Low-Alcohol Beers: Contribution to Blood-Ethanol Concentration and Its Elevation above the UK Legal Limit after ‘Topping-up’
Alcohol and Alcoholism Advance Access published online on March 25, 2009


The aim of this study was to establish the contribution of low-alcohol beers to blood-ethanol concentration (BEC) and to test if ‘topping-up’ with these beverages can increase BEC above the 80 mg/dl UK legal limit.

Healthy male and female volunteers received a dose of ethanol designed to give a BEC of just below 80 mg/dl, and then received one pint (600 ml) of a 1% v/v alcohol beer in the fasting state or after lunch, or of a zero-alcohol or a 0.5% v/v alcohol beer after fasting. BEC was determined enzymatically and data were subjected to ANOVA.

Topping-up with a pint of a 1% v/v alcohol beer increased BEC >80 mg/dl in fasting subjects, contributing an extra 12–17 mg/dl, which lasted longer in males (80 min) than in females (20 min). A 0.5% v/v alcohol beer increased BEC above 80 mg/dl only in males, which lasted for 60 min. After food intake, the 1% v/v alcohol beer increased BEC above 80 mg/dl transiently only in males.

Low-alcohol beers make a significant contribution to blood-ethanol concentration and can increase it above the UK legal limit. Their use as a ‘top-up’ should be discouraged. Low-alcohol beers have a place as a substitute for normal-strength beverages as a strategy for decreasing alcohol consumption in general and in countries where low legal alcohol limits are in force or being contemplated.

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PAT (2009)—Revisions to the Paddington Alcohol Test for Early Identification of Alcohol Misuse and Brief Advice to Reduce Emergency Department Re-attendance
Alcohol and Alcoholism Advance Access published online on March 27, 2009

The Paddington Alcohol Test (PAT) has evolved over 15 years as a clinical tool to facilitate emergency physicians and nurses giving brief advice and the offer of an appointment for brief intervention by an alcohol nurse specialist. Previous work has shown that unscheduled emergency department re-attendance is reduced by ‘making the connection’ between alcohol misuse and resultant problems necessitating emergency care. The revised ‘PAT (2009)’ now includes education on clinical signs of alcohol misuse and advice on when to request a blood alcohol concentration.

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Out-of-Home Alcohol Advertising
A 21st-Century Guide to Effective Regulation

Marin Institute has released the country’s first guide to restricting out-of-home (OOH) alcohol advertising. The guide will help policymakers draft effective state and local laws to minimize youth exposure to ubiquitous alcohol advertising in the 21st Century.

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The relationship between age at drinking onset and subsequent binge drinking among women

The European Journal of Public Health Advance Access published online on March 25, 2009

To examine the association between age at drinking onset and subsequent binge drinking, and to examine whether there are differences in this association between four countries.

Overall, 12–26% reported binge drinking once or more per month in the four countries. Median age for starting drinking was 16 years in all four countries. Women who started drinking at 14 years or younger were significantly more likely to binge drink than women who started drinking at 19 years or older with adjusted odds ratios of 2.9 (95% confidence intervals 2.3–3.7), 2.8 (2.1–3.6) and 2.6 (1.9–3.4) for binge drinking in Denmark, Iceland and Sweden, respectively. Among Norwegian women the association was stronger with an adjusted odds ratio at 4.4 (3.5–5.6). The association in all four countries was more pronounced in women younger than 30 years than in older women.

In the four Nordic countries, there is a strong relation between age at drinking onset and later binge drinking. The strong relationship found in countries with such different alcohol cultures is most likely generalizable to other Western countries.

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Sociodemographic Differences in Binge Drinking g Adults --- 14 States, 2004
MMWR Weekly April 3, 2009 / 58(12);301-304

Binge drinking, defined in this study as consuming five or more alcoholic drinks on one occasion,* was responsible for 43,731 (54.9%) of the estimated 79,646 alcohol-attributable deaths each year in the United States during 2001--2005.†

Healthy People 2010 calls for reducing the prevalence of binge drinking among adults from the 16.6% baseline in 1998 to 6.0% (1). An overarching goal of Healthy People is to eliminate health disparities among different segments of the population.§

To assess binge drinking by sex, age group, race/ethnicity, education level, and income level, CDC analyzed data from an optional module of the 2004 Behavioral Risk Factor Surveillance System (BRFSS) survey, the most recent data available on binge drinking prevalence, frequency, and intensity (i.e., the number of drinks consumed per binge episode).

This report summarizes the results of that analysis, which indicated that the prevalence of binge drinking was more common among men (24.3%), persons aged 18--24 years (27.4%) and 2534 years (24.4%), whites (17.5%), and persons with household incomes >$50,000 (17.4%). However, after adjusting for sex and age, the highest average number of binge drinking episodes during the preceding 30 days was reported by binge drinkers whose household income was <$25,000. (4.9), and the highest average number of drinks per binge episode was reported by non-Hispanic blacks (8.4) and Hispanics (8.1).

These findings underscore the need to implement effective population-based prevention strategies (e.g., increasing alcohol excise taxes) and develop effective interventions targeted at groups at higher risk





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A model of access to and continuance in Alcoholics Anonymous



These data from a nationally representative sample of US adults with alcohol use disorders revealed a robust significant association of high symptom severity with access, continuation and discontinuation from Alcoholics Anonymous.

The association of high symptom severity and negative life events supports the behavioral economic model of AA access and continuation as proposed in this paper.

Variables associated with access to AA were also associated with continuation in AA, except for the variables for gender and education level. Women were less likely to attend AA, but more likely to continue attending AA. College educated respondents were less likely to attend AA, but more likely to continue attending AA.

A sub-group of US adults with severe externalizing disorders, identified in this study, is associated with access to and continuation in AA.

