News Release - Tackling teen drinking

6 February 2008

The Home Secretary has announced tough police powers to prevent underage drinking, and called for more involvement by parents and the alcohol industry to deal with the problem of teenage alcohol abuse.

Speaking to an audience of police, local authority licencing officers and representatives from the alcohol and retail industries, she described a package of new measures designed to address alcohol-related crime and anti-social behaviour among young people.

Key actions

Among the actions to be taken are:

• a crackdown by police on underage drinkers consuming alcohol in public places
• extra powers for police to confiscate alcohol
• wider use of parenting contracts to get parents involved in helping their children deal with drinking addictions
• a new public information campaign directed at binge drinkers
• an independent review of how well industry standards are being met when it comes to responsible sales of alcohol

Good work already underway

Home Secretary Jacqui Smith emphasised that a lot of good work is already being done to address the problem of binge drinking, but there's more still to do.

'Police must have all the powers they need to make groups of young people drinking in public a thing of the past,' she said. 'A new campaign to confiscate alcohol from underage drinkers begins this month, and lessons will be learned from it.

'At the same time, we will continue to punish those few irresponsible retailers who flout the law by persistently selling to children.'

Parents will also play their part, and those whose children are consistently found drinking illegally will be given support to help their children stop drinking.

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Effectiveness of a law to reduce alcohol-impaired driving in Japan
Injury Prevention 2008;14:19-23

To estimate the effect of a new road traffic law against alcohol-impaired driving in Japan.

Japan passed a new road traffic law in June 2002 intended to reduce alcohol-impaired driving by decreasing the permissible blood alcohol level and by increasing penalties. Using data collected from police reports, the number of traffic fatalities and injuries were analyzed by time series.

Simple comparisons of the average of all severe traffic injuries, traffic fatalities, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven showed reductions after enactment of the new road traffic law in June 2002. The rate of alcohol-related traffic fatalities per billion kilometers driven decreased by 38% in the post-law period.

In segmented regression analyses with adjustment for baseline trends, seasonality, and autocorrelation, all traffic injuries, severe traffic injuries, alcohol-impaired traffic injuries, alcohol-impaired severe traffic injuries, and alcohol-impaired traffic fatalities per billion kilometers driven declined significantly from baseline after the new traffic law.

Large, immediate public health benefits resulted from the new road traffic law in Japan

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Hazardous Alcohol Drinking in the Former Soviet Union: A Cross-Sectional Study of Eight Countries
Alcohol and Alcoholism Advance Access published online on February 3, 2008




Hazardous consumption of large quantities of alcohol is a major cause of ill-health in the former Soviet Union (fSU). The objective of this study was to describe episodic heavy drinking and other hazardous drinking behaviors in eight countries of the fSU.

Data from national surveys of adults conducted in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2001 were used (overall sample size 18,428; response rates 71–88%). Heavy episodic drinking, high alcohol intake, drinking alcohol during the working day, and using illegally produced strong spirits were examined.

On average, 23% of men and 2% of women were defined as heavy episodic drinkers (2 l of beer or 750 g bottle of wine or 200 g strong spirits at least once every 2–3 weeks). This was more common in young males, women who are single or who are divorced/separated/widowed, in smokers, and in frequent alcohol drinkers. About half the respondents who drank strong spirits obtained at least some alcohol from private sources. Among drinkers, 11% of males and 7% of women usually took their first drink before the end of working day.

Heavy episodic alcohol drinking is frequent in males throughout the region—although prevalence rates may have been affected by underreporting—but is still relatively rare in women.

Alcohol policies in the region should address hazardous drinking patterns and the common use of illegally produced alcohol.



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Request Reprint E-Mail: Joceline.Pomerleau@lshtm.ac.uk
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Sensory Processing Disorder in a Primate Model: Evidence From a Longitudinal Study of Prenatal Alcohol and Prenatal Stress Effects
Child Development 79 (1), 100–113.

Disrupted sensory processing, characterized by over- or underresponsiveness to environmental stimuli, has been reported in children with a variety of developmental disabilities.

