Aims

To support the free and open dissemination of research findings and information on alcoholism and alcohol-related problems. To encourage open access to peer-reviewed articles free for all to view.

For full versions of posted research articles readers are encouraged to email requests for "electronic reprints" (text file, PDF files, FAX copies) to the corresponding or lead author, who is highlighted in the posting.

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Saturday, April 18, 2009

Wage Penalty of Abstinence and Wage Premium of Drinking -A misclassification bias due to pooling of drinking groups?


Several studies have found protective effects of low/moderate (hereafter “light”) alcohol consumption compared with “abstinence” on mortality, health and wage. Some of these studies have been criticised because former drinkers have been included among the abstainers, which may overstate the protective effect of light alcohol consumption. It has also been proposed, but not shown, that the commonly pooled group of light drinkers and former heavy drinkers would understate the protective effect of light drinking. We also suggest that former abstainers might cause the same effect when pooled with light drinkers.

The aim of this paper is to study whether pooled groups risk create bias in the form of misclassification and confounding. The analysis focuses on: ‘former drinker error’ (pooling of lifelong abstainers and former drinkers); ‘former abstainer error’ (pooling of former abstainers and lifelong light
drinkers); and ‘former heavy drinker error’ (pooling of light drinkers with and without history of heavy drinking). Swedish panel data were used in a multinomial logit model, presenting odds ratios when comparing the subgroups.

The results demonstrate that commonly pooled groups are heterogeneous with respect to a number of variables, which may implicate confounding. Given appropriate controls, misclassification bias is likely in the pooled group of light drinkers.

The direction of the misclassification bias, however, is to underestimate the beneficial effect of light alcohol consumption on wage and can therefore not explain the wage penalty of abstinence compared to light drinking.


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Fetal ethanol exposure increases ethanol intake by making it smell and taste better
PNAS March 31, 2009 vol. 106 no. 13 5359-5364


Human epidemiologic studies reveal that fetal ethanol exposure is highly predictive of adolescent ethanol avidity and abuse. Little is known about how fetal exposure produces these effects. It is hypothesized that fetal ethanol exposure results in stimulus-induced chemosensory plasticity. Here, we asked whether gestational ethanol exposure increases postnatal ethanol avidity in rats by altering its taste and odor.

Experimental rats were exposed to ethanol in utero via the dam's diet, whereas control rats were either pair-fed an iso-caloric diet or given food ad libitum. We found that fetal ethanol exposure increased the taste-mediated acceptability of both ethanol and quinine hydrochloride (bitter), but not sucrose (sweet). Importantly, a significant proportion of the increased ethanol acceptability could be attributed directly to the attenuated aversion to ethanol's quinine-like taste quality.

Fetal ethanol exposure also enhanced ethanol intake and the behavioral response to ethanol odor. Notably, the elevated intake of ethanol was also causally linked to the enhanced odor response. Our results demonstrate that fetal exposure specifically increases ethanol avidity by, in part, making it taste and smell better.

More generally, they establish an epigenetic chemosensory mechanism by which maternal patterns of drug use can be transferred to offspring. Given that many licit (e.g., tobacco products) and illicit (e.g., marijuana) drugs have noteworthy chemosensory components, our findings have broad implications for the relationship between maternal patterns of drug use, child development, and postnatal vulnerability.



Request Reprint E-Mail: youngens@upstate.edu

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Health professionals add more support for pricing controls on alcohol

The Royal College of Physicians and Royal College of Nursing Survey on Alcohol Treatment Services published last week asked gastroenterologists, hepatologists, acute physicians and nurses for their expert opinion on Government policy initiatives and national strategies to tackle alcohol related harm, the provision of service for people with alcohol related health problems and the scale of alcohol related health harms in their particular clinical environment. . . . . .


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PATHWAYS TO ABSTINENCE: IMPACT OF ALCOHOLICS ANONYMOUS





-The results of the present study support the efficacy of the fellowship of Alcoholics Anonymous to promote abstinence


-In 1992 Americans with alcohol use disorders who continued to attend AA were more likely to achieve abstinence (64%) than those who dropped out of AA (37%) or those who never attended AA (16%)

-Abstinence recovery status varies as a function of increasing age and level of severity of alcohol symptoms.


