Addiction as a complex social process: An action theoretical perspective

Addiction Research & Theory 17 December 2007




This article introduces an action theoretical perspective of addiction. The view that addiction resides solely within the individual continues to foster significant limitations across addiction theorizing, research, and treatment.

Exclusive focus on an individual neurobiological level of analysis precludes important additional layers of understanding, for example, the roles of individual and joint human actions, the socially constituting processes of addiction, and the role of gender.

Our perspective is that a neurobiological view on addiction is insufficient without consideration of goals, intentionality, relationships, and meaning. Using a composite case scenario, we offer an action theoretical framework for understanding individual and joint addiction processes over time and within the context of other life processes. This integrative framework considers manifest behaviors, internal and communicative processes, and the social meaning of addiction.

This article offers a practical application of the theory and draws broad implications for the conceptualization and subsequent language of addiction.


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Stimulant alcohol effects prime within session drinking behavior
Psychopharmacology Online First 15 December 2007



Individual differences in subjective alcohol effects have been shown to differ by risk status (e.g., family history of alcoholism) and to predict future risk for alcohol-related problems.

Presumably, individual differences in both stimulant and sedative responses affect the rewarding value of drinking which, in turn, impacts future drinking behavior. Although plausible, this theoretical model is largely untested.

The current study attempted to provide experimental evidence for the impact of subjective alcohol responses on within session drinking behavior.

Analyses indicated that an initial dose of alcohol increased experiences of both stimulation and sedation although stimulant effects were evaluated much more positively. In addition, stimulant effects after a priming dose predicted further consumption, whereas sedative effects did not.

At least among moderate to heavy drinking college students, stimulant alcohol effects are more reinforcing and predict within session drinking behavior under social stress. Increased attention should be given to stimulant alcohol effects as a risk factor for excessive consumption in this population.

Incorporating information about stimulant alcohol effects in prevention and intervention programs may also be important if additional research supports the current results.


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Acute alcohol tolerance is intrinsic to the BKCa protein, but is modulated by the lipid environment
Paper in press, published online ahead of press December 15, 2007

Ethanol tolerance, in which exposure leads to reduced sensitivity, is an important component of alcohol abuse and addiction. The molecular mechanisms underlying this process remain poorly understood.

The BKCa channel plays a central role in the behavioral response to ethanol in C. elegans (1), and Drosophila (2). In neurons, ethanol tolerance in BKCa channels has two components: a reduced number of membrane channels, and decreased potentiation of the remaining channels (3).

Here, heterologous expression, coupled with planar bilayer techniques examines two additional aspects of tolerance in human BKCa channels: 1) Is acute tolerance observed in a single channel protein complex within a lipid environment reduced to only two lipids? 2) Does lipid bilayer composition affect the appearance of acute tolerance?

We found that tolerance was observable in BKCa channels in membrane patches pulled from HEK cells, and when they are placed into reconstituted POPE/POPS membranes. Further, altering bilayer thickness by incorporating the channel into lipid mixtures of DOPE with phosphatidylcholines (PCs) of increasing chain length, or with sphingomyelin (SPM), strongly affected the sensitivity of the channel, as well as the time course of the acute response. Ethanol sensitivity changed from a strong potentiation in thin bilayers, to inhibition in thick SPM/DOPE bilayers.

Thus, tolerance can be an intrinsic property of the channel protein/lipid complex, and bilayer thickness plays an important role in shaping the pattern of response to ethanol. As a consequence of these findings the protein/lipid complex should be treated as a unit when studying ethanol action.

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News Release - No Need For Reduced Alcohol Consumption In Later Life

18 December 2007

'A little of what you fancy' this Christmas will do no harm

Provided they stick to the same guidelines about alcohol consumption as younger adults, regular moderate drinking poses no additional risks to the over 65s, and may even bring health benefits, according to two studies from the Peninsula Medical School in the South West of England.

Researchers assessed the drinking levels of over 13,000 older people in England and the US and looked at the effects on physical disability, mortality, cognitive function, depression, and well-being. They concluded that moderate drinking is fine for the over 65s – and in some cases is better than not drinking at all.

