The Check Effect Reconsidered

The “check effect” refers to the use of disability payments to purchase illegal drugs or alcohol. 

This article describes subsequent research concerning three interrelated issues: the check effect, whether receipt of disability payments is associated with more overall substance use, and potential policy responses to misuse of disability payments for substances. 

Review and synthesis of published articles. 

Increased substance use at the beginning of the month has been described in a variety of settings. The tendency to purchase substances at the beginning of the month is impacted by household wealth, the tendency to discount future rewards, and cyclical economic activity. 

However, in naturalistic observational cohort studies, beneficiaries who receive disability payments had no greater substance use than those without disability payments. 

Potential policy responses to misspending of disability checks include financial counseling that discourages spending on drugs, and the assignment of a representative payee to prevent misuse of benefits for substances. 

Assignment of a representative payee per se has not been associated with reduced substance use but payeeship administered by agencies that integrate payee practice into treatment has been. 

Disability payments impact the timing of substance use, but receipt of disability payments is not associated with more overall substance use than unalleviated poverty.

Money management-based clinical interventions, which may involve assignment of a representative payee, can minimize the purchase of substances with disability payments.

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Request Reprint E-Mail:  marc.rosen@yale.edu.   

Alcohol expectancy moderates attentional bias for alcohol cues in light drinkers

Theoretical models suggest that attentional bias for alcohol-related cues develops because cues signal the availability of alcohol, and the expectancy elicited by alcohol cues is responsible for the maintenance of attentional bias among regular drinkers. 

We investigated the moderating role of alcohol expectancy on attentional bias for alcohol-related cues. 

On a trial-by-trial basis, participants were informed of the probability (100%, 50%, 0%) that they would receive beer at the end of the trial before their eye movements towards alcohol-related and control cues were measured. 

Heavy social drinkers showed an attentional bias for alcohol-related cues regardless of alcohol expectancy. However, in light social drinkers, attentional bias was only seen on 100% probability trials, i.e. when alcohol was expected imminently.
 
Attentional bias for alcohol-related cues is sensitive to the current expectancy of receiving alcohol in light social drinkers, but it occurs independently of the current level of alcohol expectancy in heavy drinkers.


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Alcohol News - 8/2011

The Local (Sweden) - Drunk driving Swedish police rarely fired: report

Despite 55 serving police officers being caught drink driving over the past five years, only one has lost his job, the Metro daily reported on Thursday.

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Helsinkin Sanomat (Finland) - Alcohol consumption in Finland declined for third year in succession

Last year the Finns drank less alcohol than in 2009. As the consumption of alcohol has now declined for three consecutive years, the trend is no longer coincidental, believes planning officer Marke Jääskeläinen from the National Institute for Health and Welfare (THL).

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fyiLIVING (Finland) - Increased Alcohol Consumption in Men Linked to Cancer

There is a dearth of information on the relationship between alcohol and total cancer risk. Spurred by this, researchers in Finland carried out a study to examine this relationship. On analyzing data from a population-based study of 2,627 men from Eastern Finland, it was seen that the risk of cancer increased with alcohol use; around 6.7 percent of the cancer patients in this study were linked to alcohol use.

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sciencenewsline (Finland) - Why problem drinking during adolescence is never a 'phase'

The Rutgers Alcohol Problem Index (RAPI) is widely used to assess adolescent drinking-related problems. Rose and his colleagues assessed 597 Finnish twins (300 male, 297 female) at age 18 with RAPI, and later interviewed them at age 25 with the Semi-Structured Assessment of the Genetics of Alcoholism to assess alcohol abuse and dependence diagnoses.

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The Local (Sweden) - Swedes drink less alcohol: study

Swedish average alcohol consumption declined in 2009, in comparison with 2008, but remains high in a historical perspective, a new report published on Friday showed.

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The Copenhagen Post (Denmark) - Parties with drugs and booze finish in emergency room

The number of emergency room admittances due to poisoning and overdoses from drugs like cocaine and amphetamines has doubled in ten years, reports Berlingske newspaper.

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ERR (Estonia) - Estonia Ranked Sixth in World for Drinking

Drinkers throughout Estonia may be raising their glasses in a self-pitying toast this weekend - a freshly-published report by the World Health Organization has ranked the nation sixth in the world for alcohol consumption.

