Persistence with Oral Naltrexone for Alcohol Treatment: Implications for Healthcare Utilization

Concerns have been raised about patients' failure to persist in alcohol treatment. We examined prescriptions for oral naltrexone in a large, nationally distributed treatment population to identify characteristics and healthcare utilization patterns associated with persistence.

Over a 6-month period, more than 85% of patients who filled an initial prescription for naltrexone did not persist in obtaining the medication. Non-persistence was associated with significantly greater use of costly healthcare services. Because the study was correlational, it is not possible to conclude that persistence reduced healthcare costs, since better prognosis patients may have been more persistent. Research is needed to determine whether interventions that enhance persistence with naltrexone therapy improve treatment outcomes and reduce healthcare costs.

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The Performance of Elements of a “Level of Response to Alcohol”-Based Model of Drinking Behaviors in 13-Year-Olds in Bristol, England

The goals of this paper are to evaluate whether drinking practices among peers mediates the relationship between a low level of response (LR) to alcohol and a person’s heavier drinking and alcohol-related problems in 12-to-14-year-olds.

The perceived drinking practices of peers is a potentially important mediator of how a low LR to alcohol relates to drinking practices during early adolescence. The findings may be useful in developing approaches to prevent heavier drinking in this young group.

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Computer-Delivered Interventions to Reduce College Student Drinking: A Meta-Analysis

This meta-analysis evaluates the efficacy and moderators of computer-delivered interventions (CDIs) to reduce alcohol use among college students.

CDIs reduce the quantity and frequency of drinking among college students. CDIs are generally equivalent to alternative alcohol-related comparison interventions.

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ALDH2 genetic polymorphism and the risk of type II diabetes mellitus in CAD patients.

The prevalence of type II diabetes mellitus (T2DM) in coronary artery disease (CAD) patients has been steadily increasing, especially in East Asian countries. Although many studies have suggested that certain genetic variants may predispose to the development of T2DM, very few studies investigated the genetic link with T2DM in CAD patients of East Asia.

In this study, we investigated the relationship between Glu504Lys polymorphism in the acetaldehyde dehydrogenase 2 (ALDH2) gene, a key enzyme of alcohol metabolism, and the risk of having T2DM in Chinese Han CAD patients.

Logistic and linear regression analyses showed that ALDH2 mutant genotypes (^*1/^*2 and ^*2/^*2) were an independent risk factor for both T2DM in female CAD patients, even after controlling for alcohol consumption , and fasting plasma glucose (FPG) in CAD-/DM- women, whereas the association with FPG disappeared after controlling for high-sensitivity C-reactive protein, a classic inflammatory biomarker. However, there was no relationship between the ALDH2 genetic polymorphism and T2DM or FPG in men.

These findings suggest that the ALDH2 polymorphism is associated with an increased risk of T2DM in female CAD patients, and this association could be causal on the basis of the association between the polymorphism and FPG, which is partly explained by an increased inflammatory status.

These findings will benefit the screening and treatment of a high-risk population in East Asians.

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Request Reprint E-Mail: warmsunlight2006@yahoo.com.cn (Y Chen) or zhangyun@sdu.edu.cn(Y Zhang)
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Effects of a Diagnosis or Family History of Alcoholism on the Taste Intensity and Hedonic Value of Sucrose

Given inconsistent findings in published studies, we examined whether a personal lifetime history of alcohol dependence (AD) or a parental history of alcoholism affected preference for sweet solutions.

Ninety-three alcohol-dependent subjects rated the intensity and hedonic value of five different sucrose solutions, which was compared with similar data from 122 subjects screened to exclude alcohol dependence. The effect of a family history of alcoholism (FH) was examined in the AD group.

Neither the diagnosis of AD nor a family history of alcoholism was associated with ratings of sweetness intensity or sweet preference.

These findings do not support the hypothesis that sucrose preference is positively associated with either a personal lifetime history of AD or a family history of alcoholism.

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Request Reprint E-Mail: kranzler@psychiatry.uchc.edu.
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A Simple Risk Scoring System for Prediction of Relapse after Inpatient Alcohol Treatment

Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist.

Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment.

The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment.

The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment.

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Request Reprint E-Mail: mup@crf.au.dk.

