What are the policy lessons of National Alcohol Prohibition in the United States, 1920–1933?

National alcohol prohibition in the United States between 1920 and 1933 is believed widely to have been a misguided and failed social experiment that made alcohol problems worse by encouraging drinkers to switch to spirits and created a large black market for alcohol supplied by organized crime.

The standard view of alcohol prohibition provides policy lessons that are invoked routinely in policy debates about alcohol and other drugs. The alcohol industry invokes it routinely when resisting proposals to reduce the availability of alcohol, increase its price or regulate alcohol advertising and promotion. Advocates of cannabis law reform invoke it frequently in support of their cause.

This paper aims: (i) to provide an account of alcohol prohibition that is more accurate than the standard account because it is informed by historical and econometric analyses; (ii) to describe the policy debates in the 1920s and 1930s about the effectiveness of national prohibition; and (iii) to reflect on any relevance that the US experience with alcohol prohibition has for contemporary policies towards alcohol.

It is incorrect to claim that the US experience of National Prohibition indicates that prohibition as a means of regulating alcohol is always doomed to failure.

Subsequent experience shows that partial prohibitions can produce substantial public health benefits at an acceptable social cost, in the absence of substantial enforcement.

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Request Reprint E-Mail: w.hall@sph.uq.edu.au

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A review of computer-based alcohol problem services designedfor the general public

This review summarizes the literature on computer-based drinking assessment and intervention programs evaluated using members of the general public.

The primary aim was to summarize the demand, usage, and effectiveness of these services.

A systematic search of the literature identified seven online drinking assessments and eight computerized interventions that were evaluated using members of the general public.

Internet assessment users tend to be in their early 30s, are more often male, tend to be at risk for or are experiencing alcohol-related problems, more fully explore assessment sites, and are more likely to enroll in interventions linked to these sites when their drinking problem is more severe.

Although dropout from computer-based interventions is often very high and treatment models vary widely, program completers appear to show improvements.

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Request Reprint E-Mail: mvernon@arg.org

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The adoption of alcohol pharmacotherapies in the Clinical Trials Network: The influence of research network participation

Organizational participation in clinical research may lead to adoption of the intervention by treatment agencies, but it is not known whether research involvement enhances innovativeness beyond the specific interventions that are tested.

The National Institute on Drug Abuse's Clinical Trials Network (CTN) is a platform for considering this research question. To date, the CTN has not conducted research on medications for alcohol use disorders (AUDs), so greater adoption of innovative AUD pharmacotherapies by CTN-affiliated programs would suggest an added value of research network participation.

Using longitudinal data from a pooled sample of CTN and non-CTN publicly funded treatment programs, we investigate adoption of tablet naltrexone and acamprosate over a 2-year period.

CTN-affiliated programs were more likely to have adopted tablet naltrexone and acamprosate at 24-month follow-up, net of the effects of a range of organizational characteristics.

Research network participation may thus enhance organizational innovativeness to include interventions beyond the scope of the network.

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Request Reprint E-Mail: aabraham@uga.edu

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US expert says positive thinking is the smart way to recover from alcoholism

Alcoholism is a disease that leaves victims powerless and needing to stay in permanent recovery if they are serious about stopping the demon drink from inflicting further damage, conventional wisdom holds. Given that most people can't afford to pay for a stay in a Priory clinic, then the best way for chronic drinkers to tackle their addiction, so the theory goes, is to turn to Alcoholics Anonymous, seek the help of a higher power with their struggle, begin using the 12-step programme, and be ready to attend meetings for the rest of their lives.

Not so, says Joe Gerstein, a retired clinical professor of medicine in the US. "A myth has grown up that you can't get over a substance addiction without AA," he says. "It's a widely-held belief, but it's a myth." . . . . .

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Providing Alcohol-Related Screening and Brief Interventions to Adolescents through Health Care Systems: Obstacles and Solutions

Adolescent binge drinking and related disorders are worldwide public health problems.

The European School Survey Project on Alcohol and Other Drugs surveyed 16-year-old adolescents in 35 countries. Defined as the consumption of five or more drinks per episode, binge drinking had occurred in 43% of these adolescents in the prior 30 days.

Eleven countries were noted to have rates of over 50% (e.g., United Kingdom 54%; Portugal 56%) and all but two countries had rates over 30%. In the US, about one-third of high school seniors reported binge drinking in the prior two weeks. Comparable adolescent alcohol involvement has been noted for some Western Pacific countries, including Australia and New Zealand.