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The Baltic Course (Lithuania) - Kubilius: authorities should not assume responsibility for the offences of their subordinates in free time

The Lithuanians should realise that driving under influence is a conscious preparation for a crime, thus, there is no difference whether it is done by a builder, police officer or a representative of any other profession, Prime Minister Andrius Kubilius says.

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WebMD (USA) - Many Kids Get Alcohol From Family Members

Almost 6% of young people between the ages of 12 and 14 drank alcohol in the past month, and close to half of them got it at home or from family members, a study shows.

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Telegraph.co.uk (UK) - Prof Ian Gilmore: UK faces rising alcohol related deaths

In the paper published on Monday, Prof Ian Gilmore, a former president of the Royal College of Physicians, along with colleagues at the University of Southampton and Queen's Medical Centre, University Hospital, Nottingham, claims that up to 30,000 people a year die of liver disease in England and Wales each year.

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Reuters - Alcohol linked to complications after joint surgery

The more people drink before having a hip or knee replaced, the higher their risk for complications

right after the surgery, a new study suggests.

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Stuff.co.nz (New Zealand) - Youth drinking cheap spirits a 'real problem'

It is not surprising that the amount of potent spirits is on the rise, with young people the likely consumers, an Otago University professor says.

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Salt Lake Tribune (USA) - Mandatory signs going up to alert pregnant women to alcohol risks

Pediatrician Susan Lewin was horrified to overhear a pregnant woman telling friends that she knew the dangers alcohol posed for her unborn child, but she was OK because she was only drinking beer.

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RIA Novosti (Moldova) - WHO names Moldova world's leader in alcohol consumption

Moldovans consume more alcohol per head than citizens of any other country, the World Health Organization (WHO) said in its report.

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Adnkronos International English (Italy) - Italy: Alcohol sales banned for Tunisian illegal immigrants

None of the thousands of illegal immigrants who have reached the tiny Italian island of Lampedusa will be able to celebrate their arrival with a drink, according to a new law.

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Daily Mail (UK) - Children as young as FIVE are being treated in hospital for alcohol abuse

A hospital trust has revealed it treated four children aged just five for drinking dangerous levels of alcohol.

Read more

 

 

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Editorial - Minimum alcohol pricing in England

Since the BMJ last highlighted the health harms of alcohol, there has been a welcome acknowledgement by government in England that cheap drink is an important factor in driving these harms. Ministers recently revealed plans to set a minimum price by imposing a ban on selling alcohol for less than the combined tax and duty paid on it. This would result in minimum prices of £0.21 (€0.25; $0.34) per unit of beer and £0.28 per unit of spirits, which equate to £0.38 for a can of weak lager, £2.03 for a bottle of wine, and £10.71 for a litre of spirits. Although, in principle, this is an important step, in practice the price floor has been set so low that it will have no effect whatsoever on the health of the nation . 

On the positive side, for the first time recent statistics suggest an overall reduction in harm associated with alcohol, with a 6% decline in alcohol related deaths and 6% reduction in consumption in 2009. 2 3 However, these are data from a single year on a background of marked increases in consumption and … 

Request Reprint E-Mail:   igilmore@liverpool.ac.uk

 

Urinary Ethyl Glucuronide and Ethyl Sulfate Testing for Detection of Recent Drinking in an Outpatient Treatment Program for Alcohol and Drug Dependence

This study determined the information about recent alcohol consumption obtained when urinary ethyl glucuronide (EtG) and ethyl sulfate (EtS) were introduced as a routine test in outpatient treatment programs for alcohol and drug dependence.

 

Outpatients (21 men and 3 women) undergoing treatment for alcohol (N = 8) or drug (N = 10) dependence, or in methadone maintenance therapy (N = 6) volunteered for the study. Twice weekly in connection with return visits to the unit, patients gave a urine sample and completed an anonymous single-question form about any drinking in the past 3 days. Urinary EtG and EtS were determined by liquid chromatography-mass spectrometry.

   

Totally, 214 urine samples (4–14 samples/patient; mean 9) and 211 self-reports were collected over a 2–8-week period. Altogether 26% of the urine samples from 12 of 24 patients tested positive for EtG (0.5–434 mg/l) and/or EtS (0.1–87 mg/l). In one patient, samples were only positive for EtS. In 21% of 211 self-reports from 11 patients, alcohol ingestion was admitted in the past 3 days. In 87% of the 211 complete cases, the self-report information agreed with the EtG/EtS results (i.e. true positives and true negatives). The highest frequency of drinking was seen in the drug-dependent group with only 20% of the patients being abstinent according to both measures. This compares with 62.5% abstinence in the alcohol-dependent group and 50% in the methadone maintenance therapy group.