This study examined the effects of prenatal stress and moderate-level prenatal alcohol exposure on tactile sensitivity and its relationship to striatal dopamine system function in thirty-eight 5- to 7-year-old rhesus monkeys. The monkeys were from four experimental conditions: (a) prenatal alcohol exposed, (b) prenatal stress, (c) prenatal alcohol exposed + prenatal stress, and (d) sucrose controls.

Increased D₂ receptor binding in the striatum, evaluated using positron emission tomography neuroimaging, was related to increased withdrawal (aversion) responses to repetitive tactile stimuli and reduced habituation across trials.

Moreover, prenatal stress significantly increased overall withdrawal responses to repetitive tactile stimulation compared to no prenatal stress.

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Request Reprint E-Mail: schneider@education.wisc.edu.
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Fetal Alcohol Exposure Alters Cerebrovascular Reactivity to Vasoactive Intestinal Peptide in Adult Sheep
Neonatology 2008;93:45-51


Chronic fetal alcohol exposure impairs neural and vascular development. We have previously shown that fetal alcohol exposure is associated with attenuated hypoxic cerebral vasodilation and reduced neuronal vasoactive intestinal peptide (VIP) expression in fetal sheep.

In the present study, we tested the hypothesis that fetal alcohol exposure alters vascular development, leading to altered cerebral vascular reactivity to VIP in adulthood.

There was no difference in myogenic tone between arterioles exposed prenatally to alcohol (n = 18) and saline controls (n = 17). However, fetal alcohol exposure significantly (p = 0.03) enhanced the dilator responses of adult intracerebral arterioles to VIP [0.1 nM to 1 µM, logEC₅₀: -8.6 ± 0.2 (alcohol) vs. -7.4 ± 0.8 (saline)]. In contrast, there was no difference in dilator responses to H⁺ (pH 6.8 buffer), to adenosine (10 nM to 0.1 mM), or to CGS21680 (an adenosine A_2A receptor agonist, 0.01 nM to 10 µM).

Thus, fetal alcohol exposure alters vasomotor sensitivity to VIP in adult intracerebral arterioles - perhaps a compensatory response to alcohol-induced underdevelopment of neurotransmitter pathways involved in cerebral vascular regulation.

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Request Reprint E-Mail: mayock@u.washington.edu
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Fetal alcohol syndrome (FAS) in C57BL/6 mice detected through proteomics screening of the amniotic fluid
Birth Defects Research Part A: Clinical and Molecular Teratology.
Early View 31 January 2008

Fetal Alcohol Syndrome (FAS), a severe consequence of the Fetal Alcohol Spectrum Disorders, is associated with craniofacial defects, mental retardation, and stunted growth

Previous studies in C57BL/6J and C57BL/6N mice provide evidence that alcohol-induced pathogenesis follows early changes in gene expression within specific molecular pathways in the embryonic headfold. Whereas the former (B6J) pregnancies carry a high-risk for dysmorphogenesis following maternal exposure to 2.9 g/kg alcohol (two injections spaced 4.0 h apart on gestation day 8), the latter (B6N) pregnancies carry a low-risk for malformations. The present study used this murine model to screen amniotic fluid for biomarkers that could potentially discriminate between FAS-positive and FAS-negative pregnancies. We identified several peaks in the proteomics screen that were reduced consistently and specifically in exposed B6J litters. Preliminary characterization by liquid chromatography tandem mass spectrometry and multidimensional protein identification mapped the reduced peaks to alpha fetoprotein (AFP). The predictive strength of AFP deficiency as a biomarker for FAS-positive litters was confirmed by area under the receiver operating characteristic curve. These findings in genetically susceptible mice support clinical observations in maternal serum that implicate a decrease in AFP levels following prenatal alcohol damage Read Full Abstract Request Reprint E-Mail: susmita.datta@louisville.edu _________________________________________________________

Paradoxical increase of positive answers to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of decreasing alcohol consumption: results from two population-based surveys in Île-de-France, 1991 and 2005
Addiction (OnlineEarly Articles) 4 February 2008


To describe trends of responses to the Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire during a period of declining alcohol consumption, in a country with no temperance history.

