News Release - Strong public support for action on drink and drug-driving

Road safety charity Brake and Direct Line today reveal an overwhelming cry from the British public for Government action to curb the menace of drink and drug driving.

The call comes in the same month as the findings from an inquiry on drink and drug driving by Sir Peter North for the Department for Transport are due to be published.

More than 9 out of 10 drivers (92%) surveyed by the charity and motor insurer support the introduction of a new anti drug drive law to enable prosecution of anyone driving on impairing drugs, similar to the law on drink driving. At the moment, a prosecution can only be brought against a drug driver if the police also have evidence the driver was driving badly.

Drivers are also overwhelmingly in favour of a lower drink-drive limit, with more than 7 out of 10 (71%) agreeing that the current limit of 80mg alcohol per 100ml blood should be cut. Research indicates that someone driving with this much alcohol in their blood is five times more likely to crash than if they were driving without any alcohol in their system.

More than half of drivers (55%) support Brake and Direct Line’s calls for a low limit of 20mg alcohol per 100ml blood. . . . . .

Read Full Release
____________________________________________

Can the Blood Alcohol Concentration Be a Predictor for Increased Hospital Complications in Trauma Patients Involved in Motor Vehicle Crashes?

The goal of this report is to assess the relationship of varying levels of blood alcohol concentration (BAC) and hospital complications in patients admitted after motor vehicle crashes.

Data for the study was collected by a retrospective review of the University of Wisconsin Hospital trauma registry between 1999 and 2007 using the National Trauma Registry of the American College of Surgeons (NTRACS). Of 3729 patients, 2210 (59%) had a negative BAC, 338 (9%) <100>200 mg/dL.

Forty-six percent of patients had one or more hospital related complications. The odds ratio (OR) for the occurrence of alcohol withdrawal in the three alcohol groups compared to the no alcohol group was 12.02 (CI 7.0–20.7), 16.81 (CI 10.4–27.2), and 30.96 (CI 19.5–49.2) as BAC increased with a clear dose response effect.

While there were no significant differences in the frequency of the total hospital events following trauma across the four groups, rates of infections, coagulopathies, central nervous system events and renal complications were lower in the high BAC group.

Prospective studies are needed to more precisely estimate the frequency of hospital complications in patients with alcohol use disorders and in persons intoxicated at the time of the motor vehicle accident.

The study supports the use of routine BAC to predict patients at high risk for alcohol withdrawal and the early initiation of alcohol detoxification.

Read Full Article (PDF)
_______________________________________

A case–control analysis of socio-economic and marital status differentials in alcohol- and non-alcohol-related mortality among working-age Russian mal

We examined the role of socio-economic status (SES) and marital status in premature mortality among working-age Russian males. Life expectancy among this group dropped sharply following the collapse of the Soviet Union and has yet to recover despite the relative economic and political stability of the last decade.

Results revealed clear protective effects of SES and marital status against premature mortality. Although the effects for marital status were significant across alcohol- and non-alcohol-related causes of death, the effects of SES were largely limited to non-alcohol-related causes of death. When heavy drinkers were excluded from the analysis, however, SES was found to protect against premature mortality for alcohol-related causes.

While hazardous drinking is known to be a leading cause of premature mortality among working-age Russian males, it is unwise to ignore other factors. Given the substantial social and economic impacts in Russia of the dissolution of the Soviet Union, it is important to examine the health effects of SES and marital status and other social forces in the nation.

Our results reveal that while Russia has a very different past in terms of medicine, public health and economic institutions, it currently faces public health threats that follow similar patterns to those found in Western nations.

Read Full Abstract

Request Reprint E-Mail: wpridemo@indiana.edu

_____________________________________________

RCT of Effectiveness of Motivational Enhancement Therapy Delivered by Nurses for Hazardous Drinkers in Primary Care Units in Thailand

To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand.

Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group after both 3 and 6 months. The groups did not generally differ at 6 weeks.

However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study.

MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.

Read Full Abstract

Request Reprint E-Mail: beelittlebird@yahoo.com
____________________________________________

Differentiating Prenatal Exposure to Methamphetamine and Alcohol versus Alcohol and Not Methamphetamine using Tensor-Based Brain Morphometry and Discr

Here we investigate the effects of prenatal exposure to methamphetamine (MA) on local brain volume using magnetic resonance imaging.

Because many who use MA during pregnancy also use alcohol, a known teratogen, we examined whether local brain volumes differed among 61 children (ages 5–15 years), 21 with prenatal MA exposure, 18 with concomitant prenatal alcohol exposure (the MAA group), 13 with heavy prenatal alcohol but not MA exposure (ALC group), and 27 unexposed controls.

Volume reductions were observed in both exposure groups relative to controls in striatal and thalamic regions bilaterally and in right prefrontal and left occipitoparietal cortices.

Striatal volume reductions were more severe in the MAA group than in the ALC group, and, within the MAA group, a negative correlation between full-scale intelligence quotient (FSIQ) scores and caudate volume was observed.