Although based on a limited number of subjects, these results indicated that urinary EtG and EtS testing is a useful tool for objective identification of recent drinking in outpatients treated for alcohol and drug dependence. 

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Request Reprint E-Mail:  helen.dahl@karolinska.se

  

The Pricing Policy of Alcohol Monopolies: the Case of Sweden and Quebec ERASMUS

Alcohol is the reason behind a lot of valuable social interaction, but on the other side also causes a lot of harm.  This harm is created by externalities that people do not take into account when they drink. 

A good example of this is drunk-driving. One policy measure to tackle the problem is to restrict the freedom in the market. One such way is for the government to take control over the sale and distribution of alcoholic beverages. Such alcohol monopolies exist for example in parts of North America and Scandinavia. 

This thesis is designed to take a closer look at the pricing policy of such alcohol monopolies to see how these companies try to reach the goals they have. To do this the pricing policies of the alcohol monopolies in Sweden and Quebec are analyzed. 

Generally speaking North American alcohol monopolies are found to have tax collection as a main goal, while Scandinavian alcohol monopolies are mainly concerned about improving upon the public health situation. 

Because this difference and other factors, alcohol monopolies cannot be judged as a whole. However, a very general conclusion is that alcohol monopolies have a higher price for their products than other free retailers and that especially cheap spirits are relatively expensive in Sweden, which supports their health goals.

Furthermore, the pricing in Quebec raises the question whether this alcohol monopoly acts different than a privately-owned company would.





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Projections of alcohol deaths—a wake-up call

According to WHO, morbidity attributable to alcohol in countries with an established market economy (10·3% of disability adjusted life years) comes second only to that of tobacco (11·7%). Liver disease is responsible for 70% of the directly recorded mortality from alcohol, and perhaps a quarter of the total attributable mortality; the true total is uncertain but is probably between 18 000 and 30 000 per year in England and Wales. Alcohol causes around 80% of deaths from liver disease, and trends in liver mortality reflect trends in overall alcohol-related harm; liver death rates are a measure of the damage caused to society by alcohol, and a good measure for the success of alcohol policy.

 

Few can doubt that there is a particular problem in the UK. Compared with the UK, the Netherlands, Sweden, Norway, Australia, and New Zealand have similar cultures, genetic backgrounds and drinking cultures, and in 1986 they had broadly similar liver death rates. The most recent WHO liver death rates for these countries range from 2·6 per 100 000 (New Zealand) to 5·3 (Sweden); whereas in the UK liver death rates more than doubled from 4·9 to 11·4 since 1986.3 A liver death rate of around 4 per 100 000 is therefore a reasonable and achievable aspiration for an outcomes-based alcohol policy.

We projected outcomes in terms of liver death rates according to four different policy scenarios. With the black scenario, liver deaths increase at a similar rate to that seen in the UK as a whole over the past 10 years. A green scenario would see a reduction in UK death rates with the same gradient as that for France—the country with the most profound reductions in mortality. The intermediate scenarios, amber and red, would see liver deaths reduce along the gradients followed by the rates in Italy or in the European Union as a whole.  > > > >   Read More

A new AMPHORA: an introduction to the project Alcohol Measures for Public Health Research Alliance

The AMPHORA Project is a 4 years project funded by the 7th Framework Programme of the European Commission which aims to contribute with new evidence on scarcely explored or unexplored areas of alcohol consumption and alcohol-related harm in Europe. 

In this introductory article we describe the background of the Project and its main features. 

The research areas covered by AMPHORA are wide and diverse. 

Some of the most relevant are: an update on European epidemiological data; the definition of standard common indicators of alcohol consumption and harm; the measurement of the strength of alcohol policies; the study of contextual determinants of alcohol consumption, the analysis of the impact of marketing on youth; the availability of treatments at a European level; and two areas of harm reduction (contamination of illegal or surrogate alcohols and the reduction of harm in drinking venues).

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Request Reprint E-Mail:   tgual@clinic.ub.es 

Science and alcohol policy: a case study of the EU Strategy on Alcohol

To describe the extent to which the content of the European Commission's Communication on alcohol reflects public health-based scientific evidence.

Although the Communication acknowledges and supports existing interventions which have high evidence for effectiveness, such as enforcing blood alcohol concentration (BAC) limits for drivers, it extensively promotes other interventions which have been shown to be ineffective; for example, recommending education and persuasion strategies as a measure across all its five priority areas.

