Thursday, December 27, 2007 |
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Friday, January 4, 2008
Action News Vol. XVII No. 4 (2007)
Contents:
* IOS beats predictions: Attendance at CCSA's biennial conference approaches 1,000
* Youth Drug Prevention Strategy: CCSA's new five-year plan will target Canada's 10-24 year olds
* Driving after drinking persists: CCSA bases journal article on 2004 CAS drinking-driving data
* Tungasuvvingat Inuit partnership a first: CCSA signs its first Inuit-specific memorandum of agreement
* Centre Dollard-Cormier makes history: Quebec designates its first University Institute in Addictions
* New electronic newsletter launched: Network News targets Canada's substance abuse workforce
* Women's issues explored at IOS: CCSA and BCCEWH sponsor national networking session
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| January 2008 |  | vol. 9 issue 1 |
Center Line NewsletterVolume 18, Issue 4, December 2007
- Criswell and Colleagues Illuminate the Mystery of Alcohol Actions
- Ehlers Receives Thurman Lectureship Award
- Director's Column
(download in PDF format)
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The Impact of Depressive Symptoms on Alcohol and Cigarette Consumption Following Treatment for Alcohol and Nicotine Dependence Alcoholism: Clinical and Experimental Research 32 (1), 92–99.
Although depression is common among alcohol and tobacco dependent patients, its impact on treatment outcomes is not well established. The purpose of this study was to examine the impact of depressive symptoms on abstinence from tobacco and alcohol after treatment for alcohol dependence and nicotine dependence.
Depressive symptoms were prospectively related to nonabstinence from alcohol. Depressive symptoms at the previous assessment increased the odds of drinking at the subsequent time point by a factor of 1.67 (95% CI 1.14, 2.43), p <>
Depression is an important negative predictor of the ability to maintain abstinence from alcohol within the context of intensive alcoholism and smoking treatment. It may be important to include depression-specific interventions for alcohol and tobacco dependent individuals to facilitate successful drinking treatment outcomes.
Request Reprint E-Mail: Molly.Kodl@va.gov
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Thursday, January 3, 2008
Traffic Safety and Alcohol Regulation: A SymposiumReduction of alcohol-impaired driving can be considered from both sides of the problem: how to reduce traffic problems and how to reduce alcohol impairment. A variety of alcohol control and regulation strategies have been found to reduce alcohol impairment among drivers. In order to review and synthesize many of the most promising strategies in alcohol regulation, the Alcohol, Other Drugs, and Transportation Committee of the Transportation Research Board (TRB) convened a workshop to discuss the role of alcohol regulation in traffic safety. The workshop was held June 5–6, 2006, at the National Academies’ Beckman Conference Center in Irvine, California. This report provides an overview of the information presented and the discussions among the participants as well as the background papers prepared for the workshop.
Download Full Report (PDF)
Components:
- Alcohol Law Enforcement: Agencies, Methods, and Impact
- Alcohol Policies in the Americas
- Alcohol Prices and Traffic Safety
- Alcohol Regulation and Traffic Safety: An Overview
- Alcohol Regulation in Sweden and the European Union: Effects on Road Safety
- Alcohol Sales and Service to Underage Youth and Intoxicated Patrons: Effects of Responsible Beverage Service Training and Enforcement Interventions
- Detecting Alcohol Impairment by Observation of Intoxication
- Enhanced Enforcement of Laws Prohibiting Sale of Alcohol to Minors: Systematic Review of Effectiveness for Reducing Sales and Underage Drinking
- Legal Framework for Alcohol Regulation in the United States
- Limits on Hours of Sales and Service: Effects on Traffic Safety
- Limits on Outlet Density and Location: Effects on Traffic Safety
- Minimum Purchase Age Laws: How Effective Are They in Reducing Alcohol-Impaired Driving?
- Status of 14 Under-Age-21 Drinking Laws in the United States
- The Effects of Establishing Closing Hours in Juarez, Mexico
- The Importance of Alcohol Regulation at All Levels: Bringing It All Together—Lessons from Underage Drinking Controls
- Traffic Safety and Alcohol Regulation: Overview and Summary
Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2006Alcohol Drinking Status (Tables 26,27)
Download Full Report (PDF)
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Wednesday, January 2, 2008
Prime Minister takes charge of battle against binge-drinkingBy Colin Brown and Ben Russell
Published: 02 January 2008
As Britain recovers from an epic seasonal party spree, a radical package of measures to create a "cultural shift" away from the epidemic of binge drinking is being drawn up by Gordon Brown.
