News Release - Smoking May Counteract Benefit of Moderate Drinking on Stroke Risk

New research finds any beneficial effect of drinking moderate amounts of alcohol on stroke may be counteracted by cigarette smoking, according to research that will be presented as part of the late-breaking science program at the American Academy of Neurology’s 62nd Annual Meeting in Toronto, April 10 – 17, 2010.

Scientists followed the drinking and smoking habits of 22,524 people in the United Kingdom who were between the ages of 39 and 79 and did not have a history of heart attack or stroke at the start of the study. During the 12-year study, 864 strokes occurred.

The study found that the association between alcohol drinking and stroke was significantly different between smokers and non-smokers. In non-smokers, people who consumed moderate amounts of alcohol were 37 percent less likely to develop stroke than non-drinkers, while in smokers this association was not observed.

This finding suggests that smoking may modify the relationship between alcohol intake and stroke risk. Moderate drinking was defined as consuming up to 21 units of alcohol per week, which is equal to about two to three regular glasses of red wine a day. . . . . .

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SHARING EXPERIENCES FOR THE DEVELOPMENT OF THE NATIONAL POLICY ON ALCOHOL-RELATED HARM PREVENTION AND CONTROL

One of the outcomes of the multi-stakeholder Asia-Pacific Alcohol Forum, hosted by the International Center for Alcohol Policies (ICAP) in Singapore in June 2008, was the pledge to work more closely with individual countries in the region to facilitate the development of sustainable national alcohol policies.

It was in this context that the Vietnamese government delegation requested ICAP’s support for the development of a national policy on alcohol-related harm prevention and control. The Vietnamese government has recognized the need for a more strategic and comprehensive approach to alcohol policy development that would balance the demands of a growing economy with the need to address social welfare and public health. The government has tasked the Ministry of Health with drafting a National Policy on Alcohol-related Harm Prevention and Control, to be submitted to the government for review.

To that end, the Health Strategy and Policy Institute (HSPI) of the Ministry of Health of the Socialist Republic of Vietnam in cooperation with ICAP organized a workshop, titled Sharing Experiences for the Development of the National Policy on Alcohol-related Harm Prevention and Control, held on 18–19 March 2009 in Hanoi, Vietnam (see Annex 2 for the workshop program).


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Alcohol Policy Research and Alcoholic Beverage Control Systems: Annotated Bibliography and Review

The Annotated Bibliography is a comprehensive research tool featuring beverage alcohol policy and research. This new edition includes links to review the abstracts. The links are in blue.

Annotations and references are arranged according to the subject area they cover. Citations are often relevant to more than one topic area, and in these instances, they have been included in all relevant sections.

The subject areas include:

• Section 1: What makes alcohol different from other commercial products?

• Section 2: In order to reduce alcohol abuse and harm, what policies are needed and which policies are most effective?

• Section 3: Are all types of beverage alcohol the same?

• Section 4: Why should states be allowed to regulate alcohol differently from the federal government and from each other?

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Prevalence estimates of alcohol related problems in an area of northern Italy using the capture–recapture method

The alcohol-related problems (ARPs) are a relevant issue in public health and contribute to premature deaths and avoidable disease burden. The capture–recapture (C–R) method can be a useful tool to provide reliable estimates for populations with hidden nature such as subjects with ARP.

C–R method was used to estimate the ‘true count’ of individuals with ARP using three independent health-related current databases in an area of northern Italy during 2007. To predict the frequency of unascertained cases, we constructed log linear models. The goodness-of-fit of a model was measured by the likelihood ratio test and the final model was selected using Akaike’s Information Criterion. Confidence intervals (CIs) were calculated according to Hook and Regal.

Altogether 1014 subjects with ARP were directly identified from the three sources using the C–R method the estimated unknown population was 2729 subjects, giving a total of 3743 subjects with ARP (95% CI 3148–4504) and a prevalence of 8.24 (95% CI 7.97–8.50) per 1000 inhabitants aged >15 years. The analyses stratified for gender estimated 12.31/1000 (95% CI 11.85–12.77) men and 4.86/1000 (95% CI 4.58–5.14) women with ARP. Besides, the analysis calculated a prevalence of 14.99 per 1000 (95% CI 14.29–15.69) for males years (1731), corresponding to the majority of subjects with ARP.

