Fetal Alcohol-Related Growth Restriction from Birth through Young Adulthood and Moderating Effects of Maternal Prepregnancy Weight

Fetal alcohol-related growth restriction persists through infancy, but its impact later in life is less clear. Animal studies have demonstrated important roles for maternal nutrition in fetal alcohol spectrum disorders, but the impact of prenatal maternal body composition has not been studied in humans. This study examined the effects of prenatal alcohol exposure on longitudinal growth from birth through young adulthood and the degree to which maternal weight and body mass index (BMI) moderate these effects.

Nearly 480 mothers were recruited at their first prenatal clinic visit to overrepresent moderate-to-heavy use of alcohol during pregnancy, including a 5% random sample of low-level drinkers and abstainers. They were interviewed at every prenatal visit about their alcohol consumption using a timeline follow-back approach. Their children were examined for weight, length/height, and head circumference at birth, 6.5 and 13 months, and 7.5, 14, and 19 years.

In multiple regression models with repeated measures (adjusted for confounders), prenatal alcohol exposure was associated with longitudinal reductions in weight, height, and weight-for-length/BMI that were largely determined at birth. At low-to-moderate levels of exposure, these effects were more severe in infancy than in later childhood. By contrast, effects persisted among children whose mothers drank at least monthly and among those born to women with alcohol abuse and/or dependence who had consumed ≥ 4 drinks/occasion. In addition, effects on weight, height, and head circumference were markedly stronger among children born to mothers with lower prepregnancy weight.

These findings confirm prior studies demonstrating alcohol-related reductions in weight, height, weight-for-height/BMI, and head circumference that persist through young adulthood. Stronger effects were seen among children born to mothers with smaller prepregnancy weight, which may have been because of attainment of higher blood alcohol concentrations in smaller mothers for a given amount of alcohol intake or to increased vulnerability in infants born to women with poorer nutrition.


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Request Reprint E-Mail:    RobertColin.Carter@childrens.harvard.edu

Chronic Alcohol Ingestion in Rats Decreases Krüppel-Like Factor 4 Expression and Intracellular Zinc in the Lung

Chronic alcohol ingestion alters the dynamic balance between granulocyte-macrophage colony-stimulating factor (GM-CSF) and transforming growth factor beta1 (TGFβ1) signaling within the alveolar space and, in parallel, impairs alveolar macrophage and epithelial cell function by inhibiting expression of the zinc importer ZIP4 and decreasing zinc bioavailability in the alveolar compartment. As the transcription factor Krüppel-like factor 4 (KLF4) binds to ZIP4, we hypothesized that alcohol exposure and consequent perturbations in GM-CSF and TGFβ1 signaling could decrease cellular KLF4 expression and/or binding as a mechanism by which it inhibits ZIP4 expression and decreases cellular zinc levels.

Alcohol exposure in vitro or chronic ingestion in vivo decreased KLF4 expression in alveolar macrophages and epithelial cells. Treatment with GM-CSF or TGFβ1 showed an enhancing or dampening effect on KLF4 expression and binding, respectively. Further, treatment of a rat alveolar macrophage cell line with alcohol in vitro for 4 weeks decreased the expression of the zinc transporters ZIP4 and ZNT1, and of the zinc storage protein metallothionein 1. In parallel, treating these macrophages with KLF4 siRNA decreased ZIP4 expression and decreased cellular zinc and phagocytic capacity to levels equivalent to those following alcohol exposure. In epithelial monolayers, transepithelial electrical resistance (TER) was significantly decreased by alcohol ingestion as compared with control diets, and it was restored by in vitro GM-CSF treatment. In contrast, in vitro TGFβ1 treatment of the epithelial monolayers from control-fed rats significantly decreased TER as compared with untreated control monolayers.

Taken together, these results suggest that within the alveolar space, chronic alcohol exposure decreases KLF4 and ZIP4 expression and consequently decreases zinc transport into cells, which, in turn, impairs their function. Furthermore, the dynamic decrease in the relative influence of GM-CSF versus TGFβ1 could mediate the zinc deficiency and consequent cellular dysfunction that characterize the “alcoholic lung” phenotype.

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Request Reprint E-Mail:    pcjoshi@emory.edu

Commentary: How Ethanol Short-Circuits the Cerebellum—Actions on Golgi Cells in Freely—Moving Animals

This commentary discusses the important contributions of the article published in this journal by Huang and colleagues, titled, “Acute ethanol exposure increases firing and induces oscillations in cerebellar Golgi cells of freely moving rats.” 

In this manuscript, Huang and colleagues present a number of interesting and important findings. While it has been shown previously that ethanol (EtOH) causes an increase in the firing of cerebellar Golgi cells in brain slice preparations and anesthetized animals, here the authors provide the first evidence that this action of EtOH occurs in vivo in freely moving, unanesthetized animals. 