-The findings suggest that a substantial portion of the "AA drop outs" attain sobriety or abstinence after a period of AA membership and maintain their abstinence without AA


- The unmet need for AA referral is concentrated in the younger age groups, 35% in the 18-29 years group and 30% in the 30-39 years age group.


Read Full KNOL
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Friday, April 17, 2009

Effectiveness of Making Alcoholics Anonymous Easier: A group format 12-step facilitation approach
Journal of Substance Abuse Treatment Article in Press 1 April 2009


Most treatment programs recommend clients attend 12-step groups, but many drop out posttreatment. The effectiveness of Making Alcoholics Anonymous [AA] Easier (MAAEZ ), a manual-guided intervention designed to help clients connect with individuals encountered in AA, was tested using an “OFF/ON” design (n = 508).

MAAEZ effectiveness was determined by comparing abstinence rates of participants recruited during ON and OFF conditions and by studying the effect of the number of MAAEZ sessions attended. At 12 months, more clients in the ON condition (vs. OFF) reported past 30-day abstinence from alcohol (p = .012), drugs (p = .009), and both alcohol and drugs (p = .045). In multivariate analyses, ON condition participants had significantly increased odds of abstinence from alcohol (odds ratio [OR] = 1.85) and from drugs (OR = 2.21); abstinence odds also increased significantly for each additional MAAEZ session received.

MAAEZ appeared especially effective for those with more prior AA exposure, severe psychiatric problems, and atheists/agnostics. MAAEZ represents an evidence-based intervention that is easily implemented in existing treatment programs.




Request Reprint E-Mail: lkaskutas@arg.org

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Tracking Adolescent Substance Use and Abuse in North Carolina


Duke University has just launched a great website that allows policymakers and others to get information about teen aclohol and drug use in North Carolina. It pulls from multiple public information sources about teen arrests for possession by drug, emergency room visits, and much more. County data can be compared to state data, data can be examined by county on a map of North Carolina ... and that's just the start.
. . . . .


Read More
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Problemas relacionados con el consumo de alcohol en jóvenes de la provincia de Jujuy, Argentina.
Salud pública Méx [online]. 2008, v. 50, n. 4, pp. 300-307.


To examine drinking patterns and alcohol-related problems among youth in Jujuy, Argentina.

A survey was conducted in 2005 with a representative sample of 9th grade youth (12 to 17 years old) including sociodemographic and consumption data, and the AUDIT-C test.

Nine percent of girls and 11% of boys reported hazardous drinking; 12% of girls and 19% of boys reported dependence symptoms. The odds ratio for dependence symptoms (adjusted OR 0.7; 95%CI: 0.6-0.8) and for hazardous drinking (adjusted OR 0.7; 95%CI: 0.6-0.8) was significantly lower for girls compared with boys. Older age, working, and attending night school were risk factors for hazardous drinking, dependence symptoms, and harmful drinking.

A significant proportion of youth reported problematic patterns of alcohol drinking, highlighting the need to implement prevention and treatment interventions tailored to the adolescent population




Request Reprint E-Mail: e_alderete@arnet.com.ar

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Thursday, April 16, 2009

Children Living with Substance-Dependent or Substance-Abusing Parents: 2002 to 2007

Highlights:

Combined data from SAMHSA's 2002 to 2007 National Surveys on Drug Use and Health were used to provide average annualized estimates of the number of children under age 18 living with a substance abusing parent, that is, a parent who was dependent on or abused alcohol or an illicit drug.

Over 8.3 million children (11.9%) lived with at least one parent who was dependent on or abused alcohol or an illicit drug during the past year.

Of the children living with a substance abusing parent, almost 7.3 million (10.3%) lived with a parent who was dependent on or abused alcohol, and about 2.1 million (3.0%) lived with a parent who was dependent on or abused illicit drugs.

