Preventing Fetal Alcohol Spectrum Disorders: The Role of Protection Motivation Theory

This article examines health communication campaigns aimed at preventing alcohol consumption among women who are pregnant or attempting to become pregnant.

A majority of the campaigns followed the tenets of protection motivation theory by focusing on the threat variables of severity and vulnerability, as well as emphasizing response efficacy. Few campaigns focused on costs or self-efficacy.

Future fetal alcohol spectrum disorders prevention initiatives should attempt to reduce perceived costs, as well as include self-efficacy messages in order to increase women's confidence that they can carry out the recommended actions.

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Request Reprint E-Mail: Magdalena.Cismaru@uregina.ca
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Genetics of Addictions

Addictions include a group of common, heritable psychiatric illnesses that have multiple psychiatric and medical comorbidities.

Robust genetic associations have been found for alcohol dependence, nicotine dependence, and cocaine dependence.

Common genetic associations have been found between alcohol dependence and aerodigestive cancers and between nicotine dependence and lung disease.

These associations highlight the importance of understanding the genetics of substance dependence in the context of its multiple medical and psychiatric comorbidities.

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Request Reprint E-Mail: laura@wustl.edu
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Acute psychomotor effects of MDMA and ethanol (co-) administration over time in healthy volunteers

In Western societies, a considerable percentage of young people use 3,4-methylenedioxymethamphetamine (MDMA or ‘ecstasy’). The use of alcohol (ethanol) in combination with ecstasy is common.

The aim of the present study was to assess the acute psychomotor and subjective effects of (co-) administration of MDMA and ethanol over time and in relation to the pharmacokinetics.

MDMA significantly increased psychomotor speed but did not affect psychomotor accuracy and induced subjective arousal. Ethanol impaired both psychomotor speed and accuracy and induced sedation. Coadministration of ethanol and MDMA improved psychomotor speed but impaired psychomotor accuracy compared with placebo and reversed ethanol-induced sedation.

Pharmacokinetics and pharmacodynamics showed maximal effects at 90—150 min after MDMA administration after which drug effects declined in spite of persisting MDMA plasma concentration, with the exception of ethanol-induced sedation, which manifested itself fully only after the infusion was stopped.

In conclusion, results show that subjects were more aroused when intoxicated with both substances combined compared with placebo, but psychomotor accuracy was significantly impaired.

These findings may have implications for general neuropsychological functioning as this may provide a sense of adequate performance that does not agree with a significant reduction in psychomotor accuracy.

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Request Reprint E-Mail: G.J.H.Dumont@psy.umcn.
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Ethanol co-administration moderates 3,4-methylenedioxymethamphetamine effects on human physiology

Alcohol is frequently used in combination with 3,4-methylenedioxymethamphetamine (MDMA). Both drugs affect cardiovascular function, hydration and temperature regulation, but may have partly opposing effects.

The present study aims to assess the acute physiologic effects of (co-) administration of MDMA and ethanol over time.

Ethanol did not significantly affect physiologic function, with the exception of a short lasting increase in heart rate. MDMA potently increased heart rate and blood pressure and induced fluid retention as well as an increase in temperature.

Co-administration of ethanol with MDMA did not affect cardiovascular function compared to the MDMA alone condition, but attenuated the effects of MDMA on fluid retention and showed a trend for attenuation of MDMA-induced temperature increase.

In conclusion, co-administration of ethanol and MDMA did not exacerbate physiologic effects compared to all other drug conditions, and moderated some effects of MDMA alone.

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Request Reprint E-Mail: G.J.H.Dumont@psy.umcn.nl

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Polymorphisms of the µ-opioid receptor and dopamine D4 receptor genes and subjective responses to alcohol in the natural environment.

Polymorphisms of the µ-opioid receptor (OPRM1) and dopamine D4 receptor (DRD4) genes are associated with subjective responses to alcohol and urge to drink under laboratory conditions.

This study examined these associations in the natural environment using ecological momentary assessment.