These results also enhance our understanding of cerebellar functioning by describing the mechanism by which EtOH essentially de-afferentates (blocks specific inputs to) the cerebellum from the normal processing of sensory signals due to EtOH-induced Golgi neuron excitation, resulting in inhibition of granule cells. 

Furthermore, the authors characterize the novel observation of EtOH-induced neuronal oscillations, which was not previously observed in other preparations.


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Request Reprint E-Mail:    ron.freund@ucdenver.edu

Does Stress Increase Imitation of Drinking Behavior? An Experimental Study in a (Semi-)Naturalistic Context

That alcohol consumption is strongly influenced by the drinking behavior of social company has been demonstrated in observational research. However, not everyone is equally vulnerable to other people's drinking, and it is important to unravel which factors underlie these individual differences. This study focuses on the role of psychosocial stress in attempting to explain individual differences in the propensity to imitate alcohol consumption.

With a 2 (confederate's drinking condition: alcohol vs. soda) × 2 (participant's stress condition: stress vs. no stress) experimental design, we tested whether the tendency to imitate other people's drinking was related to participants' induced stress levels. The young male adults (N = 106) were randomly assigned to each of the conditions. In each session, directly after the stress or no-stress period, confederates and participants entered a bar laboratory where we observed their drinking behavior. Prior to entering the session, confederates were instructed to drink alcohol or soda.

Participants in both stress and no-stress conditions consumed substantially more alcohol when confederates drank alcohol than when they drank soda. There was no difference in alcohol consumed between stress and no-stress conditions. No moderating effect of stress on the tendency to drink along with peers was found.

Generally, it appears that among young male adults, imitation of alcohol consumption is a robust phenomenon not dependent on individual stress levels.


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Request Reprint E-Mail:   H.Larsen@uva.nl

Age of Onset and Neuropsychological Functioning in Alcohol Dependent Inpatients

Differences in clinical characteristics between early and late onset alcohol dependent patients have been examined intensively, but little is known about the differences in neuropsychological functioning between these patient groups. Clinical characteristics and neuropsychological functions of inpatients with early onset and late onset alcohol dependence are therefore investigated in this study.

Ninety-three abstinent alcohol dependent inpatients meeting a current diagnosis of DSM-IV alcohol dependence were divided into early onset alcohol dependent patients (EOA; ≤25 years; n = 36) and late onset alcohol dependent patients (LOA; >25 years; n = 57). Patients using psychoactive medication and patients dependent on other substances than alcohol (and nicotine) were excluded. A comprehensive neuropsychological test battery was administered.

EOA reported higher trait impulsivity, antisocial traits, and attention deficit hyperactivity disorder-related traits and exhibited an impulsive reflection style, especially in a high-risk context, compared with LOA. Against expectations, EOA performed significantly better on measures of planning, cognitive control, visual memory, and delayed recognition memory than LOA, whereas no significant group differences occurred on measures of delay discounting, digit span, and attention. Better Stroop interference, better visual memory, and a more impulsive reflection style was predictive of an early age of onset, and explained a significant and additional amount of variance (18.8%) on top of the clinical characteristics, together explaining 53.4% of the variance.

Both clinical characteristics and neuropsychological variables contributed independently to the age of onset of problematic alcohol use. Results indicate that especially an impulsive reflection style, besides higher trait impulsivity, may be the core feature of early onset alcohol dependence. However, the contribution of the neuropsychological variables is complex and more research is needed to clarify the role of psychiatric comorbidity and poly-substance abuse in an unselected sample of alcohol dependent patients.



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Request Reprint E-Mail:   leen.joos@ua.ac.be

ntranasal Oxytocin Blocks Alcohol Withdrawal in Human Subjects

The neuropeptide, oxytocin (OT), has been reported to block tolerance formation to alcohol and decrease withdrawal symptoms in alcohol-dependent rodents. Numerous recent studies in human subjects indicate that OT administered by the intranasal route penetrates into and exerts effects within the brain.

In a randomized, double-blind clinical trial, intranasal OT (24 IU/dose, N = 7) or placebo (N = 4) was given twice daily for 3 days in alcohol-dependent subjects admitted to a research unit for medical detoxification using Clinical Institute Withdrawal Assessment for Alcohol (CIWA) score-driven PRN administration of lorazepam. Subjects rated themselves on the Alcohol Withdrawal Symptom Checklist (AWSC) each time CIWA scores were obtained. Subjects also completed the Penn Alcohol Craving Scale, an Alcohol Craving Visual Analog Scale (ACVAS) and the Profile of Mood States (POMS) on inpatient days 2 and 3.