Parents will be encouraged to educate their children in the dangers of drink under proposals discussed at a Downing Street summit. Ministers are also contemplating moves to raise the tax on the most potent beers and mixers associated with binge drinking by putting duty on units of alcohol. Mr Brown is also being urged by Labour MPs to force supermarkets to raise the minimum price of drink to reduce the attraction of cheap alcohol.
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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 womenEuropean Heart Journal 2008 29(1):104-112
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).
Among non-carriers 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.Read Full Abstract
Request Reprint E-Mail: mkj@dce.au.dk
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Alcohol and long-term prognosis after a first acute myocardial infarction: the SHEEP studyEuropean Heart Journal 2008 29(1):45-53
Few studies have investigated the relation between alcohol consumption, former drinking, and prognosis after an acute myocardial infarction (AMI), particularly for non-fatal outcomes.
To investigate the prognostic importance of drinking habits among patients surviving a first AMI.
We recorded 267 deaths, and 145 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total and cardiac mortality were 0.77 and 0.61 for those drinking >0–<5> those drinking over 20 g per day.Risk of hospitalization for recurrent non-fatal AMI, stroke, or heart failure generally showed a similar pattern to that of total and cardiac mortality.
Recent quitters at the time of AMI had a hazard ratio of 4.55 for total mortality. Measures of insulin sensitivity appeared to be the strongest mediators of this association.
Moderate alcohol drinking might have beneficial effects on several aspects of long-term prognosis after an AMI. Our findings also highlight that former drinkers should be examined separately from long-term abstainers. The potential mechanisms that underlie this association still need to be elucidated.
Read Full Abstract
Request Reprint E-Mail: imre.janszky@ki.se
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Monday, December 31, 2007
A Systematic Single Nucleotide Polymorphism Screen to Fine-Map Alcohol Dependence Genes on Chromosome 7 Identifies Association With a Novel Susceptibility Gene ACN9Biological Psychiatry Article in Press, Corrected Proof 27 December 2007
Chromosome 7 has shown consistent evidence of linkage with a variety of phenotypes related to alcohol dependence in the Collaborative Study on the Genetics of Alcoholism (COGA) project.
With a sample of 262 densely affected families, a peak logarithm of odds (LOD) score for alcohol dependence of 2.9 was observed at D7S1799. The LOD score in the region increased to 4.1 when a subset of the sample was genotyped with the Illumina Linkage III panel for the Genetic Analysis Workshop 14 (GAW14).
To follow up on this linkage region, we systematically screened single nucleotide polymorphisms (SNPs) across a 2 LOD support interval surrounding the alcohol dependence peak.
The SNPs were selected from the HapMap Phase I CEPH data to tag linkage disequilibrium bins across the region. Across the 18-Mb region, genotyped by the Center for Inherited Disease Research (CIDR), 1340 SNPs were analyzed. Family-based association analyses were performed on a sample of 1172 individuals from 217 Caucasian families.
Eight SNPs showed association with alcohol dependence at p < .01. Four of the eight most significant SNPs were located in or very near the ACN9 gene. We conducted additional genotyping across ACN9 and identified multiple variants with significant evidence of association with alcohol dependence.
These analyses suggest that ACN9 is involved in the predisposition to alcohol dependence. Data from yeast suggest that ACN9 is involved in gluconeogenesis and the assimilation of ethanol or acetate into carbohydrate.
Request Reprint E-Mail: ddick@vcu.edu
Fetal Alcohol Syndrome Prevention Using Community-Based Narrowcasting CampaignsHealth Promotion Practice, Vol. 9, No. 1, 93-103 (2008)
Preventing fetal alcohol syndrome (FAS) by encouraging pregnant women to abstain from drinking alcohol competes with commercial alcohol marketing.
Two FAS-prevention campaigns using a narrowcast approach among young women of childbearing age in two disadvantaged Southern California communities are compared. The design, implementation process, and degree to which campaigns reached the priority populations are the focus of this article.
