Press Release - Alcohol tax increases threaten significant price rises for consumers whilst not addressing problem-drinking

The Wine and Spirit Trade Association
4 February 2008

While anti-alcohol lobbyists have argued that a tax increase on alcohol is the magic bullet to address problem-drinking, new economic research shows this is not the case. The Wine and Spirit Trade Association (WSTA) warned today that any potential tax increase on wine and spirits threatens to significantly increase the prices consumers will pay while doing nothing to reduce problem-drinking. Highlighted in its budget submission to the Treasury, the WSTA warned that not only would increases in tax punish the majority of responsible drinkers, but such increases would actually reduce revenue for the Treasury and threaten over 50,000 jobs.

Commenting on the release of the report, Jeremy Beadles, Chief Executive of the WSTA said: “Raising the price of alcohol by raising taxes will unfairly punish the majority of responsible drinkers for the misdeeds of a small minority. Our research shows that any such increases will do little to address problem-drinking while hurting the economy and the Treasury. It simply does not make any sense.”
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Read Full Copy of the WSTA Budget submission 2008 (PDF)
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Systematic review and meta-analyses of strategies targeting alcohol problems in emergency departments: interventions reduce alcohol-related injuries
Addiction 103 (3), 368–376.

To critique the methodological adequacy of evaluations of emergency department (ED)-based interventions for alcohol problems and to conduct a meta-analysis to examine the extent to which interventions in this setting are effective in reducing alcohol consumption and related harm.

Thirteen studies were identified for inclusion in the review. Methodological quality was found to be reasonable, with the exception of poor reporting of effect-size information and inconsistent selection of outcome measures. Meta-analyses revealed that interventions did not significantly reduce subsequent alcohol consumption, but were associated with approximately half the odds of experiencing an alcohol-related injury (odds ratio = 0.59, 95% confidence interval 0.42–0.84).

There are few evaluations of emergency department-based interventions for alcohol problems. Future evaluations should use consistent outcome measures and report effect sizes.

The existing evidence suggests that interventions are effective in reducing subsequent alcohol-related injuries.

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Request reprint E-Mail: a.havard@unsw.edu.au
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Longitudinal analysis of alcohol consumption and health of middle-aged women in Australia
Addiction 103 (3), 424–432.

To assess the prospective association between alcohol consumption and self-rated health: in particular whether there is a relationship between stable alcohol intake and health; whether health is affected by changes in alcohol consumption; whether having a chronic condition alters the relationships between stable and changing alcohol intake and health; and whether the health of longer-term abstainers is different from more recent and intermittent abstainers.

Longitudinal models of consistent alcohol intake showed mean scores for general health of moderate drinkers were significantly better than that of non-drinkers [mean difference = 4.3, standard error (SE) = 0.61], occasional drinkers (mean difference = 3.1, SE = 0.52) and heavy drinkers (mean difference = 2.1, SE = 1.00). Among moderate drinkers, a decrease or variation in alcohol consumption was associated with a significant decline of three to four points in general health. Similar results were obtained when women with an existing chronic condition were excluded from these models. The health of recent abstainers and intermittent drinkers was the same as longer-term abstainers.

Consistent moderate drinkers had the best health even after adjustment for having a chronic condition, depression and life-style factors. Poorer health was associated with decreased alcohol intake among occasional and moderate drinkers.

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Request Reprint E-Mail: jenny.powers@newcastle.edu.au

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Substance misuse among older adults: a neglected but treatable problem
Addiction 103 (3), 347–348.

Substance misuse is generally thought of as a problem of young people, but such problems have no age limits.

Prescription and over-the-counter drugs are used widely by older adults. About one-third of all prescribed drugs, often including benzodiazepines and opioid analgesics, are used by people aged over 65 years. Problematic use of prescribed drugs may involve inappropriate use such as ‘borrowing’ a medication from a friend or relative, occasional recreational use or persistent use and dependence. The misuse of prescribed or over-the-counter drugs may involve deliberately using higher than recommended doses, using for extended periods, hoarding medications and using medications together with alcohol.
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Active ingredients of substance use-focused self-help groups
Addiction 103 (3), 387–396.

This paper provides an overview of some of the probable active ingredients of self-help groups in light of four related theories that identify common social processes that appear to underlie effective psychosocial treatments for and continuing remission from these disorders.

Social control theory specifies active ingredients such as bonding, goal direction and structure; social learning theory specifies the importance of norms and role models, behavioral economics and behavioral choice theory emphasizes involvement in rewarding activities other than substance use, and stress and coping theory highlights building self-efficacy and effective coping skills. A review of existing studies suggests that the emphasis on these active ingredients probably underlies some aspects of the effectiveness of self-help groups.

Several issues that need to be addressed to enhance understanding of the active ingredients of action of self-help groups are discussed, including consideration of indices of Alcoholics Anonymous (AA) affiliation as active ingredients, identification of personal characteristics that may moderate the influence of active ingredients on substance use outcomes, examination of whether active ingredients of self-help groups, can amplify or compensate for treatment, identification of potential detrimental effects of involvement in self-help groups and focusing on the link between active ingredients of self-help groups and other aspects of the overall recovery milieu, such as the family and social networks

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Request Reprint E-Mail: rmoos@stanford.edu

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Association between the nociceptin receptor gene (OPRL1) single nucleotide polymorphisms and alcohol dependence
Addiction Biology 13 (1), 88–94.

