Call For Papers: Under control?: alcohol and drug regulation, past and present

Papers and panel proposals are invited for an international conference on the history of alcohol and drug regulation to be held in Bristol, UK 21st-23rd June 2013.

The conference will explore all aspects of drug, tobacco and alcohol regulation. Work covering all periods and places, including recent history, will be considered.

Confirmed keynote speakers:
Professor Virginia Berridge (London School of Hygiene and Tropical Medicine)
Professor Paul Gootenberg (State University of New York)
Professor James Simpson (Carlos III University of Madrid)

Panel proposals (3 x 20-minute papers) or individual papers (20 minutes) are invited. We will also consider proposals for fringe sessions using non-conventional formats e.g. screenings, debates etc.

Subjects may include (but are not limited to):
− Global drugs trade and the war on drugs
− Crime and policing
− Prohibition
− Tobacco control
− Regulation of drugs in art, film and literature
− Temperance and its influences
− Alcohol licensing and pricing
− Media regulation / advertising and marketing
− Religion and alcohol or drugs
− Dependency and treatment
− Policymaking and the political process
− Alcohol and radical politics / revolutions / social movements
− Use and control of drugs in premodern cultures
− Alcohol and drugs in sport and popular culture

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Substance use among 15-16 year olds in the UK: Key findings from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD)

The collection of comparative data on trends in substance use among young people across Europe is vital in supporting and developing policy, practice and research. Homogenisation of international youth cultures, globalisation of addictive goods marketing, and the increasing importance of EU strategies designed to limit the harmful impact of substance use means that it is essential that UK data are considered alongside those of other countries. The main source of data collection on substance use among European youth is The European Survey Project on Alcohol and Drugs (ESPAD). This is a high quality survey that has been conducted every four years since 1995. It collects comparable data on trends in substance use among 15-16 year old school pupils across a number of European countries (n=36). The survey provides intelligence to assist with the design and targeting of interventions that support healthy adolescent development, as well as for monitoring the impact of national policies.


In 2011, the Centre for Public Health at Liverpool John Moores University, conducted the UK element of the fifth phase of the ESPAD survey with funding from Alcohol Research UK. In total 36 countries and around 100,000 students took part; with 1712 being from the UK. A standardised methodology and questionnaire was used in order to provide comparable data on cigarette, alcohol and illicit drug use across countries and time. In the UK, the data collection period ran during March-April 2011 in a random sample of 74 secondary schools in England, Wales, Scotland and Northern Ireland (sampling was in proportion to the number of schools in each country). The final sample included 1712 school children born in 1995 and comprised a relatively even split of boys (n=865) and girls (n=847). It must be noted that this research surveyed the general school population and thus does not provide a picture of substance use among those not participating in mainstream education, where there is likely be a greater proportion of young problematic substance users. Substance use issues for these young people are likely to be different. Despite the overall number of schools agreeing to take part in the survey being lower than previous phases (approximately 1 in 17 agreed) the strength of the random sampling process means that the data can be considered representative of a wide variety of UK schools. The survey also complements other UK research into substance use, such as the Health and Social Care Information Centre’s, Smoking Drinking and Drug Use survey, which provides comparable data for 11-15 year olds in England.   > > > >   Read More

Government publishes response to the Health Select Committee Alcohol Strategy inquiry

The Government has published its response to the Health Select Committee inquiry on the Government’s Alcohol Strategy.

Download the Government Response to the House of Commons Health Select Committee Report of Session 2012-13: Government’s Alcohol Strategy

The Government's response answers the Health Select Committee's extensive inquiry which gave a mixed if not critical view of the strategy. In particular, the inquiry and other responses questioned an excessive focus on binge drinking over health issues. The response answers this in part by highlighting Department of Health guidance and resources for treatment and interventions found on the Alcohol Learning Centre.

One other key concern outlined by the Health Select Committee was that "an Alcohol Strategy should be seen as part of a wider public health strategy, and should contain some key quantified, alcohol-specific objectives... Public Health England should devise the national measures against which the strategy can be tested."   > > > >   Read More

Motivational Typologies of Drinkers: Do Enhancement and Coping Drinkers Form Two Distinct Groups?

This study used a person-centered approach to test whether drinking motive typologies could be identified.