Formative research shows that young women in disadvantaged communities receive mixed messages about dangers of drinking during pregnancy. A social norms approach using positive role models was the most acceptable message strategy based on materials pretesting.
Differences in campaign implementation and distribution strategies between communities were documented through program monitoring. Survey research indicated the more viable messaging and implementation strategies.
Findings show that low-cost community campaigns are feasible; however, variations in messaging, distribution strategies, and saturation levels determine whether such campaigns succeed or fail to reach priority populations.
Read Full Abstract
Request Reprint E-Mail: dglik@ucla.edu
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Examining the effect of linkage disequilibrium between markers on the Type I error rate and power of nonparametric multipoint linkage analysis of two-generation and multigenerational pedigrees in the presence of missing genotype dataGenetic Epidemiology Volume 32, Issue 1 , Pages 41 - 51
Because most multipoint linkage analysis programs currently assume linkage equilibrium between markers when inferring parental haplotypes, ignoring linkage disequilibrium (LD) may inflate the Type I error rate.
We investigated the effect of LD on the Type I error rate and power of nonparametric multipoint linkage analysis of two-generation and multigenerational multiplex families.
Using genome-wide single nucleotide polymorphism (SNP) data from the Collaborative Study of the Genetics of Alcoholism, we modified the original data set into 30 total data sets in order to consider six different patterns of missing data for five different levels of SNP density. To assess power, we designed simulated traits based on existing marker genotypes. For the Type I error rate, we simulated 1,000 qualitative traits from random distributions, unlinked to any of the marker data.
Overall, the different levels of SNP density examined here had only small effects on power (except sibpair data). Missing data had a substantial effect on power, with more completely genotyped pedigrees yielding the highest power (except sibpair data). Most of the missing data patterns did not cause large increases in the Type I error rate if the SNP markers were more than 0.3 cM apart.
However, in a dense 0.25-cM map, removing genotypes on founders and/or founders and parents in the middle generation caused substantial inflation of the Type I error rate, which corresponded to the increasing proportion of persons with missing data.
Results also showed that long high-LD blocks have severe effects on Type I error rate.
Read Full Abstract
Request Reprint E-Mail: hokim@snu.ac.kr or jebw@mail.nih.gov
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Hospitals admit 500 binge drinkers a dayBy James Kirkup and Caroline Gammell
31/12/2007
An epidemic of binge drinking has fuelled a dramatic increase in the number of people being hospitalised after drinking to excess, The Daily Telegraph can disclose.
The number of alcohol-related hospital admissions has increased by almost a third in just two years as 24-hour drinking laws and the greater availability of cheap alcohol lead to increased consumption.
More than 500 people a day are now being admitted to hospitals in England after drinking too much.
In some parts of the country excess drinking is the cause of almost one in 20 hospital admissions.
The figures come just two weeks after official statistics showed that nearly 13 million Britons were drinking too much because they did not appreciate the increasing strength of alcoholic drinks or the trend for larger measures.
The latest figures obtained by The Daily Telegraph are part of official data recording alcohol-related admissions to NHS hospitals in England. They show a 31 per cent rise in just two years.
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Saturday, December 29, 2007
Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings.Biochemical Pharmacology Volume 75, Issue 1, 1 January 2008, Pages 34-56
The past decade has seen an expansion of research and knowledge on pharmacotherapy for the treatment of alcohol dependence. The Food and Drug Administration (FDA)-approved medications naltrexone and acamprosate have shown mixed results in clinical trials.
Oral naltrexone and naltrexone depot formulations have generally demonstrated efficacy at treating alcohol dependence, but their treatment effect size is small, and more research is needed to compare the effects of different doses on drinking outcome.
Acamprosate has demonstrated efficacy for treating alcohol dependence in European trials, but with a small effect size. In U.S. trials, acamprosate has not proved to be efficacious.
Research continues to explore which types of alcohol-dependent individual would benefit the most from treatment with naltrexone or acamprosate. The combination of the two medications demonstrated efficacy for treating alcohol dependence in one European study but not in a multi-site U.S. study.
Another FDA-approved medication, disulfiram, is an aversive agent that does not diminish craving for alcohol. Disulfiram is most effective when given to those who are highly compliant or who are receiving their medication under supervision.
