REDUCING DRUG AND ALCOHOL HARMS TO COMMUNITIES AND FAMILIES: UPDATED GUIDANCE ON DEVELOPING LOCAL PRACTICE

This guidance takes the local community as the starting point of its approach to dealing with drug and alcohol problems. Its focus is not only on meeting national priorities, but about making a difference at a local level. Communities will perceive change and will feel more confident when they see that a difference is being made in their area and that this change responds to their concerns. Taking an approach that makes the community the starting point empowers the community to bring about changes and to take a stand about the issues that affect them.



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Why do we need to control alcohol use through legislative measures? A south east asia perspective?

Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control in several countries, contrary to other controlled substances like opium, cocaine, cannabis, and so on.

To demonstrate the similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence for both substances.

Consecutively admitted patients during the period August 2005 to May 2006, in the Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, with ICD-10 (DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome were recruited for the study and administered the alcohol or other drug (opioid) section of SSAGA-II, respectively, and the data was entered in the corresponding tally sheet.

The total sample size was 150, of which 112 consented to participate. Eighty-one (72%) were alcohol-dependent and 31 (28%) were opioid-dependent. Mean ages of the patients of alcohol dependence for opioid dependence was 35.16 ± 10.2 compared to 26.09 ± 5.65. Mean age of onset of alcohol and opioid use were similar (18.72 ± 6.84 and 20.73 ± 3.93 years, respectively). Patterns of dependence were also similar for both substances, from the first criteria to dependence (0.49 years for alcohol versus 0.64 years for opioids), and from the appearance of the second criteria to dependence (0.24 years versus 0.28 years).

This study recommends alcohol to be treated on par with opioids and calls for legislations for the control of alcohol, uniformly, across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

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Cocaethylene: responding to combined alcohol and cocaine use

A briefing paper 'Cocaethylene: responding to combined alcohol and cocaine use' has been produced by the AERC Alcohol Academy. The paper assesses the current understanding, data, trends and implications for public health and alcohol policy.

The briefing identifies that combined alcohol and cocaine use appears to be increasingly popular despite indications of significantly increased health and social risks. Combining alcohol and powder cocaine can form cocaethylene in the liver, a unique metabolite that can enhance the user's experience but significantly increase the risk of heart attack or sudden death. Its use has also been linked to other health conditions and an increased risk of violence. . . . . .

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Cost-effectiveness of volumetric alcohol taxation in Australia

To estimate the potential health benefits and cost savings of an alcohol tax rate that applies equally to all alcoholic beverages based on their alcohol content (volumetric tax) and to compare the cost savings with the cost of implementation.

Mathematical modelling of three scenarios of volumetric alcohol taxation for the population of Australia: (i) no change in deadweight loss, (ii) no change in tax revenue, and (iii) all alcoholic beverages taxed at the same rate as spirits.

The estimated cost of changing to a volumetric tax rate is $18 million. A volumetric tax that is deadweight loss-neutral would increase the cost of beer and wine and reduce the cost of spirits, resulting in an estimated annual increase in taxation revenue of $492 million and a 2.77% reduction in annual consumption of pure alcohol.

The estimated net health gain would be 21 000 disability-adjusted life-years (DALYs), with potential cost offsets of $110 million per annum.

A tax revenue-neutral scenario would result in an 0.05% decrease in consumption, and a tax on all alcohol at a spirits rate would reduce consumption by 23.85% and increase revenue by $309 million.

All volumetric tax scenarios would provide greater health benefits and cost savings to the health sector than the existing taxation system, based on current understandings of alcohol-related health effects.

An equalised volumetric tax that would reduce beer and wine consumption while increasing the consumption of spirits would need to be approached with caution.

Further research is required to examine whether alcohol-related health effects vary by type of alcoholic beverage independent of the amount of alcohol consumed to provide a strong evidence platform for alcohol taxation policies.

