

After early signs of success for a pilot project in Kenya, Diageo's East African Breweries (EAB) has begun discussions with other governments struggling with similar problems of illicit alcohol. Inquiries have come from South Africa and a number of west African countries.

In Kenya illicit alcohol is estimated to account for about half of consumption. Drink is linked not just anti-social behaviour but also to acute health problems from toxic substances used to fortify illicit spirits. The incidence of drink-related blindness and death is said to be extremely high.
. . . . . .

Read Full Article

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Press Release - Ksh15 Million Campaign Launched for the Prevention of Underage Drinking

Identification at point of purchase a key pillar of the We ID Campaign

Nairobi August 20, 2007….In an effort to proactively address concerns around access and sale of alcohol to underage people, the National Alcohol Beverages Association of Kenya (NABAK) has launched a Ksh15 million campaign to prevent underage drinking.

Speaking during the launch in Nairobi today, NABAK’s Vice Chairman, Ken Kariuki, said the campaign dubbed ‘’We ID Campaign’’, being rolled out in partnership with retail outlets, is a proactive industry initiative driven by the need to prevent access and sale of alcohol to people below the legal drinking age (18 years).

Kariuki explained that the We ID Campaign is underpinned by NABAK’s position against sale and access of alcohol by underage people. ‘’Our members are responsible corporate citizens, who do not support sale of alcoholic beverages to people below the legal drinking age’’, said he.

The Vice Chairman added the We ID campaign will include; rolling out of entrance signage (at pubs, restaurants, and hotels), point of purchase posters (at retail outlets and stores that sell alcohol), and badges for bar tenders. The key message in the communication material will be; ‘’We don’t sell alcohol to persons under 18 years’’.

Staff in retail outlets (including bar tenders and managers) will also be trained to give them tips on how to implement the identification policy. Kariuki said one of the key requirements is proof of identification for customers suspected to be below 18 years, which will help weed out underage people trying to access alcohol.

The Vice Chairman observed, ‘’we are opposed to this practice and support strict enforcement of the law which bars the sale of alcoholic beverages to people below 18 years’’.

Kariuki disclosed that NABAK has also put other measures in place to protect the young people, especially from the impact of alcohol advertising. According to the NABAK Advertising Rules which are enshrined in the Code of Conduct, alcohol beverage advertising is not directed at persons under the legal drinking age (18 years). According to the Advertising Rules, people below 25 years are not associated with the act of drinking in any ads. Kariuki said, ‘’we have stringent enforcement mechanisms in place to ensure members comply without exception’’.
. . . . . .

Read Full Press Release

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Major Genetic Components Underlying Alcoholism in Korean Population
Human Molecular Genetics Advance Access published online on December 4, 2007



Alcohol metabolism is one of the biological determinants that could significantly be influenced by genetic polymorphisms in alcohol-metabolism genes.

Alcohol dehydrogenase (ADH) converts alcohol to acetaldehyde, and aldehyde dehydrogenase (ALDH) converts acetaldehyde to acetate. The well-known genetic polymorphisms in ADH1B(His47Arg) and ALDH2(Glu487Lys) have dramatic effects on the rate of metabolizing alcohol and acetaldehyde, respectively (1-6).

The protective allele of ADH1B (ADH1B*47His) encodes for a rapid ethanol-metabolizing enzyme, and the susceptible allele of the ALDH2 (ALDH2*487Lys) is strongly associated with decreased rate of metabolizing acetaldehyde.

However, the combined genetic effects of both functional polymorphisms have not been clarified.

The combined analysis of two polymorphisms among a Korean population (n=1,032) revealed dramatic genetic effects on the risk of alcoholism. Individuals bearing susceptible alleles at both loci have 91 times greater risk for alcoholism (OR=91.43, P=1.4x 10^–32) and individuals bearing one susceptible and one protective allele at either loci have 11 times greater risk (OR=11.40, P=3.5x10^–15) compared with subjects who have both protective alleles.

