News Releas - HSE Publishes Detailed Review of Alcohol Consumption Rates and Related Harms

21st April 2008

The Health Service Executive (HSE), today, Monday 21st April, published a detailed review entitled "Alcohol Related Harm in Ireland." The report outlines the recent rising trends in alcohol consumption rates, the harmful effects these rates are having on the user and the damaging results they have on other people.

The report provides an overview of recent studies into alcohol consumption, assesses the most up to date research into their effects and offers recommendations on how best to reduce the unhealthiest consequences.

Following four years of static alcohol consumption, in 2007 there was a rise of 2.7% per capita in individual alcohol consumption.

Some of the key findings of the report include:

Alcohol Related Harm to the Drinker:

• 28% of all injury attendances in Accident and Emergency Departments in acute hospitals were alcohol related;
• Alcohol related hospital discharges, which is an indicator of attendance, increased by 92% between 1995 and 2002;
• Cancer of the liver had the highest increase in cancer incidence rates in comparison to all cancers between 1994-2003;
• Almost half of men and over a quarter of women agreed that drinking alcohol had contributed to them having sex without contraception;
• Between 1995 and 2004, Sexually Transmitted Infections (STIs) increased by 217%;
• Alcohol is a contributory factor in 36.5% of all fatal crashes;
• Between 1996 and 2002, public order adult offences increased by 247% (from 16,284 to 56,822) followed by a decrease in 2003 and 2004 but increased again in 2005;

Alcohol Related Harm to Others:

• Almost half (46%), of those who committed homicide were intoxicated at the time;
• Between 1990 and 2006, 2,462 people were killed on the roads between 9pm-4am, the time most associated with alcohol related driving;
• 44% of all respondents had experienced harm by their own or someone else's alcohol use;
• In a quarter of severe domestic abuse cases, alcohol was involved;
• The Coombe Women's Hospital found that 63% of women reported alcohol use during pregnancy, with 7% drinking 6 or more drinks per week;
• IBEC cited that alcohol related illness was cited by 12% of companies as a cause of short-term absence from work for males and 4% for females;

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Effects of craving and DRD4 VNTR genotype on the relative value of alcohol: an initial human laboratory study
Behav Brain Funct. 2007; 3: 11.

Craving for alcohol is a highly controversial subjective construct and may be clarified by Loewenstein's visceral theory, which emphasizes craving's behavioral effects on the relative value of alcohol.

Based on the visceral theory, this study examined the effects of a craving induction on the relative value of alcohol as measured by a behavioral choice task. In addition, based on previous evidence of its role in the expression of craving, the influence of DRD4 VNTR genotype (DRD4-L vs. DRD4-S) was also examined.

Factorial analysis of the craving induction revealed that it was associated with significant increase in craving (p < .001), but not greater relative value of alcohol. Factorial analyses including DRD4 VNTR genotype of did not suggest an influence on reactivity to the craving induction, although this analysis was substantially compromised by small cell sample sizes.

Continuous analyses revealed that craving was significantly associated with the relative value of alcohol (p < .05) and possession of the DRD4-L allele further amplified this relationship (p < .001).

These results are interpreted as generally supporting Loewenstein's visceral theory of craving and evidence of a functional role of DRD4 VNTR genotype in the expression of craving for alcohol.

Methodological limitations, mechanisms underlying these findings, and future directions are discussed.

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EEG Biofeedback as a Treatment for Substance Use Disorders: Review, Rating of Efficacy, and Recommendations for Further Research

Appl Psychophysiol Biofeedback. 2008 March; 33(1): 1–28. Electroencephalographic (EEG) biofeedback has been employed in substance use disorder (SUD) over the last three decades. The SUD is a complex series of disorders with frequent comorbidities and EEG abnormalities of several types. EEG biofeedback has been employed in conjunction with other therapies and may be useful in enhancing certain outcomes of therapy. Based on published clinical studies and employing efficacy criteria adapted by the Association for Applied Psychophysiology and Biofeedback and the International Society for Neurofeedback and Research, alpha theta training—either alone for alcoholism or in combination with beta training for stimulant and mixed substance abuse and combined with residential treatment programs, is probably efficacious. Considerations of further research design taking these factors into account are discussed and descriptions of contemporary research are given. Read Full Text (PDF) _______________________________________________________________

[Commentary] ALCOHOL AND FRONTAL LOBE IMPAIRMENT: FASCINATING FINDINGS
Addiction Volume 103 Issue 5 Page 736-737, May 2008

