NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England

This paper describes the development of the first set of national guidance focused on the prevention of alcohol problems in England. 

These guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) working with a multidisciplinary program development group of scientists, practitioners and lay members. In this work, screening and brief alcohol interventions represent a key element of a comprehensive public health strategy to prevent alcohol-related risk and harm across the population.

The first controlled trials of brief alcohol intervention were published in the mid to late 1980's and there are now around 60 published trials in this field. After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners. 

This paper summarises a suite of complementary system-level and practice recommendations, which were published by NICE in June 2010, and considers their likely impact on screening and brief alcohol in England.



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e.f.s.kaner@newcastle.ac.uk

Exploring the emergence of alcohol use disorder symptoms in the two years after onset of drinking: Findings from the National Surveys on Drug Use and Health

This study investigates the occurrence of clinical features of alcohol dependence and socially-maladaptive drinking during the first 24 months after the onset of alcohol use.  

Data for this study are from the nationally representative 2004-2007 National Surveys on Drug Use and Health (NSDUH). 

General population of the US, aged 12 years and older. Participants: Newly-onset alcohol users (NOAUs) were drinkers who started to drink alcohol within 24 months of the NSDUH assessment and consumed alcohol during the last 12 months.  

The NSDUH assessed for clinical features of alcohol dependence and socially-maladaptive drinking, 

consistent with the DSM-IV. 

NOAUs frequently experienced problems relating to self-reported tolerance, spending a lot of time getting over the effects of alcohol, and unsuccessful attempts at cutting down on drinking. The likelihood of experiencing the clinical features steadily increased in the first nine months after use, but appeared to plateau or only gradually increase thereafter. 

Strong evidence emerged that the clinical features measured a single latent dimensional of ‘alcohol use disorder’ (AUD) in this sample. 

The majority of the clinical features were good indicators of the underlying AUD continuum in the two years after first drinking onset. 

There may be a period of time during the second year of alcohol use when level of alcohol use disorder fluctuates rather than increases. Public health and safety efforts designed to target problematic alcohol use in the earliest stages of alcohol involvement could be useful in preventing the escalation of alcohol problems in this group of drinkers.

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Request Reprint E-Mail: o.mcbride@ulster.ac.uk 

Folic Acid and Selenite during Reproduction, Gestation and Lactation Protect against Ethanol Changed Se Bioavailability

Levels of antioxidants such as folic acid and selenium decrease in dams exposed to ethanol during gestation and lactation, affecting their antioxidant status, their reproductive function and consequently the health of their progeny.

We will study whether a Se (0.5 p.p.m.) plus folic acid (8 p.p.m.) supplemented diet administered to ethanol-exposed dams and male rats prevents the effects provoked by ethanol in Se bioavailability and in their glutathione peroxidase (GPx) activity, thus improving the health of their offspring.  

Se levels in tissue were measured by graphite-furnace atomic absorption spectrometry and serum GPx activity by spectrophotometry. 

 

Results show that ethanol decreases Se retention in dams, affecting their tissues’ Se deposits, decreasing serum GPx activity, gestational parameters and the weight of their progeny. 

Se plus folic acid balance Se bioavailability, something that is especially important during gestation and lactation, and as a direct result, the health of their progeny is improved. 

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Request Reprint E-Mail:  olimpia@us.es

Altered fronto-cerebellar connectivity in alcohol-naïve youth with a family history of alcoholism

Fronto-cerebellar connections are thought to be involved in higher-order cognitive functioning. It is suspected that damage to this network may contribute to cognitive deficits in chronic alcoholics. However, it remains to be elucidated if fronto-cerebellar circuitry is altered in high-risk individuals even prior to alcohol use onset. 

The current study used functional connectivity MRI (fcMRI) to examine fronto-cerebellar circuitry in 13 alcohol-naïve, at-risk youth with a family history of alcoholism (FH+) and 14 age-matched controls. 

In addition, we examined how white matter microstructure, as evidenced by fractional anisotropy (FA) related to fcMRI. FH + youth showed significantly reduced functional connectivity between bilateral anterior prefrontal cortices and contralateral cerebellar seed regions compared to controls. 

We found that this reduction in connectivity significantly correlated with reduced FA in the anterior limb of the internal capsule and the superior longitudinal fasciculus. 

Taken together, our findings reflect associated aberrant functional and structural connectivity in substance-naïve FH + adolescents, perhaps suggesting an identifiable neurophenotypic precursor to substance use. 

Given the role of frontal and cerebellar brain regions in subserving executive functioning, the presence of premorbid abnormalities in fronto-cerebellar circuitry may heighten the risk for developing an alcohol use disorder in FH + youth through atypical control processing.


