Number 72 July 2007

Alcohol Metabolism: An Update

Drinking heavily puts people at risk for many adverse health consequences, including alcoholism, liver damage, and variouscancers. But some people appear to be at greater risk than others for developing these problems. Why do some people drink more than others? And why do some people who drink develop problems, whereas others do not?

Research shows that alcohol use and alcohol-related problems are influenced by individual variations in alcohol metabolism, or the way in which alcohol is broken down and eliminated by the body. Alcohol metabolism is controlled by genetic factors, such as variations in the enzymes that break down alcohol; and environmental factors, such as the amount of alcohol an individual consumes and his or her overall nutrition. Differences in alcohol metabolism may put somepeople at greater risk for alcohol problems, whereas others may be at least somewhat protected from alcohol’s harmful effects.

This Alcohol Alert describes the basic process involved in the breakdown of alcohol, including how toxic byproducts of alcohol metabolism may lead to problems such as alcoholic liver disease, cancer, and pancreatitis. This Alert also describes populations who may be at particular risk for problems resulting from alcohol metabolism as well as people who may be genetically “protected” from these adverse effect . . . . . . .

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Country of origin, age of drinking onset, and drinking patterns among Mexican American young adults
Drug and Alcohol Dependence Article in Press, Corrected Proof 12 July 2007



This study examines relationships between country of origin, age of drinking onset, and adverse drinking outcomes among young adult Mexican Americans in the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

Adjusted analyses indicate the odds of adverse drinking outcomes decreased as age of drinking onset increased.

Mexican Americans who initiated drinking in Mexico had significantly lower odds of current or lifetime harmful drinking than U.S. born but the odds were not significantly different between foreign-born Mexican Americans who initiated drinking in the U.S. and U.S. born.

Irrespective of whether drinking onset was in Mexico or the U.S., foreign-born Mexican Americans had lower odds of alcohol abuse than U.S. born.

However, odds of dependence were not significantly different between foreign-born and U.S.-born Mexican Americans.

While findings suggest that being foreign born may be protective, further research on social and cultural factors impacting drinking onset and related outcomes among young Mexican Americans may help inform prevention efforts.

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Reprint Request E-Mail: lstrunin@bu.edu
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Norepinephrine transporter polymorphisms T-182C and G1287A are not associated with alcohol dependence and its clinical subgroups
Drug and Alcohol Dependence Article in Press, Corrected Proof 13 July 2007



Several studies have suggested that the norepinephrine transporter (NET) may play an important role in the pathogenesis of alcohol dependence. Additional studies have shown that the polymorphisms of T-182C (rs2242446) and G1287A (rs5569) in NET gene (hSLC6A2) may affect the NET function.

Therefore, in this study, we examined whether these hSLC6A2 gene polymorphisms are a susceptibility factor for alcohol dependence or its clinical subgroup(s).

No significant differences in genotype and allele frequencies of hSLC6A2 polymorphisms were found between controls and total alcohol dependence or between more homogeneous subgroups with alcohol dependence and controls.

This study suggests that the polymorphisms of T-182C and G1287A in hSLC6A2 gene are not major risk factors in increasing susceptibility to either alcohol dependence or its clinical subtypes.

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Reprint Request E-Mail: hsy@ndmctsgh.edu.tw
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Alcoholism Effects on Social Migration and Neighborhood Effects on Alcoholism Over the Course of 12 Years
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 13 July 2007


Although a short-term effect of neighborhood characteristics on individual alcohol abuse has been demonstrated by a quasi-experimental residential mobility study, the obversed effect of alcohol problem involvement on place of residence and residential character has not been studied.

We test the alcoholism effect on place of residence, and we also attempt to replicate the neighborhood-to-alcoholism effect.

The regression analysis shows that, the more alcohol problems a man has, the more likely he is going to remain in, or migrate into, a disadvantaged neighborhood. This effect is only evident when a number of relevant confounding variables, including initial level of socioeconomic status, age, antisocial symptomatology, and spousal alcohol-use disorder status at baseline are controlled.

