Cognitive predictors of problem drinking and AUDIT scores among college students

Evidence from a number of substance abuse populations suggests that substance abuse is associated with a cluster of differences in cognitive processes. However, investigations of this kind in non-clinical samples are relatively few. 

The present study examined the ability of alcohol-attentional bias (an alcohol Stroop task), impulsive decision-making (a delay discounting task), and impaired inhibitory control (a GO–NOGO task) to: (a) discriminate problem from non-problem drinkers among a sample of college students; (b) predict scores on the Alcohol Use Disorders Identification Test (AUDIT; a measure of alcohol consumption, drinking behaviour, and alcohol-related problems) across all of the student drinkers; (c) predict AUDIT scores within the subgroups of problem and non-problem student drinkers.

In logistic regression controlling for gender and age, student drinkers with elevated alcohol-attentional bias and impulsive decision-making were over twice as likely to be a problem than a non-problem drinker. 

Multiple regression analysis of the entire sample revealed that all three cognitive measures were significant predictors of AUDIT scores after gender and age had been controlled; the cognitive variables together accounted for 48% of the variance. 

Moreover, subsequent multiple regressions revealed that impaired inhibitory control was the only significant predictor of AUDIT scores for the group of non-problem drinkers, and alcohol-attentional bias and impulsive decision-making were the only significant predictors of AUDIT scores for the group of problem drinkers. 

Finally, both impulsive decision-making and impaired inhibitory control were significantly correlated with alcohol-attentional

bias across the whole sample. Implications are discussed relating to the development of problematic drinking.

 

 

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Request Reprint E-Mail:  Hugh.Garavan@tcd.ie    

Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence.

Analyses were done for the subsample of lifetime nicotine (n = 15,918), alcohol (n = 28,907), cannabis (n = 7389) or cocaine (n = 2259) users who participated in the first and second wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence.

The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed.

Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.


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Request Reprint E-Mail:  bgrant@willco.niaaa.nih.gov 

Press Release - U.S. Colleges and Universities Join Forces to Address High-Risk Drinking

Colleges and universities from across the country are joining forces to address high-risk drinking on American campuses. This unprecedented group initiative—the Learning Collaborative on High-Risk Drinking—will use comprehensive evaluation and measurement techniques to identify and implement the most effective ways to confront this persistent problem and lessen the harm it causes.   > > > >  Read More

Press Release - One more step towards reaching Millennium Development Goals

The First Global Ministerial Conference on Healthy Lifestyles and Non-Communicable Disease (NCDs) Control was held in Moscow in the end of April. On this global platform India and the world community achieved a big success for the future fight against NCDs. It is thanks to the strong efforts of the Indian delegation that from now on Mental Disorders are included in the list of NCDs .
 
“The members of IOGT International and surely millions of affected people and their families all over the world congratulate the WHO for this resolution and express our special thanks to the stern efforts of the Indian delegation. NCDs are a major threat to global health and societal development, killing three out of five humans in the world,” says Mr. Sven-Olov Carlsson, President of IOGT International. “We need as comprehensive a strategy as possible to tackle this problem and the Indian efforts truly contributed to this.”  > > > >   Read More

Ethanol modulation of gene networks: Implications for alcoholism

Alcoholism is a complex disease caused by a confluence of environmental and genetic factors influencing multiple brain pathways to produce a variety of behavioral sequelae, including addiction. 

Genetic factors contribute to over 50% of the risk for alcoholism and recent evidence points to a large number of genes with small effect sizes as the likely molecular basis for this disease. 

Recent progress in genomics (microarrays or RNA-Seq) and genetics has led to the identification of a large number of potential candidate genes influencing ethanol behaviors or alcoholism itself. 

To organize this complex information, investigators have begun to focus on the contribution of gene networks, rather than individual genes, for various ethanol-induced behaviors in animal models or behavioral endophenotypes comprising alcoholism. 