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TYPES OF DRINKERS AND DRINKING SETTINGS: AN APPLICATION OF A MATHEMATICAL MODEL

U.S. college drinking data and a simple population model of alcohol consumption are used to explore the impact of social and contextual parameters on the distribution of light, moderate, and heavy drinkers. Light drinkers become moderate under social influence, moderate drinkers may change environments and become heavy drinkers. 

We estimate the drinking reproduction number, Rd, the average number of individual transitions from light to moderate drinking that result from the introduction of a moderate drinker in a population of light drinkers.  

Ways of assessing and ranking progression of drinking risks and data-driven definitions of high- and low-risk drinking environments are introduced. Uncertainty and sensitivity analyses, via a novel statistical approach, are conducted to assess Rd variability and to analyze the role of context on drinking dynamics.

 Our estimates show Rd well above the critical value of 1. Rd estimates correlate positively with the proportion of time spent by moderate drinkers in high-risk drinking environments. Rd is most sensitive to variations in local social mixing contact rates within low-risk environments. The parameterized model with college data, suggests that high residence times of moderate drinkers in low-risk environments maintain heavy drinking.  

With regard to alcohol consumption in US college students, drinking places, the connectivity (traffic) between drinking venues, and the strength of socialization in local environments are important determinants in transitions between light, moderate and heavy drinking as well as in long-term prediction of the drinking dynamics.


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Request Reprint E-Mail: anujmubayi@yahoo.com 

Alcohol News - 43/2010

 

The Wall Street Journal Blog (EU) - EU Mulls Booze Warning Labels
Brussels is a battlefield of rule-making; there are always a thousand small skirmishes taking place off-camera, many with an impact on your future and the bottom lines of big companies.
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The Forigner (Norway) - Norway’s ‘no-no’ to alcohol ads could be corked
TV channels transmitting from abroad with content aimed at Norwegian viewers are not permitted to advertise alcohol under current Norwegian legislation, but this could contravene European law.
Read more

Helsinkin Sanomat (Finland) - Working group proposes new alcohol restrictions for Helsinki
A working group of the City of Helsinki is proposing radical measures to curtail what it sees as an “alcohol-friendly culture” that permeates in the city. The task force wants to ban alcohol advertising in advertising space that is owned by the city. It also proposes that the city stop serving alcoholic beverages at city events, and take stronger action against drinking among young people.
Read more

New York Times (Iraq) - Drug and Alcohol Abuse Growing in Iraqi Forces
A growing number of Iraqi security force members are becoming dependent on drugs or alcohol, which has led to concerns about a significant addiction problem among the country’s armed services as the insurgency remains a potent force and American troops prepare to depart at the end of next year.
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Morning Advertiser (UK) - Underage drinking costs NHS £19m a year
Underage drinking, fuelled by the "ludicrously cheap price of alcohol" in supermarkets, is costing the National Health Service £19m a year.
Read more

New Zealand Herald (New Zealand) - Cut drink-drive limit: doctor
The Government believes New Zealand drivers aren't ready to moderate their drinking. We know they are. So take responsibility for keeping our roads safe by signing up: Two Drinks Max.
Read more

MSN India - Smart people drink more alcohol, says new study
In the National Child Development Study in the UK and the National Longitudinal Study of Adolescent Health in the US, childhood intelligence was measured before the age of 16.
Read more

ABC Online (Australia) - NSW wants to ban energy drinks on tap
The New South Wales Government says it plans to ban the sale of energy drinks on tap at clubs and pubs.
Read more

Ivanhoe - Heavy Alcohol Use May Cause Change In Teen Cognitive Development
Alcohol, to an adolescent, is usually seen as a rite of passage. Many teenagers view drinking as a gateway into adulthood, or independence.
Read more

Businessweek - Study Confirms It: Booze Impairs Decision-Making
A new study confirms what many people may know first- or secondhand: Too much alcohol slows reaction time and increases errors during decision-making.
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USA Today - Alcohol and caffeine drinks: The next student health problem?
Three beers, a can of Red Bull and a large espresso: no big deal, many college students might say. Three beers, a can of Red Bull and a large espresso times three or four, and they still might tell you they're not intoxicated.
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Medscape - Variants in Region of Ethanol Metabolism Gene Predict Alcoholism Risk
A search for genetic factors that influence individuals' early experience with ethanol has found variants in or near CYP2E1 associated with stronger responses and inebriation after relatively low alcohol intake.
Read more

Arka News Agency (Armenia) - Minister: Armenia conducts serious negotiations with WTO on taxation of alcohol drinks and tobacco
Armenia conducts serious negotiations with WTO on taxation of alcohol drinks and cigarettes, said Armenian Minister of Economy Nerses Yeritzyan during the parliamentary discussions of state budget 2011.
Read more