For over a decade, governmental and professional organizations such as the World Health Organization (WHO), the US Surgeon General, the American Medical Association, and the American Academy of Pediatrics have called on health care practitioners to become more involved in providing screening, brief intervention, and referral for treatment (SBIRT) for adolescent drinkers.

While often somewhat general, SBIRT guidance has been offered by some organizations ( see also Box 1) and in review articles. Moreover, although there is a consensus that the health care system is an appropriate SBIRT venue, most adolescents visiting health care providers do not receive these services .

This Policy Forum identifies the problems impeding SBIRT for adolescents and proposes some solutions.

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Functional vitamin B12 deficiency in alcoholics: An intriguing finding in a retrospective study of megaloblastic anemic patients

Measurement of serum cobalamin levels is the standard investigation for assessing Vitamin B12 deficiency. However some patients with clinical evidence of cobalamin deficiency may have serum levels within the normal range.

Since falsely increased values of cobalamin can be caused by alcoholic liver disease, we evaluated the impact of this disease on the diagnosis of cobalamin and folic acid deficiency.

Vitamin B12, folate and both deficiency were found in 86, 5 and 6 cases respectively. Normal cobalamin serum levels, normal serum and erythrocyte folate levels were found only in 3 patients, all alcohol-dependent, while in another alcoholic borderline vitamin B12 serum levels were found. All the four patients responded to cobalamin treatment.

Some alcohol-dependent patients with megaloblastic anemia may respond to vitamin B12 treatment despite normal cobalamin serum levels; therefore in alcoholics caution is urged in the interpretation of these vitamin assays, because of possible functional vitamin B12 deficiency.

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Request Reprint E-Mail: alberto.fragasso@libero.it

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The Dopamine Transporter Gene, a Spectrum of Most Common Risky Behaviors, and the Legal Status of the Behaviors

This study tests the specific hypothesis that the 9R/9R genotype in the VNTR of the dopamine transporter gene (DAT1) exerts a general protective effect against a spectrum of risky behaviors in comparison to the 10R/9R and 10R/10R genotypes, drawing on three-time repeated measures of risky behaviors in adolescence and young adulthood on about 822 non-Hispanic white males from the Add Health study.

Our data have established two empirical findings. The first is a protective main effect in the DAT1 gene against risky behaviors. The second finding is that the protective effect varies over age, with the effect prominent at ages when a behavior is illegal and the effect largely vanished at ages when the behavior becomes legal or more socially tolerated.

Both the protective main effect and the gene-lifecourse interaction effect are replicated across a spectrum of most common risky behaviors: delinquency, variety of sexual partners, binge drinking, drinking quantity, smoking quantity, smoking frequency, marijuana use, cocaine use, other illegal drug use, and seatbelt non-wearing.

We also compared individuals with the protective genotype and individuals without it in terms of age, physical maturity, verbal IQ, GPA, received popularity, sent popularity, church attendance, two biological parents, and parental education.

These comparisons indicate that the protective effect of DAT1*9R/9R cannot be explained away by these background characteristics.

Our work demonstrates how legal/social contexts can enhance or reduce a genetic effect on risky behaviors.

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ASSOCIATIONS OF METABOLIC PARAMETERS AND ETHANOL CONSUMPTION WITH MESSENGER RNA EXPRESSION OF CLOCK GENES IN HEALTHY MEN

Recent studies suggest that the impairment of circadian clock function causes various pathological conditions, such as obesity, diabetes, and alcoholism, and an altered mRNA expression of clock genes was found under these conditions. However, it remains to be determined whether clock gene expression varies depending on metabolic conditions even in healthy people.

To address this issue, we investigated the associations of metabolic parameters and alcohol consumption with mRNA expression of clock genes (CLOCK, BMAL1, PER1, PER2, and PER3) in peripheral blood cells obtained from 29 healthy non-obese elderly men (age 51–78 yrs) who adhered to a regular sleep-wake routine, through a single time-of-day venous blood sampling at 09:00h.

There were significant correlations between (1) waist circumference and mRNA level of PER1 (r=−0.43), (2) plasma glucose concentration and PER2 (r=−0.50), (3) ethanol consumption and BMAL1 (r=−0.43), and (4) serum γ-GTP concentration (a sensitive marker of alcohol consumption) and PER2 (r=−0.40).

These results suggest mRNA expression of clock genes is associated with obesity, glucose tolerance, and ethanol consumption even in healthy people.