This will be good news to the elderly who want to get into the festive spirit, and who until now have lived by the commonly held belief that they have to reduce their alcohol consumption as they get older.

“We are not advocating that elderly people should go out and get ridiculously drunk,“ said Dr. Iain Lang, lead author of the two studies from the Peninsula Medical School. “What we are saying is that current guidelines on drinking for the elderly are too conservative, and that a couple of drinks a day will do no harm, and will in fact have a more beneficial affect on cognitive and general health than abstinence.”
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Moderate alcohol consumption in older adults is associated with better cognition and well-being than abstinence
Age and Ageing 2007 36(3):256-261



There is evidence of a U-shaped association between alcohol consumption and physical health outcomes in older people, such that moderate drinking is associated with better outcomes than abstinence or heavy drinking, but whether moderate drinking in older people is associated with better cognition and mental health than non-drinking has not been explored.

The objective of the study is to assess the relationship between drinking and cognitive health in middle-aged and older people.

For both men and women, better cognition and subjective well-being, and fewer depressive symptoms, were associated with moderate levels of alcohol consumption than with never having drunk any.

In middle-aged and older men and women, moderate levels of alcohol consumption are associated with better cognitive health than abstinence.


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The MAO-A gene, platelet MAO-B activity and psychosocial environment in adolescent female alcohol-related problem behaviour
Drug and Alcohol Dependence Volume 93, Issues 1-2, 11 January 2008, Pages 51-62

Antisocial behaviour has been associated with polymorphic variants in candidate genes and recently also gene–environmental interaction models have been presented.

It has been suggested that antisocial behaviour, associated with alcohol consumption in males, is related to a variation in the monoamine oxidase A gene (MAO-A) promoter. Furthermore, platelet MAO-B activity has in several studies been reported to be low in male alcoholics, while this has not been the case with regard to female alcoholics.

Aims of the present study were to: (1) investigate possible interactions between the MAO-A polymorphism, family relations and maltreatment/sexual abuse on adolescent alcohol-related problem behaviour among female adolescents; (2) to investigate if platelet MAO-B enzyme activity interacted with environment to predict female alcohol-related problems.

In contrast to what has been reported in males, presence of the long (4-repeat) variant of the MAO-A gene in females interacted significantly with an unfavourable environment (poor family relations or maltreatment/abuse/sexual abuse) to increase the risk for high scores of alcohol-related problems. Furthermore, females with low platelet MAO-B activity showed an increased risk of alcohol-related problem behaviour in an unfavourable environment.

Poor psychosocial environment interacts with the high activity MAO-A genotype and low platelet MAO-B enzyme activity to increase vulnerability for female adolescent alcohol-related problem behaviour.

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Client consensus on beliefs about abstinence: Effects on substance abuse treatment outcomes
Drug and Alcohol Dependence Volume 93, Issues 1-2, 11 January 2008, Pages 30-37


Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment.

The present paper extends this work to treatment outcomes.

Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality.

The implications of the results for substance abuse treatment are discussed.

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What Level of Alcohol Consumption Is Hazardous for Older People? Functioning and Mortality in U.S. and English National Cohorts
Journal of the American Geriatrics Society Jan;55(1):49-57.



To estimate disability plus mortality risks in older people according to level of alcohol intake.

One-tenth (10.8%) of U.S. men, 28.6% of English men, 2.9% of U.S. women, and 10.3% of English women drank more than the U.S. National Institute on Alcohol Abuse and Alcoholism recommended limit for people aged 65 and older. Odds ratios (ORs) of disability, or disability plus mortality, in subjects drinking an average of more than one to two drinks per day were similar to ORs in subjects drinking an average of more than none to one drink per day. For example, those drinking more than one to two drinks per day at baseline had an OR of 1.0 (95% confidence interval (CI)=0.8-1.2) for ADL problems, 0.7 (95% CI=0.6-1.0) for IADL problems, and 0.8 (95% CI=0.6-1.1) for poor cognitive function. Findings were robust across alternative models. The shape of the relationship between alcohol consumption and risk of disability was similar in men and women.

Functioning and mortality outcomes in older people with alcohol intakes above U.S. recommended levels for the old but within recommendations for younger adults are not poor. More empirical evidence of net benefit is needed to support screening and intervention efforts in community-living older people with no specific contraindications who drink more than one to two drinks per day.