What Uekermann and Daum have done in their excellent paper is to specify in more detail the ways in which frontal lobe dysfunction affects social cognition. For example, they have reviewed evidence that alcoholics take longer to decode emotional facial expressions than healthy comparison groups. Not only that, but alcoholics over-estimate the intensity of emotions, and they show a clear bias towards mislabelling sad expressions as hostile. They tend to judge a happy face as reflecting a negative mood state, and fear responses are enhanced. There is some evidence that the decoding of facial expressions improves following abstinence in parallel with improvements in cognitive function, but this is not always seen. Somewhat similarly, alcoholic patients show deficits in identifying the affective component of speech prosody. The association between such impairments and interpersonal problems may predispose to relapse.

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Social cognition in alcoholism: a link to prefrontal cortex dysfunction?
Addiction Volume 103 Issue 5 Page 726-735, May 2008

Alcoholism is associated with a range of cognitive deficits. These deficits might be explained by the ‘frontal lobe hypothesis’ which suggests a specific vulnerability of the prefrontal cortex (PFC) to the neurotoxic effects of alcohol. Social cognition is thought to be processed in the PFC, but so far only few studies have addressed the issue of social cognition deficits in alcoholism.

This review aims to evaluate the deficits in social cognition in alcoholic patients. In addition an outline for future perspectives is given.

Alcoholism is associated clearly with social cognition impairments which include emotional face and prosody perception problems, theory of mind deficits and humour processing difficulties.

In summary, the social cognition impairments are consistent with the frontal lobe hypothesis of alcoholism. Future studies should focus on (i) the delineation of the basic cognitive processes which underlie social cognition deficits; and (ii) their relevance as predictors of treatment outcome in alcoholism.

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Request Reprint E-Mail: jennifer.uekermann@ruhr-uni-bochum.de
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The Australia 2020 Summit - The Record

The Australia 2020 Summit Initial Report was made available to participants after the final session on Sunday April 20. This Report was presented to the Prime Minister, the Honourable Kevin Rudd MP by Professor Glyn Davis AC on behalf of all the participants.

Logistics in getting the Initial Report prepared and printed didn’t allow for the capturing of some of the ideas from the final Sunday sessions.

These Power Point slides from each of the 10 streams summarise the Ambitions and Goals, Priority Themes and Top Ideas.

A more detailed record of the Summit will be available during next month. This record will include:

• A more formal and detailed record of all the discussion sessions, picking up on the range of ideas put forward;
• Overviews of the preliminary Summit events, including the Youth Summit, local summits and schools summit;
• A strategic overview of the ideas raised in the public submission.

The Prime Minister announced that he would like to continue the “national conversation” through the Australia 2020 website.

The submissions database on this site has been disabled. The current capacity of the website will be upgraded to continue to receive submissions and ideas.

The new site to replace this current site, will be available by 7 May 2008.

• Australia 2020 Summit - Sunday Plenary Stream Report - Low Resolution - PowerPoint 1MB | PDF 618KB
• Australia 2020 Summit - Sunday Plenary Stream Report - Medium Resolution - PowerPoint 3.3MB | PDF 2.1MB

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Australia 2020 Summit - Initial Report

The Initial Report from the 2020 Summit to the Prime Minister, sets out the key results of discussion by 1000 Australians over the weekend of 19 and 20 April in Canberra.

The Report includes results across the 10 streams of the Summit, including ambitions, priority themes and top ideas from each stream.

A more detailed, final report of the Summit to the Prime Minister will be prepared next month and will be available on the web site.

Stream - A Long-term National Health Strategy

• Create a national preventative health agency. This independent health body would be funded by taxes on products with high social cost, e.g. alcohol, cigarettes and junk food (like a national version of VicHealth). The body would commission research, design interventions based on evidence, develop and deliver preventative health policy, and implement marketing and public health campaigns.

Download Australia 2020 Summit - Initial Report - WORD 2.6MB | PDF 1MB

Conference conclusions - European Alcohol Policy Conference

The third European Alcohol Policy conference, Building Capacity for Action, took place in Barcelona, 3^rd-5^th April 2008, with 352 participants from 36 countries. The conference, which was encompassed within the programme of activities organized by the Slovenian Presidency of the Council of European Union, was supported by the Ministry of Health and Consumer Affairs of Spain and the Ministry of Health of Slovenia, and was hosted by the Regional Government of Catalonia. The conference was co-financed by the European Commission, and co-sponsored by the Regional Office for Europe of the World Health Organization and the European Alcohol Policy Alliance.