The proportion of subjects giving at least two positive answers has increased by 4.2 times; the biggest increase was observed for the Guilt question (4.8 times) and the smallest for the Eye-opener question (2.6 times). Several increases were higher for women than for men: 12.9 times versus 3.3 times for two or more positive answers, 9.8 times versus 3.8 times for the Guilt question. Increases did not vary consistently by age.

These paradoxical trends do not support the use of CAGE in general population surveys. They confirm previous reports suggesting that CAGE was sensitive to community temperance level. They might reflect the emergence of a temperance movement in France, with stronger impact among women. This movement might be responsible for the fall in alcohol consumption.

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Request Reprint E-Mail: antoine.messiah@isped.u-bordeaux2.fr
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Outcomes from a randomized controlled trial of a multi-component alcohol use preventive intervention for urban youth: Project Northland Chicago
Addiction (OnlineEarly Articles) 4 February 2008

The goal of this group-randomized trial was to test the effectiveness of an adapted alcohol use preventive intervention for urban, low-income and multi-ethnic settings.

Overall, the intervention, compared with a control condition receiving ‘prevention as usual’, was not effective in reducing alcohol use, drug use or any hypothesized mediating variables (i.e. related risk and protective factors). There was a non-significant trend (P = 0.066) that suggested the ability to purchase alcohol by young-appearing buyers was reduced in the intervention communities compared to the control communities, but this could be due to chance.

Secondary outcome analyses to assess the effects of each intervention component indicated that the home-based programs were associated with reduced alcohol, marijuana and tobacco use combined (P = 0.01), with alcohol use alone approaching statistical significance (P = 0.06).

Study results indicate the importance of conducting evaluations of previously validated programs in contexts that differ from the original study sample. Also, the findings highlight the need for further research with urban, low-income adolescents from different ethnic backgrounds to identify effective methods to prevent and reduce alcohol use.

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Request Reprint E-Mail: komro@ufl.edu

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News Release - Eye blinks may help to identify children prenatally exposed to alcohol
3 February 2008

Eye blinks may help to identify children prenatally exposed to alcohol

• Not all children prenatally exposed to alcohol show distinctive facial anomalies usually associated with fetal alcohol syndrome (FAS).
• New findings indicate that deficits in eyeblink conditioning (EBC) can identify children with probable FAS.
• EBC may also serve to identify alcohol-exposed children who lack distinctive FAS features.

While children with fetal alcohol syndrome (FAS) have identifiable craniofacial abnormalities, children with alcohol-related neurodevelopmental disorder (ARND) can have significant cognitive impairments without facial anomalies. An important new study has found that a deficit in eyeblink conditioning (EBC) can identify children with probable FAS, and may also serve to identify alcohol-exposed children who lack distinctive FAS features.

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Characteristics of Suicide Attempts Preceded by Alcohol Consumption
Archives of Suicide Research, Volume 12, Issue 1 January 2008 , pages 30 - 38


Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients. The relation between alcohol and suicide risk needs, however, to be clarified.

We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded ("Alcohol + ") or not by alcohol intake.

Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,). Alcohol dependence was also more frequent in the "Alcohol + " group (43% versus 9%). Patients from the "Alcohol + " group drank more alcohol each day (6.1 versus 1.3 drinks) and more often during the week (3.6 days per week versus 1.4). They had a higher number of alcohol intoxications each week (0.9 versus 0.3). They drank more often alone (41% versus 12%, p < 0.005) and in the morning (21% versus 3%). They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9). Prevalence of drug dependence was higher in the "Alcohol + " group (21% versus 3%, respectively).

Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.

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Request Reprint E-Mail: michel.lejoyeux@lmr.ap-hop-paris.fr
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An Evaluation of µ-Opioid Receptor (OPRM1) as a Predictor of Naltrexone Response in the Treatment of Alcohol Dependence
Arch Gen Psychiatry. 2008;65(2):135-144.



Naltrexone hydrochloride treatment for alcohol dependence works for some individuals but not for everyone. Asn40Asp, a functional polymorphism of the µ-opioid receptor gene (OPRM1), might predict naltrexone response.