Alcoholics in remission tended to live in neighborhoods whose residential characteristics were not distinguishable from those of nonalcoholics.

Unremitted alcoholics, however, tended to stay in or migrate into more disadvantaged neighborhoods.

Alcoholic involvement has long-term negative effects on place of residence; involving an elevated likelihood of moving into or remaining in a disadvantaged neighborhood. Recovery from alcoholism is protective against downward social drift on the one hand, and is favorable to improvement in social conditions on the other.

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Reprint Request E-Mail: buu@umich.edu

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The DASIS Report: Treatment Admissions with Medicaid as the Primary Expected or Actual Payment Source, 2005

Highlights

• SAMHSA's Treatment Episode Data Set (TEDS) provides information on significant primary sources of payment for substance abuse treatment admissions reported voluntarily by States that complete the TEDS Supplementary Data Set. This short report is based on data reported by the 27 States or jurisdictions with a response rate of 75% or higher on this data element in 2005.

• In SAMHSA's 2005 Treatment Episode Data Set (TEDS) there were almost 614,300 substance abuse treatment facilities with known primary source of payment in the States with sufficient data for analysis. Nearly 81,100 of these substance abuse treatment admissions (13%) reported Medicaid as their primary expected or actual source of payment. Other payment sources included: other government sources (35%), self pay (23%), Blue Cross/Blue Shield (2%), other health insurance companies (4%), Medicare (1%), worker's compensation (<1%),>

• Compared to substance abuse treatment admissions paid for by non Medicaid sources, higher proportions of Medicaid-paid admissions in 2005 were young, female, Black, or "not in the labor force."

• Medicaid-paid substance abuse treatment admissions were more likely to report marijuana as their primary substance of abuse (26% vs. 17%) and less likely to report alcohol as their primary substance of abuse (28% vs. 42%).

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eNewsletter: July 13, 2007

The Recovery Community Organization: Toward A Working Definition and Description “The Recovery Community Organization: Toward A Working Definition and Description,” is an article by Phillip Valentine, Executive Director of Connecticut Community for Addiction Recovery (CCAR); Bill White; and Pat Taylor. The authors would appreciate your comments and feedback. New advocacy buttons from Faces & Voices of Recovery Faces & Voices of Recovery is releasing new buttons that you and others in the recovery community can wear to get out the message of long-term recovery and recovery advocacy. Click here to view and purchase our new “End Insurance Discrimination Now” button. Help us decide on our new “I’m in Recovery and I Vote” button. Click here to view four versions of an “I’m in Recovery and I Vote” button and email us with your favorite by Friday, July 20th! Thanks. Paul Wellstone Mental Health and Addiction Equity Act of 2007 The House Committee on Education and Labor’s Health, Employment, Labor, and Pensions Subcommittee held a hearing on H.R. 1424, "The Paul Wellstone Mental Health and Addiction Equity Act of 2007 on July 10th. Learn more… Key federal appropriations bills moving through Congress Bills that set the levels of funding for the federal government’s Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (CSAT), National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism continue to move through Congress. Learn more… Marylanders get democracy! On July 2nd, the Voter Registration Protection Act of 2007 went into effect in Maryland, re-enfranchising more than 50,000 Maryland residents who have completed their felony sentences of prison, parole and probation. Previously, only nonviolent ex-offenders could vote after a three-year waiting period, all others faced a lifetime voting ban. For a downloadable flyer and more information on this important victory, click here. Faces & Voices' new Administrative Assistant Faces & Voices welcomes Jared Hess to our staff as our new Administrative Assistant. Jared grew up in Baltimore, Maryland and graduated from the University of Central Florida with a B.A. in Political Science. He has previous experience doing public policy work in the public and private sectors. He has a deep passion for recovery advocacy as he is a person in long-term recovery, which means that he has not used drugs or alcohol since January 2003. Welcome! Resources: The ABC’s of Effective Advocacy, is a CADCA satellite broadcast/webcast for advocates wanting to learn more about how to connect with elected officials and become a valuable resource of credible information to them. July 26, 2007 from 1-2 pm EDT. Learn more… The Case Foundation’s “Make It Your Own Awards” 2007 program is looking for individuals or small organizations that are using collaborative, community-driven solutions to solve a problem. Grants of up to $35,000 will be awarded. Learn more…

Diageo-Backed California Labeling Bill Wins Key State Senate Committee Approval

    SACRAMENTO, Calif., July 12 /PRNewswire-FirstCall/ -- With support from
Diageo, the world's leading spirits, wine and beer company, a key alcohol
labeling bill has won the bipartisan approval of the State Senate
Governmental Organization Committee.

