ALCOHOL REPORTS

Wednesday, September 19, 2012

The Effects of Prenatal Alcohol Exposure and Attention-Deficit/Hyperactivity Disorder on Psychopathology and Behavior

This study examined prevalence of psychiatric disorders and behavioral problems in children with and without prenatal alcohol exposure (AE) and attention-deficit/hyperactivity disorder (ADHD).

Primary caregivers of 344 children (8 to 16 years, M = 12.28) completed the Computerized Diagnostic Interview Schedule for Children-IV (C-DISC-4.0) and the Child Behavior Checklist (CBCL). Subjects comprised 4 groups: AE with ADHD (AE+, n = 85) and without ADHD (AE−, n = 52), and nonexposed with ADHD (ADHD, n = 74) and without ADHD (CON, n = 133). The frequency of specific psychiatric disorders, number of psychiatric disorders (comorbidity), and CBCL behavioral scores were examined using chi-square and analysis of covariance techniques.

Clinical groups had greater frequency of all psychiatric disorders, except for anxiety, where the AE- and CON groups did not differ. There was a combined effect of AE and ADHD on conduct disorder. For comorbidity, children with ADHD had increased psychiatric disorders regardless of AE, which did not have an independent effect on comorbidity. For CBCL scores, there were significant main effects of AE and ADHD on all scores and significant AE × ADHD interactions for Withdrawn/Depressed, Somatic Complaints, Attention, and all Summary scores. There was a combined effect of AE and ADHD on Externalizing, Total Problems, and Attention Problems.

Findings indicate that ADHD diagnosis elevates children's risk of psychiatric diagnoses, regardless of AE, but suggest an exacerbated relation between AE and ADHD on conduct disorder and externalizing behavioral problems in children. Findings affirm a poorer behavioral prognosis for alcohol-exposed children with ADHD and suggest that more than 1 neurobehavioral profile may exist for individuals with AE.

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Request Reprint E-Mail: sarah.mattson@sdsu.edu

Fetal Brain Function in Response to Maternal Alcohol Consumption: Early Evidence of Damage

Studies of the adverse neurobehavioral effects of maternal alcohol consumption on the fetus have been largely confined to the postnatal period, after exposure to alcohol has finished. This study explored the brain function of the fetus, at the time of exposure to alcohol, to examine its effect on information processing and stability of performance.

Five groups of fetuses, defined by maternal alcohol consumption patterns, were examined: control (no alcohol); moderate (5 to 10 units/wk either drunk evenly across the week or as a binge, in 2 to 3 days); heavy (20+ units/wk drunk evenly or as a binge). Fetal habituation performance was examined on 3 occasions, separated by 7 days, beginning at 35 weeks of gestation. The number of trials required to habituate on each test session and the difference in performance across test sessions were recorded.

Fetuses exposed to heavy binge drinking required significantly more trials to habituate and exhibited a greater variability in performance across all test sessions than the other groups. Maternal drinking, either heavily but evenly or moderately as a binge, resulted in poorer habituation, and moderate binge drinking resulted in greater variability compared with no, or even, drinking.

Decreased information processing, reflected by poorer habituation, and increased variability in performance may reflect the initial manifestations of structural damage caused by alcohol to the brain. These results will lead to a greater understanding of the effects of alcohol on the fetus's brain, enable the antenatal identification of fetal alcohol spectrum disorders, and lead to the early implementation of better management strategies.

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Request Reprint E-Mail: p.hepper@qub.ac.uk

Markers of Bone Resorption and Formation During Abstinence in Male Alcoholic Patients

Reduced bone mineral density (BMD) is commonly found in alcohol-dependent patients. Many risk factors have been reported, yet the course of markers of bone formation and resorption in abstinent alcoholic patients have not received much attention.

In a prospective longitudinal study, we investigated BMD in male abstinent inpatients of an alcohol rehabilitation clinic aged 21 to 50 years at baseline and after 8 weeks of treatment. At baseline and at week 8, all patients had blood drawn for the analysis of liver function tests, calcium, phosphate, parathormone, 25-hydroxyvitamin D, osteocalcin (OC), serum crosslaps, sex hormones, and prolactin. BMD was determined by dual X-ray absorptiometry in the lumbar spine and the proximal right femur. We also determined the amount of physical activity prior to inpatient treatment by using the International Physical Activity Questionnaire (IPAQ).

Low BMD was found in 15.1% of the patients for the lumbar spine, in 5.7% for the femoral neck, and in 1.9% for the total hip. BMD differed significantly from normal values, in the lumbar spine and in the femoral neck. At baseline, crosslaps were elevated in 34% of the patients, while OC levels were lowered in 17%. Over the course of the 8 weeks, we found a significant increase in OC plasma levels, indicating a higher rate of bone formation during continuous abstinence. There were also positive correlations between IPAQ scores and BMD as reflected by Z-scores in all regions, pointing to a protective effect of physical activity.

In summary, this report confirms earlier cross-sectional studies of lowered BMD in alcoholic noncirrhotic men. We could also demonstrate that the initial imbalance between bone formation and resorption seems to adjust toward a balance between the two during abstinence.

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Request Reprint E-Mail: peter.malik@i-med.ac.at

Convergence of Genome-Wide Association and Candidate Gene Studies for Alcoholism

Genome-wide association (GWA) studies have led to a paradigm shift in how researchers study the genetics underlying disease. Many GWA studies are now publicly available and can be used to examine whether or not previously proposed candidate genes are supported by GWA data. This approach is particularly important for the field of alcoholism because the contribution of many candidate genes remains controversial.