To evaluate whether individuals with alcoholism who are heterozygous (Asp40/Asn40) or homozygous (Asp40/Asp40) for the OPRM1 Asp40 allele respond better to naltrexone.

Alcoholic subjects with an Asp40 allele receiving MM alone (no CBI) had an increased percentage of days abstinent (P = .07) and a decreased percentage of heavy drinking days (P = .04) if treated with naltrexone vs placebo, while those with the Asn40/Asn40 genotype showed no medication differences. If treated with MM alone and naltrexone, 87.1% of Asp40 carriers had a good clinical outcome, compared with only 54.8% of individuals with the Asn40/Asn40 genotype (odds ratio, 5.75; confidence interval, 1.88-17.54), while, if treated with placebo, 48.6% of Asp40 carriers and 54.0% of individuals with the Asn40/Asn40 genotype had a good clinical outcome (interaction between medication and genotype, P = .005). No gene x medication interactions were observed in those treated with both MM and CBI.

These results confirm and extend the observation that the functionally significant OPRM1 Asp40 allele predicts naltrexone treatment response in alcoholic individuals. This relationship might be obscured, however, by other efficacious treatments. OPRM1 genotyping in alcoholic individuals might be useful to assist in selecting treatment options.

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Association between the nociceptin receptor gene (OPRL1) single nucleotide polymorphisms and alcohol dependence
Addiction Biology 13 (1), 88–94.

OPRL1 encodes the nociceptin receptor, which has been shown to be involved in alcohol dependence in previous studies.

In the present study, we investigated the association between genetic polymorphisms of OPRL1 and alcohol dependence in a Scandinavian population.

We genotyped 15 single nucleotide polymorphisms (SNPs) spanning the OPRL1 locus and found that SNP rs6010718 was significantly associated with both Type I and Type II alcoholics (P < 0.05).

Linkage disequilibrium and haplotype analysis identified two haplotype blocks in this region. Furthermore, two haplotypes composed of five tag SNPs showed significant association with alcohol dependence.

These findings suggest that genetic variants of the OPRL1 gene play a role in alcohol dependence in the Scandinavian population, warranting further investigation at the OPRL1 locus.

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Request Reprint E-Mail: clawah@scripps.edu

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Phenomic, Convergent Functional Genomic, and biomarker studies in a stress-reactive genetic animal model of bipolar disorder and co-morbid alcoholism
American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, Early View, 4 Ferbruary 2008

We had previously identified the clock gene D-box binding protein (Dbp) as a potential candidate gene for bipolar disorder and for alcoholism, using a Convergent Functional Genomics (CFG) approach.

Here we report that mice with a homozygous deletion of DBP have lower locomotor activity, blunted responses to stimulants, and gain less weight over time. In response to a chronic stress paradigm, these mice exhibit a diametric switch in these phenotypes. DBP knockout mice are also activated by sleep deprivation, similar to bipolar patients, and that activation is prevented by treatment with the mood stabilizer drug valproate.

Moreover, these mice show increased alcohol intake following exposure to stress.

Microarray studies of brain and blood reveal a pattern of gene expression changes that may explain the observed phenotypes. CFG analysis of the gene expression changes identified a series of novel candidate genes and blood biomarkers for bipolar disorder, alcoholism, and stress reactivity

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Request Reprint E-Mail: anicules@iupui.edu)
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Impaired Eyeblink Conditioning in Children With Fetal Alcohol Syndrome
Alcoholism: Clinical and Experimental Research 32 (2), 365–372.


Eyeblink conditioning (EBC) is a Pavlovian paradigm that involves contingent temporal pairing of a conditioned stimulus (e.g., tone) with an unconditioned stimulus (e.g., air puff).

Animal studies have shown that binge consumption of alcohol during pregnancy impairs EBC and that this impairment is likely mediated by a loss of neurons in the inferior olive and the cerebellar cortex and deep nuclei, as well as by a reduction in neural plasticity in the cerebellar deep nuclei.