The bill, AB 346 by California Assembly members James Beall and Lori
Saldana, is part of Diageo's campaign to keep alcohol products out of the
hands of kids. It would require that all beers or other malt beverages
clearly state that they contain alcohol and reveal the alcohol content on
the label if there is any chance the container could be confused with a
non-alcoholic product.
. . . . .

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Parliament votes against increase in alcohol excise duties

Published: Friday 13 July 2007

In a non-binding legislative resolution, MEPs voted against a Commission proposal to raise the EU's minimum rates of excise duty on beer and spirits, and asked for the proposal to be withdrawn.

Brief News:

On 10 July 2007, the Parliament adopted a legislative resolution rejecting a Commission proposal to raise the EU-wide minimum rates of excise duty on alcohol other than wine. After a tight vote (303 in favour, 335 against and 44 abstentions) on the Economic Affairs Committee's report , which backs amendments calling for the minimum rates to rise by 4.5%, the MEPs decided to vote against the whole Commission proposal and request that it be withdrawn.

This was the second time that Parliament has voted on the issue. At the end of May, MEPs referred the dossier, after a series of close votes, back to the responsible committee (see EurActiv 23/05/2007).

The Parliament's rapporteur Astrid Lulling said that the Parliament did not only reject an overall rise of minimum taxes on alcohol but also now asks the Commission to prove, in a study, that the existing minimum taxes provide for more competition or at least better health protection. "Until now, the Commission has not proved in any case that its interferences in national tax autonomy have so far produced any positive effects," said Lulling.
. . . . .

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Updated NIAAA Publication
Harmful Interactions: Mixing Alcohol with Medications






This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.


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California State University’s Successful Alcohol Prevention Programs are Showcased at Board of Trustees Meeting
(July 10, 2007)

California State University’s Board of Trustees heard today the third biennial report on the CSU’s continuing efforts to educate and reduce alcohol-related problems throughout its 23-campus system. The report outlined the implementation efforts, progress and success of the trustees’ Alcohol Policy and Prevention Programs adopted in 2001.

The report showcased CSU campus reports on progress in implementing campus policies, enforcement, and education in addition to developing, implementing, and assessing alcohol prevention, training, intervention, and treatment programs. Highlights of the progress report include a documented trend toward less alcohol use among students, fewer alcohol-related incidents, and increased education programs.

The CSU’s alcohol policy is visionary and ambitious, and it has been called one of the most comprehensive in the country,” said CSU Chancellor Charles B. Reed. “For it to continue being a success, collaboration and cooperation among staff at the campus level, our public agency partners, and CSU students must continue and grow.”

Alcohol education and prevention programs currently being developed and implemented by CSU campuses are designed based on “guiding principles” and key recommendations adopted by the trustees. (The principles and recommendations may be found on p.16-17 of the Educational Policy Committee’s report. ) The programs address six areas: policies; enforcement and legal issues; education and prevention programs; training, intervention and treatment; assessment; and resources. These focus areas were also aligned with mission statements developed by each of the 23 CSU campuses to reduce alcohol abuse.
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Effect of gestational ethanol exposure on long-term memory formation in newborn chicks
Alcohol Article in Press, Corrected Proof -12 July 2007




Fetal alcohol syndrome (FAS), a condition occurring in some children of mothers who have consumed alcohol during pregnancy, is characterized by craniofacial malformations, and physical and mental retardation. It is significant that even children with history of gestational ethanol exposure but relatively unaffected overall IQ performance, often exhibit learning difficulties and behavioral problems, suggestive of impaired memory formation.