Crikey (Australia) - Universities: a marketing arm of the alcohol industry?
Public health efforts to reduce the harm caused by risky alcohol consumption should be paying much more attention to university campuses, says public health policy consultant Margo Saunders.
Read more

The Guardian (UK) - Charity calls for ban on alcohol ads on pre-watershed TV and online
Alcohol Concern has called for a ban on TV and internet alcohol ads after conducting research claiming that well over a million under-16-year-olds saw multiple drinks commercials while watching England games during the World Cup.
Read more

FairWarning (USA) - Looser About Drinking and Driving, U.S. Suffers More Alcohol-Related Deaths
Compared to most other countries, the U.S. has a lax standard for determining whether someone behind the wheel is driving drunk. The U.S. is one of only 16 nations with a limit for blood alcohol content of .08.
Read more

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The microstructural integrity of the corpus callosum and associated impulsivity in alcohol dependence: A tractography-based segmentation study using diffusion spectrum imaging

Previous post-mortem and structural magnetic resonance imaging (MRI) studies in patients with alcohol dependence have demonstrated abnormalities of brain white matter. 

The present study investigated the microstructural integrity in the corpus callosum and the associations of this integrity with neurobehavioral assessments. 

Twenty-five male cases fulfilling the DSM-IV diagnosis of alcohol dependence and 15 male control subjects were scanned using a 3T MRI system. Callosal fiber tracts were reconstructed by diffusion spectrum imaging tractography and were subdivided into seven functionally distinct segments. The microstructural integrity was quantified in terms of generalized fractional anisotropy (GFA). 

Compared with normal subjects, men with alcohol dependence showed lower GFA values on all segments of the corpus callosum. The segment interconnecting the bilateral orbitofrontal cortices was the most affected. The score on the Barratt Impulsivity Scale showed an inverse relationship with GFA on the callosal fiber tracts connecting the bilateral orbitofrontal cortices. Furthermore, the duration of regular use was negatively associated with GFA on the callosal fiber tracts connecting the bilateral temporal and parietal cortices. 

Our findings suggest that a high self-rated impulsivity level was associated with low anisotropy in white matter of corpus callosum sectors extending to the orbitofrontal cortex.

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Request Reprint E-Mail:  wytseng@ntu.edu.tw

Signs of Preclinical Wernicke's Encephalopathy and Thiamine Levels as Predictors of Neuropsychological Deficits in Alcoholism without Korsakoff's Syndrome

The purpose of this study was to determine whether meeting historical criteria for unsuspected Wernicke's encephalopathy (WE), largely under-diagnosed in vivo, explains why some alcoholics have severe neuropsychological deficits, whereas others, with a similar drinking history, exhibit preserved performance.

Demographic, clinical, alcohol related, and neuropsychological measures were collected in 56 abstinent alcoholics and 38 non-alcohol-dependent volunteers. Alcoholics were classified using the clinical criteria established by Caine et al (1997) and validated in their neuropathological study of alcoholic cases.

Our alcoholics who met a single criterion were considered ‘at risk for WE’ and those with two or more criteria with ‘signs of WE’. Whole blood thiamine was also measured in 22 of the comparison group and 28 alcoholics.

Of the alcoholics examined, 27% met no criteria, 57% were at risk for WE, and 16% had signs of WE. Neuropsychological performance of the alcoholic subgroups was graded, with those meeting zero criteria not differing from controls, those meeting one criterion presenting mild-to-moderate deficits on some of the functional domains, and those meeting two or more criteria having the most severe deficits on each of the domains examined. Thiamine levels were selectively related to memory performance in the alcoholics. 

Preclinical signs of WE can be diagnosed in vivo, enabling the identification of ostensibly ‘uncomplicated’ alcoholics who are at risk for neuropsychological complications. 

The graded effects in neuropsychological performance suggest that the presence of signs of WE explains, at least partially, the heterogeneity of alcoholism-related cognitive and motor deficits.

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edie@stanford.edu

Heavy Episodic Drinking in Early Adolescence: Gender-Specific Risk and Protective Factors

This longitudinal study examined possible gender differences regarding risk and protective factors for heavy episodic drinking among 1,222 seventh-grade students (aged 13) in the City of Stockholm, Sweden, with follow-up 2 years later.

Logistic regression analyses showed that several factors predicted heavy episodic drinking. 

The strongest predictors for boys’ heavy episodic drinking in the ninth grade were heavy episodic drinking (odds ratio [OR] = 5.30) and smoking in the seventh grade (OR = 5.80). 

Drinking peers (OR = 2.47) and smoking (OR = 2.44) in the seventh grade showed the strongest association for girls. 