Limbic structures, including the anterior and posterior cingulate, the inferior frontal gyrus (IFG), and ventral and lateral temporal lobes bilaterally, were increased in volume in both exposure groups. Furthermore, cingulate and right IFG volume increases were more pronounced in the MAA than ALC group.

Discriminant function analyses using local volume measurements and FSIQ were used to predict group membership, yielding factor scores that correctly classified 72% of participants in jackknife analyses.

These findings suggest that striatal and limbic structures, known to be sites of neurotoxicity in adult MA abusers, may be more vulnerable to prenatal MA exposure than alcohol exposure and that more severe striatal damage is associated with more severe cognitive deficit.

Read Full Abstract

Request Reprint E-Mail: esowell@ucla.edu
_____________________________________

News Release - Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-2009

A major new report commissioned by the Australian National Council on Drugs (ANCD) will be launched on Thursday 18^th of March at Parliament House by Parliamentary Secretary for International Development Assistance, Bob McMullan MP. The report has highlighted that whilst illicit drugs are becoming an increasing concern in the Pacific region alcohol is still the main issue.

This report, Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-09, was commissioned in order to provide detailed country profiles relating to alcohol and other drug issues. In addition, a regional overview has been prepared to highlight where existing regional mechanisms may be, and already have been, employed to address these issues. The report provides a much needed picture of the Pacific Region and the drug and alcohol issues they are experiencing.

The report Situational Analysis of Drug and Alcohol Issues and Responses in the Pacific 2008-09 prepared by the Burnet Institute is based on a review of published and grey literature, key informant interviews and broad consultations on detailed country profiles.

Read Full Release

ANCD research paper 21- Situational analysis of drug and alcohol issues and responses in the Pacific 2008-09 (PDF)

____________________________________________

________________________________________

YOUTH COMMISSION ON ALCOHOL ANNOUNCES FINDINGS AND RECOMMENDATIONS!

After a range of meetings with high profile industry experts, five intense residentials and two international study visits, the ground-breaking Youth Commission on Alcohol has come to an end.

The young Commissioners have attended their final residential meeting where they finalised the recommendations which they have came up with during the year long project which examined Scotland's relationship with alcohol.

They have identified eight key recommendations focussed around education, social marketing, advertising and availability to name a few. The young people have today presented their final recommendations to the Scottish Government.

Click on this link, http://www.youngscot.net/projects/index.asp?id=1441&SR=29&ssnb=5 to view the final evidence and recommendations document.

_______________________________________

Health Behaviors of Adults: United States, 2005–2007

This report presents selected prevalence estimates for key indicators of alcohol use, cigarette smoking, leisure-time physical activity, body weight status, and sleep among U.S. adults, using data from the 2005–2007 National Health Interview Survey (NHIS).

The NHIS is conducted annually by the Centers for Disease Control and Prevention’s National Center for Health Statistics.

Estimates are shown for several sociodemographic subgroups for both sexes combined and for men and women separately. The subgroups are compared in terms of their prevalence of ‘‘healthy’’ and ‘‘unhealthy’’ behaviors.

Read Full Report (PDF)
_______________________________________

Concordance of Adolescent Reports of Friend Alcohol Use, Smoking, and Deviant Behavior as Predicted by Quality of Relationship and Demographic Variabl

The strongest predictor of adolescent alcohol use is affiliation with friends who drink, use other drugs, or engage in deviant behavior. Most studies measure this variable using adolescent perceptions of friend problem behavior, but some research suggests these perceptions may be inaccurate.

The current study's objective was to determine the concordance between adolescent perceptions of their friend's drinking, smoking, and deviant behavior and the friend's self-report. Relationship characteristics and demographic variables were explored as predictors of report concordance.

The relations between target perceptions of friend and friend self-reports of drinking and smoking were statistically significant (p < .001), but concordance was driven largely by agreement regarding the absence of behavior. Although 22% of friends drank and 8.6% smoked, fewer than 60% of targets perceived these behaviors. Deviant behavior reports correlated moderately (r .45), with 51% of adolescents underreporting friend deviance. There were few predictors of report concordance.

Adolescents and their friends generally provided concordant reports of one another's drinking and smoking behaviors, but most agreement concerned the absence of behavior; most targets provided underreports of their friend's engagement in deviant behaviors.

These findings suggest that adolescent perceptions of friends' problem behavior do not exaggerate the involvement of their friends in these behaviors.

Read Full Abstract

Request Reprint E-Mail: donovanje@upmc.edu
_______________________________________

Relationship Between Alcohol Drinking and Aspartate Aminotransferase:Alanine Aminotransferase (AST:ALT) Ratio, Mean Corpuscular Volume (MCV), Gamma-Gl

The misuse of alcohol, even at levels just above two drinks per day, is a public health problem, but identifying patients with this potentially unhealthy drinking is hindered by the lack of tests. Several blood tests, such as those testing for gamma-glutamyl transpeptidase (GGT) or mean corpuscular volume (MCV), are among the commonly used markers to identify very heavy drinking, but combinations of these markers have rarely been tested in lighter drinkers.

We examined the relationship between alcohol drinking and the levels of these markers in a national population-based study composed primarily of lighter drinkers.