In the US there is a a significant geographic regional variation in access to and continuation in AA.

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Spirituality During Alcoholism Treatment and Continuous Abstinence for One Year

The International Journal of Psychiatry in Medicine Volume 38, Number 4 / 2008 , pp. 391 - 406

The primary aim of this prospective study was to examine the role of several aspects of spirituality in maintaining abstinence from alcohol for one year in persons treated for alcohol dependence. The roles of alcohol abstinence self-efficacy and Alcoholics Anonymous affiliation were also examined.

Twenty-eight participants were categorized as continuously abstinent for one year. The strongest associations between 12 month abstinence and the variables of interest were discharge scores of abstinence self-efficacy and existential well-being, and increases during treatment in scores of private spiritual practices. Increased age demonstrated a significant association with positive outcome.

The associations of private spiritual practices, existential well-being, and abstinence self-efficacy with one year of continuous abstinence following treatment discharge suggest the importance of addressing issues related to these variables during alcoholism treatment. More research is needed to understand the role of these variables in promoting and maintaining abstinence and to determine whether or not a related intervention would improve abstinence rates.

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Request Reprint E-Mail: piderman.katherine@mayo.edu

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Alcohol-related and hepatocellular cancer deaths by country of birth in England and Wales: analysis of mortality and census data

Journal of Public Health Advance Access published online on April 1, 2009

The incidence of and mortality from alcohol-related conditions, liver disease and hepatocellular cancer (HCC) are increasing in the UK. We compared mortality rates by country of birth to explore potential inequalities and inform clinical and preventive care.

Mortality from alcohol-related deaths (23 502 deaths) was particularly high for people born in Ireland (SMR for men [M]: 236, 95% confidence interval [CI]: 219–254; SMR for women [F]: 212, 95% CI: 191–235) and Scotland (SMR-M: 187, CI: 173–213; SMR-F 182, CI: 163–205) and men born in India (SMR-M: 161, CI: 144–181). Low alcohol-related mortality was found in women born in other countries and men born in Bangladesh, Middle East, West Africa, Pakistan, China and Hong Kong, and the West Indies. Similar mortality patterns were observed by country of birth for alcoholic liver disease and other liver diseases. Mortality from HCC (8266 deaths) was particularly high for people born in Bangladesh (SMR-M: 523, CI: 380–701; SMR-F: 319, CI: 146–605), China and Hong Kong (SMR-M: 492, CI: 168–667; SMR-F: 323, CI: 184–524), West Africa (SMR-M: 440, CI, 308–609; SMR-F: 319, CI: 165–557) and Pakistan (SMR-M: 216, CI: 113–287; SMR-F: 215, CI: 133–319).

These findings show persistent differences in mortality by country of birth for both alcohol-related and HCC deaths and have important clinical and public health implications. New policy, research and practical action are required to address these differences.

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Request Reprint E-Mail: neeraj.bhala@ctsu.ox.ac.uk

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Study on the affordability of alcoholic beverages in the European Union

Study on the affordability of alcoholic beverages in the European Union now available

In 2008 DG SANCO commissioned RAND Europe to conduct a study on "The affordability of alcoholic beverages in the European Union - Understanding the link between alcohol affordability, consumption and harms". Apart from an extensive study of literature, RAND Europe has consulted for this study a wide range of stakeholders (EU Member States, economic operators, public health NGOs, and other Directorates-General of the European Commission).

The responsibility for the content of this study lies with the authors, and the content does not necessarily represent the views of the European Commission; nor is the Commission responsible for any use that may be made of the information contained herein.

Report (1.9 MB)

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RETHINKING DRINKING

Do you enjoy a drink now and then? Many of us do, often when socializing with friends and family. Drinking can be beneficial or harmful, depending on your age and health status, and, of course, how much you drink.

For anyone who drinks, this site offers valuable, research-based information. What do you think about taking a look at your drinking habits and how they may affect your health? Rethinking Drinking can help you get started.

NIAAA Rethinking Drinking Website

Twelve Defining Moments in the History of Alcoholics Anonymous
Recent Developments in Alcoholism Volume 18 pp. 37-58


Misconceptions about Alcoholics Anonymous (AA) abound in spite of (or because of) the thousands of theses, dissertations, books, professional and popular articles, and Internet commentaries that have been written about AA.

One of the most pervasive characterizations of AA is that it is a “treatment” for alcoholism—a characterization that distorts the meaning of both mutual aid and alcoholism treatment.

This article describes 12 character-defining moments in the history of AA that highlight the differences between AA and alcoholism treatment.



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The Twelve-Step Recovery Model of AA: A Voluntary Mutual Help Association

Recent Developments in Alcoholism Volume 18 pp. 1-27

Alcoholism treatment has evolved to mean professionalized, scientifically based rehabilitation. Alcoholics Anonymous (AA) is not a treatment method; it is far better understood as a Twelve-Step Recovery Program within a voluntary self-help/mutual aid organization of self-defined alcoholics.

The Twelve-Step Recovery Model is elaborated in three sections, patterned on the AA logo (a triangle within a circle): The triangle’s legs represent recovery, service, and unity; the circle represents the reinforcing effect of the three legs upon each other as well as the “technology” of the sharing circle and the fellowship. The first leg of the triangle, recovery, refers to the journey of individuals to abstinence and a new “way of living.” The second leg, service, refers to helping other alcoholics which also connects the participants into a fellowship. The third leg, unity, refers to the fellowship of recovering alcoholics, their groups, and organizations.

The distinctive AA organizational structure of an inverted pyramid is one in which the members in autonomous local groups direct input to the national service bodies creating a democratic, egalitarian organization maximizing recovery.