Furthermore, high parental monitoring and having a secure attachment to parents may have a protective effect when risk factors are present. 

Our results lend support to prevention initiatives to strengthen the parent–child relation and focus on adolescents’ ability to resist peer pressure and of limiting parental provision of alcohol. The study's limitations are noted.

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Request Reprint E-Mail:   anna-karin.danielsson@ki.se

   

Chronic alcohol neuroadaptation and stress contribute to susceptibility for alcohol craving and relapse

Alcoholism is a chronic relapsing disorder. Major characteristics observed in alcoholics during an initial period of alcohol abstinence are altered physiological functions and a negative emotional state.

Evidence suggests that a persistent, cumulative adaptation involving a kindling/allostasis-like process occurs during the course of repeated chronic alcohol exposures that is critical for the negative symptoms observed during alcohol withdrawal. 

Basic studies have provided evidence for specific neurotransmitters within identified brain sites being responsible for the negative emotion induced by the persistent cumulative adaptation following intermittent-alcohol exposures. 

After an extended period of abstinence, the cumulative alcohol adaptation increases susceptibility to stress- and alcohol cue-induced negative symptoms and alcohol seeking, both of which can facilitate excessive ingestion of alcohol. In the alcoholic, stressful imagery and alcohol cues alter physiological responses, enhance negative emotion, and induce craving. 

Brain fMRI imaging following stress and alcohol cues has documented neural changes in specific brain regions of alcoholics not observed in social drinkers. 

Such altered activity in brain of abstinent alcoholics to stress and alcohol cues is consistent with a continuing ethanol adaptation being responsible. Therapies in alcoholics found to block responses to stress and alcohol cues would presumably be potential treatments by which susceptibility for continued alcohol abuse can be reduced. 

By continuing to define the neurobiological basis of the sustained alcohol adaptation critical for the increased susceptibility of alcoholics to stress and alcohol cues that facilitate craving, a new era is expected to evolve in which the high rate of relapse in alcoholism is minimized.



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Request Reprint E-Mail: george_breese@med.unc.edu   

Inverse association of the obesity predisposing FTO rs9939609 genotype with alcohol consumption and risk for alcohol dependence

To investigate whether the FTO rs9939609 A allele (a risk factor for obesity) is associated with measures of alcohol consumption. 

 

Among individuals drinking alcohol, the obesity associated ‘AA’ genotype was also associated with lower total ethanol consumption (sex, age and BMI adjusted difference: 0.21 g/day, P = 0.012) and distinct drinking habits with relatively low frequency of drinks but larger volume consumed at a time as evidenced by: (i) association between ‘AA’ and frequency/amount of typical drinks (P = 0.023, multiple logistic regression analysis); (ii) inverse correlation between ‘AA’ and drink frequency adjusted for drink size (P = 0.007 for distilled spirits, P = 0.018 for beer); (iii) decreased frequency of ‘AA’ (OR = 0.46, P = 0.0004) among those who drank small amounts of distilled spirits (≤100 ml at a time) but frequently (≥1-2 times/week). 

A decrease of ‘AA’ was also found in both cohorts of alcohol-dependent patients vs. geographically matched subjects from WOBASZ yielding a pooled estimate of OR = 0.59, CI: 0.40-0.88, P = 0.008). 

Exploratory analysis showed that those with rs9939609 AA reported lower (by 1.22) mean number of cigarettes/day during a year of most intense smoking, (P = 0.003) and were older at start of smoking by 0.44 years (P = 0.016). 

 

 

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Number of drunken children in A&E rises sharply

Growing numbers of children are ending up in hospital because they have drunk so much, with more girls needing treatment than boys, according to new NHS figures.

Under-18s have an increasingly damaging relationship with alcohol, with tens of thousands every year being attended to by ambulance crews, treated in A&E or admitted overnight, according to a report from the charity Alcohol Concern.

The number of underage drinkers admitted to hospital in England rose by 32% between 2003 and 2007, from around 11,000 in 2003 to more than 14,000 in 2007, NHS hospital records show. A total of 92,220 children and young people under 18 were admitted to hospital between 2002 and 2009 – or 36 under-18s a day.

Girls are 1.3 times more likely than boys to need to be admitted due to alcohol. Between 2004 and 2009 23,347 females under 18 received treatment compared with 18,159 males in that age group.   > > > >

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Workplace Alcohol Screening, Brief Intervention, and EAPs: BIG (Brief Intervention Group) Initiative Manual

Most people with alcohol problems work and the majority work full time. Among adults who currently have the disease of alcoholism, 75% work (59% work full-time and 16% work part time). An even higher workforce participation rate is found among adults who currently have alcohol abuse disorders: 82% are employed (66% worked full-time and 16% worked part-time). Analysis of the 2005-2007 National Survey on Drug Use and Health found the prevalence of alcohol use disorders varies substantially between industries.  > > > >

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Brief Intervention Group Initiative

BIG is an exciting new effort of the Employee Assistance industry in the U.S. and Canada to work together to identify and treat employees with alcohol-related problems as a means of increasing overall productivity and engagement in the workplace.

