Does family history of alcohol problems influence college and university drinking or substance use?: A meta-analytic review

Family history of alcohol use problems is a reliable determinant of alcohol use and problems in the population at large, but findings are inconsistent when this issue is examined in college and university students. No quantitative

summary of this literature has been reported to date. The purpose of this study was to conduct a meta-analysis on the effects of family history on substance use and abuse in college and university students.

A two-group contrast meta-analysis was conducted to evaluate the differences in substance use and abuse between family history –positive and –negative students pursuing higher education.

The studies that contributed data to this meta-analysis were conducted in five countries, with the majority of studies from the US.

A total of 65 published articles (53 samples) contributed data from 89,766 participants attending university or college.

Effect sizes were coded for alcohol consumption, problems, and use disorder symptoms, as well as other illegal drug use and abuse. Two independent coders calculated effect sizes and coded descriptive content about the articles, and discrepancies were reconciled. Family history was used as the grouping variable.

Family history had a minimal effect on alcohol consumption, with stronger effects on alcohol consequences (ds: 0.21-0.29), alcohol use disorder symptoms (ds: 0.24-0.27), and other drug involvement (ds: 0.34-0.86).

Relative to students without a family history of alcohol problems, students with positive family histories do not drink more, but may be at greater risk for difficulties with alcohol and drugs.

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The association between drinking motives and alcohol-related consequences – room for biases and measurement issues?

To investigate whether the predominant finding of generalized positive associations between self-rated motives for drinking alcohol and negative consequences of drinking alcohol are influenced by a) using raw scores of motives that may weight inter-individual response behaviours too strongly, and b) predictor-criterion contamination by using consequence items where respondents attribute alcohol use as the cause.

Cross-sectional study within the European School Survey Project on Alcohol and other Drugs (ESPAD)

School classes

Students, ages 13 to 16 (n= 5633)

Raw, rank, and mean-variance standardized scores of the Drinking Motives Questionnaire-Revised (DMQ-R); four consequences: serious problems with friends, sexual intercourse regretted the next day, physical fights, and troubles with the police, each itemized with attribution ("because of your alcohol use") and without.

As previously found in the literature, raw scores for all drinking motives had positive associations with negative consequences of drinking, while transformed (rank or z) scores showed a more specific pattern: external reinforcing motives (social, conformity) had negative, and internal reinforcing motives (enhancement, coping) had non-significant or positive associations with negative consequences. Attributed consequences showed stronger associations with motives than non-attributed ones.

Standard scoring of the Drinking Motives Questionnaire (Revised) fails to capture motives in a way that permits specific associations with different negative consequences to be identified whereas use of rank or z scores does permit this. Use of attributed consequences overestimates the association with drinking motives.

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Request Reprint E-Mail: gerhard.gmel@chuv.ch

Perceptions of addiction and recovery in Sweden: The influence of respondent characteristics

Respondents to a representative population survey were asked to rate four psychoactive substances (tobacco, alcohol, cannabis and ‘hard’ drugs) with regard to their severity to society and addictiveness, as well as the options for recovery, with and without treatment, from an addiction to the same substances.

This article explores if and how these ratings differ with regard to respondents’ socio-demographic characteristics, their own and close persons’ substance use experiences, and, their attitudes towards people with substance use problems.

Data were analysed using descriptive statistics and logistic or linear regressions.

Although the main difference goes between respondents’ perceptions of various substances and addictions, the results also point to some interesting differences with regard to respondents’ experiences and characteristics.

Thus for example, women and respondents with no personal substance use experiences, tend to play up the severity and addictiveness of most substances, and to play down the options for untreated recovery from an addiction, whereas current risk users tend to take an opposite view.

Main interpretations are that there is a general tendency to exaggerate the hazards of and risks with habits that are perceived as unfamiliar and alien, that current risk users at the same time dwell on a ‘false hope’ of being able to quit, and that women are, for various reasons, more inclined than men to worry about their own substance use habits, as well as those in their close environment.

Potential implications, for further research as well as for policy and prevention, are discussed.

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Request Reprint E-Mail: jan.blomqvist@sorad.su.se

Community context of sober living houses

The success or failure of programs designed to address alcohol and drug problems can be profoundly influenced by the communities where they are located. Support from the community is vital for long-term stability and conflict with the community can harm a program's reputation or even result in closure.

This study examined the community context of sober living houses (SLHs) in one Northern California community by interviewing key stakeholder groups. SLHs are alcohol- and drug-free living environments for individuals attempting to abstain from substance use.

Previous research on residents of SLHs showed they make long-term improvements on measures of substance use, psychiatric symptoms, arrests, and employment.

Interviews were completed with house managers, neighbors, and key informants from local government and community organizations.

Overall, stakeholders felt SLHs were necessary and had a positive impact on the community. It was emphasized that SLHs needed to practice a “good neighbor” policy that prohibited substance use and encouraged community service.

Size and density of SLHs appeared to influence neighbor perceptions. For small (six residents or less), sparsely populated houses, a strategy of blending in with the neighborhood seemed to work.

However, it was clear that larger, densely populated houses need to actively manage relationships with community stakeholders.

Strategies for improving relationships with immediate neighbors, decreasing stigma, and broadening the leadership structure are discussed. Implications for a broad array of community-based programs are discussed.