Of the non-approved medications, topiramate is among the most promising, with a medium effect size in clinical trials. Another promising medication, baclofen, has shown efficacy in small trials.
Serotonergic agents such as selective serotonin reuptake inhibitors and the serotonin-3 receptor antagonist, ondansetron, appear to be efficacious only among certain genetic subtypes of alcoholic.
As neuroscientific research progresses, other promising medications, as well as medication combinations, for treating alcohol dependence continue to be explored.
Read Full Abstract
Request Reprint E-Mail: bankolejohnson@virginia.edu
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Friday, December 28, 2007
Computational models of ethanol-induced neurodevelopmental toxicity across species: Implications for risk assessmentBirth Defects Research Part B: Developmental and Reproductive Toxicology
Early View Published online 26 December 2007
Computational, systems-based approaches can provide a quantitative construct for evaluating risk in the context of mechanistic data. Previously, we developed computational models for the rat, mouse, rhesus monkey, and human, describing the acquisition of adult neuron number in the neocortex during the key neurodevelopmental processes of neurogenesis and synaptogenesis.
Here we apply mechanistic data from the rat describing ethanol-induced toxicity in the developing neocortex to evaluate the utility of these models for analyzing neurodevelopmental toxicity across species.
Our model can explain long-term neocortical neuronal loss in the rodent model after in utero exposure to ethanol based on inhibition of proliferation during neurogenesis.
Our human model predicts a significant neuronal deficit after daily peak BECs reaching 10-20 mg/dl, which is the approximate BEC reached after drinking one standard drink within one hour. In contrast, peak daily BECs of 100 mg/dl are necessary to predict similar deficits in the rat.
Our model prediction of increased sensitivity of primate species to ethanol-induced inhibition of proliferation is based on application of in vivo experimental data from primates showing a prolonged rapid growth period in the primate versus rodent neuronal progenitor population.
To place our predictions into a broader context, we evaluate the evidence for functional low-dose effects across rats, monkeys, and humans.
Results from this critical evaluation suggest subtle effects are evident at doses causing peak BECs of approximately 20 mg/dl daily, corroborating our model predictions.
Our example highlights the utility of a systems-based modeling approach in risk assessment.
Read Full Abstract
Request Reprint E-Mail: faustman@u.washington.edu
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Thursday, December 27, 2007
GABA-A2 receptor subunit gene (GABRA2) polymorphisms and risk for alcohol dependence.Journal of Psychiatric Research
Volume 42, Issue 3, February 2008, Pages 184-191
Gamma-aminobutyric acid (GABA) A receptors are believed to mediate some of the physiological and behavioral actions of ethanol. Recent studies have suggested that genetic variants of the GABA-A receptor alpha2 subunit gene (GABRA2) are associated with alcohol dependence.
The aim of this study is to confirm and extend the role of GABRA2 haplotypes in the liability to alcohol dependence.
One genetic variant was detected to significantly differ between alcohol-dependent subjects and controls. Two common 8 SNP haplotypes and their complementary alleles were identified containing this SNP and were present in 89.9% of controls and 93.4% of the alcohol-dependent individuals.
One of the haplotypes (T-C-A-C-A-T-T-C) was significantly associated with alcohol dependence and characteristics of alcohol withdrawal and severity of alcohol dependence (delirium tremens, withdrawal seizures).
These findings support and extend the three previous studies implicating a GABA-A receptor subunit as contributing to the genetic risk for alcohol dependence. Possible implications of these findings are discussed.
Read Full AbstractRequest Reprint E-Mail: michael.soyka@med.uni-muenchen.de
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News Release - Researchers Show that Fibrosis can be Stopped, Cured and ReversedDecember 27, 2007
Modified Protein Developed by UC San Diego Researchers May Lead to First Cure for Cirrhosis of the Liver
University of California, San Diego researchers have proven in animal studies that fibrosis in the liver can be not only stopped, but reversed. Their discovery, to be published in PLoS Online on December 26, opens the door to treating and curing conditions that lead to excessive tissue scarring such as viral hepatitis, fatty liver disease, cirrhosis, pulmonary fibrosis, scleroderma and burns.