Today, fewer than 10% of issues that U.S. and Canadian EAPs address are recorded as “alcohol” related.   But many more employees struggle with alcohol-related issues than that number indicates.  Screening and Brief Intervention (SBI) is a well researched practice that has demonstrated consistent success in correctly identifying alcohol needs in employees and assisting them to reduce hazardous use.  SBI is not widely or consistently used in our field.  Not yet.

By working together to promote routine screening and brief counseling for alcohol, EAPs will help their corporate customers and their employees to remain productive and healthy.  Together, we can change EAP call centers’ and office-based EAP counselors’ adherence to SBI evidenced-based protocols. 

Click here to learn more!

Current issues in Alcohol use and HIV research and prevention in India

The Second International Conference on Alcohol and HIV: Insights from Interventions was held in New Delhi 28-30 September 2010. During the conference a special suplement of the journal "AIDS and Behavior" was launched. A number of the papers presented in the conference are available in the journal. 

This supplemental of AIDS and Behavior is a collection of recent work by Indian researchers and Indo-U.S. partnerships, examining the intersection of alcohol and HIV in India.  > >  > >

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ILLEGAL ENTREPRENEURS A Comparative Study of the Liquor Trade in Stockholm and New Orleans 1920 – 1940

The 1920s were a golden period for smuggling in Nordic waters, as systems of prohibition were established in Finland, Norway and Iceland, while in Sweden an intricate system of rationing was implemented in 1917. 

A comparative study of the illegal liquor trade in Stockholm and New Orleans shows that the actual methods of smuggling were similar in the two cities. Mother ships brought the cargo to a point outside territorial waters, where it was shifted to smaller boats. These brought the liquor in through the archipelago of Stockholm or the bayous of the Mississippi delta. 

The relative lack of corruption in Sweden did not limit the extent of the black market. According to contemporary estimates, the amount of smuggled liquor was about the same in the two cities. 

The kind of alcohol that was brought in was different, however, and the value of the trade higher in New Orleans. Also, the organization of the trade differed, in terms of ownership and distribution.

In neither city did the illegal entrepreneurs appear to be very violent. The fact that the rate of violence was much higher in New Orleans, than in Stockholm, did not seem to affect their business methods.


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Seminar - Policies Favouring Lower Alcohol Content Beverages: Motives and Consequences

Copenhagen, Hotel Admiral, 16-17 of March, 2011

The effects of favouring lower alcohol-content beverages have in different times been a topical issue in Nordic alcohol policy debate. A preference for lower-alcohol beverages is visible in policies such as higher taxes on spirits and greater availability and advertising opportunities for beer and other lower alcohol content products. These policies convey a hierarchy of perceived effects by beverages according to their alcohol content. As of yet the reasoning and the outcomes of this preferential treatment has not been properly mapped. There are no satisfying answers to questions such as: Does harm per litre vary between different beverages? What are the short and long term consequences of people being lead, due to various reasons, to drink low alcohol beverages rather than high?

The meeting strives at gathering a wide range of research, which produces evidence on the underlying motives as well as effects of such policies. Both empirical testing and pieces on historical contexts or policy rhetoric are welcome. Work that investigates the following questions is especially relevant: What decisions that lead to a favouring of lighter beverages have been made; when were they taken; what can be said about immediate and long-term effects? What were the effects of the changes in terms of trouble per litre? What did the discourses/ rhetoric underlying these policies look like?

Papers representing different drinking cultures and policy traditions will strengthen the comparative dimension of the initiative as a whole.

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Perfectionism, perceived stress, drinking to cope, and alcohol-related problems among college students.

This study investigated the association between perfectionism (categorized by adaptive perfectionistic, maladaptive perfectionistic, or nonperfectionistic groups), perceived stress, drinking alcohol to cope, and alcohol-related problems in a large sample of college students (N = 354).

Maladaptive perfectionists reported significantly higher levels of stress and drinking to cope than adaptive perfectionists and nonperfectionists. Adaptive perfectionists reported the fewest alcohol-related problems, suggesting that healthy levels of high standards may protect against drinking to cope with stress. 

Across all participants, a significant indirect effect for drinking to cope supported its role as a mediator between stress and alcohol-related problems.