The C–R technique is useful to provide a more realistic picture of the size of ARP population. This has important implications both for future planning of service provision and for the way in which the impact of ARP interventions are evaluated.

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Request Reprint E-Mail: michela.ponzio@unipv.it


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Associations of light and moderate maternal alcohol consumption with fetal growth characteristics in different periods of pregnancy: The Generation R

Excessive alcohol consumption during pregnancy has adverse effects on fetal growth and development. Less consistent associations have been shown for the associations of light-to-moderate maternal alcohol consumption during pregnancy with health outcomes in the offspring. Therefore, we examined the associations of light-to-moderate maternal alcohol consumption with various fetal growth characteristics measured in different periods of pregnancy.

This study was based on 7333 pregnant women participating in a population-based cohort study. Alcohol consumption habits and fetal growth were assessed in early , mid- (gestational age 18–24.9 weeks) and late pregnancy (gestational age 25 weeks).

We assessed the effects of different categories of alcohol consumption (no; less than one drink per week; one to three drinks per week; four to six drinks per week; one drink per day and two to three drinks per day) on repeatedly measured fetal head circumference, abdominal circumference and femur length.

In total, 37% of all mothers continued alcohol consumption during pregnancy, of whom the majority used less than three drinks per week. We observed no differences in growth rates of fetal head circumference, abdominal circumference or femur length between mothers with and without continued alcohol consumption during pregnancy. Compared with mothers without alcohol consumption, mothers with continued alcohol consumption during pregnancy had an increased fetal weight gain [difference 0.61 g (95% confidence interval: 0.18, 1.04) per week]. Cross-sectional analyses in mid- and late pregnancy showed no consistent associations between the number of alcoholic consumptions and fetal growth characteristics. All analyses were adjusted for potential confounders.

Light-to-moderate maternal alcohol consumption during pregnancy does not adversely affect fetal growth characteristics.

Further studies are needed to assess whether moderate alcohol consumption during pregnancy influences organ growth and function in postnatal life.

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Request Reprint E-Mail: v.jaddoe@erasmusmc.nl

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Indigenous perpetrators of violence: Prevalence and risk factors for offending

In this report, the available data indicate that Indigenous people are 15 to 20 times more likely than non-Indigenous people to commit violent offences.

The main risk factors linked to violent offending by Indigenous people include alcohol misuse, illicit drug use, sex, age, childhood experience of violence and abuse, exposure to pornography, education, income, employment, housing, physical and mental health, geographic location and access to services.

However alcohol, based on existing evidence, stands out as a problem over and above structural factors such as socioeconomic disadvantage.

The report concludes by drawing attention to the need to investigate the specifics of different forms of violent offending—the relationship between victims and offenders and the location and nature of different community settings. It is not, in itself, enough to continue to document the overrepresentation of Indigenous people in the criminal justice system. This can only be properly understood if more research involves the examination of what stops and inhibits offending.

There are many Indigenous people who experience a constellation of risk factors who do not offend or refrain from offending and the report ends with a recommendation for further research into resilience and what are commonly called 'protective' factors, as part of a 'developmental prevention' approach.

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Psychometric properties of alcohol screening tests in the emergency department in Argentina, Mexico and the United States

The objective of this article is to report psychometric characteristics of the AUDIT, CAGE, RAPS4, and TWEAK and to compare them across three countries: Argentina, Mexico, and the United States which used a similar protocol and methodology.

Probability samples of patients 18 years and older were drawn from emergency departments in Mar del Plata, Argentina (n = 780), Pachuca, Mexico (n = 1624) and Santa Clara, U.S. (n = 1220). Concurrent validity was assessed by comparing their performance against a diagnosis of alcohol dependence (DSM; IV) obtained through the Composite International Diagnostic Interview, and for the briefer measures, also by their correlation with the AUDIT. The internal consistency of the CAGE, RAPS4, and TWEAK scores was estimated by the KR; 20 formula and by Cronbach's Alpha for the AUDIT. Corrected item; total correlation and D; values were used as item discrimination measures.