Conference Conclusions

• Alcohol causes a high level of harm

• Young people are vulnerable to alcohol

• Alcohol causes harm to people other than the drinker
  

• Government regulation needs to be strengthened
  

• Help needs to be available for people with problems
  

• Focusing on their product, economic operators have the potential to reduce harm
  

• Raising the voice of civil society
  

• Capacity for Action
  

• Towards a Global Strategy
  

• Expanding the evidence base

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Effectiveness of the AUDIT-C as a Screening Test for Alcohol Misuse in Three Race/Ethnic Group
J Gen Intern Med, Online first 18 April 2008



The Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) is a brief validated screen for risky drinking and alcohol abuse and dependence (alcohol misuse). However, the AUDIT-C was validated in predominantly White populations, and its performance in different racial/ethnic groups is unclear.

Race/ethnicity was self-reported. Areas under the receiver operating curve (AuROCs) evaluated overall AUDIT-C performance in the 3 racial/ethnic groups compared to diagnostic interviews for alcohol misuse. AUDIT-C sensitivities and specificities at recommended screening thresholds were compared across racial/ethnic groups. AuROCs were greater than 0.85 in all 3 groups, with no significant differences across racial/ ethnic groups in men (P=.43) or women (P=.12). At previously recommended cut points, there were statistically significant differences by race in AUDIT-C sensitivities but not specificities. In women, the sensitivity was higher in Hispanic (85%) than in African-American (67%; P=.03) or White (70%; P=.04) women. In men, the sensitivity was higher inWhite (95%) than in African-Americanmen (76%; P=.01), with no significant difference from Hispanic men (85%; P=.11).

The overall performance of the AUDITC was excellent in all 3 racial/ethnic groups as reflected by high AuROCs. At recommended cut points, there weresignificant differences in the AUDIT-C’s sensitivity but not in specificity across the 3 racial/ethnic groups.

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Ministry says alcohol poses a threat to Finnish internal security
16 April 2008

Action programme urges heavier taxation and reduction in consumption to 2003 levels

Finnish drinking habits pose a considerable threat to the security of the nation.

This is the view of the Ministry of the Interior, which on Tuesday published a broad-based action programme to improve internal security in the country.

Security is being eroded by such things as marginalisation, accidents, and violence. Alcohol is seen as the most common reason for violence and the cause of countless accidents. “Finland is paying a stiff price for its alcohol culture”, says the ministry’s Permanent Secretary Ritva Viljanen.
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Alcohol and Drug Use Among European 17-18 Year Old Students

The three large ESPAD (The European School Survey Project on Alcohol and Other Drugs) surveys that were conducted in 1995, 1999 and 2003 investigated the use of alcohol and other drugs among students aged 15–16 (Hibell, Andersson et al 1997, Hibell, Andersson et al 2000, Hibell, Andersson et al 2004). Over the years an increasing number of countries have joined the
project and in the last survey 35 European countries collaborated on data collections on nationally representative samples.

The number of countries included in this study is limited but represent different parts of Europe. On many variables France and Sweden appear as opposite poles regarding alcohol consumption and drug use. The French students drink little and seldom get drunk, while the prevalence of cannabis consumption is high. In Sweden, on the other hand, drunkenness is frequent, but the prevalence of illicit drug use, mainly cannabis, is the lowest among the countries included in this study.

Overall, the results indicate that the tobacco, alcohol and drug use pattern among students aged 17–18 varies a great deal between the seven countries included in this study. For example, almost half of the students are more or less habitual smokers, except in Sweden where this is truefo r about one third.

Rather few – one fifth or less – had been drinking alcohol 10 times or more during the past 30 days, especially in Sweden. Drunkenness, on the other hand, is much more frequent among the Swedish students in comparison, but especially in relation to the Mediterranean countries, which are very low on this variable.

It is difficult to draw any conclusions from the pattern of alcohol consumption and drunkenness. It seems as if the Swedish students were more inclined to declare a high frequency of intoxication than students in other countries, despite the fact that they drink less often. The binge drinking frequency, however, is a little bit higher among the Swedes than among students in the other countries, but still not far from average.

The lifetime prevalence of illicit drug use, however, gives a picture rather opposite to the alcohol variables. France, which is generally low on most alcohol variables, is dominating the picture with 6 out of 10 students reporting use of cannabis. Italy is the country that comes closest to this, but is still lower (4 out of 10). In contrast, the use of illicit drugs other than cannabis is generally much lower in all the countries under study.