The attributable fraction (AF) of those genetic factors, calculated based on population controls, indicates that alcoholism in 86.5% of alcoholic patients can be attributed to the detrimental effect of ADH1B*47Arg and/or ALDH2*487Glu in Korean population.

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Request Reprint E-Mail: hdshin@snp-genetics.com
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Alcohol Treatment Guidelines for Indigenous Australians

The Alcohol Treatment Guidelines for Indigenous Australians have been developed to give guidance to healthcare providers working with Indigenous clients who are adversely affected by alcohol consumption.

The guidelines are designed to be a reliable source of information and direction that has sufficient flexibility for appropriate situational adjustment.
. . . . . .

Download Part One Introduction (PDF)

Download Full Document (PDF)
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National Health Interview Survey (NHIS)


WHAT'S NEW!

Based on Data From the January-June 2007 National Health Interview Survey

Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year: United States, 1977-June 2007

• For the period January through June 2007, the percentage of adults who had five or more drinks in 1 day at least once in the past year was 19.8% (95% confidence interval = 18.66–20.87%), which was not significantly different from the 2006 estimate of 19.6%.

• From 2001 through 2003, the annual percentage of adults who had five or more drinks in 1 day at least once in the past year decreased from 20.0% to 19.1%. The percentage has remained stable since 2003.

Percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by age group and sex: United States, January–June 2007

• For both men and women, younger adults were more likely than older adults to have had five or more drinks in 1 day at least once in the past year.

• In all four age groups, men were considerably more likely than women to have had five or more drinks in 1 day at least once in the past year.

Age-sex-adjusted percentage of adults aged 18 years and over who had five or more drinks in 1 day at least once in the past year, by race/ethnicity: United States, January–June 2007

• The age-sex-adjusted percentage of adults who had five or more drinks in 1 day at least once in the past year was 16.3% for Hispanic adults, 23.7% for non-Hispanic white adults, and 10.2% for non-Hispanic black adults.

• Non-Hispanic white adults were most likely to have had five or more drinks in 1 day at least once in the past year, followed by Hispanic adults and non-Hispanic black adults.

Read Full Alcohol Consumption Section (PDF)
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Comment - Yes, we can act against the corruption of children's lives


Jackie Ashley
Monday December 10, 2007
The Guardian


Be it binge-drinking or sexualisation, evidence of damaging social change is too obvious to ignore. But there are things we can do

What is moral panic and what is a social crisis? Ed Balls, the children's minister, is launching another study this week into the effects on youngsters of commercialisation, video games, early sexualisation and a hard drinking culture. It's a "condition of Britain" moment. Libertarians will respond with a groan. There they go again, politicians knee-jerking to the agenda of the tabloids. Yes, yes, the amateur historians will nod, it's always been thus, one hysteria after another about the condition of childhood. Others, including millions of parents, will mumble: what can politicians actually do?

Ed Balls had the grace to admit on television yesterday that this was dangerous territory. We all know that there have been vast social changes over the past few decades. But government is hardly all-powerful. There are things it can affect, and should. And there are things it can merely observe. Isn't all this merely populist handwringing.

Well, it certainly addresses real issues. There is a vast sleof surveys and statistics, from reputable academics and government bodies, which have charted the growth in youthful boozing. As the Institute for Alcohol Studies has pointed out, back between the wars, those in the 18 to 24 age group were the least likely to drink, and through the 1950s, with its coffee culture, they were still, relatively speaking, non-drinkers.

The pattern only started to change slowly in the 1960s, and by the 1980s this group had become the heaviest drinkers. Since then, young people have been drinking more, and earlier. By 2002 harmful drinking - defined as causing risk of physical or psychological harm - was most prevalent in teenagers and young adults. Just under a third of women aged 16 to 19 were drinking dangerously. Other surveys found very high numbers of children as young as 10 or 11 were drinking regularly. This is not hearsay or wrinkly prejudice, but careful research. Studies have also examined the effects of binge drinking on the liver and brain.
. . . . . .