All subjects had drunk heavily each day for at least 2 weeks prior to study and had previously experienced withdrawal upon stopping/decreasing alcohol consumption. OT was superior to placebo in reducing alcohol withdrawal as evidenced by: less total lorazepam required to complete detoxification (3.4 mg [4.7, SD] vs. 16.5 [4.4], p = 0.0015), lower mean CIWA scores on admission day 1 (4.3 [2.3] vs. 11.8 [0.4], p < 0.0001) and day 2 (3.4 [2.2] vs. 11.1 [3.6], p < 0.002), lower AWSC scores on days 1 and 2 (p < 0.02; p = 0.07), and lower ACVAS ratings (p = 0.01) and lower POMS Tension/Anxiety subscale scores on day 2 (p < 0.01).

This is the first demonstration that OT treatment may block alcohol withdrawal in human subjects. Our results are consistent with previous findings in rodents that OT inhibits neuroadaptation to and withdrawal from alcohol. OT could have advantages over benzodiazepines in managing alcohol withdrawal because it may reverse rather than maintain sedative-hypnotic tolerance. It will be important to test whether OT treatment is effective in reducing drinking in alcohol-dependent outpatients.


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

Sobering - The British love affair with the bottle appears to be ending

EARLIER this year David Cameron announced a crackdown on binge drinking. Using a five-year-old survey to illustrate the dissolute state of Britain’s youth, the prime minister suggested that boozing was a perennial problem. But following a peak around the millennium (when drinking hit levels not reached since before the first world war) sobriety has set in. Since 2004 alcohol consumption has dropped by one-eighth, to 8.3 litres per person per year, according to an official survey. Tax receipts tell a similar story.

The young are leading. In 2003 70% of 16- to 24-year-olds told interviewers they had had a drink in the previous week; by 2010 just 48% had. The proportion of 11- to 15-year-olds who had drunk in the previous week halved over the same period. Heavy drinking sessions are down too. (By contrast, drinking among older age groups has remained steady since the late 1990s.) The fate of “alcopops” is indicative. Luridly coloured and aimed at young women, they invited tabloid disdain. But today’s teenagers are unimpressed (see article).  > > > >   Read More

Measurement of Ethyl Glucuronide, Ethyl Sulphate and Their Ratio in the Urine and Serum of Healthy Volunteers after Two Doses of Alcohol

Ethyl glucuronide (EtG) and ethyl sulphate (EtS) are minor metabolites of ethanol, and their presence in urine provides a strong indication of recent alcohol administration. In this study, we performed a drinking experiment to investigate the kinetics of EtG and EtS formation and elimination after the administration of two doses of alcohol. 

Nineteen volunteers provided urine and serum (only 18) after administration of 4 and 8 units of alcohol (1 unit corresponds to 10 ml or ∼8 g of pure ethanol). The analysis was performed using a validated ultra-performance liquid chromatography-mass spectrometry (UPLC^®-MS/MS) method. 

After 4 units, the median EtG maximum concentration (C_max) was 0.4 µg/ml and the interquartile range (0.3 µg/ml) in serum and 3.5 mg/h (1.2 mg/h) in urine and were reached (T_max) after 2.0 h (0.8 h) and 3.0 h (1.0 h), respectively. EtS C_max was 0.2 µg/ml (0.1 µg/ml) in serum and 1.3 mg/h (0.6 mg/h) in urine, and the corresponding T_max were 1.0 h (1.0 h) and 2.0 h (0.5 h). After 8 units, EtG C_max was 1.3 µg/ml (0.4 µg/ml) in serum and 10 mg/h (3.4 mg/h) in urine and was reached after 4.0 h (1.8 h) and 4.0 h (2.0 h), respectively. EtS C_max was 0.6 µg/ml (0.1 µg/ml) in serum and 3.5 mg/h (1.1 mg/h) in urine, the corresponding T_max were 3.0 h (1.0 h) and 3.0 h (1.0 h). The EtG/EtS ratio increased as a function of the time after alcohol administration in both serum and urine samples but to a lesser extent after 8 units than 4. 

These results correlate with values obtained in previous studies. T_max of EtG and EtS increased between 4 and 8 units. The EtG:EtS ratio increased in the serum and urine samples of all volunteers as a function of time at least up to 4 h after alcohol administration.


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Request Reprint E-Mail:   david.cowan@kcl.ac.uk

Introducing FISD: Local alcohol and drug prevention in Sri Lanka

FISD recently celebrated their first anniversary, as the organization was founded only one year ago, in August 2012. The anniversary was used to launch a new Newsletter and the FISD web site. FISD was founded in the wake of the re-organization of FORUT’s programs in Sri Lanka, and the organization is now a partner to FORUT.