To analyse why some students refrain from alcohol and/or alcohol intoxication, but consume illicit drugs such as cannabis would be an important contribution to the understanding of the formation of drug habits among people this age.

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Ethanol Enhances GABAergic Transmission Onto Dopamine Neurons in the Ventral Tegmental Area of the Rat
Alcoholism: Clinical and Experimental Research Online Early Articles 15 April 2008


Activation of the dopaminergic (DA) neurons of the ventral tegmental area (VTA) by ethanol has been implicated in its rewarding and reinforcing effects. At most central synapses, ethanol generally increases inhibitory synaptic transmission; however, no studies have explored the effect of acute ethanol on GABAergic transmission in the VTA.

Acute exposure of VTA-DA neurons to ethanol (25 to 50 mM) robustly enhanced GABAergic spontaneous and miniature IPSC frequency while inducing a slight enhancement of spontaneous IPSC (sIPSC) amplitude. Ethanol (50 mM) enhanced paired-pulse depression of evoked IPSCs, further suggesting enhanced GABA release onto VTA-DA neurons. The frequency of sIPSCs was suppressed by the GABA_B agonist, baclofen (1.25 μM) and enhanced by the antagonist, SCH50911 (20 μM); however, neither appeared to modulate or occlude the effects of ethanol on sIPSC frequency.

The present results indicate that ethanol increases postsynaptic GABA_A receptor sensitivity, enhances action potential-independent GABA release onto VTA-DA neurons, and that this latter effect is independent of GABA_B auto-receptor inhibition of GABA release.

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Request Reprint E-Mail: jontheile@mail.utexas.edu
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Clinical Characteristics of Carbohydrate-Deficient Transferrin (%Disialotransferrin) Measured by HPLC: Sensitivity, Specificity, Gender Effects, and Relationship with other Alcohol Biomarkers
Alcohol and Alcoholism Advance Access published online on April 14, 2008


The sensitivity and specificity of the relative disialotransferrin amount (%DST), considered the primary single target for measurement of the alcohol biomarker carbohydrate-deficient transferrin (CDT), were compared with the absolute CDT amount determined by the CDTect assay and with GGT and AST.

No gender difference in %DST was noted for nondrinkers, but light/moderate and heavy drinking males had significantly higher levels than females. Of the alcohol biomarkers examined, %DST showed the strongest correlation with self-reported alcohol intake, except for female heavy drinkers. The area under the %DST ROC curve for male (0.83) and female (0.82) heavy drinkers was significantly higher compared with CDT by CDTect (0.68) and GGT (0.69). At the 40, 60, or 80 g ethanol/day thresholds, %DST showed lower test sensitivity in women but there was no significant gender difference in overall accuracy according to ROC curve analysis.

%DST measured by HPLC showed overall higher sensitivity for "heavy drinking" and better correlation with recent high alcohol intake, compared with the absolute CDT amount, and GGT and AST.

The observation that several "light/moderate drinkers" had elevated %DST levels and some also a measurable asialotransferrin indicated misclassification with the WHO/ISBRA Interview Schedule and emphasize the limitations of self-reports of drinking.


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Request Reprint E-Mail: anders.helander@ki.se
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The Tachykinin Receptor 3 Is Associated With Alcohol and Cocaine Dependence
Alcoholism: Clinical and Experimental Research OnlineEarly Articles 15 April 2008



A broad region on chromosome 4q was previously linked to the phenotype of alcohol dependence in the Collaborative Study on the Genetics of Alcoholism sample.

A strong positional candidate gene was identified within this region: tachykinin receptor 3 gene (TACR3), which encodes tachykinin receptor 3 (NK3R), the receptor for the tachykinin 3 (neurokinin B) peptide. Pharmacological studies have provided evidence that the administration of NK3R agonists attenuates the intake of alcohol and NK3R can also mediate the acute and chronic behavioral effects of cocaine.

Seven of the 9 SNPs in the 3' region of TACR3 provided significant evidence of association with alcohol dependence (p ≤ 0.05). Further analyses suggest that the evidence of association is strongest among those subjects with more severe alcohol dependence (defined by ICD-10) and those with co-morbid cocaine dependence. Haplotype analyses further strengthen the evidence of association in the 3' region of the gene.

These results indicate that sequence variations in TACR3 contribute to the variation in more severe alcohol dependent individuals and those who are also cocaine dependent.