This chapter reviews some of the methods used for constructing gene networks from genomic data and some of the recent progress made in applying such approaches to the study of the neurobiology of ethanol. 

We show that rapid technology development in gathering genomic data, together with sophisticated experimental design and a growing collection of sophisticated tools are producing novel insights for understanding the molecular basis of alcoholism and that such approaches promise new opportunities for therapeutic development.


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Request Reprint E-Mail:    mfmiles@vcu.edu 

A Quantitative-Trait Genome-Wide Association Study of Alcoholism Risk in the Community: Findings and Implications

Given moderately strong genetic contributions to variation in alcoholism and heaviness of drinking (50% to 60% heritability) with high correlation of genetic influences, we have conducted a quantitative trait genome-wide association study (GWAS) for phenotypes related to alcohol use and dependence.

Diagnostic interview and blood/buccal samples were obtained from sibships ascertained through the Australian Twin Registry. Genome-wide single nucleotide polymorphism (SNP) genotyping was performed with 8754 individuals (2062 alcohol-dependent cases) selected for informativeness for alcohol use disorder and associated quantitative traits. Family-based association tests were performed for alcohol dependence, dependence factor score, and heaviness of drinking factor score, with confirmatory case-population control comparisons using an unassessed population control series of 3393 Australians with genome-wide SNP data.

No findings reached genome-wide significance (p = 8.4 × 10−8 for this study), with lowest p value for primary phenotypes of 1.2 × 10−7. Convergent findings for quantitative consumption and diagnostic and quantitative dependence measures suggest possible roles for a transmembrane protein gene (TMEM108) and for ANKS1A. The major finding, however, was small effect sizes estimated for individual SNPs, suggesting that hundreds of genetic variants make modest contributions (1/4% of variance or less) to alcohol dependence risk.

We conclude that 1) meta-analyses of consumption data may contribute usefully to gene discovery; 2) translation of human alcoholism GWAS results to drug discovery or clinically useful prediction of risk will be challenging; and 3) through accumulation across studies, GWAS data may become valuable for improved genetic risk differentiation in research in biological psychiatry (e.g., prospective high-risk or resilience studies).

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Request Reprint E-Mail:  aheath@wustl.edu 

The AVPR1A Gene and Substance Use Disorders: Association, Replication, and Functional Evidence

The liability to addiction has been shown to be highly genetically correlated across drug classes, suggesting nondrug-specific mechanisms.

In 757 subjects, we performed association analysis between 1536 single nucleotide polymorphisms (SNPs) in 106 candidate genes and a drug use disorder diagnosis (DUD).

Associations (p ≤ .0008) were detected with three SNPs in the arginine vasopressin 1A receptor gene, AVPR1A, with a gene-wise p value of 3 × 10⁻⁵. Bioinformatic evidence points to a role for rs11174811 (microRNA binding site disruption) in AVPR1A function. Based on literature implicating AVPR1A in social bonding, we tested spousal as a mediator of the association of rs11174811 with the DUD. Spousal satisfaction was significantly associated with DUD in males (p < .0001). The functional AVPR1A SNP, rs11174811, was associated with spousal satisfaction in males (p = .007). Spousal satisfaction was a significant mediator of the relationship between rs11174811 and DUD. We also present replication of the association in males between rs11174811 and substance use in one clinically ascertained (n = 1399) and one epidemiologic (n = 2231). The direction of the association is consistent across the clinically-ascertained samples but reversed in the epidemiologic sample. Lastly, we found a significant impact of rs11174811 genotype on AVPR1A expression in a postmortem brain sample.

The findings of this study call for expansion of research into the role of the arginine vasopressin and other neuropeptide system variation in DUD liability.



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Request Reprint E-Mail:   bmaher@jhsph.edu  

Parenting and Trajectories of Children's Maladaptive Behaviors: A 12-Year Prospective Community Study

This study investigated how parenting accounted for interindividual differences in developmental trajectories of different child behaviors across childhood and adolescence.