Alcohol, Drugs and Development is one of FISD’s three program areas, together with Child Rights Protection and Gender & Development. As the name indicates, FISD has specialized in civil society participation and social mobilization as a development strategy. The aim is to enhance the status of women, to build a healthy environment for children, and to create a society free from alcohol, tobacco, and drugs.
Issue number two of the FISD newsletter gives some examples from local alcohol and drug prevention activities. Download the ADD presentation here.
Here is a more detailed presentation of the alcohol and drug prevention work of FISD.
FISD explains their approach: “While development has become a main area of concern for many government and nongovernmental organizations, the main focus at present tends to be on physical and infrastructure development. There are limited expertise and programs concerning social development, an integral part of improving the quality of life of the people, which in turn is a key aspect of development.
Recognizing this need for expertise and programs in the area of social development, we have identified three key areas of interest and have developed expertise concentrating on these areas, namely, the prevention of drugs and alcohol, the protection and promotion of child rights, and women and development (with particular focus on the prevention of gender based violence).
In addition working with civil society organizations, we facilitate the mobilization of the communities, enabling them to advocate for improvement in these areas. One of the special features of our programs is that they take an innovative approach based on evidence and research.”

Over the Limit: The Truth about Families and Alcohol

Over the Limit: The Truth about Families and Alcohol, warns of a silent epidemic of alcohol misuse by British families. The report warns that too many parents remain oblivious to the negative effects that alcohol can have on their parenting. An alarming 19% believe alcohol has a positive effect on their parenting ability and 62% of parents say that their drinking behaviour has no impact on their family at all.

Some of the key findings the report highlights are:

• 22% of children live with a parent who drinks hazardously
• 6% of children (around 700,000 across the country) live with a dependent drinker
• 62% of children who were subject to care proceedings were from families with parental alcohol misuse
• More than a third of all domestic violence cases involve alcohol

The report warns of the stark reality of life for families where drinking has reached hazardous levels and is calling for a series of wide ranging reforms including a commitment from the alcohol industry to recognise their responsibility to the wellbeing of consumers by diverting 1% of revenue to fund a new alcohol awareness campaign aimed at families.

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Jeter’s Leaders’ Return to NIH - Teens Team Up with NIH Scientists to Explore the Developing Brain

For Derek Jeter and his New York Yankees teammates, the dog days of summer usually mean it’s time to make another run at the pennant. But for Jeter’s Leaders—the baseball star’s teen outreach program—it’s time for another road trip to NIH. For over a decade, NIAAA has arranged site visits to Bethesda for the group. Recently, nearly 100 high schoolers from Michigan and New York came to campus to meet NIH scientists and to explore research on alcohol and the developing brain.

It was the largest contingent of participants to date, according to NIAAA public liaison officer Fred Donodeo. He started the collaboration in 2001 with a call to the Turn 2 Foundation, Jeter’s charity organization. The leadership program promotes social activism, academics and healthy lifestyles free of alcohol and substance use.

The students enjoyed a full day of science-based activities and presentations. Donodeo led things off with an NIH overview, followed by a Clinical Center tour with Greg Roa. Dr. Dan Falk from NIAAA’s Division of Treatment and Recovery Research led a question-and-answer session with the group.

Next, the students watched videos on underage drinking and fetal alcohol spectrum disorders. Then Donodeo threw the high schoolers a change-up: he challenged them to record their own short videos about what they had learned. “Everyone had a lot of fun in front of the camera and many of the kids did an impressive job voicing the importance of healthy choices,” said Donodeo.   > > > >   Read More

The Deluded World of Addiction Experts - Addiction experts are deniers of reality!

Following are five key ways in which addiction experts demonstrate this detachment from the most self-evident truths about addiction, and what causes their addiction delusions.

I. Most People Get Over Addiction. I have driven home the points revealed by the NIAAA’s NESARC research – the largest study of alcoholism ever conducted – ad nauseam. Three quarters of people overcome alcoholism, far and away most often without treatment, most without abstaining. The research led the NIAAA to announce its discovery that “alcoholism isn’t what it used to be,” reversing decades of the NIAAA's forceful adherence to disease and abstinence memes. Meanwhile, the NIDA’s National Survey on Drug Use and Health shows that peak abuse of and dependence on drugs and alcohol occurs from ages 18 to 25, and declines by a third after age 25, and by half after age 30.   > > > >  Read More

Alcohol, diabetes, and public health in the Americas

This article describes epidemiological evidence on the association between alcohol use and diabetes, and the  implications for clinical management and public health policies in the Americas. 