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Request Reprint E-Mail: akiofuji@jichi.ac.jp
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Proposed Draft Revisions to DSM Disorders and Criteria

The draft disorders and disorder criteria that have been proposed by the DSM-5 Work Groups can be found on these pages.

Use the links below to read about proposed changes to the disorders that interest you.

Please note that the proposed criteria listed here are not final. These are initial drafts of the recommendations that have been made to date by the DSM-5 Work Groups. Viewers will be able to submit comments until April 20, 2010.

After that time, this site will be available for viewing only.

Substance-Related Disorders
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SPECT imaging of nicotinic acetylcholine receptors in nonsmoking heavy alcohol drinking individuals

The high rate of comorbidity of tobacco smoking with alcohol drinking suggests common neural substrates mediate the two addictive disorders. The beta2*-containing nicotinic acetylcholine receptor (β2*-nAChR) has recently emerged as a prime candidate because some alpha and beta subunit genes have been linked to alcohol consumption and alcohol use behaviors.

We hypothesized that β2*-nAChR availability would be altered by alcohol in heavy drinking nonsmokers.

Heavy drinkers consumed on average 9.1±7.3 drinks/occasion; whereas controls drank 1.2±0.9 drinks/occasion. Heavy drinkers were imaged 2.0±1.6 days after last alcoholic beverage. Overall, there were no significant differences in β2*-nAChR availability between the heavy drinking and control nonsmokers. Exploratory analyses of other factors that may be uniquely regulated by alcohol suggested no effects of age, number of alcohol drinks, years drinking, severity of drinking, craving or withdrawal.

These preliminary analyses do not suggest a decrease in receptor availability in heavy drinking nonsmokers as compared to control nonsmokers. However, a larger study is warranted to explore effects of heavy alcohol drinking on other variables, such as sex, smoking, and genetic make up.

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Request Reprint E-Mail: irina.esterlis@yale.edu

Nicotine withdrawal in U.S. smokers with current mood, anxiety, alcohol use, and substance use disorders

The current study examined tobacco withdrawal symptoms and withdrawal-related discomfort and relapse in smokers with and without current mood disorders, anxiety disorders, alcohol use disorders (AUD), and substance use disorders (SUD).

Participants with a current mood disorder, anxiety disorder, AUD, or SUD were more likely to report withdrawal symptoms and reported more withdrawal symptoms than those without current disorders. Having a current mood disorder, anxiety disorder, or SUD was also associated with increased likelihood of withdrawal-related discomfort and relapse. There were no significant interactions between psychiatric disorders and AUDs/SUDs on withdrawal symptoms or behavior.

Participants with a current Axis I disorder were more likely to experience tobacco withdrawal symptoms and withdrawal-related discomfort and relapse. Having a co-morbid psychiatric disorder and AUD/SUD did not synergistically increase the experience of withdrawal-related symptoms or relapse. It is important to identify Axis I disorders in smokers and provide these smokers with more intensive and/or longer treatments to help them cope with withdrawal symptoms and prevent relapse.

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Request Reprint E-Mail: andrea.weinberger@yale.edu

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The serotonin transporter gene and risk for alcohol dependence: A meta-analytic review

Previous studies have implicated a relationship between particular allelic variations of the serotonin transporter gene (5HTTLPR) and alcohol dependence.

To provide a current estimate of the strength of this association, particularly in light of inconsistent results for 5HTTLPR, we conducted a meta-analytic review of the association between 5HTTLPR and a clinical diagnosis of alcohol dependence. Of 145 studies initially identified, 22 (including 8050 participants) met inclusion criteria.

Results indicated that there was a significant albeit modest association between alcohol dependence diagnosis and the presence of at least 1 short allele (OR=1.15, 95% CI=1.01, 1.30, p.05). Slightly more robust results were observed for participants who were homogeneous for the short allele (OR=1.21, 95% CI=1.02, 1.44, p.05).

These results were unrelated to sex and race/ethnicity of participants; however, the effect size was moderated by study sample size and publication year. Additionally, the fail-safe N analysis indicated potential publication bias.

Therefore, although our review indicates that there is a significant association between 5HTTLPR and alcohol dependence diagnosis, this result should be interpreted with caution.

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Request Reprint E-Mail: rkmchugh@bu.edu
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Low-to-moderate alcohol consumption and smoking cessation rates: Retrospective analysis of 4576 elderly ever-smokers

Smoking and alcohol consumption are two major risk factors for manifold morbidity and mortality outcomes and are highly correlated with each other. No conclusion has been reached concerning whether cigarette smokers drinking alcohol have more difficulties with smoking cessation.