Analysts describe the AA recovery program as complex, implicitly grounded in sound psychological principles, and more sophisticated than is typically understood. AA provides a nonmedicalized and anonymous “way of living” in the community and should probably be referred to as the Twelve-Step/Twelve Tradition Recovery Model in order to clearly differentiate it from professionally based twelve-step treatments.

There are additional self-help/mutual aid groups for alcoholics who prefer philosophies other than AA.

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Suggestive linkage at 9p22 in bipolar disorder weighted by alcohol abuse

American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published Online: 3 Mar 2009

Bipolar disorder (BP) is a highly heritable disorder, however attempts to map genetic risk factors are challenging.

One possible reason for these difficulties is the genetic heterogeneity of BP. Hence, focusing on clinically homogeneous families to create a genetically more homogeneous sample may increase the power of finding a specific variant.

Alcohol abuse (AA) and alcohol dependence (AD) are familial in BP families, and these families may carry a specific risk variant for BP.

We tested this hypothesis by performing a genome-wide linkage scan in 638 pedigrees (1,835 individuals) from the National Institute of Mental Health Genetics Initiative for BP, weighting the evidence for linkage according to the family's frequency of AA or AD. Using AA weighting, we identified a linkage region on 9p22.2 with an NPL score of 3.23. The region had previously been identified in a meta-analysis of linkage in bipolar disorder.

We used permutation analysis to assess if weighting by AA increased the linkage signal more than expected by chance and observed a significant P-value (P = 0.048). Therefore, the genetic risk factor for BP on 9p22.2 has an increased effect in families with high levels of AA.

In summary, we present an example of using covariates such as AA and AD to define subtypes of BP, demonstrate how using such subtypes can improve the power of a linkage scan, and demonstrate statistical approaches to validate the suggested interaction

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Request Reprint E-Mail: esaunders@hmc.psu.edu

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Role of GABRA2 on risk for alcohol, nicotine, and cannabis dependence in the Iowa Adoption Studies

Psychiatric Genetics:Volume 19(2)April 2009pp 91-98

A number of studies have shown that genetic variation at GABRA2 alters vulnerability to alcohol dependence. The exact identity of the causal variant(s), and the relationship of these variants to other forms of substance use and behavioral illness is, however, uncertain.

Therefore, we genotyped 516 individuals from the Iowa Adoption Studies, a large longitudinal case and control adoption study of substance use, at 39 single nucleotide polymorphisms encompassing the GABRA2 locus and analyzed them with respect to their lifetime history of three common forms of substance use dependence [alcohol dependence (AD), nicotine dependence (ND), and cannabis dependence (CD)] in the Iowa Adoption Studies and relevant exposure variables.

Using regression analysis, we found substantial evidence that both GABRA2 genotype and haplotype are significantly related to vulnerability to AD, ND, and CD, with the strongest relationships noted with respect to ND. Consistent with earlier studies suggesting exposure is an important step in the development of substance use, we found the inclusion of substance exposure data in our analytic models markedly increased the strength of the genetic associations of GABRA2 haplotype with substance use. Finally, we report that the genetic effects were markedly more pronounced in females than in males.

We conclude that genetic variation at or near the GABRA2 locus significantly affects vulnerability not only to AD, but to other forms of substance use including ND and CD, and that the effects may be sex dependent

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Request Reprint E-Mail: robert-philibert@uiowa.edu

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The Role of AA Sponsors: A Pilot Study
Alcohol and Alcoholism Advance Access published online on March 18, 2009


The aim of this study was to explore the roles of Alcoholics Anonymous (AA) sponsors and to describe the characteristics of a sample of sponsors.

Sample characteristics were as follows: the median length of AA attendance was 9.5 years (range 5–28); the median length of sobriety was 11 years (range 4.5–28); the median number of sponsees per sponsor was 1 but there was a wide range (0–17, interquartile range 3.75); and the sponsors were highly affiliated to AA (median AAAS score 8.75, range 5.5–8.75, maximum possible score 9). Past alcohol dependence scores were surprisingly low: 5 (18%) sponsors had mild, 14 (50%) moderate and 9 (32%) severe dependence according to the SADQ-C (median 26.5, range 11–56).

Sponsorship roles were as follows: 16 roles were identified through the initial content analysis. These were distilled into three super-ordinate roles through a thematic analysis: (1) encouraging sponsees to work the programme of AA (doing the 12 steps and engaging in AA activity); (2) support (regular contact, emotional support and practical support); and (3) carrying the message of AA (sharing sponsor's personal experience of recovery with sponsees).

The roles identified broadly corresponded with the AA literature delineating the duties of a sponsor. This non-random sample of sponsors was highly engaged in AA activity but only had a past history of moderate alcohol dependence.

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Request Reprint E-Mail: paul.whelan@nhs.net
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Age Variability in the Association Between Heavy Episodic Drinking and Adolescent Suicide Attempts: Findings From a Large-Scale, School-Based Screening Program

Journal of the American Academy of Child & Adolescent Psychiatry: March 2009 - Volume 48 - Issue 3 - pp 262-270

Alcohol use is a risk factor for suicidal behavior among adolescents, but it is not clear whether this association is consistent during the adolescent period. This study examined the age-specific associations between heavy episodic drinking (HED) and self-reported suicide attempts in a large and diverse sample of adolescents.

Heavy episodic drinking was significantly associated with self-reported suicide attempts (odds ratio 1.78, p <.05) controlling for depressive symptoms. However, there was substantial age variability in this association, with the association between HED and self-reported attempts stronger among younger adolescents. Among youths aged 13 years and younger, those who reported an episode of HED during the past year were roughly 2.6 times more likely to report an attempt than those who did not report HED in the past year, in contrast to 1.2 times among youths aged 18 years and older.