Read Full Article
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UK Alcohol Treatment Trial: client-treatment matching effects
Addiction (OnlineEarly Articles). 7 Dec 20o7

To test a priori hypotheses concerning client–treatment matching in the treatment of alcohol problems and to evaluate the more general hypothesis that client–treatment matching adds to the overall effectiveness of treatment.

Pragmatic, multi-centre, randomized controlled trial (the UK Alcohol Treatment Trial: UKATT) with open follow-up at 3 months after entry and blind follow-up at 12 months.

None of five matching hypotheses was confirmed at either follow-up point on any outcome variable.

The findings strongly support the conclusion reached in Project MATCH in the United States that client–treatment matching, at least of the kind examined, is unlikely to result in substantial improvements to the effectiveness of treatment for alcohol problems.

Possible reasons for this failure to support the general matching hypothesis are discussed, as are the implications of UKATT findings for the provision of treatment for alcohol problems in the United Kingdom.

Read Full Abstract


Request Reprint E-Mail: nick.heather@unn.ac.uk
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Commentary - ALCOHOL AND VIOLENCE: A COMPLEX NEXUS OF DRINKING ENVIRONMENT AND DRINKING PATTERN
Addiction 103 (1), 78–79.

While studies of homicide victims, for example by Parker [1], Cherpitel et al. [2] and others, have demonstrated a strong association of drinking and violence, explanations of this relationship were often elusive. A part of this conundrum was whether this resulted from personal characteristics including personality and genetics of the individual victim (or perpetrator), or the drinking group, or the effects of alcohol on the victim, or the perpetrator, or both in the moment. This produced a disinhibition explanation of violence and alcohol; i.e. because drinkers are impaired by alcohol, their ability to make reasonable decisions about behavior, including conflict avoidance, is diminished. One of my favorite drawings from the ‘Dark Side’ cartoon series shows three obviously drunk dogs standing on a hill looking down into a cage in the zoo occupied by a large black panther. Two dogs are encouraging a third to enter the panther's cage with the statement, ‘Go ahead . . . you can take him!’. This, in a nutshell, presents one of the popular explanations for why drinkers become involved in violence, i.e. drunk people make stupid decisions and get into fights.

Fortunately, three papers in this issue provide rich insights into the basis for explaining the association of alcohol and violence [3–5]. Hughes et al. [3] studied the relationship of drinking before and after going out into public spaces and violence in an effort to explore how personal drinking patterns and location or setting of pre-public drinking influenced alcohol-related problems in public spaces, including licensed alcohol establishments. They found that drinkers who began drinking at home or at a friend's home before going out to public drinking venues in England reported significantly higher levels of total consumption over the night out and an almost three times greater risk of being involved in a fight in such public drinking settings. The authors suggested that the relative price per drink differential between private drinking (using off-premise purchased alcohol) and in pubs and nightclubs (using on-premise purchased alcohol) may well contribute to this pattern. This ‘pre-loading’ on alcohol using low-cost sources prior to going out seemed to increase the risk of violence. They even proposed that ‘Measures to tackle drunkenness and alcohol-related violence in nightlife should expand beyond those solely targeted at nightlife environments’ [3].

The second study, by Boyle et al. [4], examined self-reported drinking and personal hostility within a large cohort of individuals from the United States who were involved in the Vietnam War. They found that hostility, i.e. as measured by an abbreviated version of the Cook–Medley hostility scale (ACM), was associated with total monthly intake of alcohol as well as drinks per drinking day and heavy episodic drinking. They concluded that hostility is associated with a heavy per-occasion drinking pattern and thus, not surprisingly, elevated personal mortality.

Treno et al. [5] found that individuals living in neighborhoods in California, USA with high concentrations of pubs and bars held personal values of greater acceptability of alcohol-related aggression and carried out more frequent heavy drinking at bars and pubs as well as at parties and friends' homes. While the direction of influence is unknown via this cross-sectional research, the authors concluded that both alcohol outlet densities and the personal acceptability of alcohol-related violence co-occur together.

At first glance, these three studies appear to be separate aspects of the nexus of drinking with violence [3–5]. However, all three studies found an association of heavy consumption per drinking event and self-reported violence or hostility.
. . . . . .