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Children and young people alcohol reports

Further reports examining children and young people's alcohol use have been released including:

Influences on how children and young people learn about and behave towards alcohol

Young people, alcohol and the news: preliminary findings

Young people and alcohol: meanings, practices and contexts

Read More
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The molecular biology of addictive drugs

The addictive drugs alcohol, morphine, cocaine, and amphetamine are each associated with the development of tolerance and physical dependence. Changes in gene expression occur in cell culture and in vivo with the administration of these centrally-acting drugs.

This article reviews those experiments that have studied drug-induced alterations in gene transcription.

Ethanol has diverse effects on the amounts of messenger RNA molecules within the central nervous system. Ion channels, neuropeptides, membrane receptors, and immediate early genes represent several regulated mRNAs. The effects are selective, however, as many other specific products are not altered. Evidence for a genetic predisposition to ethanol use reinforces the importance of the genotype.

Opioids, cocaine, and amphetamine also affect gene transcription. Messenger RNAs studied have included many of those demonstrated to be altered by alcohol use. Interestingly, use of any of these drugs alters the expression of immediate early genes. These genes may represent an initial step in the pathway that leads to drug addiction.

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Request Reprint E-Mail: SMACKLER@MAIL.MED.UPENN.EDU
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The impact of parenthood on alcohol consumption trajectories: Variations as a function of timing of parenthood, familial alcoholism, and gender

The current study tested the impact of the transition to parenthood on growth in alcohol consumption from early adolescence through emerging adulthood.

We measured age-related discontinuity in trajectories of alcohol consumption associated with timing of the parenthood transition, above and beyond the effects of accrued educational status, gender, and time-varying marital status. We also examined the impact of a familial selection factor for the transmission of alcohol use problems, family history density of alcoholism (FHD), on both risk for adolescent parenthood and risk for adolescent parents' continuity in alcohol consumption after the parent transition within a mediation structural equation model.

Premature timing of parenthood had a distinct effect on emerging adult alcohol trajectories. Although participants who became parents as emerging adults showed role-related decline in alcohol consumption, those who became parents during adolescence showed a role-related rise in emerging adult alcohol consumption.

Gender moderated adolescent parents' role-related growth in emerging adult alcohol consumption. Adolescent fathers showed an adverse rise in alcohol consumption after becoming parents, whereas adolescent mothers' alcohol consumption did not change significantly.

FHD was related to high adolescent alcohol consumption, which mediated risk for the incidence of early parenthood.

Finally, the adverse effect of FHD on trajectories of emerging adult alcohol use was mediated by a dual pathway: (a) developmental continuity of conduct problems and (b) early transition to parenthood.

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Request Reprint E-Mail: Michelle.Little@utsa.edu. _____________________________________________________

Screening and Brief Intervention for Alcohol use in a Custody Suite: The Shape of Things to Come?

Irresponsible and excessive consumption of alcohol and the associated problems it carries in its wake have become one of the key concerns for central government both in terms of community safety and public health.

In response to the Alcohol Harm Reduction Strategy for England (DoH, 2007), the Department of Health (DoH) have announced a series of measures, one of which is to pilot screening and intervention for alcohol use programmes in a variety of locations, of which one is within a probation setting.

This paper reports on the findings of a project that pre-empts the DoH initiatives, thus providing the opening comments in what is sure to be a debate about a new strategic and evidence-based approach to dealing with problematic alcohol use.

The paper provides data and discussions on the Screening and Brief Intervention (SBI) project that screened 3,900 detainees in the Charles Cross custody suite in Plymouth, England during the period March 2007 to March 2008.

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Request Reprint E-Mail: abarton@plymouth.ac.uk
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Maternal alcohol consumption may influence cord blood ascorbic acid concentration: findings from a study of Brazilian mothers and their newborns

Studies that have investigated ascorbic acid (AA) concentrations in cord blood have pointed to significant associations with maternal blood AA concentrations, smoking, age, diet, type of delivery, duration of gestation, fetal distress and birth weight.

The aim of the present study was to determine the relationship between cord blood AA concentrations in newborns and maternal characteristics.

The linear regression model including maternal AA concentration, alcohol consumption, smoking, parity, vitamin C-rich food intake score and per capita income explained 31·13 % of the variation in cord blood AA concentrations in newborns.