Data were analyzed from 8,708 adult participants in the third U.S. National Health and Nutrition Examination Survey after excluding subjects with iron overload; with hepatitis B and C; who were pregnant; and who were taking prescription drugs such as phenytoin (Dilantin), barbiturates, and hydroxyurea (Droxia and Hydrea). The relationship between the amount of alcohol drinking and GGT, aspartate aminotransferase:alanine aminotransferase ratio, MCV of erythrocytes, and apolipoprotein A1 and B were analyzed and adjusted for potential liver injury risk factors.

The prevalence of unhealthy alcohol drinking (defined as consumption of more than two standard drinks per day) was 6.7%. Heavier drinkers tended to be younger and reported an average of 4.2 drinks per day. When tested alone or in combination, the sensitivity and positive predictive values for these blood tests were too low to be clinically useful in identifying the subjects in the heavier drinking category.

In this large, national, population-based study, the markers of heavy drinking studied here, either alone or in combination, did not appear to be useful in identifying unhealthy drinking. More work is needed to find the novel marker(s) associated with risky alcohol drinking.

Read Full Abstract

Request Reprint E-Mail: sliangpu@iupui.edu
______________________________________

Drinking, Driving, and Crashing: A Traffic-Flow Model of Alcohol-Related Motor Vehicle Accidents

This study examined the influence of on-premise alcohol-outlet densities and of drinking-driver densities on rates of alcohol-related motor vehicle crashes.

A traffic-flow model is developed to represent geographic relationships between residential locations of drinking drivers, alcohol outlets, and alcohol-related motor vehicle crashes.

Cross-sectional analyses showed that effects relating on-premise densities to alcohol-related crashes were moderated by highway traffic flow. Depending on levels of highway traffic flow, 10% greater densities were related to 0% to 150% greater rates of SVN crashes. Time-series cross-sectional analyses showed that changes in the population pool of drinking drivers and on-premise densities interacted to increase SVN crash rates.

A simple traffic-flow model can assess the effects of on-premise alcohol-outlet densities and of drinking-driver densities as they vary across communities to produce alcohol-related crashes. Analyses based on these models can usefully guide policy decisions on the siting of on-premise alcohol outlets.

Read Full Abstract

Request Reprint E-Mail: paul@prev.org
_______________________________________

Examining Perceived Alcoholism Stigma Effect on Racial-Ethnic Disparities in Treatment and Quality of Life Among Alcoholics

The aim of this study was to examine racial-ethnic differences in perceived stigmatization of former alcoholics and their effect on associations of race-ethnicity with treatment history and psychological function among lifetime alcoholics.

Stigma scores were lowest for Whites and Native Americans, higher for Blacks, and highest for Asians and Hispanics, both in the total population and among lifetime alcoholics. Neither race-ethnicity nor stigma was associated with treatment utilization. Psychological function was negatively associated with stigma, but the impact of stigma on racial-ethnic differences in psychological function fell short of statistical significance.

Stigma may reduce quality of life among those with alcohol dependence, but there is no clear evidence that it affects racial-ethnic differences in quality of life.

Read Full Abstract

Request Reprint E-Mail: smithsh1@mail.nih.gov
________________________________________

Transitioning Into and Out of Problem Drinking Across Seven Years

The extent to which problem drinkers transition into and out of problem drinking was examined using Markov modeling.

Although all possible patterns were observed, a latent Markov model with heterogeneous transitions and five patterns fit the data. The sampling frame and baseline alcohol severity related to pattern.

The data indicate that, although they do change over time, problem drinkers on the whole are more likely either to remain problem drinkers or to cease to be problem drinkers than they are to move into and out of problem-drinking status. Once they transition out of problem drinking, they are more likely to remain nonproblem drinkers.

Read Full Abstract

Request Reprint E-Mail: kdelucchi@lppi.ucsf.edu
_______________________________________

Effects of Alcohol- and Cigarette-Use Disorders on Global and Specific Measures of Cognition in Middle-Age Adults

This study examined the effects of alcohol- and tobacco-use disorders on global and specific cognitive abilities in middle age.

Lifetime alcohol- and tobacco-use disorders were not associated with cognition among men. Women having a diagnosis of tobacco dependence (according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) performed less well on measures of global cognition and executive functioning. A lifetime diagnosis of DSM-IV alcohol abuse or dependence was associated with higher working memory among women only.

These results demonstrate few negative effects of alcohol-use disorders on midlife cognition, especially if current consumption is light. Differential susceptibility to the effects of cigarette use on cognition was found with women showing greater deficits in visuospatial abilities, processing speed, and executive-functioning abilities.

Read Full Abstract

Request Reprint E-Mail: kristin-caspers@uiowa.edu

_______________________________________

An Ecological Analysis of Alcohol-Outlet Density and Campus-Reported Violence at 32 U.S. Colleges

The purpose of this study was to assess the relationships among campus violence, student drinking levels, and the physical availability of alcohol at off-campus outlets in a multisite design.

Both on- and off-premise alcohol-outlet densities were associated with the campus rape-offense rate but not with the assault or robbery rates. Student drinking level was associated with both campus rape and assault rates but not with the campus robbery rate.