Longitudinal study of college students within the Intensive
Multivariate Prospective Alcohol College-Transitions (IMPACTS) dataset.

University campus in the USA.

University students (baseline n reporting alcohol motives = 2158; baseline age = 18.60 years old).

The Drinking Motives Questionnaire-Revised (DMQ-R; Cooper, 1994).

Using Steinley and Brusco's cluster analysis approach (based on the theoretical ratio expected between the within sum of squares and the total sum of squares when the data are divided into two clusters when no cluster structure is present; the cutoff for the ratio is.25 for uniform [multivariate uniform] distributions and.36 for normal [multivariare normal] distributions), we examined whether there was evidence for distinct clusters of individuals that differed on their overall level of motives to drink. We tested the fit of a one-group (cluster) solution compared to multi-cluster solutions. Both cross-sectionally and prospectively, the data could not be partitioned into two or more clusters (regardless if the cutoff assuming a multivariate uniform distribution [i.e.,.25] or the more liberal multivariate normal distribution [i.e.,.36] was used). These findings showed that enhancement and coping drinkers do not form two distinct groups but rather these motives exist on a continuum such that individuals who are high in one internal motive tend to be high in the other motive.

Coping and enhancement drinkers do not form two distinct groups. Variable-centered approaches to drinking motives may be a better alternative to classifying all drinkers as either enhancement or coping drinkers for both clinical and research endeavors.

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Request Reprint E-Mail:   littlefielda@missouri.edu

Department of Drug and Alcohol Programs Employee Receives National Substance Use Prevention Award

The Department of Drug and Alcohol Programs (DDAP) announced today that its director of prevention and intervention Garrison Gladfelter, was awarded the 2012 Ketty Award from the National Prevention Network (NPN) for outstanding national leadership in substance use prevention services.

“Prevention services are vital in maintaining a healthy community,” said DDAP Secretary Gary Tennis. “Garrison Gladfelter’s leadership and receipt of this award demonstrates what we already know − that Pennsylvania leads the nation in drug and alcohol prevention programming.”

Since 1989, the Ketty Award has been awarded annually to NPN representatives who have made outstanding  ontributions to the network and to the field of substance use prevention. The award is named for Ketty Rey, a pioneer in the substance use prevention field.  > > > >   Read More

East Africa: Conference On Alcohol Policy in East Africa Opens

THE Third International Conference on alcohol policy formulation in the East Africa region begins in Arusha on Monday.

The two-day conference to be held at Naura Springs Resort brings together 80 people from the region as well as Malawi, Sweden and Norway who have worthy of knowledge to share on the impact of irresponsible drinking and the role alcohol policy can play in reducing the negative impact of alcohol.


Tanzanian Minister for Health and Social Welfare, Dr Hussein Mwinyi will officially open the conference with a theme of "Alcohol is a problem, act now" and Swedish Ambassador to Tanzania, Dr Lennrth Hjelmaker will deliver a key message on alcohol abuse.

Irresponsible drinking has so far reached a negative impact including gender based violence and accidents leading to deaths and serious injuries.

A representative from Malawi will make a presentation on how to share the country's experience in developing the national policy on alcohol, so that the Eastern African countries which have not developed alcohol policy can learn from them.

The second day of the conference four parallel workshops will be held each with a different theme, but all focusing on aspects of alcohol policy.  > > > >  Read More

Glass Shape Influences Consumption Rate for Alcoholic Beverages

High levels of alcohol consumption and increases in heavy episodic drinking (binge drinking) are a growing public concern, due to their association with increased risk of personal and societal harm. Alcohol consumption has been shown to be sensitive to factors such as price and availability. The aim of this study was to explore the influence of glass shape on the rate of consumption of alcoholic and non-alcoholic beverages.

This was an experimental design with beverage (lager, soft drink), glass (straight, curved) and quantity (6 fl oz, 12 fl oz) as between-subjects factors. Social male and female alcohol consumers (n = 159) attended two experimental sessions, and were randomised to drink either lager or a soft drink from either a curved or straight-sided glass, and complete a computerised task identifying perceived midpoint of the two glasses (order counterbalanced). Ethical approval was granted by the Faculty of Science Research Ethics Committee at the University of Bristol. The primary outcome measures were total drinking time of an alcoholic or non-alcoholic beverage, and perceptual judgement of the half-way point of a straight and curved glass.