We recommend further experimental studies to assess the effects of ethanol on placental AA uptake, and epidemiological cohort studies to evaluate in detail the influence of maternal alcohol consumption on cord blood AA concentrations.

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Request Reprint E-Mail: andmo@usp.br
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McGrath softens drink law position

The highest-profile opponent of Noel Dempsey’s controversial new drink-driving legislation said yesterday he might support the watered-down version the transport minister published last Friday.

Mattie McGrath, the South Tipperary TD who led a backbench revolt within Fianna Fail against the reduction of the blood alcohol limit from 80mg per 100ml to 50mg, said the softer penalties for those caught with readings of less than 80mg was “a step in the right direction”. . . . . . .

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TRENDS IN ALCOHOL- AND DRUG-RELATED ED AND PRIMARY CARE VISITS: DATA FROM THREE U.S. NATIONAL SURVEYS (1995–2005)

To evaluate trends in alcohol- and drug-related ED and primary care visits over the previous decade.

Although an upward trend was observed in alcohol-related ED visits from 1995 to 2005, this increase was not significant. A significant trend was found for drug-related ED visits from 0.6% in 1995 to 3.7% in 2005 In multiple logistic regression, year of survey (2000 vs. 1995) was positively predictive of drug-related ED visits, controlling for gender, age, ethnicity and health insurance coverage; however, year of survey (2005 vs. 2000) was not significant.

These data suggest that drug-related ED visits are continuing to increase, although the increase has not been as substantial between 2000 and 2005, as that which was observed between 1995 and 2000, and highlight the opportunity provided by the ED and primary care settings for screening and brief intervention for substance-related problems. These findings also suggest that Healthy People 2010 objectives calling for a reduction in substance-related visits may not be reached.

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Alcohol, Other Drugs, and Health: Current Evidence

Current Issue: September–October 2009

View PDF of newsletter (Download Adobe Acrobat Reader)

Interventions and Assessments

• Heroin to Treat Opioid Dependence: A Randomized Trial
• Meta-analysis Confirms Methadone Maintenance Reduces Illicit Opioid Use and Improves Treatment Retention in Patients with Opioid Dependence
• Methadone Maintenance Therapy Decreases Arrests
• Impaired Memory in Subjects Receiving Opioid Agonist Treatment Who Also Abuse Benzodiazepines
• Impact of Buprenorphine Inquiries and Treatment on an Urban Community Health Center
• Improving Entry into Post-detoxification Treatment
• Injectable Risperidone for the Treatment of Methamphetamine Dependence

Health Outcomes

• AUDIT-C Scores Greater than 7 Predict Fracture Risk
• Does Heavy Alcohol Use Increase Risk of Prostate Cancer?
• Alcohol Consumption Limits Associated with Alcohol Problems in Older Adults
• Greater Alcohol Intake Increases the Risk for Hypertension, but Perhaps Not for Consumers of Red Wine
• Moderate Alcohol Intake Is Associated with Better Endothelial Function
• More than Half of All Deaths in Russia among People Aged 15–54 Years Are Attributable to Alcohol
• Action toward Change Predicts Reduced Alcohol Consumption among Unhealthy Drinkers, but Recognition of the Problem Does Not

Slide Presentations

• Update on Alcohol, Other Drugs, and Health
• Journal Club

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An Exploratory Study of the Nature of Family Resilience in Families Affected by Parental Alcohol Abuse

Resilient families are able to adapt to adversities, but the nature of family resilience is not well understood.

This study examines patterns of family functioning that may protect families from the negative impact of alcohol abuse. Naturally occurring patterns of family functioning are identified and associations between these patterns and parenting, current parental alcohol use, recent family stressful events, supportive relationships outside the family, and demographic characteristics are assessed.

The study results reveal a continuum of family functioning associated with parenting, child’s perception of teacher caring, and race.

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Request Reprint E-Mail: jcoyle@uwindsor.ca
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Maternal Alcohol Intake and Offspring Pulse Wave Velocity.

Intrauterine exposure to alcohol may affect cardiovascular development, increasing risk of cardiovascular malformations. Intrauterine exposure to light maternal alcohol intake has been reported to affect human umbilical arterial contractility, and adult sheep exposed in utero have had altered cerebrovascular reactivity. In human adults, alcohol intake affects arterial stiffness.