OPRL1 encodes the nociceptin receptor, which has been shown to be involved in alcohol dependence in previous studies.

In the present study, we investigated the association between genetic polymorphisms of OPRL1 and alcohol dependence in a Scandinavian population.

We genotyped 15 single nucleotide polymorphisms (SNPs) spanning the OPRL1 locus and found that SNP rs6010718 was significantly associated with both Type I and Type II alcoholics (P < 0.05). Linkage disequilibrium and haplotype analysis identified two haplotype blocks in this region. Furthermore, two haplotypes composed of five tag SNPs showed significant association with alcohol dependence.

These findings suggest that genetic variants of the OPRL1 gene play a role in alcohol dependence in the Scandinavian population, warranting further investigation at the OPRL1 locus.

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Request Reprint E-Mail: clawah@scripps.edu
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Invited Review Article - Ethanol drinking in rodents: is free-choice drinking related to the reinforcing effects of ethanol�
Alcohol Volume 42, Issue 1, February 2008, Pages 1-11


Many studies have used voluntary ethanol consumption by animals to assess the influence of genetic and environmental manipulations on ethanol drinking. However, the relationship between home cage ethanol consumption and more formal assessments of ethanol-reinforced behavior using operant and instrumental conditioning procedures is not always clear.

The present review attempted to evaluate whether there are consistent correlations between mouse and rat home cage ethanol drinking on the one hand, and either operant oral self-administration (OSA), conditioned taste aversion (CTA), or conditioned place preference (CPP) with ethanol on the other. We also review literature on intravenous ethanol self-administration (IVSA).

To collect data, we evaluated a range of genetic manipulations that can change both genes and ethanol drinking behavior including selective breeding, transgenic and knockout models, and inbred and recombinant inbred strain panels. For a genetic model to be included in the analysis, there had to be published data resulting in differences on home cage drinking and data for at least one of the other behavioral measures.

A consistent, positive correlation was observed between ethanol drinking and OSA, suggesting that instrumental behavior is closely genetically related to consummatory and ingestive behavior directed at ethanol.

A negative correlation was observed between CTA and drinking, suggesting that ethanol's aversive actions may limit oral consumption of ethanol.

A more modest, positive relationship was observed between drinking and CPP, and there were not enough studies available to determine a relationship with IVSA.

That some consistent outcomes were observed between widely disparate behavioral procedures and genetic populations may increase confidence in the validity of findings from these assays.

These findings may also have important implications when researchers decide which phenotypes to use in measuring alcohol-reward relevant behaviors in novel animal models.

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Role of nitric oxide in alcohol-induced changes in lipid profile of moderate and heavy alcoholics
Alcohol Volume 42, Issue 1, February 2008, Pages 47-53


Biochemical changes in plasma and red cell membrane in moderate and heavy alcoholics were investigated to compare them with teetotalers in the present study.

Significant changes in lipid, lipoprotein profile, and lipid peroxidation were evident from the study suggesting the cardioprotective effect in moderate alcoholics, and adverse changes leading to cardiovascular risk in heavy alcoholics. Both nitrite and nitrate levels in plasma of moderate alcoholics increased significantly when compared with teetotalers and the increase is more pronounced in heavy alcoholics.

The results of the present study showed no significant difference in osmotic hemolysis in red cells from moderate and heavy alcoholics incubated with NaCl at concentrations ranging from 0.1% to 0.9%. Further, the study showed a possible relationship of nitric oxide (NO) with changes in plasma lipid profile.

To sum up, these changes in both moderate and heavy alcoholics clearly indicated the involvement of NO in rendering tolerance to alcohol-induced effects and also in modulation of alcohol effects.

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G cells and gastrin in chronic alcohol-treated rats
Alcohol Volume 42, Issue 1, February 2008, Pages 37-45

Numerous reports have described gastric mucosal injury in rats treated with high ethanol concentrations. However, to the best of our knowledge, ultrastructural characteristics of G cells and antral gastrin levels have not been previously reported, either in rats that chronically consumed alcohol or in human alcoholics.

The goal of this study was to examine the effect of ethanol consumption (8.5 g/kg) over a 4-month period, under controlled nutritional conditions, on antral and plasma levels of gastrin, ultrastructure of G cells, morphometric characteristics of G cells by stereological methods, and analysis of endocrine cells in the gastric mucosa by immunohistochemistry.

The chronic alcohol consumption resulted in a nonsignificant decrease in gastrin plasma levels and unchanged antral gastrin concentrations. A slightly damaged glandular portion of the gastric mucosa and dilatation of small blood vessels detected by histological analysis, suggests that ethanol has a toxic effect on the mucosal surface.

Chronic alcohol treatment significantly decreased the number of antral G cells per unit area, and increased their cellular, nuclear, and cytoplasmatic profile areas. In addition, the volume density and diameter of G-cell granules, predominantly the pale and lucent types, were increased, indicating inhibition of gastrin release.