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Request Reprint E-Mail: dlpolcin@aol.com

Effects of alcohol on the membrane excitability and synaptic transmission of medium spiny neurons in the nucleus accumbens

Chronic and excessive alcohol drinking lead to alcohol dependence and loss of control over alcohol consumption, with serious detrimental health consequences. Chronic alcohol exposure followed by protracted withdrawal causes profound alterations in the brain reward system that leads to marked changes in reinforcement mechanisms and motivational state. These long-lasting neuroadaptations are thought to contribute to the development of cravings and relapse.

The nucleus accumbens (NAcc), a central component of the brain reward system, plays a critical role in alcohol-induced neuroadaptive changes underlying alcohol-seeking behaviors.

Here we review the findings that chronic alcohol exposure produces long-lasting neuroadaptive changes in various ion channels that govern intrinsic membrane properties and neuronal excitability, as well as excitatory and inhibitory synaptic transmission in the NAcc that underlie alcohol-seeking behavior during protracted withdrawal.


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Request Reprint E-Mail: vincentmarty@ucla.edu

Protective effect of Opuntia ficus indica f. inermis prickly pear juice upon ethanol-induced damages in rat erythrocytes

Juice from the fruit of the cactus Opuntia ficus indica is claimed to possess several health-beneficial properties.

The present study was carried out to determine whether O. ficus indica f. inermis fruit extract might have a protective effect upon physiological and morphological damages inflicted to erythrocytes membrane by chronic ethanol poisoning, per os, in rat

Chemical analysis of the extract revealed the presence of polyphenols, flavonoids, ascorbic acid, carotenoids, and betalains.

Ethanol administration (3 g/kg b.w, per day for 90 days) induced an increase of malondialdehyde (MDA) and carbonylated proteins levels and a decrease of glutathione (GSH) level in erythrocyte. Ethanol administration also reduced the scavenging activity in plasma and enhanced erythrocytes hemolysis, as compared to control rats. In addition, ethanol intake increased the erythrocyte shape index by +895.5% and decreased the erythrocyte diameter by −61.53% as compared to controls.

In animals also given prickly pear juice during the same experimental period, the studied parameters were much less shifted.

This protective effect was found to be dose-dependent. It is likely that the beneficial effect of the extract is due to the high content of antioxidant compounds.



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Changes in cytokine levels during admission and mortality in acute alcoholic hepatitis

Cytokine levels are raised in acute alcoholic hepatitis. However, there are disparate results regarding the duration of altered plasma levels, and there are also discrepancies about the relation of changes during the first 15 days after admission with short-term (in-hospital) or long-term mortality.

In 56 patients with acute alcoholic hepatitis we found that IL-8, IL-4, Interferon-γ (IFN-γ), malondialdehyde and C-reactive protein remained higher in patients than in 18 age- and sex-matched controls at admission, at the 7th day and at the 15th day after admission. Moreover, IL-4 levels (and to a lesser extent, IL-10 and IFN-γ ones) increased along the three determinations. However, comparing patients who died during the admission with those who did not, there were no statistically significant differences, but there was a nearly significant trend for MDA (Z = 1.89; p = 0.059), with higher levels among those who died.

When changes between the first and the second determinations were compared with long-term survival, only IL-8 and IFN-γ showed a relation with mortality.

IFN-γ values increased among those who survived and decreased among those who died (p = 0.048). IFN-γ values at the first determination also showed a relation with long-term mortality, especially when patients with IFN-γ values in the first quartile were compared with those of the 4th one (log rank = 5.64; p = 0.018; Breslow = 4.64; p = 0.031).

Besides Interferon-γ, only C-reactive protein showed differences between the first and the 4th quartile regarding mortality (Log rank = 4.50; p = 0.034; Breslow 4.33; p = 0.038).

In contrast with other studies, no relation was found between TNF-α or IL-6 and mortality.


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Effects of early life stress on drinking and serotonin system activity in rhesus macaques: 5-hydroxyindoleacetic acid in cerebrospinal fluid predicts

Early childhood stress is a risk factor for the development of substance-abuse disorders. A nonhuman primate model of early life stress, social impoverishment through nursery-rearing rather than mother-rearing, has been shown to produce increased impulsive and anxiety-like behaviors, cognitive and motor deficits, and increased alcohol consumption. These behavioral changes have been linked to changes in cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), a serotonin (5-HT) metabolite.

The effects of different rearing conditions on ethanol drinking and three measures of 5-HT function in the central nervous system were evaluated, including CSF 5-HIAA levels and tissue levels of 5-HT and 5-HIAA in brain samples. Brain samples were taken from the dorsal caudate, putamen, substantia nigra (SN) pars reticulata, SN pars compacta and hippocampus.

There was a clear effect of rearing condition on the 5-HT system. Overall 5-HIAA and 5-HIAA/5-HT ratio measures of 5-HT turnover were significantly lower in nursery reared compared to mother-reared animals. In addition, there was a strong within-subject correlation between CSF and brain tissue 5-HIAA levels. Ethanol drinking was greater in nursery reared monkeys, consistent with previous results.

These findings show that CSF 5-HIAA measurements can be used to predict brain 5-HT activity that may be involved in behavioral outcomes such as anxiety and alcohol consumption.

Thus, CSF sampling may provide a minimally invasive test for neurochemical risk factors related to alcohol abuse.