Using the Human Genome Epidemiology (HuGE) Navigator, we selected candidate genes for alcoholism that have been frequently examined in scientific articles in the past decade. Specific candidate loci as well as all the reported single nucleotide polymorphisms (SNPs) in candidate genes were examined in the Study of Addiction: Genetics and Environment (SAGE), a GWA study comparing alcohol-dependent and nondependent subjects.

Several commonly reported candidate loci, including rs1800497 in DRD2, rs698 in ADH1C, rs1799971 in OPRM1, and rs4680 in COMT, are not replicated in SAGE (p > 0.05). Among candidate loci available for analysis, only rs279858 in GABRA2 (p = 0.0052, OR = 1.16) demonstrated a modest association. Examination of all SNPs reported in SAGE in over 50 candidate genes revealed no SNPs with large frequency differences between cases and controls, and the lowest p-value of any SNP was 0.0006.

We provide evidence that several extensively studied candidate loci do not have a strong contribution to risk of developing alcohol dependence in European and African ancestry populations. Owing to the lack of coverage, we were unable to rule out the contribution of other variants, and these genes and particular loci warrant further investigation. Our analysis demonstrates that publicly available GWA results can be used to better understand which if any of previously proposed candidate genes contribute to disease. Furthermore, we illustrate how examining the convergence of candidate gene and GWA studies can help elucidate the genetic architecture of alcoholism and more generally complex diseases.

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Request Reprint E-Mail: laura@wustl.edu

Clinical Indices of Familial Alcohol Use Disorder

Alcohol use disorders (AUDs) are clinically heterogeneous and strongly influenced by familial/genetic factors. Can we identify specific clinical features of AUDs that index familial liability to illness?

In twins from the Virginia Adult Twin Study of Psychiatric and Substance Use Disorders meeting DSM-IV criteria for lifetime AUDs, we examined whether clinical features of AUDs, including individual DSM-IV criteria for alcohol dependence (AD) and alcohol abuse (AA), predicted risk for AUDs in cotwins and/or parents. Analyses of individual criterion were repeated controlling for the total number of endorsed criteria.

Across these analyses, examining narrowly and broadly defined AUDs, risk of AUDs in relatives was more consistently predicted by abuse criteria than by dependence criteria, and by criteria reflecting negative psychosocial consequences rather than pharmacologic/biological criteria. Age at onset (AAO) poorly predicted risk in relatives. AUD associated legal problems, the one criterion slated for removal in DSM-5, was the most consistent single predictor of familial risk. Associations observed between individual criteria and risks of illness in relatives were generally stronger in monozygotic than dizygotic twin pairs, suggesting that these symptoms reflect a genetic risk for AUDs.

Individual DSM-IV criteria for AA and AD differ meaningfully in the degree to which they reflect the familial/genetic liability to AUDs. Contrary to expectation, the familial/genetic risk to AUDs was better reflected by symptoms of abuse and negative psychosocial consequences of AUD than by early AAO, or symptoms of tolerance and withdrawal.

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Request Reprint E-Mail: kendler@vcu.edu

State Panel Estimates of the Effects of the Minimum Legal Drinking Age on Alcohol Consumption for 1950 to 2002

Despite strong evidence supporting the effectiveness of the minimum legal drinking age (MLDA), recent movements have attempted to evoke policy changes that will allow 18- to 20-year-olds to buy and drink alcohol legally. The primary aim of this study was to evaluate the effects of both raising and lowering the MLDA on per capita ethanol (EtOH) consumption in longer and more accurate time series panel than any previous study.

Generalized least squares model specifications controlling for income, unemployment rates, and population characteristics were implemented using MLDA and aggregate EtOH consumption data from U.S. states from 1950 to 2002.

Results from the full 1950 to 2002 period, which include both the lowering and raising of the MLDA, show that an increase in the MLDA by 3 years was associated with decreases in per capita total EtOH consumption (1.51% reduction), as well as in beer (2.31% reduction) and spirits consumption (1.86% reduction).

Lowering the MLDA would likely induce increased rates of drinking and subsequent alcohol-related consequences. If increased consumption is of concern, policymakers should resist movements to lower the MLDA.

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Request Reprint E-Mail: meenakshi_subbaraman@brown.edu

Letting Children Sip Understanding Why Parents Allow Alcohol Use by Elementary School–aged Children

To investigate prosipping beliefs about alcohol among parents and the relations among these beliefs, parents' alcohol-specific attitudes and practices, and children's reports of initiation of alcohol use.

Telephone interview study of parent-child dyads. Data for the present study are from the baseline interviews of a 4-year intervention trial.

Southeastern United States.

One thousand fifty pairs of mothers or mother surrogates and their third-grade children who were recruited for the 4-year intervention trial.

Key measures from parents included prosipping beliefs (ie, beliefs that sipping alcohol has protective consequences for children), attitudes about children's sipping, and parenting practices that affect children's opportunity to try alcohol. The key measure from children was experience sipping beer, wine, or other types of alcohol.

The belief among mothers that allowing children to sip alcohol can have protective consequences for children, including making children less likely to drink as adolescents and making them better at resisting peer influence to drink, ranged from approximately 15% to almost 40%. Alcohol use was reported by 32.8% of children. A strong, significant association was found between parental prosipping beliefs and children's reported alcohol use.

The notion that early exposure to alcohol can be beneficial has a strong foothold among some parents of elementary school–aged children. More research is needed to understand how parents acquire prosipping beliefs and to test messages that effectively modify such beliefs and associated prosipping attitudes and practices among parents.