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Alcohol policy reform in Australia: what can we learn from the evidence?

• Alcohol consumption is a major risk factor contributing to the burden of disease in Australia.

• The National Preventative Health Taskforce recommends the long-term goal of reshaping Australia’s drinking culture to produce healthier and safer outcomes.

• A study of the cost-effectiveness of interventions to reduce alcohol-related harm in Australia suggests that policymakers could achieve over 10 times the health gain if they reallocated the current level of investment.

• The optimal package of interventions identified in the study comprises, in order of cost-effectiveness, volumetric taxation, advertising bans, an increase in the minimum legal drinking age to 21 years, brief intervention by primary care practitioners, licensing controls, a drink-driving mass media campaign, and random breath testing.

• Australia has a window of opportunity to significantly expand activities to reduce alcohol-related harm. It is important that federal and state governments take this opportunity to reform alcohol policy in Australia.

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How can we reduce alcohol-related road crash deaths among young Australians?

• In the United States, policy experiments over a 20-year period have demonstrated that road crash deaths among young adults can be substantially reduced by raising the minimum legal drinking age to 21 years.

• A recent evaluation of the cost-effectiveness of policies for reducing alcohol-related harm in Australia found that, if the US experience were to be replicated in Australia, raising the minimum legal drinking age would be more cost-effective than random breath testing and drink-driving campaigns.

• Given the major political obstacles to increasing the minimum legal drinking age, we propose another policy that could achieve a similar reduction in road crash deaths — requiring licensed drivers to maintain a blood alcohol concentration (BAC) of zero until at least the age of 21 years (close to the current policy of zero BAC until age 22 years in Victoria), and preferably until 25 years. This would allow young Australians to drink or drive but not to combine these activities for at least the first several years of driving.

• If all Australian jurisdictions had adopted this policy in 2003, 17 deaths could have been be averted among young Australians as they aged from 18 to 21 years and many more serious injuries could have been prevented each year. If we had enforced a zero BAC until age 25, the number of deaths averted until age 25 years could have been as high as 50.

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Sociodemographic, Behavioral, and Cognitive Predictors of Alcohol-Impaired Driving in a Sample of U.S. College Students

Alcohol-impaired driving continues to be a major public health concern, particularly among college students.

The current study examined whether sociodemographic, behavioral, and cognitive variables predicted alcohol-impaired driving in a sample of college students. Data were collected via telephone interviews from a random sample of undergraduates, ages 18-25 years old, stratified by sex and class in school.

Using hierarchical logistic regression analyses (n = 330), results revealed that higher levels of weekly alcohol use, being age 21 or older, and perceived difficulty in obtaining alternative transportation were associated with a greater likelihood of drinking and driving.

In addition, perceived likelihood of drinking and driving-related consequences was associated with a lower likelihood of drinking and driving.

Knowledge of the .08% per se and zero tolerance laws did not predict alcohol-impaired driving.

Findings are discussed in terms of their implications for college media campaigns designed to reduce alcohol-impaired driving.

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Request Reprint E-Mail: mark_wood @uri.edu


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Seminar - What is Addiction Neuroethics?

Professor Wayne Hall Seminar

Where:

UQCCR Main Auditorium Level 2 (Ground floor)

When:

Starts: Thursday, April 22, 2010 - 12:00 PM

Ends: Thursday, April 22, 2010 - 1:00 PM

Professor Wayne Hall is an NHMRC Australia Fellow in addiction neuroethics at the University of Queensland Centre for Clinical Research. He was formerly: Professor of Public Health Policy in the School of Population Health (2005-2010) and Director of the Office of Public Policy and Ethics at the Institute for Molecular Bioscience (2001-2005) at the University of Queensland; and Director of the National Drug and Alcohol Research Centre at UNSW (1994-2001). He has advised the World Health Organization on: the health effects of cannabis use; the effectiveness of drug substitution treatment; the scientific quality of the Swiss heroin trials; the contribution of illicit drug use to the global burden of disease; and the ethical implications of genetic and neuroscience research on addiction.. In 2001 he was identified by the Institute for Scientific Analysis as one of the world's most highly cited social scientists in the past 20 years. He was awarded an NHMRC Australia Fellowship in 2009 to research the public health, social policy and ethical implications of genetic and neuroscience research on drug use and addiction