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Request Reprint E-Mail: srjones@wfubmc.edu

Timing-dependent reduction in ethanol sedation and drinking preference by NMDA receptor co-agonist d-serine

NMDA receptors become a major contributor to acute ethanol intoxication effects at high concentrations as ethanol binds to a unique site on the receptor and inhibits glutamatergic activity in multiple brain areas. Although a convincing body of literature exists on the ability of NMDA receptor antagonists to mimic and worsen cellular and behavioral ethanol effects, receptor agonists have been less well-studied. In addition to a primary agonist site for glutamate, the NMDA receptor contains a separate co-agonist site that responds to endogenous amino acids glycine and d-serine. d-serine is both selective for this co-agonist site and potent in boosting NMDA dependent activity even after systemic administration.

In this study, we hypothesized that exogenous d-serine might ameliorate some acute ethanol behaviors by opposing NMDA receptor inhibition.

We injected adult male C57 mice with a high concentration of d-serine at various time windows relative to ethanol administration and monitored sedation, motor coordination and voluntary ethanol drinking. d-serine (2.7 g/kg, ip) prolonged latency to a loss of righting reflex (LoRR) and shortened LoRR duration when given 15 min before ethanol (3 g/kg) but not when it was injected with or shortly after ethanol.

Blood samples taken at sedative recovery and at fixed time intervals revealed no effect of d-serine on ethanol concentration but an ethanol-induced decrease in l-serine and glycine content was prevented by acute d-serine pre-administration. d-serine had no effect on ethanol-induced (2 g/kg) rotarod deficits in young adult animals but independently and interactively degraded motor performance in a subset of older mice.

Finally, a week-long series of daily ip injections resulted in a 50% decrease in free choice ethanol preference for d-serine treated animals compared to saline-injected controls in a two-bottle choice experiment.


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Request Reprint E-Mail: yuanx033@umn.edu

Access to Health Care and Heavy Drinking in Patients With Diabetes or Hypertension: Implications for Alcohol Interventions

Supported by a National Institute of Alcoholism and Alcohol Abuse grant, this study examined associations between health care access and heavy drinking in patients with hypertension and diabetes.

Using a sample of 7,428 US adults from the 2007 National Health Interview Survey data, multivariate logistic regressions were performed.

Better access to health care, as indicated by regular source of care and frequent use of primary care, was associated with reduced odds of heavy drinking. Alcohol interventions may be more effective if targeted at patients with chronic conditions adversely affected by drinking.

Future research needs to investigate factors facilitating such interventions.

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Alcoholism - Radio Show

It’s estimated that about 12% of Americans suffer from alcoholism at some point in their lives. In a recent Wall Street Journal article writer Paul Carr described his very personal struggle with alcohol and the steps he took to overcome his addiction. He didn’t join Alcoholics Anonymous, but over the last few decades many have with impressive results: A look at the disease of alcoholism, what makes some people especially vulnerable, and the latest research on what works and what doesn’t in the effort to stay sober.

Guests

Paul Carr writer and columnist

Samantha ' a member of Alcoholics Anonymous

Dr. Markus Heilig clinical director, National Institute on Alcohol Abuse and Alcoholism

• Listen

Protecting the unborn baby from alcohol, 7 September 2011, European Parliament, Brussels

Under the patronage of Prof Jerzy Buzek, President of the European Parliament

Key note speakers: John Dalli, EU Commissioner for Health and Consumer Protection and Adam Fronczak, Ministry for Health, Poland

Hosted by MEP: Elzbieta Lukacijewska (EPP, Poland)

Organisers:PARPA (Polish State Agency for Prevention of Alcohol-Related Problems) and Eurocare

Eurocare and PARPA gathered over 120 participants from more than 15 European countries at the event in the European Parliament in September. Both the EU Commissioner for Health and Consumer Protection John Dalli and Chair of the EU Alcohol and Health Forum Dr Spanou participated in the policy debate which highlighted important issues around alcohol and pregnancy. > > > > Read More

Religiosity and Adolescent Substance Use: Evidence From the National Survey on Drug Use and Health Read More: http://informahealthcare.com/doi/abs/

Prior research indicates that religiosity is associated with lower levels of substance use in adolescence. The extant research, however, is limited by issues related to data quality and analytic strategy.

The current research uses the National Survey on Drug Use and Health to further our understanding of the nature of the relationship between religiosity and substance use during adolescence.

Results show that religiosity reduces the odds of tobacco use, heavy drinking, prescription drug misuse, marijuana use, and other illicit drug use. These associations are partially explained by respondent and peer attitudes toward substance use and, to a lesser extent, respondent psychological well-being. The influence of respondent substance use attitude is especially pronounced, explaining between 41% (marijuana) and 53% (tobacco) of the association between religiosity and substance use.

In fully adjusted models, all mediators account
for between 46% (marijuana) and 59% (tobacco) of the association between religiosity and substance use.


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Request Reprint E-Mail: jaford@mail.ucf.edu

Research Article Variants Located Upstream of CHRNB4 on Chromosome 15q25.1 Are Associated with Age at Onset of Daily Smoking and Habitual Smoking

Several genome-wide association and candidate gene studies have linked chromosome 15q24–q25.1 (a region including the CHRNA5-CHRNA3-CHRNB4 gene cluster) with alcohol dependence, nicotine dependence and smoking-related illnesses such as lung cancer and chronic obstructive pulmonary disease.