Ethanol treatment also decreased the number of gastric somatostatin-, serotonin-, and histamine-immunoreactive cells, except the somatostatin cells in the pyloric mucosa, as well as both G: D: enterochromaffin cells (EC) cell ratios in the antrum and D: ECL cell ratios in the fundus.

These results indicate that the change of morphometric parameters in G cells may be related to cellular dysfunction.

Our findings also suggest that regulation of G-cell secretion was not mediated by locally produced somatostatin in ethanol-consuming rats, but may involve gastric luminal content and/or neurotransmitters of gastric nerve fibers.


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Ethanol exposure of neonatal rats does not increase biomarkers of oxidative stress in isolated cerebellar granule neurons
Alcohol Volume 42, Issue 1, February 2008, Pages 29-36

Oxidative stress is a candidate mechanism for ethanol neuropathology in fetal alcohol spectrum disorders. Oxidative stress often involves production of reactive oxygen species (ROS), deterioration of the mitochondrial membrane potential (MMP), and cell death. Previous studies have produced conflicting results regarding the role of oxidative stress and the benefit of antioxidants in ethanol neuropathology in the developing brain.

This study investigated the hypothesis that ethanol neurotoxicity involves production of ROS with negative downstream consequences for MMP and neuron survival. This was modeled in neonatal rats at postnatal day 4 (P4) and P14. It is well established that granule neurons in the rat cerebellar cortex are more vulnerable to ethanol neurotoxicity on P4 than at later ages. Thus, it was hypothesized that ethanol produces more oxidative stress and its negative consequences on P4 than on P14.

A novel experimental approach was used in which ethanol was administered to animals in vivo (gavage 6 g/kg), granule neurons were isolated 2–24 h post-treatment, and ROS production and relative MMP were immediately assessed in the viable cells. Cells were also placed in culture and survival was measured 24 h later.

The results revealed that ethanol did not induce granule cells to produce ROS, cause deterioration of neuronal MMP, or cause neuron death when compared to vehicle controls. Further, granule neurons from neither P4 nor P14 animals mounted an oxidative response to ethanol.

These findings do not support the hypothesis that oxidative stress is obligate to granule neuron death after ethanol exposure in the neonatal rat brain. Other investigators have reached a similar conclusion using either brain homogenates or cell cultures.

In this context, it is likely that oxidative stress is not the sole and perhaps not the principal mechanism of ethanol neurotoxicity for cerebellar granule neurons during this stage of brain development.

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Acute ethanol administration causes malformations but does not affect cranial morphometry in neonatal mice
Alcohol Volume 42, Issue 1, February 2008, Pages 21-27


Ethanol is a known teratogen and has been implicated in the etiology of human fetal alcohol syndrome (FAS), which is characterized by distinct craniofacial abnormalities such as microcephaly, agnathia, and ocular aberrations.

Attempts at quantifying the craniofacial anomalies arising from ethanol exposure have largely been limited to radiographic evaluation in postnatal rats. Such studies discount the role of the cranial soft tissue in the morphology of FAS.

We present a study whose aim was to conduct measurements of the entire head including soft and hard tissue in full-term fetuses of mice by means of a digital analyzer, while at the same time comparing stained skeletal tissues in treated and untreated animals.

Ethanol-exposed mice showed a number of abnormalities such as anophthalmia and agnathia, but these were not significantly increased over those from nontreated fetuses (P = .5). Birth weight (P = .5), crown-rump length (P = .8), and mandibular length (P = .9) were also not significantly reduced compared to control fetuses. However, defects in some cranial bones and degrees of ossification that trailed same-stage controls were observed in treated animals, at a nonstatistically significant level (P = .14).

Acute maternal ingestion of alcohol in mice during pregnancy may not cause a significant increase in craniofacial or skeletal defects when evaluated at term. However, these effects may be latent, manifesting postnatally.

The postnatal ability of mice for recovery from alcohol-induced birth defects deserves further investigation.


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Effects of mGlu1-receptor blockade on ethanol self-administration in inbred alcohol-preferring rats
Alcohol Volume 42, Issue 1, February 2008, Pages 13-20


The Group I family of metabotropic glutamate receptors includes subtype 1 (mGlu1) and subtype 5 (mGlu5) receptors. This family of receptors has generated interest as potential targets for different areas of therapeutic development, including intervention for alcohol and drug abuse. Most of this interest is driven by findings showing involvement of mGlu5 receptors in the regulation of drug self-administration; however, studies examining the role of mGlu1 receptors in drug self-administration are limited.

The purpose of this work was to examine the role of mGlu1-receptor antagonism in the maintenance of ethanol self-administration and the self-administration of an alternate nondrug reward, sucrose.

Ethanol self-administration was dose dependently reduced by JNJ16259685. This reduction was likely due to a motor impairment as the lowest effective dose (0.1 mg/kg) significantly reduced locomotor behavior. Sucrose self-administration was reduced by the highest JNJ16259685 dose (1.0 mg/kg), and this reduction was also likely due to a motor impairment. Interestingly, ethanol self-administration was more sensitive to mGlu1-receptor antagonism than sucrose self-administration as lower JNJ16259685 doses reduced ethanol-reinforced responding and motor behavior.