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A Ribosomal S-6 Kinase–Mediated Signal to C/EBP-Ī² Is Critical for the Development of Liver FibrosisPLoS ONE 2(12): e1372
In response to liver injury, hepatic stellate cell (HSC) activation causes excessive liver fibrosis. Here we show that activation of RSK and phosphorylation of C/EBPĪ² on Thr217 in activated HSC is critical for the progression of liver fibrosis.
Chronic treatment with the hepatotoxin CCl4 induced severe liver fibrosis in C/EBPĪ²+/+ mice but not in mice expressing C/EBPĪ²-Ala217, a non-phosphorylatable RSK-inhibitory transgene. C/EBPĪ²-Ala217 was present within the death receptor complex II, with active caspase 8, and induced apoptosis of activated HSC.
The C/EBPĪ²-Ala217 peptides directly stimulated caspase 8 activation in a cell-free system. C/EBPĪ²+/+ mice with CCl4-induced severe liver fibrosis, while continuing on CCl4, were treated with a cell permeant RSK-inhibitory peptide for 4 or 8 weeks. The peptide inhibited RSK activation, stimulating apoptosis of HSC, preventing progression and inducing regression of liver fibrosis.
We found a similar activation of RSK and phosphorylation of human C/EBPĪ² on Thr266 (human phosphoacceptor) in activated HSC in patients with severe liver fibrosis but not in normal livers, suggesting that this pathway may also be relevant in human liver fibrosis.
These data indicate that the RSK-C/EBPĪ² phosphorylation pathway is critical for the development of liver fibrosis and suggest a potential therapeutic target.
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The DRAM, 3(11) - Childhood Sexual Abuse, Age of First Drink, and Onset of Alcohol DependenceDecember 26, 2007
Studies linking childhood sexual abuse (CSA) to higher likelihood of alcohol dependence (AD) later in life (i.e., Dinwiddie et al., 2000; Fergusson, Horwood, & Lynskey, 1996; Kendler et al., 2000; Kilpatrick et al., 2000; Molnair, Buka, & Kessler, 2001; Nelson et al., 2002) might lack adequate control for environmental and genetic factors that influence the relationship between CSA and AD.
These studies are also inconclusive because an earlier age of first drink is associated with later AD regardless of CSA status (DeWit, 2000).
This week’s DRAM reviews a study that controls for the influence of environmental and genetic characteristics, as well as the influence of drinking at an early age using a sample of twins
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Read Full Article
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Wednesday, December 26, 2007
By DAVID LEONHARDT
Published: December 26, 2007
“We are fortunate to be living in a time when there is a lot of good wine from around the world,” Philip Cook was telling me the other day.
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The main cause of this golden age of inexpensive wine is the obvious one: globalization. Once confined to a small part of Europe, the making (and exporting) of great wine is now done across the globe.
But there is also another factor that gets less attention. Since the early 1990s, the federal tax on wine — $1.07 a gallon — hasn’t budged. The taxes on beer and liquor haven’t changed either, which means that, in inflation-adjusted terms, alcohol taxes have been steadily falling.
Each of the three taxes is now effectively 33 percent lower than it was in 1992. Since 1970, the federal beer tax has plummeted 63 percent. Many states taxes have also been falling.
At first blush, this sounds like good news: who likes to pay taxes, right? But taxes serve a purpose beyond merely raising general government revenue. Taxes on a given activity are also supposed to pay the costs that activity imposes on society. And for all that is wonderful about wine, beer and liquor, they clearly bring some heavy costs.
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Mr. Cook, besides being a wine lover, has been thinking about the costs and benefits of alcohol for much of his career, and he has come up with a blunt way of describing the problem. “Do you think we should be subsidizing alcohol?” he asks. “Because that’s what we’re doing.”
. . . . And if it were somehow possible to tax only those people who were going to drive drunk in the future, it would be a wonderful idea. (Then again, we might just want to take away their driver’s licenses.) Barring clairvoyance, though, raising alcohol taxes from their current lows seems to be the fairest solution.
Mr. Cook has written a wonderful little book, “Paying the Tab,” making this case. In it, he draws on history, political philosophy and straight economics to point out that higher alcohol taxes would fit squarely in the American tradition.
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News Release - Cognitive, genetic clues identified in imaging study of alcohol addictionUniversity of North Carolina at Chapel Hill
Public release date: 25-Dec-2007
People with clinical addictions know first-hand the ravages the disease can take on almost every aspect of their lives. So why do they continue addictive behaviors, even after a period of peaceable abstinence"
Some answers appear rooted in regions of the brain active during decision making.