Measures to influence price are mentioned only once in relation to sales in drinking venues limiting two-for-one drinks offers. Measures to control physical availability are mentioned infrequently.

The Communication reflects the science, in that it acknowledges the significance of alcohol as a social and health determinant in Europe. However, it places more emphasis on policy actions with less evidence for effectiveness than on those with strong evidence.

It also focuses its efforts more on mapping member state actions and coordinating knowledge exchange than on providing concrete recommendations for action or developing Europe-wide policy measures. This may be a compromise between the rights of Member States to develop national policy and legislation and the obligation of the European Union as a collaborative body to protect health.

Furthermore, it has been suggested that the European Union's roots as a trading block emphasizes collaboration with industry stakeholders and this influences the ability to prioritize health over trade considerations.




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Request Reprint E-Mail:  peteranderson.mail@gmail.com 

Reflections on science and the governance of alcohol policy

To consider, briefly, science's role in informing alcohol policy, and how science could help reframe the present governance of alcohol policy.

Expression of the two project coordinators’ reflections based on discussions during project meetings of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project.

Three endeavours are considered important for science's role in informing alcohol policy: modelling studies that help predict the outcomes of differing policy approaches; studying the impact of live policy changes as a powerful set of natural experiments; and, improved study of the impact of integrated, coordinated and joined up alcohol policies, as opposed to the impact of individual alcohol policy measures.

Three areas where science can contribute to strengthened alcohol policy governance include: analysis of different governance architectures that might promote joined-up actions between different sectors; the design of better metrics that measure the impact of public and private sector actions on health; and, by identifying incentives that help consumers make choices on the use of alcohol that improve health.

The impact of science on better alcohol policy governance can only happen if there is more and better dialogue between scientists and those who design alcohol policy.



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Request Reprint E-Mail:   peteranderson.mail@gmail.com 

Indicators of alcohol consumption and attributable harm for monitoring and surveillance in European Union countries

Alcohol is a major risk factor for burden of disease and injury in Europe, and contributes markedly to between region differences in life expectancy. Monitoring and surveillance systems have shown to be a key factor in implementing effective policies. 

The aim of this paper is to propose a system of indicators for alcohol consumption and attributable harm which can be used as an over-time monitoring tool at the country level as well as for comparisons between countries. 

A systematic research in electronic data bases was conducted but most of the information was derived from ongoing international efforts to establish alcohol monitoring and surveillance systems.

Adult per capita alcohol consumption, prevalence of abstention, and frequency of drinking more than 60g pure alcohol in one occasion are proposed as a minimal set of alcohol exposure indicators, which can quickly be implemented in all EU countries. 

With respect to health harm indicators, the best minimal choice which can be implemented quickly in all countries of the EU would be alcohol-attributable years of life lost due to premature death. 

In addition, country specific indicators could be added, when alcohol places specific burden on specific diseases.

National and European Union-wide monitoring systems for alcohol exposure and attributable harm to inform public health-related policy decisions could be implemented easily. The establishement of such monitoring systems would follow the recent World Assembly resolution for a global strategy to reduce alcohol-related harm.


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Request Reprint E-Mail:  jtrehm@aol.com   

Epidemiology and alcohol policy in Europe

 

To describe three aspects of the epidemiology of alcohol-attributable deaths in Europe, dose, demography and place, and to illustrate how such knowledge can better be used to inform alcohol policy formulation and implementation.

The absolute risk of dying from an alcohol-attributable disease and injury (accounting for a protective effect for ischaemic diseases) increases with increasing daily alcohol consumption beyond 10g alcohol per day, the first data point. 

Over 2/3 of all alcohol-attributable deaths occurring amongst the 20–64 year old population of the European Union (minus Cyprus and Malta) occur in the 45–64 year olds. 

About 25% of the difference in life expectancy between western and eastern Europe for men aged 20–64 years in 2002 can be attributed to alcohol, largely, but not exclusively, as a result of differences in heavy episodic drinking patterns.

Any reduction in the dose of alcohol consumed, at least down to 10g/day, will reduce the annual and lifetime risk of an alcohol-related death. 

There is a need for alcohol policy to focus on measures in reducing alcohol consumption, throughout middle age, with immediacy of impact. Policy should strive to reduce alcohol-related health inequalities, with the specific recommendations for policy depending on the cost-effectiveness of interventions related to the epidemiological profile of the country or region under consideration.