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Onset Drinking: How It Is Related Both to Mother's Drinking and Mother–Child Relationships

Employing the National Longitudinal Survey of Youth (NLSY) as a sample of adolescents and their mothers, the present study connected the onset of adolescents’ drinking to certain posited risk and protective factors characterizing their families.

Via event history analysis and the discrete-time method, the data analysis involved more than 6,331 pair-interview-year units.

The results show that both peer influences and mother's daily alcohol consumption enhance the risk that an adolescent aged between 10 and 14 years will begin drinking.

At the same time, the quality of a mother's relationship with her child is an important posited protective factor delaying onset drinking.

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Request Reprint E-Mail: clo@ua.edu


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Prevalence and Correlates of At-Risk Drinking Among Older Adults: The Project SHARE Study.

At-risk drinking, excessive or potentially harmful alcohol use in combination with select comorbidities or medication use, affects about 10% of elderly adults and is associated with higher mortality. Yet, our knowledge is incomplete regarding the prevalence of different categories of at-risk drinking and their associations with patient demographics.

To examine the prevalence and correlates of different categories of at-risk drinking among older adults. DESIGN: Cross-sectional analysis of survey data. SUBJECTS: Current drinkers ages 60 and older accessing primary care clinics around Santa Barbara, California (n = 3,308).

At-risk drinkers were identified using the Comorbidity Alcohol Risk Evaluation Tool (CARET). At-risk alcohol use was categorized as alcohol use in the setting of 1) high-risk comorbidities or 2) high-risk medication use, and 3) excessive alcohol use alone. Adjusted associations of participant characteristics with at-risk drinking in each of the three at-risk categories and with at-risk drinking of any kind were estimated using logistic regression.

Over one-third of our sample (34.7%) was at risk. Among at-risk individuals, 61.9% had alcohol use in the context of high-risk comorbidities, 61.0% had high-risk medication use, and 64.3% had high-risk alcohol behaviors. The adjusted odds of at-risk drinking of any kind were decreased and significant for women (odds ratio, OR = 0.41; 95% confidence interval: 0.35-0.48; p-value < 0.001), adults over age 80 (OR = 0.55; CI: 0.43-0.72; p < 0.001 vs. ages 60-64), Asians (OR = 0.40; CI: 0.20-0.80; p = 0.01 vs. Caucasians) and individuals with higher education levels. Similar associations were observed in all three categories of at-risk drinking.

High-risk alcohol use was common among older adults in this large sample of primary care patients, and male Caucasians, those ages 60-64, and those with lower levels of education were most likely to have high-risk alcohol use of any type. Our findings could help physicians identify older patients at increased risk for problems from alcohol consumption.

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Request Reprint E-Mail: abarnes2@gmail.com


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The effects of minimum legal drinking age 21 laws on alcohol-related driving in the United States

To examine trends in alcohol consumption and alcohol-related crashes among people younger than 21 in the United States and to review evidence on the effects of minimum legal drinking age (MLDA) laws.

Trends in alcohol-related crashes and alcohol consumption among young people were examined, and studies on the effects of lowering and raising the drinking age were reviewed.

MLDA laws underwent many changes during the 20th century in the United States. Since July 1988, the MLDA has been 21 in all 50 states and the District of Columbia. Surveys tracking alcohol consumption among high school students and young adults found that drinking declined since the late 1970 s, and most of the decline occurred by the early 1990 s. These were the years when states were establishing, or reinstating, a MLDA-21.