Participants were non-treatment-seeking heavy drinkers (n = 112, 52% female, 61% alcohol dependent) who enrolled in a study of naltrexone effects on craving and drinking in the natural environment. Data were culled from 5 consecutive days of drinking reports prior to medication randomization.

Analyses revealed that, after drinking, carriers of the Asp40 allele of the OPRM1 gene reported higher overall levels of vigor and lower levels negative mood, as compared to homozygotes for the Asn40 variant.

Carriers of the long allele (i.e., =7 tandem repeats) of the DRD4 endorsed greater urge to drink than homozygotes for the short allele.

Effects of OPRM1 and DRD4 variable-number-of-tandem-repeats genotypes appear to be alcohol dose-dependent. Specifically, carriers of the DRD4-L allele reported slight decreases in urge to drink at higher levels of estimated blood alcohol concentration (eBAC), and Asp40 carriers reported decreases in vigor and increases in negative mood as eBAC rose, as compared to carriers of the major allele for each gene.

Self-reported vigor and urge to drink were positively associated with alcohol consumption within the same drinking episode.

This study extends findings on subjective intoxication, urge to drink, and their genetic bases from controlled laboratory to naturalistic settings.

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Request Reprint E-Mail: Lara Ray@brown.edu

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Do changes in drinking motives mediate the relation between personality change and “maturing out” of problem drinking?.

Recent research has indicated that developmental changes in the personality traits of neuroticism and impulsivity correlate with changes in problem drinking during emerging and young adulthood.

However, it remains unclear what potential mechanisms, or mediators, could account for these associations. Drinking motives, particularly drinking to regulate negative affect (drinking to cope) and to get “high” or “drunk” (drinking for enhancement), have been posited to mediate the relationship between personality and drinking problems.

Recent work indicates that changes in drinking motives parallel changes in alcohol involvement from adolescence to young adulthood.

The present study examined changes in drinking motives (i.e., coping and enhancement) as potential mediators of the relation between changes in personality (impulsivity and neuroticism) with changes in alcohol problems in emerging and young adulthood.

Analyses were based on data collected from a cohort of college students (N = 489) at varying risk for alcohol use disorders from ages 18 to 35.

Parallel process latent growth modeling indicated that change in coping (but not enhancement) motives specifically mediated the relation between changes in neuroticism and alcohol problems as well as the relation between changes in impulsivity and alcohol problems.

Findings suggest that change in coping motives is an important mechanism in the relation between personality change and the “maturing out” of problematic alcohol involvement.

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Request Reprint E-Mail: ittlefielda@missouri.edu
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Alcohol demand, delayed reward discounting, and craving in relation to drinking and alcohol use disorders.

A behavioral economic approach to alcohol use disorders (AUDs) emphasizes both individual and environmental determinants of alcohol use.

The current study examined individual differences in alcohol demand (i.e., motivation for alcohol under escalating conditions of price) and delayed reward discounting (i.e., preference for immediate small rewards compared to delayed larger rewards) in 61 heavy drinkers (62% with an AUD).

In addition, based on theoretical accounts that emphasize the role of craving in reward valuation and preferences for immediate rewards, craving for alcohol was also examined in relation to these behavioral economic variables and the alcohol-related variables.

Intensity of alcohol demand and delayed reward discounting were significantly associated with AUD symptoms, but not with quantitative measures of alcohol use, and were also moderately correlated with each other.

Likewise, craving was significantly associated with AUD symptoms, but not with alcohol use, and was also significantly correlated with both intensity of demand and delayed reward discounting.

These findings further emphasize the relevance of behavioral economic indices of motivation to AUDs and the potential importance of craving for alcohol in this relationship.

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Request Reprint E-Mail: james_mackillop@brown.edu
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New doubt on drink prices crackdown – by expert used to justify policy

ONE of the scientists whose research has underpinned the Scottish Government's push to introduce minimum pricing for alcohol admitted yesterday there is no evidence to show the controversial policy would work.

Sheffield University senior lecturer Dr Petra Meier told Holyrood's health committee the effects of the SNP's minimum pricing policy were "like the weather forecast" because her work was just "a model" of what might happen.

