Patient Reactance as a Moderator of the Effect of Therapist Structure on Posttreatment Alcohol Use

We sought to replicate findings about the effect of therapist-imposed structure on alcoholism-treatment effectiveness for aftercare patients at different levels of interpersonal reactance and to examine if the effect generalizes to patients in a primary phase of treatment.

The results indicated that increased therapist structure during aftercare treatment predicted fewer abstinent days and more heavy-drinking days for persons at a high level of reactance than for persons at a low level of reactance. The effect was a consistent predictor of alcohol use throughout each 3-month interval within the follow-up period. The interaction effect was not supported in the primary outpatient treatment sites, and it was not supported as a predictor of time to first drink or time to first heavy drink in either the aftercare or the outpatient sites.

This study successfully replicated the finding that level of patient reactance appears to moderate the effect of therapist structure on alcohol-use outcomes in aftercare treatment settings. The lack of support for this effect in primary outpatient treatment settings suggests that the negative effect of structured treatment may be limited to patients who are further along in the recovery process.

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Request Reprint E-Mail: karno@ucla.edu.
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Risk Profile of Male College Athletes Who Use Performance-Enhancing Substances

There is a general perception that use of performance-enhancing substances (PESs) does not fit the standard profile of substance use.

This study sought to determine whether users of PESs report high-risk patterns of alcohol and other drug use and demonstrate risk behaviors associated with problematic substance use.

Male athlete PES users (n = 73) compared with nonusers (n = 160) reported more problematic alcohol-use behaviors and more alcohol- and drug-use-related problems. The former compared with the latter was also more likely to report past-year use of tobacco products, marijuana, cocaine, psychedelics, and prescription drugs without a prescription. In addition, PES users demonstrated higher sensation seeking, and greater coping and enhancement motivations for drinking and marijuana use than non-PES users.

Although banned PESs are not typically viewed as having a high addiction potential, male athletes who use these drugs may be more likely to participate in other problematic substance-use behaviors. Importantly, the male athletes in this study who reported PES use also participated in substance-use behaviors that can have profound negative effects on athletic performance. More research on the use of PESs in college athletes is needed.

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Request Reprint E-Mail: jbuckman@rutgers.edu

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Disturbed Sleep and Its Relationship to Alcohol Use

To review evidence of an association between disturbed sleep and alcohol use.

Behavioral studies suggest that up to 2 to 3 standard drinks before bedtime initially promotes sleep, but these effects diminish in as few as 3 days of continued use. Clinical investigations support a relationship between sleep disturbance and alcohol use, but variability in the definition and measurement of these domains and a preponderance of cross-sectional studies make uncertain the strength and direction of the association.

The association of insomnia with alcohol use disorders suggests that the clinical evaluation of patients with sleep problems should include a careful assessment of alcohol use. Future studies of this relationship should employ prospective designs with standardized, validated measures of both sleep and alcohol use. Rigorous treatment studies for chronic insomnia in alcohol dependent patients are also needed.

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Deletion of vanilloid receptor (TRPV1) in mice alters behavioral effects of ethanol

The vanilloid receptor TRPV1 is activated by ethanol and this may be important for some of the central and peripheral actions of ethanol.

To determine if this receptor has a role in ethanol-mediated behaviors, we studied null mutant mice in which the Trpv1 gene was deleted.

Mice lacking this gene showed significantly higher preference for ethanol and consumed more ethanol in a two-bottle choice test as compared with wild type littermates. Null mutant mice showed shorter duration of loss of righting reflex induced by low doses of ethanol (3.2 and 3.4 g/kg) and faster recovery from motor incoordination induced by ethanol (2 g/kg).

However, there were no differences between null mutant and wild type mice in severity of ethanol-induced acute withdrawal (4 g/kg) or conditioned taste aversion to ethanol (2.5 g/kg).

