Sober thoughts of Sir Walter Raleigh

11/03/2008

Those filled with despair at the prevalence of binge drinking in 21st-century Britain cannot say they were not warned - Sir Walter Raleigh cautioned over the dangers of alcohol more than 400 years ago.

The one-time favourite of Queen Elizabeth I even wrote a little-known treatise on the matter, warning future generations - and his son, also called Walter, in particular - that excessive alcohol consumption "transformeth a Man into a Beast" and was "a bewitching and infectious Vice" which destroyed health and led to premature ageing.
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Secular Trends in the Lifetime Prevalence of Alcohol Dependence in the United States: A Re-evaluation
Alcoholism: Clinical and Experimental Research, OnlineEarly Articles
11 Mar 2008

U.S. epidemiologic surveys have consistently found higher lifetime prevalence of alcohol dependence among younger subjects than among older groups. Because lifetime prevalence is cumulative, such patterns are suggestive of strong secular trends; i.e., more-recently born subjects have developed more disease in a shorter period of time than their elders. However, it remains unclear whether such patterns truly reflect secular trends or are confounded by age-dependent factors such as differential recall, differential mortality, and other effects.

Using data from 2 large, national epidemiological surveys, a repeated cross-sectional analysis was conducted to compare lifetime prevalence of alcohol dependence across temporally adjacent birth cohorts surveyed at the same age, thus enabling estimates of cross-cohort differences while controlling for age-related factors.

In contrast with results from single cross-sectional analyses, there were few significant cross-cohort differences among groups of men compared at similar ages. On the other hand, women born between 1954 and 1963 were at 1.2-fold higher odds for lifetime drinking, and those who drank were at 1.5-fold higher odds for lifetime alcohol dependence, compared with the immediately preceding birth cohort (1944 to 1953). The 1944 to 1953 cohort was also at elevated odds for lifetime drinking compared with their predecessors (1934 to 1943). These results were largely due to changes among White and Hispanic women.

These results suggest that there have been substantial secular increases in drinking and alcohol dependence among women, but not men. Analyses of single cross-sectional studies may tend to over-estimate secular trends by failing to account for age-dependent effects. Nonetheless, secular increases in drinking and alcohol dependence among women are evident after taking age-related factors into account.

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Genetic and Environmental Influences on the Rate of Progression to Alcohol Dependence in Young Women
Alcoholism: Clinical and Experimental ResearchOnlineEarly Articles 6 Mar 2008

The development of alcohol dependence (AD) involves transitions through multiple stages of drinking behaviors and is shaped by both heritable and environmental influences.

We attempted to capture this dynamic process by characterizing genetic and environmental contributions to the rate at which women progressed through 3 significant transitions along the pathway to AD: nonuse to initiation, initiation to onset of first alcohol-related problem, and first problem to onset of AD.

Heritable influences were found for rate of progression across all 3 transitions, accounting for 30 to 47% of the variance in transition times. Shared environmental contributions were evident only in rate of progression from nonuse to initiation (i.e., age at first drink). Heritable contributions to the rate of movement through successive drinking milestones were attributable to a common factor, whereas environmental influences were transition-specific.

The current study is unique in its use of a genetically informative design to document the rate of movement between drinking milestones in a female sample and to examine genetic contributions to multiple transition times over the course of AD development.

Results indicate that an earlier report of heritability for males in rate of progression from regular drinking to AD generalizes to women and to other alcohol stage transitions. Findings also suggest the need to consider stage-specific environmental contributions to alcohol outcomes in developing interventions.

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Association of ADH and ALDH Genes With Alcohol Dependence in the Irish Affected Sib Pair Study of Alcohol Dependence (IASPSAD) Sample
Alcoholism: Clinical and Experimental Research OnlineEarly Articles 6 March 2008

The genes coding for ethanol metabolism enzymes [alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH)] have been widely studied for their influence on the risk to develop alcohol dependence (AD). However, the relation between polymorphisms of these metabolism genes and AD in Caucasian subjects has not been clearly established.

The present study examined evidence for the association of alcohol metabolism genes with AD in the Irish Affected Sib Pair Study of alcohol dependence.

We conducted a case–control association study with 575 independent subjects who met Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, AD diagnosis and 530 controls. A total of 77 single nucleotide polymorphisms (SNPs) in the seven ADH (ADH1-7) and two ALDH genes (ALDH1A1 and ALDH2) were genotyped using the Illumina GoldenGate protocols. Several statistical procedures were implemented to control for false discoveries.