Heavy episodic drinking is a clear risk factor for suicidal behavior among younger adolescents, beyond the risk conveyed by depressive symptoms. Further research investigating the bases for increased suicide risk among younger adolescents engaging in HED is warranted. Results provide support to AACAP's practice parameters calling for attention to substance abuse in the assessment of suicide risk and suggest that routine screening for HED by physicians may improve the detection of adolescent suicide risk, particularly among younger adolescents.

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Request Reprint E-Mail: aseltine@uchc.edu

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Molecular Nutrition and Food Research,
Molecular Nutrition & Food Research Volume 53 Issue 2, Pages 240 - 255


Past reviews have concluded that there is no association between alcohol use and prostate cancer incidence.

We performed a meta-analysis of existing epidemiological studies finding, in contrast, evidence to suggest that prostate incidence is positively linearly associated with heavier alcohol use.

This finding was largely due to the contribution of population case-control studies and those measuring men recruited before age 60. No relationship between alcohol consumption and prostate cancer was found for cohort and hospital case-control studies. Analyses of design effects modestly suggests that population case-control studies were probably better suited to identify potential alcohol-prostate cancer relationships due to the close temporal proximity of the measurement of level of alcohol consumption to diagnosis.

Future efforts should be made to exclude all ill subjects from control groups/baseline samples in addition to accounting for changes in consumption with advancing age and the onset of illness.

The alcohol-prostate cancer association remained significant despite controlling for the degree to which studies endeavored to eliminate false negatives from their control group

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Request Reprint E-Mail: t.n.chikritzhs@curtin.edu
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Weakening of one more alcohol control pillar: a review of the effects of the alcohol tax cuts in Finland in 2004

Addiction Volume 104 Issue 4, Pages 554 - 563

To review the consequences of the changes in Finnish alcohol policy in 2004, when quotas for travellers' tax-free imports of alcoholic beverages from other European Union (EU) countries were abolished, Estonia joined the EU and excise duties on alcoholic beverages were reduced in Finland by one-third, on average.

Alcohol consumption increased 10% in 2004, clearly more than in the early 2000s. With few exceptions, alcohol-related harms increased. Alcohol-induced liver disease deaths increased the most, by 46% in 2004–06 compared to 2001–03, which indicates a strong effect on pre-2004 heavy drinkers. Consumption and harms increased most among middle-aged and older segments of the population, and harms in the worst-off parts of the population in particular.

Alcohol taxation and alcohol prices affect consumption and related harms, and heavy drinkers are responsive to price. In Finland in 2004, the worst-off parts of the population paid the highest price in terms of health for cuts in alcohol prices. The removal of travellers' import quotas, which was an inherent part of creating the single European market, had serious public health consequences in Finland.

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Request Reprint E-Mail: pia.makela@thl.fi

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Concurrent Illicit Drug and Alcohol Use

Because of possible additive or interactive drug effects, data from SAMHSA's 2006 and 2007 National Surveys on Drug Use and Health were pooled to examine the likelihood of multiple concurrent substance use. The measure used to define concurrent substance use for this report was illicit drug use during or within 2 hours of last alcohol use.

About 6% (7.1 million) of persons age 12 or older who drank alcohol in the past month also reported using an illicit drug during or within 2 hours of their last alcohol drink.

Among past month alcohol drinkers, American Indian or Alaska Natives (11.7%) and Blacks (9.9%) were the most likely racial groups and Native Hawaiian or Other Pacific Islanders (4.2%) and Asians (2.1%) were the least likely racial groups to use an illicit drug concurrently with alcohol.

Youth aged 12 to 17 and young adults aged 18 to 25 were more likely than older persons among the past month alcohol drinkers to drink alcohol concurrently with an illicit drug.

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Alcohol Use and Risk of Pancreatic Cancer

American Journal of Epidemiology Advance Access published online on March 18, 2009

The epidemiologic evidence for the role of alcohol use in pancreatic cancer development is equivocal.

The authors prospectively examined the relation between alcohol use and risk of pancreatic cancer among 470,681 participants who were aged 50–71 years in 1995–1996 in the US National Institutes of Health-AARP Diet and Health Study. The authors identified 1,149 eligible exocrine pancreatic cancer cases through December 2003. Multivariate Cox proportional hazards regression models were used to calculate relative risks and 95% confidence intervals with the referent group being light drinkers

The relative risks of developing pancreatic cancer were 1.45 (95% confidence interval (CI): 1.17, 1.80; Ptrend = 0.002) for heavy total alcohol use (3 drinks/day, 40 g of alcohol/day) and 1.62 (95% CI: 1.24, 2.10; Ptrend = 0.001) for heavy liquor use, compared with the respective referent group. The increased risk with heavy total alcohol use was seen in never smokers (relative risk = 1.35, 95% CI: 0.79, 2.30) and participants who quit smoking 10 or more years ago before baseline (relative risk = 1.41, 95% CI: 1.01, 2.00).

These findings suggest a moderately increased pancreatic cancer risk with heavy alcohol use, particularly liquor; however, residual confounding by cigarette smoking cannot be completely excluded.

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Request Reprint E-Mail: jiaol@mail.nih.gov

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Longitudinal Trends in Hazardous Alcohol Consumption Among Women With Human Immunodeficiency Virus Infection, 1995–2006

American Journal of Epidemiology Advance Access published online on March 6, 2009

Hazardous alcohol consumption among women with human immunodeficiency virus (HIV) infection is associated with several adverse health and behavioral outcomes, but the proportion of HIV-positive women who engage in hazardous drinking over time is unclear.

The authors sought to determine rates of hazardous alcohol consumption among these women over time and to identify factors associated with this behavior. Subjects were 2,770 HIV-positive women recruited from 6 US cities who participated in semiannual follow-up visits in the Women's Interagency HIV Study from 1995 to 2006. Hazardous alcohol consumption was defined as exceeding daily (4 drinks) or weekly (>7 drinks) consumption recommendations.