We investigated whether intrauterine exposure to alcohol was associated with childhood pulse wave velocity (PWV), a measure of arterial stiffness.

Carotid-femoral PWV in adults is predictive of cardiovascular morbidity and mortality. The degree of continuity between childhood and adulthood PWV is unknown, but as we found an association between prenatal alcohol exposure and carotid-femoral PWV at 9 years, a permanent change in vessel wall structure or function is possible. These findings need to be confirmed in other and larger cohorts, and mechanistic animal studies are needed

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Request Reprint E-Mail: ruth.morley@mcri.edu.au
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WHO - A response to the need for comprehensive, consistent and comparable information on health risks at global and regional level.

The leading global risks for mortality in the world are high blood pressure (responsible for 13% of deaths globally), tobacco use (9%), high blood glucose (6%), physical inactivity (6%), and overweight and obesity (5%). These risks are responsible for raising the risk of chronic diseases such as heart disease, diabetes and cancers. They affect countries across all income groups: high, middle and low.

The leading global risks for burden of disease as measured in disability-adjusted life years (DALYs) are underweight (6% of global DALYs) and unsafe sex (5%), followed by alcohol use (5%) and unsafe water, sanitation and hygiene (4%). Three of these risks particularly affect populations in low-income countries, especially in the regions of South-East Asia and sub-Saharan Africa. The fourth risk – alcohol use – shows a unique geographic and sex pattern,with its burden highest for men in Africa, in middle-income countries in the Americas and in some high-income countries.

Download the full report [pdf 3.77Mb]

MORE INFORMATION ON THE REPORT
Key figures and graphs [ppt 1.17Mb]

THE REPORT IN SECTIONS

:: Front cover, table of contents and summary [pdf 930kb]
:: Part 1: Introduction [pdf 994kb]
:: Part 2: Results [pdf 1.57Mb]
:: Part 3: Joint effects of risk factors [pdf 443kb]
:: Annex A: Data and methods [pdf 841kb]
:: References [pdf 148kb]

STATISTICS FROM THE REPORT

:: Regional estimates of YLL, YLD, DALYs, and deaths attributable to 24 risk factors for 2004: estimates of exposure prevalence for selected risk factors
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Alcohol Expectancy and Hazardous Drinking: A 6-Year Longitudinal and Nationwide Study of Medical Doctors

The study's aim was to determine whether medical doctors' expectancy that alcohol use reduces tension predicts the extent of their hazardous drinking and whether this effect is mediated by drinking to cope.

Efforts to reduce drinking among medical students and doctors should target both alcohol expectancies (beliefs) and hazardous drinking (behavior)..

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Request Reprint E-Mail: k.s.grotmol@medisin.uio.no
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Craving and Attentional Bias Respond Differently to Alcohol Priming: A Field Study in the Pub

Several experimental laboratory studies have shown that subjective craving for alcohol increases as a result of low-to-moderate levels of alcohol consumption.

Less is known about alcohol prime effects on relatively automatic appetitive motivational processes such as attentional bias (AB). Also, it is not known whether the effects from laboratory studies can be generalized to real-life drinking environments, and whether effects change after higher alcohol doses than those that have been administered in lab studies.

This field study validates earlier experimental research on alcohol prime effects in a real drinking situation. Further, it demonstrates prime effects up to much higher alcohol doses than in previous lab studies.

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Request Reprint E-Mail: schoenmakers@ivo.nl
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When zero tolerance looks like the safest option

It is no longer seen as ''safe'' for families to allow their teenagers an occasional drink.

WHEN the National Health and Medical Research Council guidelines on drinking alcohol were released earlier this year, some parents were surprised to discover that sharing the occasional beer or glass of wine with their teenagers might be dangerous. ''Parents and carers should be advised that children under 15 years of age are at the greatest risk of harm from drinking and that for this age group, not drinking alcohol is especially important,'' says guideline three. ''For young people aged 15-17 years, the safest option is to delay the initiation of drinking for as long as possible.''

This was a significant change. The previous 2001 guidelines had recommended under-18s not drink above the levels suggested for adults. The new advice challenged entrenched ideas about what sensible drinking means. In many Australian households, parents occasionally serve alcohol to their children as a way of teaching them how to enjoy a drink responsibly. Could it really be safer to ban under-age drinking in the home altogether and allow them to find their own way once they turn 18? . . . . . .