We aimed to elucidate the association of concurrent alcohol consumption with the probability of smoking cessation in non-clinical populations.

Using alcohol abstainers as the reference group and controlling for potential confounders, relative cessation rates (95% CI) increased to 1.17 (1.02, 1.34), 1.36 (1.20, 1.55), 1.45 (1.27, 1.66) and 1.32 (1.13, 1.53) with concurrent consumption of 1–39, 40–99, 100–199 and 200+g alcohol/week. This pattern persisted in extensive sensitivity analyses.

The results of these analyses of time-varying concurrent alcohol consumption and smoking suggest that drinking low-to-moderate amounts of alcohol as common in the general population might actually facilitate cessation in non-clinical settings

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Request Reprint E-Mail: lutz.breitling@gmail.com

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Alcohol Consumption, Weight Gain, and Risk of Becoming Overweight in Middle-aged and Older Women

The obesity epidemic is a major health problem in the United States. Alcohol consumption is a source of energy intake that may contribute to body weight gain and development of obesity. However, previous studies of this relationship have been limited, with inconsistent results.

There was an inverse association between amount of alcohol consumed at baseline and weight gained during 12.9 years of follow-up. A total of 7942 (41.3%) initially normal-weight women became overweight or obese (BMI 25) and 732 (3.8%) became obese (BMI 30). After adjusting for age, baseline BMI, smoking status, nonalcohol energy intake, physical activity level, and other lifestyle and dietary factors, the relative risks of becoming overweight or obese across total alcohol intake of 0, more than 0 to less than 5, 5 to less than 15, 15 to less than 30, and 30 g/d or more were 1.00, 0.96, 0.86, 0.70, and 0.73, respectively (P for trend <.001). The corresponding relative risks of becoming obese were 1.00, 0.75, 0.43, 0.39, and 0.29 (P for trend <.001). The associations were similar by subgroups of age, smoking status, physical activity level, and baseline BMI.

Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.

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Request Reprint E-Mail: luwang@rics.bwh.harvard.edu .

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The National Collegiate Recovery Conference

The National Collegiate Recovery Conference will be on April 15-17, 2010 at Texas Tech University. Find out more about Collegiate Recovery Communities and Research, Recovery and the Collegiate Population.

Conference includes two main tracks:

• Collegiate Recovery Communities
  Starting and sustaining vibrant collegiate recovery communities

• Research, Recovery and the Collegiate Population
  Cutting edge research from experts within the field

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An Exploratory Approach to Analyzing Alcohol Control Policy Opinions Held by Ontario Adults

Telephone interview data from a representative sample of 1,216 Ontario adults were analyzed using latent class analysis to determine whether distinct and homogeneous classes of individuals could be identified based on their responding patterns to 11 alcohol policy items.

Five latent classes were identified and labeled as: dedicated liberalizers, moderate liberalizers, moderate controllers, dedicated controllers, and an ambivalent class.

Multinomial regression analysis indicated that demographic and alcohol factors differentiated the classes. Those most opposed to alcohol controls, dedicated liberalizers, were more likely to be male, younger and heavier drinkers. Given their young age it is possible that further erosion of public support for alcohol controls may be expected.

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Campaigns updates as new materials released

The current NHS alcohol campaign 'Drinking causes damage you can't see' is backed by the release of a range of new materials. The materials will soon be available to order or can be downloaded as PDFs, including the key 'Your drinking and you' booklet (pdf).

The campaign, which includes two TV ads, builds on the previous units campaign and aims to raise awareness of the hidden health harm that can be caused by regularly drinking too much. Members of the public can also order a free alcohol information pack. . . . . .

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The unique contribution of attitudes toward non-alcoholic drinks to the prediction of adolescents' and young adults' alcohol consumption

Attitudes toward alternative behaviors, such as drinking soda instead of alcohol, might contribute to the prediction of young people's drinking behavior.

The current study explored the associations between late adolescents' and young adults' attitudes toward alcoholic and non-alcoholic drinks and their alcohol consumption, and whether these associations were moderated by participants' sex, age and education level.

The shared variance in both attitudes, attitudes toward alcoholic drinks were positively related and attitudes toward non-alcoholic drinks were negatively related to participants' monthly alcohol use and binge drinking.