Participants were 60% slower to consume an alcoholic beverage from a straight glass compared to a curved glass. This effect was only observed for a full glass and not a half-full glass, and was not observed for a non-alcoholic beverage. Participants also misjudged the half-way point of a curved glass to a greater degree than that of a straight glass, and there was a trend towards a positive association between the degree of error and total drinking time.

Glass shape appears to influence the rate of drinking of alcoholic beverages. This may represent a modifiable target for public health interventions.

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Alcohol Industry Influence on Public Policy: A Case Study of Pricing and Promotions Policy in the UK

In the field of health policy, much attention has been paid to attempts by Transnational Tobacco Corporations (TTCs) to stymie regulation of their industry (Holden and Lee 2009). Relatively little research has been conducted on alcohol industry actors and their attempts to influence policies to reduce alcohol related harm. This is surprising given the rising burden of disease in many countries associated with harmful and hazardous levels of alcohol consumption. In the UK, increasing levels of alcohol consumption – and the associated harms – over recent decades have coincided with the increased availability and affordability of alcohol. There has been a trend away from consuming alcohol in licensed premises towards the purchase of cheaper alcohol from the off-sales sector for consumption at home (Foster and Ferguson 2012). In particular, significant volumes of alcohol are now sold through the ‘big four’ supermarkets, which wield significant political power (Seth and Randall 1999). On the production side, the UK alcohol market has become increasingly dominated by a small number of large, multi-national corporations (Jernigan 2009).

Alcohol policy under New Labour followed an agenda closely aligned with that advocated by alcohol industry actors (Cabinet Office 2004; Department of Health 2007). Policies targeted interventions on those sections of the public seen to be at greatest risk of harm, placing education, public information, health and treatment services, crime and disorder at the centre of the strategy. Particular emphasis was given to the role of the alcohol industry as a key partner in achieving policy goals through a system of voluntary self-regulation (see Portman Group 1996; Advertising Standards Agency et al. 2005).The thrust of this policy stands in stark contrast to the policy prescriptions advocated by public health researchers and campaigners , who favoured ‘whole population’ measures to restrict the availability and price of alcohol, which were supported by a significant evidence base (Babor et al. 2010).
> > > >  Read More

Global Actions September 20, 2012

Key Recent Milestones:

· China: ICAP President Marcus Grant and Senior Vice President Brett Bivans met with Global Actions partners in Beijing from government, health, industry associations, and sponsor companies to review achievements in the three initiatives being implemented in China and to discuss initial plans for continued activities in 2013.

Global Actions in Focus: Nigeria Alcohol Marketing Summit

The self-regulation summit “Management of the Potential Impact of Alcohol Beverage Marketing and Marketing Communications on Society” organized by ICAP, the Advertising Practitioners Council of Nigeria (APCON), and the Beer Sector Group of the Manufacturing Association of Nigeria (MAN) took place on September 18, 2012 in Lagos, Nigeria.

The invitation-only event brought together beverage alcohol producers, marketers, advertisers, and regulators to discuss issues regarding the potential impact of unrestricted marketing and advertising on public perceptions of the product.

“The forum addressed ethical issues in marketing and marketing communications practice as they affect the alcohol industry from all stakeholders’ perspectives,” said Global Actions Nigeria Country Manager Lanre Onigbogi. “The summit was successful with the agreement of all parties to comply with freshly agreed details.”

Managing Director of the World Federation of Advertisers (WFA) Stephen Loerke delivered a keynote address. Loerke’s presentation focused on how self-regulation could work in the framework of overall regulation that allows for parties to respect the code agreed on and also provide a mechanism for address.

What’s Happening Next:

· Colombia: Global Actions will meet with Quibdo Mayor's Office and the Secretaries of Health and Transit on September 18 and 19, 2012 to plan joint work on drink driving enforcement and public awareness. On September 21, Global Actions Colombia will observe and evaluate sobriety checkpoints in the city of Chia to continue phase two of "Project Patrullero." 