Her comments came as the committee considers the first stage of the Scottish Government's Alcohol Bill and they have raised further doubts about the value of the Sheffield University study into drinking in Scotland, which SNP ministers have claimed proves the case for introducing minimum pricing. . . . . .

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Irregular Heavy Drinking Occasions and Risk of Ischemic Heart Disease: A Systematic Review and Meta-Analysis

Contrary to a cardioprotective effect of moderate regular alcohol consumption, accumulating evidence points to a detrimental effect of irregular heavy drinking occasions (>60 g of pure alcohol or 5 drinks per occasion at least monthly) on ischemic heart disease risk, even for drinkers whose average consumption is moderate.

In a random-effects model, the pooled relative risk of irregular heavy drinking occasions compared with regular moderate drinking was 1.45 (95% confidence interval: 1.24, 1.70), with significant between-study heterogeneity (I² = 53.9%). Results were robust in several sensitivity analyses.

The authors concluded that the cardioprotective effect of moderate alcohol consumption disappears when, on average, light to moderate drinking is mixed with irregular heavy drinking occasions.

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Request Reprint E-Mail: m.roerecke@web.de
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Witnessed community and parental violence in relation to substance use and delinquency in a national sample of adolescents

This study examined whether witnessed community and parental violence represented risk factors for substance use and delinquency among adolescents, beyond the contribution of direct violence and other risk factors. We also examined the role of violence characteristics.

While accounting for trauma history and other risk factors, witnessed community and parental violence were associated with delinquency. Community violence was associated with substance use. Chronic violence, knowing the perpetrator, and violence outside of school were correlated with substance use and delinquency among adolescents who witnessed community violence.

These findings highlight the importance of targeting witnessed violence in prevention and intervention efforts

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Request Reprint E-Mail: hzinzow@clemson.edu
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Recidivist drink drivers’ self-reported reasons for driving whilst unlicensed—A qualitative analysis

This paper presents qualitative data from an in-depth interview study of 40 repeat drink drivers in Perth Western Australia to inform countermeasures for these high risk offenders.

Most respondents who had had their licence suspended admitted to driving whilst under suspension. Employment and social factors were key themes emerging in respondents’ accounts of driving whilst under licence suspension.

Whilst a range of enforcement countermeasures are needed to deter drunk and unlicensed driving, this study suggests that where possible we aim to keep offenders within the system that consists of formal laws and informal social controls, rather than apply penalties in ways that undermine adherence to the law by increasing unlicensed driving. Allowing for interlock installation early in the driving suspension period, and allowing fines to offset cost of interlock installation and monitoring, may maximise community benefit and reduce unlicensed driving.

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Request Reprint E-Mail: s.lenton@curtin.edu.au:

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The role of substance use and psychosocial characteristics in explaining unintentional injuries

The objective of this study was to examine the relationship between the use of various substances and selected psychosocial characteristics with unintentional injury.

For the univariate analyses, both frequency of cocaine and cannabis use, risk-taking/impulsivity, stress, and coping were significantly related to injuries.

For the multivariate analyses, only risk-taking/impulsivity, stress, age, and sex were significantly related to injuries.

The results provide important information regarding factors associated with reported injuries among individuals in addiction treatment.

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Request Reprint E-Mail: mcoghlan@uvic.ca

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Sweet preferences and analgesia during childhood: effects of family history of alcoholism and depression

To determine whether depression and family history of alcoholism are associated with heightened sweet preferences in children, before they have experienced alcohol or tobacco and at a time during the life-span when sweets are particularly salient.

The co-occurrence of having a family history of alcoholism and self-reports of depressive symptomatology was associated significantly with a preference for a more concentrated sucrose solution, while depressive symptomatology alone was associated with greater liking for sweet-tasting foods and candies and increased pain sensitivity. Depression antagonized the analgesic properties of sucrose.