Fortunately, there are evidence-based policy options that reduce the amount of alcohol consumed and many alcohol-related harms with immediate effect, that reduce the risk of an alcohol-related death in middle age, and that would help to close the health gap between eastern and western Europe.

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Request Reprint E-Mail: trehm@aol.com 

Do infrastructures impact on alcohol policy making?

The importance of building and strengthening effective infrastructures within the field of public health has increasingly been recognized. A wide variety of actors and structures can be identified for alcohol policy, including systems for policy development, monitoring, research and work-force development, but too little is known about the complex systems of infrastructure available across European countries and their impact on alcohol policy.

This study is part of the Alcohol Measures for Public Health Research Alliance (AMPHORA) project, and aims to map existing infrastructures, but also to examine the relationship between infrastructures and alcohol policy change.

A survey of alcohol policy infrastructure and infrastructure needs at the national level will be conducted using an updated and adapted questionnaire based on the Health Promotion (HP) Source Project tool. Case studies involving in-depth interviews will be conducted for a selection of countries. Data will be analysed descriptively, mapping alcohol policy infrastructure and identifying needs to reveal any relationship between infrastructure and alcohol policy.

This study can contribute to building the scientific knowledge base on this topic as well to policy development. First, the Alcohol Measures for Public Health Research Alliance will produce an extended map of alcohol policy infrastructures in a wide range of European countries. Secondly, the Alcohol Measures for Public Health Research Alliance will foster a better understanding and expand the knowledge base on the role and influence of infrastructure on alcohol policy and practice. 

Recommendations deriving from this study will identify the need for better utilization of existing infrastructures and for the development of new infrastructures, necessary to develop and implement effective alcohol policy from a public health perspective.

 
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Request Reprint E-Mail:  claudia.konig@psyhp.uib.no 

Environmental factors in drinking venues and alcohol-related harm: the evidence base for European intervention

Reducing alcohol-related harm in young people is a major priority across Europe. Much alcohol use and associated harm in young people occurs in public drinking environments. 

This review aims to identity environmental factors in drinking establishements that are associated with increased alcohol consumption and associated harm and to understand the extent of study in this area across Europe.

A systematic literature search identified studies that had explored associations between physical, staffing and social factors in drinking environments and increased alcohol use or alcohol-related harm.

Fifty-three papers were identified, covering 34 studies implemented in nine countries. Most studies had been implemented in non-European countries and many had collected data more than a decade prior to the review. The majority had used observational research techniques. Throughout the studies, a wide range of physical, staffing and social factors had been associated with higher levels of alcohol use and related harm in drinking environments. Factors that appeared particularly important in contributing to alcohol-related problems included a permissive environment, cheap alcohol availability, poor cleanliness, crowding, loud music, a focus on dancing and poor staff practice. However, findings were not always consistent across studies.

Drinking establishments, their management and the behaviours of the young people who use them vary widely across Europe. While international research shows that environmental factors in drinking settings can have an important influence on alcohol-related harm, there is currently a scarcity of knowledge on the relevance and impacts of such factors in modern European settings. Developing this knowledge will support the implementation of strategies to create drinking environments in Europe that are less conducive to risky drinking and alcohol-related harm.


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Request Reprint E-Mail: k.e.hughes@ljmu.ac.uk    

STEPS Outpatient Program Improves Alcohol Treatment Outcomes in Ukrainian Regional Narcologic Dispensary

Alcohol abuse is of epidemic proportions in Ukraine, including the Vinnitsya Oblast (county), a midsized urban area in central Ukraine. Care for persons with alcohol disorders, provided in regional narcologic dispensaries, consists primarily of inpatient medical detoxification and short-term psychologic care. Structured outpatient and aftercare programs have not been investigated systematically for potential widespread dissemination.

This study investigated the feasibility and efficacy of adding a 12 step-based outpatient and aftercare program (STEPS) to inpatient Regional Narcological Dispensary (RND) treatment using a randomized controlled design. 

Persons with alcohol disorders (N=68) were recruited from the Vinnitsya RND. After approximately 30 days of inpatient RND treatment, controls were discharged whereas experimental participants voluntarily entered 2 months of STEPS outpatient day treatment, plus 1 month of aftercare and 1 month of sponsors' group.

Both RND and STEPS produced positive alcohol-related outcomes at 2 months that were sustained at 4 months. 