To further examine the impact of these genes on the development of substance use disorders, we tested whether variants within and flanking the CHRNA5-CHRNA3-CHRNB4 gene cluster affect the transition to daily smoking (individuals who smoked cigarettes 4 or more days per week) in a cross sectional sample of adolescents and young adults from the COGA (Collaborative Study of the Genetics of Alcoholism) families. Subjects were recruited from families affected with alcoholism (either as a first or second degree relative) and the comparison families. Participants completed the SSAGA interview, a comprehensive assessment of alcohol and other substance use and related behaviors.

Using the Quantitative trait disequilibrium test (QTDT) significant association was detected between age at onset of daily smoking and variants located upstream of CHRNB4.

Multivariate analysis using a Cox proportional hazards model further revealed that these variants significantly predict the age at onset of habitual smoking among daily smokers.

These variants were not in high linkage disequilibrium with variants that have previously been reported to affect risk for nicotine dependence and smoking related diseases in adults.

The data suggests that an age-associated relationship underlies the association of SNPs in CHRNB4 with onset of chronic smoking behaviors in adolescents and young adults and may improve genetic information that will lead to better prevention and intervention for substance use disorders among adolescents and young adults.


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How drunk am I? Misperceiving one's level of intoxication in the college drinking environment.

One effective event-level index that can assist in identifying risky intoxication levels among college students is blood alcohol concentration (BAC). Despite widespread exposure to BAC information, doubt exists as to whether American college students can accurately estimate their own BAC level or drinking behaviors while intoxicated.

This study assessed whether students can accurately guesstimate their BAC level and drinking behaviors used to estimate BAC (eBAC) while drinking in social college settings.

Participants (N = 225; 56.4% male) consisted of emerging adults attending either a 2- or 4-year college who had at least one alcoholic drink within the 2 hr before assessment. Participants were approached at night when returning from parties and/or alcohol-serving establishments. They completed an initial questionnaire, gave a breath sample to assess breath alcohol content, and then completed an online follow-up questionnaire within 48 hr of baseline assessment.

Participants at lower levels of intoxication tended to slightly overestimate their BAC level, while those at higher levels tended to markedly underestimate their BAC level. In addition, discrepancies among breath alcohol content, guesstimated BAC, and eBAC were found as a function of gender. Lastly, differences in eBAC scores did not differ when drinking behaviors were obtained via in vivo versus retrospective methodology.

Findings suggest that college students generally have difficulty assessing their BAC level and drinking behaviors while drinking in the college social setting.

This study offers particular insight for research relying on estimates of BAC as well as interventions utilizing BAC education.


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Request Reprint E-Mail: jlabrie@lmu.edu

Predictors of postdeployment alcohol use disorders in National Guard soldiers deployed to Operation Iraqi Freedom.

Alcohol use in the military is a significant problem. The goal of this study was to examine the associations between personality, posttraumatic stress disorder (PTSD) symptoms, and postdeployment alcohol use disorders (AUDs) among a group of Operation Iraqi Freedom (OIF) deployed National Guard soldiers, with a focus on differentiating predeployment and postdeployment onset AUDs.

Participants were 348 National Guard soldiers deployed to Iraq from March 2006 to July 2007 drawn from the Readiness and Resilience in National Guard Soldiers (RINGS) study. Participants completed self-report measures one month before deployment and 3 to 6 months postdeployment; current and lifetime history of AUDs were assessed 6 to 12 months postdeployment, using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th ed. text rev.; DSM–IV; American Psychiatric Association, 2000).

Overall, 13% of the panel was diagnosed with a current AUD. Of those who met criteria for a current AUD, 38% had an AUD that developed following return from deployment (new onset AUD).

The development of new onset AUDs was uniquely predicted by higher levels of PTSD symptom severity, higher levels of avoidance-specific PTSD symptoms, and lower levels of positive emotionality.

AUDs with onset prior to deployment were predicted by higher levels of negative emotionality and disconstraint.

Results of this study suggest that combat deployed soldiers with current AUDs are a heterogeneous group and point to the influence of combat-related PTSD symptoms in the development of AUDs following deployment.


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Request Reprint E-Mail: Shannon.Kehle@va.gov

The Government’s Alcohol Strategy

Tackling binge drinking

Our alcohol strategy sets out proposals to crackdown on our 'binge drinking' culture, cut the alcohol fuelled violence and disorder that blights too many of our communities, and slash the number of people drinking to damaging levels.

The strategy includes commitments to:

• introduce a minimum unit price for alcohol
• consult on a ban on the sale of multi-buy alcohol discounting
• introduce stronger powers for local areas to control the density of licensed premises including making the impact on health a consideration for this
• pilot innovative sobriety schemes to challenge alcohol-related offending

Read Full Alcohol Strategy (PDF)

How significant is a minimum unit price for alcohol of 40p?

The Home Office has today published its alcohol strategy which contains a number of measures designed to curb excess alcohol consumption and the associated social harms. The most high-profile is the plan to introduce a minimum price per unit of alcohol in England and Wales (a similar policy is currently before the Scottish Parliament), with 40p per unit set as an illustrative rate.