Rodent models of alcoholic liver disease: Of mice and men

Alcoholic liver disease (ALD) is a major cause of acute and chronic liver disease worldwide. The progressive nature of ALD is well described; however, the complex interactions under which these pathologies evolve remain to be fully elucidated. 

Clinically there are no clear biomarkers or universally accepted, effective treatment strategies for ALD. Experimental models of ALD are an important component in identifying underlying mechanisms of alcohol-induced injury to develop better diagnostic markers, predictors of disease progression, and therapeutic targets to manage, halt, or reverse disease progression. Rodents remain the most accessible model for studying ALD pathology.

Effective rodent models must mimic the natural history of ALD while allowing examination of complex interactions between multiple hepatic, and non-hepatic, cell types in the setting of altered metabolic or oxidative/nitrosative stress, inflammatory responses, and sensitivity to cytotoxic stress. 

Additionally, mode and duration of alcohol delivery influence hepatic response and present unique challenges in understanding disease pathology. 

This review provides an overview of rodent models of ALD, their strengths and weaknesses relative to human disease states, and provides insight of the potential to develop novel rodent models to simulate the course of human ALD.



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iain.mckillop@carolinashealthcare.org

Assessment of the interoceptive effects of alcohol in rats using short-term training procedures

In the present study, we sought to determine whether the interoceptive effects of alcohol (1 g/kg, IG) could be assessed using a Pavlovian discrimination method, in which the alcohol drug state sets the occasion for which an environmental stimulus (e.g., light) will be followed by a sucrose reward. 

This procedure takes advantage of a naturally occurring behavior (i.e., food-seeking) which can be trained rapidly prior to the initiation of discrimination training. Given that the interoceptive effects of alcohol are routinely assessed using operant drug discrimination methods, another group of rats was trained using standard two-lever operant drug discrimination procedures in an effort to compare the Pavlovian procedure to a known behavioral benchmark. 

The results from this work show that, in addition to operant discrimination procedures, a Pavlovian discrimination task can be used to evaluate the interoceptive effects of alcohol. In addition to the brief behavioral sucrose access training (3 days) required prior to the initiation of the Pavlovian discrimination, the alcohol discrimination was acquired relatively rapidly (i.e., 8 training sessions), shortening the overall duration of the experiment. 

These features of the Pavlovian procedure make it a valuable method by which to assess the interoceptive effects of alcohol if a short experimental time frame is required, such as assessing the interoceptive effects of alcohol during a brief developmental window (e.g., adolescence) or determining the effects of a pretreatment (i.e., chronic stress, chronic drug pretreatment) on the acquisition of the alcohol discrimination. As such, this initial characterization confirms the feasibility of using this Pavlovian discrimination training method as an additional tool by which to assess the interoceptive effects of alcohol, as there may be experimental situations that necessitate short term discrimination training.


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

ALCOHOL IN MODERATION 21ST ANNIVERSARY CONFERENCE

This forum focuses on two globally important themes:

‘Alcohol Education, what works?’ 
and
The development of lower alcohol beverages, with a spotlight on successful markets and innovations.

Thursday, 18th October 2012


Read Conference Programme

Early Onset of Drinking and Risk of Heavy Drinking in Young Adulthood—A 13-Year Prospective Study

Prevention programs often aim at preventing early onset of drinking (EOD) on the grounds that this may curb heavy drinking in adulthood. While many studies have shown an association between EOD and adult alcohol use disorders, these findings could be inflated by retrospective reports or insufficient control for confounders. This study examined the association between EOD behavior assessed in early adolescence and heavy drinking in adulthood, controlling for deviant behavior and parental heavy drinking.

Data were collected prospectively over a 13-year period from 1,311 Norwegian school students. At t1 (ages 13 to 14 years), onset of drinking behavior (any drinking and heavy episodic drinking), conduct problems (CP), other problem behaviors, and parental heavy drinking were assessed. At t2 (ages 26 to 27 years), heavy drinking behavior was assessed in terms of heavy episodic drinking frequency and AUDIT score.

EOD behavior was associated with CP, other problem behaviors, and parental heavy drinking in early adolescence. A higher risk of heavy drinking in adulthood was found among those with EOD behavior, yet after control for CP, this association became small and statistically nonsignificant. Among low-risk individuals (i.e., those with no CP at t1), there was no association between EOD behavior and heavy drinking in adulthood, while there was a significant association among those with CP.