The apparent effect of on-premise outlet density on campus rape-offense rates was reduced when student drinking level was included in the model, suggesting that the effect of on-premise outlet density may be mediated by student drinking level.

Separate analyses revealed a similar mediational role for off-premise outlet density.

These findings demonstrate that there is a campus-level association between sexual violence and the campus-community alcohol environment.

Read Full Abstract

Request Reprint E-Mail: rscrib@LSUMC.edu

_______________________________________

Anticipated Versus Actual Alcohol Consumption During 21st Birthday Celebrations

The 21st birthday celebration is often associated with excessive alcohol consumption.

The current study examined whether individuals consume more alcohol than anticipated during their celebration and whether situational factors contribute to prediction errors.

The majority of 21st birthday celebrants consumed more alcohol than they anticipated, with men showing greater prediction error than women. Situational factors were positively associated with the discrepancy between anticipated and actual alcohol consumption.

Drinking shots, drinking at a fast pace, celebrating with influential peers, and engaging in 21st birthday traditions were associated with drinking more alcohol than anticipated during 21st birthday celebrations.

Findings suggest future interventions that target situational factors could reduce excessive 21st birthday drinking.

Read Full Abstract

Request Reprint E-Mail: hbrister@mail.utexas.edu
______________________________________

Alcohol-Consumption Trajectories and Associated Characteristics Among Adults Older Than Age 50

This study examined changes in drinking behavior after age 50 and baseline personal characteristics and subsequent life events associated with different alcohol-consumption trajectories during a 14-year follow-up period.

Overall, alcohol consumption declined. However, rates of decline differed appreciably among sample persons, and for a minority, alcohol consumption increased. Persons with increasing consumption over time were more likely to be affluent (relative-risk ratio [RRR] = 1.09, 95% CI [1.05, 1.12]), highly educated (RRR = 1.20, 95% CI [1.09, 1.31]), male, White (RRR = 3.54, 95% CI [1.01, 12.39]), unmarried, less religious, and in excellent to good health.

A history of problem drinking before baseline was associated with increases in alcohol use, whereas the reverse was true for persons with histories of few or no drinking problems.

There are substantial differences in drinking trajectories at the individual level in midlife and late life. A problem-drinking history is predictive of alcohol consumption patterns in later life.

Read Full Abstract

Request Reprint E-Mail: alyssa.platt@duke.edu
______________________________________

Retired Status and Older Adults' 10-Year Drinking Trajectories

Little research has examined the role of retirement in shaping late-life drinking careers, and it has generally been limited to cross-sectional designs or short-term follow-ups that emphasize group-level comparisons of retirees and nonretirees.

The purpose of this study was to determine the following: (a) the effect of retired status on older adults' 10-year within-person drinking trajectories and (b) whether age, gender, income, health, and problem-drinker status account for or moderate this effect.

Participants' drinking frequency declined moderately over the 10-year interval, and retired status hastened the decline. However, this effect disappeared once covariates were added to the model: Baseline poorer health, lower income, and current problem-drinker status predicted steeper decline in drinking frequency, whereas former problem-drinker status predicted slower decline. Lower income and current drinking problems also predicted steeper declines in amount of alcohol consumed.

There were no statistically significant or uniquely contributive interactions between retired status and age, gender, health, income, or drinking problems for predicting late-life drinking trajectories

Baseline health, income, and problem-drinking history are more important than retired status for predicting older adults' long-term within-person drinking trajectories. These factors--and recency of drinking problems--should be considered in future studies of retirement and late-life drinking patterns.

Read Full Abstract

Request Reprint E-Mail: penny.brennan@med.va.gov ________________________________________

Drinking patterns, gender and health III: Avoiding versus seeking health care

Inability to predict most health services use and costs using demographics and health status suggests that other factors affect use, including attitudes and practices that influence health and willingness to seek care.

Alcohol consumption has generated interest because heavy, chronic consumption causes adverse health consequences, acute consumption increases injury, and moderate drinking is linked to better health while hazardous drinking and alcohol-related problems are stigmatized and may affect willingness to seek care.

Quantitative results suggest health-related practices and attitudes predict subsequent service use. Consistent predictors of care were having quit drinking, current at-risk consumption, cigarette smoking, higher body mass index, disliking visiting doctors, and strong religious/spiritual beliefs. Qualitative analyses suggest embarrassment and shame are strong motivators for avoiding care.

Although models included numerous health, functional status, attitudinal and behavioral predictors, variance explained was similar to previous reports, suggesting more complex relationships than expected. Qualitative analyses suggest several potential predictive factors not typically measured in service-use studies: embarrassment and shame, fear, faith that the body will heal, expectations about likelihood of becoming seriously ill, disliking the care process, the need to understand health problems, and the effects of self-assessments of health-related functional limitations.

Read Full Abstract

Request Reprint E-Mail: carla.a.green@kpchr.org

______________________________________

Drinking patterns, gender and health II: Predictors of preventive service use

Chronic diseases and injuries are elevated among people with substance use problems/dependence, yet heavier drinkers use fewer routine and preventive health services than non-drinkers and moderate drinkers, while former drinkers and abstainers use more than moderate drinkers.