However, adding STEPS resulted in outcomes superior to RND alone. At 4-month follow-up, STEPS reduced average total drinking days in the last 30 days from 18.2 to 2.5 days; average number of drinks per drinking day from 13.6 to 2.9 drinks; and heavy drinking days from 7.7 to 0.4 days. 

Participation in STEPS also was associated with fewer negative alcohol-related consequences, less depression, and better signs of mental health as compared with RND treatment alone.

Adding a 12 step-based outpatient and aftercare intervention to standard inpatient alcohol detoxification was feasible and efficacious for alcohol-dependent patients in a midsized Ukrainian city.


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Request Reprint E-Mail: jschum@uab.edu 

Guardian attacks Government alcohol policy claiming responsibilty deal 'on the rocks'

The Guardian last week published a series of articles questioning the Government's alcohol policy and the state of the responsibilty deal. In the article 'Alcohol policy in tatters as health experts revolt', the Guardian claimed health members planned to walk away, angry at their limited influence in favour of industry agendas. It reports "The so-called responsibility deal will do the "bare minimum", such as putting information on beer mats", whilst issues such as marketing and promotion were said to be "outside the parameters of the discussions".

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Selected risk factors associated with pulmonary tuberculosis among Saharia tribe of Madhya Pradesh, central India

Tuberculosis (TB) is a major public health problem among the Saharia, a marginalized tribal group in Madhya Pradesh state, central India. However, there is no information on the risk factors associated with the development of TB disease in this community. 

A cross-sectional TB prevalence survey was conducted among the Saharia residing in Sheopur district of Madhya Pradesh. Information on tobacco smoking and alcohol consumption was collected from all the individuals. 

Persons aged ≥45 years, males, smokers and alcohol consumers had higher risks of developing TB disease. 

There is an urgent need to develop and implement culturally appropriate awareness raising activities to target smoking and alcohol consumption to support the efforts to control TB in this community. 

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Request Reprint E-Mail:  drvgrao@rediffmail.com

 

Surviving Drug Addiction: The Effect of Treatment and Abstinence on Mortality

We examined the relationships between substance abuse treatment, abstinence, and mortality in a sample of individuals entering treatment. We also estimated overall mortality rates and the extent to which they varied according to demographic, clinical severity, and treatment variables.

We used data from a 9-year longitudinal study of 1326 adults entering substance abuse treatment on the west side of Chicago, of whom 131 died (11.0 per 1000 person-years). Baseline predictors, initial and long-term treatment response, and substance use patterns were used to predict mortality rates and time to mortality.

Older age, health problems, and substance use were associated with an increased risk of mortality, and higher percentages of time abstinent and longer durations of continuous abstinence were associated with a reduced risk of mortality. 

Treatment readmission in the first 6 months after baseline was related to an increased likelihood of abstinence, whereas readmission after 6 months was related to a decreased likelihood of abstinence, suggesting that treatment timing is significant.

Our findings suggest the need to shift the addiction treatment field from an acute care model to a chronic disease management paradigm and the need for more aggressive screening, intervention, and addiction management over time. 

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Request Reprint E-Mail:  cscott@chestnut.org .

TLRs, Alcohol, HCV, and Tumorigenesis

Chronic liver damage caused by viral infection, alcohol, or obesity can result in increased risk for hepatocellular carcinoma (HCC). 

Ample epidemiological evidence suggests that there is a strong synergism between hepatitis C virus (HCV) and alcoholic liver diseases (ALD). The Toll-like receptor (TLR) signaling pathway is upregulated in chronic liver diseases. 

Alcoholism is associated with endotoxemia that stimulates expression of proinflammatory cytokine expression and inflammation in the liver and fat tissues. 

Recent studies of HCC have centered on cancer-initiating stem cell (CSC), including detection of CSC in cancer, identification of CSC markers, and isolation of CSC from human HCC cell lines. 

Synergism between alcohol and HCV may lead to liver tumorigenesis through TLR signaling.

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Alcohol intoxication and memory for events: A snapshot of alcohol myopia in a real-world drinking scenario

Alcohol typically has a detrimental impact on memory across a variety of encoding and retrieval conditions (e.g., Mintzer, 2007; Ray & Bates, 2006). 

No research has addressed alcohol's effect on memory for lengthy and interactive events and little has tested alcohol's effect on free recall. 

In this study 94 participants were randomly assigned to alcohol, placebo, or control groups and consumed drinks in a bar-lab setting while interacting with a “bartender”. Immediately afterwards all participants freely recalled the bar interaction. 