EOD behavior appears not per se responsible for heavy drinking in adulthood unless being part of a broader array of problem behaviors.

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Request Reprint E-Mail:   ir@sirus.no 

Sensitivity and Specificity of a Brief Personality Screening Instrument in Predicting Future Substance Use, Emotional, and Behavioral Problems: 18-Month Predictive Validity of the Substance Use Risk Profile Scale

This study assessed the validity, sensitivity, and specificity of the Substance Use Risk Profile Scale (SURPS), a measure of personality risk factors for substance use and other behavioral problems in adolescence.

The concurrent and predictive validity of the SURPS was tested in a sample of 1,162 adolescents (mean age: 13.7 years) using linear and logistic regressions, while its sensitivity and specificity were examined using the receiver operating characteristics curve analyses.

Concurrent and predictive validity tests showed that all 4 brief scales—hopelessness (H), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS)—were related, in theoretically expected ways, to measures of substance use and other behavioral and emotional problems. Results also showed that when using the 4 SURPS subscales to identify adolescents “at risk,” one can identify a high number of those who developed problems (high sensitivity scores ranging from 72 to 91%). And, as predicted, because each scale is related to specific substance and mental health problems, good specificity was obtained when using the individual personality subscales (e.g., most adolescents identified at high risk by the IMP scale developed conduct or drug use problems within the next 18 months [a high specificity score of 70 to 80%]).

The SURPS is a valuable tool for identifying adolescents at high risk for substance misuse and other emotional and behavioral problems. Implications of findings for the use of this measure in future research and prevention interventions are discussed.


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Request Reprint E-Mail:    natalie.castellanos.ryan@umontreal.ca

A Systematic Review and Meta-Analysis of Alcohol Consumption and Injury Risk as a Function of Study Design and Recall Period

It is well established that alcohol consumption is associated with an increased risk of injury. This systematic review and meta-analysis addresses important methodological issues commonly encountered in the alcohol and injury field by delineating the effect of study design and alcohol consumption recall period on effect size magnitude and by conducting gender-specific analyses.

We performed meta-analyses using random-effect models. Data sources were peer-reviewed studies on alcohol and injury from 1970 to 2009 from MEDLINE, PsychInfo, and on-line journals. Case–control or case-crossover emergency department (ED) studies reporting injury risk from alcohol consumption 6 hours before injury were included.

The overall odds of injury were 2.799 (2.214 to 3.538, p < 0.001). For case-crossover studies, the odds were 3.815 (2.646 to 5.499,p < 0.001); for ED case–control studies, the odds were 1.977 (1.385 to 2.821, p < 0.001); and for population case–control designs, the odds were 3.145 (1.583 to 6.247, p < 0.005). The “usual frequency” recall period yielded an odds ratio of 4.235 (2.541 to 7.057, p < 0.001), compared to 2.320 (1.789 to 3.008, p < 0.001) for all other methods. There were significant differences in odds ratio magnitude when comparing studies by design and recall period. Females had higher odds of injury than males, 2.285 (1.361 to 3.836, p < 0.005) versus 1.071 (0.715 to 1.605, p = 0.737).

Study design and alcohol consumption recall period have significant effects on effect size magnitude in estimating the risk of injury from alcohol consumption 6 hours prior to injury. For the “usual frequency” case-crossover design, significant moderator effects were found, resulting in overestimates of injury risk from alcohol. ED case-crossover designs tend to overestimate risk, and ED case–control designs tend to underestimate. We provide recommendations for future ED research.

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Rerquest Reprint E-Mail:     czeisser@uvic.ca

Scientific Publications and Research Groups on Alcohol Consumption and Related Problems Worldwide: Authorship Analysis of Papers Indexed in PubMed and Scopus Databases (2005 to 2009)

The research of alcohol consumption-related problems is a multidisciplinary field. The aim of this study is to analyze the worldwide scientific production in the area of alcohol-drinking and alcohol-related problems from 2005 to 2009.