Relations between attitudes towards alcoholic drinks and monthly alcohol consumption were stronger for boys than for girls and stronger for participants with intermediate education background. Relations between both attitudes and binge drinking were strongest for high educated participants.

According to our data, non-alcohol attitudes provide a unique contribution to the prediction of alcohol use.

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Request Reprint E-Mail: r.spijkerman@pwo.ru.nl


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Protective strategies: A mediator of risk associated with age of drinking onset

The goal of the current study was to determine if failure to develop/utilize alcohol-specific strategies to manage drinking behavior might serve as a mechanism through which early alcohol exposure leads to higher levels of later alcohol use and alcohol-related negative consequences, while taking into account impulsivity as an underlying risk factor for both of these outcomes.

Data were collected between September and December of 2005 from a random sample of college students via an online survey. A total of 309 students provided complete data on all measure of interest.

Separate regression analyses predicting typical weekly alcohol consumption and alcohol-related problems indicated that use of alcohol-specific protective strategies partially mediated the effect of age of first use on these outcomes.

An earlier age of onset was associated with less frequent use of alcohol-specific protective strategies, which in turn was associated with drinking- and alcohol-related problems.

Implications for tailoring alcohol prevention and intervention programs targeting adolescents are discussed.

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Request Reprint E-Mail: Rebekka.Palmer@Yale.edu

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Are You Going to Finish That Drink?

Data are from the 2000 National Alcohol Survey Methodological Follow-up, which includes 323 individuals from across the United States.

Directly measured estimates of drink volume and amount left unfinished along with self-report of the frequency and reasons for which drinks are not finished and are compared across groups.

Overall, 12% of drinks reported in the sample were not finished. Smaller amounts of beer and wine volume were left by men, “heavier drinkers” and older persons.

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Request Reprint E-Mail: wkerr@arg.org.

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Performance of the Alcohol Use Disorders Identification Test Among Tuberculosis Patients in Russia

The alcohol use disorders identification test (AUDIT), a screening instrument to identify individuals at risk of alcohol use-related problems, has not been validated in a Russian primary care population.

We assessed the reliability, factor structure, sensitivity, and specificity of AUDIT scores among 254 subjects initiating tuberculosis treatment from 2005 to 2007 in Tomsk City.

Our findings support the use of the AUDIT as a screening instrument among Russian individuals seeking primary care.

We discuss implications, limitations, and future research.

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Request Reprint E-Mail: tmathew@medicine.umsmed.edu

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The Social Consequences of Binge Drinking Among 24- to 32-Year-Olds in Six European Countries

Data were available from general population surveys carried out in six countries in the years 2000 to 2005 under the auspices of Gender, Alcohol and Culture: An International Study (GENACIS).

A total of 2089 adults aged 24–32 in the Czech Republic, Denmark, the Isle of Man, Spain, Sweden, and the United Kingdom (UK) responded to questions about their drinking habits and social consequences directly resulting from their drinking. Survey methods varied from quota sampling with face-to-face interviewing in Spain and the UK to telephone surveys in Denmark and Sweden. Response rates varied from 50% to 72%.

“Binge drinking” defined as a usual amount of more than 8 UK “units” for men and more than 6 units for women was more likely than moderate drinking to lead to social consequences, fights, or being asked to cut down on drinking.

There were highly significant differences between the countries both in the percentages of “heavy” drinkers and in the adverse consequences of binge drinking. In Spain, the UK, and the Czech Republic binge drinking was more likely to lead to adverse consequences than was binge drinking in the other three countries.

Male gender, low educational level, high drinking frequency, and single marital status were also significantly associated with adverse social consequences from drinking, but none of these variables explained the country differences. The presence of children had little effect.

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Request Reprint E-Mail: martin.plant@uwe.ac.uk
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Patients With Dual Diagnoses or Substance Use Disorders Only: 12-Step Group Participation and 1-Year Outcomes

We compared outpatients (regional facility) with substance use and psychiatric (N = 199) or only substance use (N = 146) disorders on baseline and one-year symptoms (93% follow-up), and treatment and 12-step group participation over the year (2005).

We examined whether diagnostic status moderated associations between participation and outcomes (Addiction Severity Index) with regressions.

At follow-up, dual diagnosis patients had more severe symptoms, despite comparable treatment.

The groups were comparable on 12-step participation, which was associated with better outcomes. However, associations of participation with better outcomes were weaker for dual diagnosis patients.

Study (VA HSR&D-funded) implications and limitations are noted and research suggested.

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Request Reprint E-Mail: ctimko@stanford.edu.
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