About 5.4 million children under 18 years of age lived with a father who met the criteria for past year substance dependence or abuse and 3.4 million lived with a mother who met the criteria.

Read Full Report (PDF)

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Reclaiming Futures Launches Blog Dedicated to Substance Abuse and Teens in the Juvenile Justice System

Reclaiming Futures Every Day is a professionally-staffed blog that aims to keep people informed of the latest happenings in juvenile justice and substance abuse treatment. Launched by Reclaiming Futures, an initiative of the Robert Wood Johnson Foundation, it can be found at http://blog.reclaimingfutures.org/, and is designed to help readers:
  • Discuss the national challenge of helping teens break the cycle of drugs, alcohol and crime.
  • Comment on new developments in teen alcohol and drug treatment and juvenile justice reform.
  • Stay in touch with what's going on in the 23 communities using the proven Reclaiming Futures approach.
  • Receive expert opinions and commentary from regular contributors who are leaders in the field.
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Wednesday, April 15, 2009

Disparity Between Tonic and Phasic Ethanol-Induced Dopamine Increases in the Nucleus Accumbens of Rats
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

Dopamine concentrations in the nucleus accumbens fluctuate on phasic (subsecond) and tonic (over minutes) timescales in awake rats. Acute ethanol increases tonic concentrations of dopamine, but its effect on subsecond dopamine transients has not been fully explored.

Microdialysis samples yielded significant tonic increases in dopamine concentrations at 1 to 2 g/kg ethanol in each rat, while repeated saline infusions had no effect. When monitored with fast scan cyclic voltammetry, ethanol increased the frequency of dopamine transients in 6 of 16 recording sites, in contrast to the uniform effect of ethanol as measured with microdialysis. In the remaining 10 recording sites that were unresponsive to ethanol, dopamine transients either decreased in frequency or were unaffected by cumulative ethanol infusions, patterns also observed during repeated saline infusions. The responsiveness of particular recording sites to ethanol was not correlated with either core versus shell placement of the electrodes or the basal rate of dopamine transients. Importantly, the phasic response pattern to a single dose of ethanol at a particular site was qualitatively reproduced when a second dose of ethanol was administered, suggesting that the variable between-site effects reflected specific pharmacology at that recording site.

These data demonstrate that the relatively uniform dopamine concentrations obtained with microdialysis can mask a dramatic heterogeneity of phasic dopamine release within the accumbens.

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Request Reprint E-Mail: DLR@unc.edu
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Proopiomelanocortin Peptides Are Not Essential for Development of Ethanol-Induced Behavioral Sensitization
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

Behavioral sensitization is a result of neuroadaptation to repeated drug administration and is hypothesized to reflect an increased susceptibility to drug abuse. Proopiomelanocortin (POMC) derived peptides including β-endorphin and α-melanocyte stimulating hormone have been implicated in development of behavioral sensitization and the reinforcing effects of alcohol and other drugs of abuse.

This study used a genetically engineered mouse strain that is deficient for neural POMC to directly determine if any POMC peptides are necessary for the development of ethanol-induced locomotor sensitization.

There was no significant difference in BEC between genotypes (WT = 2.11 ± 0.06; KO = 2.03 ± 0.08 mg/ml). Both WT and nPOMC-deficient mice treated repeatedly with ethanol demonstrated a significant increase in locomotor activity on test day when compared to repeated saline-treated counterparts. In addition, mice of both genotypes in the repeated saline groups showed a significant locomotor stimulant response to acute ethanol injection.

Central POMC peptides are not required for either the acute locomotor stimulatory effect of ethanol or the development of ethanol-induced locomotor sensitization. While these peptides may modulate other ethanol-associated behaviors, they are not essential for development of behavioral sensitization.

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Request Reprint E-Mail: sharpea@uthscsa.edu
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The Impact of Underage Drinking Laws on Alcohol-Related Fatal Crashes of Young Drivers
Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009

This study used a pre- to post-design to evaluate the influence on drinking-and-driving fatal crashes of 6 laws directed at youth aged 20 and younger and 4 laws targeting all drivers..