"It's perhaps not just that people are slaves to pleasure, but that they have trouble thinking through a decision," said Charlotte Boettiger, an assistant professor of psychology at the University of North Carolina at Chapel Hill, and lead author of a study in the December issue of the Journal of Neuroscience that took a novel tack in addiction imaging research.
"Our data suggest there may be a cognitive difference in people with addictions," Boettiger said. "Their brains may not fully process the long-term consequences of their choices. They may compute information less efficiently."
The study also found that a variant of the COMT gene, which controls the level of the neurotransmitter dopamine in the cortex, was associated with a tendency to make impulsive decisions and with high activity in certain brain areas during decision making.
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Read Full News Release
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Immediate Reward Bias in Humans: Fronto-Parietal Networks and a Role for the Catechol-O-Methyltransferase 158Val/Val GenotypeThe Journal of Neuroscience, December 26, 2007, 27(52):14383-14391
The tendency to choose lesser immediate benefits over greater long-term benefits characterizes alcoholism and other addictive disorders. However, despite its medical and socioeconomic importance, little is known about its neurobiological mechanisms.
Brain regions that are activated when deciding between immediate or delayed rewards have been identified (McClure et al., 2004, 2007), as have areas in which responses to reward stimuli predict a paper-and-pencil measure of temporal discounting (Hariri et al., 2006). These studies assume "hot" and "cool" response selection systems, with the hot system proposed to generate impulsive choices in the presence of a proximate reward. However, to date, brain regions in which the magnitude of activity during decision making reliably predicts intertemporal choice behavior have not been identified.
Here we address this question in sober alcoholics and non-substance-abusing control subjects and show that immediate reward bias directly scales with the magnitude of functional magnetic resonance imaging bold oxygen level-dependent (BOLD) signal during decision making at sites within the posterior parietal cortex (PPC), dorsal prefrontal cortex (dPFC), and rostral parahippocampal gyrus regions.
Conversely, the tendency of an individual to wait for a larger, delayed reward correlates directly with BOLD signal in the lateral orbitofrontal cortex. In addition, genotype at the Val158Met polymorphism of the catechol-O-methyltransferase gene predicts both impulsive choice behavior and activity levels in the dPFC and PPC during decision making.
These genotype effects remained significant after controlling for alcohol abuse history.
These results shed new light on the neurobiological underpinnings of temporal discounting behavior and identify novel behavioral and neural consequences of genetic variation in dopamine metabolism.
Read Full Abstract
Request Reprint E-Mail: cab@unc.edu
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Tuesday, December 25, 2007
Doctors may soon offer what alcoholics need (if not what they want)By Melissa Healy, Los Angeles Times Staff Writer
December 24, 2007
British songstress Amy Winehouse, who croons "no, no, no" to rehab, has a lot of American company this time of year -- both in her heavy-drinking ways and her unwillingness to spend weeks in a specialized facility to get sober.
But experts say there may be new hope for rehab refuseniks like Winehouse and an estimated 5.7 million alcoholics in the United States who are not in treatment -- hope that could be as close as the family doctor.
New research and a growing arsenal of medications have set the stage for a major shift in the treatment of alcoholism, from specialized clinic to the "primary care office setting," the Journal of the American Medical Assn. reported in its Dec. 5 issue.
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Read Full Article
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Monday, December 24, 2007
Network Support for Drinking: An Application of Multiple Groups Growth Mixture Modeling to Examine Client-Treatment MatchingJ. Stud. Alcohol Drugs 69: 21-29, 2008
The current study re-examined the Project MATCH (Matching Alcoholism Treatments to Client Heterogeneity) hypothesis that individuals with high network support for drinking would have the best treatment outcomes if they were assigned to twelve-step facilitation (TSF).
Drinking consequences, as measured by the Drinking Inventory of Consequences, was the primary outcome measure. Growth mixture models with multiple groups were used to estimate the drinking consequence trajectories of 952 outpatients during the 12 months following treatment for each of the three Project MATCH treatment conditions. Growth factors within latent trajectory classes were regressed on network support for drinking to assess whether treatment condition moderated the relationship between network support for drinking and drinking consequences over time.