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SHAAP: Latest News

• “conversations on ALCOHOL......”

5th December – Irvine Welsh talks to Lesley Riddoch about Scottish drinking culture, consumerism and banning alcohol advertising in sport. Listen to what Irvine had to say - .mp3.

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Press Release - Ed Balls launches plan for children
Department for Children, Schools and Families (National)





Tuesday 11 December 2007

WORLD CLASS AMBITIONS FOR ALL CHILDREN - 2020 GOALS OUTLINED - £1 BILLION ALLOCATED TO FUND THE PLAN OVER THE NEXT THREE YEARS

BETTER SUPPORT FOR PARENTS AND FAMILIES CENTRAL TO THE PLAN

NEW ERA FOR KIDS' PLAY AND POSITIVE ACTIVITIES FOR YOUNG PEOPLE - FREE CHILDCARE FOR TWO YEAR OLDS FROM DEPRIVED COMMUNITIES - OVERHAUL OF THE PRIMARY CURRICULUM

Secretary of State for Children, Schools and Families, Ed Balls today launched the 'Children's Plan', a long term vision to improve schools and a step-change in the way parents and families are supported to deal with the new challenges faced by young people in the 21st century.

Building on a decade of reform and results, and responding directly to parents and young people's concerns, the Children's Plan:

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* a youth alcohol action plan will be published in the Spring 2008, around the same time as the new drugs strategy which will improve alcohol education in schools and consider the case for further action on alcohol advertising;
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ALCOHOL AND DRUG ABUSE TRENDS: January – June 2007 (Phase 22)
19 November 2007

Background

The SACENDU Project is an alcohol and other drug (AOD) sentinel surveillance system now operational in 8 provinces in South Africa: Western Cape (WC: Cape Town), KwaZulu- Natal (KZN: Durban, Pietermaritzburg), Eastern Cape (EC), Mpumalanga (MP), Gauteng (GT: Johannesburg, Pretoria), Free State (FS), Northern Cape (NC), and Northwest (NW).
The last 3 provinces form part of what is termed the Central Region (CR) and provided data from 2006b. The system, operational since 1996, monitors trends in AOD use and associated consequences on a six-monthly basis from specialist AOD treatment programmes. The surveillance system has been expanded to all provinces during 2007, with Limpopo collecting data from July 2007. This report will focus on data on treatment admissions from the 9414 patients seen across the 72 centres/programmes in the 1st half of 2007.


Latest key findings by substance of abuse (unless stated otherwise the findings relate to the 1st half of 2007)

Alcohol remains the dominant substance of abuse across all sites except WC. Between 44% (WC) and 70% (CR) of patients in treatment have alcohol as a primary or secondary drug of abuse. The proportion reporting it as a primary drug of abuse (Table 1) continued to decrease in MP (44%) and KZN (50%). Treatment admissions for alcohol-related problems in persons under 20 years of age are generally less common, ranging between 4% (WC) and 26% (EC) of all patients in this age group (Table 1).
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Campaign Against Alcohol Intake By Pregnant Women Gets to Cape Coast
Public Agenda (Accra)

10 December 2007

Kwaku Baah-Achemfour

Cape Coast Township was last Saturday converted into a classroom setting when Ghana Organization on Fetal Alcoholic Syndrome (GOFAS) organized a three day seminar to sensitize pregnant women on the dangers associated with the intake of alcohol on their health and the unborn babies.

Speaking to Public Agenda in Cape Coast, the Chief Executive Officer of the group, Mrs. Amanorbea Opoku-Boakye explained that the seminars were organized in Accra and Cape Coast due to their research findings that revealed that many pregnant women continue to rub shoulders with men in the drinking bars with dire consequences on their unborn babies.

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A RAT MODEL REPRODUCING KEY PATHOLOGIC RESPONSES OF ALCOHOLIC CHRONIC PANCREATITIS
Am J Physiol Gastrointest Liver Physiol Onlie Early (September 20, 2007)

Although alcohol abuse is the major cause of chronic pancreatitis, the pathogenesis of alcoholic chronic pancreatitis (ACP) remains obscure. A critical obstacle to understanding the mechanism of ACP is lack of animal models.