Together, these results suggest that mGlu1 receptors do not play a specific role in modulating ethanol self-administration or the self-administration of an alternate nondrug reward (i.e., sucrose).

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Request Reprint E-Mail: jbesheer@med.unc.edu
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News Release - Tackling teen drinking

6 February 2008

The Home Secretary has announced tough police powers to prevent underage drinking, and called for more involvement by parents and the alcohol industry to deal with the problem of teenage alcohol abuse.

Speaking to an audience of police, local authority licencing officers and representatives from the alcohol and retail industries, she described a package of new measures designed to address alcohol-related crime and anti-social behaviour among young people.

Key actions

Among the actions to be taken are:

• a crackdown by police on underage drinkers consuming alcohol in public places
• extra powers for police to confiscate alcohol
• wider use of parenting contracts to get parents involved in helping their children deal with drinking addictions
• a new public information campaign directed at binge drinkers
• an independent review of how well industry standards are being met when it comes to responsible sales of alcohol

Good work already underway

Home Secretary Jacqui Smith emphasised that a lot of good work is already being done to address the problem of binge drinking, but there's more still to do.

'Police must have all the powers they need to make groups of young people drinking in public a thing of the past,' she said. 'A new campaign to confiscate alcohol from underage drinkers begins this month, and lessons will be learned from it.

'At the same time, we will continue to punish those few irresponsible retailers who flout the law by persistently selling to children.'

Parents will also play their part, and those whose children are consistently found drinking illegally will be given support to help their children stop drinking.

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Effectiveness of a law to reduce alcohol-impaired driving in Japan
Injury Prevention 2008;14:19-23

To estimate the effect of a new road traffic law against alcohol-impaired driving in Japan.

Japan passed a new road traffic law in June 2002 intended to reduce alcohol-impaired driving by decreasing the permissible blood alcohol level and by increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries were analyzed by time series.

Simple comparisons of the average of all severe traffic injuries, traffic fatalities, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven showed reductions after enactment of the new road traffic law in June 2002. The rate of alcohol-related traffic fatalities per billion kilometers driven decreased by 38% in the post-law period.

In segmented regression analyses with adjustment for baseline trends, seasonality, and autocorrelation, all traffic injuries, severe traffic injuries, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven declined significantly from baseline after the new traffic law.

Large, immediate public health benefits resulted from the new road traffic law in Japan

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Hazardous Alcohol Drinking in the Former Soviet Union: A Cross-Sectional Study of Eight Countries
Alcohol and Alcoholism Advance Access published online on February 3, 2008




Hazardous consumption of large quantities of alcohol is a major cause of ill-health in the former Soviet Union (fSU). The objective of this study was to describe episodic heavy drinking and other hazardous drinking behaviors in eight countries of the fSU.

Data from national surveys of adults conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2001 were used (overall sample size 18,428; response rates 71–88%). Heavy episodic drinking, high alcohol intake, drinking alcohol during the working day, and using illegally produced strong spirits were examined.

On average, 23% of men and 2% of women were defined as heavy episodic drinkers (2 l of beer or 750 g bottle of wine or 200 g strong spirits at least once every 2–3 weeks). This was more common in young males, women who are single or who are divorced/separated/widowed, in smokers, and in frequent alcohol drinkers. About half the respondents who drank strong spirits obtained at least some alcohol from private sources. Among drinkers, 11% of males and 7% of women usually took their first drink before the end of working day.

Heavy episodic alcohol drinking is frequent in males throughout the region—although prevalence rates may have been affected by underreporting—but is still relatively rare in women.

Alcohol policies in the region should address hazardous drinking patterns and the common use of illegally produced alcohol.



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Request Reprint E-Mail: Joceline.Pomerleau@lshtm.ac.uk
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Sensory Processing Disorder in a Primate Model: Evidence From a Longitudinal Study of Prenatal Alcohol and Prenatal Stress Effects
Child Development 79 (1), 100–113.

Disrupted sensory processing, characterized by over- or underresponsiveness to environmental stimuli, has been reported in children with a variety of developmental disabilities.

This study examined the effects of prenatal stress and moderate-level prenatal alcohol exposure on tactile sensitivity and its relationship to striatal dopamine system function in thirty-eight 5- to 7-year-old rhesus monkeys. The monkeys were from four experimental conditions: (a) prenatal alcohol exposed, (b) prenatal stress, (c) prenatal alcohol exposed + prenatal stress, and (d) sucrose controls.

Increased D₂ receptor binding in the striatum, evaluated using positron emission tomography neuroimaging, was related to increased withdrawal (aversion) responses to repetitive tactile stimuli and reduced habituation across trials.

Moreover, prenatal stress significantly increased overall withdrawal responses to repetitive tactile stimulation compared to no prenatal stress.