In Argentina and Mexico the AUDIT and the RAPS4 showed the highest validity. Reliability of all instruments was higher in the US than in Argentina or Mexico. In all three countries, reliability of the TWEAK was lowest, while the AUDIT was highest. With a few exceptions, all items showed good discrimination powers.

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Request Reprint E-Mail: mcremont@mdp.edu.ar

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News Release - Using Stem Cells to Study Alcohol Dependence

An estimated 14 million Americans – one in eight – are addicted to alcohol or will develop an alcohol use disorder. Yet despite the very high personal and economic costs, the vast majority of individuals with an alcohol use disorder never receive treatment.

Researchers at the UConn Health Center are trying to do something about that. And they have a powerful ally – stem cells. . . . . .

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Developing a Quantitative Measure of Alcohol Consumption for Genomic Studies on Prospective Cohorts

The purpose of this study was to develop a quantitative measure of alcohol consumption for gene-mapping studies.

Using a sample of 3,787 young-adult twin women and an independent sample of 489 men and women from a college drinking study, we developed an alcohol-consumption factor score indexed by (1) maximum typical consumption (log-transformed quantity frequency [LQNTFRQ]), (2) maximum drinks in a 24-hours period (LMAXALC), (3) frequency of drinking five or more drinks per day (FIVE), and (4) frequency of drinking to intoxication (INTOX).

We tested (1) for factorial and psychometric equivalence across samples and genders; (2) for construct validity and its equivalence, across samples and genders, using measures of tobacco and cannabis use and family history of alcoholism; and (3) to determine the heritability of the alcohol-consumption factor score using a genetic psychometric model.

A single-factor model fit well with factor loadings ranging from .60 to .90. With rare exception, we found support for measurement invariance across the two samples and across genders. Measures of nicotine and cannabis use as well as family history of alcoholism were associated, to a similar extent across samples and genders, with the underlying alcohol-consumption factor.

Psychometric twin modeling revealed that each of the alcohol-consumption measures (h-squared = 34%-47%) and the underlying factor score (h-squared = 50%) were heritable, with the remainder of the variance attributable to individual-specific environmental factors.

This moderately heritable alcohol-consumption factor also accounted for a majority of the genetic variance in LQNTFRQ, LMAXALC, FIVE, and INTOX.

Quantitative measures of alcohol consumption with the favorable attributes of measurement invariance, construct validity, and moderate heritability can greatly enhance future gene-mapping efforts, supplementing information afforded by conventional diagnostic measures of alcohol abuse/dependence.

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Prospective Study of Adolescent Alcohol Consumption and Risk of Benign Breast Disease in Young Women

To investigate prospectively, using alcoholic beverage consumption data collected in real time, the association between adolescent drinking and risk of biopsy-confirmed benign breast disease (BBD) in young women.

The Growing Up Today Study is a prospective cohort study of US girls, aged 9 to 15 years at baseline, with annual questionnaires from 1996 through 2001, followed by questionnaires in 2003, 2005, and 2007. On the 2003 survey, the participants (then aged 16–23 years) provided information about their alcoholic beverage consumption in the previous year. On the 2005 and 2007 surveys, a total of 6899 women (aged 18–27 years) reported whether a health care provider had ever diagnosed them with BBD (n = 147 cases) and whether it was confirmed by biopsy (n = 67 cases); 6752 women reported never being diagnosed with BBD.

Adjusted for age and BMI, quantity of alcohol consumed was associated with increased risk of biopsy-confirmed BBD (odds ratio: 1.50 per drink per day [95% confidence interval: 1.19–1.90]). Girls who typically drank 6 or 7 days/week were at higher risk (odds ratio: 5.50 [95% confidence interval: 1.23–24.53]) compared with those who never drank or who drank less than once per week.

