Empirically defined subtypes of alcohol dependence in an Irish family sample

Alcohol dependence (AD) is clinically and etiologically heterogeneous. The goal of this study was to explore AD subtypes among a sample of 1221 participants in the Irish Affected Sib Pair Study of Alcohol Dependence, all of whom met DSM-IV criteria for AD.

Variables used to identify the subtypes included major depressive disorder, antisocial personality disorder, illicit drug dependence (cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens), nicotine dependence, the personality traits of neuroticism and novelty seeking, and early alcohol use.

Using latent class analysis, a 3-class solution was identified as the most parsimonious description of the data. Individuals in a Mild class were least likely to have comorbid psychopathology, whereas a severe class had highest probabilities of all comorbid psychopathology. The third class was characterized by high probabilities of major depression and higher neuroticism scores, but lower likelihood of other comorbid disorders than seen in the severe class.

Overall, sibling pair resemblance for class was stronger within than between classes, and was greatest for siblings within the severe class, suggesting a stronger familial etiology for this class.

These findings are consistent with the affective regulation and behavioral disinhibition subtypes of alcoholism, and are in line with prior work suggesting familial influences on subtype etiology.

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Request Reprint E-Mail: cprescot@usc.edu

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Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings

The Australian Government Department of Health and Ageing funded the National Drug and Alcohol Research Centre (NDARC) to develop guidelines on the management of co-occurring mental health conditions in alcohol and other drug (AOD) treatment settings. The Guidelines are based on the best available evidence and draw upon the experience and knowledge of clinicians, researchers, consumers and carers.

The Guidelines aim to:

• Increase AOD workers’ knowledge and awareness of mental health conditions.
• Improve the confidence and skills of AOD workers working with clients with comorbid mental health conditions.
• Provide guiding principles for working with clients with comorbid mental health conditions.
• Improve AOD workers’ ability to identify mental health conditions.
• Provide practical information on the management of comorbid mental health conditions.
• Provide information regarding the treatment of comorbid mental health conditions.
• Provide information regarding referral processes.
• Provide resources that may be used to facilitate all of the above.

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News Release - Price hikes unlikely to reduce alcohol consumption

The urgent need to tackle Britain’s drink-fuelled violence and health problems has led to calls for a minimum retail price for alcohol. But rather than reduce consumption of alcohol, new research shows that if the price of alcohol was significantly increased in supermarkets, only 21% (just over 1 in 5) of adult British drinkers said they would buy less alcohol and spend the same amount as they do now.

The research is published today in the Wilson Drinks Report, a new research based report on industry trends and changing consumer attitudes relating to the sale and consumption of alcohol in the UK.

Although gaining support, minimum pricing may do little to cut consumption. Over half (52%) of adult drinkers said they would either spend more on the same amount of drink or look for cheaper alternatives, including switching to cheaper brands and drinks. . . . . .

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Does Bingeing Affect Earnings?

While excessive drinking is associated with lower earnings through adverse health effects, absenteeism and low productivity, moderate acohol consumption has been argued to generate positive wage effects. These positive wage premiums are usually expected to arise from the social effect of drinking and the beneficial health consequences of drinking in moderation.

Using unit-record data from the Australian National Drug Strategy Household Survey, this paper examines the impact of drinking patterns on individuals’ earnings, controlling for selectivity bias driven by the endogenous relationship between drinking and earnings.

In particular, a Multinomial Logit Selectivity model is estimated for four drinking statuses.

This study shows that frequent bingeing is associated with reduced earnings whilst non bingers and occasional bingers earn a positive premium over abstainers.

Further, a decomposition of the earnings differentials indicates that, across various occupations, abstainers are at least as, if not more, ‘productive’ than drinkers and frequent bingers are less ‘productive’ than non bingers and occasional bingers.

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Reforming Taxes and Improving Health: A Revenue-Neutral Tax

The aim of this paper is to analyse a tax reform consisting of an increment of the indirect taxes on alcohol and tobacco to finance the elimination of VAT on health and pharmaceutical services.

We first estimate an Almost Ideal Demand System for the purpose of evaluating expenditure and price elasticities. We then micro-simulate the abolition of VAT on health services combined with a increment on alcohol and tobacco excise duties, so that total revenue remains unchanged.

This reform would generate small private and social welfare gains complemented with externalities derived from the tobacco and alcohol demand cut.