Researchers hypothesize that drinking clusters with attitudes and practices that produce better health among moderate drinkers and that heavy drinkers avoid doctors until they become ill, subsequently quitting and using more services. Gender differences in alcohol consumption, health-related attitudes, practices, and prevention-services use may affect these relationships.

Controlling for attitudes, practices, and health, female lifelong abstainers and former drinkers were less likely to have mammograms; individuals with alcohol-use disorders and positive AUDIT scores were less likely to obtain influenza vaccinations. AUDIT-positive women were less likely to undergo colorectal screening than AUDIT-positive men. Consistent predictors of prevention-services use were: self-report of having a primary care provider (positive); disliking visiting the doctor (negative); smoking cigarettes (negative), and higher body mass index (BMI) (negative).

When factors associated with drinking are controlled, patterns of alcohol consumption have limited effects on preventive service use. Individuals with stigmatized behaviors (e.g., hazardous/harmful drinking, smoking, or high BMIs) are less likely to receive care. Making care experiences positive and carefully addressing stigmatized health practices could increase preventive service use.

Read Full Abstract

Request Reprint E-Mail: carla.a.green@kpchr.org

_____________________________________________

Drinking patterns, gender and health I: Attitudes and health practices

Despite considerable research, relationships among gender, alcohol consumption, and health remain controversial, due to potential confounding by health-related attitudes and practices associated with drinking, measurement challenges, and marked gender differences in drinking.

We examined gender/alcohol consumption differences in health-related attitudes and practices, and evaluated how these factors affected relationships among gender, alcohol consumption, and health status.

More frequent heavy drinking was associated with worse health-related attitudes and values, worse feelings about visiting the doctor, and worse health-related practices. Relationships between health-related practices and alcohol use differed by gender, and daily or almost daily heavy drinking was associated with significantly lower physical and mental health for women compared to men. Drinking status (lifelong abstainers, former drinkers, and level of regular alcohol consumption) was related to health status and vitality, even after adjusting for health-related attitudes, values, and practices. Relationships did not differ by gender. Former drinkers reported lower physical and mental health status than either lifelong abstainers or current drinkers.

Drinking status is independently related to physical health, mental health, and vitality, even after controlling for the health-related attitudes, values, and practices expected to confound these relationships. Among current drinkers, women who engage in very frequent heavy drinking have worse physical and mental health than their male counterparts.

Read Full Abstract

Request Reprint E-Mail: Carla.A.Green@kpchr.org

____________________________________________

Kerala's love affair with alcohol

People in the southern state of Kerala are the heaviest drinkers in India, and sales of alcohol are rising fast. The BBC's Soutik Biswas examines why. . . . . .

Read More
_______________________________________

Move to 0.02 alcohol limit 'inevitable'

Reducing Australia's blood alcohol limit for drivers to 0.02 is probably inevitable, a public health expert says as other prominent academics also voice their support for the move.

Professor Mike Daube, from Western Australia's Curtin University, said the move would send an important and, in many cases, life-saving signal to motorists amid the "national crisis" that was Australia's road toll.

"This is an important proposal that deserves very careful consideration and is probably inevitable over time," said Prof Daube, who is Professor of Health Policy and Director of Curtin's Public Health Advocacy Institute. . . . . .

Read More

__________________________________________

A Double-Blind, Placebo-Controlled Trial Combining Sertraline and Naltrexone for Treating Co-Occurring Depression and Alcohol Dependence

Empirical evidence has only weakly supported antidepressant treatment for patients with co-occurring depression and alcohol dependence. While some studies have demonstrated that antidepressants reduce depressive symptoms in individuals with depression and alcohol dependence, most studies have not found antidepressant treatment helpful in reducing excessive drinking in these patients.

The authors provide results from a double-blind, placebo-controlled trial that evaluated the efficacy of combining approved medications for depression (sertraline) and alcohol dependence (naltrexone) in treating patients with both disorders.

The sertraline plus naltrexone combination produced a higher alcohol abstinence rate (53.7%) and demonstrated a longer delay before relapse to heavy drinking (median delay=98 days) than the naltrexone (abstinence rate: 21.3%; delay=29 days), sertraline (abstinence rate: 27.5%; delay=23 days), and placebo (abstinence rate: 23.1%; delay=26 days) groups.

The number of patients in the medication combination group not depressed by the end of treatment (83.3%) approached significance when compared with patients in the other treatment groups.

The serious adverse event rate was 25.9%, with fewer reported with the medication combination (11.9%) than the other treatments.

More depressed alcohol-dependent patients receiving the sertraline plus naltrexone combination achieved abstinence from alcohol, had delayed relapse to heavy drinking, reported fewer serious adverse events, and tended to not be depressed by the end of treatment.

Read Full Abstract

Request Reprint E-Mail: PETTINATI_H@MAIL.TRC.UPENN.EDU
_______________________________________

TIP 51: Substance Abuse Treatment: Addressing the Specific Needs of Women

The primary goal of TIP 51, Substance Abuse Treatment: Addressing the Specific Needs of Women, is to assist substance abuse treatment providers in offering effective, up-to-date treatment to adult women with substance use disorders.