As in our previous analyses of minimum pricing, we continue to argue that a preferable approach would be to introduce a floor price for alcohol through the duty system, moving towards a more equal tax treatment of alcohol by type and strength combined with a restriction on selling alcohol below the total tax levied on it. Such a system could be designed to achieve an increase in the price of low cost alcohol similar to that that from a minimum price. But it would have the advantage of raising money for the Exchequer, whereas a minimum price would transfer revenues to the alcohol industry instead. If set at 40p, we estimate that these transfers could be as much as £850 million per year. The alcohol strategy document suggests that the government will "... work with industry to use any additional revenue to provide better value to customers in other areas ..." though quite how this could be enforced or monitored is hard to see.

How significant would a 40p minimum price be? We examine the policy using detailed data recording the off-licence alcohol purchased by more than 19,000 households in 2010. The data do not include alcohol bought in pubs and restaurants. However, it is unlikely that a minimum price would have much direct impact for on-licence prices. > > > > Read More

NIH launches online resource on behavioral and social science research methods

A Web-based interactive anthology will provide psychologists, economists, anthropologists, sociologists and other scientists with the latest research methods and tools to address emerging challenges in public health, such as the obesity epidemic and the rise of chronic diseases such as heart disease. The Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health collaborated with New England Research Institutes to create the free resource, called e-Source.

Because behavioral and social scientists hail from widely varying disciplines from political science to social work research, there was a need for a central resource for current, high quality behavioral and social science research methods. With contributions from international experts, this anthology provides authoritative answers to methodological questions and sets quality standards for the research community.

The goal of the program is to demonstrate the potential of behavioral and social science research, focusing on applying research findings to public health activities and the potential to enhance biomedical research. It is also a useful training resource for biological scientists, providing them with a basic foundation for collaborations with behavioral and social scientists. > > > > Read More

Alcohol warnings to pregnant women

A plan to target pregnant women in warning labels on alcohol products may have already encountered a setback, with Dominion Breweries (DB) confirming they won't be complying for at least two years - when the rule is likely to become mandatory.

Pregnant women are set to be at the heart of warning campaign on New Zealand and Australian alcohol products, to be phased in over the next two years.

The change comes after Australia and New Zealand's Legislative and Governance Forum on Food Regulation agreed to introduce labels warning of the risks.

About 30 per cent of pregnant women in New Zealand drink alcohol, according to Ministry of Health data.

The issue of compulsory health warnings, similar to those found on cigarette packets, has been debated by the Government and alcohol watchdogs since 2006. > > > > Read More

Cognitive changes in topiramate-treated patients with alcoholism: A 12-week prospective study in patients recently detoxified

The aim of this study was to determine the 12-week cognitive changes in topiramate-treated patients recently detoxified from alcohol.

Participants were inpatients with DSM-IV alcohol dependence. All of them were discharged within 14 days after the initiation of topiramate treatment. The topiramate dose range was 50–300 mg/day. The Montreal Cognitive Assessment (MoCA) was used on day 0, day 29, day 57, and day 85. Differences of the MoCA total and seven subtest scores among four time-points were compared.

Thirty-eight participants (36 men and two women) had a mean ± SD age of 43.1 ± 8.6 years old. At enrollment, they were abstinent for a mean ± SD of 11.5 ± 5.3 days. Five, one, and three patients dropped out of the study on day 29, day 57, and day 85, respectively. On day 85, the mean ± SD dose of topiramate was 253.1 ± 60.8 mg/day. Alcohol consumption decreased drastically during follow up. At each time-point, 75%–80% of the participants were continuous abstainers. The mean ± SD MoCA total, language subtest, and delayed recall subtest scores increased significantly from day 0 to day 85, from 22.0 ± 4.7 to 24.7 ± 3.4 (P < 0.01), from 1.1 ± 1.0 to 1.3 ± 1.0 (P = 0.03), and from 2.7 ± 1.7 to 4.1 ± 1.0 (P < 0.01), respectively.

Topiramate-treated patients recently detoxified from alcohol usually have an improvement of their cognitive function, especially in the language and delayed recall domains. This phenomenon may be caused by the greater influence of cognitive recovery associated with decreased drinking as compared with topiramate-induced cognitive impairment.

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Request Reprint E-Mail: manit.s@cmu.ac.th

Public Health Grand Rounds - Preventing Excessive Alcohol Use: What Public Health Can Do

Excessive alcohol use, including underage drinking and binge drinking (drinking 5 or more drinks during a single occasion for men or 4 or more drinks during a single occasion for women), is responsible for 80,000 deaths and 2.3 million years of potential life lost in the U.S. each year, and cost the United States $223.5 billion in 2006 or about $1.90 per drink.

This powerful session of Public Health Grand Rounds explored the public health impact of excessive alcohol use and evidence-based strategies to prevent it, with specific attention to the role that state and local public health agencies play in addressing this important public health problem. > > > > Read More

AUDIT-C Alcohol Screening Results and Postoperative Inpatient Health Care Use

Alcohol screening scores ≥5 on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) up to a year before surgery have been associated with postoperative complications, but the association with postoperative health care use is unknown. This study evaluated whether AUDIT-C scores in the year before surgery were associated with postoperative hospital length of stay, total ICU days, return to the operating room, and hospital readmission.