Among fatally injured drivers ages 16–20, the percentage with positive BACs declined from 61% in 1982 to 31% in 1995, a bigger decline than for older age groups; declines occurred among the ages directly affected by raising MLDAs (ages 18–20) and among young teenagers not directly affected (ages 16–17).

Almost all studies designed specifically to gauge the effects of drinking age changes show MLDAs of 21 reduce drinking, problematic drinking, drinking and driving, and alcohol-related crashes among young people. Yet many underage people still drink, many drink and drive, and alcohol remains an important risk factor in serious crashes of young drivers, especially as they progress through the teenage years. Stepped-up enforcement of MLDA and drinking and driving laws can reduce underage drinking.

Recent efforts to lower MLDAs to 18 and issue licenses to drink upon completion of alcohol education have gained local and national media attention. There is no evidence that alcohol education can even partially replace the effect of MLDA-21.

The cause and effect relationship between MLDAs of 21 and reductions in highway crashes is clear. Initiatives to lower the drinking age to 18 ignore the demonstrated public health benefits of MLDAs of 21.

Lowering the drinking age to 18 will increase highway crash deaths among young people.

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Request Reprint E-Mail: amccartt@iihs.org

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“Everyone Deserves Services No Matter What”: Defining Success in Harm-Reduction-Based Substance User Treatment

This article reports qualitative interview data from a study of participant-generated outcomes of two harm reduction programs in the United States.

We address the question:“What does success in harm-reduction-based substance user treatment look like?”

Providers in this study understood harm reduction to adhere to notions of “any positive change,” client centeredness, and low-threshold services.

Participants reported changes in demarginalization, engagement in the program, quality of life, social functioning, changes in substance use, and changes in future goals and plans.

The nature of these changes is difficult to articulate within traditional notions of success (i.e., abstinence, program completion, etc.).

We conclude that participants in harm reduction programs experience tangible positive changes but that legitimation of these changes calls for a reconceptualization of “outcomes” and“success” in the current context of substance user treatment and research.

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Request Reprint E-Mail: hsophialee@gmail.com.

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Cohabitation, Gender, and Alcohol Consumption in 19 Countries: A Multilevel Analysis

We used an ecological paradigm and multilevel analytic techniques to analyze gender-specific relationships of cohabitation (versus marriage) to drinking in 19 countries (n = 32,922) and to“heavy episodic drinking” (HED) in 17 countries (n = 24,525) in surveys (1996–2004) from Gender, Alcohol, and Culture: An International Study.

Cohabitation was associated with elevated risk of HED among drinkers of both genders, controlling for age, education, and societal characteristics. The association between cohabitation and HED tended to be stronger for female drinkers than for male drinkers. HED was more prevalent among younger drinkers, especially among younger women in countries with higher per capita gross domestic product.

Cross-culturally, cohabiters deserve special attention in prevention efforts for hazardous drinking, considering both individual-level and societal factors.

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Request Reprint E-Mail: youliqing@hotmail.com

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“Alcohol is Something That Been With Us Like a Common Cold”: Community Perceptions of American Indian Drinking

This study examined tribal members’ perspectives on alcohol, risk factors, consequences, and community responses.

Focus groups were conducted with five American Indian tribes between 1997 and 2001. Participants were knowledgeable of the cultural lives of their reservation communities.

Although there was agreement regarding the pervasiveness of heavy drinking, participants reported different opinions about the meaning of alcohol and appropriate intervention strategies.

Three dilemmas were identified, suggesting that community ambivalence may serve as a barrier to reducing problem drinking. Implications, limitations, and future research directions are discussed.

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Request Reprint E-Mail:

nyuan@email.arizona.edu.

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The Effect of Alcohol Treatment on Social Costs of Alcohol Dependence: Results From the COMBINE Study

The COMBINE (combined pharmacotherapies and behavioral intervention) clinical trial recently evaluated the efficacy of pharmacotherapies, behavioral therapies, and their combinations for the treatment of alcohol dependence.