The TIP reviews gender-specific research and best practices beginning with the common patterns of initiation of substance use among women and extending to specific treatment issues and strategies across substance abuse treatment services.

It provides clinical and administrative information to assist counselors, clinical supervisors, program administrators, and others working with female clients with substance use disorders on how they can best respond to the specific treatment needs of women.

Contents

Consensus Panel

Editorial Board

KAP Expert Panel and Federal Government Participants

Foreword

Executive Summary

Chapter 1: Creating the Context

Chapter 2: Patterns of Use: From Initiation to Treatment

Chapter 3: Physiological Effects of Alcohol, Drugs, and Tobacco on Women

Chapter 4: Screening and Assessment

Chapter 5: Treatment Engagement, Placement, and Planning

Chapter 6: Substance Abuse Among Specific Population Groups and Settings

Chapter 7: Substance Abuse Treatment for Women

Chapter 8: Recovery Management and Administrative Considerations

Appendix A: Bibliography

Appendix B: CSAT’s Comprehensive Substance Abuse Treatment Model for Women and Their Children

Appendix C: Screening and Assessment Instruments

Appendix D: Allen Barriers to Treatment Instrument

Appendix E: DSM-IV-TR Criteria for Posttraumatic Stress Disorder

Appendix F: Integration Self-Assessment for Providers

Appendix G: Resource Panel Members

Appendix H: Cultural Competency and Diversity Network Participants

Appendix I: Field Reviewers

Appendix J: Acknowledgments

___________________________________________

Beer and its Non-Alcoholic Compounds: Role in Pancreatic Exocrine Secretion, Alcoholic Pancreatitis and Pancreatic Carcinoma

In this article we provide an overview of the newest data concerning the effect of non-alcoholic constituents of alcoholic beverages, especially of beer, on pancreatic secretion, and their possible role in alcoholic pancreatitis and pancreatic carcinoma.

The data indicate that non-alcoholic constituents of beer stimulate pancreatic enzyme secretion in humans and rats, at least in part, by direct action on pancreatic acinar cells.

Some non-alcoholic compounds of beer, such as quercetin, resveratrol, ellagic acid or catechins, have been shown to be protective against experimentally induced pancreatitis by inhibiting pancreatic secretion, stellate cell activation or by reducing oxidative stress. Quercetin, ellagic acid and resveratrol also show anti-carcinogenic potential in vitro and in vivo.

However, beer contains many more non-alcoholic ingredients. Their relevance in beer-induced functional alterations of pancreatic cells leading to pancreatitis and pancreatic cancer in humans needs to be further evaluated.

_____________________________________

Read Full Text (PDF)

A New View of Alcohol Metabolism and Alcoholism—Role of the High-Km Class Ⅲ Alcohol Dehydrogenase (ADH3)

The conventional view is that alcohol metabolism is carried out by ADH1 (Class I) in the liver. However, it has been suggested that another pathway plays an important role in alcohol metabolism, especially when the level of blood ethanol is high or when drinking is chronic.

Over the past three decades, vigorous attempts to identify the enzyme responsible for the non-ADH1 pathway have focused on the microsomal ethanol oxidizing system (MEOS) and catalase, but have failed to clarify their roles in systemic alcohol metabolism.

Recently, using ADH3-null mutant mice, we demonstrated that ADH3 (Class III), which has a high K_m and is a ubiquitous enzyme of ancient origin, contributes to systemic alcohol metabolism in a dose-dependent manner, thereby diminishing acute alcohol intoxication.

Although the activity of ADH3 toward ethanol is usually low in vitro due to its very high K_m, the catalytic efficiency (k_cat/K_m) is markedly enhanced when the solution hydrophobicity of the reaction medium increases.

Activation of ADH3 by increasing hydrophobicity should also occur in liver cells; a cytoplasmic solution of mouse liver cells was shown to be much more hydrophobic than a buffer solution when using Nile red as a hydrophobicity probe.

When various doses of ethanol are administered to mice, liver ADH3 activity is dynamically regulated through induction or kinetic activation, while ADH1 activity is markedly lower at high doses (3–5 g/kg).

These data suggest that ADH3 plays a dynamic role in alcohol metabolism, either collaborating with ADH1 or compensating for the reduced role of ADH1. A complex two-ADH model that ascribes total liver ADH activity to both ADH1 and ADH3 explains the dose-dependent changes in the pharmacokinetic parameters (b, CL_T, AUC) of blood ethanol very well, suggesting that alcohol metabolism in mice is primarily governed by these two ADHs.

In patients with alcoholic liver disease, liver ADH3 activity increases, while ADH1 activity decreases, as alcohol intake increases. Furthermore, ADH3 is induced in damaged cells that have greater hydrophobicity, whereas ADH1 activity is lower when there is severe liver disease.

These data suggest that chronic binge drinking and the resulting liver disease shifts the key enzyme in alcohol metabolism from low-K_m ADH1 to high-K_m ADH3, thereby reducing the rate of alcohol metabolism.