This cohort study included male Veterans Affairs patients who completed the AUDIT-C on mailed surveys (October 2003 through September 2006) and were hospitalized for nonemergent noncardiac major operations in the following year. Postoperative health care use was evaluated across 4 AUDIT-C risk groups (scores 0, 1 to 4, 5 to 8, and 9 to 12) using linear or logistic regression models adjusted for sociodemographics, smoking status, surgical category, relative value unit, and time from AUDIT-C to surgery. Patients with AUDIT-C scores indicating low-risk drinking (scores 1 to 4) were the referent group.

Adjusted analyses revealed that among eligible surgical patients (n = 5,171), those with the highest AUDIT-C scores (ie, 9 to 12) had longer postoperative hospital length of stay (5.8 [95% CI, 5.0−6.7] vs 5.0 [95% CI, 4.7−5.3] days), more ICU days (4.5 [95% CI, 3.2−5.8] vs 2.8 [95% CI, 2.6−3.1] days), and increased probability of return to the operating room (10% [95% CI, 6−13%] vs 5% [95% CI, 4−6%]) in the 30 days after surgery, but not increased hospital readmission within 30 days postdischarge, relative to the low-risk group.

AUDIT-C screening results could be used to identify patients at risk for increased postoperative health care use who might benefit from preoperative alcohol interventions.

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Request Reprint E-Mail: Anna.Rubinsky@va.gov

Ethanol up-regulates nucleus accumbens neuronal activity dependent pentraxin (Narp): implications for alcohol-induced behavioral plasticity

Neuronal activity dependent pentraxin (Narp) interacts with α-amino-3-hydroxyl-5-methyl-4-isoxazole-propionate (AMPA) glutamate receptors to facilitate excitatory synapse formation by aggregating them at established synapses. Alcohol is well-characterized to influence central glutamatergic transmission, including AMPA receptor function.

Herein, we examined the influence of injected and ingested alcohol upon Narp protein expression, as well as basal Narp expression in mouse lines selectively bred for high blood alcohol concentrations under limited access conditions. Alcohol up-regulated accumbens Narp levels, concomitant with increases in levels of the GluR1 AMPA receptor subunit. However, accumbens Narp or GluR1 levels did not vary as a function of selectively bred genotype.

We next employed a Narp knock-out (KO) strategy to begin to understand the behavioral relevance of alcohol-induced changes in protein expression in several assays of alcohol reward.

Compared to wild-type mice, Narp KO animals: fail to escalate daily intake of high alcohol concentrations under free-access conditions; shift their preference away from high alcohol concentrations with repeated alcohol experience; exhibit a conditioned place-aversion in response to the repeated pairing of 3 g/kg alcohol with a distinct environment and fail to exhibit alcohol-induced locomotor hyperactivity following repeated alcohol treatment.

Narp deletion did not influence the daily intake of either food or water, nor did it alter any aspect of spontaneous or alcohol-induced motor activity, including the development of tolerance to its motor-impairing effects with repeated treatment.

Taken together, these data indicate that Narp induction, and presumably subsequent aggregation of AMPA receptors, may be important for neuroplasticity within limbic subcircuits mediating or maintaining the rewarding properties of alcohol.


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Request Reprint E-Mail: szumlinski@psych.ucsb.edu

Chronic tolerance to the locomotor stimulating effect of ethanol in preweanling rats as a function of social stress

During early stages of development rats are highly sensitive to the locomotor stimulating effect of relatively high ethanol doses, an effect strongly modulated by social stress. This ethanol effect can be modulated by pharmacological treatments that also can attenuate the development of ethanol-induced locomotor sensitization in mice. By the end of the preweanling period the mechanisms underlying sensitization induced by psychostimulants are functional.

The aim of the present study was to analyze the locomotor response to ethanol in preweanling rats as a function of repeated exposure to the drug under two different social conditions.

Subjects were treated with ethanol between postnatal days 15 and 18 after being isolated for four hours (Experiment 1a) or simply residing in their home-cage (Experiment 1b). After two days of withdrawal locomotor response to ethanol was assessed in both social conditions. In Experiment 2 naïve rats were tested in terms of ethanol-induced activation of th

Results from the present study showed no evidence of locomotor sensitization in preweanling rats in any of the social conditions. Instead we observed behavioral tolerance to the stimulating effect of ethanol in animals trained in the home-cage condition, in which subjects trained with ethanol showed sedation in response to ethanol at testing.

Overall these results contribute to the understanding of the sensitivity of rats to the acute and chronic locomotor response to ethanol in an ontogenetic period characterized by high sensitivity to ethanol.



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Request Reprint E-Mail: afelicidade@yahoo.es

Effects of binge drinking on infant growth and development in an Inuit sample

Prenatal exposure to an average of 0.5 oz absolute alcohol per day (the equivalent of 7 standard drinks per week) during pregnancy has been found to be associated with numerous adverse effects on pre- and postnatal development. In the animal model, concentrated alcohol exposure has been found to lead to more adverse effects than exposure to the same total quantity of alcohol ingested in smaller doses over a longer period of time.

The primary aim of this study is to determine whether, in a population where binge drinking is common but total alcohol consumption across pregnancy is low, prenatal exposure to alcohol is associated with effects on prenatal growth, visual acuity and cognitive development during infancy. The second aim is to determine which of several indicators of alcohol consumption best predicts pre- and postnatal outcomes.

Data were collected from 216 Inuit women and their infants living in Nunavik, the northern region of Québec. Maternal interviews were conducted during mid-pregnancy and at 1 and 6 months postpartum. Birth weight, length, and head circumference were assessed at delivery. Visual acuity and cognitive development were assessed at 6 months of age.