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Request Reprint E-Mail: schneider@education.wisc.edu.
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Fetal Alcohol Exposure Alters Cerebrovascular Reactivity to Vasoactive Intestinal Peptide in Adult Sheep
Neonatology 2008;93:45-51


Chronic fetal alcohol exposure impairs neural and vascular development. We have previously shown that fetal alcohol exposure is associated with attenuated hypoxic cerebral vasodilation and reduced neuronal vasoactive intestinal peptide (VIP) expression in fetal sheep.

In the present study, we tested the hypothesis that fetal alcohol exposure alters vascular development, leading to altered cerebral vascular reactivity to VIP in adulthood.

There was no difference in myogenic tone between arterioles exposed prenatally to alcohol (n = 18) and saline controls (n = 17). However, fetal alcohol exposure significantly (p = 0.03) enhanced the dilator responses of adult intracerebral arterioles to VIP [0.1 nM to 1 µM, logEC₅₀: -8.6 ± 0.2 (alcohol) vs. -7.4 ± 0.8 (saline)]. In contrast, there was no difference in dilator responses to H⁺ (pH 6.8 buffer), to adenosine (10 nM to 0.1 mM), or to CGS21680 (an adenosine A_2A receptor agonist, 0.01 nM to 10 µM).

Thus, fetal alcohol exposure alters vasomotor sensitivity to VIP in adult intracerebral arterioles - perhaps a compensatory response to alcohol-induced underdevelopment of neurotransmitter pathways involved in cerebral vascular regulation.

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Request Reprint E-Mail: mayock@u.washington.edu
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Fetal alcohol syndrome (FAS) in C57BL/6 mice detected through proteomics screening of the amniotic fluid
Birth Defects Research Part A: Clinical and Molecular Teratology.
Early View 31 January 2008

Fetal Alcohol Syndrome (FAS), a severe consequence of the Fetal Alcohol Spectrum Disorders, is associated with craniofacial defects, mental retardation, and stunted growth

Previous studies in C57BL/6J and C57BL/6N mice provide evidence that alcohol-induced pathogenesis follows early changes in gene expression within specific molecular pathways in the embryonic headfold. Whereas the former (B6J) pregnancies carry a high-risk for dysmorphogenesis following maternal exposure to 2.9 g/kg alcohol (two injections spaced 4.0 h apart on gestation day 8), the latter (B6N) pregnancies carry a low-risk for malformations. The present study used this murine model to screen amniotic fluid for biomarkers that could potentially discriminate between FAS-positive and FAS-negative pregnancies. We identified several peaks in the proteomics screen that were reduced consistently and specifically in exposed B6J litters. Preliminary characterization by liquid chromatography tandem mass spectrometry and multidimensional protein identification mapped the reduced peaks to alpha fetoprotein (AFP). The predictive strength of AFP deficiency as a biomarker for FAS-positive litters was confirmed by area under the receiver operating characteristic curve. These findings in genetically susceptible mice support clinical observations in maternal serum that implicate a decrease in AFP levels following prenatal alcohol damage Read Full Abstract Request Reprint E-Mail: susmita.datta@louisville.edu _________________________________________________________

Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: results from two population-based surveys in Île-de-France, 1991 and 2005
Addiction (OnlineEarly Articles) 4 February 2008


To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history.

The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age.

These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.

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Request Reprint E-Mail: antoine.messiah@isped.u-bordeaux2.fr
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Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: Project Northland Chicago
Addiction (OnlineEarly Articles) 4 February 2008

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings.

Overall, the intervention, compared with a control condition receiving ‘prevention as usual’, was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance.

Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06).

Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

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Request Reprint E-Mail: komro@ufl.edu

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News Release - Eye blinks may help to identify children prenatally exposed to alcohol
3 February 2008

Eye blinks may help to identify children prenatally exposed to alcohol

• Not all children prenatally exposed to alcohol show distinctive facial anomalies usually associated with fetal alcohol syndrome (FAS).
• New findings indicate that deficits in eyeblink conditioning (EBC) can identify children with probable FAS.
• EBC may also serve to identify alcohol-exposed children who lack distinctive FAS features.

While children with fetal alcohol syndrome (FAS) have identifiable craniofacial abnormalities, children with alcohol-related neurodevelopmental disorder (ARND) can have significant cognitive impairments without facial anomalies. An important new study has found that a deficit in eyeblink conditioning (EBC) can identify children with probable FAS, and may also serve to identify alcohol-exposed children who lack distinctive FAS features.

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Characteristics of Suicide Attempts Preceded by Alcohol Consumption
Archives of Suicide Research, Volume 12, Issue 1 January 2008 , pages 30 - 38


Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients. The relation between alcohol and suicide risk needs, however, to be clarified.

We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded ("Alcohol + ") or not by alcohol intake.

Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,). Alcohol dependence was also more frequent in the "Alcohol + " group (43% versus 9%). Patients from the "Alcohol + " group drank more alcohol each day (6.1 versus 1.3 drinks) and more often during the week (3.6 days per week versus 1.4). They had a higher number of alcohol intoxications each week (0.9 versus 0.3). They drank more often alone (41% versus 12%, p < 0.005) and in the morning (21% versus 3%). They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9). Prevalence of drug dependence was higher in the "Alcohol + " group (21% versus 3%, respectively).

Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.

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Request Reprint E-Mail: michel.lejoyeux@lmr.ap-hop-paris.fr
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An Evaluation of µ-Opioid Receptor (OPRM1) as a Predictor of Naltrexone Response in the Treatment of Alcohol Dependence
Arch Gen Psychiatry. 2008;65(2):135-144.



Naltrexone hydrochloride treatment for alcohol dependence works for some individuals but not for everyone. Asn40Asp, a functional polymorphism of the µ-opioid receptor gene (OPRM1), might predict naltrexone response.

To evaluate whether individuals with alcoholism who are heterozygous (Asp40/Asn40) or homozygous (Asp40/Asp40) for the OPRM1 Asp40 allele respond better to naltrexone.

Alcoholic subjects with an Asp40 allele receiving MM alone (no CBI) had an increased percentage of days abstinent (P = .07) and a decreased percentage of heavy drinking days (P = .04) if treated with naltrexone vs placebo, while those with the Asn40/Asn40 genotype showed no medication differences. If treated with MM alone and naltrexone, 87.1% of Asp40 carriers had a good clinical outcome, compared with only 54.8% of individuals with the Asn40/Asn40 genotype (odds ratio, 5.75; confidence interval, 1.88-17.54), while, if treated with placebo, 48.6% of Asp40 carriers and 54.0% of individuals with the Asn40/Asn40 genotype had a good clinical outcome (interaction between medication and genotype, P = .005). No gene x medication interactions were observed in those treated with both MM and CBI.

These results confirm and extend the observation that the functionally significant OPRM1 Asp40 allele predicts naltrexone treatment response in alcoholic individuals. This relationship might be obscured, however, by other efficacious treatments. OPRM1 genotyping in alcoholic individuals might be useful to assist in selecting treatment options.

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Association between the nociceptin receptor gene (OPRL1) single nucleotide polymorphisms and alcohol dependence
Addiction Biology 13 (1), 88–94.

OPRL1 encodes the nociceptin receptor, which has been shown to be involved in alcohol dependence in previous studies.

In the present study, we investigated the association between genetic polymorphisms of OPRL1 and alcohol dependence in a Scandinavian population.

We genotyped 15 single nucleotide polymorphisms (SNPs) spanning the OPRL1 locus and found that SNP rs6010718 was significantly associated with both Type I and Type II alcoholics (P < 0.05).

Linkage disequilibrium and haplotype analysis identified two haplotype blocks in this region. Furthermore, two haplotypes composed of five tag SNPs showed significant association with alcohol dependence.

These findings suggest that genetic variants of the OPRL1 gene play a role in alcohol dependence in the Scandinavian population, warranting further investigation at the OPRL1 locus.

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Request Reprint E-Mail: clawah@scripps.edu

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Phenomic, Convergent Functional Genomic, and biomarker studies in a stress-reactive genetic animal model of bipolar disorder and co-morbid alcoholism
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Early View, 4 Ferbruary 2008

We had previously identified the clock gene D-box binding protein (Dbp) as a potential candidate gene for bipolar disorder and for alcoholism, using a Convergent Functional Genomics (CFG) approach.

Here we report that mice with a homozygous deletion of DBP have lower locomotor activity, blunted responses to stimulants, and gain less weight over time. In response to a chronic stress paradigm, these mice exhibit a diametric switch in these phenotypes. DBP knockout mice are also activated by sleep deprivation, similar to bipolar patients, and that activation is prevented by treatment with the mood stabilizer drug valproate.

Moreover, these mice show increased alcohol intake following exposure to stress.

Microarray studies of brain and blood reveal a pattern of gene expression changes that may explain the observed phenotypes. CFG analysis of the gene expression changes identified a series of novel candidate genes and blood biomarkers for bipolar disorder, alcoholism, and stress reactivity

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Request Reprint E-Mail: anicules@iupui.edu)
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Impaired Eyeblink Conditioning in Children With Fetal Alcohol Syndrome
Alcoholism: Clinical and Experimental Research 32 (2), 365–372.


Eyeblink conditioning (EBC) is a Pavlovian paradigm that involves contingent temporal pairing of a conditioned stimulus (e.g., tone) with an unconditioned stimulus (e.g., air puff).

Animal studies have shown that binge consumption of alcohol during pregnancy impairs EBC and that this impairment is likely mediated by a loss of neurons in the inferior olive and the cerebellar cortex and deep nuclei, as well as by a reduction in neural plasticity in the cerebellar deep nuclei.

Not a single child with FAS met criterion for conditioning as contrasted with 75.0% of the controls. Whereas 86.7% of the controls who were conditioned met criterion by the end of Session 2, a large proportion of the relatively few alcohol-exposed nonsyndromal children who conditioned did not do so until Session 3. These alcohol effects on EBC persisted after controlling for IQ. Three of 4 microcephalic children who were not exposed to alcohol were successfully conditioned.

This is the first prospective study to demonstrate impaired EBC in children diagnosed with FAS. Successful EBC in a microcephalic group supports the inference that the EBC deficit is specific to prenatal alcohol exposure and a potential biomarker for diagnosis of exposed children lacking the distinctive FAS dysmorphology.