All markers with minor allele frequency greater than 0.01 were in Hardy–Weinberg equilibrium. Numerous SNPs in ADH genes showed association with AD, including one marker in the coding region of ADH1C (rs1693482 in exon6, Ile271Gln). Haplotypic association was observed in the ADH5 and ADH1C genes, and in a long haplotype block formed by the ADH1A and ADH1B loci. We detected two significant interactions between pairs of markers in intron 6 of ADH6 and intron 12 of ALDH2 (p = 5 × 10⁻⁵), and 5' of both ADH4 and ADH1A (p = 2 × 10⁻⁴).

We found evidence for the association of several ADH genes with AD in a sample of Western European origin. The significant interaction effects between markers in ADH and ALDH genes suggest possible epistatic roles between alcohol metabolic enzymes in the risk for AD.

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Novel 3-aroylpyrazolo[5,1-c][1,2,4]
benzotriazine 5-oxides 8-substituted, ligands at GABA_A/benzodiazepine receptor complex: Synthesis, pharmacological and molecular modeling studies
Bioorganic & Medicinal Chemistry Article in Press, Corrected Proof 5 March 2008


The synthesis and binding studies of a series of 3-acylpyrazolo[5,1-c][1,2,4]benzotriazine 5-oxides 8-substituted are reported.

High-affinity ligands at benzodiazepine site on GABA_A receptor complex (GABA_A/BzR complex) were obtained when the 3-aroyl substituent is represented by a five-member heteroaroyl ring (furoyl-, thenoyl-, and pyrroyl-). Moreover the type of heteroaroyl ring at position 3 influences the feature of the substituent at position 8 to obtain high-affinity ligands: a ‘hydrogen-bond acceptor ring’ at position 3 is synergic with an electron donor substituent at position 8, while a ‘hydrogen-bond donor ring’ is synergic with a withdrawing substituent.

Compounds 8a, 9b, and 11 were deeply studied in vivo for their pharmacological effects considering six potential benzodiazepine actions: motor coordination, anticonvulsant action, spontaneous motor activity and explorative activity, anxiolytic-like effects, mouse learning and memory modulation, and ethanol-potentiating action.

To rationalize and qualitatively interpret the GABA_A/Bz binding affinities of compounds 8a and 11, a dynamic molecular modeling study has been performed, with the aim of assessing the preferred geometry of protein–ligand complex.

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Adopting Moderate Alcohol Consumption in Middle Age: Subsequent Cardiovascular Events
The American Journal of Medicine , Volume 121, Issue 3, March 2008, Pages 201-206

Moderate alcohol use is part of a healthy lifestyle, yet current guidelines caution nondrinkers against starting to drink alcohol in middle age. The purpose of this study was to evaluate whether adopting moderate alcohol consumption in middle age would result in subsequent lower cardiovascular risk.

This study examined a cohort of adults aged 45-64 years participating in the Atherosclerosis Risk in Communities study over a 10-year period. The primary outcome was fatal or nonfatal cardiovascular events.

Of 7697 participants who had no history of cardiovascular disease and were nondrinkers at baseline, within a 6-year follow-up period, 6.0% began moderate alcohol consumption (2 drinks per day or fewer for men, 1 drink per day or fewer for women) and 0.4% began heavier drinking. After 4 years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently nondrinking counterparts. This difference persisted after adjustment for demographic and cardiovascular risk factors (odds ratio 0.62, 95% confidence interval, 0.40-0.95). There was no difference in all-cause mortality between the new drinkers and persistent nondrinkers (odds ratio 0.71, 95% confidence interval, 0.31-1.64).

People who newly begin consuming alcohol in middle age rarely do so beyond recommended amounts. Those who begin drinking moderately experience a relatively prompt benefit of lower rates of cardiovascular disease morbidity with no change in mortality rates after 4 years.

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Reported Health and Health-Influencing Behaviors Among Urban American Indians and Alaska Natives.

This analysis of the national Behavioral Risk Factor Surveillance System (BRFSS) was conducte in an effort to better understand the health and health-influencing behaviors of urban American Indians and Alaska Natives. BRFSS is an annual telephone-based survey of adults carried out by states and US territories with the assistance of the Centers for Disease Control and Prevention, and is the world’s largest ongoing telephone survey.

This is the first report using BRFSS that focuses on American Indians and Alaska Natives (AIAN) living in counties served by the network of 34 Title V urban Indian health organizations. It shows a number of areas where AIAN living in these urban areas are not doing as well as the general population. Many of the reported disparities will come as no surprise to those working in urban AIAN health, and this report will serve to reinforce the importance of work already being done.

However, additional analyses comparing income groups showed a complicated picture, where the relationship between income and certain health indicators among American Indians and Alaska Natives differed from the general population. This report does not focus on the causes of thesedifferences, however it is hoped that these findings may lead to further investigation into which societal and personal factors may be most important in impacting the health of urban American Indians and Alaska Natives. Through a better understanding of the reasons for health disparities, interventions aimed at the root causes of poor health outcomes can be developed and advocated for.