Previously, the cost and cost-effectiveness of COMBINE have been studied. Policy makers, patients, and nonalcohol-dependent individuals may be concerned not only with alcohol treatment costs but also with the effect of alcohol interventions on broader social costs and outcomes.

To estimate the sum of treatment costs plus the costs of health care utilization, arrests, and motor vehicle accidents for the 9 treatments in COMBINE 3 years postrandomization.

Multivariate results show no significant differences in mean costs between any of the treatment arms as compared with medical management (MM) + placebo for the 3-year postrandomization sample. The median costs of MM + acamprosate, MM + naltrexone, MM + acamprosate + naltrexone, and MM + acamprosate + combined behavioral intervention were significantly lower than the median cost for MM + placebo.

The results show that social cost savings are generated relative to MM + placebo by 3 years postrandomization, and the magnitude of these cost savings is greater than the costs of the COMBINE treatment received 3 years prior.

Our study suggests that several alcohol treatments may indeed lead to reduced median social costs associated with health care, arrests, and motor vehicle accidents.

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Request Reprint E-Mail: gaz rti.org

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PhenX consensus measures for Phenotypes and eXposures

PhenX is a three year project led by RTI International and funded by the National Human Genome Research Institute (NHGRI) to contribute to the integration of genetics and epidemiologic research PhenX has prioritized 21 research domains related to complex diseases and environmental exposures Consensus building is being used to develop a recommended minimal set of high priority measures for use in Genome-wide Association Studies (GWAS) and other large-scale genomic research efforts High priority measures will maximize benefits of future research by enabling cross-study comparisons and analysis Selection and specification of the measures are driven by the scientific community via the PhenX Steering Committee, Working Groups and community consensus. The PhenX Toolkit presents the selected high priority measures to the scientific community

PhenX Toolkit Release Notes

PhenX Home Site _______________________________________

Alcohol-Induced Neurodegeneration, Suppression of Transforming Growth Factor-β, and Cognitive Impairment in Rats: Prevention by Group II Metabotropic

Glutamatergic neurotransmission has been implicated in mechanisms of alcohol-induced neurodegeneration and cognitive impairment, but the underlying mechanism remains unknown.

Here, we examined whether the group II metabotropic glutamate receptor agonist LY379268 prevents neuronal death and learning deficits in a rat model of binge-like exposure to alcohol.

Following 4-day binge alcohol exposure concurrent with LY379268 or vehicle treatment, Fluoro-Jade B and transforming growth factor-β (TGF-β) staining were carried out, and reversal learning in the Morris water maze was assessed.

Fluoro-Jade B staining indicating neurodegeneration was most extensive in the ventral hippocampus and the entorhinal cortex (EC). LY379268 was potently neuroprotective in the EC but not in the dentate gyrus of the hippocampus.

In parallel, binge alcohol exposure suppressed TGF-β expression in both the EC and dentate gyrus, whereas LY379268 increased TGF-β in the EC only.

Finally, neuroprotective effects of LY379268 were accompanied by prevention of deficits in spatial reversal learning.

Our data support a neuroprotective role for group II metabotropic glutamate receptor agonists and TGF-β in alcohol-induced neurodegeneration.

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Request Reprint E-Mail: markus.heilig@mail.nih.gov

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Metabotropic Glutamate Receptor 5 Activity in the Nucleus Accumbens Is Required for the Maintenance of Ethanol Self-Administration in a Rat Genetic Mo

Systemic modulation of Group I and II metabotropic glutamate receptors (mGluRs) regulate ethanol self-administration in a variety of animal models. Although these receptors are expressed in reward-related brain regions, the anatomical specificity of their functional involvement in ethanol self-administration remains to be characterized.

This study sought to evaluate the functional role of Group I (mGluR5) and Group II (mGluR2/3) in mesocorticolimbic brain regions in ethanol self-administration.