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Alcohol abuse and dependence symptoms: A multidimensional model of common and specific etiology

This study tested a theoretical model hypothesizing differential pathways from 5 predictors to alcohol abuse and dependence symptoms.

Social norms, perceived utility of alcohol use, and family history of alcohol problems were indirectly associated with Time 2 abuse and dependence symptoms through influencing level of alcohol consumption.

Poor behavioral control had a direct effect on alcohol abuse but not on dependence symptoms at Time 2, whereas affective lability exhibited a direct prospective effect on alcohol dependence but not on abuse symptoms.

A multigroup analysis showed that high levels of poor control increased the strength of paths from both consumption level and affective lability to abuse symptoms.

Implications for prevention of alcohol problems among college students are discussed.

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Request Reprint E-Mail: jsimons@usd.edu

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Local Routes: Guidance for developing alcohol treatment pathways

This document provides good practice guidance on the development of integrated care pathways for people with alcohol problems – alcohol treatment pathways (ATPs). It is illustrated with a number of examples but is not intended to provide an exhaustive resource of off-the-shelf pathways.

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Neuropeptide Y (NPY) suppresses yohimbine-induced reinstatement of alcohol seeking

Reinstatement of responding to a previously alcohol-associated lever following extinction is an established model of relapse-like behavior and can be triggered by stress exposure. Here, we examined whether neuropeptide Y (NPY), an endogenous anti-stress mediator, blocks reinstatement of alcohol-seeking induced by the pharmacological stressor yohimbine.

The analysis was focused on a network of structures previously implicated in yohimbine-induced reinstatement, comprised of central (CeA) and basolateral (BLA) amygdala and the shell of the nucleus accumbens (Nc AccS). Within this network, both yohimbine and NPY potently induced neuronal activation, and their effects were additive, presumably indicating activation of excitatory and inhibitory neuronal populations, respectively.

These results suggest that NPY selectively suppresses relapse to alcohol seeking induced by stressful events and support the NPY system as an attractive target for the treatment of alcohol addiction.

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Request Reprint E-Mail: markus.heilig@mail.nih.gov
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Pre-announcement: First European Conference on FASD

The aim of this conference is to bring together European researchers, public health workers, and FAS-related NGOs for the first time in order to share knowledge and promote collaborations. Presentations will cover latest developments worldwide, with an emphasis on European experience:

* Latest research on FASD in Europe
* Public health and preventions
* Diagnosis and intervention
* Consequences for justice and politics

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Perceived Need for Treatment for Alcohol Use Disorders: Results From Two National Surveys

Most individuals with alcohol use disorders receive no treatment for their disorder. Past research suggests that a major reason for this is that individuals with alcohol use disorders do not perceive a need for treatment. The research presented here had two objectives. First, to provide updated estimates of the percentage of individuals with alcohol use disorders who perceive a need for treatment, and among those, the percentage who receive any treatment for alcohol use disorders. And second, to investigate the determinants of perceived need for and utilization of treatment for alcohol use disorders.

In both surveys fewer than one in nine individuals with an alcohol use disorder perceived a need for treatment. In predicting perceived need, the explanatory power of diagnostic variables was much greater than that of demographic variables. Among those with perceived need, two out of every three persons reported receiving treatment in the past year.

Our results suggest that failure to perceive need continues to be the major reason that individuals with alcohol use disorders do not receive treatment. On the other hand, among those who perceived a need, a majority received treatment. It is likely that high levels of unmet need for treatment services for alcohol use disorders will persist as long as perceived need is low. Efforts are needed to increase levels of perceived need among those with alcohol use disorders.

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Request Reprint E-Mail: mjedlund@uams.edu
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Circulating Cytokines as Biomarkers of Alcohol Abuse and Alcoholism

There are currently no consistent objective biochemical markers of alcohol abuse and alcoholism. Development of reliable diagnostic biomarkers that permit accurate assessment of alcohol intake and patterns of drinking is of prime importance to treatment and research fields. Diagnostic biomarker development in other diseases has demonstrated the utility of both open, systems biology, screening for biomarkers and more rational focused efforts on specific biomolecules or families of biomolecules.

Long-term alcohol consumption leads to altered inflammatory cell and adaptive immune responses with associated pathologies and increased incidence of infections. This has led researchers to focus attention on identifying cytokine biomarkers in models of alcohol abuse. Alcohol is known to alter cytokine levels in plasma and a variety of tissues including lung, liver, and very importantly brain.