Our objective was to develop one such model.

Rats were pair-fed for 8 weeks ethanol or control Lieber-DeCarli liquid diet. For the last 2 weeks, they received cyclosporin A (CsA; 20 mg/kg once daily) or vehicle. After 1 week on CsA, one episode of acute pancreatitis was induced by 4 x 20 µg/kg injections of cerulein (Cer); controls received saline. Pancreas was analyzed 1 week after the acute pancreatitis.

CsA or Cer treatments alone did not result in pancreatic injury in either control (C)- or ethanol (E)-fed rats. We found, however, that alcohol dramatically aggravated pathologic effect of the combined CsA+Cer treatment on pancreas, resulting in massive loss of acinar cells, persistent inflammatory infiltration, and fibrosis. Macrophages were prominent in the inflammatory infiltrate.

Compared with control-fed C+CsA+Cer rats, their ethanol-fed E+CsA+Cer counterparts showed marked increases in pancreatic NF-B activation and cytokine/chemokine mRNA expression; collagen and fibronectin; the expression and activities of matrix metalloproteinases 2 and 9; and activation of pancreatic stellate cells.

Thus, we have developed a model of alcohol mediated post-acute pancreatitis that reproduces 3 key responses of human ACP: loss of parenchyma, sustained inflammation, and fibrosis.

The results indicate that alcohol impairs recovery from acute pancreatitis, suggesting a mechanism by which alcohol sensitizes pancreas to chronic injury.

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Editorial - The status of addiction treatment research with co-occurring substance use and psychiatric disorders
Journal of Substance Abuse Treatment Volume 34, Issue 1, January 2008, Pages 1-2

If you “Google” the term “dual disorder patient,” you will see pages of references to the treatment of hypertension and diabetes! Most of us do not think of that combination when we hear the term, but this is just the most common of the many “comorbid” or “co-occurring” combinations of health problems found in contemporary treatment settings. Although the dual disorders of hypertension and diabetes combine to create a very serious condition, the individuals who seek treatment for this combination have some advantages over individuals who seek treatment for a substance use combined with a mental health disorder.

Both hypertension and diabetes are unarguably health conditions—neither is considered a sin, a sign of moral weakness, or a lifestyle. Those seeking treatment may feel reasonably confident that their primary care physician has received training in both of the conditions, that (in most cases) the same providers will be able to diagnose and treat both conditions, and that however problematic the health care coverage may be, it will be reasonably comparable for both conditions. These rather basic aspects of care delivery cannot be assumed when substance use and mental illnesses combine. Yet, these “dual disorders” do combine with great regularity, producing significant debilitation for the individuals affected and their families, significant costs to the health care system, and regular confounding of efforts for those who try to treat either condition without addressing the other. Despite the problems created by the trifurcated research, treatment, and insurance systems in this country (general medical, mental health, and substance use), there have been significant advances in the research and treatment—but not in the insurance coverage—of various combinations of mental and substance use disorders. This special issue of the Journal of Substance Abuse Treatment pays tribute to those clinical researchers who have overcome these systemic impediments to advance our knowledge about these “co-occurring” disorders.
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Perceived health status, alcohol-related problems, and readiness to change among medically hospitalized, alcohol-dependent patients
Journal of Hospital Medicine Volume 2, Issue 6 , Pages 372 - 377

Alcohol dependence is prevalent among medically hospitalized patients, and acute illness has the potential to increase motivation to change and provide a therapeutic window for treatment of alcohol dependence. This study evaluated the correlations of readiness to change drinking behavior with perceived physical and mental health status and specific alcohol-related consequences of medical inpatients. Problem recognition and ambivalence about change , but not taking steps to change drinking were significantly associated with perceived physical health. Perceived mental health was not associated with these variables, but greater alcohol-specific consequences were typically associated with greater recognition, ambivalence, and intent to change. Among alcohol-dependent patients with acute medical illness requiring hospitalization, poorer perceived health status was associated with increased recognition of drinking problems and thoughts about changing drinking behavior. Future research should evaluate if problem recognition and ambivalence modify treatment involvement and outcomes following hospitalization and if hospital-based interventions designed to link medical conditions and their treatment to alcohol dependence enhance recognition and ambivalence. Read Full Abstract Request Reprint E-Mail: stewarsh@musc.edu _____________________________________________________________________

Association of NFKB1, which encodes a subunit of the transcription factor NF-B, with Alcohol Dependence
Human Molecular Genetics Advance Access published online on December 12, 2007


A broad region on chromosome 4q has been linked to alcohol dependence (alcoholism). We hypothesized that such broad linkage regions represent the combined action of multiple genes.