It was observed that chick embryos exposed to 10% ethanol on gestational days 1–3 had significant reduction in all body parameters when compared with appropriate controls. Further, ethanol-exposed chick embryos had significantly impaired (P < .05) long-term memory (LTM) formation after training, though short-term or intermediate-term memory formation was unimpaired.

Thus, the findings of the current study demonstrate the detrimental effects of ethanol exposure during early pregnancy on developing chick embryos in general and on memory formation in particular.

Hence, it is suggested that impairment in LTM could be a fundamental mechanism for learning disorders and neurobehavioral abnormalities observed in FAS.


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Reprint Request E-Mail: jchaud@midwestern.edu
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Binge Drinking and Associated Health Risk Behaviors Among High School Students
PEDIATRICS Vol. 119 No. 1 January 2007, pp. 76-85





Underage drinking contributes to the 3 leading causes of death (unintentional injury, homicide, and suicide) among persons aged 12 to 20 years.

Most adverse health effects from underage drinking stem from acute intoxication resulting from binge drinking. Although binge drinking, typically defined as consuming 5 drinks on an occasion, is a common pattern of alcohol consumption among youth, few population-based studies have focused specifically on the characteristics of underage binge drinkers and their associated health risk behaviors.

Overall, 44.9% of high school students reported drinking alcohol during the past 30 days (28.8% binge drank and 16.1% drank alcohol but did not binge drink). Although girls reported more current drinking with no binge drinking, binge-drinking rates were similar among boys and girls. Binge-drinking rates increased with age and school grade.

Students who binge drank were more likely than both nondrinkers and current drinkers who did not binge to report poor school performance and involvement in other health risk behaviors such as riding with a driver who had been drinking, being currently sexually active, smoking cigarettes or cigars, being a victim of dating violence, attempting suicide, and using illicit drugs.

A strong dose-response relationship was found between the frequency of binge drinking and the prevalence of other health risk behaviors.

Binge drinking is the most common pattern of alcohol consumption among high school youth who drink alcohol and is strongly associated with a wide range of other health risk behaviors.

Effective intervention strategies (eg, enforcement of the minimum legal drinking age, screening and brief intervention, and increasing alcohol taxes) should be implemented to prevent underage alcohol consumption and adverse health and social consequences resulting from this behavior.


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Reprint Request E-Mail: JMiller5@cdc.gov
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Australasian Therapeutic Communities Association’s 2007 Conference

PAST PRESENT & FUTURE – Celebrating ATCA’s 21st Birthday
November 14th, 15th & 16th

Venue: Park Hyatt, Parliament Square, Melbourne, Australia

This year’s conference will celebrate the 21st Anniversary of the Association and we plan to showcase the many positive contributions Therapeutic Communities have made to the treatment of drug and alcohol addiction in Australia & New Zealand.

The 2007 ATCA Conference will also demonstrate that Australia & New Zealand have formed alliances with international Therapeutic Community organisations and recognise the unique impact Therapeutic Communities have as an effective intervention for drug alcohol and comorbid client groups.
As the theme suggests, the conference will look at past achievements, present practice and future initiatives.

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Contributor: Rowdy Yates

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Altered Brain Activation by a False Recognition Task in Young Abstinent Patients With Alcohol Dependence
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles) 11 Julu 2007



Heavy alcohol intake induces both structural and functional changes in the central nervous system.

Recent research developments converged on the idea that even in patients with alcohol dependence without apparent structural brain changes, some cognitive impairment exists, and associated functional change could be visualized by neuroimaging techniques.

However, these data were from old (more than 50 years) patients using working memory and response inhibition tasks. Whether young abstinent patients show aberrant signs of brain activation is a matter of interest, specifically by the long-term memory retrieval task.

The young patients with alcohol dependence showed reduced activation in the right dorsolateral prefrontal cortex, anterior cingulate cortex (ACC), left pulvinar in the thalamus, and in the right ventral striatum, although behavioral performances and regional patterns of brain activation were similar between patients and controls.

Long-term memory retrieval induced altered activations in prefrontal lobes, ACC, thalamus, and ventral striatum in young patients with alcohol dependence. These findings were correspondent to deficits of goal directed behavior, monitoring the erroneous responses, memory function, and drug-seeking behavior.