Structural equation modeling analyses supported the moderating role of perfectionism in this mediation model, such that maladaptive perfectionists were more likely to drink to cope under stress and report alcohol-related problems, whereas higher stress was associated with fewer alcohol-related problems among nonperfectionists.

Additional analyses revealed higher stress levels for women and a stronger link between stress and drinking to cope for women compared to men. 

Future research directions as well as clinical implications regarding perfectionism, stress, drinking to cope, and alcohol-related problems are discussed. 


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Request Reprint E-Mail: kgr1@ufl.edu  

Upregulation of Cannabinoid Type 1 Receptors in Dopamine D2 Receptor Knockout Mice Is Reversed by Chronic Forced Ethanol Consumption

The anatomical proximity of the cannabinoid type 1 (CNR1/CB1R) and the dopamine D2 receptors (DRD2), their ability to form CB1R–DRD2 heteromers, their opposing roles in locomotion, and their involvement in ethanol’s reinforcing and addictive properties prompted us to study the levels and distribution of CB1R after chronic ethanol intake, in the presence and absence of DRD2.

We monitored the drinking patterns and locomotor activity of Drd2+/+ and Drd2−/− mice consuming either water or a 20% (v/v) ethanol solution (forced ethanol intake) for 6 months and used the selective CB1 receptor antagonist [³H]SR141716A to quantify CB1R levels in different brain regions with in vitro receptor autoradiography.

We found that the lack of DRD2 leads to a marked upregulation (approximately 2-fold increase) of CB1R in the cerebral cortex, the caudate-putamen, and the nucleus accumbens, which was reversed by chronic ethanol intake.

The results suggest that DRD2-mediated dopaminergic neurotransmission and chronic ethanol intake exert an inhibitory effect on cannabinoid receptor expression in cortical and striatal regions implicated in the reinforcing and addictive properties of ethanol.


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Request Reprint E-Mail:  thanos@bnl.gov

The Investigation into CYP2E1 in Relation to the Level of Response to Alcohol Through a Combination of Linkage and Association Analysis

A low level of response to alcohol during an individual’s early experience with alcohol is associated with an increase risk of alcoholism. A family-based genome-wide linkage analysis using sibling pairs that underwent an alcohol challenge where the level of response to alcohol was measured with the Subjective High Assessment Scale (SHAS) implicated the 10q terminal (10qter) region. CYP2E1, a gene known for its involvement with ethanol metabolism, maps to this region.

Variance component multipoint linkage analysis was performed on a combined map of single-nucleotide polymorphism (SNP) and microsatellite data. To account for the heterogeneity evident in the dataset, a calculation assuming locus heterogeneity was made using the Heterogeneity Log of Odds (HLOD) score. Association between SNP marker allele counts and copy number and SHAS scores were evaluated using a logistic regression model.

Linkage analysis detected significant linkage to CYP2E1, which was diminished because of apparent locus heterogeneity traced to a single family with extreme phenotypes. In retrospect, circumstances recorded during testing for this family suggest that their phenotype data are likely to be unreliable. Significant allelic associations were detected for several CYP2E1 polymorphisms and the SHAS score. DNA sequencing from families that contributed the greatest evidence for linkage did not detect any changes directly affecting the primary amino acid sequence. With the removal of a single family, combined evidence from microsatellites and SNPs offers significant linkage between the level of response to alcohol and the region on the end of chromosome 10.

Combined linkage and association indicate that sequence changes in or near CYP2E1CYP2E1 in the level of response to alcohol allows inferences to be made about how the brain perceives alcohol.


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Request Reprint E-Mail:   kirk@med.unc.edu 

Adolescent Substance Abuse: The Effects of Alcohol and Marijuana on Neuropsychological Performance

Adolescence is a period in which cognition and brain undergo dramatic parallel development. Whereas chronic use of alcohol and marijuana is known to cause cognitive impairments in adults, far less is known about the effect of these substances of abuse on adolescent cognition, including possible interactions with developmental processes.

Neuropsychological performance, alcohol use, and marijuana use were assessed in 48 adolescents (ages 12 to 18), recruited in 3 groups: a healthy control group (HC, n = 15), a group diagnosed with substance abuse or dependence (SUD, n = 19), and a group with a family history positive for alcohol use disorder (AUD) but no personal substance use disorder (FHP, n = 14). Age, drinks per drinking day (DPDD), percentage days drinking, and percentage days using marijuana were considered as covariates in a MANCOVA in which 6 neuropsychological composites (Verbal Reasoning, Visuospatial Ability, Executive Function, Memory, Attention, and Processing Speed) served as dependent variables.

More DPDD predicted poorer performance on Attention and Executive Function composites, and more frequent use of marijuana was associated with poorer Memory performance. In separate analyses, adolescents in the SUD group had lower scores on Attention, Memory, and Processing Speed composites, and FHP adolescents had poorer Visuospatial Ability.