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Request Reprint E-Mail: tforoud@iupui.edu

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Impact of parents' alcohol dependency on children: new report

Saturday, April 19, 2008

Alcohol Concern have jointly produced a report with the Princess Royal Trust for Carers on the impact of parental alcohol dependency on children. The report, titled 'Keeping it in the family' estimates that around one million children currently live with a parent who is alcohol dependent. Looking at a range of research and findings the document considers the serious impact of parental alcohol misuse including long term psychological damage and a range of other pressures put on children, such as being forced into taking the role of carers themselves. It argues that there are not enough services currently available to support young carers or alcohol dependent parents.

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Minimum pricing for alcohol? The debate hots up..

Saturday, April 19, 2008

As Government ministers consider options for setting minimum prices on alcohol, the debate is hotting up amongst the industry and public alike as to whether such a move would make any difference, or is politically acceptable. This month the Daily Telegraph suggested that preparations to bring in minumum pricing are underway. However it understood that minsters are still only considering such options and awaiting further reviews as to the effectiveness and impacts of such policies.
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Alcohol Use Disorders: Old Insights, New Treatments/ Markus Heilig.

This lecture will cover alcoholism, its symptoms, and the latest research on the disease.

Alcohol Use Disorders: Old Insights, New Treatments Wednesday, October 03, 2007 Markus Heilig, M.D., Ph.D., National Institute of Alcohol Abuse and Alcoholism Total Running Time: 01:02:59 Category: Medicine for the Public more information

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Genetic and environmental influences on alcohol drinking behavior / Ting-Kai Li.

Throughout his career, Dr. Li has been at the center of advances that have transformed both the way alcoholism is understood and the means of investigating alcohol's effects on the body and the brain. A major focus of Dr. Li's research has been to characterize the structure and dynamics of the multiple genetic variants of alcohol dehydrogenase (ADH), the enzyme that catalyzes the first step in the metabolism of ethanol. Dr. Li was honored with a MERIT award for research on the molecular basis of differences among individuals in the physiology of these enzymes. Dr. Li also pioneered the development of animal models in which marked differences in the level of voluntary alcohol consumption could be observed, paralleling the same inborn variation seen in human behavior. The development of these animal lines helped cement the once radical notion that alcohol consumption behavior was genetically influenced. NIH Neuroscience Seminar Series.

Genetic and Environmental Influences on Alcohol Drinking Behavior Monday, November 03, 2003 Ting-Kai Li, M.D., NIAAA Director Total Running Time: 00:54:13 Play Relevant Content (08:20) Category: Neuroscience more information

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NIAAA NEWSLETTER - featuring information from the National Institute on Alcohol Abuse and Alcoholism
SPRING 2008 Number 15


CONTENTS

• Free Online Training for Clinicians

• Personnel News

• APIS Updates Alcohol Information Policy

• NIH Vodcast on YouTube Features Interview with Director Willenbring

• New Publications

• Conference Series Spotlights Mechanisms of Behavior Change

• Calendar

Download Full Newsletter (PDF)
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International survey of diagnostic services for children with Fetal Alcohol Spectrum Disorders
BMC Pediatrics 2008, 8:12

Early diagnosis and intervention for children with Fetal Alcohol Spectrum Disorder (FASD) reduces the risk of developing a range of secondary social, emotional and behavioural problems and provides an opportunity for prevention of further alcohol exposed pregnancies. The objective of this study was to describe specialist clinical service provision for the diagnosis and assessment of children exposed to alcohol in pregnancy.

Fetal Alcohol Spectrum Disorder (FASD) diagnostic clinics were identified through literature and internet searches. Clinics were sent a questionnaire asking for information on the clinic population, clinic staff, assessment process and other services provided.

Questionnaires were completed for 34 clinics: 29 were in North America, 2 in Africa, 2 in Europe and 1 in South America. No clinics were identified in Asia or Australasia. There was a variety of funding sources, services offered, clinic populations, staff and methods of assessment. Thirty-three clinics had a multi-disciplinary team. In 32 clinics, at least one member of the team had specialist training in assessment of FASD. Neurobehavioural assessment was completed in 32 clinics. Eleven clinics used more than one set of diagnostic criteria or an adaptation of published criteria.

Diagnostic services are concentrated in North America. Most responding clinics are using a multidisciplinary approach with neurobehavioural assessment as recommended in published guidelines. Agreement on diagnostic criteria would enable comparison of clinical and research data, and enhance FASD research particularly for intervention trials.

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