A MEDLINE and Scopus search on alcohol (alcohol-drinking and alcohol-related problems) published from 2005 to 2009 was carried out. Using bibliometric indicators, the distribution of the publications was determined within the journals that publish said articles, specialty of the journal (broad subject terms), article type, language of the publication, and country where the journal is published. Also, authorship characteristics were assessed (collaboration index and number of authors who have published more than 9 documents). The existing research groups were also determined.

About 24,100 documents on alcohol, published in 3,862 journals, and authored by 69,640 authors were retrieved from MEDLINE and Scopus between the years 2005 and 2009. The collaboration index of the articles was 4.83 ± 3.7. The number of consolidated research groups in the field was identified as 383, with 1,933 authors. Documents on alcohol were published mainly in journals covering the field of “Substance-Related Disorders,” 23.18%, followed by “Medicine,” 8.7%, “Psychiatry,” 6.17%, and “Gastroenterology,” 5.25%.

Research on alcohol is a consolidated field, with an average of 4,820 documents published each year between 2005 and 2009 in MEDLINE and Scopus. Alcohol-related publications have a marked multidisciplinary nature. Collaboration was common among alcohol researchers. There is an underrepresentation of alcohol-related publications in languages other than English and from developing countries, in MEDLINE and Scopus databases.

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Request Reprint E-Mail:    alvarez@med.uva.es

Differences in the Profiles of DSM-IV and DSM-5 Alcohol Use Disorders: Implications for Clinicians

Existing information on consequences of the DSM-5 revision for the diagnosis of alcohol use disorders (AUD) has gaps, including missing information critical to understanding implications of the revision for clinical practice.

Data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used to compare AUD severity, alcohol consumption and treatment, sociodemographic and health characteristics, and psychiatric comorbidity among individuals with DSM-IV abuse versus DSM-5 moderate AUD and DSM-IV dependence versus DSM-5 severe AUD. For each pair of disorders, we additionally compared 3 mutually exclusive groups: individuals positive solely for the DSM-IV disorder, those positive solely for the DSM-5 disorder, and those positive for both.

Whereas 80.5% of individuals positive for DSM-IV dependence were positive for DSM-5 severe AUD, only 58.0% of those positive for abuse were positive for moderate AUD. The profiles of individuals with DSM-IV dependence and DSM-5 severe AUD were almost identical. The only significant (p < 0.005) difference, more AUD criteria among the former, reflected the higher criterion threshold (≥4 vs. ≥3) for severe AUD relative to dependence. In contrast, the profiles of individuals with DSM-5 moderate AUD and DSM-IV abuse differed substantially. The former endorsed more AUD criteria, had higher rates of physiological dependence, were less likely to be White individuals and men, had lower incomes, were less likely to have private and more likely to have public health insurance, and had higher levels of comorbid anxiety disorders than the latter.

Similarities between the profiles of DSM-IV and DSM-5 AUD far outweigh differences; however, clinicians may face some changes with respect to appropriate screening and referral for cases at the milder end of the AUD severity spectrum, and the mechanisms through which these will be reimbursed may shift slightly from the private to public sector.

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Request Reprint E-Mail:  deborah.anne.dawson@gmail.com

Further Development of a Neurobehavioral Profile of Fetal Alcohol Spectrum Disorders

Heavy prenatal alcohol exposure (AE) results in a broad array of neurobehavioral deficits. Recent research has focused on identification of a neurobehavioral profile or profiles that will improve the identification of children affected by AE. This study aimed to build on our preliminary neurobehavioral profile to improve classification accuracy and test the specificity of the resulting profile in an alternate clinical group.

 

A standardized neuropsychological test battery was administered to 3 groups of children: subjects with AE (n = 209), typically developing controls (CON, n = 185), and subjects with attention-deficit/hyperactivity disorder (ADHD, n = 74). We assessed a large sample from 6 sites in the United States and South Africa, using standardized methodology. Data were analyzed using 3 latent profile analyses including (i) subjects with fetal alcohol syndrome (FAS) and controls, (ii) subjects with AE without FAS and controls, and (iii) subjects with AE (with or without FAS) and subjects with ADHD.

Classification accuracy was moderate but significant across the 3 analyses. In analysis 1, overall classification accuracy was 76.1% (77.2% FAS, 75.7% CON). In the second analysis, overall classification accuracy was 71.5% (70.1% AE/non-FAS, 72.4% CON). In the third analysis, overall classification accuracy was 73.9% (59.8% AE, 75.7% ADHD). Subjects that were misclassified were examined for systematic differences from those that were correctly classified.