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Request Reprint E-Mail: cjackson@rti.org

Reduced expression of α-synuclein in alcoholic brain: influence of SNCA-Rep1 genotype

α-Synuclein has recently been implicated in the pathophysiology of alcohol abuse due to its role in dopaminergic neurotransmission.

In these studies, genetic variability in the α-synuclein gene influences its expression which may contribute to susceptibility to chronic alcohol abuse. Real-time PCR was used to quantify α-synuclein mRNA expression in autopsy samples of human dorsolateral prefrontal cortex. Because of the association between length of the α-synuclein-repeat 1 microsatellite marker and expression levels of the gene, this marker was genotyped in a Caucasian sample of 126 controls and 117 alcoholics using capillary gel electrophoresis.

The allele and genotype frequencies of α-synuclein-repeat 1 marker differed significantly between alcoholics and controls. Alcoholics had greater frequencies of the shortest allele found (267 bp). The shortest allele of the α-synuclein-repeat 1 marker was associated with decreased expression of α-synuclein in prefrontal cortex. Individuals with at least one copy of the 267 bp allele were more likely to exhibit an alcohol abuse phenotype.

These results suggest that individuals with the 267 bp allele may be at increased risk of developing alcoholism and that genetic variation at the α-synuclein-repeat 1 locus may influence α-synuclein expression in the prefrontal cortex.

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Request Reprint E-Mail: j.lewohl@griffith.edu.au

Tuesday, September 18, 2012

The association between DRD2/ANKK1 and genetically informed measures of alcohol use and problems

In 1990, Blum and colleagues first reported an association between DRD2 and alcoholism. While there have been subsequent replications of this genetic association, there have also been numerous studies that failed to detect an association between DRD2 and alcohol dependence.

We propose that one aspect contributing to this inconsistency is the variation in alcohol phenotype used across studies. Within the population-based Finnish twin sample, FinnTwin16, we previously performed multivariate twin analyses to extract latent genetic factors, which account for the variation across seven measures of alcohol consumption (frequency of drinking, frequency × quantity, frequency of heavy drinking, frequency of intoxication and maximum drinks in a 24-hour period) and problems (the Rutgers Alcohol Problem Index—RAPI and the Mälmö-modified Michigan Alcohol Screen Test—MmMAST) in 3065 twins.

In the present study, we examined the association between 31 DRD2/ANKK1 single-nucleotide polymorphisms (SNPs) and the genetic factor scores generated by twin analyses in a subset of FinnTwin16 (n = 602). We focus on two of the genetic factors: a general alcohol consumption and problems factor score, which represents shared genetic variance across alcohol measures, and a alcohol problems genetic factor score, which loads onto the two indices of problematic drinking (MAST and RAPI).

After correction for multiple testing across SNPs and phenotypes, of the 31 SNPs genotyped across DRD2/ANKK1, one SNP (rs10891549) showed significant association with the general alcohol consumption and problems factor score (P = 0.004), and four SNPs (rs10891549, rs1554929, rs6275, rs6279), representing two independent signals after accounting for linkage disequilibrium, showed significant association with the alcohol problems genetic factor score (P = 0.005, P = 0.005, P = 0.003, P = 0.003).

In this study, we provide additional positive evidence for the association between DRD2/ANKK1 and alcohol outcomes, including frequency of drinking and drinking problems.

Additionally, post hoc analyses indicate stronger association signals using genetic factor scores than individual measures, which suggest that accounting for the genetic architecture of the alcohol measures reduces genetic heterogeneity in alcohol dependence outcomes in this sample and enhances the ability to detect association.

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Request Reprint E-Mail: ddick@vcu.edu

Alcohol News - 38/2012

Medical Daily (Finland) - Terrifying PSA Asks: Are You a Monster When You're Drunk? [VIDEO]

A Finnish non-profit organization has created an advertisement that aims to stop parents from being drunk around their children.
Read more

The Baltic Course (Lithuania) - Degutiene: higher excise duty on alcohol could fight alcoholism in Lithuania

The issue of raising excise duty on alcohol requires more deliberation, yet, it could be one of the measures to fight growing alcoholism in Lithuania, says Seimas Speaker Irena Degutiene.

Baku Today (Latvia) - 95% of Latvian high school seniors drank alcohol

5% of students 8-10 classes in Latvia at least once drank alcohol, and 25000 of them consume alcoholic beverages at least once a week, the 14 September, reporter BakuToday with reference to data Research Centre for disease prevention and control.

ERR News (Estonia) - Homicides Down, but Alcohol Seen as Fueling Assault and Battery

Murders and other homicides were down by 16 percent in the first six months of the year while cases of assault and/or battery increased 11 percent, prompting concern from officials.

Helsinkin Sanomat (Finland/Russia) - Alcohol remains a major health concern in Russian Karelia

"Long live Karelia" Denis Vlasov shouts, raising his hands up in the air. It is Wednesday evening in Petrozavodsk, the capital of Russian Karelia. It is nearly ten in the evening, and under new rules, sales of vodka must end at 11:00 PM. Vlasov is also getting some while he can. "I drink on fishing trips and whenever I want to hug women", he says with a hearty laugh.

ABC News (Sweden) - Swedish Police to Parents: Pick up Your Drunk Kids

Teenagers drinking, brawling, vomiting and passing out. It's a weekend ritual in many parts of the world that often begs the question: Where are the parents?

The Local (Sweden) - Systembolaget to launch home delivery

Swedish state-owned alcohol monopoly retailer Systembolaget has been given the green light to begin offering a home delivery service.

Wall Street Journal (Chech Republic) - After Poisonings, Czech Republic Bans Hard Liquor

The Czech Republic continued Sunday to enforce a ban on sales of hard liquor, as deaths and injuries from methanol-laced bootleg alcohol rose and as Poland prohibited sales of spirits imported from its southern neighbor.