Heavy alcohol use is a risk factor for both diabetes and poor treatment adherence, despite evidence that moderate drinking can protect against type 2 diabetes under some circumstances. The burden of disease from diabetes associated with excessive alcohol consumption warrants both
clinical and public health measures. 

On the clinical level, research on early interventions to prevent hazardous drinking shows that new screening, brief intervention, and referral techniques are effective ways to manage hazardous drinking in primary care settings. 

On the population level, restrictions on alcohol marketing and other alcohol control policies reduce the frequency and intensity of alcohol consumption in at-risk populations. 

These policy actions are recommended within the context of the World Health Organization’s global strategy to reduce the harmful use of alcohol.


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Partnerships: survey respondents’ perceptions of inter-professional collaboration to address alcohol-related harms in England

Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multi-component programmes in the United States, Australia and Europe. Partnership working, already embedded in service delivery structures, is a core mechanism for delivery of the new UK Government Alcohol Strategy. 

This article reports findings from a study of alcohol partnerships across England. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. 

Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. 

Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed.


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Request Reprint E-Mail:   b.thom@mdx.ac.uk

Alcohol industry influence on UK alcohol policy: a new research agenda for public health

The British government has been criticised for according industry interests too much weight in alcohol policy-making. Consequently, it has been argued that alcohol strategy in the UK is built around policies for which the evidence base is weak. This has clear implications for public health. 

The purpose of this commentary is to map recent developments in UK alcohol policy and related debates within the alcohol policy literature, thus laying the foundations for a systematic examination of the influence of the alcohol industry on alcohol policy. 

It highlights the changing structure of the industry and summarises what is known about the positions and strategies of industry actors towards alcohol policy. In so doing, it aims to contribute not just to debates about alcohol policy, but to a broader understanding of health policy processes and the relationships between government and other stakeholders. 

It advances a new research agenda focused on the role of corporate actors in the field of alcohol policy and public health more broadly.


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Commentary - Dealing Responsibly with the Alcohol Industry in London

The 2012 UK Government's Alcohol Strategy for England and Wales has been welcomed broadly and resulted only in muted criticism within the UK public health community. This is despite strong continuities with previous alcohol industry constructions of the nature of the problem and preferred policy responses. 

This is probably because the strategy shows progress on the public health lobby's key issue of pricing of alcohol beverages. There are, however, many problems with the wider content of the strategy, showing little interest in much needed industry regulation other than on price, and an absence of commitment to investment in research. Some dilemmas posed for the research community are discussed.            


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Global Actions October 3, 2012

Key Recent Milestones: 

·         Colombia: Global Actions completed evaluation of sobriety checkpoints in Chia, Colombia. The checkpoints are part of phase two of the “Project Patrullero” campaign to reduce drink driving in the city. 


Global Actions in Focus: Global Actions Conference 

The first of its kind international conference on alcohol policy, Global Actions: Initiatives to Reduce Harmful Drinking will be held October 8 and 9, 2012 at the Capital Hilton hotel in Washington D.C. 



Participants from 45 countries representing over 140 different government, industry, and health organizations will be attending. 

More than two years after WHO’s adoption of the Global Strategy to Reduce the Harmful Use of Alcohol, the conference will take stock of industry actions in support of the strategy and deliver news about important future commitments being made for 2013 and beyond. 

On the first day of the two-day event, Ambassador & Permanent Representative of the Republic of Kenya to the United Nations Tom Mboya Okeyo (in photo) and Brown-Forman Chairman & Chief Executive Officer Paul Varga will speak on “WHO Global Strategy: Making a Difference.” 

“This event will highlight our actions to reduce the abuse and misuse of beverage alcohol and underscores our commitment going forward,” said Varga. “While it is focused on industry’s role in addressing harmful drinking, we will benefit greatly from the viewpoints of a diversity of participants who share our concern.”



Conference keynote speakers include Pernod Ricard CEO Pierre Pringuet and Anheuser-Busch InBev CEO Carlos Brito. Visit the event website for more information on speakers, conference agenda, and initiatives: http://event.global-actions.org/ 

Follow the event Twitter feed @globalactions and visit our new ICAP Facebook page. Both will feature conference highlights and information before and during the event. 


What’s Happening Next:  

·         Canada: The 54th International Conference on Alcohol and Addiction hosted by the International Council on Alcohol and Addiction will be held in Montreal from November 12 to 15, 2012.  

Vital Signs: Drinking and Driving Among High School Students Aged ≥16 Years — United States, 1991–2011

CDC analyzed data from the 1991–2011 national Youth Risk Behavior Surveys (YRBS) to describe the trend in prevalence of drinking and driving (defined as driving one or more times when they had been drinking alcohol during the 30 days before the survey) among U.S. high school students aged ≥16 years. The 2011 national YRBS data were used to describe selected subgroup differences in drinking and driving, and 2011 state YRBSs data were used to describe drinking and driving prevalence in 41 states.