 

The results of this study indicate that the neuropsychological effects of AE are clinically meaningful and can be used to accurately distinguish alcohol-affected children from both typically developing children and children with ADHD. Further, in combination with other recent studies, these data suggest that approximately 70% of children with heavy prenatal alcohol exposure are neurobehaviorally affected, while the remaining 30% are spared these often-devastating consequences, at least those in the domains under study. Refining the neurobehavioral profile will allow improved identification and treatment development for children affected by prenatal alcohol exposure.


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Request Reprint E-Mail:     mailto:sarah.mattson@sdsu.edu

 

The Effects of Prenatal Alcohol Exposure and Attention-Deficit/Hyperactivity Disorder on Psychopathology and Behavior

 

This study examined prevalence of psychiatric disorders and behavioral problems in children with and without prenatal alcohol exposure (AE) and attention-deficit/hyperactivity disorder (ADHD).

 

Primary caregivers of 344 children (8 to 16 years, M = 12.28) completed the Computerized Diagnostic Interview Schedule for Children-IV (C-DISC-4.0) and the Child Behavior Checklist (CBCL). Subjects comprised 4 groups: AE with ADHD (AE+, n = 85) and without ADHD (AE−, n = 52), and nonexposed with ADHD (ADHD, n = 74) and without ADHD (CON, n = 133). The frequency of specific psychiatric disorders, number of psychiatric disorders (comorbidity), and CBCL behavioral scores were examined using chi-square and analysis of covariance techniques.

 

Clinical groups had greater frequency of all psychiatric disorders, except for anxiety, where the AE- and CON groups did not differ. There was a combined effect of AE and ADHD on conduct disorder. For comorbidity, children with ADHD had increased psychiatric disorders regardless of AE, which did not have an independent effect on comorbidity. For CBCL scores, there were significant main effects of AE and ADHD on all scores and significant AE × ADHD interactions for Withdrawn/Depressed, Somatic Complaints, Attention, and all Summary scores. There was a combined effect of AE and ADHD on Externalizing, Total Problems, and Attention Problems.

 

Findings indicate that ADHD diagnosis elevates children's risk of psychiatric diagnoses, regardless of AE, but suggest an exacerbated relation between AE and ADHD on conduct disorder and externalizing behavioral problems in children. Findings affirm a poorer behavioral prognosis for alcohol-exposed children with ADHD and suggest that more than 1 neurobehavioral profile may exist for individuals with AE.


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Request Reprint E-Mail:    sarah.mattson@sdsu.edu  
 

Fetal Brain Function in Response to Maternal Alcohol Consumption: Early Evidence of Damage

Studies of the adverse neurobehavioral effects of maternal alcohol consumption on the fetus have been largely confined to the postnatal period, after exposure to alcohol has finished. This study explored the brain function of the fetus, at the time of exposure to alcohol, to examine its effect on information processing and stability of performance.

Five groups of fetuses, defined by maternal alcohol consumption patterns, were examined: control (no alcohol); moderate (5 to 10 units/wk either drunk evenly across the week or as a binge, in 2 to 3 days); heavy (20+ units/wk drunk evenly or as a binge). Fetal habituation performance was examined on 3 occasions, separated by 7 days, beginning at 35 weeks of gestation. The number of trials required to habituate on each test session and the difference in performance across test sessions were recorded.

Fetuses exposed to heavy binge drinking required significantly more trials to habituate and exhibited a greater variability in performance across all test sessions than the other groups. Maternal drinking, either heavily but evenly or moderately as a binge, resulted in poorer habituation, and moderate binge drinking resulted in greater variability compared with no, or even, drinking.

Decreased information processing, reflected by poorer habituation, and increased variability in performance may reflect the initial manifestations of structural damage caused by alcohol to the brain. These results will lead to a greater understanding of the effects of alcohol on the fetus's brain, enable the antenatal identification of fetal alcohol spectrum disorders, and lead to the early implementation of better management strategies.

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Request Reprint E-Mail: p.hepper@qub.ac.uk