Read Full Commentary (PDF)

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Banning Glassware from Nightclubs in Glasgow (Scotland): Observed Impacts, Compliance and Patron’s Views
Alcohol and Alcoholism Advance Access published online on October 11, 2007



To examine the impact of a glassware ban policy on disorder-related harm within licensed premises (nightclubs) and how this action was viewed by their patrons.

Exemptions to the ban had enabled some premises (three out of eight) to continue to serve alcoholic drinks in glass vessels, and injurious violence resulting from these practices was observed. Disorder in all-plastic venues was observed to incur less injury risk. Patrons also reported feeling safer in these nightclubs than in others.

This research demonstrated the potential of such policy to reduce the severity of alcohol-related violence in the night-time economy. It is recommended that future bans of this nature be tailored towards the elimination of all types of glassware from such premises.

Read Full Abstract

Request Reprint E-Mail: Alasdair.Forsyth@gcal.ac.uk

Source: IHRA eNewsletter Dec 2007 Article of the Month
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Anti-drink ad 'not effective'
James Randerson, science correspondent
The Guardian,
Monday December 10 2007

A drinks industry-funded campaign to encourage responsible drinking in the run up to Christmas is ill-conceived, according to researchers who have studied young people's attitudes to alcohol.

"The Choice Is Yours" campaign features two adverts each depicting a very different night out. One ends in drunken behaviour, embarrassment and a hangover, while the other shows the positive and sociable side of responsible drinking.

But the researchers say that the drunken antics depicted in the "bad" night out are seen by most young people as part of a bonding experience with friends.

"I don't think it will be really effective," said Professor Christine Griffin of Bath University, who led the study.

She said that even nights culminating in a trip to casualty are often seen as a badge of honour by young drinkers. She said that focusing on the longer-term consequences of drinking would be more effective.

The researchers gathered information on attitudes to drinking by conducting 10 structured focus groups with men and women aged 18 to 25, plus four interviews. The research will be published in the International Journal of Drug Policy.
. . . . . .

Read Full Article

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Clinical and temperamental differences between early- and late-onset alcoholism in Korean men
Comprehensive Psychiatry Volume 49, Issue 1, January-February 2008, Pages 94-97

The aims of this study were to elucidate the clinical and temperamental differences between early- and late-onset alcoholism among Korean men and to ascertain the validity of Cloninger's typology model of alcoholism for Koreans.

Early-onset patients exhibited more criminality, suicide attempts, and family history of alcoholism . With regard to the tridimensional personality questionnaire profile, the early-onset patients exhibited a higher score of novelty seeking, with the difference still being significant after adjusting for age by analysis of covariance (using age as a covariate). However, harm avoidance, reward dependence, and persistence did not differ between the 2 groups.

There were several distinct clinical and temperamental differences between early- and late-onset alcoholism among Korean male alcoholic patients. It is suggested that the age at the onset of alcoholism can be used to discriminate alcoholic subtypes.

Our data also partly support Cloninger's typology of 2 types of alcoholic individuals.

Read Full Abstract

Request Reprint E-Mail: leehjeong@korea.ac.kr

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The association of self-reported neighborhood disorganization and social capital with adolescent alcohol and drug use, dependence, and access to treatment
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 173-182



This research examines adolescent perceptions of neighborhood disorganization and social capital to determine if they are associated with adolescent alcohol or drug (AOD) use, AOD dependence, and access to AOD treatment.

Neighborhood disorganization was self-reported by youth in response to eight items; 10 items measured social capital. AOD use was also self-reported. AOD dependence was assessed by a series of questions regarding symptoms and impairment that is consistent with the criteria specified in the DSM-IV.

A little more than half of the youth reported never using alcohol or drugs (54.3%), 41.1% reported lifetime AOD use, and 4.6% were AOD dependent. Two percent reported receiving AOD treatment.

Medium and high levels of social capital were negatively associated with AOD use and dependence. Social capital was unrelated to access to AOD treatment.