Two behavioral phenotypes (decreased sensitivity to ethanol-induced sedation and faster recovery from ethanol-induced motor incoordination) seen in null mutant mice were reproduced in wild type mice by injection of a TRPV1 antagonist, capsazepine (10 mg/kg). These two ethanol behaviors were changed in the opposite direction after injection of capsaicin, a selective TRPV1 agonist, in wild type mice.

The studies provide the first evidence that TRPV1 is important for specific behavioral actions of ethanol.

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Neural Substrates of Alcohol-Induced Smoking Urge in Heavy Drinking Nondaily Smokers

A strong link exists between cigarette smoking and alcohol use, which may be explained by the experimental observation that alcohol ingestion promotes cigarette craving and precipitates smoking.

At the neuroanatomic level, it is unclear where and how alcohol exerts these effects, although the process likely involves the ventral striatum given its function in motivational salience and appetitive reinforcement.

In a double-blinded, placebo-controlled, crossover study, heavy drinking nondaily social smokers (ie, light smokers or 'chippers') were examined using functional magnetic resonance imaging after they ingested an acute dose of alcohol or placebo.

We probed reactivity in the ventral striatum and other brain regions during exposure to visual smoking vs nonsmoking control cues. We found that alcohol enhanced self-reported ratings of desire to smoke, and in this context, significantly increased ventral striatum responses to smoking compared with control cues. I

n exploratory analyses, we observed that alcohol dampened orbitofrontal activity across both cue types, whereas dorsolateral prefrontal and anterior cingulate cortex activation to smoking cues was not affected by alcohol.

This study bridges a pharmacological challenge approach to the study of brain reactivity to smoking cues, extends prior cigarette cue imaging studies to nondependent smokers, and elucidates a potential neurobiological mechanism to explain the co-consumption of alcohol and cigarettes in nondependent users.

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Request Reprint E-Mail: aking@bsdad.uchicago.edu
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Have I Had One Drink Too Many? Assessing Gender Differences in Misperceptions of Intoxication Among College Students

The present study extends the literature on factors involved in college students' drinking tendencies by examining differences between men and women in their ability to accurately estimate personal intoxication. The study also assessed whether men and women who typically consume large quantities of alcohol when they attend parties have more difficulty accurately assessing intoxication compared with lighter drinkers.

The study revealed that approximately 20% (n = 710) of participants underestimated their blood alcohol concentration using the ECA. Among participants who made underestimation errors, gender differences were observed in that women made significantly more underestimation errors in the scenarios that contained four to five drinks and men made more underestimation errors in the scenarios that contained six to seven drinks.

In addition, a three-way interaction revealed that female students who reported typically drinking larger amounts of alcohol in party settings were more likely to make errors when estimating their intoxication for moderately high numbers of drinks (e.g., four to five drinks).

The results are discussed in terms of examining the importance of college student drinking, gender, typical alcohol consumption at a party, and estimation of intoxication. Implications of gender effects in relation to high-risk drinking activities (i.e., pregaming and drinking games) as well as prevention efforts are discussed.

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Request Reprint E-Mail: kmallett@psu.edu
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At-Risk and Heavy Episodic Drinking, Motivation to Change, and the Development of Alcohol Dependence Among Men

The purpose of this study was to analyze whether general hospital inpatients with at-risk and heavy episodic drinking (ARHE) have a higher motivation to change drinking habits and a higher risk of developing alcohol dependence than individuals with at-risk drinking only (AR) or heavy episodic drinking only (HE).

At baseline, multinomial regressions revealed that individuals with ARHE had higher odds of taking action to change drinking habits than individuals with HE or AR . At follow-up, individuals with ARHE had higher odds of having alcohol dependence, as defined by the Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition, compared with individuals with AR.

Inpatients with ARHE indicated greater readiness to change drinking habits than those with AR or HE, and they had higher odds for short-term development of alcohol dependence than those with AR. Brief alcohol intervention should include risk-specific information based on the risky drinking pattern.