Delay EBC has a high sensitivity for identifying individuals with a diagnosis of probable FAS.

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Organizational- and individual-level correlates of posttreatment substance use: A multilevel analysis
Journal of Substance Abuse Treatment Volume 34, Issue 2, March 2008, Pages 249-262

In addressing the need to study the effects of organizational factors on individual-level treatment outcomes, this study used hierarchical models to examine the organizational- and individual-level correlates of posttreatment substance use.

Risk for posttreatment use varied significantly across organizations. Factors in the external institutional environment of facilities significantly influenced risk for use: managed care regulation increased the risk, whereas Joint Commission on the Accreditation of Healthcare
Organizations accreditation decreased it (p < .01 for both).

On the individual level, longer treatment episodes and treatment completion reduced the risk (p < .01 for both) after controlling for client characteristics.

The benefits of length of stay in treatment were modified by elements of the external institutional environment and organizational treatment technology. The ameliorative effects of prolonged treatment were reduced by higher levels of managed care regulation, organizational monitoring, caseload size (p < .01 for all), and proportion of degreed staff (p < .05).

The results highlight the influence of organizational factors on posttreatment use.

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Editorial - Welcome to Mental Health and Substance Use: dual diagnosis (MHSU).
Mental Health and Substance Use: dual diagnosis
Vol. 1, No. 1, February 2008, 1



Increased recognition of co-existing mental health and substance use problems has led to a growing body of discussion and research into the efficacy of interventions, treatment, and service delivery. As knowledge and skill advances, professionals need an effective and stimulating forum to share information, debate, and develop new, and existing, concepts. MHSU aims to explore complex issues, inform, and educate professionals by pooling and sharing knowledge and skills. It is an essential source for the professional exploring the complex needs of the individual and family experiencing co-existing mental health and substance use problems.

The issue of appropriate terminology is one that caused a great deal of discussion when exploring the concept of this journal. There appears to be a lack of consensus around terminology internationally. Dual diagnosis is used interchangeably with terms like coexisting, co-morbid, and co-occurring mental health and substance use. It is questionable whether any of the terms applied fully reflect the complexity of issues surrounding the individual, nor the mutually dependent nature of mental health and substance use problems.

The term dual diagnosis has been criticised as a restrictive and unhelpful label. It encourages a focus on two distinct problems that may lead to inaccurate case formulations and inappropriate interventions, or, no intervention at all! However, whilst dual diagnosis is inadequate, it is currently the most widely recognised and used term. It is our belief that a journal aiming to explore and develop knowledge, interest, and understanding of this complex issue, should lead the debate to identify and define a universally agreed term that reflects the multifaceted needs of individuals experiencing mental health and substance use problems. This issue opens that debate with a paper presenting an argument for adopting the term co-existing problems. We are keen to hear your views, and welcome further manuscripts or correspondence to stimulate this discussion.

Whether you are a new or experienced clinician, educator, researcher, manager or service developer, MHSU is about keeping you up-to-date. We encourage submission from new and established authors. Our experienced Associate Editors and International Advisory Board will, when appropriate, advise and guide you through to publication, where possible. Guidance on submitting a manuscript is available at www.informaworld. com/mhsu. We hope MHSU meets your expectations and look forward to hearing your views.

Philip D. Cooper

Editor

Email: editor@mhsu.co.uk

Differences in mental health, substance use, and other problems among dual diagnosis patients attending psychiatric or substance misuse treatment services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 54 - 63

The study investigates differences in dual diagnosis disorders among patients in psychiatric and in substance use treatment services.

Important clinical differences were found between dual diagnosis patients in psychiatry and substance use treatment services. Dual diagnosis patients in psychiatry services were more likely to have a psychotic illness: those in the inpatient psychiatry service had the most severe mental health problems, and were exposed to the greatest risks to their safety. Psychiatric outpatients were least likely to have an alcohol dependence disorder, although a high rate of drug use disorders (mainly involving cannabis) was found among the psychiatric inpatients. High rates of affective disorders and suicide risk were found among patients in all treatment services.

The term 'dual' diagnosis can be misleading. Dual diagnosis patients present with complex mental health, physical health, psychosocial disability, and safety needs, and the pattern of problems presented by dual diagnosis patients varies across different treatment se


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The views of consumers and frontline workers regarding coordination among addiction and mental health services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 21 - 32


Increasing co-ordination among addiction and mental health services is often recommended to improve service delivery for people with co-occurring addiction and mental health disorders.

Regarding their experiences in the addiction and mental health systems, and the development of a model of co-ordination in their community, this study compares the views of 16 consumers and 26 frontline workers to the current literature.

Consumers and frontline workers placed a higher priority on training workers and providing consumers with a welcoming place to go than on co-ordination. Consumers expressed concern about workers sharing client information. Consumers underscored the importance of peer support groups, and the formal system facilitating the development and maintenance of peer supports. Consumers offered suggestions for how the systems could more effectively obtain their input while frontline workers demonstrated disinterest in participating in planning initiatives.