While children as a group innately like sweets and feel better after eating them, the present study reveals significant contributions of family history of alcoholism and depression to this effect. Whether the heightened sweet preference and the use of sweets to alleviate depression are markers for developing alcohol-related problems or responses that are protective are important areas for future research.

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Request Reprint E-Mail: mennella@monell.org

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Internet-based prevention for alcohol and cannabis use: final results of the Climate Schools course

To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools.

This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools.

Internet-based prevention programs for school-age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.

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Request Rerprint E-Mail: nickien@unsw.edu.au

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How much alcohol do you buy? A comparison of self-reported alcohol purchases with actual sales

Unrecorded alcohol has increased in the Nordic countries during recent years, above all in terms of cross-border trade. This implies that trends and levels of per capita consumption would look different without estimates of this source of alcohol, estimates that in Sweden and other countries are made through surveys.

Of the recorded amount of purchases at Systembolaget, 87% was reported in the survey, compared with the 40–60% usually found for self-reported consumption. Significant differences across beverages were revealed, showing a lower coverage rate for beer and spirits and a higher coverage rate for wine and cider. Changes in purchases of all beverages were captured fairly well, at least changes taking place from one month to another.

Self-reported alcohol purchases achieve a higher coverage rate than found typically in studies based on self-reported use of alcohol. If adjustments are to be made to correct for underreporting in self-reported data on alcohol purchases, different weights should be applied to different beverages. Furthermore, at least major changes in how much alcohol is purchased in the population can be monitored using well-designed population surveys.

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Request Reprint E-Mail: mats.ramstedt@sorad.su.se

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How does variability in alcohol consumption over time affect the relationship with mortality and coronary heart disease?

To examine the relationship between alcohol consumption and risk of mortality and incident coronary heart disease (CHD), taking account of variation in intake during follow-up.

We found evidence that drinkers who vary their intake during follow-up, regardless of average level, have increased risk of total mortality (hazard ratio of high versus low variability 1.52: 95% CI: 1.07–2.17), but not of incident CHD. Using average consumption level, as opposed to only a baseline measure, gave slightly higher risk estimates for CHD compared to moderate drinkers at the extremes of the drinking range.

Multiple repeated measures are required to explore the effects of variation in exposure over time. Caution is needed when interpreting risks of exposures measured only once at baseline, without consideration of changes over time.

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Request Reprint E-Mail: a.britton@ucl.ac.uk

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Consequences of eliminating federal disability benefits for substance abusers

Using annual, repeated cross-sections from national household surveys, we estimate how the January 1997 termination of federal disability insurance, Supplemental Security Income (SSI), for those with Drug Addiction and Alcoholism affected labor market outcomes among individuals targeted by the legislation.

We also examine whether the policy change affected health insurance, health care utilization, and arrests. We employ propensity-score methods to address differences in observed characteristics between likely substance users and others, and we used a difference-in-difference-in-difference approach to mitigate potential omitted variables bias.

In the short-run (1997–1998), declines in SSI receipt accompanied appreciable increases in labor force participation and current employment. There was little measurable effect of the policy change on insurance and utilization, but we have limited power to detect effects on these outcomes.

In the later period after the policy change (1999–2002), the rate of SSI receipt rose, and short-run gains in labor market outcomes diminished.

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Request Reprint E-Mail: meara@hcp.med.harvard.edu

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Readiness to Change in Brief Motivational Interventions: A Requisite Condition for Drinking Reductions?

Brief motivational interventions (BMIs) have been found to be efficacious for reducing alcohol use and consequences among college student drinkers. Despite the putative emphasis on motivation, surprisingly little is known about the role of motivation in BMI-facilitated changes.

Using data from three published randomized trials implementing BMIs, we examined motivation or readiness to change (RTC) as a potential mechanism of behavior change. Two of the three studies indicated that BMI were associated with increases in motivation to change alcohol use that are apparent immediately after BMI sessions and persist up to 6-months post-intervention.

However, RTC does not appear to be a mechanism of behavior change, as it did not mediate reductions in alcohol use or problems in any of the studies.