Neighborhood disorganization was positively associated with AOD use, dependence, and access to treatment After controlling for individual- and family-level characteristics, neighborhood disorganization and social capital were associated with AOD use and dependence.

The findings suggest that subjective measures of social context may be an important component of the complex biopsychosocial model of adolescent AOD addiction and treatment utilization.

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Request Reprint E-Mail: erinwinstanley@mac.com

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Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 239-247


We extend the literature on the association of early onset of drug use and estimated risk for developing a substance use disorder (SUD) by investigating the risk that recent onset of alcohol and cannabis use confers for developing a substance use disorder at each chronological age of adolescence and young adulthood (12–21-years-old).

The results indicated that the teenage years were strongly linked to an elevated risk status.

The odds ratio (OR) of having a prior year alcohol use disorder (AUD) among recent onset alcohol users was significantly elevated for youth at ages 14, 16, 17 and 18 (range of ORs = 2.0–2.1) compared to the estimated risk for AUD among recent onset users aged 22–26.

For cannabis, we obtained significantly elevated ORs for a cannabis use disorder (CUD) at each of teenage years (ages 12–18; range of ORs = 3.9–7.2), when compared to older recent onset users (aged 22–26).

These data provide further epidemiological support that adolescence is a particularly vulnerable period for developing a SUD.

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Request Reprint E-Mail: winte001@umn.edu

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Responsiveness of EQ-5D utility indices in alcohol-dependent patients
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 291-295

The EQ-5D provides community-based preference weights (utilities) for calculating quality adjusted life years (QALYs) in cost-utility analysis.

This study aimed to analyze the responsiveness of EQ-5D-based utilities in patients with alcohol dependence.

ES were rather trivial to medium for all EQ-5D indices (ranging from |0.10| to |0.59|) related to a shift from “same” to “less” problems in the two anchors. Differences in scores of the EQ-5D indices revealing a shift from “same” to “less” problems according to the two anchors were not significant.

These results suggest that the EQ-5D indices are less responsive and require larger patient samples to detect meaningful clinical differences compared to the other used instruments. Additional research is needed to compare societal and clinical views on relevant change in health status in this patient group.

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Request Reprint E-Mail: oliver.guenther@medizin.uni-leipzig.de

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Smaller feedback ERN amplitudes during the BART are associated with a greater family history density of alcohol problems in treatment-naïve alcoholics
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 141-148

Alcoholism is characterized by impaired decision-making (i.e., choosing intoxication in the face of mounting negative consequences). This impairment may involve a reduced brain response to the negative consequences of behavior, which supports an inclination to engage in risky behaviors.

The feedback error-related negativity (F-ERN) is hypothesized to reflect the valence attached to the negative consequences of behavior. Performance on the Balloon Analogue Risk Task (BART) measures risk-taking propensity. We recorded F-ERNs during the BART and during a BART simulation, where individuals observed the rewards and consequences of (someone else's) BART performance.

F-ERNs over fronto-central electrode sites were observed to balloon pops in the BART and BART simulation. F-ERNs during the BART were more than twice the amplitude of F-ERNs during the BART simulation. Smaller F-ERN amplitudes from the BART (but not the BART simulation) were associated with a greater family history density of alcohol problems.

The results suggest a possible link between the genetic vulnerability toward developing alcoholism and the brain's response to the negative consequences of behavior.

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Request Reprint E-Mail: george@nbresearch.com

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The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 123-131


Legal coercion is frequently used to leverage substance abuse treatment upon persons who would otherwise not seek it voluntarily. Various methodological and conceptual problems of the existing research have prevented a clear understanding of its effectiveness.

The influence of legal coercion on retention in substance abuse treatment was examined using a national survey of programs in the public sector of care and three different treatment modalities including short-term residential , long-term residential , and outpatient treatment.

Legal coercion was found to reduce the risk of dropout across all three treatment modalities. The greatest effect was among persons in short-term residential treatment. The smallest effect was observed in outpatient treatment.