In combination, these analyses suggest that heavy alcohol use in adolescence leads to reduction in attention and executive functioning and that marijuana use exerts an independent deleterious effect on memory. At the same time, premorbid deficits associated with family history of AUD appeared to be specific to visuospatial ability.


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Request Reprint E-Mail:   rjthoma@salud.unm.edu

The Effects of Maternal Binge Drinking During Pregnancy on Neural Correlates of Response Inhibition and Memory in Childhood

Although an extensive literature has documented a broad range of cognitive performance deficits in children with prenatal alcohol exposure, little is known about how the neurophysiological processes underlying these deficits may be affected. Event-related potentials (ERPs), which reflect task-specific changes in brain electrical activity, provide a method for examining multiple constituents of cognitive processing at the neural level.

We recorded ERPs in 217 children from Inuit communities in Arctic Quebec (M age = 11.3 years) during 2 different tasks—Go/No-go response inhibition and continuous recognition memory. Children were classified as either alcohol-exposed (ALC) or controls (CON) depending on whether the mother reported binge drinking during pregnancy.

Both groups performed comparably in terms of accuracy and reaction time on the tasks, and both tasks elicited the expected effects on ERPs when responses were compared across conditions. However, the ALC group showed slower P2 latencies on Go/No-go, suggesting an altered neurophysiological response associated with initial visual processing of the stimuli. On the memory task, the ALC group showed reduced FN400 amplitude to New items, known as the familiarity effect, and reduced amplitude for the late positive component, possibly reflecting impairment in memory retrieval.

These findings show that, even in tasks in which alcohol-exposed children exhibit behavioral performance that is comparable to controls, fetal alcohol exposure is associated with altered neurophysiological processing of response inhibition and recognition memory. The data suggest that fetal alcohol exposure is associated with reduced efficiency in the initial extracting of the meaning of a stimulus, reduced allocation of attention to the task, and poorer conscious, explicit recognition memory processing.


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Request Reprint E-Mail:  joseph.jacobson@wayne.edu 

A new method of prenatal alcohol classification accounting for dose, pattern and timing of exposure: improving our ability to examine fetal effects from low to moderate alcohol

When examining the association between prenatal alcohol exposure and fetal effects, the timing and intensity of exposure have been ignored in epidemiological studies. The effect of using dose, pattern and timing of consumption (“composite” method) was investigated in this study, to examine the association between prenatal alcohol exposure and fetal effects. 

The composite method resulted in six categories of exposure (abstinent, low, moderate, binge <1 and 1+ drinks per day and with stratification by quantity ignoring dose per occasion. Data used for the analyses were from a 10% random sample of non-Indigenous women delivering a live infant in Western Australia (1995–1997). Participants from the 1995-1996 cohort were invited to participate in an 8-year longitudinal survey (78% response rate n=2224; 85% were followed-up at 2 years, 73% at 5 years and 61% at 8 years). 

The effect of moderate and binge levels of exposure was only evident with the composite method; anxiety/depression following first-trimester moderate exposure (OR 2.24, 95% CI 1.16 to 4.34), and following late pregnancy moderate (aggressive behaviour OR 1.93, 95% CI 0.91 to 4.09) and binge (language delay OR 3.00, 95% CI 0.90 to 9.93) exposures. Results for heavy levels of exposure were similar with each method. The estimates for late pregnancy were imprecise due to small numbers. 

The composite method of classification more closely reflects real-life drinking patterns and better discriminates maternal drinking than the other methods, particularly low, moderate and binge levels.

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Request Reprint E-Mail:  colleeno@ichr.uwa.edu.au 

Alcohol Awareness week: 18th October 2010 - is alcohol damaging childhood?

As Alcohol Awarness Week (AWW) kicks off from 18 to 24 October, a joint report from Alcohol Concern and the Children’s Society has been released:

Swept under the carpet: children affected by parental alcohol misuse 

The report identifies:

• An estimated 2.6 million children live with a parent whose drinking puts them at risk of neglect, and 705,000 live with a dependent drinker
• More than 100 children as young as five contacting ChildLine every week with worries about their parent's drinking
• 78% of young offenders who misuse alcohol found to have grown up in homes with parental alcohol abuse and domestic abuse   > > > >   Read More

Higher Duties on Alcohol 'Won't Curb Abuse'

The government’s plans to raise excise duties on alcoholic beverages would have little effect on curbing alcohol abuse.

 

The government’s plans to raise excise duties on alcoholic beverages would have little effect on curbing alcohol abuse, South African Breweries (SAB) said on Friday. 