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Alcohol as a risk factor for type 2 diabetes: A systematic review and meta-analysis.

To clarify the dose-response relationship between alcohol consumption and type 2 diabetes.

The search revealed 20 cohort studies that met our inclusion criteria. A U-shaped relationship was found for both sexes. Compared with lifetime abstainers, the relative risk (RR) for type 2 diabetes among men was most protective when consuming 22 g/day alcohol (RR 0.87 [95% CI 0.76–1.00]) and became deleterious at just over 60 g/day alcohol (1.01 [0.71–1.44]). Among women, consumption of 24 g/day alcohol was most protective (0.60 [0.52–0.69]) and became deleterious at about 50 g/day alcohol (1.02 [0.83–1.26]).

Our analysis confirms previous research findings that moderate alcohol consumption is protective for type 2 diabetes in men and women.

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Request Reprint E-Mail: dolly.baliunas@utoronto.ca.
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Booze putting teen brains at risk

A GENERATION of Victorian teenagers are drinking themselves into oblivion, with more than a quarter of 15-year-olds bingeing until they black out - the point at which brain damage is likely to occur.

Research has also found that more than a third of 11-year-old boys have consumed alcohol.

The figures, contained in a study by the Murdoch Children's Research Institute, have alarmed brain development experts who say a generation of young people are destroying their chances of reaching their full potential. . . . . . . .

Read More

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Alcohol Sensitivity in Drosophila: Translational Potential of Systems Genetics

Identification of risk alleles for human behavioral disorders through genomewide association studies (GWAS) has been hampered by a daunting multiple testing problem. This problem can be circumvented for some phenotypes by combining genomewide studies in model organisms with subsequent candidate gene association analyses in human populations.

Here, we characterized genetic networks that underlie the response to ethanol exposure in Drosophila melanogaster by measuring ethanol knockdown time in 40 wild-derived inbred Drosophila lines. We associated phenotypic variation in ethanol responses with genomewide variation in gene expression and identified modules of correlated transcripts associated with a first and second exposure to ethanol vapors as well as the induction of tolerance. We validated the computational networks and assessed their robustness by transposon-mediated disruption of focal genes within modules in a laboratory inbred strain, followed by measurements of transcript abundance of connected genes within the module.

Many genes within the modules have human orthologs, which provides a stepping stone for the identification of candidate genes associated with alcohol drinking behavior in human populations. We demonstrated the potential of this translational approach by identifying seven intronic single nucleotide polymorphisms of the Malic Enzyme 1 (ME1) gene that are associated with cocktail drinking in 1687 individuals of the Framingham Offspring cohort, implicating that variation in levels of cytoplasmic malic enzyme may contribute to variation in alcohol consumption.

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Request Reprint E-Mail: anholt@ncsu.edu
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Endogenous BDNF in the Dorsolateral Striatum Gates Alcohol Drinking

We previously found that brain-derived neurotrophic factor (BDNF)-haplodeficient mice exhibit greater ethanol-induced place preference and psychomotor sensitization, and greater ethanol consumption after deprivation, than control mice. We further observed that, in mice, voluntary ethanol intake increases BDNF expression in the dorsal striatum (DS).

Here, we determined whether BDNF within the DS regulates ethanol self-administration in Long–Evans rats trained to self-administer a 10% ethanol solution.

We observed a greater increase in BDNF expression after ethanol self-administration in the dorsolateral striatum (DLS) than in the dorsomedial striatum (DMS). We further found that downregulation of endogenous BDNF using viral-mediated siRNA in the DLS, but not in the DMS, significantly increased ethanol self-administration. Infusion of exogenous BDNF (0.25 µg/µl/side into the DMS; 0.25 and 0.75 µg/µl/side into the DLS) attenuated responding for ethanol when infused 3 h before the beginning of the self-administration session. Although the decrease in ethanol intake was similar in the DLS and DMS, BDNF infused in the DLS, but not in the DMS, induced an early termination of the drinking episode. Furthermore, the action of BDNF in the DLS was specific for ethanol, as infusion of the neurotrophic factor in the DMS, but not DLS, resulted in a reduction of sucrose intake.

Together, these findings demonstrate that the BDNF pathway within the DLS controls the level of ethanol self-administration. Importantly, our results suggest that an endogenous signaling pathway within the same brain region that mediates drug-taking behavior also plays a critical role in gating the level of ethanol intake.