This study shows that legal coercion significantly reduces the risk of dropout in substance abuse treatment. However, the differential effects across treatment conditions must be carefully considered when using coercion to involve individuals in treatment.

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Request Reprint E-Mail: beperron@umich.edu
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Problem-free drinking over 16 years among individuals with alcohol use disorders
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 116-122


Limited data exist on the rates and long-term stability of non-problem drinking in individuals who sought help for an alcohol use disorder.

A sample of initially untreated individuals with alcohol use disorders (n = 420) was surveyed at baseline and 1 year and was re-assessed at 8 and 16 years.

In the 6 months prior to the 1-year assessment, 36% (n = 152) of participants reported abstinence from alcohol, 48% (n = 200) reported drinking with problems, and 16% (n = 68) reported non-problem drinking.

At each follow up, 16–21% of the sample reported non-problem drinking. Compared to individuals in the abstinent and problem-drinking groups, individuals who were drinking in a problem-free manner at 1 year had reported, at baseline, fewer days of intoxication, drinks per drinking day, alcohol dependence symptoms, and alcohol-related problems, less depression, and more adaptive coping mechanisms.

Over time, 48% of participants who engaged in non-problem drinking at 1 year continued to report positive outcomes (either non-problem drinking or abstinence) throughout the long-term follow-up, whereas 77% of those abstaining at 1 year reported positive outcomes throughout the same time period.

Additionally, 43% of individuals with problematic alcohol consumption at 1 year reported positive outcomes over the remaining follow-up interval, a rate that was not significantly different from the rate of positive outcomes of 48% observed in those with initial problem-free drinking.

Although some individuals report non-problem drinking a year after initially seeking help, this pattern of alcohol use is relatively infrequent and is less stable over time than is abstinence.

An accurate understanding of the long-term course of alcohol use and problems could help shape expectations about the realistic probability of positive outcomes for individuals considering moderate drinking as a treatment goal.

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Request Reprint E-Mail: mark.ilgen@va.gov

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Ethnic differences in alcohol treatment outcomes and the effect of concurrent smoking cessation treatment
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 61-68

The Timing of Alcohol and Smoking Cessation (TASC) Study tested the optimal timing of smoking cessation treatment in an alcohol-dependent population. Previously reported results suggest that providing concurrent smoking cessation treatment adversely affects alcohol outcomes.

The purpose of this analysis was to investigate whether there are ethnic differences in alcohol and tobacco outcomes among a diverse sample of alcohol-dependent smokers using data from the TASC trial in which 499 participants were randomized to either concurrent (during alcohol treatment) or delayed (6 months later) smoking intervention.

This analysis focused on smokers of Caucasian (n = 381) and African American (n = 78) ethnicity. Alcohol outcomes included 6 months sustained alcohol abstinence rates and time to first use of alcohol post-treatment. Tobacco outcomes included 7-day point prevalence smoking abstinence. Random effects logistic regression analysis was used to investigate intervention group and ethnic differences in the longitudinally assessed alcohol outcomes.

Alcohol abstinence outcomes were consistently worse in the concurrent group than the delayed group among Caucasians, but this was not the case for African Americans. No significant ethnic differences were observed in smoking cessation outcomes.

Findings from this analysis suggest that concurrent smoking cessation treatment adversely affects alcohol outcomes for Caucasians but not necessarily for African Americans.

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Request Reprint E-Mail: Steven.Fu@va.gov
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Prefrontal cortex modulation using transcranial DC stimulation reduces alcohol craving: A double-blind, sham-controlled study
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 55-60


Functional neuroimaging studies have shown that specific brain areas are associated with alcohol craving including the dorsolateral prefrontal cortex (DLPFC). We tested whether modulation of DLPFC using transcranial direct current stimulation (tDCS) could alter alcohol craving in patients with alcohol dependence while being exposed to alcohol cues.

Our results showed that both anodal left/cathodal right and anodal right/cathodal left significantly decreased alcohol craving compared to sham stimulation (p <>

Our findings showed that tDCS treatment to DLPFC can reduce alcohol craving. These findings extend the results of previous studies using noninvasive brain stimulation to reduce craving in humans. Given the relatively rapid suppressive effect of tDCS and the highly fluctuating nature of alcohol craving, this technique may prove to be a valuable treatment strategy within the clinical setting.