The Atlantic - Study: Red Wine Is Healthier When It's Non-Alcoholic (Sorry)

Drinking red wine in moderation has been shown to ward off heart disease, and many have latched onto the research as an excuse to indulge a little bit, or a lot. But where does alcohol factor into the benefits?

CBS News - Consuming three or more alcoholic drinks daily may raise risk for hemorrhagic stroke

Having three or more alcoholic beverages each day may put you at higher risk of having a a type of hemorrhagic stroke known as an intracerebral hemorrhage at an earlier age, according to a new study.

The Press Association (UK) - Alcohol price plan faces objection

A controversial plan to set a minimum price for alcohol is being delayed by an objection from Bulgaria, an industry body has revealed.

Science Codex - Abstinence from alcohol plus physical exercise can help reclaim bone loss due to alcoholism

Osteoporosis, or reduced bone mineral density (BMD), is defined by an absolute decrease in total bone mass, caused mostly by an imbalance between osteoclastic bone resorption and osteoblastic bone formation.

Science Codex - Symptoms of alcohol abuse, not dependence, may better reflect family risk for alcohol use disorders

Individuals with alcohol use disorders (AUDs) vary widely in their age of onset of use, patterns of drinking, and symptom profiles. AUDs are often 'divided' into two categories: alcohol abuse (AA) and alcohol dependence (AD), with AA perceived as a milder syndrome that might develop into AD over time.

ABC Online (Australia) - Alcohol abuse causing forgotten children

The repurcussions of harmful drinking are never localised. The Salvation Army has released new research about alcohol abuse in families.

TVNZ (New Zealand) - Alcohol reform an opportunity missed – expert

A leading Auckland researcher in suicide prevention says the government missed a trick when the alcohol laws passed through parliament unchanged last month.

Scottish Daily Record (Scotland) - Revealed: The cost of alcohol abuse by council area in Scotland

ALCOHOL-RELATED harm could cost more than £1000 per person in Scotland's largest council, new figures have revealed.

Phys.org - Research: Substances present in alcohol found to influence superconductivity

In previous research, the National Institute for Materials Science (NIMS) discovered that iron telluride compounds [Fe(Te,S) system], which are iron-based superconducting related substances, become superconductors when simmered in alcoholic beverages.

BBC News (UK) - Help kids in drink abuse homes, says commission

The government should pay as much attention to the parents who drink too much as it does to those who misuse illegal drugs, says a report.

Taranaki Daily News (New Zealand) - Linking alcohol abuse to high youth suicide

Dr Cranshaw pointed out New Zealand has the second highest rate of youth suicide in the OECD and that alcohol is the major factor in youth suicide.

eGov monitor (UK) - Alcohol pricing in England could save elderly lives

Introducing a minimum price of 50p per unit of alcohol could help save 5,000 lives each year, according to new research.

Irish Examiner (Ireland) - Alcohol is the most used date rape drug

Alcohol is the most common date rape drug in the country, according to rape crisis groups. The Rape Crisis Network Ireland said that while there was little evidence to show that better-known rape drugs, such as Rohypnol, were being used, alcohol was regularly involved in sex attacks.

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Monday, September 17, 2012

NIAAA Spectrum September 2012

IN THIS ISSUE

FEATURES
1 Facebook Offers Clues Into College Drinking

1 A View From the Top—NIAAA Taps College Presidents to Address Harmful Student Drinking

BY THE NUMBERS
Estimated percentage
4 Alcohol-Related Deaths Among U.S. College Students

NEWS FROM THE FIELD
2 Examining College Drinking Styles Beyond Simply “How Much?” and “How Often?”

5 Alcohol Increases Risk Taking by Altering Reward Circuitry in the Brain

5 Study Finds Increased Risk for Alcohol Use Disorders After Weight-Loss Surgery

7 Hispanic Immigrants’ Drinking Habits Change As They Adopt U.S. Culture

A CLOSER LOOK
6 Colleges Offer Students a Way Out During Alcohol Emergencies

5 QUESTIONS WITH...
7 Jonathan Gibralter, Ph.D.

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Ghrelin Increases GABAergic Transmission and Interacts with Ethanol Actions in the Rat Central Nucleus of the Amygdala

The neural circuitry that processes natural rewards converges with that engaged by addictive drugs. Because of this common neurocircuitry, drugs of abuse have been able to engage the hedonic mechanisms normally associated with the processing of natural rewards. Ghrelin is an orexigenic peptide that stimulates food intake by activating GHS-R1A receptors in the hypothalamus. However, ghrelin also activates GHS-R1A receptors on extrahypothalamic targets that mediate alcohol reward. The central nucleus of the amygdala (CeA) has a critical role in regulating ethanol consumption and the response to ethanol withdrawal.

We previously demonstrated that rat CeA GABAergic transmission is enhanced by acute and chronic ethanol treatment. Here, we used quantitative RT-PCR (qRT-PCR) to detect Ghsr mRNA in the CeA and performed electrophysiological recordings to measure ghrelin effects on GABA transmission in this brain region.

Furthermore, we examined whether acute or chronic ethanol treatment would alter these electrophysiological effects.

Our qRT-PCR studies show the presence of Ghsr mRNA in the CeA. In naive animals, superfusion of ghrelin increased the amplitude of evoked inhibitory postsynaptic potentials (IPSPs) and the frequency of miniature inhibitory postsynaptic currents (mIPSCs).