Alcohol-preferring (P) rats, a genetic model of high alcohol drinking, were trained to self-administer ethanol (15% v/v) versus water in operant conditioning chambers. Effects of brain site-specific infusion of the mGluR5 antagonist 2-methyl-6-(phenylethynyl)pyridine hydrochloride (MPEP) and the mGluR2/3 agonist were then assessed on the maintenance of self-administration.

Microinjection of the mGluR5 antagonist MPEP in the nucleus accumbens reduced ethanol self-administration at a dose that did not alter locomotor activity. By contrast, infusion of the mGluR2/3 agonist LY379268 in the nucleus accumbens reduced self-administration and produced nonspecific reductions in locomotor activity.

The mGluR5 involvement showed anatomical specificity as evidenced by lack of effect of MPEP infusion in the dorsomedial caudate or medial prefrontal cortex on ethanol self-administration.

To determine reinforcer specificity, P-rats were trained to self-administer sucrose (.4% w/v) versus water, and effects of intra-accumbens MPEP were tested. The MPEP did not alter sucrose self-administration or motor behavior.

These results suggest that mGluR5 activity specifically in the nucleus accumbens is required for the maintenance of ethanol self-administration in individuals with genetic risk for high alcohol consumption.

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Request Reprint E-Mail: chodge@med.unc.edu

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Serotonin 1B Receptor Imaging in Alcohol Dependence

Although animal models suggest that alcohol dependence (AD) is associated with elevations in the number of serotonin 1B receptors (5-HT_1BR), 5-HT_1BR levels have not been investigated in people with AD. The selective 5-HT_1BR antagonist radioligand, [¹¹C]P943, permits in vivo assessment of central 5-HT_1BR binding potential (BP_ND) with positron emission tomography. Because of its central role in AD, we were particularly interested in ventral striatal 5-HT_1BR BP_ND values.

Twelve medication-free, recently abstinent (at least 4 weeks) patients with AD (mean age 35.2 ± 10.2 years, 5 women) and 12 healthy control subjects (HC) (mean age 30.6 ± 9.2 years, 5 women) completed [¹¹C]P943 positron emission tomography on a high-resolution research tomograph. Individual magnetic resonance imaging scans were collected to exclude individuals with anatomical abnormalities and for coregistration. Imaging data were analyzed with a multilinear reference tissue model.

Ventral striatal 5-HT_1BR BP_ND values (2.01 ± .57% and 1.55 ± .09%, respectively; 29% between-group difference, p = .006) were increased in AD compared with HC subjects. No influence of demographic or clinical variables or amount of injected radiotracer was observed.

This study provides the first evidence that AD in humans is, like in rodent models, associated with increased levels of ventral striatal 5-HT_1BRs.

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Request Reprint E-Mail: alexander.neumeister@mssm.edu

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Press Release - Remembering the good times helps alcoholics stay sober

Recovering alcoholics who focus on positive experiences in their past may be more successful in managing their addiction. This is the finding of a study by Sarah Davies and Professor Gail Kinman of the University of Bedfordshire that was presented on the 16th April 2010, at the British Psychological Society’s Annual Conference in Stratford-upon-Avon.

A hundred and one members of Alcoholics Anonymous (53 per cent male) completed questionnaires that assessed the extent to which they were oriented towards the past, present or future, and whether this orientation was mostly positive or negative. They were also asked about their spiritual experiences, level of abstinence, compulsion to drink and anxiety.

The results showed that problem drinkers who were oriented towards the past and who had a positive view of their previous life experiences were more likely to be successful in managing alcohol dependency than those with a more negative focus on the past. Participants who held a present hedonistic orientation (focusing on having fun in the here and now) also tended to experience stronger compulsions to drink alcohol.

High levels of spirituality were also found to be a protective factor in helping recovering alcoholics stay sober and manage the anxiety associated with addiction and withdrawal. . . . . .

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