A number of cytokine biomarker candidates have been identified, including: tumor necrosis factor-alpha, interleukin (IL)-1-alpha, IL-1-beta, IL-6, IL-8, IL-12, and monocyte chemoattractant protein-1.

This is an emerging and potentially exciting avenue of research in that circulating cytokines may contribute to diagnostic biomarker panels, and a combination of multiple biomarkers may significantly increase the sensitivity and specificity of the biochemical tests aiding reliable and accurate detection of excessive alcohol intake.

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Request Reprint E-Mail: kvrana@psu.edu
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Neuropeptide Y Signaling in the Central Nucleus of Amygdala Regulates Alcohol-Drinking and Anxiety-Like Behaviors of Alcohol-Prefering Rats

The neuropeptide Y (NPY) system of the central nucleus of amygdala (CeA) has been shown to be involved in anxiety and alcoholism. In this study, we investigated the molecular mechanisms by which NPY in the CeA regulates anxiety and alcohol drinking behaviors using alcohol-preferring (P) rats as an animal model.

We found that NPY infusion into the CeA produced anxiolytic effects, as measured by the LDB exploration test, and also decreased alcohol intake in P rats. NPY infusion into the CeA significantly increased levels of CaMK IV and phosphorylated cAMP responsive element-binding (pCREB) protein and increased mRNA and protein levels of NPY, but produced no changes in protein levels of CREB or the catalytic α-subunit of protein kinase A (PKA-Cα) in the CeA. We also observed that alcohol intake produced anxiolytic effects in P rats in the LDB test and also increased NPY expression and protein levels of pCREB and PKA-Cα without modulating protein levels of CREB or CaMK IV, in both the CeA and medial nucleus of amygdala. In addition, we found that CaMK IV-positive cells were co-localized with NPY in amygdaloid structures of P rats.

These results suggest that NPY infusion may increase the expression of endogenous NPY in the CeA, which is most likely attributable to an increase in CaMK IV-dependent CREB phosphorylation and this molecular mechanism may be involved in regulating anxiety and alcohol drinking behaviors of P rats.

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Request Reprint E-Mail: scpandey@uic.edu

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The Restraint Bias: How the Illusion of Self-Restraint Promotes Impulsive Behavior

Four studies examined how impulse-control beliefs—beliefs regarding one's ability to regulate visceral impulses, such as hunger, drug craving, and sexual arousal—influence the self-control process.

The findings provide evidence for a restraint bias: a tendency for people to overestimate their capacity for impulse control. This biased perception of restraint had important consequences for people's self-control strategies. Inflated impulse-control beliefs led people to overexpose themselves to temptation, thereby promoting impulsive behavior.

-In Study 4, for example, the impulse-control beliefs of recovering smokers predicted their exposure to situations in which they would be tempted to smoke. Recovering smokers with more inflated impulse-control beliefs exposed themselves to more temptation, which led to higher rates of relapse 4 months later.

The restraint bias offers unique insight into how erroneous beliefs about self-restraint promote impulsive behavior.

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Request Reprint E-Mail: L-nordgren@kellogg.northwestern.edu.
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The public face of binge drinking: British and Danish young women, recent trends in alcohol consumption and the European binge drinking debate

International and national data sets are utilized to compare changes in young women’s alcohol consumption between the UK and Denmark, two European countries renowned for their alcohol-related problems.

Explanations for young women’s increased sessional drinking have previously focused on the public spectacle of the binge drinker and the notion of a ‘convergence’ between women’s and men’s consumption patterns, incomes and broader lifestyles.

An apparent decline in young women’s binge drinking and weekly drinking in both countries since 2000 is counterbalanced by more frequent drinking, home drinking and wine drinking into middle age, associated with professional occupations.

In the face of an enduring polarization of the public excesses of youth with supposedly civilized moderation within the home, the article argues for a more nuanced understanding of the relationship between alcohol, women’s changing lives and northern European drinking cultures.

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Request Reprint E-Mail: f.measham@lancaster.ac.uk

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Ecological Associations of Alcohol Outlets With Underage and Young Adult Injuries

This paper argues that associations between rates of 3 specific problems related to alcohol (i.e., accidents, traffic crashes, and assaults) should be differentially related to densities of alcohol outlets among underage youth and young adults based upon age-related patterns of alcohol outlet use.

Densities of off-premise alcohol outlets were significantly related to injuries from accidents, assaults, and traffic crashes for both underage youth and young adults. Densities of bars were associated with more assaults and densities of restaurants were associated with more traffic crash injuries for young adults.