During 1991–2011, the national prevalence of self-reported drinking and driving among high school students aged ≥16 years declined by 54%, from 22.3% to 10.3%. In 2011, 84.6% of students who drove after drinking also binge drank. Drinking and driving prevalence varied threefold across 41 states, from 4.6% in Utah to 14.5% in North Dakota; higher prevalences were clustered among states in the upper Midwest and along the Gulf Coast.

Although substantial progress has been made during the past 2 decades to reduce drinking and driving among teens, in 2011, one in 10 students aged ≥16 years reported driving after drinking during the past 30 days. Most students who drove after drinking alcohol also binge drank.

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Alcohol consumption and the risk of incident atrial fibrillation among people with cardiovascular disease

Moderate alcohol consumption may reduce cardiovascular events, but little is known about its effect on atrial fibrillation in people at high risk of such events. We examined the association between moderate alcohol consumption and the risk of incident atrial fibrillation among older adults with existing cardiovascular disease or diabetes.

We analyzed data for 30 433 adults who participated in 2 large antihypertensive drug treatment trials and who had no atrial fibrillation at baseline. The patients were 55 years or older and had a history of cardiovascular disease or diabetes with end-organ damage. We classified levels of alcohol consumption according to median cut-off values for low, moderate and high intake based on guidelines used in various countries, and we defined binge drinking as more than 5 drinks a day. The primary outcome measure was incident atrial fibrillation.

A total of 2093 patients had incident atrial fibrillation. The age- and sex- standardized incidence rate per 1000 person-years was 14.5 among those with a low level of alcohol consumption, 17.3 among those with a moderate level and 20.8 among those with a high level. Compared with participants who had a low level of consumption, those with higher levels had an increased risk of incident atrial fibrillation (adjusted hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.04–1.26, for moderate consumption; 1.32, 95% CI 0.97–1.80, for high consumption). Results were similar after we excluded binge drinkers. Among those with moderate alcohol consumption, binge drinkers had an increased risk of atrial fibrillation compared with non–binge drinkers (adjusted HR 1.29, 95% CI 1.02–1.62).

Moderate to high alcohol intake was associated with an increased incidence of atrial fibrillation among people aged 55 or older with cardiovascular disease or diabetes. Among moderate drinkers, the effect of binge drinking on the risk of atrial fibrillation was similar to that of habitual heavy drinking.

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Activation of GABAA receptors suppresses ethanol-induced up-regulation of type 1 IP3 receptors†

Although type 1 inositol 1,4,5-trisphosphate receptors (IP3Rs-1) are one of the major calcium channels to regulate intracellular Ca²⁺ concentration, there have been few available data how their expression is modified by long-term exposure to ethanol.

The present study attempted to clarify mechanisms of modification of IP3R-1 expression during long-term ethanol exposure by γ-aminobutyric acid (GABA)A receptors using mouse cerebral cortical neurons.

Long-term exposure to ethanol induced IP3R-1 protein up-regulation following increased expression of its mRNA. Pre-treatment with muscimol, a selective GABAA receptor agonist, significantly suppressed the ethanol-induced up-regulation of IP3R-1 protein and its mRNA, which was significantly abolished by bicuculline, a selective GABAA receptor antagonist.

These results indicate that GABAA receptors negatively regulate the ethanol-induced up-regulation of IP3R-1 protein expression via the suppression of gene transcription


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Request Reprint E-Mail:    sohkuma@bcc.kawasaki-m.ac.jp

Long-term ethanol effects on acute stress responses: modulation by dynorphin

The brain stress-response system is critically involved in the addiction process, stimulating drug consumption and the relapse to drug taking in abstinent addicts. At the same time, its functioning is affected by chronic drug exposure. 

Here, we have investigated the role of the endogenous opioid peptide dynorphin as a modulator of effects of long-term ethanol consumption on the brain stress-response system. 

Using the two-bottle choice paradigm, we demonstrate an enhanced ethanol preference in male dynorphin knockout mice. Exposure to mild foot shock increased ethanol consumption in wild-type control littermates, but not in dynorphin-deficient animals. Blood adrenocorticotropic hormone levels determined 5 minutes after the shock were not affected by the genotype.

We also determined the neuronal reactivity after foot shock exposure using c-Fos immunoreactivity in limbic structures. This was strongly influenced by both genotype and chronic ethanol consumption. 

Long-term alcohol exposure elevated the foot shock-induced c-Fos expression in the basolateral amygdala in wild-type animals, but had the opposite effect in dynorphin-deficient mice. An altered c-Fos reactivity was also found in the periventricular nucleus, the thalamus and the hippocampus of dynorphin knockouts. 