Higher amounts consumed, and more frequent consumption, of alcoholic beverages in adolescence may increase the occurrence of BBD in young women. Advising teenagers to avoid alcoholic beverages, along with smoking and sun exposure, may reduce cancer incidence in adulthood.

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Request Reprint E-Mail: catherine.berkey@channing.harvard.edu

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COMMITTEE ON SUBSTANCE ABUSE - Policy Statement—Alcohol Use by Youth and Adolescents: A Pediatric Concern

Alcohol use continues to be a major problem from preadolescence through young adulthood in the United States.

Results of recent neuroscience research have substantiated the deleterious effects of alcohol on adolescent brain development and added even more evidence to support the call to prevent and reduce underaged drinking.

Pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment.

The integration of alcohol use prevention programs in the community and our educational system from elementary school through college should be promoted by pediatricians and the health care community.

Promotion of media responsibility to connect alcohol consumption with realistic consequences should be supported by pediatricians.

Additional research into the prevention, screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents continues to be needed to improve evidence-based practices.

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High mortality among people suspected of drunk-driving. An 18-year register-based follow-up

The aim of this study was to examine the overall and cause-specific mortality of DUI arrestees compared to a reference population with no history of DUI and to recognize the risk factors of premature death.

The data used were a register of all DUI arrestees between April 1988 and December 2006. All drivers with drug-positive samples were excluded. DUI arrestees were compared to a reference population with no previous history of DUI. Overall and cause-specific hazard ratios were calculated and risk factors were estimated.

Alcohol causes, diseases of the circulatory system and accidents constituted the most common causes of death among DUI arrestees. Suspected DUI was linked with higher mortality in every observed cause of death. The risk of death by alcohol-related or external cause was especially high. Among women DUI arrests caused sharper increase to the risk of death than increase found among male arrestees. Within the group of DUI arrestees the risk of death was affected by age, sex, marital status, education, multiple arrests as well as time and observed blood alcohol level of the arrest. Half of the suspected DUI cases and one in five of the references had alcohol as a contributing factor to death.

Arrest on suspicion of drunk-driving is an indicator for elevated risk of death. Alcohol is often related to deaths of DUI arrestees. Drunk-drivers should be efficiently guided with respect to evaluations and treatments for harmful drinking.

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Request Reprint E-Mail: antti.impinen@thl.fi

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Predictors of longitudinal substance use and mental health outcomes for patients in two integrated service delivery systems

Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes.

This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a health maintenance organization (HMO).

Sub-samples from each system were selected using multiple criteria indicating severity of mental health problems at admission to substance use disorder treatment (VA = 401; HMO = 331). Separate and multiple group structural equation model analyses used baseline characteristics, service use, and 12-step participation as predictors of substance use and mental health outcomes at 1 and 5 years following admission.

Substance use and related problems showed stability across time, however, these relationships were stronger among VA patients.

More continuing care substance use outpatient visits were associated with reductions in mental health symptoms in both groups, whereas receipt of outpatient mental health services was associated with more severe psychological symptoms.

Participation in 12-step groups had a stronger effect on reducing cocaine use among VA patients, whereas it had a stronger effect on reducing alcohol use among HMO patients.

More outpatient psychological services had a stronger effect on reducing alcohol use among HMO patients.

Common findings across these two systems demonstrate the persistence of substance use and related psychological problems, but also show that continuing care services and participation in 12-step groups are associated with better outcomes in both systems.

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Request Reprint E-Mail: grella@ucla.edu

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Can 12-step group participation strengthen and extend the benefits of adolescent addiction treatment? A prospective analysis

Despite advances in the development of treatments for adolescents with substance use disorders (SUD), relapse remains common following an index treatment episode. Community continuing care resources, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), have been shown to be helpful and cost-effective recovery resources among adults. However, little is known about the clinical utility and effectiveness of AA/NA for adolescents, despite widespread treatment referrals.

Adolescents (N = 127; 24% female, 87% White, M age = 16.7 years) enrolled in a naturalistic, prospective study of community outpatient treatment were assessed at intake, and 3 and 6 months later using a battery of standardized and validated measures.