Not a single child with FAS met criterion for conditioning as contrasted with 75.0% of the controls. Whereas 86.7% of the controls who were conditioned met criterion by the end of Session 2, a large proportion of the relatively few alcohol-exposed nonsyndromal children who conditioned did not do so until Session 3. These alcohol effects on EBC persisted after controlling for IQ. Three of 4 microcephalic children who were not exposed to alcohol were successfully conditioned.

This is the first prospective study to demonstrate impaired EBC in children diagnosed with FAS. Successful EBC in a microcephalic group supports the inference that the EBC deficit is specific to prenatal alcohol exposure and a potential biomarker for diagnosis of exposed children lacking the distinctive FAS dysmorphology.

Delay EBC has a high sensitivity for identifying individuals with a diagnosis of probable FAS.

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Request Reprint E-Mail: sandra.jacobson@wayne.edu

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Organizational- and individual-level correlates of posttreatment substance use: A multilevel analysis
Journal of Substance Abuse Treatment Volume 34, Issue 2, March 2008, Pages 249-262

In addressing the need to study the effects of organizational factors on individual-level treatment outcomes, this study used hierarchical models to examine the organizational- and individual-level correlates of posttreatment substance use.

Risk for posttreatment use varied significantly across organizations. Factors in the external institutional environment of facilities significantly influenced risk for use: managed care regulation increased the risk, whereas Joint Commission on the Accreditation of Healthcare
Organizations accreditation decreased it (p < .01 for both).

On the individual level, longer treatment episodes and treatment completion reduced the risk (p < .01 for both) after controlling for client characteristics.

The benefits of length of stay in treatment were modified by elements of the external institutional environment and organizational treatment technology. The ameliorative effects of prolonged treatment were reduced by higher levels of managed care regulation, organizational monitoring, caseload size (p < .01 for all), and proportion of degreed staff (p < .05).

The results highlight the influence of organizational factors on posttreatment use.

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Request Reprint E-Mail: toorjo.ghose@yale.edu

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Editorial - Welcome to Mental Health and Substance Use: dual diagnosis (MHSU).
Mental Health and Substance Use: dual diagnosis
Vol. 1, No. 1, February 2008, 1



Increased recognition of co-existing mental health and substance use problems has led to a growing body of discussion and research into the efficacy of interventions, treatment, and service delivery. As knowledge and skill advances, professionals need an effective and stimulating forum to share information, debate, and develop new, and existing, concepts. MHSU aims to explore complex issues, inform, and educate professionals by pooling and sharing knowledge and skills. It is an essential source for the professional exploring the complex needs of the individual and family experiencing co-existing mental health and substance use problems.

The issue of appropriate terminology is one that caused a great deal of discussion when exploring the concept of this journal. There appears to be a lack of consensus around terminology internationally. Dual diagnosis is used interchangeably with terms like coexisting, co-morbid, and co-occurring mental health and substance use. It is questionable whether any of the terms applied fully reflect the complexity of issues surrounding the individual, nor the mutually dependent nature of mental health and substance use problems.

The term dual diagnosis has been criticised as a restrictive and unhelpful label. It encourages a focus on two distinct problems that may lead to inaccurate case formulations and inappropriate interventions, or, no intervention at all! However, whilst dual diagnosis is inadequate, it is currently the most widely recognised and used term. It is our belief that a journal aiming to explore and develop knowledge, interest, and understanding of this complex issue, should lead the debate to identify and define a universally agreed term that reflects the multifaceted needs of individuals experiencing mental health and substance use problems. This issue opens that debate with a paper presenting an argument for adopting the term co-existing problems. We are keen to hear your views, and welcome further manuscripts or correspondence to stimulate this discussion.

Whether you are a new or experienced clinician, educator, researcher, manager or service developer, MHSU is about keeping you up-to-date. We encourage submission from new and established authors. Our experienced Associate Editors and International Advisory Board will, when appropriate, advise and guide you through to publication, where possible. Guidance on submitting a manuscript is available at www.informaworld. com/mhsu. We hope MHSU meets your expectations and look forward to hearing your views.