Significant decreases in the underage fatal CIR were associated with presence of 4 of the laws targeting youth (possession, purchase, use and lose, and zero tolerance) and 3 of the laws targeting all drivers (0.08 blood alcohol concentration illegal per se law, secondary or upgrade to a primary seat belt law, and an administrative license revocation law). Beer consumption was associated with a significant increase in the underage fatal CIR. The direct effects of laws targeting drivers of all ages on adult drinking drivers aged 26 and older were similar but of a smaller magnitude compared to the findings for those aged 20 and younger. It is estimated that the 2 core underage drinking laws (purchase and possession) and the zero tolerance law are currently saving an estimated 732 lives per year controlling for other exposure factors. If all states adopted use and lose laws, an additional 165 lives could be saved annually.

These results provide substantial support for the effectiveness of under age 21 drinking laws with 4 of the 6 laws examined having significant associations with reductions in underage drinking-and-driving fatal crashes. These findings point to the importance of key underage drinking and traffic safety laws in efforts to reduce underage drinking-driver crashes.

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Request Reprint E-Mail: fell@pire.org
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IgA Immune Responses Against Acetaldehyde Adducts and Biomarkers of Alcohol Consumption in Patients with IgA Glomerulonephritis

Alcoholism: Clinical and Experimental Research Published Online: 9 Apr 2009


The pathogenesis of IgA glomerulonephritis (IgAGN) involves intense deposition of IgAs within the glomerulus. Although previous studies have shown that heavy drinking frequently leads to the generation of IgA antibodies against neo-antigens induced by ethanol metabolites and tissue deposition of IgAs, the associations between alcohol consumption, IgA immune responses, and kidney disease have not been examined.

In male IgAGN patients, drinking status was significantly associated with MCV, p < 0.001; CDT, p < 0.01; and γ -CDT, p < 0.05. In the reference population, all biomarkers and anti-adduct IgA levels were found to vary according to drinking status. In IgAGN patients, anti-adduct IgA levels were elevated in 63% of the cases but the titers did not associate with self-reported ethanol intake

These data indicate high levels of IgA antibodies against acetaldehyde-derived antigens in IgAGN patients, which may hamper the use of the immune responses as markers of alcohol consumption among such patients. Future studies on the pathogenic and prognostic significance of anti-adduct immune responses in IgAGN patients are warranted


Read Full Abstract


Request Reprint E-Mail: kati.kaartinen@elisanet.fi
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Monday, April 13, 2009

New Manual Teaches Strategies to Manage Depressive Symptoms in Substance Abuse Clients

Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery, a new manual which offers substance abuse counselors new insights on working with clients with depressive symptoms and substance use disorders, is now available from the Substance Abuse and Mental Health Services Administration (SAMHSA).

The manual is #48 in the Treatment Improvement Protocol (TIP) series. TIPs are best-practice guidelines used for the treatment of substance use disorders, issued by SAMHSA’s Center for Substance Abuse Treatment (CSAT). This and future TIPs will be organized in a new format.

The new format consists of three parts. The parts of this TIP are:
- Part 1 - Managing Depressive Symptoms in Substance Abuse Clients During Early Recovery
- Part 2 - Managing Depressive Symptoms: An Implementation Guide for Administrators
- Part 3 - Managing Depressive Symptoms: A Review of the Literature

Read Full Manual (PDF)
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Sunday, April 12, 2009

A Behavioral Economic Reward Index Predicts Drinking Resolutions: Moderation Revisited and Compared With Other Outcomes
Journal of Consulting and Clinical Psychology Volume 77, Issue 2, April 2009, Pages 219-228


Data were pooled from 3 studies of recently resolved community-dwelling problem drinkers to determine whether a behavioral economic index of the value of rewards available over different time horizons distinguished among moderation (n = 30), abstinent (n = 95), and unresolved (n = 77) outcomes.

Moderation over 1- to 2-year prospective follow-up intervals was hypothesized to involve longer term behavior regulation processes than abstinence or relapse and to be predicted by more balanced preresolution monetary allocations between short-term and longer term objectives (i.e., drinking and saving for the future).