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Request Reprint E-Mail: ffregni@bidmc.harvard.edu
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Norepinephrine transporter polymorphisms T-182C and G1287A are not associated with alcohol dependence and its clinical subgroups
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 20-26


Several studies have suggested that the norepinephrine transporter (NET) may play an important role in the pathogenesis of alcohol dependence. Additional studies have shown that the polymorphisms of T-182C (rs2242446) and G1287A (rs5569) in NET gene (hSLC6A2) may affect the NET function.

Therefore, in this study, we examined whether these hSLC6A2 gene polymorphisms are a susceptibility factor for alcohol dependence or its clinical subgroup(s).

No significant differences in genotype and allele frequencies of hSLC6A2 polymorphisms were found between controls and total alcohol dependence or between more homogeneous subgroups with alcohol dependence and controls.

This study suggests that the polymorphisms of T-182C and G1287A in hSLC6A2 gene are not major risk factors in increasing susceptibility to either alcohol dependence or its clinical subtypes.

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Request Reprint E-Mail: hsy@ndmctsgh.edu.tw
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The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): Reliability of new psychiatric diagnostic modules and risk factors in a general population sample
Drug and Alcohol Dependence Volume 92, Issues 1-3, 1 January 2008, Pages 27-36


This study presents test–retest reliability statistics and information on internal consistency for new diagnostic modules and risk factors for alcohol, drug, and psychiatric disorders from the Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV).

Test–retest statistics were derived from a random sample of 1899 adults selected from 34,653 respondents who participated in the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Internal consistency of continuous scales was assessed using the entire Wave 2 NESARC. Both test and retest interviews were conducted face-to-face.

Test–retest and internal consistency results for diagnoses and symptom scales associated with posttraumatic stress disorder, attention-deficit/hyperactivity disorder, and borderline, narcissistic, and schizotypal personality disorders were predominantly good (kappa > 0.63; ICC > 0.69; alpha > 0.75) and reliability for risk factor measures fell within the good to excellent range (intraclass correlations = 0.50–0.94; alpha = 0.64–0.90).

The high degree of reliability found in this study suggests that new AUDADIS-IV diagnostic measures can be useful tools in research settings.

The availability of highly reliable measures of risk factors for alcohol, drug, and psychiatric disorders will contribute to the validity of conclusions drawn from future research in the domains of substance use disorder and psychiatric epidemiology.


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Request Reprint E-Mail: bgrant@willco.niaaa.nih.gov
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Modeling the complexity of post-treatment drinking: It's a rocky road to relapse
Clinical Psychology Review Volume 27, Issue 6, July 2007, Pages 724-738



The most widely cited road block to successful treatment outcomes for psychological and substance use disorders has been described as the return to the previous behavior, or “relapse.”

The operational definition of “relapse” varies from study to study and between clinicians, but in general the term is used to indicate the return to previous levels of symptomatic behavior.

One explanation for the variation in the operationalization of relapse is the wide variety of behaviors for which the term is applied, including (but not limited to): depression, substance abuse, schizophrenia, mania, sexual offending, risky sexual behavior, dieting, and the anxiety disorders. A second explanation for the multitude of definitions for relapse is the inherent complexity in the process of behavior change.

In this paper we present the most recent treatment outcome research evaluating relapse rates, with a special focus on the substance use disorders. Following this review of the literature we present an argument for the operationalization of relapse as a dynamic process, which can be empirically characterized using dynamical systems theory.

We support this argument by presenting results from the analysis of alcohol treatment outcomes using catastrophe modeling techniques. These results demonstrate the utility of catastrophe theory in modeling the alcohol relapse process.

The implications of these analyses for the treatment of alcohol use disorders, as well as a discussion of future research incorporating nonlinear dynamical systems theory is provided.

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Request Reprint E-Mail: kate19@u.washington.edu
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