Coapplication of ethanol further increased the ghrelin-induced enhancement of IPSP amplitude, but to a lesser extent than ethanol alone. When applied alone, ethanol significantly increased IPSP amplitude, but this effect was attenuated by the application of ghrelin.

In neurons from chronic ethanol-treated (CET) animals, the magnitude of ghrelin-induced increases in IPSP amplitude was not significantly different from that in naive animals, but the ethanol-induced increase in amplitude was abolished. Superfusion of the GHS-R1A antagonists D-Lys3-GHRP-6 and JMV 3002 decreased evoked IPSP and mIPSC frequency, revealing tonic ghrelin activity in the CeA. D-Lys3-GHRP-6 and JMV 3002 also blocked ghrelin-induced increases in GABAergic responses. Furthermore, D-Lys3-GHRP-6 did not affect ethanol-induced increases in IPSP amplitude.

These studies implicate a potential role for the ghrelin system in regulating GABAergic transmission and a complex interaction with ethanol at CeA GABAergic synapses.

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Request Reprint E-Mail: mroberto@scripps.edu

Stereotypic information about drinkers and students’ observed alcohol intake: An experimental study on prototype–behavior relations in males and femal

Cross-sectional and longitudinal research has shown that favorable drinker prototypes (i.e., perceptions about the typical drinker) are related to higher levels of alcohol consumption in adolescents and college students. So far, few studies have experimentally tested the causality of this relationship and it is not clear what type of manipulation affects drinker prototypes and drinking levels.

In an experimental 1-factor design with two levels, we tested the short-term effects of exposing students to either positive or negative stereotypic information about drinkers on their drinker prototypes and actual drinking behaviors. We exposed 192 male and female college students to positive drinker prototype information (drinkers in general were presented as being attractive, sociable and successful), or to negative information (unattractive, unsociable and unsuccessful). Subsequently, participants’ levels of alcohol consumption were observed unobtrusively while they were interacting with peers in a naturalistic drinking context, namely a bar lab.

Participants exposed to positive stereotypic information about drinkers reported more favorable drinker prototypes than participants exposed to negative stereotypic information. Multilevel analyses revealed that men's subsequent alcohol consumption in the bar lab was higher in the positive prototype condition than in the negative prototype condition. For women, no prototype effects on alcohol use were found.

These findings underline that drinker prototypes affect actual alcohol use in men and suggest that changing perceptions of drinkers may be a useful tool in alcohol prevention programs.

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Request Reprint E-Mail: H.Teunissen@pwo.ru.nl

Transition to parenthood and substance use disorders: Findings from a 30-year longitudinal study

This study examined the associations between the transition to parenthood and substance use disorders from ages 18 to 30 in a New Zealand birth cohort.

Outcomes included: DSM-IV criteria for: (a) alcohol abuse/dependence (AAD) and (b) illicit substance abuse/dependence. The study also used measures transition to parenthood during the period 18–30 years; and observed covariate factors including: family socio-economic status; family functioning; childhood abuse exposure; childhood personal and behavioural characteristics; and psychosocial adjustment in adolescence. Data were analysed using repeated measures Generalised Estimating Equation models, and conditional fixed effects regression modelling to control for confounding. Gender interactions were examined using moderated regression analyses.

Those who became parents had unadjusted odds of substance use disorder outcomes that were approximately 50% lower than those who had not become parents. Adjustment of the associations for both: (a) observed confounding factors and (b) non-observed fixed effects; strengthened the associations between parenthood status and substance use disorders. Custodial parents had odds of substance use disorders that were 57–78% lower than those who did not become parents after adjusting for non-observed fixed effects. Additional analyses suggested these effects were confined to custodial parents only. There was also evidence for gender × parenthood status interactions for AAD, with the effects of parenthood on AAD being stronger for females.

The results suggest that the transition to custodial parenthood may result in reduced risks of substance use disorder, particularly amongst female cohort members.

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Request Reprint E-Mail: dm.fergusson@otago.ac.nz

Sobriety as an admission criterion for transitional housing: A multi-site comparison of programs with a sobriety requirement to programs with no sobri

This study examined whether homeless clients enrolled in transitional housing programs that required sobriety (SR) as an admission criterion have outcomes comparable to clients enrolled in programs that did not require sobriety (NSR) as an admission criterion.

A total of 1062 military veterans in 40 transitional housing programs funded by the United States Department of Veterans Affairs were grouped based on whether they were in SR or NSR programs and followed over a one-year period after program discharge. Participants in SR and NSR programs were compared on their ratings of the social climate of the program, and housing and psychosocial outcomes.

Participants in SR programs reported more days housed and better psychosocial outcomes than participants in NSR programs, although the differences were small and there were no differences in ratings of their social climate. Both participants in SR and NSR programs showed improvements on most outcomes after discharge from transitional housing. There were no significant differences in outcomes between participants actively abusing substances at program entry compared to those who were not.

Requiring sobriety as an admission criterion in transitional housing made only a small difference in housing outcomes post-discharge. Further study is needed to determine whether requiring sobriety at admission in transitional housing is necessary for successful client outcomes.

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Request Reprint E-Mail: Jack.Tsai@yale.edu

Quality of life among alcohol-dependent patients: How satisfactory are the available instruments? A systematic review

The purpose of this systematic review was to compare quality-of-life instruments used as outcome measures in randomized clinical trials for alcohol-dependence treatment.

Randomized controlled clinical trials, indexed in the EMBASE, PubMed and PsycINFO databases since 1981, which aimed at improving the quality of life in alcohol-dependent patients and used as instrument to measure the quality of life, as specifically designated by the authors, were included.