This report also helps to establish a baseline for the discussion as to why culturally appropriate care is necessary in addressing health needs of urban AIAN communities. Care designed for the general population may not be as effective for this population, given that the needs and underlining causes of health outcomes may be different, as seen in this report.

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Can Recovering Drug Addicts Drink?


Written by William L. White, MA
Tuesday, 04 March 2008

The essay briefly noted a period in the history of therapeutic communities when clients (mostly recovering heroin addicts) could earn “drinking privileges” during the later stages of their treatment. The number of resulting emails regarding this practice and their pointed questions and animated comments suggested the need to elaborate on this fascinating chapter in the history of treatment. The twin purposes of this article are to recount the evolving policies toward alcohol within therapeutic communities and to offer reflections on the lessons that can be extracted from this interesting footnote in the history of addiction treatment and recovery in America.

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Mortality associated with depression

A forty-year perspective from the Stirling County Study
Social Psychiatry and Psychiatric Epidemiology, Online first, 8 March 2008

This report concerns long-term mortality risks associated with depression, and the potentially confounding factors of alcoholism and cigarette smoking, as experienced by a general population assessed at a baseline in 1952, followed for re-assessment of survivors in 1968, and for death by 1992.

At the baseline in 1952, depression was somewhat more common among women than men (4% compared to 6%) but was found to carry a significant mortality risk only among men (HR 2.7, 95% CI 1.6–4.7). Based on re-assessments made in 1968, depression was associated with mortality risk among both men (HR 2.2, 95% CI 1.0–4.5) and women (HR 2.1, 95% CI 1.2–3.8). In 1952, more than 20% of men smoked cigarettes excessively and 8% abused alcohol, but very few of these groups of men were also depressed. In the original sample and also among the survivors, depression, alcoholism, and heavy smoking were separately associated with mortality among men. Depression and alcoholism carried a more immediate mortality risk while heavy smoking a more delayed one.

At the baseline of the Stirling County Study, the mortality risk associated with depression among men was not enhanced or explained by abuse of alcohol or nicotine, mainly because comorbidity was rare at that time. The longitudinal research of the study has pointed to a number of psychiatrically-relevant time-trends such as the fact that an association between depression and cigarette smoking did not appear until the 1990s. It is hypothesized that a similar trend may emerge over time regarding the comorbidity of depression and alcoholism. A trend reported here was that, while depressed women in the original sample did not carry a significant mortality risk, the surviving women who were depressed at the time of re-assessment exhibited a mortality risk that was as significant as that for men. Such information may provide a useful back-drop for future investigations.

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Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: Role for a specialist nurse



In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery.

Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level.

Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level. One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes.

Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury. The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months.

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Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: A prospective randomised controlled trial
British Journal of Oral and Maxillofacial Surgery, Volume 46, Issue 2, March 2008, Pages 96-101

To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries.

A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed.

A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p <>

Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test to reduce their drinking, and this effect was apparent 12 months after the intervention.

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Alcohol Act meant to discourage liquor consumption - Health Minister
March 10, 2008

The Government introduced the Tobacco and Alcohol Act to discourage the use of Alcohol, considering the fact that alcohol is the major reason for domestic violence in rural and urban areas, said Health Minister Nimal Siripala de Silva.

Minister De Silva expressed these sentiments at a ceremony arranged to hand over nutrition packs, chemical mosquito nets and bank accounts to 1,000 pregnant mothers, held at the Urban Botanical Garden, Badulla, to coincide with the International Women’s Day.
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The functional limitations of clients with coexisting disabilities
Journal of Rehabilitation, Oct-Dec, 2007

As a group, people with disabilities have a higher rate of alcohol and drug use problems when compared to the general population (Heinemann, Goranson, Ginsburg, & Schnoll, 1989; Moore & Li, 1998; Stern, Byard, Tomashefski, & Doershuk, 1987). A report by the National Association on Alcohol, Drugs, and Disability (NAADD) estimated that up to six million people with disabilities also have co-existing substance abuse problems and that these disabilities may present obstacles to recovery (de Miranda, 1998). Nelipovich and Buss (1991) estimated that between 15-30% of the disabled population abuse alcohol or drugs--a rate of about two times found in the general population. The incidence of alcohol and/or drug problems appears to vary by disability type; traumatic brain injury and spinal cord injury (50-75%) and mental illness (50%), tend to have the highest rates of abuse/addiction, while people with mental retardation (10%) have been found to have a rate comparable to that of the non-disabled population (Rehabilitation Research and Training Center (RRTC), 1996).