In a cohort sequential community sample of 1,049 children, latent class growth analysis was applied to three parent-reported dimensions (monitoring, positive parenting, inconsistent discipline) across 12 annual assessments (ages 6-18). 

Four longitudinal parenting styles (authoritative, authoritarian, indulgent, uninvolved) were differentiated on the basis of levels and rates of change in the constituent parenting dimensions. 

Multigroup analyses demonstrated that these parenting styles were differentially related to changes in parent- and child-reported measures of children's alcohol and cigarette use, antisocial behavior, and internalizing symptoms, with the authoritative parenting class being related to the most optimal long-term development.

 

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Request Reprint E-Mail:   Koen.Luyckx@psy.kuleuven.be.  

Millions of NCD deaths can be prevented

In 20081, 36.1 million people died from conditions such as heart disease, strokes, chronic lung diseases, cancers and diabetes. Nearly 80% of these deaths occurred in low- and middle-income countries. The Global Status Report on Noncommunicable Diseases 2010 is the first report on the worldwide epidemic of cardiovascular diseases, cancer, diabetes and chronic respiratory diseases, along with their risk factors and determinants.

"The rise of chronic noncommunicable diseases presents an enormous challenge," says WHO Director-General Dr Margaret Chan, who launched the report during the WHO Global Forum on addressing the challenge of noncommunicable diseases, being held today in Moscow, the Russian Federation. > > > >  Read More

The Moscow WHO Global Forum 27 April brought together a wide group of stakeholders to share views and experiences on the challenges and opportunities in noncommunicable disease (NCD) prevention, treatment and control. The forum participants discussed the challenges of NCDs, their expectations for outcomes of the September 2011 UN High-level Meeting (HLM) on NCDs and their possible contributions in support of NCD prevention and control.

The WHO Global Forum provided an opportunity for civil society to give inputs to the First global ministerial conference on healthy lifestyles and noncommunicable disease control held in Moscow 28-29 April.  > > > >  Read More

Press Release - China’s Adoption of Advertising Code Applauded, Supported by Global Actions on Harmful Drinking

The first joint China advertising self-regulation code has been announced in Beijing, where the World Federation of Advertisers (WFA) and China Association of National Advertisers (CANA) have launched Global Advertiser Week. The code calls for all brand communications to be legal, decent, honest and truthful, recognizes the special care required in marketing to children and young people, and includes rules applying to advertising for medicines, health products, food, cosmetics, and alcohol beverages.   > > > >  Read More

Editorial - Alcohol harm—the urgent need for a global response

There is an urgent need for a comprehensive and well funded global response to the activities of transnational corporations (TNCs) which are increasing global demand for alcohol by means of sophisticated supply and marketing techniques, and to the TNCs’ front organizations which are working to impede the development of effective policy.     > > > >   Read More

Alcohol and cancer: a position statement from Cancer Council Australia

Alcohol use is widespread in Australia and has had a dominant role in defining Australian culture for more than 200 years.  However, it is also an important cause of illness, injury and death, whether resulting from short-term episodes of intoxication or from long-term, chronic use.

 

Addressing the health and social damage resulting from risky drinking is one of the three key priority areas identified by the Australian National Preventative Health Taskforce. 

Levels of harm from alcohol use are increasing, and a range of policy measures have been proposed to address the current drinking “culture” in Australia.

 

In this article, we provide a brief overview of the evidence concerning alcohol use and cancer, and outline the current Cancer Council Australia (CCA) recommendations on alcohol consumption. The consensus process for developing this position statement is described in Box 1, and a summary of the key evidence-based points is provided in Box 2.   > > > >   Read More

“Man-ing” up and getting drunk: The role of masculine norms, alcohol intoxication and alcohol-related problems among college men

Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. 

Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. 

The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. 

Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a “playboy”, risk-taking, and winning were risk factors of drinking to intoxication; while, being a “playboy”, risk-taking, and self-reliance increased the risks of alcohol-related problems.

Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication.

Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings.


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Request Reprint E-Mail:   diwamoto2@psyc.umd.edu 

Chrysin Modulates Ethanol Metabolism in Wistar Rats: A Promising Role against Organ Toxicities

Hepato- and nephro-protective efficacy of chrysin was investigated against sequential increase of ethanol intake on the alteration of alcohol metabolizing enzymes–alcohol dehydrogenase (ADH), cytochrome P450 2E1 (CYP 2E1), xanthine oxidase (XO) and oxidant/anti-oxidant status. 

Thirty female Wistar rats segregated into five groups, each with six animals, were put to different doses. Group I as control followed by Group II, III and IV were treated with ethanol (5,8,10 and 12g/kg body weight per week respectively) for 4 weeks. While Group III and IV were administered with chrysin at 20 mg (D1) and 40 mg/kg body weight (D2), respectively, prior to ethanol administration. Group V was given only chrysin (D2). Various oxidative stress and ethanol metabolizing enzymes were estimated in hepatic and renal tissues.

Ethanol administration significantly induced CYP 2E1, ADH and XO in liver and kidneys, respectively, along with an enhancement in levels of malondialdehyde and serum alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, creatinine and lactate dehydrogenase when compared with the control group and this enhancement is significantly normalized with chrysin administration. Oxidative stress markers: reduced glutathione, glutathione peroxidase, catalase and glutathione reductase were significantly (P < 0.001) depleted in the ethanol-treated group, while chrysin administration significantly restored all of these. Only chrysin administration did not show any adverse effect.  

Results demonstrate that chrysin administration prevents the liver and kidney of Wistar rats against oxidative damage during chronic ethanol consumption by inhibiting the activities of ADH, CYP 2E1, XO and catalase.


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Request Reprint E-Mail:    sarwat786@rediffmail.com  

Alcohol Drinking and Esophageal Cancer Risk: An Evaluation Based on a Systematic Review of Epidemiologic Evidence Among the Japanese Population

Although alcohol drinking is considered as an important risk factor for esophageal cancer, the magnitude of the association might be varied among geographic areas. 

Therefore, we reviewed epidemiologic studies on the association between alcohol drinking and esophageal cancer among the Japanese population. 

Original data were obtained from MEDLINE, searched using PubMed or from searches of the Ichushi database, complemented with manual searches. Evaluation of associations was based on the strength of evidence (‘convincing’, ‘probable’, ‘possible’ or ‘insufficient’) and the magnitude of association (‘strong’, ‘moderate’, ‘weak’ or ‘no association’), together with biological plausibility as previously evaluated by the International Agency of Research on Cancer. 

We identified four cohort studies and nine case–control studies. All cohort studies and case–control studies showed strong positive associations between esophageal cancer and alcohol drinking. 

All cohort studies and six case–control studies showed that alcohol drinking had the dose- or frequency-response relationships with esophageal cancer. 

In addition, four case–control studies showed that acetaldehyde dehydrogenase Glu504Lys polymorphism had strong effect modification with alcohol drinking. 

We conclude that there is convincing evidence that alcohol drinking increases the risk of esophageal cancer in the Japanese population. 

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Request Reprint E-Mail:  kmatsuo@aichi-cc.jp 

Effects of Adrenal Sensitivity, Stress- and Cue-Induced Craving, and Anxiety on Subsequent Alcohol Relapse and Treatment Outcomes

Alcoholism is a chronic, relapsing illness in which stress and alcohol cues contribute significantly to relapse risk. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis, increased anxiety, and high alcohol craving have been documented during early alcohol recovery, but their influence on relapse risk has not been well studied.

To investigate these responses in treatment-engaged, 1-month–abstinent, recovering alcohol-dependent patients relative to matched controls (study 1) and to assess whether HPA axis function, anxiety, and craving responses are predictive of subsequent alcohol relapse and treatment outcome (study 2).