Just over one-quarter of youth attended AA/NA meetings during the first 3 months, which was predicted by a goal of abstinence, prior AA/NA attendance, and prior SUD treatment experiences. Controlled multiple regression analyses revealed an independent effect of AA/NA on abstinence, in both contemporaneous and lagged models, which persisted over and above the effects of pre-treatment AA/NA attendance, prior treatment, self-efficacy, abstinence goal, and concomitant outpatient treatment.

Results suggest that, similar to findings comparing adult outpatients to inpatients, AA/NA participation is less common among less severe adolescent outpatients. Nonetheless, attendance appears to strengthen and extend the benefits of typical community outpatient treatment.

Given the dramatic increase in rates of substance use among same-aged peers in the population at this life-stage, and the relative dearth of abstainers and recovery-specific supports, these resources may provide a concentrated cost-effective social recovery resource for young people.

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Request Reprint E-Mail: jkelly11@partners.org

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Impact of brief interventions and brief treatment on admissions to chemical dependency treatment

This study examined two issues. One, whether individuals with possible substance use disorders were more likely to be admitted to specialized chemical dependency (CD) treatment after receiving a brief intervention (BI) – either alone or in combination with other services – than similar individuals who did not receive a BI. Two, whether participation in brief treatment (BT) following a BI was helpful in facilitating admission to CD treatment.

The study took place in the emergency department (ED) of a large urban safety-net hospital where CD professionals screened patients for alcohol/drug problems and provided BI, BT, and referral to specialized CD treatment when appropriate (SBIRT). Substance use disorders were indicated by alcohol/drug problems noted in administrative records. Hospital records were used to match patients with likely substance use disorders who received BI with similar ED patients who had not been screened. Admission to publicly funded CD treatment was determined by matching patient identifiers to state administrative records of CD treatment.

Results indicated that individuals with a likely substance use disorder who received a BI (regardless of subsequent participation in BT) were significantly more likely to enter specialized CD treatment in the subsequent year than similar individuals who did not receive a BI.

This result was particularly pronounced for patients with no CD treatment in the past two years.

Results also indicated that participation in BT facilitated admission into CD treatment.

The results suggest that SBIRT programs could serve an important role in increasing entry to specialized treatment for individuals with substance use disorders.

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Request Reprint E-Mail: Krupski@u.washington.edu
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Drinking to have fun and to get drunk: Motives as predictors of weekend drinking over and above usual drinking habits

Most evidence on the motives-alcohol use link has come from cross-sectional research using retrospective assessments. It remains also to be demonstrated whether motives predict drinking in particular circumstances.

In the present study, drinking motives assessed 2 weeks prior to a diary study were used to predict the number of drinks on weekend days as reported via short message service (SMS). Multilevel regression models were estimated based on 391 reports from 55 participants (mean age 22.7).

The results revealed that enhancement motives but not gender, age, or social, coping, or conformity motives predicted weekend drinking over and above usual consumption.

Consumption and motives together explained more than three-quarters of the inter-individual variance in weekend drinking.

To conclude, this study points to a heavy episodic weekend drinking culture of young people who drink large quantities on Friday and Saturday nights apparently because they are seeking fun and excitement.

Preventive measures should aim to counteract young people's drinking at peak times and in high-risk situations.

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Request Reprint E-Mail: ekuntsche@sfa-ispa.ch


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Identification of alcohol involvement in injury-related hospitalisations using routine data compared to medical record review

To quantify the extent that alcohol related injuries are adequately identified in hospitalisation data using ICD-10-AM codes indicative of alcohol involvement.

A random sample of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across four states in Australia. From this sample, cases were identified as involving alcohol if they contained an ICD-10-AM diagnosis or external cause code referring to alcohol, or if the text description extracted from the medical records mentioned alcohol involvement.

Overall, identification of alcohol involvement using ICD codes detected 38% of the alcohol-related sample, while almost 94% of alcohol-related cases were identified through a search of the text extracted from the medical records. The resultant estimate of alcohol involvement in injury-related hospitalisations in this sample was 10%. Emergency department records were the most likely to identify whether the injury was alcohol-related with almost three-quarters of alcohol-related cases mentioning alcohol in the text abstracted from these records.