Read Full Abstract.

Request Reprint E-Mail: dorit.ron@ucsf.edu
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Molecular reconstruction of mGluR5a-mediated endocannabinoid signaling cascade in single rat sympathetic neurons.

Endocannabinoids (eCB) such as 2-arachidonylglycerol (2-AG) are lipid metabolites that are synthesized in a postsynaptic neurons and act upon CB(1) cannabinoid receptors (CB(1)R) in presynaptic nerve terminals. This retrograde transmission underlies several forms of short and long term synaptic plasticity within the CNS.

Here, we constructed a model system based on isolated rat sympathetic neurons, in which an eCB signaling cascade could be studied in a reduced, spatially compact, and genetically malleable system. We constructed a complete eCB production/mobilization pathway by sequential addition of molecular components. Heterologous expression of four components was required for eCB production and detection: metabotropic glutamate receptor 5a (mGluR5a), Homer 2b, diacylglycerol lipase alpha, and CB(1)R. In these neurons, application of l-glutamate produced voltage-dependent modulation of N-type Ca(2+) channels mediated by activation of CB(1)R.

Using both molecular dissection and pharmacological agents, we provide evidence that activation of mGluR5a results in rapid enzymatic production of 2-AG followed by activation of CB(1)R. These experiments define the critical elements required to recapitulate retrograde eCB production and signaling in a single peripheral neuron. Moreover, production/mobilization of eCB can be detected on a physiologically relevant time scale using electrophysiological techniques.

The system provides a platform for testing candidate molecules underlying facilitation of eCB transport across the plasma membrane.

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Request Reprint E-Mail: sikeda@mail.nih.gov
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H2 haplotype at chromosome 17q21.31 protects against childhood sexual abuse-associated risk for alcohol consumption and dependence

Animal research supports a central role for corticotropin-releasing factor (CRF) in actions of ethanol on brain function. An examination of alcohol consumption in adolescents reported a significant genotype × environment (G × E) interaction involving rs1876831, a corticotropin-releasing hormone receptor 1 (CRHR1) polymorphism, and negative events. CRHR1 and at least four other genes are located at 17q21.31 in an extremely large block of high linkage disequilibrium resulting from a local chromosomal inversion; the minor allele of rs1876831 is contained within the H2 haplotype.

Here, we examine whether G × E interactions involving this haplotype and childhood sexual abuse (CSA) are associated with risk for alcohol consumption and dependence in Australian participants (n = 1128 respondents from 476 families) of the Nicotine Addiction Genetics project.

Individuals reporting a history of CSA had significantly higher ACFS and increased risk for alcohol dependence. A significant G × E interaction was found for ACFS involving the H2 haplotype and CSA . A similar G × E interaction was associated with protective effects against alcohol dependence risk . For each outcome, no significant CSA-associated risk was observed in H2 haplotype carriers.

These findings support conducting further investigation of the H2 haplotype to determine the gene(s) responsible. Our results also suggest that severe early trauma may prove to be an important clinical covariate in the treatment of alcohol dependence.

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Request Reprint E-Mail: nelsone@wustl.edu
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Estonia will increase tax on alcohol and tobacco in 2010

The Estonian government agreed yesterday on principle on next the state budget 2010 and in order to cover spending in this budget, the state will increase the excise tax on alcohol and tobacco, Estonian dailies write.

It was agreed that the spending will amount to 89 billion kroons and the revenue volume will be 84 billion kroons. If the decision of the government is finalised, next year the excise tax on alcohol will increase by ten percent and excise tax on tobacco will be raised by 20 percent by the beginning of 2011. . . . . . .

Read Full Article
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A Beer Tax Won't Reduce The Clap

Booze, STDs and the irrational exuberance of public health experts.


In the history of medicine, nothing has been used so widely and to so little effect as Hirudo Medicinalis--better known as the leech. For two millennia, leeches were used to balance the humors--or to drain the patient of "excess" blood and other substances thought to be the cause of most of humanity's physical and mental ailments. In a similar vein, some doctors and public health advocates are turning to a modern equivalent of the leech--taxes--in order to draw "excess" money from going to "unhealthy" activities, thereby reducing disease and balancing health care spending.