Experimental exposure to stress, alcohol cues, and neutral, relaxing context to provoke alcohol craving, anxiety, and HPA axis responses (corticotropin and cortisol levels and cortisol to corticotropin ratio) and a prospective 90-day follow-up outcome design to assess alcohol relapse and aftercare treatment outcomes.

Inpatient treatment in a community mental health center and hospital-based research unit.

Treatment-engaged alcohol-dependent individuals and healthy controls.

Time to alcohol relapse and to heavy drinking relapse.

Significant HPA axis dysregulation, marked by higher basal corticotropin level and lack of stress- and cue-induced corticotropin and cortisol responses, higher anxiety, and greater stress- and cue-induced alcohol craving, was seen in the alcohol-dependent patients vs the control group. Stress- and cue-induced anxiety and stress-induced alcohol craving were associated with fewer days in aftercare alcohol treatment. High provoked alcohol craving to both stress and to cues and greater neutral, relaxed–state cortisol to corticotropin ratio (adrenal sensitivity) were each predictive of shorter time to alcohol relapse.

These results identify a significant effect of high adrenal sensitivity, anxiety, and increased stress- and cue-induced alcohol craving on subsequent alcohol relapse and treatment outcomes. Findings suggest that new treatments that decrease adrenal sensitivity, stress- and cue-induced alcohol craving, and anxiety could be beneficial in improving alcohol relapse outcomes.


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Request Reprint E-Mail:  rajita.sinha@yale.edu  

Multi-Language Initiative

KAP's Multi-Language Initiative (MLI) adapts KAP and other Federal Government publications for clients and the general public whose first language is not English. It addresses the unfulfilled needs for treatment products among members of non–English-speaking groups or those with limited English-language abilities. After MLI products are translated and culturally adapted, they are provided online and can be printed electronically.  > > > >  Read More

The mitochondria-targeted ubiquinone MitoQ decreases ethanol-dependent micro and macro hepatosteatosis

Chronic alcohol-induced liver disease results in inflammation, steatosis and increased oxidative and nitrosative damage to the mitochondrion. 

We hypothesized that targeting an antioxidant to the mitochondria would prevent oxidative damage and attenuate the steatosis associated with alcoholic liver disease. 

To test this we investigated the effects of mitochondria-targeted ubiquinone, MitoQ, (5 & 25 mg/kg/d for 6 weeks) in male Sprague-Dawley rats consuming ethanol using the Lieber-DeCarli diet with pair-fed controls. 

Hepatic steatosis, 3-nitrotyosine (3-NT), 4-hydroxynonenal (4-HNE), hypoxia inducible factor α (HIF1α) and the activity of the mitochondrial respiratory chain complexes were assessed. 

As reported previously, ethanol consumption resulted in hepatocyte ballooning, increased lipid accumulation in the form of micro and macrovesicular steatosis and induction of CYP2E1. MitoQ had a minor on the ethanol-dependent decrease in mitochondrial respiratory chain proteins and their activities, it did however decrease hepatic steatosis in ethanol consuming animals and prevented the ethanol-induced formation of 3-NT and 4-HNE. 

Interestingly, MitoQ completely blocks the increase in HIF1α in all ethanol-fed groups which has previously been demonstrated in cell culture models and shown to be essential in ethanol-dependent hepatosteatosis. 

These results demonstrate the antioxidant capacity of MitoQ in alleviating alcohol associated mitochondrial ROS and several downstream effects of ROS/RNS production such as inhibiting protein nitration and protein aldehyde formation and specifically ROS-dependant HIF1α stabilization. 

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Request Reprint E-Mail:   darley@uab.edu

Alcohol News - 18/2011

ABC Online (Australia) - Alcohol strongly linked to cancer

The Cancer Council of Australia has issued a new position statement recommending that people limit their alcohol intake to reduce their risk of developing cancer.