The interdependent increase in the ADH3/ADH1 activity ratio and AUC may be a factor in the development of alcoholic liver disease. However, the adaptive increase in ADH3 sustains alcohol metabolism, even in patients with alcoholic liver cirrhosis, which makes it possible for them to drink themselves to death.

Thus, the regulation of ADH3 activity may be important in preventing alcoholism development.

Read Full Article (PDF)
_______________________________________

From floated to conventional confidence intervals for the relative risks based on published dose–response data

A dose–response meta-analysis of epidemiological studies can encounter different types of confidence intervals (floated vs. conventional).

This paper illustrates how to back calculate conventional confidence intervals from a set of relative risks reported with floated confidence intervals or floated standard errors.

Furthermore, we provide an implementation of the formulas in a user-friendly program developed for Stata software.

I exemplify the point using published data about alcohol intake and endometrial cancer incidence from the Million Women Study.

Read Full Abstract

Request Reprint E-Mail: nicola.orsini@ki.se

_______________________________________

Treatment Admissions Reporting Abuse of Both Alcohol and Drugs: 1997-2007

● Between 1997 and 2007, the proportion of substance abuse treatment admissions reporting co-abuse of alcohol and drugs declined from 45.3 to 39.4 percent

● Regardless of which substance was the primary substance of abuse, the most common combinations reported by co-abuse admissions in both 1997 and 2007 were alcohol and marijuana and alcohol and cocaine; however, the proportion of co-abuse admissions reporting alcohol and cocaine decreased between 1997 and 2007, from 51.1 percent to 44.8 percent

● Nearly two thirds of co-abuse admissions had been in treatment at least once before (61.3 in 1997 and 59.6 percent in 2007).

Read Full Text (PDF)
_______________________________________

The relation between different dimensions of alcohol consumption and burden of disease: an overview

As part of a larger study to estimate the global burden of disease and injury attributable to alcohol: to evaluate the evidence for a causal impact of average volume of alcohol consumption and pattern of drinking on diseases and injuries; to quantify relationships identified as causal based on published meta-analyses; to separate the impact on mortality versus morbidity where possible; and to assess the impact of the quality of alcohol on burden of disease.

Evidence of a causal impact of average volume of alcohol consumption was found for the following major diseases: tuberculosis, mouth, nasopharynx, other pharynx and oropharynx cancer, oesophageal cancer, colon and rectum cancer, liver cancer, female breast cancer, diabetes mellitus, alcohol use disorders, unipolar depressive disorders, epilepsy, hypertensive heart disease, ischaemic heart disease (IHD), ischaemic and haemorrhagic stroke, conduction disorders and other dysrhythmias, lower respiratory infections (pneumonia), cirrhosis of the liver, preterm birth complications and fetal alcohol syndrome.

Dose–response relationships could be quantified for all disease categories except for depressive disorders, with the relative risk increasing with increased level of alcohol consumption for most diseases.

Both average volume and drinking pattern were linked causally to IHD, fetal alcohol syndrome and unintentional and intentional injuries.

For IHD, ischaemic stroke and diabetes mellitus beneficial effects were observed for patterns of light to moderate drinking without heavy drinking occasions (as defined by 60+ g pure alcohol per day).

For several disease and injury categories, the effects were stronger on mortality compared to morbidity.

There was insufficient evidence to establish whether quality of alcohol had a major impact on disease burden.

Overall, these findings indicate that alcohol impacts many disease outcomes causally, both chronic and acute, and injuries. In addition, a pattern of heavy episodic drinking increases risk for some disease and all injury outcomes.

Future studies need to address a number of methodological issues, especially the differential role of average volume versus drinking pattern, in order to obtain more accurate risk estimates and to understand more clearly the nature of alcohol–disease relationships.

Read Full Abstract

Request Reprint E-Mail: jtrehm@aol.com

__________________________________________

Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: molecular mechanisms of carcinogenesis

Esophageal cancer is the eighth most common incident cancer in the world and ranks sixth among all cancers in mortality. Esophageal cancers are classified into two histological types; esophageal squamous cell carcinoma (ESCC), and adenocarcinoma, and the incidences of these types show a striking variety of geographic distribution, possibly reflecting differences in exposure to specific environmental factors.

Both alcohol consumption and cigarette smoking are major risk factors for the development of ESCC. Acetaldehyde is the most toxic ethanol metabolite in alcohol-associated carcinogenesis, while ethanol itself stimulates carcinogenesis by inhibiting DNA methylation and by interacting with retinoid metabolism.

Cigarette smoke contains more than 60 carcinogens and there are strong links between some of these carcinogens and various smoking-induced cancers; these mechanisms are well established.

Synergistic effects of cigarette smoking and alcohol consumption are also observed in carcinogenesis of the upper aerodigestive tract.

Of note, intensive molecular biological studies have revealed the molecular mechanisms involved in the development of ESCC, including genetic and epigenetic alterations. However, a wide range of molecular changes is associated with ESCC, possibly because the esophagus is exposed to many kinds of carcinogens including alcohol and cigarette smoke, and it remains unclear which alterations are the most critical for esophageal carcinogenesis.