In this population in which infrequent heavy episodic drinking is common, even occasional binge exposure was associated with reduced prenatal growth and poorer visual acuity at 6 months of age. A simple dichotomous measure of binge drinking during pregnancy provided the best predictor of fetal growth and 6-month acuity. The population studied here is unusual in terms of its pattern of binge alcohol consumption.

To our knowledge, this is the first study to observe effects of binge drinking during pregnancy on infant growth and development in a sample where the average daily alcohol intake is low (<0.5 ounces).


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Urocortins: CRF's siblings and their potential role in anxiety, depression and alcohol drinking behavior

It is widely accepted that stress, anxiety, depression and alcohol abuse-related disorders are in large part controlled by corticotropin-releasing factor (CRF) receptors. However, evidence is accumulating that some of the actions on these receptors are mediated not by CRF, but by a family of related Urocortin (Ucn) peptides Ucn1, Ucn2 and Ucn3. The initial narrow focus on CRF as the potential main player acting on CRF receptors appears outdated. Instead it is suggested that CRF and the individual Ucns act in a complementary and brain region-specific fashion to regulate anxiety-related behaviors and alcohol consumption.

This review, based on a symposium held in 2011 at the research meeting on “Alcoholism and Stress” in Volterra, Italy, highlights recent evidence for regulation of these behaviors by Ucns.

In studies on stress and anxiety, the roles of Ucns, and in particular Ucn1, appear more visible in experiments analyzing adaptation to stressors rather than testing basal anxiety states. Based on these studies, we propose that the contribution of Ucn1 to regulating mood follows a U-like pattern with both high and low activity of Ucn1 contributing to high anxiety states.

In studies on alcohol use disorders, the CRF system appears to regulate not only dependence-induced drinking, but also binge drinking and even basal consumption of alcohol. While dependence-induced and binge drinking rely on the actions of CRF on CRFR1 receptors, alcohol consumption in models of these behaviors is inhibited by actions of Ucns on CRFR2.

In contrast, alcohol preference is positively influenced by actions of Ucn1, which is capable of acting on both CRFR1 and CRFR2.

Because of complex distribution of Ucns in the nervous system, advances in this field will critically depend on development of new tools allowing site-specific analyses of the roles of Ucns
and CRF.


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Request Reprint E-Mail: ryabinin@ohsu.edu

Alcohol News - 13/2012

Reuters (UK) - Britain plans minimum alcohol price to curb binge drinking

Britain plans to introduce a minimum price for the sale of alcohol in England and Wales as part of an initiative to clamp down on binge drinking and anti-social behavior, which has become a major problem in many town centres across the country.

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The Guardian (UK) - Alcohol abuse contributes to big rise in deaths from liver disease

Heavy drinking is a major cause of a 25% increase in deaths from liver disease in England in under a decade, according to the government's specialist NHS unit on terminal care.

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U.S. News & World Report (USA) - Caring Teachers May Help Keep Kids From Trying Alcohol, Drugs

The connections youth have with their teachers may help prevent kids from experimenting with alcohol and drugs at an early age, a new study suggests.

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The Guardian (UK) - How Lansley and drinks industry lined up against alcohol pricing moves

Just hours after the revelation that alcohol has fuelled a 25% increase in liver deaths in the past decade, Downing Street has finally given health experts what they have long clamoured for – and what health secretary Andrew Lansley has resisted – a minimum price per unit.

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RT (Russia) - Strasbourg to review Russia’s alcohol zero-tolerance

Russia's anti-drink-driving law has become subject to review in the European Court of Human Rights. This comes as Strasbourg has received a number of complaints since 2010, when Russia adopted its zero-tolerance stance.

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Sky News (UK) - Police Chief Wants Curb On Alcohol Adverts

One of Britain's most senior police officers has called for a daytime ban on alcohol advertising on TV and in cinemas.

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Stuff.co.nz (New Zealand) - Kiwi kids 'marinating in alcohol'

At-risk young New Zealanders are growing up in lives "marinating in alcohol", a leading paediatrician says. Speaking at the Babies, Children and Alcohol conference at Te Papa this morning, Dr Nick Baker said children who were exposed to alcohol in the womb and while growing up had the odds stacked against them.

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Irish Examiner (Ireland) - More children in care over parents’ alcohol abuse

More and more children are being taken into care due to families’ problems with drugs and alcohol addiction, according to the Frances Fitzgerald, the children’s minister.

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CBC.ca (Canada) - Alcohol major factor in many northern deaths, coroner says

Addictions and mental health issues are almost always factors in the deaths investigated by the Northwest Territories’ chief coroner, she says.

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Kyiv Post (Ukraine) - Kyiv: New Stag Party Capital Of World?

After taking over Prague and Riga, organized stag parties are attracting growing crowds of raucous young men further east to Ukraine with the promise of cheap entertainment, alcohol – and, of course, beautiful women.

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New Zealand Doctor Online (New Zealand) - Foetal alcohol syndrome one price of booze culture

Foetal alcohol syndrome disorders damage lives forever, speakers reminded the attendees at today's Alcohol Action conference in Wellington.