Standardized odds ratios (ORs) based on changes in standard deviation units from a multinomial logistic regression indicated that increases on this “Alcohol-Savings Discretionary Expenditure” index predicted higher rates of abstinence (OR = 1.93, p = .004) and relapse (OR = 2.89, p < .0001) compared with moderation outcomes. The index had incremental utility in predicting moderation in complex models that included other established predictors.

The study adds to evidence supporting a behavioral economic analysis of drinking resolutions and shows that a systematic analysis of preresolution spending patterns aids in predicting moderation.



Request Reprint E-Mail: jtucker@uab.edu

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Friday, April 10, 2009

The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption
PLoS Med 6(3)

ALDH2 Lys487 allele contributes to both the alcohol flushing response
and an elevated risk of squamous cell esophageal cancer from alcohol
consumption.

Read Full Article (PDF)
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Alcohol Treatment: Need, Utilization, and Barriers

Highlights:

SAMHSA's National Survey on Drug Use & Health defines need for alcohol treatment as meeting criteria for alcohol dependence or abuse using criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The criteria includes symptoms such as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year. Also included are people who received treatment in a specialty substance abuse treatment facility in the past year for their alcohol use.
Based on SAMHSA's 2007 National Survey on Drug Use & Health, 7.8% (19.3 million) persons aged 12 or older needed treatment for their alcohol problem in the past year.

The majority of those who needed alcohol treatment either did not perceive the need for treatment or did not receive it. Of those who needed alcohol treatment in the past year, 8.1% received treatment at a specialty treatment facility, 4.5% did not receive treatment but felt they needed it, and 87.4% neither received nor perceived a need for alcohol treatment.

Among those who did not receive alcohol treatment but felt they needed it, only 27.9% actually made an effort to get treatment in the past year.
Combined data from SAMHSA's 2004 to 2007 National Surveys on Drug Use & Health were used to determine reasons for not receiving alcohol treatment. The most common reasons given for not receiving alcohol treatment among those who felt the need for it were: 42% were not ready to stop using alcohol and 34.5% had cost or insurance barriers.


Read Full Report (PDF)

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Wednesday, April 8, 2009

British teenagers amongst worst in Europe for excessive drinking - 2007 ESPAD report

The 2007 European School Survey Project on Alcohol and other Drugs (ESPAD) report was published last week. The study focuses on alcohol and drug use amongst 15 to 16 year-olds in 35 European countries and found that UK consumption for young people was highest behind only Denmark and the Isle of Man.

The report adds weight to calls for minimum pricing. Professor Martin Plant who leads the UK part of the ESPAD study said:
There is a clear scientific consensus that alcohol education and mass media campaigns have a very poor track record in influencing drinking habits. Far more effective - and cost effective - policies include using taxation to make alcohol less affordable.
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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.

Read Full Abstract

Request Reprint E-Mail: ABadawy@uwic.ac.uk

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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.

Read Full Text (PDF)
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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.

Read Full Guide (PDF)
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Tuesday, April 7, 2009

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.




Request Reprint E-Mail: mg@niph.dk

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Monday, April 6, 2009

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





Read Full Report


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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.

Read Full Knol
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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.


Read Full Abstract

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

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Saturday, April 4, 2009

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.




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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Wednesday, April 1, 2009

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.

Saturday, March 28, 2009

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.



Read Full Abstract

Request Reprint E-Mail: bwhite@chestnut.org

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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.



Request Reprint E-Mail: tborkman@gmu.edu

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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
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
Request Reprint E-Mail: robert-philibert@uiowa.edu
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Tuesday, March 24, 2009

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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Monday, March 23, 2009

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.
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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Friday, March 20, 2009

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

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Friday, March 6, 2009

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.


Request Reprint E-Mail: cookrl@phhp.ufl.edu
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Thursday, March 5, 2009

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.




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.
Request Reprint E-Mail: jlabrie@lmu.edu
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