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Request Reprint E-Mail: coder@uni-greifswald.de
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Exploring Religious Mechanisms for Healthy Alcohol Use: Religious Messages and Drinking Among Korean Women in California

This research identifies social reinforcers within religious institutions associated with alcohol consumption among Korean women in California.

Approximately 70.4% of women reported any lifetime drinking, and drinkers drank a mean (SD) of 1.10 (1.22) drinks on drinking days. About 30.8% reported any exposure to religious leaders' messages discouraging excessive drinking, and 28.2% reported any exposure to similar messages from congregants. Each congregant's message was statistically significantly associated with a 5.1% lower probability) of any lifetime drinking. also, each congregant's message was associated with a 13.8% lower drinking rate, which was statistically significant after adjusting for covariates using a one-tailed test. Exposure to leaders' messages was not statistically significantly associated with any lifetime drinking or drinking rate.

Social reinforcement in the form of religious messages may be one mechanism by which religious institutions influence drinking behaviors. For Korean women, messages from congregants had a unique impact beyond the traditional religiosity indicators. These social mechanisms provide public health interventionists with religious pathways to improve drinking behaviors.

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Request Reprint E-Mail: rhofstet@mail.sdsu.edu
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Childhood Exposure to Adversity and Risk of Substance-Use Disorder in Two American Indian Populations: The Meditational Role of Early Substance-Use In

We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure.

The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder.

Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter.

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Request Reprint E-Mail: : nancy.whitesell@uchsc.edu
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Alcoholism risk moderation by a socio-religious dimension

Religious affiliation is inversely associated with the development of alcohol-dependence symptoms in adolescents, but the mechanisms of this effect are unclear. The degree to which religious affiliations accommodate to or differentiate from cultural values may influence attitudes about alcohol use.

We hypothesized that, given permissive cultural norms about alcohol in the United States, if a religious affiliation differentiates itself from cultural norms, then high-risk adolescents (those with parents having a history of alcoholism) would exhibit fewer alcohol-dependence symptoms compared with other affiliations and nonreligious adolescents.

Findings indicated that (1) parental alcohol history robustly predicted increased offspring alcohol-dependence symptoms, (2) religious rearing appeared protective (offspring exhibited fewer alcohol-dependence symptoms), (3) religious differentiation accounted for most of the protective effect, (4) other religious variables did not account for the differentiation effect, and (5) black religious adolescents were more frequently raised with differentiating affiliations and exhibited greater protective effects.

Results demonstrate that religious differentiation accounts for most of the protective influence of religious affiliation. This may be because religious differences from cultural norms (that include permissive alcohol norms) counteract these social influences given alternative "higher" religious ideals

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Request Reprint E-Mail: rhaber@pgsp.edu
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Screening, Brief Intervention, and Referral to Treatment (SBIRT) in a Polish Emergency Department: Three-Month Outcomes of a Randomized, Controlled Cl

A randomized, controlled trial of screening, brief intervention, and referral to treatment (SBIRT) for drinking and related problems among at-risk and dependent drinkers was conducted in an emergency department (ED) in Sosnowiec, Poland, among patients ages 18 years and older.

At 3-month follow-up, both groups showed significant decreases in the proportion who were positive for at-risk drinking, the primary outcome variable. Both groups also showed significant decreases in drinking days per week, drinks per drinking day, maximum

Using analysis of covariance to control for baseline measures and demographic characteristics, no difference in outcome measures was found between intervention and assessment conditions. Subgroup analysis found some significant interactions between intervention and secondary outcomes.

Although the main findings were similar to those from other brief-intervention studies in Western cultures, findings here also suggest that intervention may have differential benefits for specific subgroups of patients in the ED, an area of research that may warrant additional study of brief intervention in the ED setting.

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Request Reprint E-Mail: ccherpitel@arg.org
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Hispanic Americans Baseline Alcohol Survey (HABLAS): Alcohol-Related Problems Across Hispanic National Groups

The purpose of this study was to examine the prevalence and correlates of alcohol-related problems across four Hispanic national groups: Mexican Americans, Puerto Ricans, Cuban Americans, and South/Central Americans.