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Fox News - Alcohol Bigger Cancer Danger Than Originally Thought, Study Says

A fresh analysis of cancer rates published in Australia on Monday suggests alcohol is to blame for many more cases than previously thought—with 5.6 percent likely to be triggered by regular drinking even at moderate levels.

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BusinessWeek - You're Not Doing Your Teen Any Favors by Letting Them Drink

Young teens who are allowed to drink alcohol under adult supervision don't learn about responsible drinking and actually drink more as they get older, a new study says.

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Boston Globe (USA) - MommyJuice: Pushing alcohol on stressed parents

Mommy blogs and Twitter addresses with alcohol or wine in the names are endless; there’s even a Twitter group that meets for online wine “parties,’’ where moms sit at their respective computers and drink a glass of wine in solidarity as they tweet.

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3News NZ (New Zealand) - Alcohol law changes fall short – scientists

The Alcohol Reform Bill, which would affect bar hours, off-licence trading, liquor advertising and the purchase age, is being considered by a parliamentary committee. It is due to be reported back to Parliament in August.

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Independent Online (South Africa) - Zero alcohol limit proposal

Drivers in South Africa could soon be banned from drinking any alcohol at all before getting behind the wheel.

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Reuters - Factbox: Tobacco, alcohol, fat have huge health impact

The World Health Organisation (WHO) published a report on Wednesday on chronic, or non-communicable diseases -- which include diabetes, cancer and respiratory and heart diseases. A large percentage of NCDs could be prevented by reductions in their four main behavioral risk factors -- tobacco use, physical inactivity, alcohol and unhealthy diets, the WHO said.

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Internal Medicine News Digital Network (USA) - Screening for Alcohol Use Disorders Important, Simple

When it comes to screening patients for alcohol use disorders, the small check box on the patient history form sometimes fails to tell physicians what they need to know about the patient’s alcohol use, experts said at the annual meeting of the American Society of Addiction Medicine.

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TIME - Kids With ADHD May Use Drugs and Alcohol More Often

Two recent studies find that being diagnosed with attention deficit hyperactivity disorder (ADHD) in childhood may predict a child's likelihood of later dependence on nicotine, alcohol or other drugs.

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thejournal.ie (Ireland) - Ireland’s biggest drinkers live in Louth and Dublin, according to survey

NEW RESEARCH BY insurer Aviva has found that Irish people drink excessively and spend almost €2,000 a year on alcohol.

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ABC Local (Australia) - Calls for tough alcohol licensing laws to be made permanent in the Illawarra

The New South Wales Police Association says it wants tough licensing laws to be made permanent in the Illawarra.

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Herald Scotland (Scotland) - Scratchcard warning over alcohol intake

CUSTOMERS at high-street chemists will be invited to assess how much they drink under new proposals to tackle Scotland’s alcohol problem.

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IBNLive.com (Thailand) - Alcohol-ban to be imposed at Thai factories

A new ban on alcohol trade and consumption at factories during working hours will soon be imposed across Thailand to promote a healthy workforce and reduce alcohol-related problems, seen as a gift to mark the National Labour Day and the International Workers' Day, known as the May Day.

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SOS Children (Russia) - Russia aims to tackle its alcohol problem

The problem of alcohol misuse is particularly acute in Russia, where the average Russian drinks more than twice the maximum amount considered healthy by the WHO. One in five men will die of alcohol-related causes in Russia and the Russian president admitted earlier this year that alcoholism in the country is a “national disaster”.

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Considerations (UK) - Drunk Driving and the Culture of England

The Daily Mail reports on efforts to change British drinking habits and stop an increase in incidents like drunk dri­ving: Such scenes are not uncommon, which is why Cardiff — one of the country’s worst cities for binge drinking — has just banned boozing on the streets.

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Medical News Today - Zero Tolerance Better For Kids Future Than Drinking With Them At Home

You may think that allowing your teenager to consume alcohol under your supervision at home is better for them, but a new study suggests the risk of subsequent alcohol-related problems is greater, compared to the zero tolerance approach.

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