The current best estimates of the frequency of hospital admissions where alcohol is involved prior to the injury underestimate the burden by around 62%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine administrative data sources for identification of alcohol-related injuries.

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Request Reprint E-Mail: k.mckenzie@qut.edu.au

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A high-performing NHS? A review of progress 1997–2010

With a general election imminent, the NHS has once again emerged as a priority among voters in England, and political parties are competing to be seen as the best qualified to improve the service. Opposition parties paint a picture of an NHS with major deficiencies while the Labour government believes that the NHS is ‘good’ but needs further transformation to become ‘great’. These calls for further reform follow an unprecedented increase in funding for the NHS since 2000.

This review assesses how far the investment and accompanying reforms since 1997 have transformed the NHS in England into a high-performing health system. The review focuses on England because health policy has now diverged from that in the devolved administrations of Scotland, Wales and Northern Ireland. It has drawn on official data, government and other official reports and academic research to assess how much progress the NHS has made in eight domains since 1997. The review asks whether the NHS is: accessible; safe; promoting health and managing long-term conditions; clinically effective; delivering a positive patient experience; equitable; efficient and accountable.

Alcohol pp. 37-40
Overall, there is no sign that the government’s aims to reduce harmful alcohol consumption have been achieved. However, as the government has recently acknowledged, much of the potential improvement lies outside the NHS, including greater control of advertising, pricing strategies, and initiatives to limit the physical availability of alcohol.

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β-Endorphin Mediates Behavioral Despair and the Effect of Ethanol on the Tail Suspension Test in Mice

The opioid peptide β-endorphin (β-E) is synthesized and released in response to stressful stimuli as well as acute alcohol administration. The release of β-E following exposure to an inescapable aversive situation may mediate behaviors that contribute to allostasis of the stress response.

The present study examines the effects of β-E on immobility in assays involving inescapable stress, both under basal conditions and after acute administration of EtOH.

Female and male transgenic mice with varying capacities to translate β-E were subjected to either the forced swim (FST, Experiment 1) or the tail suspension test (TST, Experiment 2). In Experiment 3, mice were divided into three groups based on hormonal status (male, female-estrous, and female-nonestrous) and injected with either 1 g/kg EtOH or equivolume saline 14 minutes prior to behavioral assessment on the TST.

Experiments 1 and 2 demonstrated a direct relationship between β-E levels and immobility. There were also sex differences in behavior in these tests, with males displaying more immobility than females. A main effect of genotype in Experiment 3 replicated findings in Experiments 1 and 2. There was also an effect of EtOH (increasing immobility) and a significant interaction reflecting a particularly robust effect of the drug in mice with low β-E. In addition, there were interactions between β-E, EtOH effects, and hormonal status.

These findings support the contention that β-E moderates behavioral responses to stressful stimuli and suggest a role for this peptide in coping behavior. Furthermore, the effects of EtOH on the response to stress may be mediated by β-E. Sex differences in this influence may contribute to sex differences in disease susceptibility and expression.

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Request Reprint E-Mail: Judy.grisel@furman.edu

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Perceived Social Support from Counselors and Client Sobriety During Aftercare: A Pilot Study of Emotional and Functional Support

In an empirical study, we asked whether client perceptions of the degree of emotional support and functional support provided by counselors during treatment are related to client sobriety during the aftercare phase of clients' recovery.

Functional support was assessed using a scale that tapped the degree to which clients felt encouraged to become actively involved in six key components of Alcoholics Anonymous.

Results derived from 76 former inpatients showed associations linking abstinence at the point of 2-year follow-up to counselor provision of both kinds of social support in early-stage recovery.

Mental health service providers may be able to strengthen their client's long-term ability to maintain sobriety by providing them, in the short term, with high levels of esteem support and abstinence-focused “instrumental” support.

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Request Reprint E-Mail: kenhart@uwindsor.ca


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