Over the 11-year follow-up period, 14%–24% of the women reported past-year hazardous drinking, with a slight decrease in hazardous drinking over time. Women were significantly more likely to report hazardous drinking if they were unemployed, were not high school graduates, had been enrolled in the original cohort (1994–1995), had a CD4 cell count of 200–500 cells/mL, were hepatitis C-seropositive, or had symptoms of depression. Approximately 1 in 5 of the women met criteria for hazardous drinking.

Interventions to identify and address hazardous drinking among HIV-positive women are urgently needed.

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Request Reprint E-Mail: cookrl@phhp.ufl.edu

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Role of the HPA Axis and the A118G Polymorphism of the µ-Opioid Receptor in Stress-Induced Drinking Behavior
Alcohol and Alcoholism Advance Access published online on February 24, 2009

The present study sought to investigate the relationship between the HPA axis reactivity to stress, the endogenous opioid system and stress-induced drinking behavior.

In the present study, 74 non-treatment-seeking alcohol-dependent subjects were tested under two mood conditions, neutral and stress, in separate testing sessions. Salivary cortisol measurements were obtained following stress induction and during the neutral control condition. Multiple measurements of alcohol intake, latency to access the alcohol cue and craving for alcohol were obtained during cue-availability testing. In addition, 52 of the study subjects were genotyped for the µ-opioid receptor.

A blunted cortisol response to stress was significantly correlated with increased alcohol intake following stress exposure compared to alcohol intake during the neutral session. There was not a clear correlation between the change in cortisol in response to stress and the change in latency to access alcohol or alcohol craving in response to stress. Carriers of the Asp40 variant of the µ-opioid receptor exhibited a dampened cortisol response to stress, higher alcohol intake and greater craving in response to stress compared to Asn40 homozygotes, although these differences were not statistically significant.

The results of the present study indicate that a blunted biological stress response was correlated with increased drinking in response to stress. The Asp40 variant of the µ-opioid receptor may be associated with this HPA axis hyporeactivity although the small sample size used in the present study did not permit adequate evaluation of this association.

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Request Reprint E-Mail: wpratt@iupui.edu

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Television-supported self-help for problem drinkers: A randomized pragmatic trial
Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 451-457


To test the effectiveness of a television-supported self-help intervention for problem drinking.

Dutch television viewers (N = 181) drinking in excess of the guidelines for low-risk alcohol use were randomly assigned either to the Drinking Less TV self-help course (consisting of five televised sessions supplemented by a self-help manual and a self-help website) or to a waitlisted control group. To ensure trial integrity, intervention delivery was mimicked beforehand by sending intervention participants weekly DVDs in advance of the actual telecasts in 2006. Pre-post assessments were carried out on both groups, as well as a 3-month follow-up assessment on the intervention group to study effect maintenance. The primary outcome measure was low-risk drinking.

The intervention group was more successful than the waitlist group in achieving low-risk drinking at post-intervention (OR = 9.4); the effects were maintained in the intervention group at 3-month follow-up.

The low-threshold television-based course Drinking Less appears effective in reducing problem drinking.

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Request Reprint E-Mail: jkramer@trimbos.nl
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Alcohol criteria endorsement and psychiatric and drug use disorders among DUI offenders: Greater severity among women and multiple offenders
Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 432-439

Data from the Collaborative Study on the Genetics of Alcoholism (COGA), a high-risk family study of alcohol dependence, were used to examine differences in alcohol diagnostic criteria endorsement and psychiatric and drug use disorders by gender and by number of DUI offenses.

Individuals with two or more DUIs exhibited greater severity of alcohol dependence than those with none or one DUI. This severity was characterized in three ways: (1) higher endorsement of alcohol diagnostic criterion items, with evidence of greater severity among women, (2) higher prevalence of co-occurring lifetime psychiatric disorders, and (3) higher rates of drug use and of dependence on cocaine, stimulants, and, for women only, marijuana and opiates.

By examining gradations of disorder within a combination of two high-risk indicators, DUI and family vulnerability, this study provides useful information for clinical research about individuals with chronic and severe alcohol problems. In addition, the observed gender differences in this high-risk sample will contribute to the literature on alcohol dependence among women at the more severe end of the dependence spectrum.

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Request Reprint E-Mail: vmccutcheon@wustl.edu
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Family history of alcohol abuse moderates effectiveness of a group motivational enhancement intervention in college women

Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 415-420

This study examined whether a self-reported family history of alcohol abuse (FH+) moderated the effects of a female-specific group motivational enhancement intervention with first-year college women.

First-year college women (N = 287) completed an initial questionnaire and attended an intervention (n = 161) or control (n = 126) group session, of which 118 reported FH+. Repeated measures ANCOVA models were estimated to investigate whether the effectiveness of the intervention varied as a function of one's reported family history of alcohol abuse.

Results revealed that family history of alcohol abuse moderated intervention efficacy. Although the intervention was effective in producing less risky drinking relative to controls, among those participants who received the intervention, FH+ women drank less across five weeks of follow-up than FH− women.

The current findings provide preliminary support for the differential effectiveness of motivational enhancement interventions with FH+ women.

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Request Reprint E-Mail: jlabrie@lmu.edu

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Validation of the Dutch version of the brief young adult alcohol consequences questionnaire (B-YAACQ)

Addictive Behaviors Volume 34, Issue 5, May 2009, Pages 411-414

The purpose of this study was to validate the Dutch version of the Brief Young Adult Alcohol Consequences Questionnaire (B-YAACQ).