In a study regarding current alcohol use, Moore and Li (1994) reported that 71.5% of people with spinal cord injuries drank, followed by hearing impairment (60.9%) and visual impairment (57.5%). Drinking was cause for concern in this sample because 51% of the respondents were also taking prescription medication and still others had medical/health concerns that could create problems with even minimal amounts of alcohol. These complicating factors makes it more likely that even relatively low levels of alcohol or drug use may become problematic (i.e., abuse) for people with disabilities.
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Alcohol consumption among recreational boaters: Factors for intervention
Accident Analysis & Prevention, Volume 40, Issue 2, March 2008, Pages 496-501


Recreational boating is a popular leisure time activity in many countries. It is estimated that, in Australia, boating incidents cause more harm than rail and air crashes combined and, in terms of transport, are second only to motor vehicle crashes as a cause of serious injury. The consumption of alcohol among recreational boaters is considered an important risk factor for fatalities and injuries among both operators and passengers.

Using a database of all recreational vessels registered in Western Australia (WA), a sample of 500 adult boaters was recruited to participate in a telephone survey. The effects of demographic variables and boating characteristics upon the use of alcohol among recreational boaters on their last trip were explored using logistic regression.

The odds of not having a drink were associated, after adjusting for age, with having completed a boating education course and with carrying children less than 12 years on board. The use of alcohol was not found to be prevalent among WA recreational boat owners.

Based on these findings, it is recommended that efforts to decrease boating-related incidents, such as through education and legislation measures, be monitored over time to determine the effects of these strategies upon safety behaviours.

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Request Reprint E-Mail: terri.pikora@uwa.edu.au
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Regional Self-Regulation Workshops

New meeting report from the workshop in the Latin America region (Santiago, Chile).

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INFORMING CONSUMERS ABOUT BEVERAGE ALCOHOL

This ICAP Report focuses on factual consumer information about alcohol beverages and how it is currently provided in different countries. It is intended as a companion document to the table reviewing the general information required for on-product labeling in 43 nations and the European Union.

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Alcohol Concern's 2008 Budget Submission

The 2008 Budget submission argues that a 10% rise in the price of alcohol across the board would reduce adult alcohol-related mortality by up to 37%.

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Start drinking in middle age for healthier heart


By Nic Fleming, Medical Correspondent

08/03/2008

Teetotallers who become moderate drinkers in middle age are significantly less likely to suffer heart attacks and strokes than those who continue to abstain, according to a study published yesterday.

Researchers found that women aged between 45 and 64 who began consuming an average of one alcoholic drink per day cut their risk of developing cardiovascular disease by almost 40 per cent.

The same was true for middle-aged men who allowed themselves up to two alcoholic drinks per day.
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Now ALL the major political parties say they will raise taxes on alcohol, as they battle to look the toughest on binge drinking

By GLEN OWER and BRENDAN CARLIN
8th March 2008

A bidding war over "binge drinking" taxes broke out last night as duty on alcohol became a key political battleground ahead of this week's Budget.

By last night, all three parties had pledged to raise taxes on alcohol, with Chancellor Alistair Darling indicating that he will be hiking duties on wines and spirits in his debut Budget on Wednesday.

Liberal Democrat Treasury spokesman Vincent Cable added a novel contribution to the debate, telling his party's spring conference that VAT on fruit juice and smoothies should be cut from 17.5 per cent to five per cent to help encourage healthy diets, with the anticipated £225million shortfall made up by raising the tax on some alcoholic drinks.

The Conservatives promised on Friday to raise tax on super-strength beer, cider and alcopops to tackle binge-drinking, while reducing the tax on low-strength beer and cider enjoyed by 'sensible' drinkers.
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A regulatory variation in OPRK1, the gene encoding the -opioid receptor, is associated with alcohol dependence
Human Molecular Genetics Advance Access published online on March 4, 2008


Variations in OPRK1, which encodes the -opioid receptor, are associated with the risk for alcohol dependence.

Sequencing DNAs with higher and lower risk haplotypes revealed an insertion/deletion (indel) with a net addition of 830 bp located 1986 bp upstream of the translation start site (1389 bp upstream of the transcription start site).

We demonstrated that the upstream region extending from -1647 to -10 bp or from -2312 to -10 bp (relative to the translation start site) could function as a promoter in transient transfection assays. We then determined that the presence of the indel reduced transcriptional activity by half.

We used a PCR assay to genotype individuals in 219 multiplex alcohol dependent families of European American descent for the presence or absence of this indel.

Family-based association analyses detected significant evidence of association of this insertion with alcoholism; the longer allele (with the indel), which had lower expression, is associated with higher risk for alcoholism.

This indel is, therefore, a functional regulatory variation likely to explain at least part of the association of OPRK1 with alcohol dependence.

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