Several of the findings are not reflected in the current literature. Funders and agencies might benefit from obtaining input from their local consumers and frontline workers as their views could influence the focus of community initiatives. Recommendations for future research are provided.

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Moving away from medicalised and partisan terminology: a contribution to the debate

Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 2 - 9


There is a growing awareness within both mental health and substance misuse services of the importance of co-existing problems. Clients with these co-existing problems impact upon a wide range of professionals, and often present major challenges due to their complex needs.

However, there is confusion about both terminology, and many of the underlying and treatment issues, related to these co-existing problems.

This paper examines some of these confusions and debates, arriving at the view that practice in the field will be enhanced by the adoption of a broad and inclusive definition of co-existing problems which avoids medicalised terminology such as 'dual diagnosis' or 'co-morbidity'. We argue that the term 'co-existing mental health and drug and alcohol problems' is consistent with a case formulation driven approach and adoption of this term will thus enhance practitioners' confidence in the detection, assessment and treatment of co-existing problems.

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Survey of professional attitudes to addiction treatment policy
Journal of Substance Use 4 February 2008

There has been increasing concern in England regarding the neglect of alcohol treatment in favour of treatment for illicit drug users (especially offenders).

The project sought to obtain the views of addiction professionals in specialist NHS services in England regarding recent changes to service provision.

Postal survey questionnaires were sent to the duty worker at 120 Community Drug and Alcohol Teams in the England. Responses were received from 180 participants representing at least one clinician at 87 of the teams.

Respondents had 1660 years of experience in substance misuse treatment. Only 11% felt that alcohol treatment services had improved over the last few years and 53% agreed that 'Government targets for treatment of illicit drug users has had a disastrous effect on the provision of alcohol treatment services'. The enhanced treatment for offenders was widely regarded as unfair to other service users. Half of respondents considered that the recent Government Alcohol Strategy was either 'pathetic' or 'a recipe for ineffectiveness.'

Despite the limited number of self-selecting participants, the opinions are clearly cause for concern.

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Doctors warn of alcohol risk to patients facing surgery
Alok Jha
February 4 2008

Patients due for surgery should control the amount of alcohol they drink beforehand, doctors have warned. A new study shows drinking even moderate amounts prior to surgery could slow down recovery and weaken the immune system.

Claudia Spies, an intensive care specialist at the Charité University hospital in Berlin, said: "A significantly high rate of complications can develop in patients who consume alcohol at levels that are less than excessive."

She said that around 20% of adults admitted to hospital drink three beers or two glasses of wine every day for a prolonged period, and they were more likely to fall victim to pneumonia or heart muscle disease or suffer complications such as bleeding after surgery. "In addition," Spies said, "some 50% of patients who are committed to hospitals after an accident suffered their injuries under the influence of alcohol. Consequently, the rate of immune-system complications in emergency medicine is also very high."
. . . . . .

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Effects of Ethanol on Cytokine Production After Surgery in a Murine Model of Gram-Negative Pneumonia
Alcoholism: Clinical and Experimental Research 32 (2), 331–338

Both alcohol abuse and surgery have been shown to impair immune function. The frequency of postoperative infectious complications is 2- to 5-fold increased in long-term alcoholic patients, leading to prolonged hospital stay. Following surgery, an increase in interleukin (IL)-6 has been shown to be associated with increased tissue injury and interleukin 1-(IL-10) is known to represent an anti-inflammatory signal.

The purpose of this study was to test the hypothesis that several days of excess alcohol consumption results in more pronounced immunosuppression. We assume that alcoholic animals show increased levels of IL-10 in response to infection and increased IL-6 due to a more pronounced lung pathology.

Alcohol-exposed mice exhibited a worsened clinical appearance. The histological assessment demonstrated a distinct deterioration of the pulmonary structure in alcohol-treated animals. In the lung, IL-6 and IL-10 was significantly increased in alcohol-exposed infected mice compared to saline-treated infected mice. The clinical score correlated significantly with IL-6 (r = 0.71; p <>r = 0.64; p <>

Ethanol treatment in this surgical model led to a more severe pulmonary infection with K. pneumoniae which was associated with more tissue destruction and increased levels of IL-6 and IL-10 and a worsened clinical score.

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World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Substance Use and Related Disorders, Part 1: Alcoholism
World Journal of Biological Psychiatry 31 January 2008


These practice guidelines for the biological treatment of substance use disorders were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP).

The goal during the development of these guidelines was to review systematically all available evidence pertaining to the treatment of substance use disorders, and to reach a consensus on a series of practice recommendations that are clinically and scientifically meaningful based on the available evidence.

These guidelines are intended for use by physicians evaluating and treating people with substance use disorders and are primarily concerned with the biological treatment of adults suffering from substance use disorders.

The data used to develop these guidelines were extracted primarily from various national treatment guidelines for substance use disorders, as well as from meta-analyses, reviews and randomized clinical trials on the efficacy of pharmacological and other biological treatment interventions identified by a search of the MEDLINE database and Cochrane Library. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorized into four levels of evidence (A-D).

This first part of the guidelines covers the treatment of alcohol dependence; Part 2 will be devoted to the treatment of drug dependence.


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