Consistent with alcohol myopia theory, intoxicated participants only differed from placebo and control groups when recalling peripheral information. 

Expanding on the original hypervigilance hypothesis, placebo participants showed more conservative reporting behaviour than the alcohol or control groups by providing more uncertain and “don't know” responses. 

Thus, alcohol intoxication had confined effects on memory for events, supporting and extending current theories. 

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Request Reprint E-Mail:   schreibe@fiu.edu  

Alcohol Treatment and Cognitive-Behavioral Therapy: Enhancing Effectiveness by Incorporating Spirituality and Religion

Cognitive-behavioral therapy (CBT) is an effective modality for the treatment of alcoholism. Given widespread interest in incorporating spirituality into professional treatment, this article orients practitioners to spiritually modified CBT, an approach that may enhance outcomes with some spiritually motivated clients.

More specifically, by integrating clients' spiritual beliefs and practices into treatment, this modality may speed recovery, enhance treatment compliance, prevent relapse, and reduce treatment disparities by providing more culturally congruent services. 

The process of constructing spiritually modified CBT self-statements is described and illustrated, and suggestions are provided for working with client spirituality in an ethical manner.

The article concludes by emphasizing the importance of this approach in light of the growing spiritual diversity that characterizes contemporary society. 

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Request Reprint E-Mail: davidhodge@asu.edu    

Preoperative Alcohol Screening Scores: Association with Complications in Men Undergoing Total Joint Arthroplasty

The risks associated with preoperative alcohol misuse by patients before undergoing total joint arthroplasty are not well known, yet alcohol misuse by surgical patients is common and has been linked to an increased risk of complications after other procedures.  

The purpose of this study was to evaluate the association between a patient's preoperative standardized alcohol-misuse screening score and his or her risk of complications after total joint arthroplasty.

The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) is an alcohol-misuse screening instrument administered annually to all patients receiving care through the Veterans Health Administration (VHA). The scores range from 0 to 12, with higher scores signifying greater and more frequent consumption. In a study of 185 male patients who had alcohol screening scores recorded in the year preceding surgery at a Palo Alto VHA facility, and who reported at least some alcohol use, we estimated the association between preoperative screening scores and the number of surgical complications in an age and comorbidity-adjusted regression analyses.

Of the 185 patients reporting at least some drinking in the year before their total joint replacement, 17% (thirty-two) had an alcohol screening score suggestive of alcohol misuse; six of those thirty-two patients had one complication, four had two complications, and two had three complications. The screening scores were significantly related to the number of complications in a negative binomial regression analysis (exp[β] = 1.29, p = 0.035), which demonstrated a 29% increase in the expected number of complications with every additional point of the screening score above 1, although with wide confidence intervals for the higher scores.

Complications following total joint arthroplasty were significantly related to alcohol misuse in this group of male patients treated at a VHA facility. The AUDIT-C has three simple questions that can be incorporated into a preoperative evaluation and can alert the treatment team to patients with increased postoperative risk. Preoperative screening for alcohol misuse, and perhaps preoperative counseling or referral to treatment for heavy drinkers, may be indicated for patients who are to undergo total joint arthroplasty.


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Request Reprint E-Mail:   Alexander.Harris2@va.gov
  

Ethanol Influences on Bax Translocation, Mitochondrial Membrane Potential, and Reactive Oxygen Species Generation Are Modulated by Vitamin E and Brain-Derived Neurotrophic Factor

This study investigated ethanol influences on intracellular events that predispose developing neurons toward apoptosis and the capacity of the antioxidant α-tocopherol (vitamin E) and the neurotrophin brain-derived neurotrophic factor (BDNF) to modulate these effects. Assessments were made of the following: (i) ethanol-induced translocation of the pro-apoptotic Bax protein to the mitochondrial membrane, a key upstream event in the initiation of apoptotic cell death; (ii) disruption of the mitochondrial membrane potential (MMP) as a result of ethanol exposure, an important process in triggering the apoptotic cascade; and (iii) generation of damaging reactive oxygen species (ROS) as a function of ethanol exposure.

These interactions were investigated in cultured postnatal day 8 neonatal rat cerebellar granule cells, a population vulnerable to developmental ethanol exposure in vivo and in vitro. Bax mitochondrial translocation was analyzed via subcellular fractionation followed by Western blot, and mitochondrial membrane integrity was determined using the lipophilic dye, JC-1, that exhibits potential-dependent accumulation in the mitochondrial membrane as a function of the MMP.