Seeking to identify genes within that region that are associated with alcoholism, we have tested the association of NFKB1, located at 4q24, with alcoholism. NFKB1 encodes a 105 kDa transcription inhibitor that is cleaved to the 50 kDa DNA binding subunit of the ubiquitous transcription factor NF-B. NF-B regulates many genes relevant to brain function, and its actions can be potentiated by ethanol; thus NFKB1 is an excellent candidate gene for alcoholism.

Nineteen SNPs in and near NFKB1 were analyzed in a sample of 219 multiplex alcoholic families of European American descent.

Family based association analyses detected significant evidence of association with eight SNPs and marginal evidence for five more. The association was driven by the affected individuals with earlier onset of alcoholism (55% of the sample with onset 21 years). Further analysis of the age of onset as a quantitative variable provided evidence for the association of 12 SNPs in this gene.

Thus variations in NFKB1 appear to affect the risk for alcoholism, particularly contributing to an earlier onset of the disease.

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Baby risk labels proposed on alcohol

Sunday December 16, 2007

Alcohol bottles could be slapped with new labels warning pregnant women to steer clear under a new proposal floated by the trans-Tasman food regulator.

Food Standards Australia New Zealand (FSANZ) is inviting comment on the concept of putting baby risk warning labels on beers, wines and spirits.

The application has been proposed by the Alcohol Advisory Council of New Zealand (ALAC) but would also apply in Australia if ultimately approved.

Under the scheme "suppliers would be required to place a label on alcoholic beverage containers advising of the risks of consuming alcohol when planning to become pregnant and during pregnancy," the regulator said in a statement.
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Ingredient and nutrition information labelling of alcoholic beverages: do consumers want it? The World Today — Letters
Med J Aust 2007; 187 (11/12): 669.

To the Editor: In Australia, the packaging of alcoholic beverages, unlike that of non-alcoholic beverages, is not required to display a list of ingredients or nutritional information, such as the amount of sugar, calories, and any preservatives contained in the drink.1 It is possible that consumers, especially some population groups such as weight-conscious young women, might be less inclined to drink as much alcohol if they knew the calorie content of what they were consuming. There has been no published research on whether Australian consumers want this information.

In April 2007, we invited (by letter and email) a random sample of 13 000 students aged 17–25 years at an Australian university to complete a web survey on alcohol consumption, health effects, and attitudes toward nutrition/ingredient labelling. Of the students invited, 7237 responded (56% response rate), and 6497 of these (90%) had consumed alcohol in the preceding 12 months.

Results suggest that more than three-quarters of this population group want to see both ingredients and nutritional information displayed on alcoholic beverage packaging.
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Identifying Opinion Leaders to Promote Behavior Change
Health Education & Behavior, Vol. 34, No. 6, 881-896 (2007)

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health.

The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each.

Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

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Identifying Opinion Leaders to Promote Behavior Change
Health Education & Behavior, Vol. 34, No. 6, 881-896 (2007)

This article reviews 10 techniques used to identify opinion leaders to promote behavior change. Opinion leaders can act as gatekeepers for interventions, help change social norms, and accelerate behavior change. Few studies document the manner in which opinion leaders are identified, recruited, and trained to promote health.

The authors categorize close to 200 studies that have studied or used opinion leaders to promote behavior change into 10 different methods. They present the advantages and disadvantages of the 10 opinion leader identification methods and provide sample instruments for each.

Factors that might influence programs to select one or another method are then discussed, and the article closes with a discussion of combining and comparing methods.

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Request Reprint E-Mail: tvalente@usc.edu

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