Data from 667 undergraduate and graduate students (184 men and 483 women) who reported alcohol use during the past year was used in the analysis. On average, students in this study report 4.7 alcohol-related consequences. The Dutch B-YAACQ was shown to have a high reliability and validity: Cronbach's Alpha was 0.816, and B-YAACQ scores correlated significantly with AUDIT-PC scores (r = 0.747). B-YAACQ scores correlated significantly

The Dutch B-YAACQ is a useful new tool for screening of alcohol-related consequences.

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Request Reprint E-Mail: j.c.verster@uu.nl

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New insights into the genetics of addiction

Nature Reviews Genetics, advance online publication, 24 February 2009

Drug addiction is a common brain disorder that is extremely costly to the individual and to society. Genetics contributes significantly to vulnerability to this disorder, but identification of susceptibility genes has been slow. Recent genome-wide linkage and association studies have implicated several regions and genes in addiction to various substances, including alcohol and, more recently, tobacco. Current efforts aim not only to replicate these findings in independent samples but also to determine the functional mechanisms of these genes and variants.

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Request Reprint E-Mail: Ming_Li@virginia.edu

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Interaction between dopamine D2 receptor genotype and parental rule-setting in adolescent alcohol use: evidence for a gene-parenting interaction

Molecular Psychiatry advance online publication 24 February 2009

Association studies investigating the link between the dopamine D2 receptor gene (DRD2) and alcohol (mis)use have shown inconsistent results. This may be due to lack of attention for environmental factors. High levels of parental rule-setting are associated with lower levels of adolescent alcohol use and delay of initiation of drinking.

We tested whether DRD2 TaqI A (rs1800497) genotype interacts with alcohol-specific parenting practices in predicting the uptake of regular adolescent alcohol use.

Parental rule-setting was directly and inversely related to adolescent alcohol use over time.

For DRD2 genotype no significant main effect was found. DRD2 genotype interacted with parental rule-setting on adolescent alcohol use over time: adolescents, with parents highly permissive toward alcohol consumption and carrying a genotype with the DRD2 A1 (rs1800497T) allele, used significantly more alcohol over time than adolescents without these characteristics.

The DRD2 genotype may pose an increased risk for alcohol use and abuse, depending on the presence of environmental risk factors, such as alcohol-specific parenting.

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Request Reprint E-Mail: C.vanderZwaluw@bsi.ru.nl_

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Finland's u-turn on alcohol tax



Health ministers are describing drinking as the new smoking amid rising concern about the price of alcohol in the UK.

The Scottish government has suggested a range of radical measures, including a minimum price per unit of alcohol.

After a public consultation they are due to respond with more detailed proposals for legislation later this month.

The idea of minimum pricing is supported by medical organisations and charities, but opposed by retailers who say moderate drinkers would be unfairly penalised.

The Scottish government says the connection between price and consumption is backed by international evidence, including the recent experience of Finland.

Tax cut
In 2004 tax on alcohol in Finland was dramatically reduced, leading to price reductions of up to a third, depending on the type of alcohol.

Health campaigners say alcohol related harm visibly increased within the space of two or three years.
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Moderate Alcohol Intake and Cancer Incidence in Women

Journal of the National Cancer Institute Advance Access published online on February 24, 2009

With the exception of breast cancer, little is known about the effect of moderate intakes of alcohol, or of particular types of alcohol, on cancer risk in women.

A quarter of the cohort reported drinking no alcohol; 98% of drinkers consumed fewer than 21 drinks per week, with drinkers consuming an average of 10 g alcohol (1 drink) per day. During an average 7.2 years of follow-up per woman 68 775 invasive cancers occurred. Increasing alcohol consumption was associated with increased risks of cancers of the oral cavity and pharynx (increase per 10 g/d = 29%, 95% CI = 14% to 45%, Ptrend < .001), esophagus (22%, 95% CI = 8% to 38%, Ptrend = .002), larynx (44%, 95% CI = 10% to 88%, Ptrend = .008), rectum (10%, 95% CI = 2% to 18%, Ptrend = .02), liver (24%, 95% CI = 2% to 51%, Ptrend = .03), breast (12%, 95% CI = 9% to 14%, Ptrend < .001), and total cancer (6%, 95% CI = 4% to 7%, Ptrend < .001). The trends were similar in women who drank wine exclusively and other consumers of alcohol. For cancers of the upper aerodigestive tract, the alcohol-associated risk was confined to current smokers, with little or no effect of alcohol among never and past smokers (Pheterogeneity < .001). Increasing levels of alcohol consumption were associated with a decreased risk of thyroid cancer (Ptrend = .005), non–Hodgkin lymphoma (Ptrend = .001), and renal cell carcinoma (Ptrend = .03).

Low to moderate alcohol consumption in women increases the risk of certain cancers. For every additional drink regularly consumed per day, the increase in incidence up to age 75 years per 1000 for women in developed countries is estimated to be about 11 for breast cancer, 1 for cancers of the oral cavity and pharynx, 1 for cancer of the rectum, and 0.7 each for cancers of the esophagus, larynx and liver, giving a total excess of about 15 cancers per 1000 women up to age 75.

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Request Reprint E-Mail: naomi.allen@ceu.ox.ac.uk

Alcohol Intake and Cigarette Smoking and Risk of a Contralateral Breast Cancer

American Journal of Epidemiology Advance Access published online on February 11, 2009

Women with primary breast cancer are at increased risk of developing second primary breast cancer. Few studies have evaluated risk factors for the development of asynchronous contralateral breast cancer in women with breast cancer.

In the Women's Environmental Cancer and Radiation Epidemiology Study (1985–2001), the roles of alcohol and smoking were examined in 708 women with asynchronous contralateral breast cancer (cases) compared with 1,399 women with unilateral breast cancer (controls).