Recently, taxes on sugary sodas have been hailed as a painless way to tackle obesity, despite the absence of proof that the taxes would actually achieve this goal. Now the latest advice for "leeching" America comes from Dr. Lloyd I. Sederer, medical director for the New York State Office of Mental Health, and Dr. Eric Goplerud, director of the Center for Integrated Behavioral Health Policy at George Washington University. Writing in the Washington Post, they argue that imposing heavy taxes on alcohol would both reduce the harmful effects of heavy drinking and help pay for health reform. The logic is that if teens drink less, they'll have less unprotected sex, reducing their exposure to sexually transmitted diseases. . . . . . .

Read Full Article

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Children, young people and alcohol: how they learn and how to prevent excessive use

What influences how children and young people behave towards alcohol.

Two linked research reviews examine:

• How young people acquire their knowledge, attitudes, expectations and intentions about alcohol, and:
• What interventions work best to prevent excessive use of alcohol

'Influences on how children and young people learn about and behave towards alcohol: A review of the literature for the Joseph Rowntree Foundation (part one)' (PDF, 420KB) looks in detail at the influences on children, including family processes and structures, peers, marketing and cultural representations, and other major forces such as religion, school and community.

Alcohol prevention programmes: A review of the literature for the Joseph Rowntree Foundation (part two) (PDF, 390KB) reviews what interventions have been attempted to try to prevent excessive use of alcohol by young people, summarises the findings and suggests how a universal prevention programme might be delivered.

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Press Release - Alcohol more harmful than many illegal drugs, claims drugs expert

Alcohol probably poses the biggest drugs harm challenge today, according to a new briefing from the Centre for Crime and Justice Studies. In `Estimating drug harms: a risky business', Professor David Nutt, of Imperial College London argues that the relative harms of legal drugs such as alcohol and tobacco are greater than those of a number of illegal drugs, including cannabis, LSD and ecstasy.

Professor Nutt proposes a `drug harm ranking', which compares the harms caused by legal as well as illegal drugs. Alcohol ranks as the fifth most harmful drug after heroin, cocaine, barbiturates and methadone. Tobacco is ranked ninth. Cannabis, LSD and ecstasy, while harmful, are ranked lower at 11, 14 and 18 respectively. Professor Nutt argues that simply focussing on the harms caused by illegal drugs, without assessing them against those of drugs such as alcohol and tobacco, results in an `isolated and arbitrary' debate about relative drug harms. . . . . . .

Read Full Press Release

SNP left high and dry as Labour rejects minimum alcohol pricing

Angus Macleod, Scottish Political Editor

The minority SNP government’s plans to adopt a minimum price for alcohol appear doomed after Labour’s appointment of a new shadow health secretary who is strongly against the move.

Jackie Baillie, whose constituency includes a big whisky firm employing 600 people, was appointed to the shadow health portfolio this week by Iain Gray, the Labour leader at Holyrood. . . . . . .

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Alcohol, Tobacco, and Nonmedical Drug Use in Older U.S. Adults: Data from the 2001/02 National Epidemiologic Survey of Alcohol and Related Conditions

Journal of the American Geriatrics Society Early View 26 Oct 2009

To examine the prevalence and sociodemographic and health-related correlates of substance use, including alcohol, tobacco, and nonmedical drug use, in adults aged 65 and older.

Most older adults had used substances over their lifetimes and in the previous 12 months. Alcohol is the substance of choice for this age group, followed by tobacco; few report nonmedical drug use.

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Request Reprint E-Mail: aamoore@mednet.ucla.edu

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Alcohol Consumption, Mortality and Morbidity - Key Findings

Key findings from Professor Martin Plant, Alcohol Health and Research Unit, Faculty of Health and Sciences, University of the West of England and Alcohol Concern, the national agency on alcohol misuse.

Professor Plant and his team were commissioned by Alcohol Concern in April 2009 to investigate what the future may hold for the nation’s drinking habits nd associated harms1. Professor Plant’s forecasting allows us to answer how our drinking patterns are likely to affect the state of the nation’s health in 2035.

For the first time in the UK, the relationship between alcohol consumption and mortality has been calculated. The research indicates a definitive link: the higher our society’s alcohol consumption, the more deaths occur as a result. Based on this, it is possible to forecast how health harms from alcohol may ncrease in the next 10 years if we continue to drink at the rate of the last 15 years.