Discussions between the Treasury and the drinks industry started last month over increases to the benchmark level for excise duties levied on beer, wine and spirits.

In his February budget, Finance Minister Pravin Gordhan said a consultation process to raise the benchmarks would start this year, partly out of a need to curb abuse.

“While an increase in excise may have a short-term impact on overall consumption, alcohol abuse will not decline,” SAB spokeswoman Robyn Chalmers said.  > > > >

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City high on booze list

The big city syndrome has caught on in Chandigarh. Its teenagers, the ones aged 15 to 19, have taken to alcohol at an alarming rate, with the numbers having increased 100% in the last 10 years. These shocking statistics pit Chandigarh youths only third to their peers in NCR- Delhi and Mumbai.

The problem of teenage drinking has been fuelled by absent parents, easy pocket money, cheap booze and rising stress among the urban young.    > > > >

 

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Socioeconomic Risk Factors and Depressive Symptoms in Alcohol Use Disorders Among Male Suicides in South Tirol, Italy

The aim of the current study was to evaluate whether socioeconomics risk factors and depressive symptoms are associated with suicide in men with alcohol use disorders in South Tirol, Italy. 

The authors hypothesize that socioeconomics inequalities interact with greater psychopathology in men with alcohol use disorders who committed suicide. 

The authors found a positive association between unstable work positions and low educational attainment and alcohol use disorders in individuals who committed suicide. 

The results point to the need for careful assessment of subsyndromal depression in individuals with alcohol use disorders, especially when abuse is associated with socioeconomic risk factors such as lower educational attainment and unemployment or employment instability. 

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Request  Reprint E-Mail:  giancarlo.giupponi@asbz.it  

Sex Differences in Striatal Dopamine Release in Young Adults After Oral Alcohol Challenge: A Positron Emission Tomography Imaging Study With [11C]Raclopride

We used a positron emission tomography paradigm with the D2/3 radiotracer [11C]raclopride and an alcohol challenge to examine the magnitude of alcohol-induced dopamine release and compare it between young men and women.

 

Twenty-one nonalcohol-dependent young social drinkers completed two positron emission tomography scans on separate days following ingestion of a juice mix containing either ethanol (.75 mg/kg body water) or trace ethanol only. The extent of dopamine released after alcohol was estimated by the percentage difference in [11C]raclopride binding potential (ΔBPND) between days.

 

Alcohol administration significantly displaced [11C]raclopride in all striatal subregions, indicating dopamine release, with the largest effect observed in the ventral striatum. Linear mixed model analysis across all striatal subregions of regional ΔBPND with region of interest as repeated measure showed a highly significant effect of sex (p < .001). Ventrostriatal dopamine release in men, but not in women, showed a significant positive correlation to alcohol-induced measures of subjective activation. Furthermore, we found a significant negative correlation between the frequency of maximum alcohol consumption per 24 hours and ventrostriatal ΔBPND (r = .739, p = .009) in men.

 

This study provides definitive evidence that oral alcohol induces dopamine release in nonalcoholic human subjects and shows sex differences in the magnitude of this effect. The ability of alcohol to stimulate dopamine release may contribute to its rewarding effects and, thereby, to its abuse liability in humans. Our report further suggests several biological mechanisms that may mediate the difference in vulnerability for alcoholism between men and women.

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Lay and professional concepts of alcohol dependence in the process of recovery from addiction among treated and non-treated individuals in Poland: A qualitative study

The study identifies and categorizes concepts of addiction among treated and non-treated former alcohol dependents, and their function in the process of recovery from addiction within the post-communist treatment system dominated by the Minnesota model. 

This qualitative study is based on a media recruited sample of 29 former alcohol dependents (ICD-10) in Warsaw/Poland 2006/2007. 

They reported a recovery time of at least 2 years (M_recovery=11, SD=9). In-depth interviews were analysed according to the Problem-Centred Interview method using Atlas.ti software. The applied triangulation procedures ensure reliability and validity of the data collected and the analysis of the narrative accounts. 

The results of the study show that professional concepts of addiction reconstructed on the basis of narratives from treated respondents resemble the disease model of addiction. 

A first category of lay concepts of self-changers adopt a medical–moral model of dependence including strong will as a key element of the successful recovery. 

A second category describes dependence as a symptom of maladaptive social functioning and recovery as a process of understanding one's role in society and fulfilling social expectations. 

While self-changers relied on one of these lay concepts, treated respondents were confronted with a conflict between lay and professional definition of dependence. 

It is argued that lack of recognition of lay concepts of addiction by treatment providers may weaken help-seeking and increase drop-out rates. 

The disease model implies the stability of the status of the alcoholic – which potentially weakens the individual's chance to reach the stage of stable recovery.

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zulewska@ipin.edu.pl