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Scotsman (Scotland) - Dr Evelyn Gillan: Time to lift our national alcohol burden

For a long time, it appeared that Westminster would not be following Scotland’s lead in introducing minimum unit pricing, favouring instead a ban on below-cost selling.

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The Local (France) - TV ads to tackle 'le binge drinking'

A rise in the number of young people getting drunk has prompted the government to commission a series of adverts to tackle the problem.

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Environmental influences predominate in remission from alcohol use disorder in young adult twins

Familial influences on remission from alcohol use disorder (AUD) have been studied using family history of AUD rather than family history of remission. The current study used a remission phenotype in a twin sample to examine the relative contributions of genetic and environmental influences to remission.

The sample comprised 6183 twins with an average age of 30 years from the Australian Twin Registry. Lifetime history of alcohol abuse and dependence symptoms and symptom recency were assessed with a structured telephone interview. AUD was defined broadly and narrowly as history of two or more or three or more abuse or dependence symptoms. Remission was defined as absence of symptoms at time of interview among individuals with lifetime AUD. Standard bivariate genetic analyses were conducted to derive estimates of genetic and environmental influences on AUD and remission.

Environmental influences alone accounted for remission in males and for 89% of influences on remission in females, with 11% due to genetic influences shared with AUD, which decreased the likelihood of remission. For women, more than 80% of influences on remission were distinct from influences on AUD, and environmental influences were from individual experiences only. For men, just over 50% of influences on remission were distinct from those on AUD, and the influence of environments shared with the co-twin were substantial. The results for the broad and narrow phenotypes were similar.

The current study establishes young adult remission as a phenotype distinct from AUD and highlights the importance of environmental influences on remission.

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Request Reprint E-Mail: vmccutcheon@wustl.edu

Understanding Naltrexone Mechanism of Action and Pharmacogenetics in Asian Americans via Behavioral Economics: A Preliminary Study.

A behavioral economic approach to understanding the relative value of alcohol may be useful for advancing medication development for alcoholism. Naltrexone is a heavily researched and moderately effective treatment for alcohol dependence making it a good candidate for a proof-of-concept study of behavioral economics and alcoholism pharmacotherapy.

This study examines naltrexone efficacy and pharmacogenetics in terms of the relative value of alcohol, assessed via demand curve analysis.

Participants were 35 heavy drinking (AUDIT ≥8) Asian Americans. A within-subjects cross-over medication design was used along with an intravenous alcohol challenge completed after 4 days of both naltrexone and placebo. At baseline and BrAC = 0.06g/dl, participants completed an Alcohol Purchase Task, which assessed estimated alcohol consumption along escalating prices. Behavioral economic demand curve analysis yielded measures of intensity, elasticity, maximum expenditure (Omax), proportionate price insensitivity (Pmax) and breakpoint.

Compared to placebo, naltrexone significantly reduced intensity, Omax and breakpoint. There were also trend-level medication effects on Pmax. BrAC was associated with increases in Pmax and breakpoint. A significant naltrexone × OPRM1 genotype interaction was observed for intensity of demand.

The present study extends the literature on naltrexone's mechanisms through the application of a novel behavioral economic paradigm. These results indicate that naltrexone reduces several indices of demand for alcohol.

This preliminary report provides further evidence for the effectiveness of naltrexone and supports the utility of a behavioral economic approach to alcoholism pharmacotherapy development.



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Request Reprint E-Mail: lararay@psych.ucla.edu

Global Actions: March 21, 2012

Key Recent Milestones:

· Thailand: Our partner in Thailand, the Population and Community Development Association (PDA) recently traveled to selected villages in Thailand for the noncommercial alcohol initiative of Global Actions. In collaboration with the Thai Foundation for Responsible Drinking (TFRD), PDA staff interviewed village people and leaders about the impact of unrecorded alcohol on local communities.



Global Actions in Focus: Country Managers in Washington, D.C.

Global Actions country managers and ICAP regional coordinators convened in Washington, D.C. at the International Center for Alcohol Policies (ICAP) headquarters for a week-long collaboration to discuss Global Actions strategies. The week of March 12, coordinators participated in evaluation workshops with Channel Research, a communications workshop, and other meetings with ICAP staff and senior consultants.



The meeting marked the second gathering of all Global Actions country managers and regional coordinators to ICAP headquarters. ICAP president Marcus Grant launched the week with an overview of ICAP strategic review and plans for the future.



“We’re clear that ICAP’s goal is to be respected as the world’s leading think tank on alcohol. But our thinking only becomes relevant when it is translated into policies and programs,” said Grant. “The group gathered in Washington for this meeting represents the front line in testing how ICAP’s thinking works in the real world.”



The meeting included daily workshops by Channel Research. “The main purpose of the monitoring and evaluation workshop was to further enhance the linkages between planning, monitoring, and evaluation of the Global Actions initiatives by equipping the coordinators with a set of tools,” said Annina Mattsson.



“The group was enthusiastic and very receptive to the new tools provided,” Mattsson continued. “Channel Research will continue supporting the coordinators' monitoring and evaluation efforts in a coaching role throughout 2012.”



ICAP’s YouTube channel will soon be updated with interviews filmed during the week. Visit our Facebook page for event photos.



What’s Happening Next:

· Mexico: Global Actions Mexico is partnering with Aguas con el Alcohol to participate in a health fair hosted by Universidad de las Americas. The event will be held at the university in Puebla on March 22 and 23.