Philip D. Cooper

Editor

Email: editor@mhsu.co.uk

Differences in mental health, substance use, and other problems among dual diagnosis patients attending psychiatric or substance misuse treatment services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 54 - 63

The study investigates differences in dual diagnosis disorders among patients in psychiatric and in substance use treatment services.

Important clinical differences were found between dual diagnosis patients in psychiatry and substance use treatment services. Dual diagnosis patients in psychiatry services were more likely to have a psychotic illness: those in the inpatient psychiatry service had the most severe mental health problems, and were exposed to the greatest risks to their safety. Psychiatric outpatients were least likely to have an alcohol dependence disorder, although a high rate of drug use disorders (mainly involving cannabis) was found among the psychiatric inpatients. High rates of affective disorders and suicide risk were found among patients in all treatment services.

The term 'dual' diagnosis can be misleading. Dual diagnosis patients present with complex mental health, physical health, psychosocial disability, and safety needs, and the pattern of problems presented by dual diagnosis patients varies across different treatment se


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Request Reprint E-Mail: Victoria.Manning@iop.kcl.ac.uk
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The views of consumers and frontline workers regarding coordination among addiction and mental health services
Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 21 - 32


Increasing co-ordination among addiction and mental health services is often recommended to improve service delivery for people with co-occurring addiction and mental health disorders.

Regarding their experiences in the addiction and mental health systems, and the development of a model of co-ordination in their community, this study compares the views of 16 consumers and 26 frontline workers to the current literature.

Consumers and frontline workers placed a higher priority on training workers and providing consumers with a welcoming place to go than on co-ordination. Consumers expressed concern about workers sharing client information. Consumers underscored the importance of peer support groups, and the formal system facilitating the development and maintenance of peer supports. Consumers offered suggestions for how the systems could more effectively obtain their input while frontline workers demonstrated disinterest in participating in planning initiatives.

Several of the findings are not reflected in the current literature. Funders and agencies might benefit from obtaining input from their local consumers and frontline workers as their views could influence the focus of community initiatives. Recommendations for future research are provided.

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Request Reprint E-Mail: kcalder@uwindsor.ca
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Moving away from medicalised and partisan terminology: a contribution to the debate

Mental Health and Substance Use: dual diagnosis, Volume 1, Issue 1 February 2008 , pages 2 - 9


There is a growing awareness within both mental health and substance misuse services of the importance of co-existing problems. Clients with these co-existing problems impact upon a wide range of professionals, and often present major challenges due to their complex needs.

However, there is confusion about both terminology, and many of the underlying and treatment issues, related to these co-existing problems.

This paper examines some of these confusions and debates, arriving at the view that practice in the field will be enhanced by the adoption of a broad and inclusive definition of co-existing problems which avoids medicalised terminology such as 'dual diagnosis' or 'co-morbidity'. We argue that the term 'co-existing mental health and drug and alcohol problems' is consistent with a case formulation driven approach and adoption of this term will thus enhance practitioners' confidence in the detection, assessment and treatment of co-existing problems.

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Request Reprint E-Mail: R.D.B.Velleman@bath.ac.uk
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Survey of professional attitudes to addiction treatment policy
Journal of Substance Use 4 February 2008

There has been increasing concern in England regarding the neglect of alcohol treatment in favour of treatment for illicit drug users (especially offenders).

The project sought to obtain the views of addiction professionals in specialist NHS services in England regarding recent changes to service provision.

Postal survey questionnaires were sent to the duty worker at 120 Community Drug and Alcohol Teams in the England. Responses were received from 180 participants representing at least one clinician at 87 of the teams.

Respondents had 1660 years of experience in substance misuse treatment. Only 11% felt that alcohol treatment services had improved over the last few years and 53% agreed that 'Government targets for treatment of illicit drug users has had a disastrous effect on the provision of alcohol treatment services'. The enhanced treatment for offenders was widely regarded as unfair to other service users. Half of respondents considered that the recent Government Alcohol Strategy was either 'pathetic' or 'a recipe for ineffectiveness.'

Despite the limited number of self-selecting participants, the opinions are clearly cause for concern.

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Request Reprint E-Mail: sl006h3607@blueyonder.co.uk