Ever regular drinking was associated with an increased risk of asynchronous contralateral breast cancer (rate ratio = 1.3, 95% confidence interval: 1.0, 1.6), and the risk increased with increasing duration (P = 0.03). Smoking was not related to asynchronous contralateral breast cancer.

In this, the largest study of asynchronous contralateral breast cancer to date, alcohol is a risk factor for the disease, as it is for a first primary breast cancer.

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Request Reprint E-Mail: knight@lunenfeld.ca

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Sequence Variations of the Human MPDZ Gene and Association With Alcoholism in Subjects With European Ancestry

Alcoholism: Clinical and Experimental Research Published Online: 28 Jan 2009

Mpdz gene variations are known contributors of acute alcohol withdrawal severity and seizures in mice.

Sixty-seven new, mostly rare variants were discovered in the human MPDZ gene. Sequence comparison revealed that the human gene does not have variations identical to those comprising Mpdz gene haplotype associated with AWS in mice. We also found no significant association between MPDZ haplotypes and AWS in humans. However, a global test of haplotype association revealed a significant difference in haplotype frequencies between alcohol-dependent subjects without AWS and Coriell controls (p = 0.015), suggesting a potential role of MPDZ in alcoholism and/or related phenotypes other than AWS. Haplotype-specific tests for the most common haplotypes (frequency > 0.05), revealed a specific high-risk haplotype (p = 0.006, maximum statistic p = 0.051), containing rs13297480G allele also found to be significantly more prevalent in alcoholics without AWS compared with nonalcoholic Coriell subjects (p = 0.019).

Sequencing of MPDZ gene in individuals with EA ancestry revealed no variations in the sites identical to those associated with AWS in mice. Exploratory haplotype and single SNP association analyses suggest a possible association between the MPDZ gene and alcohol dependence but not AWS.

Further functional genomic analysis of MPDZ variants and investigation of their association with a broader array of alcoholism-related phenotypes could reveal additional genetic markers of alcoholism.

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Request Reprint E-Mail: karpyak.victor@mayo.edu

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Media coverage of celebrity DUIs: teachable moments or problematic social modeling?
Alcohol and Alcoholism Advance Access published online on0 on February 16, 2009

Alcohol in the media influences norms around use, particularly for young people. A recent spate of celebrity arrests for drinking and driving (DUI) has received considerable media attention. We asked whether these newsworthy events serve as teachable moments or problematic social modeling for young women. .

Stories were brief, episodic and focused around glamorous celebrity images. They included routine discussion of the consequences of the DUI for the individual celebrities without much evidence of a consideration of the public health dimensions of drinking and driving or possible prevention measures.

Our analysis found little material in the media coverage that dealt with preventing injury or promoting individual and collective responsibility for ensuring such protection. Media attention to such newsworthy events is a missed opportunity that can and should be addressed through media advocacy efforts.

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Request Reprint E-Mail: kasmith@jhsph.edu
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Alcohol, Gestation and Breastfeeding: Selenium as an Antioxidant Therapy
Alcohol and Alcoholism Advance Access published online on February 12, 2009

The aim of this paper is to study the relationship between alcohol, selenium and oxidative stress in breastfeeding rat pups exposed to ethanol during gestation and lactation. We have also studied how a Se-supplemented diet among mothers could prevent different oxidative liver disorders in the pups.

In the liver of pups, exposure to ethanol provoked a decrease in selenium and GPx activity and an increase in GR and CAT activity, as well as in carbonyl groups in protein. A pups had higher Se levels and GPx activity in serum than C pups. Administering Se with alcohol balances the activities of scavenging enzymes and reduces peroxidation protein products.

These results suggest that selenium could be effective in neutralizing the damage of ethanol consumption during gestation and lactation in pups since it repairs selenium levels in liver as well as the activity of scavenging enzymes and peroxidation protein products. In serum, Se also recovers GPx activity and increases the levels of Se that are available to other organs.

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Request Reprint E-Mail: olimpia@us.es
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The TEDS Report: Treatment Outcomes among Clients Discharged from Residential Substance Abuse Treatment:

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  SAMHSA's annual Treatment Episode Data Set (TEDS) provides data on completion rates by race, gender, primary substance of abuse, and type of residential treatment for those with discharge information provided by the States for their specialty substance abuse treatment facilities.


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  In 2005, clients discharged from short-term residential treatment (30 days or less) were more likely to complete treatment than those discharged from long-term residential treatment (57% vs. 38%).


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  Among short-term residential treatment discharges, a higher proportion of American Indian/Alaska Natives (63%) and Asian/Pacific Islanders (60%) completed treatment than Whites (57%), Blacks (55%), or Hispanics (52%).


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  Clients who reported alcohol as their primary drug of abuse were more likely to complete treatment among residential short-term discharges (66%) and long-term discharges (46%) than those with other primary drugs of abuse.


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  Discharged clients who reported stimulants as their primary drug of abuse were the least likely to complete short-term residential treatment (46%) and were almost as likely (19%) as those reporting opiates (21%) as their primary drug to drop out of short-term residential treatment.


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  Treatment completion among clients discharged from long-term residential treatment was lowest among those reporting cocaine abuse (33%) or opiate abuse (35%) as their primary drug of abuse.

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Health Disadvantage in US Adults Aged 50 to 74 Years: A Comparison of the Health of Rich and Poor Americans With That of Europeans

American Journal of Public Health March 2009, Vol 99, No. 3, 540-548

We compared the health of older US, English, and other European adults, stratified by wealth.