Issues regarding the conceptualization and measurement of RTC are discussed, as well as promising directions for future research.

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Cerebral white matter recovery in abstinent alcoholics—a multimodality magnetic resonance study

Most previous neuroimaging studies of alcohol-induced brain injury and recovery thereof during abstinence from alcohol used a single imaging modality. They have demonstrated widespread microstructural, macrostructural or metabolite abnormalities that were partially reversible with abstinence, with the cigarette smoking potentially modulating these processes.

The goals of this study were to evaluate white matter injury and recovery thereof, simultaneously with diffusion tensor imaging, magnetic resonance imaging and spectroscopy in the same cohort; and to evaluate the relationships between outcome measures of similar regions.

We scanned 16 non-smoking and 20 smoking alcohol-dependent individuals at 1 week of abstinence from alcohol and 22 non-smoking light drinkers using a 1.5 T magnetic resonance scanner. Ten non-smoking alcohol-dependent individuals and 11 smoking alcohol-dependent individuals were re-scanned at 1 month of abstinence.

All regional diffusion tensor imaging, magnetic resonance imaging and spectroscopic outcome measures were calculated over comparable volumes of frontal, temporal, parietal and occipital white matter.

At 1 week of abstinence and relative to non-smoking light drinkers, non-smoking alcohol-dependent individuals had higher mean diffusivity in frontal, temporal and parietal white matter (all P <> whereas smoking alcohol-dependent individuals had elevated mean diffusivity only in frontal white matter (P = 0.03).

Smoking alcohol-dependent individuals demonstrated lower concentrations of N-acetyl-aspartate (a marker of neuronal viability) in frontal white matter (P = 0.03), whereas non-smoking alcohol-dependent individuals had lower N-acetyl-aspartate in parietal white matter (P = 0.05).

These abnormalities were not accompanied by detectable white matter atrophy. However, the patterns of white matter recovery were different between non-smoking alcohol-dependent individuals and smoking alcohol-dependent individuals. In non-smoking alcohol-dependent individuals, the increase in fractional anisotropy of temporal white matter (P = 0.003) was accompanied by a pattern of decreases mean diffusivity in all regions over 1 month of abstinence; no corresponding changes were observed in smoking alcohol-dependent individuals.

In contrast, a pattern of white matter volume increase in frontal and temporal lobes was apparent in smoking alcohol-dependent individuals but not in non-smoking alcohol-dependent individuals. These results were not accompanied by significant changes in metabolite concentrations.

Finally, there were no consistent patterns of association between measures obtained with different imaging modalities, either cross-sectionally or longitudinally.

These data demonstrate significant white matter improvements with abstinence from alcohol, reflected either as microstructural recovery or volumetric increases that depend on the smoking status of the participants.

We believe our results to be important, as they demonstrate that use of a single imaging modality provides an incomplete picture of neurobiological processes associated with alcohol-induced brain injury and recovery thereof that may even lead to improper interpretation of results.

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Request Reprint E-Mail: stefan.gazdzinski@uj.edu.pl
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Silicon in beer and brewing

It has been claimed that beer is one of the richest sources of silicon in the diet; however, little is known of the relationship between silicon content and beer style and the manner in which beer is produced.

The purpose of this study was to measure silicon in a diversity of beers and ascertain the grist selection and brewing factors that impact the level of silicon obtained in beer.

Commercial beers ranged from 6.4 to 56.5 mg L^-1 in silicon. Products derived from a grist of barley tended to contain more silicon than did those from a wheat-based grist, likely because of the high levels of silica in the retained husk layer of barley. Hops contain substantially more silicon than does grain, but quantitatively hops make a much smaller contribution than malt to the production of beer and therefore relatively less silicon in beer derives from them. During brewing the vast majority of the silicon remains with the spent grains; however, aggressive treatment during wort production in the brewhouse leads to increased extraction of silicon into wort and much of this survives into beer.

It is confirmed that beer is a very rich source of silicon.

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Request Reprint E-Mail: cwbamforth@ucdavis.edu
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