Of the 331 articles screened, 18 studies were included in the review. Eight different quality-of-life instruments were used as outcome measures. Twenty-seven life domains were explored. Between-scale heterogeneity was high. The scale most frequently used was the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Only 1 clinical trial demonstrated a significant difference between intervention groups at all endpoints, using the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q).

Because many different instruments were used, it is difficult to compare quality-of-life improvement between trials. The most frequently used instrument was a generic health status measure that may not be well suited as a quality-of-life measure for subjects with alcohol dependence. The construction and validation of a specific patient-reported outcome based on alcohol-dependent patients’ concerns would effectively contribute to the assessment of treatment efficacy.

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Request Reprint E-Mail: amandineluquiens@yahoo.fr

The genetics of alcohol dependence: Advancing towards systems-based approaches

Personalized treatment for psychopathologies, in particular alcoholism, is highly dependent upon our ability to identify patterns of genetic and environmental effects that influence a person's risk. Unfortunately, array-based whole genome investigations into heritable factors that explain why one person becomes dependent upon alcohol and another does not, have indicated that alcohol's genetic architecture is highly complex.

That said, uncovering and interpreting the missing heritability in alcohol genetics research has become all the more important, especially since the problem may extend to our inability to model the cumulative and combinatorial relationships between common and rare genetic variants.

As numerous studies begin to illustrate the dependency of alcohol pharmacotherapies on an individual's genotype, the field is further challenged to identify new ways to transcend agnostic genomewide association approaches.

We discuss insights from genetic studies of alcohol related diseases, as well as issues surrounding alcohol's genetic complexity and etiological heterogeneity.

Finally, we describe the need for innovative systems-based approaches (Systems Genetics) that can provide additional statistical power that can enhance future gene-finding strategies and help to identify heretofore-unrealized mechanisms that may provide new targets for prevention/treatments efforts.

Emerging evidence from early studies suggest that Systems Genetics has the potential to organize our neurological, pharmacological, and genetic understanding of alcohol dependence into a biologically plausible framework that represents how perturbations across evolutionarily robust biological systems determine susceptibility to alcohol dependence.

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Request Reprint E-Mail: Roha_Palmer@Brown.edu

Missed and Inconsistent Classification of Current Drinkers: Results from the 2005 US National Alcohol Survey

This study compares current 12-month drinkers who do not report drinking in the last 30 days with current drinkers who drank in the last 30 days and assesses possible misclassification errors from use of a 30-day consumption measure.

Data are from the 2005 US National Alcohol Survey (N=6919), a national household probability survey.

Telephone interviews were used to measure alcohol use and alcohol-related problems.

This study compared 1,300 current drinkers who did not drink in the last 30 days with 2,956 current drinkers who drank in the last 30 days.

Volume was measured by Quantity/Frequency Scales (12-month and 30-day) and a Graduated Frequency Scale (12-month). Both groups were compared by demographic, alcohol volume, days of 5 or more drinks, social consequences and dependence measures.

Results indicate a significantly lower prevalence rate of current drinking for 30-day measures - 47.3% (45.8%, 48.8%) versus 67.3% (66.0%, 68.7%) with 12-month measure. Further, 385 non 30-day drinkers reported 12-month drinking frequencies of once a month or more often, suggesting a possibly inconsistent reporting of their alcohol use. When this group of “inconsistent” respondents is compared with the 915 non 30-day current drinkers who reported less than monthly drinking, they reported significantly higher yearly volume, days of 5 or more drinks, mean social consequences, and proportion reporting alcohol dependence.

In population surveys assessing alcohol use, asking about the previous 12 months rather than the past 30 days provides higher estimates of current use including more days of heavy episodic use.

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Request Reprint E-Mail: lmidanik@berkeley.edu

Sunday, September 16, 2012

Addressing fetal alcohol spectrum disorder in Australia

This report was produced by the National Indigenous Drug and Alcohol Committee as a position paper on fetal alcohol spectrum disorder (FASD). The report contains an overview of FASD in Australia, including the health and social impacts of alcohol use during pregnancy. The report also contains recommendations to address the condition, which include:

implementing broad ranging social marketing campaigns to raise awareness of FASD, and the risks to the fetus or baby if the mother consumes alcohol while pregnant and breastfeeding
supporting health professionals and services through the development of national policy and clinical practice guidelines, as well as workforce development and training.

NIDAC officially released this position paper on the opening day of the NIDAC conference (6 June 2012).

Abstract adapted from National Indigenous Drug and Alcohol Committee

Possible barriers to enrollment in substance abuse treatment among a diverse sample of Asian Americans and Pacific Islanders: Opinions of treatment cl

This mixed methods study examined motivations and barriers to substance abuse treatment entry and treatment continuation among Asian American and Pacific Islander (AAPI) substance users.

AAPI substance users (N = 61) were recruited from substance abuse treatment programs in California and Hawaii. Semi-structured interviews and interviewer-administered surveys assessed barriers and facilitators to entering substance abuse treatment. Barriers included peer pressure, family influences, and face loss concerns. Facilitators included peer support, involvement in the criminal justice system, a perceived need for treatment, and culturally competent substance abuse treatment services. Family and peer influences may act as both facilitators and impediments.

AAPI substance using populations face many of the same individual-level and structural and systems barriers to entry to treatment as other substance using populations.

However, similar to other racial/ethnic minority groups, it is important to address cultural differences and develop culturally competent substance abuse treatments for the AAPI population.

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Request Rerprint E-Mail: carmen.masson@ucsf.edu

Extended-release naltrexone plus medical management alcohol treatment in primary care: findings at 15 months

The feasibility of long-term extended-release naltrexone (XR-NTX) alcohol treatment is unknown. Following an initial 12-week, single-arm, observational trial of XR-NTX plus medical management (MM) in primary care, we offered 48 additional weeks of XR-NTX treatment (12 additional monthly injections) in two public primary care clinics as a naturalistic extension study.