This brief review summarizes the general mechanisms of alcohol- and smoking-induced carcinogenesis and then discusses the mechanisms of the development of ESCC, with special attention to alcohol consumption and cigarette smoking.

Read Full Abstract

Request Reprint E-Mail: ytoh@nk-cc.go.jp
_______________________________________

Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: epidemiology, clinical findings, and prevention

Both cigarette smoking and alcohol drinking are well-established risk factors for esophageal squamous cell carcinoma (ESCC), and the relationship of dose to cancer risk has already been described. Furthermore, the synergistic effect of these two factors has been reported.

Our case–control study revealed the odds ratio of ESCC to be 50.1 for those who were both heavy smokers and heavy drinkers in comparison to people who neither drank nor smoked.

In patients with ESCC, head and neck cancers as well as dysplastic lesions are frequently observed. Heavy smoking and heavy drinking are closely related to such multicentric carcinogenesis events in the upper aerodigestive tract (UADT), including the esophagus and head andneck region.

Polymorphisms in acetaldehyde dehydrogenase 2 (ALDH2) are reported to be a key event in deciding individual susceptibility to UADT cancer. Patients with inactive ALDH2, in whom facial flushing is usually observed after the drinking of alcohol, are at high risk for ESCC as well as multiple UADT cancers.

For the early detection of the disease, effective follow up using endoscopy with Lugol staining or narrow band imaging endoscopy is strongly recommended for high-risk populations, such as smokers, heavy drinkers, people with experience of flushing after the drinking of alcohol, and patients with UADT cancer.

Read Full Abstract

Request Reprint E-Mail: masarum@surg2.med.kyushu-u.ac.jp
________________________________________

Nationwide Epidemiologic Survey of Idiopathic Osteonecrosis of the Femoral Head

Although numerous studies describe the clinical characteristics of idiopathic osteonecrosis of the femoral head (ONFH) in specific study populations, these have not been confirmed in countrywide studies.

We therefore determined: (1) the annual number of patients seeking medical care and number of patients newly diagnosed; and (2) the distribution of the age and gender of the patients, potential causative factors, severity of the disease, and operative procedures performed.

The number of patients who sought medical care for idiopathic ONFH during 2004 was estimated to be 11,400 (95% confidence interval, 10,100–12,800). We obtained clinical information from 1502 of these patients. The peak in age distribution occurred in the 40s. Potential causative factors were systemic steroid administration (51%) and habitual alcohol use (31%). Hip replacement was the most frequently performed procedure (65%). Among patients with a history of systemic steroid administration, systemic lupus erythematosus was reported most frequently (31%) as the underlying disease. Among patients younger than 40 years, steroid use was the most prominent potential causative factor (60%), and hip replacement frequently was performed (45%). A greater proportion of patients with no history of steroid or alcohol use was observed among patients 65 years or older (41%).

In addition to the disease burden of idiopathic ONFH in Japan, our results confirmed the importance of developing preventive and treatment strategies, especially among the younger population.

Read Full Article (PDF)

_____________________________________

Co-Occurring Disorders: Integrated Dual Disorders Treatment

Integrated Dual Diagnosis Treatment is for people who have co-occurring disorders, mental illness and a substance abuse addiction. This treatment approach helps people recover by offering both mental health and substance abuse services at the same time and in one setting.

Integrated Treatment for Co-Occurring Disorders-CD/DVD Version EPB KIT

• How to Use the Evidence-Based Practices KITs (PDF, 357 KB)
• Getting Started with Evidence-Based Practices (PDF, 527 KB)
• Building Your Program (PDF, 673 KB)
• Training Frontline Staff (PDF, 1.4 MB)
• Evaluating Your Program (PDF, 1.3 MB)
• Using Multimedia to Introduce Your EBP (PDF, 1.9 MB)
• Brochure (English) (PDF, 725 KB)
• Brochure (Spanish) (PDF, 705 KB)
• The Evidence (PDF, 720 KB)

___________________________________

Correlates of substance abuse treatment completion among disadvantaged communities in Cape Town, South Africa

Completion of substance abuse treatment is a proximal indicator of positive treatment outcomes. To design interventions to improve outcomes, it is therefore important to unpack the factors contributing to treatment completion. To date, substance abuse research has not examined the factors associated with treatment completion among poor, disadvantaged communities in developing countries.

This study aimed to address this gap by exploring client-level factors associated with treatment completion among poor communities in South Africa.

Findings suggest that treatment completion rates of individuals from poor South African communities can be enhanced by i) improving perceptions of substance abuse treatment through introducing quality improvement initiatives into substance abuse services, ii) strengthening clients' abstinence-oriented social networks and, iii) strengthening the counselor-client therapeutic alliance.

Read Full Text (PDF)
____________________________________

Drink Driving in Queensland - discussion paper

Over 600 people have been killed as a result of crashes involving drink drivers in the eight years prior to 30 June 2009. This represents, on average, 22.9 per cent of all road fatalities in Queensland for that period.

As part of our commitment to working with the community, the Queensland Government has developed a discussion paper to gain input on a range of possible drink driving initiatives.

Read More

__________________________________________