Cuban Americans had the lowest prevalence of alcohol-related problems. Significant differences across national group for zero versus two or more problems and for one versus two or more problems existed among men. Puerto Rican women were most likely to report two or more problems. The presence of zero versus two or more problems varied significantly across groups. There was variation in problem type across national groups among both men and women. Regression analyses showed that all groups were more likely than Cuban Americans to report two or more problems (vs zero). Heavy episodic drinking less than once a month was associated with two or more problems . Heavy episodic drinking one or more times a month was associated with one problem and two or more problems.

It is important to recognize that Hispanics are not a homogenous group.

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Request Reprint E-Mail: patrice.vaeth@utsouthwestern.edu
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Drinking Histories in Alcohol-Use-Disordered Youth: Preliminary Findings on Relationships to Platelet Serotonin Transporter Expression With Genotypes

The serotonin (5-HT) transporter (5-HTT) is thought to play a key role in the onset of alcohol use, with potential behavioral and biological mechanisms mediated by the level of 5-HT in the synapse and in cerebral spinal fluid. Although 5-HT dysregulation has been related to poor impulse control, the biological mechanism is unknown, although functional control of the serotonergic system has been shown to be regulated in part by differential expression of the 5-HTT. The gene responsible for encoding 5-HTT has a functional polymorphism at the 5'-regulatory promoter region, which results in two forms: long (L) and short (S). The LL genotype is hypothesized to play a key role in the early onset of alcohol use and may be related to poor impulse control.

The objective of this pilot study is to determine whether adolescents with a current alcohol-use disorder (AUD) (N = 21) have platelet measures of the 5-HTT functioning that are related to 5-HTT genotype and poor impulse control. Specifically, we wanted to examine the relationships between the following: platelet 5-HTT and 5-HTT genotype; platelet 5-HTT parameters and age at onset, as well as duration of drinking; and 5-HTT genotype and impulse control.

Our main findings showed significantly higher paroxetine binding (density of 5-HTT) in LL genotype versus S carriers (SS or SL genotypes); also, the LL group had a significantly earlier age at onset of drinking and longer duration of drinking, and poorer impulse control.

These findings provide partial support for the hypothesis that, among currently drinking adolescents with an AUD, differential expression of 5-HTT may play an important role in the onset of adolescent AUD.

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Request Reprint E-Mail: dawes@uthscsa.edu
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Drinking trajectories from adolescence to the fifties among alcohol-dependent men

Although it has been recognized that the course of alcoholism may differ across individuals, little work has characterized drinking trajectories from drinking onset to midlife.

The current study examined trajectories of alcohol dependence from adolescence to the mid-50s in a sample of 420 men with a lifetime diagnosis of alcohol dependence.

Latent growth mixture modeling was used to define four drinking trajectories: young-adult, late-onset, severe-nonchronic, and severe-chronic alcoholics. Further analyses with other diagnostic variables, other drinking variables, alcohol expectancies, personality scales, and religiousness scores were completed to differentiate men best categorized by each trajectory.

Extension of Latent Growth Mixture Modeling (LGMM) into the mid-50s revealed that, although some individuals remain chronic alcohol users, others decline in alcohol problem use.

Differences seen among these groups may help in the treatment of alcohol dependence, such that more energy can be spent treating those likely to be in the more severe trajectories.

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Request Reprint E-Mail: tjacob@odd.stanford.edu

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Alcohol Use Among Older Adults in the National Epidemiologic Survey on Alcohol and Related Conditions: A Latent Class Analysis

We examined latent classes of alcohol use among current drinkers ages 60 and older and explored risk factors associated with class.

Latent class analysis identified three latent classes. Individuals in the low-risk drinker class (89.17%) displayed low endorsement of heavy episodic use, at-risk consumption, and alcohol abuse/dependence criteria. Individuals in the moderate-risk drinker class (9.65%) were more likely to exceed consumption guidelines, and those in the high-risk drinker class (1.17%) displayed high probabilities of both Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and risky alcohol consumption items.