Of 65 alcohol dependent adults initiating XR-NTX treatment, 40 (62%) completed the initial 12-week XR-NTX observational trial, and 19 (29%) continued treatment for a median of 38 weeks total (range, 16–72 weeks; median 8 total XR-NTX injections).

Among active extension phase participants, self-reported rates of drinking days (vs. last 30 days pre-treatment baseline) were low: median 0.2 vs. 6.0 drinks per day; 82 vs. 38% days abstinent; 11 vs. 61% heavy drinking days.

Long-term XR-NTX treatment in a primary care MM model was feasible and may promote lasting drinking reductions or alcohol abstinence.

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Request Reprint E-Mail: joshua.lee@med.nyu.edu

ALCOHOL CONSUMPTION AND MAJOR DEPRESSION IN THE GENERAL POPULATION: THE CRITICAL IMPORTANCE OF DEPENDENCE

Substance use disorders and major depressive episodes (MDEs) often co-occur. Alcohol consumption may contribute to the aetiology of depressive episodes and/or vice versa. In Canada, the National Population Health Survey (NPHS) evaluated several aspects of alcohol use and MDE in a large population cohort over 12 years of follow-up. We evaluated the incidence of MDE in relation to different patterns of alcohol use, and examined the incidence of alcohol misuse in respondents with and without MDE.

The NPHS is a longitudinal study that began data collection in 1994 and whose cohort has been followed with biannual interviews. These interviews assess MDE using the Composite International Diagnostic Interview Short Form for Major Depression (CIDI-SFMD). Another CIDI-SF module assessed alcohol dependence during two interviews. Any alcohol consumption, exceeding moderate drinking guidelines and binge drinking were also assessed. We used logistic regression and proportional hazards models to assess longitudinal relationships between these variables

Respondents with alcohol dependence were at higher risk of MDE, but any alcohol consumption, exceeding guidelines for moderate drinking and binge drinking were not. Respondents with MDE showed no increase of alcohol consumption, but the risk of alcohol dependence was elevated in depressed men.

Of direct clinical significance is the bidirectional relationship between alcohol dependence and MDE. Associations between alcohol consumption and MDE were not observed except when dependence was indicated. Alcohol dependence increased the risk of MDE, and MDE increased the risk of alcohol dependence, but only in men.

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Request Reprint E-Mail: bulloch@ucalgary.ca

FASD News - 37/2012

NEWS AND ARTICLES

NIH (USA) - NIH statement on International FASD Awareness Day

International Fetal Alcohol Spectrum Disorders (FASD) Awareness Day, recognized every year on the ninth day of the ninth month, is an important reminder that prenatal alcohol exposure is the leading preventable cause of birth defects and developmental disorders in the United States.
Read more

CDC (USA) - Fetal Alcohol Spectrum Disorders Awareness Day

September 9th is Fetal Alcohol Spectrum Disorders (FASDs) Awareness Day. Drinking alcohol during pregnancy can cause FASDs. Read about Melissa’s experience with alcohol use during pregnancy. Information about the new FASD app is also provided.

WellandTribune (Canada) - Give children with FASD opportunities to shine

Five years ago, if someone had told Melanie her adopted daughter would win three gold medals in a figure skating competition, she would have laughed. Her daughter, now nine years old, was born with fetal alcohol spectrum disorder — an umbrella term used to describe the issues experienced by someone whose mother drank during pregnancy.

The Chronicle Journal (Canada) - Fetal alcohol syndrome awareness on the rise

It takes a community to raise a child and to heal a child. Fetal alcohol spectrum disorder is a life-long illness that not only requires physical care, but spiritual care as well.

CBS Atlanta (USA) - At Emory University, experts try new approach to treating fetal alcohol syndrome

Health experts from the American Academy of Pediatrics issued a recommendation last week that every child be screened for Fetal Alcohol Syndrome. It is believed that nearly one in every three women drink while they're pregnant, and experts at Emory University have started a new approach to the treatment of those babies born with FAS.

The Canberra Times (Australia) - Alcohol in pregnancy warning

Drinking alcohol during pregnancy can be more damaging to an unborn child than smoking or consuming other potential toxins, according to a leading expert on foetal alcohol spectrum disorder.

The New Age Online (South Africa) - Sobriety Week hopes to reduce high FAS statistics

As South Africa marks its annual Sobriety Week, the DA in the province says it is “deeply concerned that (alcohol abuse in pregnancy) statistics remain unacceptably high”.

RESOURCES

NOFAS-UK - Resources for teachers

Below is a list of resources about the issues and challenges faced by students with FASD and those working with them in UK educational settings.

NOFAS-UK - Educating Children and Young People with Fetal Alcohol Spectrum Disorders: Constructing Personalised Pathways to Learning

The range of learning difficulties associated with children and young people who have Fetal Alcohol Spectrum Disorders (FASD) has been highlighted as an emerging but little understood area of Special Educational Needs.

SSAT - Complex Learning Difficulties and Disabilities (CLDD) research project

The Department for Education identified through feedback from schools that educators needed a new teaching and learning framework to meet the needs of children and young people with Complex Learning Difficulties and Disabilities (CLDD). SSAT was commissioned to develop resources to support schools in educating these children.

CCSA - Fetal Alcohol Spectrum Disorder (FASD) Readings and Resources

This page is intended to support Canadian practitioners addressing FASD by:

Providing recent, accurate information on the important and complex issue of substance use and pregnancy through this Web section and through a toll-free telephone information and reference service; and Serving as a gateway to other credible Canadian sources of information.