Brief ethanol exposure in these preparations precipitated Bax translocation, but both vitamin E and BDNF reduced this effect to control levels. Ethanol treatment also resulted in a disturbance of the MMP, and this effect was blunted by the antioxidant and the neurotrophin. ROS generation was enhanced by a short ethanol exposure in these cells, but the production of these harmful free radicals was diminished to control levels by cotreatment with either vitamin E or BDNF.

These results indicate that both antioxidants and neurotrophic factors have the potential to ameliorate ethanol neurotoxicity and suggest possible interventions that could be implemented in preventing or lessening the severity of the damaging effects of ethanol in the developing central nervous system seen in the fetal alcohol syndrome (FAS).


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Request Reprint E-Mail:  heaton@mbi.ufl.edu    

Changes in Heart Rate Variability Associated With Acute Alcohol Consumption: Current Knowledge and Implications for Practice and Research

Alcohol consumption is associated with a broad array of physiologic and behavioral effects including changes in heart rate

However, the physiologic mechanisms of alcohol effects and the reasons for individual differences in the cardiac response remain unknown. 

Measuring changes in resting heart rate (measured as beats/min) has not been found to be as sensitive to alcohol’s effects as changes in heart rate variability (HRV). 

HRV is defined as fluctuations in interbeat interval length which reflect the heart’s response to extracardiac factors that affect heart rate. HRV allows simultaneous assessment of both sympathetic and parasympathetic activity and the interplay between them. 

Increased HRV has been associated with exercise and aerobic fitness, while decreased HRV has been associated with aging, chronic stress, and a wide variety of medical and psychiatric disorders. 

Decreased HRV has predictive value for mortality in general population samples and patients with myocardial infarction and used as an indicator of altered autonomic function. 

A significant inverse correlation was found between HRV and both the severity of depression and the duration of the depressive episode. 

HRV analysis provides insights into mechanisms of autonomic regulation and is extensively used to clarify relationships between depression and cardiovascular disease. 

This article will review the methodology of HRV measurements and contemporary knowledge about effects of acute alcohol consumption on HRV. 

Potential implications of this research include HRV response to alcohol that could serve as a marker for susceptibility to alcoholism. At present however there is almost no research data supporting this hypothesis.

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-karpyak.victor@mayo.edu    

Alcohol, Smoking, and Drug Use Among Inuit Women of Childbearing Age During Pregnancy and the Risk to Children

Alcohol consumption during pregnancy, a known teratogen often associated with drug use and smoking is a well-known public health concern.

This study provides prevalence data for alcohol, smoking, and illicit drug use before, during, and after pregnancy among Inuit. Factors associated with alcohol use are also identified.

Two hundred and eight Inuit women from Arctic Quebec were interviewed at mid-pregnancy, and at 1 and 11 months postpartum to provide descriptive data on smoking, alcohol, and drug use during pregnancy, and the year before and after pregnancy. Sociodemographic and family characteristics potentially associated with alcohol use were documented
.

Ninety-two percent of the women reported smoking and 61% reported drinking during pregnancy. Episodes of binging during pregnancy were reported by 62% of the alcohol users, which correspond to 38% of pregnant women. Thirty-six percent of the participants reported using marijuana during pregnancy. Alcohol use and binge drinking during pregnancy were more likely to be reported by women who lived in less crowded houses, had a better knowledge of a second language, drank alcohol more often and in larger amounts prior to pregnancy, and used illicit drugs. Binge drinkers were more likely to be single women and to have had fewer previous pregnancies. Postpartum distress and violence were more likely to be experienced by women who used alcohol during pregnancy. Binge drinking during pregnancy was best predicted by drinking habits before pregnancy, maternal symptoms of depression, the use of illicit drugs during pregnancy, and the number of young children living with the mother.

These results confirm that alcohol is a major risk factor to maternal and child health in this population, underscoring the need for culturally relevant and effective prevention programs.


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Subcortical Volumes in Long-Term Abstinent Alcoholics: Associations With Psychiatric Comorbidity

Research in chronic alcoholics on memory, decision-making, learning, stress, and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated.
 

Structural MRI was used to compare volumes of 8 subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) in 24 female and 28 male LTAA (mean abstinence = 6.3 years, mean age = 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age = 45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC.

We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with versus without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption.

Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with the recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.


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