Female gender, older age, and African-American race were associated with decreased risk of being a moderate-risk drinker. Being the adult child of an alcoholic, being a previous smoker, and being a current smoker were associated with increased risk. Female gender, older age, and college education were associated with decreased odds of being a high-risk drinker. having major depression, being the child of an alcoholic, and being a current smoker were associated with increased odds of being a high-risk drinker.

Individuals classified in the high-risk drinker class had significantly lower self-rated mental and physical health than low-risk drinkers.

A subpopulation of older drinkers may exceed consumption guidelines without DSM-defined alcohol-related problems. However, for some older drinkers, risky alcohol use is part of a larger pattern of health risks including current smoking, major depression, and alcohol abuse/dependence history.

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Request Reprint E-Mail: psacco@gwbmail.wustl.edu
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Managing the Needs of Drunk and Incapable People in Scotland: a Literature Review and Needs Assessment

This is the final report of a research study commissioned by the Scottish Government and conducted by Griesbach & Associates between June and November 2008.

The purpose of this research was to carry out a needs assessment, to identify what need there is in Scotland for services for people who become drunk and incapable in public. This involved not only estimating the size and nature of the problem, but also looking in detail at how the needs of this population are currently being addressed, both in Scotland and elsewhere, and how those needs may be addressed most effectively.

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TIP 49: Treating Alcohol Use Disorders with Medication

People with alcohol use disorders (AUDs) now have more options in seeking help. A new resource from SAMHSA provides clinical guidelines for the proper use of medications in the treatment of AUDs.

Treatment Improvement Protocol (TIP) 49, Incorporating Alcohol Pharmacotherapies Into Medical Practice, provides the basic information, evidence- and consensus-based guidelines, tools, and resources necessary to help health care providers treat patients with AUDs. . . . . .

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Acute alcohol impairs conditioning of a behavioural reward-seeking response and inhibitory control processes—implications for addictive disorders

To investigate whether acute alcohol would affect performance of a conditioned behavioural response to obtain a reward outcome and impair performance in a task measuring inhibitory control to provide new knowledge of how the acute effects of alcohol might contribute to the transition from alcohol use to dependence.

These results demonstrate that alcohol is affecting inhibitory control of behavioural responses to external signals even when associated with punishment, contributing in this way to the transition from alcohol use to dependence.

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Request Reprint E-Mail: t.duka@sussex.ac.uk
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The age-21 minimum legal drinking age: a case study linking past and current debates

The minimum legal drinking age (MLDA) in the United States (U.S.) has raised debate over the past several decades. During the 1970s many states lowered their MLDAs from age 21 to 18, 19, or 20. However, as a result of studies showing that these lower MLDAs were associated with increases in traffic crashes, state-level movements began in the later1970s to return MLDAs to age 21. A new movement has arisen to again lower the MLDA in the U.S.

The aim is to discuss this current MLDA debate within the context of the long history of the U.S. MLDA.

The complexity of state movements to change their MLDAs is illustrated by the Michigan experience, where strong political forces on both sides of the issue were involved, resulting in the MLDA returning to 21. Because the 21st Constitutional amendment prevents the federal government from mandating a MLDA for all states, a federal policy was proposed to provide incentives for all states to implement age-21 MLDAs. Due largely to strong research evidence, the National Minimum Legal Drinking Age Act was enacted in 1984, stipulating that states set their MLDA to 21 or face loss of federal highway funds. By 1988, all states had an age-21 MLDA.

Any current debate about the MLDA should be informed by the historical context of this policy and the available research.

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Request Reprint E-Mail: toome001@umn.edu

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Press Release - Health researchers call for alcohol industry to prove no harm in funding of sports

Researchers from Australia and the UK are calling for a new approach to the debate over whether alcohol industry sponsorship of sports increases drinking among sports participants. They want to shift the burden of proof to the alcohol industry.

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