American adults reported worse health than did English or European adults. Eighteen percent of Americans reported heart disease, compared with 12% of English and 11% of Europeans. At all wealth levels, Americans were less healthy than were Europeans, but differences were more marked among the poor. Health disparities by wealth were significantly smaller in Europe than in the United States and England. Odds ratios of heart disease in a comparison of the top and bottom wealth tertiles were 1.94 (95% confidence interval [CI] = 1.69, 2.24) in the United States, 2.13 (95% CI = 1.73, 2.62) in England, and 1.38 (95% CI = 1.23, 1.56) in Europe. Smoking, obesity, physical activity levels, and alcohol consumption explained a fraction of health variations.

American adults are less healthy than Europeans at all wealth levels. The poorest Americans experience the greatest disadvantage relative to Europeans.

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Request Reprint E-Mail: m.avendanopabon@erasmusmc.nl

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Curbing Problem Drinking with Personalized-Feedback Interventions: A Meta-Analysis

American Journal of Preventive MedicineVolume 36, Issue 3, March 2009, Pages 247-255

The effectiveness of personalized-feedback interventions to reduce problem drinking has been evaluated in several RCTs and systematic reviews.

A meta-analysis was performed to examine the overall effectiveness of brief, single-session personalized-feedback interventions without therapeutic guidance.

The selection and analyses of studies were conducted in 2008. Fourteen RCTs of single-session personalized-feedback interventions without therapeutic guidance were identified, and their combined effectiveness on the reduction of problematic alcohol consumption was evaluated in a meta-analysis. Alcohol consumption was the primary outcome measure.

The use of single-session personalized-feedback interventions without therapeutic guidance appears to be a viable and probably cost-effective option for reducing problem drinking in student and general populations. The Internet offers ample opportunities to deliver personalized-feedback interventions on a broad scale, and problem drinkers are known to be amenable to Internet-based interventions. More research is needed on the long-term effectiveness of personalized-feedback interventions for problem drinking, on its potential as a first step in a stepped-care approach, and on its effectiveness with other groups (such as youth obliged to use judicial service programs because of violations of minimum-age drinking laws) and in other settings (such as primary care).

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Request Reprint E-Mail: hriper@trimbos.nl

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State Alcohol-Use Estimates Among Youth and Adults, 1993–2005

American Journal of Preventive MedicineVolume 36, Issue 3, March 2009, Pages 218-224

Underage drinking, particularly binge drinking, is an important public health problem that results in substantial premature mortality and morbidity. Little is known about the potential influence of the alcohol-use behaviors of adults on youth alcohol use at a population level.

The purpose of this study was to examine the correlation of alcohol-use behaviors among youth with those of adults at a population level.

Overall and subgroup-specific state youth estimates of current drinking and binge drinking were generally moderately to strongly correlated with adult alcohol use (range of r -values for pooled estimates across all years: 0.35–0.68 for current drinking

Most state youth alcohol-use estimates were correlated with state adult estimates. These findings have implications for underage-drinking control strategies and suggest that efforts to address this problem need to be targeted on a broader societal level.

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Request Reprint E-Mail: den2@cdc.gov

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Binge Drinking Among U.S. Active-Duty Military Personnel

American Journal of Preventive MedicineVolume 36, Issue 3, March 2009, Pages 208-217

Binge drinking (drinking on a single occasion ≥5 drinks for men or ≥4 drinks for women) is a common risk behavior among U.S. adults that is associated with many adverse health and social consequences. However, little is known about binge drinking among active-duty military personnel (ADMP). The objectives of this study were to quantify episodes of binge drinking, to characterize ADMP who binge-drink, and to examine the relationship between binge drinking and related harms.

In 2005, a total of 43.2% of ADMP reported past-month binge drinking, resulting in 29.7 episodes per person per year. In all, 67.1% of binge episodes were reported by personnel aged 17–25 years (46.7% of ADMP), and 25.1% of these episodes were reported by underage youth (aged 17–20 years). Heavy drinkers (19.8% of ADMP) were responsible for 71.5% of the binge-drinking episodes and had the highest number of annual per-capita episodes of binge drinking (112.6 episodes). Compared to nonbinge drinkers, binge drinkers were more likely to report alcohol-related harms, including job performance problems (AOR=6.5; 95% CI=4.65, 9.15); alcohol-impaired driving (AOR=4.9; 95% CI=3.68, 6.49); and criminal justice problems (AOR=6.2; 95% CI=4.00, 9.72).

Binge drinking is common among ADMP and is strongly associated with adverse health and social consequences. Effective interventions (e.g., the enforcement and retainment of the minimum legal drinking age) to prevent binge drinking should be implemented across the military and in conjunction with military communities to discourage binge drinking.

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Request Reprint E-Mail: mstahre@cdc.gov

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New Resource Available on Detoxification


The Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Substance Abuse Treatment (CSAT) is pleased to announce the availability of the Detoxification and Substance Abuse Treatment Training Manual.

This new curriculum, based on Treatment Improvement Protocol (TIP) 45, is for use by clinical supervisors for training staff members about detoxification services for individuals with substance use disorders.

The manual includes information on the physiology of withdrawal, pharmacological management of withdrawal, patient placement, and incorporating detoxification services into comprehensive systems of care. It includes step-by-step instructions for providing inservice training.

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Low alcohol alternatives: A promising strategy for reducing alcohol related harm

International J Drug Policy Volume 20, Issue 2, Pages 183-187 (March 2009)

Less than 1% of the beer market in British Columbia comprises beers with an alcohol content below 4%, despite the success of low alcohol beers in other countries, e.g. Australia.

A small experimental study is described in which male students were given either unmarked low alcohol beer (3.8%) or regular strength beer (5.3%) to investigate their enjoyment and subjective intoxication..

We conclude beer drinkers cannot readily distinguish low and regular strength beers and can enjoy socializing equally with either. We recommend taxation strategies to create incentives for the manufacture, marketing and consumption of low alcohol alternatives.

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Request Reprint E-Mail: dsegal@uvic.ca

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