Furthermore, these reduced activations can be considered as latent "lesions," suggesting subclinical pathology in alcoholic brains.

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Reprint Request E-Mail: motokato@tc4.so-net.ne.jp
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Cloninger’s typology and treatment outcome in alcohol-dependent subjects during pharmacotherapy with naltrexone
Addiction Biology (OnlineEarly Articles) 16 June 2007

Naltrexone is an opiate receptor antagonist mainly at the µ-receptor that is thought to reduce the positively reinforcing, pleasurable effects of alcohol and to reduce craving.
An increase in time to first relapse to heavy drinking has been the most consistent finding obtained with naltrexone, although not all trials including two of the largest have been positive. Inconsistent outcome data suggest that effectiveness varies among different subgroups of patients.

This paper re-evaluates recent data on the effectiveness of naltrexone in subjects differentiated according to Cloninger Type I and II. Moreover, it combines and cross-validates results of two recent European studies that found naltrexone treatment more beneficial in alcohol-dependent patients with early age at onset of drinking problems (Cloninger Type II).

It is discussed whether especially these subjects should be targeted for pharmacological relapse prevention treatment with naltrexone.

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Reprint Request E-Mail: falk.kiefer@zi-mannheim.de ___________________________________________________________

The theory of planned behavior and binge drinking: Assessing the impact of binge drinker prototypes
Addictive Behaviors
Volume 32, Issue 9, September 2007, Pages 1753-1768




The present study assessed the value of including prototype perceptions within the theory of planned behavior (TPB) when predicting young people's binge drinking intentions and behavior.

The TPB explained 58% of the variance in binge drinking intentions and 22% of the variance in binge drinking at one-week follow-up. The prototype perception measures explained additional variance in both binge drinking intentions and behavior, although only prototype similarity emerged as a significant predictor.

In addition, a significant interaction was found between prototype similarity and subjective norm in relation to the prediction of binge drinking behavior, suggesting that the perception of supportive norms may enhance the impact of prototype perceptions on health-risk behavior.

The implications of the findings for interventions to encourage more appropriate drinking behavior are outlined.

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Reprint Request E-Mail: p.norman@sheffield.ac.uk
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UWE Researcher backs calls for higher alcohol taxation

Issue date: 10/07/2007

Martin Plant, Professor of Addiction Studies at UWE, is backing a call from a group of senior politicians for higher alcohol taxation. In a letter in today's Guardian Newspaper, Professor Plant has written as follows:

“Dear Editor,

The Conservative Party's Social Justice Policy Group has recommended that taxation should be used to curb binge drinking. This Group is to be congratulated for raising an 'inconvenient truth.' The UK is one very few Western countries where alcohol consumption, as well related mortality and public nuisance, have been rising steadily. A series of authoritative reports from Government advisors, medical and scientific authorities have drawn attention to the fact that controlling the availability of alcohol is essential in order to reduce heavy drinking and its related harm. Moreover, the UK is a signatory to the World Health Organization's European Charter. This commits governments to "promote health by controlling the availability, for example, for young people, and influencing the price of alcohol alcoholic beverages, for instance by taxation." Few credible scientists contest the fact that price control is vital if the UK's appalling level of alcohol-related harm is to be reduced. It is not enough to use empty rhetoric or to rely or low impact policy options. The latter include alcohol education, exhortation, media campaigns or unjustified advice (such as asking pregnant women not to drink at all. . . . . .

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Evaluating Readiness and Treatment Seeking Effects in a Pharmacotherapy Trial for Alcohol Dependence
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles). 11 July 2007


Decreases in drinking behavior prior to treatment onset often occur in pharmacotherapy trials for alcohol dependence. We propose that these decreases are associated with both trait and state factors operating before initiation of treatment to influence participants’ expectation or perception of future treatment outcome.

While trait factors typically include personality traits, state factors can include readiness to change and severity of drinking at screening. Understanding the characteristics of changes in drinking early in the process of entering treatment can improve clinical trials and outcomes.