Three latent classes were identified, representing low (n = 154, 16.2%), medium (n = 400, 42%), and high (n = 398, 41.8%) levels of drinking consequences. Classes did not differ across treatment groups. Greater network support for drinking predicted more drinking consequences over time but only for clients assigned to cognitive-behavioral therapy and motivational enhancement therapy, not TSF.
This study provides further support for one of the original Project MATCH matching hypotheses: Clients with social networks supportive of drinking had better outcomes immediately after treatment if they were assigned to TSF.
Because the original Project MATCH studies found this matching effect only at the 3-year follow-up, these results add validity to the network support for drinking matching effect.
The study also provides additional evidence that accounting for heterogeneity in alcohol treatment outcomes is important for accurately estimating treatment effectiveness.
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Request Reprint E-Mail: jwu24@uic.edu
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Alcohol Consumption in Australia: A Snapshot, 2004-05This article provides an overview of the level, prevalence and type of alcohol consumption; the health status, risk factors and demographic characteristics of those who drink alcohol at risky or high risk levels; as well as information on mortality and health costs.
This article uses data from the 2004-05 National Health Survey (NHS), the 2004-05 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) and the Causes of Death Collection.
This article also draws on measures of alcohol consumption from the Apparent Consumption of Alcohol Collection, which uses excise and import trade administrative data to produce an indirect measure of consumption of alcohol, based on a population aged 15 years or more (ABS 2006a).
Data from the 2004 National Drug Strategy Household Survey (NDSHS) are also used in this article (AIHW 2005a).
Both short and long term risk of harm were measured in the 2004-05 NHS (footnote 1). Unless otherwise stated, this article presents NHS information on alcohol consumption for long term risk of harm. Survey respondents were categorised as drinking alcohol at low, risky or high risk levels based on the guidelines of the National Health and Medical Research Council (NHMRC) (footnote 2).
Data were collected in the 2004-05 NHS from those aged 18 years and over, and from those aged 14 and over (with a small sample from 12-13 year olds) in the 2004 NDSHS.
Read Full Report
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Sunday, December 23, 2007
HIDDEN MARKOV MODELS FOR ALCOHOLISM TREATMENT TRIAL DATAUniversity of Pennsylvania and Syracuse University
In a clinical trial of a treatment for alcoholism, the usual response variable of interest is the number of alcoholic drinks consumed by each subject each day. Subjects in these trials are typically volunteers who are alcoholics, and thus are prone to erratic drinking behaviors, often characterized by alternating periods of heavy drinking and abstinence. For this reason, many statistical models for time series that assume steady behavior over time and white noise errors do not fit alcohol data well.
In this paper, we propose to describe subjects' drinking behavior using a Hidden Markov model (HMM) for categorical data, where the counts of drinks per day are summarized as a categorical variable with three levels, as is the convention in alcohol research.
We compare the HMM's properties to those of other models, focusing on out-of-sample prediction error as well as interpretability; to do this, we analyze data from a clinical trial of the drug Naltrexone using each model.
The HMM performs at a level comparable to the other models with respect to out-of-sample prediction error, and contains unique features that allow for useful clinical interpretations.
Read Full Text (PDF)
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Alcohol Drinking Patterns and Prevalence of Alcohol-Abuse and Dependence in the Israel National Health SurveyIsr J Psychiatry Relat Sci Vol 44 No. 2 (2007) 126–135
Coexistence of disparate religious/cultural mores with regard to alcohol drinking within the changing social milieu of Israel provides an informative environment for investigation of alcohol consumption patternsand alcohol-related mental disorders.
Half of the 4,859 respondents reported any alcohol consumption in the year prior to interview; 5% drink 3 ormore times weekly. DSM-IV criteria for alcohol abuse or dependence (lifetime) were met by 4.3% of respondents. Significantly higher rates were found among males (AOR, adjusted odds ratio=7.3), younger adults (AOR=5.0), immigrants from the former Soviet Union (AOR=2.0), and those who were never married (AOR=1.6).
Under-reporting remains a potential concern in health behavior surveys, particularly in the face of opposing religious norms.
The lifetime prevalence of alcohol abuse in Israel is identical to other European countries while drinking levels are considerably lower, suggesting a biological sensitivity alongside socio-cultural factors.
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