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Alcohol in moderation, premorbid intelligence and cognition in older adults: results from the Psychiatric Morbidity Survey

Journal of Neurology, Neurosurgery, and Psychiatry 2009;80:1236-1239

To test the hypothesis that the association previously reported between moderate alcohol use and better cognition is an artefact of confounding by (a) higher premorbid education and socioeconomic status; (b) a lifestyle of moderation (using smoking as a risk marker); and (c) decreased alcohol consumption in people with physical illnesses.

In people who were not problem drinkers, higher alcohol intake was not associated with improved current cognition after controlling for premorbid intelligence and physical health. Our findings suggest that, despite previous suggestions, moderate alcohol consumption does not protect older people from cognitive decline.

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Request Reprint E-Mail: ccooper@doctors.org.uk

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Underage Drinking Research Initiative

Welcome

Steering Committee Roster
The Surgeon General's Call to Action toPrevent and Reduce Underage Drinking

Print and Multimedia Resources
Statistics on Underage Drinking

Other Resources
NIAAA Interdisciplinary Team

Selected Research Literature
Research Findings on Underage Drinking and the Minimum Legal Drinking AgeResearch Findings on College Drinking and the Minimum Legal Drinking AgePediatrics 2008;121: Issue Supplement

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Alcohol-related hospital admissions data for 2008/09 released

Provisional alcohol-related hospital admissions data for 2008/09 is now available from the North West Public Health Observatory (download the Quarterly data excel sheet from the data download tab). The data shows the overall rate of alcohol-related hospital admissions is still rising, though the rate of increase is slowing down. . . . . . .

Read More
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Falls in alcohol consumption but longer term trend and impact not clear

Levels of alcohol consumption have been on a downward trend since 2004, prompting the British Beer and Pub Association (BBPA) to call out against 'population' based approaches to alcohol harm reduction such as pricing measures and the mandatory licensing code.

Based on figures from HM Revenues and Customs data, sales have been falling since their 2004 peak, although 2007 levels showed a slight increase on the previous year. Nonetheless the longer term trend has been one of a more significant increase as demonstrated in the recent report from the Alcohol Health and Research Unit 'Future Proof'.

However consideration is urged when interpreting the data and assessing trends - consumption falls may be predominantly determined by significant decreases in consumption levels amongst younger drinkers in particular (16-24 age group). This was highlighted in the report released earlier this year by the JRF 'Drinking in the UK: an exploration of trends'. The impact of the recession, continued rise in home consumption and issues such as convergence between men and women's drinking patterns is also unclear. . . . . . .

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Association of Substance Use Disorders With Childhood Trauma but not African Genetic Heritage in an African American Cohort

Am J Psychiatry. Author manuscript; available in PMC 2009 October 27.

Genetic variation influences differential vulnerability to addiction within populations. However, it remains unclear whether differences in frequencies of vulnerability alleles contribute to disparities between populations and to what extent ancestry correlates with differential exposure to environmental risk factors, including poverty and trauma.

These results suggest that African genetic heritage does not increase the likelihood of genetic risk for addictions. They highlight the complex interrelation between genetic ancestry and social, economic, and environmental conditions and the strong relation of those factors to addiction. Studies of epidemiological samples characterized for genetic ancestry and social, psychological, demographic, economic, cultural, and historical factors are needed to better disentangle the effects of genetic and environmental factors underlying interpopulation differences in vulnerability to addiction and other health disparities.

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Chronic alcoholism: Insights from neurophysiology

Neurophysiologie Clinique/Clinical Neurophysiology Volume 39, Issues 4-5, October-November 2009, Pages 191-207

Increasing knowledge of the anatomical structures and cellular processes underlying psychiatric disorders may help bridge the gap between clinical signs and basic physiological processes. Accordingly, considerable insight has been gained in recent years into a common psychiatric condition, i.e., chronic alcoholism.

The heterogeneity of alcoholic disorders in terms of symptomatology, course and outcome is the result of various pathophysiological processes that physiological parameters may help to define. These alterations may be related to precise cognitive processes that could be easily monitored neurophysiologically in order to create more homogeneous subgroups of alcoholic individuals.

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Request Reprint E-Mail: salvatore.campanella@chu-brugmann.be

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