Together these data suggest that dynorphin plays an important role in the modulation of the brain stress-response systems after chronic ethanol exposure.


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Request Reprint E-Mail:   neuro@uni-bonn.de

Rare ADH Variant Constellations are Specific for Alcohol Dependence

 
Some of the well-known functional alcohol dehydrogenase (ADH) gene variants (e.g. ADH1B*2, ADH1B*3 and ADH1C*2) that significantly affect the risk of alcohol dependence are rare variants in most populations. In the present study, we comprehensively examined the associations between rare ADH variants [minor allele frequency (MAF) <0 .05=".05" alcohol="alcohol" and="and" as="as" dependence="dependence" disorders="disorders" font="font" neurological="neurological" neuropsychiatric="neuropsychiatric" other="other" reference.="reference." several="several" with="with">

A total of 49,358 subjects in 22 independent cohorts with 11 different neuropsychiatric and neurological disorders were analyzed, including 3 cohorts with alcohol dependence. The entire ADH gene cluster (ADH7–ADH1C–ADH1B–ADH1A–ADH6–ADH4–ADH5 at Chr4) was imputed in all samples using the same reference panels that included whole-genome sequencing data. We stringently cleaned the phenotype and genotype data to obtain a total of 870 single nucleotide polymorphisms with 0< MAF <0 .05=".05" association="association" font="font" for="for"> analysis

We found that a rare variant constellation across the entire ADH gene cluster was significantly associated with alcohol dependence in European-Americans (Fp1: simulated global P = 0.045), European-Australians (Fp5: global P = 0.027; collapsing: P = 0.038) and African-Americans (Fp5: global P = 0.050; collapsing: P = 0.038), but not with any other neuropsychiatric disease. Association signals in this region came principally from ADH6, ADH7, ADH1B and ADH1C. In particular, a rare ADH6 variant constellation showed a replicable association with alcohol dependence across these three independent cohorts. No individual rare variants were statistically significantly associated with any disease examined after group- and region-wide correction for multiple comparisons. 

We conclude that rare ADH variants are specific for alcohol dependence. The ADH gene cluster may harbor a causal variant(s) for alcohol dependence.


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Request Reprint E-Mail:   xingguang.luo@yale.edu

Modelling the Cost-Effectiveness of Alcohol Screening and Brief Interventions in Primary Care in England

To estimate the cost-effectiveness and resourcing implications of universal alcohol screening and brief intervention (SBI) programmes in primary care in England. 

This was a health economic model, combining evidence of the effectiveness and health care resource requirements of SBI activities with existing epidemiological modelling of the relationship between alcohol consumption and health harms.

Screening patients on registration with a family doctor would steadily capture ∼40% of the population over a 10-year programme; screening patients at next primary care consultation would capture 96% of the population over the same period, but with high resourcing needs in the first year. The registration approach, delivered by a practice nurse, provides modest cost savings to the health care system of £120 m over 30 years. Health gains over the same period amount to 32,000 quality-adjusted life years (QALYs). This SBI programme still appears cost-effective (at £6900 per QALY gained) compared with no programme, under pessimistic effectiveness assumptions. Switching to a consultation approach, delivered by a doctor, would incur an incremental net cost of £108 m, with incremental health gains equivalent to 92,000 QALYs, giving an incremental cost-effectiveness ratio of £1175 per QALY gained compared with current practice. 

A universal programme of alcohol SBI in primary care is estimated to be cost-effective, under all but the most pessimistic assumptions for programme costs and effectiveness. Policymakers should ensure that SBI programmes are routinely evaluated and followed up, given the substantial uncertainty over the effects of many of the implementation details.


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Parents and children both affected by substance misuse: Adfam and Children's Commissioner reports call for recongition

A new report has identified parents as sufferers of abuse and violence from substance misusing children. The report by Adfam and Against Violence and Abuse (AVA) explores and documents Child to Parent Violence (CPV) and consulted with 88 parents seeking support from services.   > > > >   Read More 

Alcohol News - 40/2012

Suomi.fi (Finland) - Easy availability of alcohol increases risky drinking among the working aged

Moving to live near an on-site alcohol outlet increases the likelihood of risky alcohol behaviour. Moving further away may in turn decrease risky drinking. This was the conclusion of a recent Finnish study on the effect of the distance between home and an alcohol outlet on risky alcohol behaviour.

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Healthy Living (Sweden) - Heredity behind subjective effects of alcohol

‘The experience of every person to alcohol is an important tool to understand why some people develop alcoholism and may be an indicator in itself to find out how alcohol a person can develop. Our discovery is part of the work prevention that can help a certain group of people who are at risk of drinking too much alcohol.