Our goal was to evaluate drinking behavior before initiating a randomized, double-blind pharmacotherapy clinical trial for alcohol dependence.

A significant reduction in alcohol consumption occurred among heavy drinkers between the baseline assessment and the last week of single-blind placebo administration.

In contrast, the reduction in alcohol consumption by nonheavy drinkers over the same period was not significant. Partial correlations indicated that the significant predictors of drinking reductions during this period were: level of drinking and the Stages-of-Change subscales of precontemplation contemplation and maintenance.

Personality factors on the MacAndrew Alcoholism Scale did not predict drinking reductions during this same period.

Participants with higher motivation levels and greater drinking severity were most likely to reduce their drinking behavior before double-blind treatment. These state factors are important to consider when randomizing participants in trials, and are more important than trait or personality factors in accounting for the initial reduction in drinking in this population during the pretreatment period.

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Reprint Request E-Mail: jkp2n@virginia.edu
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Blunted Rostral Anterior Cingulate Response During a Simplified Decoding Task of Negative Emotional Facial Expressions in Alcoholic Patients
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles). 11 July 2007

Alcoholism is characterized by deficits in emotional functioning as well as by deficits in cognitive functioning. However, most brain imaging research on alcoholism has focused on cognition rather than emotion.

Alcoholics and controls not differ in accurately identifying the intensity level on the simple emotional decoding task but there were significant differences in their BOLD response during evaluation of facial emotion.

In general, alcoholics showed less brain activation than nonalcoholic controls. The greatest differences in activation were during decoding of facial expressions of fear and disgust during which alcoholics had significantly less activation than controls in the affective division of the anterior cingulate cortex (ACC).

Alcoholics also had significantly less activation than controls in the affective division of the ACC, while viewing sad faces. Only to facial expressions of anger did the alcoholics show significant activation in the affective ACC and in this case, their BOLD response did not significantly differ from that of the controls.

Alcoholics show a deficit in the function of the affective division of the ACC during evaluation of negative facial emotions that can serve as cues for flight or avoidance. This deficit may underlie some of the behavioral dysfunction in alcoholism.

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Reprint Request E-Mail: jasmins@mail.nih.gov

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Drug Challenges Reveal Differences in Mediation of Stress Facilitation of Voluntary Alcohol Drinking and Withdrawal-Induced Anxiety in Alcohol-Preferring P Rats
Alcoholism: Clinical and Experimental Research (OnlineEarly Articles). 11 July 2007

There is controversy over whether exposure to stress precipitates relapse and/or increases alcohol (ethanol) intake.

Our laboratory has demonstrated that repeated stress prior to withdrawal from a brief forced exposure to alcohol results in withdrawal-induced anxiety-like behavior. Because anxiety is often regarded as a precipitating factor in relapsing alcoholics, we decided to examine the consequences of stressing alcohol-preferring P rats on both voluntary alcohol drinking and withdrawal-induced anxiety.

Stressed, deprived P rats exhibited both a longer duration of elevated alcohol drinking and anxiety-like behavior in the social interaction test upon withdrawal after the third cycle of voluntary alcohol drinking.

When given prior to each of the restraint stresses, the benzodiazepine receptor antagonist flumazenil (5 mg/kg), the corticotrophin releasing factor receptor antagonists CRA1000 (3 mg/kg) and CP154,526 (10 mg/kg), the serotonin 5-HT_1A receptor partial agonist buspirone (0.6 mg/kg), and the mixed 5-HT_2C/D2 receptor antagonist olanzapine were effective in reducing the increased duration of elevated alcohol drinking and the withdrawal-induced anxiety-like behavior.

In contrast, while the opiate receptor antagonist naloxone (20 mg/kg), the 5-HT_2C receptor antagonist SB242084 (3 mg/kg), and the dopamine receptor antagonist haloperidol (0.1 mg/kg) also reduced drinking, they did not significantly alter anxiety like behavior.

These results suggest that stress-induced facilitation of alcohol drinking and withdrawal-induced anxiety-like behavior in P rats may be closely but imperfectly linked.

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

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