Human Relations Media - UNDERSTANDING FETAL ALCOHOL SYNDROME

In this video, viewers meet Liz, a teenager who is afflicted with Fetal Alcohol Syndrome (FAS) because her mother drank alcohol during her pregnancy. FAS represents a spectrum of physical and emotional disorders that occur because of alcohol poisoning before birth.

NCBI (USA) - Resources for Fetal Alcohol Syndrome

RESEARCH

Pediatrics - Blood Alcohol Levels for American Indian Mothers and Newborns

elmadrassa - Children with fetal disorders (FASD) have more severe behavioral problems that children with attention deficit hyperactivity disorder (ADHD), according to a study

Our results show that, overall, children with FASD have more severe behavioral problems, said Bush. In terms of social cognition and emotional processing, the base deficit in FASD appears to be the understanding and interpretation of another state of mind and emotions.

Hindawi - Severe Gastrooesophageal Reflux Disease Associated with Foetal Alcohol Syndrome

Prenatal alcohol exposure may have adverse effects on the developing foetus resulting in significant growth restriction, characteristic craniofacial features, and central nervous system dysfunction. The toxic effects of alcohol on the developing brain are well recognised.

Saturday, September 15, 2012

Editor's Notes

Editor's Notes

A message from Robert West, Editor-in-Chief

It is with great sadness that I have to announce tha

t Professor Griffith Edwards has died. Griffith was a towering figure in our field and he was active in the journal and filled with extra-ordinary intellectual and creative energy to the end. We will be setting up a number of projects to respect his memory and take his vision forward. If you wish to send message of goodwill to his family, please email Gill Rangel: gill@addictionjournal.org

Friday, September 14, 2012

Blood Alcohol Levels for American Indian Mothers and Newborns

Very little is known about the alcohol elimination rates of newborns who have had chronic alcohol exposure in utero.

In these case reports, blood alcohol levels were taken immediately before delivery, at delivery, and postdelivery for 2 mothers who drank alcohol during their pregnancies and 3 single-birth newborns.

Newborn A1 of Mother A had no physical characteristics of fetal alcohol syndrome (FAS). The initial blood alcohol level for this newborn was 38.4 mg/dL 129 minutes after birth, with a subsequent blood alcohol level of 5.5 mg/dL 304 minutes after delivery, resulting in an alcohol elimination rate of 11.3 mg/dL per hour. The blood alcohol level for Mother A was 87.4 mg/dL 66 minutes before delivery.

Newborn A2 of mother A had FAS. Sixty minutes after delivery, the blood alcohol level for this newborn was 39.5 mg/dL, and the alcohol level of the mother was 42.1 mg/dL.

Newborn B1 of mother B had FAS. At 67 minutes after birth, newborn B1 had a blood alcohol level of 246.5 mg/dL, which dropped to 178.7 mg/dL 302 minutes after birth, resulting in an alcohol elimination rate of 17.3 mg/dL per hour. This alcohol elimination rate is within the metabolism range (15–49 mg/dL per hour) of adults with alcoholism. The maternal blood alcohol level was 265.9 mg/dL 27 minutes before delivery.

Blood alcohol levels drawn on both the mother and newborn at delivery and 2 or 3 hourly follow-up levels can provide evidence that fetal alcohol dehydrogenase activity is induced by chronic maternal alcohol use.

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Request Reprint E-Mail: kvig6@aol.com

Thursday, September 13, 2012

Global Actions September 13, 2012

Key Recent Milestones:

· Worldwide: More speakers have been added to the agenda for the international conference Global Actions: Initiatives to Reduce Harmful Drinking to be held October 8 and 9, 2012 in Washington, D.C. Visit the event website for a full agenda.

Global Actions in Focus: Drink Driving Progress in China

Global Actions drink driving initiatives are progressing in Xi’an and Nanjing, China with successful public awareness campaigns in place. Education materials have been widely distributed in both cities and major media outlets have reported on the campaigns.

A total of 40,000 fans containing drink driving safety education information were distributed to primary and middle school students in Xi’an (see photo). Billboards and posters have been set up at bus stations, taxi companies, and driver schools, and 3,000 fans distributed to drivers and passengers.

Education information is now available on flat panel displays (pictured) in the back seats of 15,000 taxis in Xi’an. In addition, the Xi’an Health Inspection Station has distributed 4,000 posters to catering and entertainment venues.

Similar interventions are being implemented in Nanjing, with 23,000 educational brochures given to drivers, and billboards set up at vehicle inspection stations. In residential areas throughout Nanjing, 27,000 brochures have been handed to citizens. Five one-hour lectures were organized and administered to over 200 drink driving offenders.

Local media outreach is a key component of the campaign. Xi’an’s television station welcomed Xi’an Bureau of Public Security’s Mr. Tianjun, Xi’an Hospital Deputy Director Ms. Zhi Yiqin, and Xi’an Institute for Health Education Director Ms. Chen as invited guests. Newspapers, television, and radio stations across Xi’an and Nanjing have lent support with extensive coverage of the initiatives.

Enhanced enforcement operations by traffic police are currently underway in both cities. Global Actions partners in this initiative include the Nanjing Traffic Management Bureau and the Xi’an Institute for Health Education.

What’s Happening Next:

· France: The second HEC Paris Workshop on “Regulation: Regulating Lifestyle Risks in Europe - The Case of Alcohol, Tobacco, Unhealthy Diets & Gambling” will take place September 20 and 21, 2012. Visit the HEC website for program information.

Aims