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Marketplace.org (USA) - African-American youth seeing more alcohol ads

Young African-Americans are being exposed to substantially more ads for alcohol than the rest of their peers, according to report by the Johns Hopkins School of Public Health.

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NPR - Mini-Counseling Sessions Can Curb Problem Drinking

Brief counseling from primary care doctors reduces "risky" drinking, defined as having more than four drinks a day for men, three for women, a federal task force says.

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NEWS.com.au (Australia) - Survey shows growing support for ban on alcohol until 21

ONE in three people believe that the legal drinking age should be lifted from 18 to 21, a new survey has found.

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BBC News (UK) - UK government to back Scotland on minimum alcohol pricing

The UK government is to back the Scottish government when its minimum alcohol pricing legislation is challenged in the courts.

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Times Online (EU) - Minimum alcohol pricing is delayed as Europe mulls over free trade

SNP Ministers’ attempts to introduce a minimum price for alcohol could be delayed after questions over their legality were raised in Europe.

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General Surgery News - Alcohol Use Disorder Increases in Second Year After Bariatric Surgery

The prevalence of alcohol use disorder (AUD) increases in the second year after bariatric surgery compared with the year prior to surgery and postoperative year 1 (POY 1), according to a study in JAMA (2012;307:2516-2525).

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Irish Times (Ireland) - Fears for future of Shortall's alcohol strategy

CAMPAIGNERS AGAINST alcohol abuse say there is “huge concern” for the future of the Government’s plan to tackle the issue following the resignation of Róisín Shortall.

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Radio Prague (Chech Republic) - Czech government eases ban on liquor sales

Czech authorities believe they have the methanol crisis under control, and they have eased the ban on spirits sales. As of Thursday afternoon, hard liquor produced before 2012 can be sold without restrictions. But the government has also warned that the risk of poisoning is still very high as another two patients with methanol intoxication have been admitted to hospital over the last 24 hours.

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UPI.com (Thailand) - Thais prefer alcohol to milk

Residents of Thailand consume alcoholic beverages at a 3-to-1ratio over milk, a national campaign for healthy alternatives said.

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New Zealand Herald (New Zealand) - Sharp rise in drug and alcohol use in arrested people – study

A large number of people detained by police are drunk or on drugs at the time of their arrest, a new report shows.

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Medical Xpress - Effect of behavioral intervention on alcohol misuse evaluated

Behavioral counseling interventions may be beneficial for adults with risky drinking behaviors, according to a review and meta-analysis published online Sept. 25 in the Annals of Internal Medicine.

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The Guardian (Scotland) - Charity to support Scottish government in legal battle over alcohol price

A campaigning charity has won the right to support the Scottish government in its legal battle with drinks manufacturers that oppose the introduction of minimum pricing.

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MedPage Today - Family Benefits From Treating Alcoholism

Treating alcohol addiction reduces its burden on the family budget and improves life for those who live with alcoholic patients, German researchers found.

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Scottish Daily Record (Scotland) - Health secretary Alex Neil: We'll show EU minimum pricing on alcohol is justified

SCOTTISH Health Secretary Alex Neil last night insisted the Government will win their battle with Euro bigwigs in Brussels over minimum booze pricing plans.

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Washington Post (Russia) - Drunken driving tragedy forces Russia to think hard about safety on its roads

It took a weekend road tragedy to jolt Russia into action over one of its most deadly threats: a chronic culture of drunken driving.

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New Vision - Alcohol’s effects are more than intoxicating

Alcohol has been named the world’s third greatest risk factor in the development of premature disease. This seemingly innocent drink is a staple in social gatherings but its effects often spills over into society as a whole.

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U.S. Preventive Services Task Force Issues Draft Recommendation on Screening & Behavioral Counseling to Reduce Alcohol Misuse

The U.S. Preventive Services Task Force (Task Force) today posted a draft recommendation statement on screening and behavioral counseling to reduce alcohol misuse. The Task Force is providing an opportunity for public comment on this draft recommendation until October 22. All public comments will be considered as the Task Force develops its final recommendation. 

The draft recommendation applies specifically to screening and behavioral counseling interventions to reduce alcohol misuse in the primary care setting. It does not apply to people with signs or symptoms of alcohol misuse or who already are seeking evaluation or treatment for alcohol use.

The draft recommendation has two parts: 

 The Task Force recommended that clinicians screen all adults 18 and older and pregnant women for alcohol misuse and provide individuals engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. 

 The Task Force also determined that there currently is not enough evidence to make a recommendation about whether it is effective to screen and provide behavioral counseling interventions to reduce alcohol misuse for adolescents aged 12 to 17.
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