The distribution of alcohol-related injuries relative to alcohol outlets reflect patterns of alcohol outlet use.

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Request Reprint E-Mail: paul@prev.org

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Mechanisms of Postural Control in Alcoholic Men and Women: Biomechanical Analysis of Musculoskeletal Coordination During Quiet Standing

Excessive sway during quiet standing is a common sequela of chronic alcoholism even with prolonged sobriety. Whether alcoholic men and women who have remained abstinent from alcohol for weeks to months differ from each other in the degree of residual postural instability and biomechanical control mechanisms has not been directly tested.

Reduction in sway and closed-loop activity during quiet standing with stabilizing factors shows some differential expression in men and women with histories of alcohol dependence. Nonetheless, enduring deficits in postural instability of both alcoholic men and alcoholic women suggest persisting liability for falling.

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Request Reprint E-Mail: edie@stanford.edu
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Subjective Response to Alcohol: A Critical Review of the Literature

Subjective response to alcohol (SR), which reflects individual differences in sensitivity to the pharmacological effects of alcohol, may be an important endophenotype in understanding genetic influences on drinking behavior and alcohol use disorders (AUDs). SR predicts alcohol use and problems and has been found to differ by a range of established risk factors for the development of AUDs (e.g., family history of alcoholism). The exact pattern of SR associated with increased risk for alcohol problems, however, remains unclear. The Low Level of Response Model (LLR) suggests that high-risk individuals experience decreased sensitivity to the full range of alcohol effects, while the Differentiator Model (DM) asserts that high risks status is associated with increased sensitivity to alcohol's positive effects but decreased sensitivity to negative effects.

Despite commendable advances in SR research, important questions remain unanswered. Inconsistent results across studies may be attributable to a combination of an inadequate understanding of the underlying construct and methodological differences across studies (e.g., number and timing of assessments across the BAC, inclusion of a placebo condition). With respect to the underlying construct, existing measures fail to adequately distinguish between cognitive/behavioral impairment and sedation, aspects of which may be perceived positively (e.g., anxiolysis) due to their ability to act as negative reinforcers.

Addressing the concerns raised by the current review will be integral to making meaningful scientific progress in the field of subjective response.

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Request Reprint E-Mail: Meghan.Morean@yale.edu

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The Effect of Moderate to Heavy Alcohol Consumption on Neuropsychological Performance as Measured by the Repeatable Battery for the Assessment of Neur

Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the indiividual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined.

The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance.

Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.

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Request Reprint E-Mail: alisa@med.usyd.edu.au
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Gene Expression in the Neuropeptide Y System During Ethanol Withdrawal Kindling in Rats

Multiple episodes of ethanol intoxication and withdrawal result in progressive, irreversible intensification of the withdrawal reaction, a process termed "ethanol withdrawal kindling." Previous studies show that a single episode of chronic ethanol intoxication and withdrawal causes prominent changes in neuropeptide Y (NPY) and its receptors that have been implicated in regulating withdrawal hyperexcitability.

This study for the first time examined the NPY system during ethanol withdrawal kindling.

Multiple withdrawal episodes reversibly decreased NPY and NPY receptor mRNA levels at peak withdrawal, with smaller decreases in NPY mRNA levels and augmented decreases in Y1/Y5 mRNA levels compared with a SW episode. Multiple withdrawal-induced seizures increased the Y2 mRNA levels in PirCx. These complex changes in NPY system gene expression could play a role in the ethanol withdrawal kindling process.

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Request Reprint E-Mail: woldbye@sund.ku.dk
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Disruptions in Functional Network Connectivity During Alcohol Intoxicated Driving

Driving while under the influence of alcohol is a major public health problem whose neural basis is not well understood. In a recently published functional magnetic resonance imaging (fMRI) study (Meda et al., 2009), our group identified 5, independent critical driving-associated brain circuits whose inter-regional connectivity was disrupted by alcohol intoxication. However, the functional connectivity between these circuits has not yet been explored in order to determine how these networks communicate with each other during sober and alcohol-intoxicated states.

Connections between frontal-temporal-basal ganglia and cerebellum have recently been explored; these may be responsible in part for maintaining normal motor behavior by integrating their overlapping motor control functions. These connections appear to be disrupted by alcohol intoxication, in turn associated with an explicit type of impaired driving behavior.

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Rerquest Reprint E-Mail: crzepecki@harthosp.org
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